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Caste is a complex ontological construction. Despite several anti-caste movements and constitutional provisions, caste exists in the Indian psyche as part of everyday life. Even in the advent of globalization, caste continues to foster social and economic inequalities and exclusion in newer forms and perpetuates violence. The available research on caste-based stigma and humiliation provides a limited understanding as it deals with Dalits only; and ignores caste-Hindus (upper-caste) agency. Based largely on qualitative data collected at an intense three-day workshop, including two Focus Group Discussions and a year-long ethnography, this article illustrates the micro processes of everyday life experiences of caste-based stigma and humiliation among university students, academic staff and administrative staff. It explores subtle and overt caste discrimination, prejudices and stereotypes existing in the spatial morphologies of Indian higher education, its perpetuation on campuses and its impact on students’ psyche. It highlights the dearth of scholarship in this area of caste identity and stigma; and proposes nuanced questions for future research to understand why universities in India are turning into places of social defeat for Dalit and OBC students. The article argues the basis of caste discrimination and humiliation in universities is not the same as it exists in other social institutions. Instead of asserting conclusions on this matter we set out justifiable lines of inquiry. There are two issues that this article examines: first, how students in Indian higher education evolve strategies for coping with threatened identities. Second, what structural repair in higher education is required to heal the wounded (caste) psyche?

Aims The occurrence of AIDS in 1980s posed difficult problems for haemophilia clinicians worldwide. The impact of these events is substantial, and the events continue to be subject to judicial proceedings and publications. The stance of haemophilia physicians, particularly their professional resilience, is of importance and remains unexamined. Methods Deploying oral histories informed by literature review of scientific publications and past inquiry reports, this qualitative study addresses how physicians continued to work in haemophilia during those years and attributes that contributed to their resilience. Results and conclusions Experience and role in laboratory aspects were of value in handling and communicating uncertainty. Collegiality, peer support and scholarship were important in sustaining their roles, in clinical decision-making and re-instating confidence in the therapeutic relationship during the toughest years of their practice.

Background & objectives: Comprehension and process of consent are important for persons with mental illness as they may not be impaired in considering research participation. The American Psychiatric Association developed a detailed Cultural Formulation Interview (CFI). The present study was a part of field testing of CFI, aimed to standardize cultural information affecting the patients' management in India. This paper describes the process and conclusions from the consent-seeking process of this study. Methods: The purpose and procedures about field trial of the CFI were introduced and the patient and caregiver were requested for participation. Consent process was carried out step by step, by reading out the consent form to the first new patient of the day in the psychiatry outpatients department of a tertiary care hospital in north India, inviting questions followed by the 'comprehension' questions. The entire process was audiotaped without any personal identifiers. The process was repeated if not comprehended. Results: A total of 67 patients consented, 11 refused and majority were educated more than secondary school. Some concerns shown by the patients and caregivers included risk of participation, loss or benefits of participation, privacy, etc. All types of mentally ill patients participated in the study. Interpretation & conclusions: Translations of consent forms used simple words, consonant with understanding of the potential participants. Patients' belief that participating in this long process would improve their care, and serve humanity, influenced their decision to participate. Except for intoxication and severe psychosis, patients could understand and comprehend issues around consent. Main issues were confidentiality and culture. Our experience in the psychiatry OPD refutes the commonly held belief that mentally ill persons lack comprehension and ability to consent.

In 2015, the UK government made its counter‐radicalisation policy a statutory duty for all National Health Service (NHS) staff. Staff are now tasked to identify and report individuals they suspect may be vulnerable to radicalisation. Prevent training employs a combination of psychological and ideological frames to convey the meaning of radicalisation to healthcare staff, but studies have shown that the threat of terrorism is racialised as well. The guiding question of our ethnography is: how is counter‐radicalisation training understood and practiced by healthcare professionals? A frame analysis draws upon 2 years of ethnographic fieldwork, which includes participant observation in Prevent training and NHS staff interviews. This article demonstrates how Prevent engages in performative colour‐blindness – the active recognition and dismissal of the race frame which associates racialised Muslims with the threat of terrorism. It concludes with a discussion of institutional racism in the NHS – how racialised policies like Prevent impact the minutia of clinical interactions; how the pretence of a ‘post‐racial’ society obscures institutional racism; how psychologisation is integral to the performance of colour‐blindness; and why it is difficult to address the racism associated with colourblind policies which purport to address the threat of the Far‐Right.

