Psychiatry in Sri Lanka
Traditional forms of healing may vary from applying a chanted or charmed thread to exorcism. In exorcism the basic assumption is that mental illnesses are caused by supernatural influences and the healer performs a variety of rituals including drumming and dancing in order to get rid of the suspected evil spirit from the patient's body or soul (see Figs 1 and 2). Some believe that the influence of the spirits of dead relatives or ghosts can cause mental illness. Significant numbers of patients or their relatives perform a variety of religious activities and rituals believing that they can enhance the healing process. A survey carried out in a provincial general hospital by K.A.L.A.K.(further details available from the author upon request) showed that up to 80% of the patients with puerperal mental disorders sought help from some form of religious or traditional healing method (at least applying a chanted thread) in addition to Western treatment. The common belief is that it will help the recovery process and protect the patient from evil spirits. Selective serotonin reuptake inhibitors (fluoxetine and paroxetine) have been available over the last few years, mainly in the private sector. Clinicians have to think twice before prescribing these newer drugs as poor people find them difficult to afford because of the relatively high cost. Clozapine and risperidone are also available. However, also due to high cost these drugs are prescribed in a limited way. Clinicians incorporate principles of cognitive-behavioural therapy in their patient management, particularly for anxiety disorders and depressive illness, as it is an affordable form of psychotherapy.
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