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Schizophrenia: A socio-cultural perspective


Payal Khatore


Psychiatric facilities in India still have a long way to go in terms of the quality and accessibility of treatment. Moreover, the stigma surrounding mental illness makes it even more difficult to live with an illness such as schizophrenia. A study by Santosh Loganathan and Srinivasa Murthy focuses on this difficulty from the perspective of gender. 

A sample of 200 people was selected from Bangalore out of which 118 were men and 82 were women and half of them came from urban areas and the other half from rural. This was a qualitative study which concluded that while people were stigmatised irrespective of their gender, men were more stigmatised in their work lives and women in their marital lives. The paper aimed at using qualitative research methods to look at the perspective of gender with regard to stigma. 
The major problems that emerged were: marriage being viewed as a cure for schizophrenia, custody-loss of children, normalising of psychotic episodes post-pregnancy, violence (especially for women) and difficulty in getting jobs and keeping them. The authors acknowledge a major limitation in this paper, that is, it is limited to one state and cannot be used to draw general conclusions. While the authors do mention that men are more affected by schizophrenia statistically, the sample used for the study is still skewed in gender ratios. A plus point of the study is that it considers urban and rural backgrounds and lays emphasis on the experiences of the people affected by schizophrenia instead of second-hand accounts. Thematic analysis helped them fulfil their purpose of focusing on personal, lived experiences of affected people. 

The aim of this study was to gather information in order to improve the quality of treatment provided to the patients to make it more suitable to their socio-cultural context. While this study has several qualitative limitations, a slightly gender-skewed sample and geographical limitations, it can be seen as an example of the kinds of studies that can provide crucial information. An important contribution of this paper is that it brings out the perspective of the affected, using a legitimate platform. Even the existence of such a paper can be seen as a step towards understanding and restructuring our opinions of people who have schizophrenia. The popular representations in movies and other media lead to a sort of fear towards people who have schizophrenia and making the experiences and problems of these people accessible, contributes to allaying this fear.

100 patients out of the 200 selected for the study belonged to urban areas and visited National Institute of Mental Health and Neurosciences (NIMHANS)  for treatment. The other 100 lived in rural areas and 51 of them went to the NIMHANS out-patient psychiatric facilities and 49 of them went to the outreach centres of the institute. The results of this study suggest that making treatment available is only the first step towards handling mental illness. Situating psychological treatment within socio-cultural context, therefore, becomes crucial.

Homogenising of experiences and quantification often makes one lose out on the documentation of everyday situations that are faced by individuals. Despite its limitations, this paper quotes people directly and while personal experience cannot be generalised, we can observe patterns of discrimination that emerge. These patterns can thereby help us analyse a specific case using more knowledge about other people’s experiences. Moreover, the paper uses these quotations to further make suggestions on how to address the problems of patients using professional techniques. For example, it suggests the formation of focus groups in order to discuss sensitive issues and common experiences. This paper, while failing multiple statistical criteria, manages to live upto its own purpose. The publication of this paper itself, can be seen as a step towards understanding and focusing on socio-cultural context using scientific methods. 




References: 
Loganathan, S., & Murthy, R. S. (2011). Living with schizophrenia in India: gender perspectives. Transcultural psychiatry, 48(5), 569-84.

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