Nearly 4,00,000 farmers committed suicide in India between 1995 and 2018. This translates into approximately 48 suicides every day. The majority of suicides were those from ‘backwarded’ castes including Dalit farmers. This ethnographic study on cotton farmer suicide reports narratives of surviving Dalit families. The results reveal that financial and moral debt when accrued within a web of family and caste-related relationships result in patterns of personal and familial humiliation, producing a profound sense of hopelessness in the Self. This loss of hope and pervasive humiliation is ‘cultivated’ by a cascade of decisions taken by others with little or no responsibility to the farmers and the land they hope to cultivate as they follow different cultural and financial logic. Suicide resolves the farmers’ humiliation and is a logical conclusion to the farmer’s distress, which results from a reconfiguration of agricultural spaces into socially toxic places, in turn framing a local panopticon. The current corona virus pandemic is likely to impact adversely on peoples who are culturally distanced.

Colonial thinking runs deep in psychiatry. Recent anti-racist statements from the APA and RCPsych are to be welcomed. However, we argue that if it is to really tackle deep-seated racism and decolonise its curriculum, the discipline will need to critically interrogate the origins of some of its fundamental assumptions, values and priorities. This will not be an easy task. By its very nature, the quest to decolonise is fraught with contradictions and difficulties. However, we make the case that this moment presents an opportunity for psychiatry to engage positively with other forms of critical reflection on structures of power/knowledge in the field of mental health. We propose a number of paths along which progress might be made.

The PREVENT policy introduced a duty for British health professionals to identify and report patients they suspect may be vulnerable towards radicalisa- tion. Research on PREVENT’s impact in healthcare is scant, especially on the lived experiences of staff. This study examined individual interviews with 16 critical National Health Service (NHS) professionals who participated in mandatory PRE- VENT counter-radicalisation training, half of whom are Muslims. Results reveal two themes underlying the self-censorship healthcare staff. The first theme is fear, which critical NHS staff experienced as a result of the political and moral subscript underlying PREVENT training: the ‘good’ position is to accept the PREVENT duty, and the ‘bad’ position is to reject it. This fear is experienced more acutely by British Muslim healthcare staff. The second theme relates to the structures which extend beyond PREVENT but nonetheless contribute to self-censorship: distrustful settings in which the gaze of unknown colleagues stifles personal expression; reluctant trainers who admit PREVENT may be unethical but nonetheless relinquish responsibility from the act of training; and socio-political conditions affecting the NHS which overwhelm staff with other concerns. This paper argues that counter- terrorism within healthcare settings may reveal racist structures which dispropor- tionality impact British Muslims, and raises questions regarding freedom of conscience.

Cultural psychiatry as a clinical specialty sprung mainly from Europe and North America, in order to respond to growing concerns of ethnic minorities in high-income countries. Academic psychiatrists pursuing comparative international studies on mental health, together with medical anthropologists conducting clinical ethnographies, contributed to its theoretical basis (Kleinman, 1987; Littlewood, 1990). What at first appeared to be a marginal specialty is no longer so. For example, the UK alone has witnessed a steady growth of the field, as evidenced by its mandatory inclusion in mental health training curricula, and the existence of several taught masters courses, academic positions in universities and three dedicated journals, as well as, more recently, lead papers in mainstream publications that have debated the cultural position of ‘biology’ itself (Timimi & Taylor, 2004). Additionally, with a proliferation of clinical jobs for ‘ethnic minority’ services in hospital trusts across the country, there is ample scope for employment. The overall evidence indicates that ‘cultural psychiatry’ in the UK is now a specialty in its own right.

National histories of violence shape experiences of suffering and the ways that mental health professionals respond to them. In Ecuador, mental health literature addressing this crucial issue is scarce and little debated. In contrast, local psychiatrists and psychologists within the country face contemporary challenges that are deeply rooted in a violent colonial past and the perpetuation of its fundamental ethos. This paper critically reviews relevant literature on collective memory and historical trauma, and focuses on Ecuador as a case study on how to incorporate history into modern mental health challenges. The discussion poses key questions and outlines possible ways for Ecuador to address the link between history and mental health, including insights from countries that have struggled with their violent pasts. This paper contributes to ongoing international debate on the role of cultural history in mental health with implications for social scientists and practising clinicians in former colonised nations.

