精神経誌（2008）110 巻 7 号

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第回日本精神神経学会総会

シ ⃞ン ⃞ポ ⃞ジ ⃞ウ ⃞ム⃞

Women Psychiatrists―Indian Impetus
Syeda Ruksheda N(M.B.B.S, D.P.M , F.I.PS., Consultant Psychiatrist : Trellis Family Centre, M umbai, India)

Incredible India is a multicultural, multilingual, multifaceted, country of contradictions,where the women mental health professionals are participating in substantially increasing
numbers. Evolving social,cultural and economical factors have facilitated the empowerment ofwomen which is reﬂected in the health services. The contemporary Indian Woman M edical
Professional is liberated,articulate and free. Remunerative employment has decreased economic
vulnerability and dependence on men. Her decisions though, from choosing medicine as avocation, opting for psychiatry, to specializing in a particular ﬁeld are all coloured by class,caste, sex, region and religion.
Cultural expectations and inﬂuences set norms for all in a society, dictating the behaviour
and attitude of colleagues, superiors, patients, family and that of the psychiatrist herself.
Egalitarianism,while on the rise,the long tradition of social hierarchies replicates themselves inprofessional arenas. An ever increasing number, women are still less than 10% of all Indian
psychiatrists. Women psychiatrists continue to be underrepresented as policy makers in mostpsychiatric organizations and institutes. This article will discuss some of the experiences of theyoung Indian woman psychiatrist inﬂuencing her life architecture.
Key words: Indian women psychiatrist, social and cultural impact, career graphIndian Demographic Portrait
India,home to 1.1 billion people ,with 1 6 of the world population and 2.4% of its land massis adjusting culturally, socially and economically. A country of ancient civilizations, it has overmany centuries successfully integrated various communities and its ethos. This cultural pluralismof over 2000 ethnic groups is reﬂected in Indiaʼ
s vernacular with more than 216 languages out of
which 22 are oﬃcial national languages . Religious diversity is another unique aspect of thiscountry with the majority（80%）belonging to the Hindu,13.4% Muslim,2.3% Christian,1.93% Sikh
and 0.77% Buddhist community. The Schedule Caste（16.2%）, Schedule Tribe（8.2%）constitutes
another important part of the populace . 70% of Indians reside in its 550,000 villages and agricultural is the main occupation .
Women Doctors―Socio‑cultural impact
In recent years an impetus is seen in the number of women doctors globallyand this is paralleledin India. The data providing an exact ﬁgure indicating this phenomenon is unavailable, soシンポジウム：各国の状況：女性医師の状況を中心に

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information is gathered from more general sources. With urbanization, increasing awareness,
improving literacy rate,economic growth and exposure to global media,a more anti‑discriminative
attitude towards the education of girls and women is changing the Indian scenario. Funding
facilities for medical education is now easier and available to a larger section of the society.
Shifting ethno dynamics and sociodynamics are creating a tension between tradition and change ina way that some values remain the same, though the reasoning behind them may have undergone
alterations. “A woman doctor is eminently more marriageable”. A daughterʼs marriage is a hugesocial and personal responsibility for Indian parents and ﬁnding a ʻsuitableʼmatch is their privilege
and life goal. Increasing urbanization,media driven consumeristic lifestyle,has made double income
households a commonity. Doctors bring in more disposable income and parents are willing to invest
in the education of girls to ʻsafe guardʼtheir future. “Women are best suited as healers or teachers”.
Traditional view points based on social acceptability and religious dicta deem these professions
desirable as these women a prestigious addition to the familytree. In some communities it is looked
down upon if the daughter or daughter‑in‑law is a working woman as it may imply that the menor the family cannot provide for all ﬁnancial needs adequately. As the healing and teachingprofessions are considered ʻ
nobleʼand a service to the society, involvement in such occupations is
not only acceptable but also honorable.
Psychiatry Training
Each year 17000 students in India enter medical school,which is the largest number of doctors
in training,in the world . After studying for 4 and a half years plus a year of internship,the students
compete for postgraduate placements. 1954 saw its ﬁrst psychiatric training centre in Bangalore（NIM HANS）for DPM（diploma course for 2 years）. Currently there are around 300 training posts
for psychiatry（including 51 centers for M D and 28 for DPM ）, low considering the demand andrequirement of such a large population . Like other specialties,psychiatric training spans over 3‑
year residency system with an exit exam. Though standards of training vary across institutes allresidents imbibe the essentials of psychiatric evaluation, diagnosis, treatment formulation andimplementation. Regular lectures, seminars and workshops are designed for the residents by thedepartment and other organizations（at local,zonal and national levels）. Participation in researchand presentations at all levels is encouraged. During these 3 years each trainee has to complete athesis which involves a research project executed and written under the guidance of a supervisor.
One of the major concern remains that the hours are not regulated（though M CI regulations apply）
and on call duty frequency is subject to number of residents in each department. There are no on
call duty compensatory leave or pay. Women residents especially those who are married ﬁnd thatan ordinary day is a juggling act. Balancing work,family and personal demands is a stress inducing
factor. The male doctors are at an advantage as they can spend more time in academic and clinicalpursuits and donʼt have as many family obligations.
Opting for Psychiatry
Over the last few years the stigma attached to psychiatric illnesses has seen a gradual decline

