Biomedical subjects
Publications and source records attributed to C Shamasundar.
Until recently, both love and praxis as therapist qualities have not enjoyed the attention they deserve. The components of praxis and the derivatives of love (namely, empathy and good-will) are important ingredients of therapeutic behavior. They are also capable of promoting mental health. Inculcating the trainees with these qualities should become foci of training in psychotherapy.
Over a period of time, the author arrived at a few tentative postulates concerning empathy and related processes based on some of his experiences and observations. The central theme of these postulates is, firstly, that interpersonal interaction is an interaction of the personal-space fields. Secondly, empathy, therapeutic benefit, and the professional stress are all related to the same process of interpersonal interaction. This interaction takes place as an enmeshment of personal spaces of the interacting individuals, and involves transfer of a wide range of information in the affective, cognitive, and other areas. This is because the personal spaces have fieldlike qualities analogous to what Kurt Lewin described. Thus, such phenomena as empathy, therapeutic benefit, professional stress are all consequences of the same process. It is possible to substantiate these postulates by diverse evidences in the published literature. The natural consequences of such an interpersonal interaction are empathic understanding, transfer of mood states (like hope, distress or expectancy), affective states (like anxiety, sadness, anger or hostility), ideas, images and even attitudes and values, etc. This phenomenon of transfer can explain such processes as therapeutic benefit in individual and group settings, professional stress, shared delusions, and even experimenter bias. Whether one becomes aware of such transferred information or not depends upon the intent and sensitivity of the participants.
The usefulness of anecdotal analogies from Indian mythology in therapeutic work with rural mental health patients has been reported. The author encountered evidences for the same in his clinical work. He then undertook to collect from Indian mythological literature excerpts containing psychotherapeutic and related themes. Examples of a few of those themes are presented to stimulate the interest of therapists in the vast therapeutic potential in mythologies. The mental health profession would benefit from examining mythologies of other cultures, and experimenting in using them in therapy.
Psychiatric morbidity in an Indian general practice was studied using the 12 item version of the General Health Questionnaire to screen 882 patients who represented 9000 consecutive adult patients attending the practice. The questionnaire was valid with a cutting score of 1/2 when compared with section 1 of the standardised Indian Psychiatric Survey Schedule. The probable prevalence of psychiatric morbidity was 35.9%. The general practitioner identified only about 25% of patients. Five of the 12 questions on the General Health Questionnaire had a higher discriminatory capacity, and the performance of the patients on these five questions was valid when compared to section 1 of the Indian Psychiatric Survey Schedule.
In clinical psychiatric practice, the use of various psychotherapeutic techniques is a useful therapeutic tool in its own right and a helpful adjunct to other forms of treatment. Training of post-graduate students of psychiatry in the practical use of psychotherapeutic and related psychodynamic principles is of prime necessity. Where, for various reasons, the use of the medical model of management dominates clinical practice, the task of supplementing it with a psychotherapeutic approach faces considerable resistance. A brief account of the author's efforts in introducing a psychodynamic orientation is such a situation, and his experiences and observations, are presented and discussed.
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The relationship between psychiatric morbidity in 30 leprosy patients under treatment as assessed by the General Health Questionnaire (GHQ-12) and certain variables of their illness and psychosocial factors is examined in this paper. Physical disability and duration of illness were the illness variables considered; knowledge and adjustment were the psychosocial variables included. Bell's Adjustment Inventory (BAI) measured the latter, psychiatric morbidity was positively correlated with physical disability (p < 0.05), knowledge about the disease (p < 0.01) and social, emotional and health maladjustment (p < 0.01), but not with duration of illness (p > 0.05). The importance of appropriate knowledge, social stigma and physical disability in leprosy is discussed in addressing the psychiatric morbidity of leprosy patients.
The psychiatric morbidity of 30 leprosy patients was compared with that of psoriasis in a clinic set-up. The prevalence of psychiatric morbidity was significantly less among leprosy patients (122/1000) than among those with psoriasis (476/1000); but the severity of the problem, as measured by General Health Questionnaire (GHQ), was significantly greater among leprosy patients (p < 0.05). There was no difference in the pattern of psychopathology diagnosis between the two groups. Depressive neurosis was the most common diagnosis in both the groups. The relevance of these findings in relation to leprosy is discussed.