Is There A Universal Therapy System?: ‘Indianising’ Therapy

There been a slow but steady climb towards prioritising mental health care, and more and more Indians are finally talking and taking therapy.

But is there a specific Indian way to do therapy? Since psychology was born out of research and practices in a primarily Western context, much of therapy has been tailored for that population.

So how does this specific idea of therapy interact universally with all the rich, diversity of the world? How can we adapt this to us and ‘Indianise’ therapy?

To find out more, we sat with Suhasini Subhramanian, a counselling psychologist at Karma Care, and Dr Sameer Malhotra, a psychiatrist at Max Healthcare, to shed some light on the complex relationship between mental health and culture.

How do Indian Mental Health Practitioners Adapt the Theory to Our Culture?

Suhasini Subramanian (SS): “Cultural context is an extremely important concept in the practice of psychology. There are many constructs of Indian culture that interact greatly with therapeutic practice. For example the respect of elders and authority figures is deeply ingrained in community beliefs. This also applies to practice as most patients/clients enter the setting with a preset level of authority-type veneration.

Whereas theoretically (and ethically), it is suggested that client and therapist relationship to be a collaborative effort (NOT teacher and student)—and this is what I work hard to maintain. This can often be challenging as many individuals can enter into the space hoping for “advice” or for you to tell them what to do and how exactly to do it.

Emotional freedom is also something that is somewhat an interacting factor. It is not as culturally accepted to speak freely and openly about emotions and feelings for the most part, especially when compared to “western” cultures. In a therapeutic context this can go two ways: a) that the person needs more ‘training’ on how to speak about and thus explore their internal feelings OR b) that the space becomes the only place that individuals are even able to express their emotions.

Sameer Malhotra (SM): The concept of ‘self’ that is important in therapy is very different in the East and West. In the West, it is skin deep but in the East, it’s very tied to your community and goes deeper than just you.

Can We Have a Static ‘Indian’ Way of Therapy’?

SS: India is an immensely socially diverse country, and with social media and the internet it’s hard to group the 1.4 billion people as one. We have massive disparities in wealth, and a huge socieconomic bracket. It is not easy or advisable to create a generalized concept on how practice looks different between these two groups. Often the level of education is what makes a slight difference.

It is up to each practitioner to be able to gauge what is most appropriate and what will be most effective in each given context. This means treating every individual as a fingerprint, completely unique that have their own personalities, experiences, cultural norms and desires. Over time there will be certain underlying themes in each culture that emerge and that must be accounted for, and sometimes even anticipated but this is part of the job for us to stay on our toes and be intuitive and observant.

So like there is no static way of being Indian or one static Indian culture, we cannot have just one form of therapy to treat all of us.

SM: With exposure to other cultures and globalisation, Eastern and Western ways of doing things are melding together. There is a growing appreciation of the other way in each, and so things are more fluid.

The West Is Known to Be More Individualistic While the East Emphasizes Highly Emotional Bonds and Collectivism. How Does This Affect Therapy?

SS: I wouldn’t say that highly emotional bonds and collectivism are necessarily always mutually present. Collectivism can often be accompanied by a great deal of social pressure, expectation and obligation that is not necessarily emotion(affection) based but rather a representation of social acceptance exclusivity. So as you can imagine this can create a deal of distress for certain roles within these communities, especially such as mothers/female figures.

In collectivist cultures, clients are likely to be highly influenced by societal expectations and not by their own preferences. The focus on individual autonomy and personal growth may be viewed as ‘selfish’ in a culture that promotes common good, especially for women.

Malhotra adds that the inter-dependent nature of Indian society can work to our benefit.

SM: Yes, in Indian cultures we are more dependent on each other and there is a strong family and community bond. There is a sharing of roles and responsibilities, and the pressure to perform on one person reduces. This is what happened in the joint family context, and change to nuclear families and living alone has seen a rise in cases of stress.

Are There Certain Cultures More Likely to Have the Same Type of Mental Illness?

SS: There is a fascinating concept known as culture-bound syndromes, which is a combination of psychological and psychiatric symptoms that appear specific to a culture - this happens everywhere, not just in India.

SM: There have been certain cultural norms, and one needs to look into the basis of these to understand them and see how they might have helped when we didn’t have many medications or structured therapies available. For example, Hanuman complex is a feeling of inferiority or not being aware of your own powers, and it is overcome by listening to the mythology.

SS: Psychoeducation, an integral part of psychotherapy, plays a role here. Concepts of clinical mental disorders may not be as widely understood (or accepted) in many communities. So it is important to educate someone that what they are experiencing is “normal” and is not an unheard of but rather an experience shared by others that can be treated. Plus, even if we are treating something scientifically, it’s important to do that without undermining the culture or religion of the patient.

So it’s not always a battle between science and religion, but often they can co-exist to the benefit of the patient.