chapter  18
11 Pages

Mental health services in Sri Lanka


Introduction The understanding of mental health is largely determined by the meanings given by people to their experiences and feelings and the worldviews they hold about the nature of the human condition. In pursuing a universal definition of mental health, Sudhir Kakar (1984), a European-trained psychoanalyst who has worked in India for decades, uses the term as ‘a rubric, a label which covers different perspectives and concerns, such as the absence of incapacitating symptoms, integration of psychological functioning, effective conduct or personal and social life, feelings of ethical and spiritual well-being and so on’ (p. 3). There are no reliable studies reported in the English-language literature of what mental health may mean to people in Sri Lanka. So, the nearest we can get to such an understanding is by exploring how the people in the island deal with (what they see as) mental health problems – what sorts of help or ‘therapy’ they seek and/or benefit from, considered against their social and political background. As in many countries of South Asia, Sri Lankan people use multiple medical and healing systems for personal problems they regarded as ‘illness’ (see Nichter, 1980; Sachs, 1989; Waxler-Morrison, 1988). In the case of (what in the West are called) ‘mental health problems’ these would include allopathic (Western) medical systems (i.e. psychiatry), indigenous medical systems and non-medical healing of various types (see Amarasingham, 1980; Obeyesekere, 1981; Waxler, 1984). The traditional words for madness are pissu (in Sinhala) and paithiyam, mananoi and ulanoi (in Tamil); but there has been an increasing tendency in the past decade to use the literal translations of the English ‘mental illness’, namely mãnasikaroga (in Sinhala) and mananoi (in Tamil). The Trauma and Global Health (TGH) Program,1 a programme of research, capacity building and knowledge transfer coordinated by staff at McGill University in Montreal, was implemented between 2007 and 2011. The work in Sri Lanka was led by one of us (CW), and the other author (SF ) was consultant to the programme. In this chapter we report on the lessons derived about mental health development during our work on the programme, set against the background of ‘mental health’ in Sri Lanka.2