The famous aerospace engineer, Wernher von Braun, once wittingly said, “research is what I’m doing when I don’t know what I’m doing”, which perhaps was implied on the essence of inquiry — a question to seek an answer for — that every scientific study carries within its core. But it’s not uncommon to take Braun’s quote for granted and measure incomprehensible ideas under the label of research, only to ice them later with the “scientific method”. The vivid undertone of this analogy has been justified by the sorry state of mental health research and awareness in India.
In a recent one, The Indian Council of Medical Research (ICMR) sanctioned funds for a large-scale study which intends to find out whether whispering mahamrityunjay mantra into the ears of patients with traumatic brain injuries will prove helpful in their recovery from states of coma. The methodology is precisely as it sounds and Dr Ashok Kumar, after getting his proposal rejected from AIIMS for being unscientific, has finally been allowed a hefty fellowship by the ICMR.
A second news headline captured a protest by IISC students against a campus event which invited Sri Sri Ravi Shankar to give a talk on World Mental Health Day. A petition signed by 700 students opposed the event calling it ‘unscientific’ while demanding for eligible experts such as those from NIMHANS. Ravi Shankar’s response to the opposition, as described in a report by The Indian Express, was that “his brand of healing had just as much to offer as researchers from NIMHANS”.
This is not the first time invalid and untested claims on mental healthcare have emerged and are being uplifted by larger bodies. The collective fascination with cow excreta as medicinal “cure” for a range of conditions including cancer has been a great example familiar to us. In developmental psychology, ‘Garbh Sanskar’ has been popular among many would-be parents. The practice provides a list of prenatal activities (including a guide to concieve) that promises the 'perfect' progeny.
The plight, as seen from the above reports and several alike, signifies gross contamination in the field of mental health research and its related areas. The boundaries between scientific and unscientific continue to blur allowing groundless ideological and pseudo-spiritual influence to penetrate the sphere of mental health. What’s astonishing is that the promotion of such ideas is rampant in a time when the Indian system of mental health in all its professional and public aspects is struggling to attain recognition.
But what drives such ideas to surface in the country? Would criticising them means to limit the scope of research and abolish the encouragement of novel prepositions betraying the very purpose of research? Are we saying that research like the one funded by ICMR shouldn’t take place?
Bhargavi Davar, founder of Bapu Trust, a Pune-based community mental health organisation, weighs in on this saying, “this [ICMR project] research is quite interesting because, within our work, we use arts-based therapy which has a focus on vocalisation and breath work and these elements do have healing aspects. However, both our work and the work studied in the research is of a group getting together with positive thoughts and intentions. I feel that research like this can have controlled conditions where the group setting remains and the words of the chants are changed to nonsense words, or adapted for the religion of the patient, for example, Quranic reading for Muslim patients. Then, we would be able to say whether it's the group focus and the positive intention that's healing, or the words themselves, or both.”
But should researches like the ones above be treated as priority? Or should we first strive to fill the gaps of robust mental health data for a diverse set of the population? Davar says, "We don't yet know fully understand the length and breadth of psychosocial distress experienced by Indian citizens and perhaps, using culturally valid tools to measure it would be a more urgent need, since it would tell us groups that are under severe distress and need interventions very soon.”
The reinforcement of stigma
However, opinions on scientific temper also call for radical changes. Vaidehi Chilwarwar, a Mumbai-based psychologist and researcher highlights a considerable lack of scientific temper in mental health research in India, saying, “since mental illness is already considered a mysterious and mystical territory; indulging in faith based (read superstition) practices appear a convenient resort to the uninformed (not uneducated) sections of the society.”
Spiritual leaders like Ravi Shankar and many others seem to be reinforcing the stigma that characterises mental health issues as illegitimate constructs that do not require professional expertise to help. We never observe leaders calling themselves as gastrointestinal or oncological experts, but given the covert nature of mental illness, it becomes easy for someone to claim authority which, as Ravi Shankar believes, has as much to offer as researchers who have spent decades studying it from every possible dimension.
Aiming at the reason behind the popularity of such ideas, Vaidehi further adds, “The power of crafting 'healing techniques' lies with those who intend to project a political image rather than minimise the damage. A majority of the service users seem to miss out on the authenticity of such steps and accept decisions on the face value without reflecting on its usefulness.”
Historically, the oppressive forces have concealed their tyranny under the label of research. In the sketchy past, be it medicine or psychiatry, in particular, research had been used to justify oppression against marginalised communities. The eugenics movement, the racist history of intelligence testing, the misdiagnosis of hysteria in women are all classic examples of a universal mindset that attempts to justify its perpetuation.
It’s not wrong to entertain that all scientific findings were once just plain imaginations but with every research pertaining to the human mind, comes great ethical responsibility that speaks to the psychosocial individuality of the person. Stressing on this lack of autonomy in decision making, Vaidehi says, “The interventions are not seen to be evenly distributed and spread across community members. In fact, the interventionists take decisions for the sufferers. And thus people who actually experience issues are seldom invited to have a say in formulating solutions.”
The need for direction
Another argument that defends ideological influence on psychiatric research claims preference of ‘eastern’ ideas over ‘western’. This is despite concepts such as group therapy, community care, art-based therapies being rooted in the Indian tradition. Similarly, Buddhist psychology and its use of meditation within mindfulness-based therapies are well known to bring effective change in people and are validated by research.
Before exploring the ‘metaphysical’ boundaries, India needs to fill its own gaps of research in existing interventions. For example, an important untouched concern is the effectiveness of Indian mental health professionals. Due to mushrooming courses and a rigid academic system, there is a rise in quackery which isn’t adequately prevented under law.
“Decentralisation of decision-making power over research projects pertaining to health and welfare is highly needed," Vaidehi says. “Rather than discouraging the participation of people in deciding what works best for them, the authorities need to be inclusive in terms of research which is not just an attempt to address the concerns of mental illness but also its related areas such as gender, sexuality, oppression etc, all these of which are in dire need of scientific validity.”
It’s crucial that medical organisations consider the literature supporting the research hypothesis with utmost care as well as with a subsequent lookout for the need of the hour. There are much more viable candidates for research ideas given India’s high levels of psychological distress and a relatively low budget for research. Once the leftover amount is invested into taking care of our basic interventive frameworks, it would then seem rational to take on exploratory studies of a sceptical nature. We have a long way to go before we can even imagine meeting the mental health treatment gap. It’s high time we decide whether we are going to have fruitful discussions which actually help the people, or are we just going to sail within the political winds.
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Updated Date: Nov 24, 2019 09:21:53 IST