Navigating diagnoses: understanding mind-body relations, mental health, and stigma in Nepal

Abstract

Anthropologists and psychiatrists traditionally have used the salience of a mind-body dichotomy to distinguish Western from non-Western ethnopsychologies. However, despite claims of mind-body holism in non-Western cultures, mind-body divisions are prominent in non-Western groups. In this article, we discuss three issues: the ethnopsychology of mind-body dichotomies in Nepal, the relationship between mind-body dichotomies and the hierarchy of resort in a medical pluralistic context, and, finally, the role of mind-body dichotomies in public health interventions (biomedical and psychosocial) aimed toward decreasing the stigmatization of mental illness. We assert that, by understanding mind-body relations in non-Western settings, their implications, and ways in which to reconstitute these relations in a less stigmatizing manner, medical anthropologists and mental health workers can contribute to the reduction of stigma in global mental health care.

Figure 1

The framing of suffering by healers in Nepal through Mind–body relations. Note: Solid arrows represent interrelations among the divisions of self. Dotted ellipses represent healing domains. For example, traditional healers often explain suffering in terms of saato, jiu and samaj (society), while psychiatrists reframe suffering according dimaag. We acknowledge that this schematic simplifies the divisions, but we do this for heuristic purposes to highlight how the primary domains of different healing disciplines reframe and reconstitute suffering. Also note that “traditional healers” encompasses a wide range of practitioners from varied ethnic and religious backgrounds and is overly simplistic; although using the category in this way orients us with medical discourse, we strategically do so for the purposes of this article.

Figure 2. Navigating Diagnoses: Pathways of helpseeking for psychological distress

Note: Numbers in brackets represent the ratio of practitioners to population, e.g. there are 5000 people per physician in Nepal. Direction of arrows represents pathway of care, e.g. sufferers seek out traditional healers and physicians, whereas psychosocial workers seek out clients.