How might urban mental health be understood when animals reconfigure human wellbeing in the lived city? Drawing upon ethnographic fieldwork on people and macaques in New Delhi and forging novel conversations between urban studies, ecology and psychiatry, our ontology of urban mental health moves from lived experience of the built environment to those configured by dwelling with various interlocutors: animals, astral bodies and supernatural currents. These relations create microspaces of wellbeing, keeping forces of urban precarity at bay. This paper discusses mental health ecologies in different registers: subjectivity being environmental, its scale being relational rather than binary, enmeshed in the dynamics of other-than-human life, and involving conversations between medical and vernacular practices rather than hierarchies of knowledge.

OBJECTIVE: This study's objective is to analyze training methods clinicians reported as most and least helpful during the DSM-5 Cultural Formulation Interview field trial, reasons why, and associations between demographic characteristics and method preferences. METHOD: The authors used mixed methods to analyze interviews from 75 clinicians in five continents on their training preferences after a standardized training session and clinicians' first administration of the Cultural Formulation Interview. Content analysis identified most and least helpful educational methods by reason. Bivariate and logistic regression analysis compared clinician characteristics to method preferences. RESULTS: Most frequently, clinicians named case-based behavioral simulations as "most helpful" and video as "least helpful" training methods. Bivariate and logistic regression models, first unadjusted and then clustered by country, found that each additional year of a clinician's age was associated with a preference for behavioral simulations: OR = 1.05 (95 % CI: 1.01-1.10; p = 0.025). CONCLUSIONS: Most clinicians preferred active behavioral simulations in cultural competence training, and this effect was most pronounced among older clinicians. Effective training may be best accomplished through a combination of reviewing written guidelines, video demonstration, and behavioral simulations. Future work can examine the impact of clinician training satisfaction on patient symptoms and quality of life.

SummaryPrevent is a UK-wide programme within the government's anti-terrorism strategy aimed at stopping individuals from supporting or taking part in terrorist activities. NHS England's Prevent Training and Competencies Framework requires health professionals to understand the concept of pre-criminal space. This article examines pre-criminal space, a new term which refers to a period of time during which a person is referred to a specific Prevent-related safeguarding panel, Channel. It is unclear what the concept of pre-criminal space adds to the Prevent programme. The term should be either clarified or removed from the Framework.

The Outline for Cultural Formulation (OCF) introduced with DSM-IV provided a framework for clinicians to organize cultural information relevant to diagnostic assessment and treatment planning. However, use of the OCF has been inconsistent, raising questions about the need for guidance on implementation, training, and application in diverse settings. To address this need, DSM-5 introduced a cultural formulation interview (CFI) that operationalizes the process of data collection for the OCF. The CFI includes patient and informant versions and 12 supplementary modules addressing specific domains of the OCF. This article summarizes the literature reviews and analyses of experience with the OCF conducted by the DSM-5 Cross-Cultural Issues Subgroup (DCCIS) that informed the development of the CFI. We review the history and contents of the DSM-IV OCF, its use in training programs, and previous attempts to render it operational through questionnaires, protocols, and semi-structured interview formats. Results of research based on the OCF are discussed. For each domain of the OCF, we summarize findings from the DCCIS that led to content revision and operationalization in the CFI. The conclusion discusses training and implementation issues essential to service delivery.

The impact of conservation policies on human wellbeing is critical to the integration of poverty alleviation and biodiversity conservation. In many low-income countries, human–wildlife conflict adversely affects wellbeing of communities that closely interface with wildlife. Approaches to framing and mitigating conflict emphasize its visible costs. Hidden impacts, i.e. costs that are uncompensated, temporally delayed, or psychosocial in nature, remain poorly addressed. This paper examines the hidden impacts of human–wildlife conflict in low-income countries. It presents an account of the known and potential hidden impacts, investigating their effects on rural communities. Hidden impacts of human–wildlife conflict include diminished psychosocial wellbeing, disruption of livelihoods and food insecurity. Considerable opportunity costs are incurred through crop and livestock guarding. When seeking compensation for damage, bureaucratic inadequacies result in added transaction costs. Even though communities may be tolerant of wildlife, the hidden impacts of conflict jeopardize various components of global wellbeing. The paper concludes by identifying gaps in knowledge and outlining areas for future research that better address hidden dimensions of human–wildlife conflict.

