*‘Pagalon ke doctor banoge tum? Unke saath rahoge to khud bhi pagal ho jaoge’ *
(You want to treat the mad ones? If you stay with them then you will go mad yourself.)
These were the words my psychiatrist told me on our first meeting. It was then that I realized that being a psychiatrist isn’t as easy as it seems and definitely not as approved as I used to think it was.
India definitely needs more psychiatrists but being a psychiatrist in India is not that easy. Let’s take a look.
Getting into MBBS
The first roadblock to an aspiring psychiatrist is the lack of seats in the MBBS course in India. The admission is done through a national level competitive exam which is considered one of the toughest in the country.
Nearly 13 lakh aspiring doctors appear every year and only a thousand actually make it through.
At this point, it is unlikely that any student is dreaming to be a psychiatrist.
The main focus is mostly on getting into the course and being a doctor before anything else. The choice of specialization is mostly made through the course of the 5-year long arduous course.
It is actually in this time that most people are introduced to the medical aspect of psychiatry and mental illnesses for the first time.
Intro to Psych
In case you didn’t know, at the end of the 4.5-year course that is MBBS, there is a compulsory 12-month internship period where you are rotated across various departments to get a hands-on experience of what the practice is like.
This includes departments like paediatrics, OB/GYN and psychiatry among others.
Normally, each department gets a time of around a month or more.
Psychiatry, on the other hand, gets just 15 days. These 15 days are sometimes written off as a formality as well.
Even before that, psychiatry is not an independent examination subject and the attendance of classes is not compulsory.
A study in a medical college in North India showed that only 5% of students attended more than 50% of the classes.
Researchers also found that psychiatry as a career option was being discouraged by family members and peers.
Studies have also shown that students during an internship in the psych ward often report feelings of fear and apprehension while interacting with the mentally ill.
“Ye violent ho gaya to? Inka to pata bhi nahi chalta”
(What if he turns violent? You never know with these people.)
Shared by one of the interns during an interview
This was when no patient admitted had any history of violence.
When our own healers and possible future psychiatrists feel this way, it is not hard to understand why there is such a shortage of psychiatrists in India.
There is something inherently wrong with psychiatry and how it is taught.
The interesting thing though is that in a study on undergraduate medical students in India, it was discovered that 73% of students believed that we need more psychiatrists in India in order to treat psychiatric patients. Just 13% of them, actually wanted to be psychiatrists themselves.
In the first year of the course, 95.6% (!!!) students said that they felt uncomfortable around mentally ill patients. By the time they came to the fourth year, the number went down to 84%. Still a worryingly high number.
It is clear to see why psychiatry is seen with such a taboo in today’s times.
Even those who are possible future psychiatrists or doctors don’t see the mentally ill as human beings. People still consider it a pseudo-science and not on the same level as other medical fields.
The situation does not encourage a great deal of optimism and hope. It is grim with little chances of getting better.
Western Psychiatry and a Long Shadow
The history of western psychiatry is one of cruelty and inhuman acts. In my book ‘Shhh! Don’t Talk About Mental Health’, I try to underpin the past of mental illnesses and how cruelty has been meted out to the mentally ill, often from those who were seeking help.
Right from the Bethlem Hospital to the infamous asylums of USA in the 1900s where ‘inmates’ were chained to tables and beds; psychiatry is understandably feared.
In the older times, it was believed that the mentally ill were possessed by devils or spirits. The psychiatrists of those times used to beat people up to run the spirits away. They used to chain people up to their beds with no clothing at times to get them to ‘calm down’.
Psychiatry is understandably feared even in modern times.
The anti-psychiatry movement in USA in the 1960s and 70s was founded on the mistreatment rampant in psychiatric asylums.
‘Arkham Asylum’, famous from the Batman comic books is a product of the same anti-psychiatric sentiment of the time.
Thomas Szasz famously compared psychiatry to astrology and said that the modern psychiatrist (1960s) is a warden in a prison rather than a healer in a hospital.
The fears of those times continue to carry on in modern times. It is this long shadow of the dark past of psychiatry’s history and the lack of biological test of mental illnesses that keep psychiatry on the boundaries of medical sciences instead of on the centre.
It is this history of violence and mistreatment that has carried on to the modern setting in India and abroad as well.
Despite improved legislation and regulations, we continue to see psychiatric patients being mistreated in Indian hospitals.
In Their Shoes
Now put yourself in the shoes of someone who is about to make the most important decision of his/her life.
You cleared the post-graduate exam for specialization in medicine (another tough exam) and now you get to choose where you wish to go.
Do you go for a field which has a high pay, great respect in the society and is comparatively relaxed or do you choose a field which you don’t understand very well, whose patients you are slightly afraid of and one that is often misunderstood by the society?
The choice is pretty simple.
It is because of these factors that we have so few psychiatrists in India.
The few we have though, are the ones we need to take care of. They need to be cherished and understood while also making sure that we ensure they practice empathy and sensitivity.
It is not easy to be a psychiatrist in India.
People continue to see the profession with a suspicious eye and often avoid taking medications due to the fears associated with them.
We need to take care of the psychiatrists we have. The good ones, though few, are upholding psychiatry in India.
The need for sensitization and awareness is necessary even within the medical community. It is important that we de-stigmatize the profession of psychiatry while breaking down the stigma of mental illnesses as well.
Gupta, A. (2019) Shhh! Don’t Talk About Mental Health, Notion Press, Chennai, India
Kodakandla, Krishna & Nasirabadi, Minhaj & Shahid Pasha, Mohammed. (2016). Attitude of Interns towards Mental illness and Psychiatry: A study from two medical colleges in South India. Asian Journal of Psychiatry. 22. 10.1016/j.ajp.2016.06.008.
Lingeswaran A. (2010). Psychiatric curriculum and its impact on the attitude of Indian undergraduate medical students and interns. Indian journal of psychological medicine, 32 (2), 119–127. doi:10.4103/0253-7176.78509
Arjun Gupta is the author of 'Shhh! Don't Talk About Mental Health' and a mental health blogger. He has spoken in various educational institutes about the importance of mental health in daily life. Opening an organization that promotes mental health awareness is a dream he is currently pursuing.
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