Current Problems of Clinical Psychology in India

After reading this article you will learn about the current problems of clinical psychology in India.

The problem of mental illness and the position and prospects of clinical psychology in India have been very much neglected and require special attention, in view of the steady rise in the percentage of mental illness.

With the influence of urbanisation and civilisation, Western thought on Indian culture and increase in needs with less avenues for the successful channelization of these needs, people of India are suffering from behaviour disorder in quite a rapid speed.

Modern Indian youth faces a lot of frustration, stress and unhappiness due to economic depression, no fixed and clear goal in life, lack of meaningful values and to add to all these he does not know how to utilise his time properly. Lack of proper engagement, hopeless future and unemployment problem, all these taken together have put heavy burden on the modern Indian youths, men and women.

Poverty among the majority of Indian mass, fulfilment of the basic needs in the weaker section of the society, frustrations in the personal and social level, conflict of values and inability to cope with the changing social environment have increased the anxieties and worries of people.

Modern age is said to be an age of anxiety. With the increase in anxiety and stress there has been parallel increase in mental illness. But it is a matter of regret that with the increasing rise in the level of mental illness among the people of India, there has not been corresponding increase in the number of mental hospitals. Neither the Lunacy Act of 1908 amended in 1936 has worked properly.

Treatment of mental patients from the humanitarian point of view has become a dream rather than a reality. The attitude towards lunatics has not also changed. It is really painful and disheartening to observe mental patients kept in the most inhuman condition in many mental hospitals of India.

The Indian Psychiatric Society in its annual conference in 1960 advanced certain proposals for the need of a new bill with further amendments in view of the radical change in the opinion of psychiatrists regarding mental illness throughout the world and in the therapeutic procedures and innovative techniques adopted by them for the treatment of mental illness.

The old Lunatic Act of 1936 which is still being practiced, makes it compulsory for every mentally ill person to get a certificate from a magistrate that he is mentally ill before he can be admitted to a government mental hospital. This makes his admission quite complicated and difficult as well as time consuming.

Lapse of time elevates the illness in many cases leading to final breakdown. Though the mental hospital at Trivandrum has already passed an order to abolish this difficulty of the bill, it is yet to be followed by many other mental hospitals.

Many mentally ill patients and delinquents who need special care are picked up by the police and thrown into the jail with other criminals without any psychiatric help. Sometimes, they are even humiliated psychologically and brutally treated, till death.

Staying together with the criminals makes the case of mentally ill persons much more distressing instead of alleviating their depression. In fact, as observations show, association with the criminals has a very bad repercussion on their already maladjusted personality.

With these sad states of affairs it is really unfortunate and painful as well as shocking to find the lunatics and mentally ill people in the most devastating conditions in the mental hospitals of India. The shocking ignorance that surrounds the problem of mental health in India today, cannot under any condition be ignored.

Out-dated methods of therapy, lack of appointment of suitably trained and efficient personnel’s, make the situation worst. Many a times, the disease is not properly diagnosed and the method of treatment is faulty. In many cases, the physical symptoms are manifestations of mental illness. Under such circumstances, medical men and psychiatrists should join hand for the treatment of such cases.

It is indeed unfortunate to find that in most medical colleges in India, the M.B.B.S. courses do not give emphasis on the study of clinical psychology in depth. The medical graduates have only to attend a few lectures, varying from 10-25 on the subject and only for three weeks or so psychiatric wards provide these attached to their colleges.

To add to this, students have not to appear in the examination in the psychiatric paper. That makes the situation still worst for the medical graduates without providing them any motivation to enter deep into the subject matter of clinical psychology.

Out of the 101 medical colleges in India only 58 have psychiatric departments. Besides, there are 35 public mental hospitals all over the country. As estimates show, only 700 trained psychiatrists and about 100 professional psychoanalysts are practising in the cities of India. This number unfortunately is very small, keeping in view the country’s vast population and the rise in mental illness.

On the contrary, U.S.A. in comparison to India, has 25,000 psychiatrists and U.S.S.R. has 20,000. This comparison shows the sad state of affair and the condition of mentally ill persons in India in comparison to their western counterparts.

In 1946, the Bhore Committee estimated the urgent necessity for 800,000 psychiatric beds. Today the estimation is approximately 20, 00,000 but the number of beds now existing is about 17,000. Besides, out of 350 non- teaching public hospitals, about 30 have psychiatric units.

About 15,000 inpatients are accommodated in the 35 public mental hospitals of the country. Few of these mental hospitals unfortunately have outpatient facilities. The acute shortage of mental hospitals along with the lack of facilities for outpatient treatment has made the treatment problem of mentally ill persons in India much more aggravated.

Even the private clinics practicing psychotherapy are so small in number that innumerable patients needing some sort of guidance feel very helpless and miserable in its absence.

The turmoil of mental illness is much worse than physical disease in the sense that the cure of physical illness is more economical and less time taking. Secondly, the psychological and behavioural disorganization arising out of chronic anxiety and depression have dangerous and devastating psychological consequences.