Human-wildlife conflicts impact upon the wellbeing of marginalised people, worldwide. Although tangible losses from such conflicts are well documented, hidden health consequences remain under-researched. Based on preliminary clinical ethnographic inquiries and sustained fieldwork in Assam, India, this paper documents mental health antecedents and consequences including severe untreated psychiatric morbidity and substance abuse. The case studies presented make visible the hidden mental health dimensions of human-elephant conflict. The paper illustrates how health impacts of conflicts penetrate far deeper than immediate physical threat from elephants, worsens pre-existing mental illness of marginalised people, and leads to newer psychiatric and social pathologies. These conflicts are enacted and perpetuated in institutional spaces of inequality. The authors argue that both wildlife conservation and community mental health disciplines would be enhanced by coordinated intervention. The paper concludes by generating questions that are fundamental for a new interdisciplinary paradigm that bridges ecology and the clinic.

India's National Mental Health Program (NMHP) was initiated in 1982 with the objective of promoting community participation and accessible mental health services. A key component involves central government calculation and funding for psychotropic medication. Based on clinical ethnography of a community psychiatry program in north India, this article traces the biosocial journey of psychotropic pills from the centre to the periphery. As the pill journeys from the Ministry of Health to the clinic, its symbolic meaning transforms from an emphasis on accessibility and participation to the administration of a discrete `treatment.' Instead of embodying participation and access, the pill achieves the opposite: silencing community voices, re-enforcing existing barriers to care, and relying on pharmacological solutions for psychosocial problems. The symbolic inscription of NMHP policies on the pill fail because they are undercut by more powerful meanings generated from local cultural contexts. An understanding of this process is critical for the development of training and policy that can more effectively address local mental health concerns in rural India.

This article is the first comprehensive cultural critique of India's official community mental health policy and program. Data are based on a literature review of published papers, conference proceedings, analyses of official policy and popular media, interviews with key Indian mental health professionals, and fieldwork in Kanpur district, Uttar Pradesh (2004–2006). The authors demonstrate how three influences have shaped community psychiatry in India: a cultural asymmetry between health professionals and the wider society, psychiatry's search for both professional and social legitimacy, and WHO policies that have provided the overall direction to the development of services. Taken together, the consequences are that rural community voices have been edited out. The authors hypothesize that community psychiatry in India is a bureaucratic and culturally incongruent endeavor that increases the divide between psychiatry and local rural communities. Such a claim requires sustained ethnographic fieldwork to reveal the dynamics of the gap between community and professional experiences. The development of culturally sensitive psychiatric theory and clinical services is essential to improve the mental health of rural citizens who place their trust in India's biomedical network.

The uncritical application of western psychiatric concepts in non-western societies resulting in culturally invalid psychiatric syndromes, have been extensively documented. Such instances are considered 'category errors'. In contrast, 'reverse category errors' although theoretically postulated, have never been empirically demonstrated. Diagnostic criteria of an established South Asian culture specific neurosis, Dhāt syndrome, were deployed by a psychiatrist of South Asian origin, amongst 47 white Britons in London, UK, presenting for the first time with a clinic diagnosis of ICD-9 Depressive Neurosis (Dysthymic Disroder, ICD-11). The proceedure yielded a new disorder, Semen Retention Syndrome. Based on narrative accounts and quantitative scores on the Hamilton Depression Rating Scale, the evidence suggests that a significant subset of white British subjects diagnosed with Dysthymic Disorder, may in fact be expressing a psychological variation of a previously unknown local White British somatisation phenomena labelled Semen Retention Syndrome. Anxiety and depressive symptoms presented by this subset of subjects were primarily attributed to a core irrational belief and a cognitive error centered around misunderstood concepts of semen physiology. Consequently, the undue focus on mood idioms by both white British patients and their health professionals, leads to a mistaken diagnosis of Mood Disorder, and results in incorrect treatment. The implications of this ethnocentric mode of reasoning raises concerns about existing concepts in psychiatric phenomenology and for official international diagnostic classificatory systems. The paper concludes by arguing that category errors in both directions are instances of cultural iatrogenesis, and underscore the importance of a culturally valid psychiatry.

