Beliefs about Etiology, Help-seeking and Consequences of Mental Illness: A Study on Tribal Patients from a Psychiatric Setup

Abstract

Cultural disparity affects the Indian mental health care system that ranges from perceptions of etiology, treatment-seeking help-sseking, and management. The preference of treatment seeking is also influenced by culture. In India, varied and diverse modern and traditional healers are found in each corner, throughout the country to alleviate mental illness. Folk and religious healers are the predominant choices for the majority of the population. Being home to the largest tribal population of the world, India, with 705 tribal groups, has a greater vulnerability to mental health issues for a variety of reasons. In the case of tribal society, magico-religious practices are frequently resorted to the treatment of various illnesses, including mental illness. They have traditional beliefs, customs, and practices to deal with mental illnesses, which have not been explored much. Attributing supernatural powers as the prevalent etiology because of a strong belief in those forces in their culture, lack of awareness about mental illnesses, inaccessible, inadequate or no modern medical facilities could be the major barriers among the tribal populace to seek healthcare from the tertiary healthcare centers. The objectives of the present study are 1) to explore the beliefs about the etiology of mental illness among the tribal patients visiting a psychiatric setup; 2) to find out the prevalent help-seeking practices of mental illness by the patients; 3) to explore the consequences of mental illness on patients and their family members. The proposed study has applied a ‘mixed method approach’ to achieve the objectives of the study. The proposed study has been carried out in the institutional setup. The researcher has selected the Department of Psychiatry, Ispat General Hospital (IGH), Rourkela, Odisha. IGH is a multi-specialty hospital located in sector 19 of Rourkela city. The present study has fifty cases of tribal patients with mental illness. The sampling procedure had followed the ‘purposive sampling’. In the current research, a semi-structured interview schedule was designed to collect and document information about tribal patients visiting a psychiatric set-up. Two types of data sets, such as (i) qualitative and (ii) quantitative, were obtained from the cases studied. The researcher has used content analysis to analyze the qualitative data and the simple percentage ratio method has been employed to analyze the quantitative data. The study has been approved by the Ethical Committee Review Board of Ispat General Hospital (IGH) Rourkela, Odisha and Institute Ethical Committee, National Institute of Technology Rourkela Odisha India. The major findings of the study are presented thematically in the following paragraphs: Beliefs about the etiology of mental illness: Nearly about 40% of the patients with mental illness believe in supernatural factors as the main etiology of mental illness. Sixty percent of the tribal patients with mental illness believe in natural etiology of mental illness i.e., due to different stress, western physiology, and non-western physiology. Half of the respondents (48%) reported that the state of mental illness is a very serious illness. Suicidal ideation or fear to die is the main dread among most of the respondents (40%). Local nomenclature used by the people to denote the mental illness is Mundi/Munda Kharap, Mental dosha, Dimag bimari, Bhut lagiba, and Manasika bikruti, etc. Help-seeking practices for mental illness Nearly one-third (36%) of the patients with mental illness consulted the traditional healers and medical professionals, respectively, after the onset of the illness in the first instance. The traditional healers include all types of healing other than modern health care practices. It includes faith healers, religious healers, astrologers, temple healing, and local herbal healers, etc., which follow the non-scientific way of healing practices. The respondents taking no action accounted for 28% at the onset of mental illness due to the absence of awareness about mental illness, which may become a leading cause for aggravation of illness at the later stage. The notable reasons for choosing modern health care practices are: ‘cure the illness at the earliest’ (90%), ‘patient’s behavior/pain was unbearable’ (74%), ‘medical professional/ doctor is well known in the area’ (72%), ‘no other options to get cure of the illness’ (72%). The mean duration between the onset of the illness and the first psychiatric consultation is 23.42 months. The range of the consultation varies from one month to 120 months. The majority of the patients (88%) are not interested in hospital stay for the reasons like: a) there is no illness (20%); b) the psychiatric ward is not patient’s friendly (20%); c) unwillingness of the caregivers (family members) for the hospital stay (76%). Easy availability is the foremost motivational factor for approaching traditional healing practices. About one-third of the respondents (36%) consulted both traditional healers and psychiatrists simultaneously to cure the illness as earliest and have trust in the traditional healing. Nearly one-third (30%) of the patients with mental illness performed ritual practices to cure the illness at the earliest. Consequences of mental illness on the patient and their family members Marriage and mental health problems are closely related and multi-faceted ones. The evidence shows that there is an adverse effect of mental illness on marriage and marital life among the patient with mental illness. Mental health problems are working as a conflagration in marriage and marital life in the Indian marriage system. Patients have reported a decrease in appetite pattern (56%) of patients, deterioration in health condition (44%), and deterioration in the working ability (56%) after diagnosis of the illness. The researcher found that the effect of mental illness is on education, marriage, financial problem, family stress, disruption of family routine activities, physical abuse and violence in the family, social isolation, lack of caregiver’s personal care and care to other children in the family and damage in household accessories. Besides filling some gaps in the literature, the findings sometimes affirm and sometimes appear to contradict what has previously been written. The current study makes significant contributions in a multi-dimensional approach.