SPIRITUAL PSYCHIATRIES

With her background as a medical anthropologist, Natalie is able to take a wider view of the relationship between culture, beliefs and medicine with special reference to mental health practices in India and the UK. Her book is based on extensive fieldwork and interviews exploring both theories and practice for a wide range of mental conditions, which are ultimately about wellbeing - but perhaps more profoundly about inner peace. She works as a participant-observer relating vividly her own experiences of the places and people she visits. Her approach is interdisciplinary, looking at biomedical, religious and spiritual strategies for addressing mental health.

She begins with Dr Basu, a psychiatrist from West Bengal where she conducts 40 interviews, mainly with healthcare practitioners and mental health patients, but also with philosophers, a guru, a priest, a Muslim cleric and two clairvoyants. Very early on, we learn that the Western model does not fit Indian beliefs about the nature of existence - a central theme that pervades the book. For instance, very few western psychiatrists take spirit possession seriously in the way that it might be recognised in India or indeed Brazil. In addition, consultations are not individual but involve the whole family so that there might be up to 18 people in the room. Patients themselves might consult priests, medical herbalists, homoeopaths, healers or astrologers in addition to psychiatrists and psychologists. This reflects the range of perceived causal factors (such as past lives) and the corresponding explanation of symptoms. The reader also learns about the importance of social expectations, especially in relation to gender. Dr Basu observes that many Indian symptoms do not fit in with the latest formulations of the DSM and that cultural differences must be taken into account. He also explains that he keeps notes according to DSM criteria but also his own private classification.

The second part looks at treatment strategies, including pharmacology, homoeopathy, herbal medicine and flower remedies as well as the contribution of religious practices and spiritual establishments. All this is detailed in a series of informative charts. Dr Mistry explains his own background, including the role of Sri Aurobindo, who features prominently in the book. Mistry advocates a recognition of energy levels as well as biochemistry. Natalie relates her experiences of various holy places and healing rituals, noting that pilgrimages can also be an important component of mental health in helping maintain inner peace.

The next part looks at explanations for mental distress with chapters on mundane and esoteric models. The first considers substance abuse, physiological and psychological disorders, the influence of environment and disequilibrium. The second goes beyond orthodox Western models in considering planetary influences, past lives, subtle influences and spirit possession. This leads on to a discussion of the dominance of Western ideas and philosophy and medicine, including epistemology or the theory of knowledge. One can appreciate their resentment of the hegemony of Western approaches that take their own validity for granted and do not take into account the history of other ancient traditions that recognise levels beyond the physical. The idea, for instance, that a divine force should permeate the whole individual is foreign to Western philosophy although not to Western mysticism. We also learn that Dr Bisht was instrumental in adding the spiritual dimension to the WHO definition of health.

Models of health are embedded in existential paradigms that have a distinctive philosophy of the self and explanatory framework about the nature of reality. Many Indian practitioners feel that there is too much emphasis on the mechanistic model and that the causal efficacy of consciousness and mind should be recognised. Natalie goes on to show how these considerations are relevant to UK populations, especially those with high ethnic diversity. 40% of the population of London are from minority ethnic groups, with 32% born outside the UK. Mental health currently costs £105 billion a year or 23% of the total budget. One can appreciate the importance of broader cultural perspectives in this context and Natalie's call for some cultural humility. An important part of her work is the explanation of the relevance of other cultural models to the standard clinical medical model as physicians will certainly encounter these in their practice as reflected in the experience of their patients. This may be a step too far for some, but it is important to understand the psychological impact of other beliefs.

Natalie then reports on some of her own initiatives in Harrow and their potential transferability. She makes a compelling case for a deeper interpretation of human experiences and the relevance of other cultural beliefs, and that they may be more verifiable than we might think from a materialistic or Eurocentric perspective. There are more things in heaven and earth than are dreamt of in (this) philosophy. Natalie's sympathetic and wide-ranging book advocates wider models of mental health based on real human experiences that should inform mental health practices in multicultural societies.