The author during her 27 years teaching experience in premier colleges of Orissa, has come across many college youths, who suffer from mild mental illness to severe depression, mania and schizophrenia. Many of them are mentally disturbed, psychologically disorganized, emotionally maladjusted, socially in-secured, personally overflowed with anxiety and obsession.

Some of them have come to the author for guidance, counselling and psychological help in the absence of professional psychiatrists. The career and life of many brilliant scholars; many innocent youths of future India have been spoiled, wasted due to these sort of disorders.

They have been usually sympathised by family members, ridiculed by peers and humiliated by the society, for certain behaviour for which they are not responsible. Their cry for help has not been duly responded due to the paucity of provision for outpatient treatment and psychological clinics.

It is really embarrassing to state that while the W.H.O. has recommended one bed for mentally ill persons for every 10 general hospital beds, it is less than 3 per cent in large cities. And in villages, who cares for the rural innocent people when the urban affluent are not properly treated?

Keeping in view these problems, the number of beds should be increased reasonably in mental hospitals and the facilities for outpatient treatment and community mental hospitals should be established just like the U.S.A. and other progressive nations of the world.

More and more psychiatrists should come forward to open private clinics in the absence of government affiliation and assistance for the treatment and cure of mild as well as severe mental illness.

In addition to public and private mental hospitals and community psychiatric services, day hospitals should be opened in rural areas for the benefit of the rural poor. Provisions should be made for twenty four hour services in rural areas; specially in emergency cases.

The attitude of the mass towards lunatics and mildly disturbed people are traditionally of humiliation and hatred. The public also considers mental illness as an incurable disease. But this is only a prejudice and a false belief of the past. Current views on mental abnormality are radically different.

Through various mass medias like T.V., Radios and Movies, people of India should be made aware of the fact that mental disease like any other physical disease can be cured in most cases if the diagnosis is accurate and the treatment is suitable. To achieve this end, the psychologists, specially the clinical psychologists of India have a lot of duties and responsibilities.

Whatever facilities of therapy exist in India, it is, to be frank, mostly for the urban elite, for the affluent mass. According to one recent investigation, there is not a single mental clinic in the rural areas throughout the home country.

This estimate does not include the quacks of course who do much harm than good to the mental patients by treating them in the most un-psychological and dehumanized manner, such as beating, whipping, lashing and physically torturing mental patients. These quacks should be banned by law and discouraged by the public.

In-spite of the fact that in the urban societies, in cities, the behaviour disorder is much higher in view of greater repression and suppression, competitiveness, higher aspiration and less achievement ability, lack of frustration tolerance and conflict of values and sudden change of social system, the rural mass also suffer from mental abnormality and should be given their share of treatment.

They should not be totally denied such considerations. Finally, clinical psychologists in particular should come forward with a devotion to their job, with a sense of dedication, a genuine desire to serve the mentally ill persons. Psychiatric services should be made available at every primary health centre and bed allocation provision should be made in the district headquarter general hospitals.

Only a very few states of India, such as Kerala, Karnataka and Tamil Nadu, have provision for psychiatric services at every health centre. Some other states are contemplating over the matter, but it is high time to put it into practice immediately. The plans about opening psychiatric centres, community mental hospitals, outpatient treatment provisions etc. should no more exist in mere pen and paper.

More and more researches and surveys should be conducted in India on the behavioural dysfunctions of Indian people without being only guided and biased by western methods of assessment, prognosis and treatment of mental diseases.

One of the important drawbacks of Indian clinical psychologists is the use of western test materials and therapeutic procedures without keeping the Indian cultural differences in mind. India is a country of diverse religions. It has a complicated caste system, its socio-cultural system is pyramidal by nature. All these undoubtedly influence the nature and degree of adaptability of the people of India.

Traditional methods of treatment like ECT have been challenged because of its major side effects. Drugs also do not cure the disease permanently. Hence more and more psychotherapy, group therapy, community therapy and family therapy should be introduced and used.

Finally, prevention of behavioural disorder is another major aim of any clinical psychologist. In India, there is no such programme for the prevention of behaviour disorders. Today the problem of drug abuse, drug addiction, divorce, suicide, delinquency, social maladjustment, crime, street violence have alarmingly increased.

Besides, politicians, executives, government authorities turn to psychiatrists for reducing and eradicating these social evils. But prevention of these problems will definitely make it easier and prevention has always been better than cure.

Prevention programmes will include child guidance clinics, adult counselling centres, improvement of nutritional deficiencies which cause retardation etc. Counselling to parents for conclusive and flexible child rearing practices, training to teachers for the balanced personality development of the child, social discipline and so on should also be included under the prevention programme.

In view of the growing need of clinical psychologists and psychological clinics in India with appropriate and modern therapeutic procedures, equipment’s and facilities, the joint cooperation of clinical psychologists, sociologists, medical men, government authorities and public by and large is extremely essential. It is a joint responsibility and should be shouldered by everyone.