three therapies of south india 65
is normally given to schizophrenic patients, while fl uoxetine, which is used
for treating depression, is second. Although treatment is free at government
facilities, which are widely available in Kerala, and medications are subsidized,
poorer patients are sometimes forced to discontinue treatment because they
are not able to aff ord medicines or the cost of travel to treatment facilities. Th e
same is true for patients of ayurveda.
After the initial meeting, consultations with psychiatrists at the facilities
I visited are brief, 5- to 10-minute sessions that are largely devoted to medi-
cation management. Th ese short sessions are not due to lack of interest on
the part of psychiatrists, but are the consequence of a limited number of staff
trying to serve a large number of patients. Although patients who can aff ord
to visit psychiatrists in private practice where more time can be devoted to
psychotherapy, this should not be taken to imply that private psychiatric treat-
ment is always better: private psychiatry is variable in terms of quality, and
the most highly reputed psychiatrists in the state usually work in government
hospitals while also maintaining a private practice.
Many allopathic psychiatrists believe that certain patients, such as people
they consider chronically schizophrenic, do not generally benefi t from psy-
chotherapy and their problems can be managed only through medication.
Th is emphasis on medication over counseling at the government facilities may
also relate to the lack of time available for consultation with each patient, and
although biological orientations to mental illness are increasingly emphasized
in the international community of biomedical practitioners, the emphasis on
the use of medication in India is also likely due to advertising, promotion and
the sponsorship of research by pharmaceutical companies. Indian pharmaceut-
ical manufacturers send advertisements and promotional literature to psych-
iatrists’ offi ce, and representatives of these companies appear during outpatient
consultations to distribute literature and free samples of their products.
On one occasion a pharmaceutical representative off ered me drug samples
at an outpatient center. Although I explained I was not a psychiatrist and
probably should not have them, he placed the samples on the table in front of
me before he left. I kept the packaging containing promotional mater ial, and
knowing that free samples are passed on to patients, lightening the burden of
paying for medications, I gave the pills to a psychiatrist I knew. Although I
feel that psychiatrists today in India and the United States rely too much on
the use of medications, I realized that through this act I was reinforcing the
use of medications for treating psychopathologies. Th is small example gave
me an insight into how through everyday, often well- intentioned practices,
the pharmaceutical orientation to mental illness becomes further entrenched
despite the skeptical views of many health professionals regarding the