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      How do psychiatrists in India construct their professional identity? A critical literature review

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          Abstract

          Psychiatric practice in India is marked by an increasing gulf between largely urban-based mental health professionals and a majority rural population. Based on the premise that any engagement is a mutually constructed humane process, an understanding of the culture of psychiatry including social process of local knowledge acquisition by trainee psychiatrists is critical. This paper reviews existing literature on training of psychiatrists in India, the cultural construction of their professional identities and autobiographical reflections. The results reveal a scarcity of research on how identities, knowledge, and values are constructed, contested, resisted, sustained, and operationalized through practice. This paper hypothesizes that psychiatric training and practice in India continues to operate chiefly in an instrumental fashion and bears a circular relationship between cultural, hierarchical training structures and patient–carer concerns. The absence of interpretative social science training generates a professional identity that predominantly focuses on the patient and his/her social world as the site of pathology. Infrequent and often superfluous critical cultural reflexivity gained through routine clinical practice further alienates professionals from patients, caregivers, and their own social landscapes. This results in a peculiar brand of theory and practice that is skewed toward a narrow understanding of what constitutes suffering. The authors argue that such omissions could be addressed through nuanced ethnographies on the professional development of psychiatrists during postgraduate training, including the political economies of their social institutions and local cultural landscapes. Further research will also help enhance culturally sensitive epistemology and shape locally responsive mental health training programs. This is critical for majority rural Indians who place their trust in State biomedical care.

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          Most cited references190

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          Diagnostic and Statistical Manual of Mental Disorders

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            The clinical application of the biopsychosocial model.

            G L Engel (1980)
            How physicians approach patients and the problems they present is much influenced by the conceptual models around which their knowledge is organized. In this paper the implications of the biopsychosocial model for the study and care of a patient with an acute myocardial infarction are presented and contrasted with approaches used by adherents of the more traditional biomedical model. A medical rather than psychiatric patient was selected to emphasize the unity of medicine and to help define the place of psychiatrists in the education of physicians of the future.
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              Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry

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                Author and article information

                Journal
                Indian J Psychiatry
                Indian J Psychiatry
                IJPsy
                Indian Journal of Psychiatry
                Medknow Publications & Media Pvt Ltd (India )
                0019-5545
                1998-3794
                Jan-Mar 2017
                : 59
                : 1
                : 27-38
                Affiliations
                [1]Division of Psychiatry, University College London, London WC1E 6BT, United Kingdom
                [1 ]Department of Psychiatry, Centre of Excellence in Mental Health, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
                Author notes
                Address for correspondence: Dr. Sushrut Jadhav, Division of Psychiatry, University College London, London WC1E 6BT, United Kingdom. E-mail: s.jadhav@ 123456ucl.ac.uk
                Article
                IJPsy-59-27
                10.4103/psychiatry.IndianJPsychiatry_16_17
                5419009
                28529358
                61c35373-899c-4581-a246-f394d0430d31
                Copyright: © 2017 Indian Journal of Psychiatry

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Invited Article

                Clinical Psychology & Psychiatry
                clinical ethnography,cultural identity,global mental health,india,local mental health,professional identity,psychiatric training

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