Despite their potential significance for public policy and health provision in different societies, popular conceptualizations of and social responses to severe psychiatric illness remain relatively unexamined. Two general research procedures may be identified: (1) the anthropological approach uses ethnographic methods to look at explicit categorizations, and (2) the sociological approach employs quantitative survey methods to examine the public `stigma' of psychiatric illness. This article reviews methodological and conceptual approaches to the study of stigma and describes the development of an ethnographically grounded questionnaire to examine `stigmatization' from data in different cultures. The difficulties of achieving cross-cultural comparability of meaning are discussed and the psychometric properties of the instrument are presented.

Background: Major international studies on course and outcome of schizophrenia suggest a better prognosis in the rural world and in low-income nations. Industrialization is thought to result in increased stigma for mental illness, which in turn is thought to worsen prognosis. The lack of an ethnographically derived and cross-culturally valid measure of stigma has hampered investigation. The present study deploys such a scale and examines stigmatizing attitudes towards the severely mentally ill among rural and urban community dwellers in India. Aim: To test the hypothesis that there are fewer stigmatizing attitudes towards the mentally ill amongst rural compared to urban community dwellers in India. Materials and Methods: An ethnographically derived and vignette-based stigmatization scale was administered to a general community sample comprising two rural and one urban site in India. Responses were analyzed using univariate and multivariate statistical methods. Result: Rural Indians showed significantly higher stigma scores, especially those with a manual occupation. The overall pattern of differences between rural and urban samples suggests that the former deploy a punitive model towards the severely mentally ill, while the urban group expressed a liberal view of severe mental illness. Urban Indians showed a strong link between stigma and not wishing to work with a mentally ill individual, whereas no such link existed for rural Indians. Conclusion: This is the first study, using an ethnographically derived stigmatization scale, to report increased stigma amongst a rural Indian population. Findings from this study do not fully support the industrialization hypothesis to explain better outcome of severe mental illness in low-income nations. The lack of a link between stigma and work attitudes may partly explain this phenomenon.

Despite the important roles families play in the lives of many individuals with mental illness across cultures, there is a dearth of data worldwide on how family members perceive the process of cultural assessment as well as to how to best include them. This study addresses this gap in our knowledge through analysis of data collected across six countries as part of a DSM-5 Field Trial of the Cultural Formulation Interview (CFI). At clinician discretion, individuals who accompanied patients to the clinic visit (i.e. patient companions) at the time the CFI was conducted were invited to participate in the cultural assessment and answer questions about their experience. The specific aims of this paper are (1) to describe patterns of participation of patient companions in the CFI across the six countries, and (2) to examine the comparative feasibility, acceptability, and clinical utility of the CFI from companion perspectives through analysis of both quantitative and qualitative data. Among the 321 patient interviews, only 86 (at four of 12 sites) included companions, all of whom were family members or other relatives. The utility, feasibility and acceptability of the CFI were rated favourably by relatives, supported by qualitative analyses of debriefing interviews. Cross-site differences in frequency of accompaniment merit further study.

Objective: To assess the effect of experienced stigma on depth of multidimensional poverty of persons with severe mental illness (PSMI) in Delhi, India, controlling for gender, age and caste. Design: Matching case (hospital)–control (population) study. Setting: University Hospital (cases) and National Capital Region (controls), India. Participants: A case–control study was conducted from November 2011 to June 2012. 647 cases diagnosed with schizophrenia or affective disorders were recruited and 647 individuals of same age, sex and location of residence were matched as controls at a ratio of 1:2:1. Individuals who refused consent or provided incomplete interview were excluded. Main outcome measures: Higher risk of poverty due to stigma among PSMI. Results: 38.5% of PSMI compared with 22.2% of controls were found poor on six dimensions or more. The difference in multidimensional poverty index was 69% between groups with employment and income of the main contributors. Multidimensional poverty was strongly associated with stigma (OR 2.60, 95% CI 1.27 to 5.31), scheduled castes/scheduled tribes/other backward castes (2.39, 1.39 to 4.08), mental illness (2.07, 1.25 to 3.41) and female gender (1.87, 1.36 to 2.58). A significant interaction between stigma, mental illness and gender or caste indicates female PSMI or PSMI from ‘lower castes’ were more likely to be poor due to stigma than male controls (p

