three therapies of south india 61
Much of the discourse and style of allopathic medicine is shaped by its
Western and colonial origins although it has also developed context-specifi c
features as practitioners adapt it to the local setting. Dr. K. A. Kumar, a senior
psychiatrist at Trivandrum Medical College who has practiced in Kerala and
in the United States, explained that the primary diff erence he saw in psychi-
atric practice in these two contexts is that there is a greater involvement of the
family in treatment in Kerala. Th is distinction was cited by other psychiatrists,
based on what they had heard or read about psychiatry in the United States,
and it struck me too as being the most salient local feature of allopathic psy-
chiatric healing in Kerala. Most patients visited treatment centers accompan-
ied by one or more family members who did much or most of the talking and
who are also counseled as part of the treatment. Dr. Kumar explained that he
explicitly attempted to determine which family member would serve as the
best catalyst in treating a patient’s illness. Th at is, he would identify and work
with the person who would be the most appropriate mediator between the ill
person and other family members, someone who could also act as a facilitator
inspiring the patient to follow his treatment regimen and overcome her prob-
lem, which could just as well be a family/community problem.^16
Family involvement is, of course, a concern in psychotherapy in the United
States and elsewhere, but what distinguishes psychiatry in Kerala, at least
as compared to the United States and European contexts, is the degree and
explicitness of family involvement: one or several family members normally
accompany a patient during therapy sessions, therapy decisions are often made
by the family, and counseling is often directed at the family group. Nunley
(1998) similarly asserted that “[i]n India, then, most information psychiatrists
have about their patients comes from members of patients’ families,” and, as
a result of this broad involvement in a patient’s therapy, “[t]here is relatively
little confi dentiality in Indian psychiatry... A few psychiatrists provided
therapeut ic justifi cations for this lack of privacy, but most of these seemed to
me to have the fl avor of post-hoc apologies for what is actually a culturally
grounded status quo” (329).
In addition to the central role of family involvement in psychiatric therapy,
pathological behaviors related to eating mark a diff erence between the prac-
tice of psychiatry in India and normative, Western psychiatric texts and dis-
courses. A psychiatrist at the Trivandrum Medical College pointed out that
the International Classifi cation of Diseases diagnostic manual, which they use,
mentions that anorexia or obesity can be complicating factors in several syn-
dromes but observed that such eating disorders are rarely seen among patients
in India. Pathologies related to the consumption of food are present in Kerala,
but these included playing with food, taking a long time to eat or delaying