精神経誌（2008）110 巻 7 号556

due to the combined eﬀort from all avenues. Media with its omnipresence and its judicious use bysome pioneering mental health professionals has aided this progress a great deal. This lesspejorative attitude in the common man and the professionals alike has brought to light theopportunities in this profession attracting young doctors to join psychiatry.
M arriage is one of the most important mile stones in an Indian womanʼs life. As mostmarriages are still arranged by the family, the ʻmarriageable ageʼfor women is the mid‑twenties,
by which time most doctors complete their graduate studies and are at the point in their careers
where they need to opt for specialties. This phase of the Indian women doctorsʼpersonal andprofessional life is ﬁlled with weighing a lot of options while decision making so as to please herfamily（which by now mayinclude a ﬁance or husband and in‑laws）as well as pursue her ambitions.
Family approval is important as a mark of respect and their cooperation eases the burden ofbalancing home and work. Undertaking postgraduate studies is expensive and such an importantﬁnancial decision that cannot be taken without the ʻ
guidanceʼand ʻ
permissionʼof the family.
“Psychiatric residency is less demanding than other specialties”. There are no documented
studies but a common myth that prevails among the medical professionals is that the residency
program for psychiatry allows for less demanding work load and better working hours. This allows
the women doctors to pay attention to personal and family obligations. Pragmatic issues of familycare including cooking, house work and child rearing are still a womanʼs purview and have to be
their priority. The male doctors on the other hand donʼt require to assist in the house hold chores
and are not the primary care givers for the children.
“A psychiatrist has more time to devote to her family”. A woman psychiatrist has more regular
hours and can adjust them to suit the needs of the family especially the children. Unlike a surgeon,or an obstetrician who are always ʻon callʼthis job comes with less uncertainties. In case of an
emergency at night hours,the husband will have to accompany the doctor to the hospital as it isnʼtproper or even safe to go out alone which is a rarity with psychiatrists. If a doctor wishes to workin the private sector,it requires an initial investment far lower than for another medical professional
as psychiatric treatment is not technology intensive.
Not Opting for Psychiatry
Unfavourable attitudes toward psychiatry or psychiatric illnesses are not found to be the cause
for low recruitment in this ﬁeld. Assumption that it is a ﬁnancially unrewarding career and lessexposure to the subject are the main reasons for choosing alternate medical specialties.
Career Choices
Sub‑specialties in psychiatry are not yet developed（except in one of the central institute）andmany professionals develop their own areas of special interest during and after training. “Childpsychiatry―the obvious solution”. Children, women and families perceive women psychiatrists tobe more compassionate, better able to understand them and be more eﬀective. Women are more
comfortable sharing intimacies with a female rather than a male psychiatrist as they can identify
with them. This perception is advantageous and many women psychiatrists put it to good use inPowered by TCPDF (www.tcpdf.org)

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intersectoral eﬀorts with schools and special groups. Fields like substance, exposes one to ugly
truths and arenʼtʻsafeʼ. Care givers of patients with psychosis are less embarrassed and concernedwith a male psychiatrist when the patient may be abusive, disinhibited or violent. A young
psychiatrist has a lot of options upon completion of the training period. Some go overseas forfurther training or experience, some choose research. The majority have an option between
government jobs and the private sector. The preference for placements in government institutes,isdue to the prestige , security and stability it oﬀers. As government institutes are often teachingcenters, this is another attraction for women psychiatrists. Academic and research opportunities
are better. Fixed,regular incomes with ﬁxed hours are some other considerations. Competition ishigh as there are limited vacancies, psychiatry being a low priority compared to other specialties
and pressing issues in the health care system of a developing country. “Private practice isnʼt her cupof tea”
. Work in the private sector is time consuming, capricious and provides a lees structuredenvironment. This view is slowly changing as more women ﬁnd,being their own boss and ﬂexible
hours a superior choice. 50% of all Indian psychiatrists work in the private sector and more than
10.5% of these are women doctors . During child rearing years a woman psychiatrist has toprioritize home over career which is expected and accepted by all. This temporary ʻ
slow downʼinthe career graph challenges adjustment and coping skills. Dissonance between personal growth andsocietal norms is reduced as more women now, seek professional help for temporary diﬃculties.
Women are more ready to accept situational support and in most cases family members aid inproviding care for the children.
Conclusion
The increasing number of women doctors choosing to specialize in psychiatry are the cause andeﬀect of the changing socio‑cultural paradigms. Some of the issues faced by Indian women
psychiatrists are mirrored elsewhere in Asia. Culturally rooted expectations of family and society,impacts career choices of women psychiatrists everyday. Systemic issues of traditional frameworkaﬀects the personal and professional trajectories of more women than men. The increment in thenumbers of women in the ﬁeld will bring to focus the long,unaddressed issues. Equalizing the power
imbalance and introspection by the women psychiatrists will lessen conﬂicting career and life goals.
References
1）Census of India 2001, Oﬃce of Registrar General, India2）M other tongues of India : Census of India 2001
3）The ﬁrst report on religion : Census of India 2001
4）India M inistry of Health and Family Welfare report 2003（http: www.mohfw.nic.in）Kulhara P.,Chakraborti S., Postgraduate Training in India―Current Status & Future Directions5）M ental Health : An Indian perspective: 1946‑2003 Agarwal A.K.,Katiyar M .,Status of Psychiatric Education in India at Postgraduate level6）John‑Alexander, P., et al.: India Journal of Psychiatry 1993; 357）Kala A.K.: Mental Health ; An Indian Perspective（1946―2003）, Private Sector Psychiatry: Phenomenal
Growth & Persistent M yths