ABSTRACT
A freshly graduated psychiatrist in India may be well equipped with an armamentarium of diagnostic and therapeutic skills appropriate for practice in Western societies, but these may nevertheless require extensive modification for practice in urban India. To make these skills useful locally, there is still much to learn, unlearn, and adapt for the two essential tasks of helping patients and facilitating professional survival. In this chapter we consider this process of cultural recalibration, a framework to guide it, what it entails, and its value for clinical practice. At the outset, it is useful to examine the local practice setting, characteristics and expectations of patients, and the orientations of practitioners. With a strong family system and rich cultural traditions, the local approaches to identifying and managing psychological and interpersonal problems in middleclass urban India constitute a context that shapes the needs and expectations of mental health services. We shall consider how a cultural perspective generally, and a particular emic framework that has emerged from research in cultural epidemiology, may guide a locally appropriate clinical practice. Clinical applications and implications of this cultural orientation are reviewed and illustrated with examples from experience in the private practice of psychiatry in urban Pune. In deference to that clinical setting, which experience discussed here is based on, the terms psychiatrist, therapist, and doctor are used interchangeably in the text.