Planned and unplanned migrations, diverse social practices, and emerging disease vectors transform how health and wellbeing are understood and negotiated. Simultaneously, familiar illnesses—both communicable and non-communicable—continue to affect individual health and household, community, and state economies. Together, these forces shape medical knowledge and how it is understood, how it comes to be valued, and when and how it is adopted and applied. Perceptions of physical and psychological wellbeing differ substantially across and within societies. Although cultures often merge and change, human diversity assures that different lifestyles and beliefs will persist so that systems of value remain autonomous and distinct. In this sense, culture can be understood as not only habits and beliefs about perceived wellbeing, but also political, economic, legal, ethical, and moral practices and values. Although culture can be considered as a set of subjective values that oppose scientific objectivity, we challenge this view in this Commission by claiming that all people have systems of value that are unexamined. Such systems are, at times, diffuse, and often taken for granted, but are always dynamic and changing. They produce novel and sometimes perplexing needs, to which established caregiving practices often adjust slowly. Ideas about health are, therefore, cultural. They vary widely across societies and should not merely be defined by measures of clinical care and disease. Health can be defined in worldwide terms or quite local and familiar ones. Yet, in clinical settings, a tendency to standardise human nature can be, paradoxically, driven by both an absence of awareness of the diversity with which wellbeing is contextualised and a commitment to express both patient needs and caregiver obligations in universally understandable terms. We believe, therefore, that the perceived distinction between the objectivity of science and the subjectivity of culture is itself a social fact (a common perception). We attribute the absence of awareness of the cultural dimensions of scientific practice to this distinction, especially for macrocultures and large societies, which define only small-scale, microcultures as cultural. We recommend a broad view of culture that embraces not only social systems of belief as cultural, but also presumptions of objectivity that permeate views of local and global health, health care, and health-care delivery. If the role of cultural systems of value in health is ignored, biological wellness can be focused on as the sole measure of wellbeing, and the potential for culture to become a key component in health maintenance and promotion can be eroded. This erosion is especially true where resources are scarce or absent. Under restricted and pressured conditions, behavioural variables that affect biological outcomes are dismissed as merely sociocultural, rather than medical. Especially when money is short, or when institutions claim to have discharged fully their public health obligations, blame for ill health can be projected onto those who are already disadvantaged. As a result, many thinkers in health-care provision across disciplines attribute poor health-care outcomes to factors that are beyond the control of care providers—namely, on peculiar, individual, or largely inaccessible cultural systems of value. Others, having witnessed the ramifications of such thinking, argue that all health-care provision should, rather, be made more culturally sensitive. Yet others declare merely that multiculturalism has failed and the concept should be abandoned, citing its divisive potential.1 Irrespective of who is blamed, failure to recognise the intersection of culture with other structural and societal factors creates and compounds poor health outcomes, multiplying financial, intellectual, and humanitarian costs. However, the effect of cultural systems of values on health outcomes is huge, within and across cultures, in multicultural settings, and even within the cultures of institutions established to advance health. In all cultural settings—local, national, worldwide, and even biomedical—the need to understand the relation between culture and health, especially the cultural factors that affect health-improving behaviours, is now crucial. In view of the financial fragility of so many systems of care around the world, and the wastefulness of so much of health-care spending, a line can no longer be drawn between biomedical care and systems of value that define our understanding of human wellbeing. Where economic limitations dictate what is feasible, socioeconomic status produces its own cultures of security and insecurity that cut across nationality, ethnic background, gender orientation, age, and political persuasion. Socioeconomic status produces new cultures defined by degrees of social security and limitations on choice that privilege some people and disadvantage others. Financial equity is, therefore, a very large part of the cultural picture; but it is not the entire picture. The capacity to attend to adversity—to believe that one can affect one's own future—is conditioned by a sense of social security that is only partly financial. In this Commission, we review health and health practices as they relate to culture, identify and assess pressing issues, and recommend lines of research that are needed to address those pressing issues and emerging needs. We examine overlapping domains of culture and health: cultural competence, health inequalities, and communities of care. In these three domains, we show how inseparable health is from culturally affected perceptions of wellbeing. After examination of these key domains, we identify 12 findings in need of immediate attention: Medicine should accommodate the cultural construction of wellbeing • Culture should be better defined • Culture should not be neglected in health and health-care provision • Culture should become central to care practices • Clinical cultures should be reshaped • People who are not healthy should be recapacitated within the culture of biomedicine • Agency should be better understood with respect to culture • Training cultures should be better understood • Competence should be reconsidered across all cultures and systems of care • Exported and imported practices and services should be aligned with local cultural meaning • Building of trust in health care should be prioritised as a cultural value • New models of wellbeing and care should be identified and nourished across cultures We believe that these points are imperative to the advancement of health worldwide and are the greatest challenges for health. Together, they constitute an agenda for reversal of the systematic neglect of culture in health, the single biggest barrier to advancement of the highest attainable standard of health worldwide.

This guest editorial considers the relevance of caste in today's world in terms of ‘castes of mind’.

Public responses to depression have a powerful effect on patients' personal experience of illness, the course and outcome of the illness, and their ability to obtain gainful employment. Mental illness-related stigma reduction has become a priority, and to be effective, it requires innovative and effective public mental health interventions informed by a clear understanding of what stigma means. Based on Goffman's formulation as spoiled identity, local concepts of stigma were validated and compared in clinical cultural epidemiological studies of depression in Bangalore, India, and London, England, using the EMIC, an instrument for studying illness-related experience, its meaning, and related behaviour. Similar indicators were validated in both centres, and the internal consistency was examined to identify those that contributed to a locally coherent concept and scale for stigma. Qualitative meaning of specific features of stigma at each site was clarified from patients' prose narrative accounts. Concerns a...

Cultural pluralism that characterises many major urban centres, especially London, underscores needs for research in cultural psychiatry to identify distinctive needs for mental health services and clinical treatment. Such questions motivated development of this study of the cultural experience and meaning of depression amongst white Britons in London, involving development of a British EMIC interview for depression by adapting an earlier version of the EMIC used in Bangalore, India. Steps in the process involved historical and ethnographic study of depression, and extensive pilot testing. This report focuses on the experience of depression with reference to patterns of distress and its meaning with reference to perceived causes. A wide range of contradictory, overlapping and linked explanations, consistent with reports from previous studies of Indian and other non-Western cultures, were notable among white Britons, whose illness concepts are likely to appear as diverse and inconsistent to an outside obse...

The current emphasis on Global Mental Health risks losing the focus on the local and the particular and rendering anthropological insight pertinent. A more critical examination of pedagogical methods and curricula, and of the challenges of establishing collaborative, balanced partnerships is required. Since 2006, a group of clinical anthropologists1 based at UCL and members of The Banyan2, have been working together on an innovative series of short, annual courses on social science theory and methods applied to mental health in South Asia. A UCL/BALM3 research unit was also established in 2008 employing local researchers to conduct joint studies into mental health and its related stigma in the Indian context. Following a brief history and outline of the collaboration, this paper discusses specific challenges: institutional issues and local economics; history and power dynamics; teaching versus training; working within mixed disciplinary and �cultural� domains both in the UK and India; and the spatial and temporal challenges of supervising research across continents. The paper concludes by reflecting on the contribution this collaboration has made to knowledge flow, examining localised and culturally specific understandings of pedagogy. These insights offer potential for similar international organisations seeking to establish inclusive and effective partnerships between frequently disparate contexts.

Focusing on the British cultural vocabulary of guilt, fatigue, energy, stress and depression; this paper argues that such vocabularies have their own unique histories and meanings; deeply embedded, in this instance, within "white British and western European" institutions. Predicated on a western epistemology, these constructs developed in response to prevailing concerns at different periods in western history; but are now assumed to be universal natural entities that await further scientific research and investigation. The cross-cultural validity of depression as a universal disorder is therefore dubious and needs an extensive re-examination.

Culture-bound syndromes have attracted the attention of Western-trained psychiatrists attempting to make sense of cultural variations of mental disorders from ‘standardized’ European versions. This contribution draws on the example of dhat syndrome to illustrate the fallacies that have generated and legitimized dubious clinical entities in non-Western cultures. The article provides evidence to suggest that dhat syndrome is an imprecise and misleading term that is neither unique nor specific to South Asians. Dhat syndrome is predicated on a false theoretical premise of exotizing non-Western cultures and their explanations. The condition is best understood as a form of cultural iatrogenesis wherein a mismatch between Western-trained doctors and local patients' explanations are viewed as clinical conditions of the latter. The article concludes with a suggested outline for future research in the discipline, and argues for the development of locally rooted pluralistic psychiatry.