We agree with Taitimu & Read that discussing biomedical beliefs in conjunction with indigenous beliefs in the clinical setting is challenging. However, patients, their relatives and the general public seem to simultaneously hold multiple and contradictory beliefs related to mental illness and its treatment (Reference Joel, Sathyaseelan and JayakaranJoel et al, 2003). Biomedical explanations (e.g. disease, abnormality, infection, degeneration, etc.) often coexist with indigenous beliefs (e.g. supernatural causation, sin and punishment, karma, etc.) in many cultures (Reference Saravanan, Jacob and PrinceSaravanan et al, 2004). It is common for people in India to simultaneously seek help and treatment from practitioners of modern medicine and from traditional and faith healers (Reference JacobJacob, 1999). This may not lead to conflict providing that each practitioner does not claim exclusivity. We have hypothesised that such multiple models may be advantageous, ‘buffering’ notions of loss and stigma and preventing social disintegration (Reference Saravanan, Jacob and PrinceSaravanan et al, 2004).

We agree that the acceptance of mental illness labels may increase perceived stigma. Nevertheless, holding alternative beliefs of causality also has costs. This is particularly true for people with chronic psychosis for whom antipsychotic medication has a powerful effect on outcome. Studies which have reported a better outcome for people with schizophrenia from low- and middle-income countries included many patients on psychotropic medication. The complete failure to subscribe to a disease model often results in a delay in seeking treatment and a poorer outcome.

The acknowledgement that individual health systems do not comprehensively address every issue for all mental disorders is useful in patient care (Reference JacobJacob, 1999). It provides for alternatives in clinical situations, especially for psychiatrists practising in non-Western cultures, and allows the use of regional therapies, yoga and meditation, and respects folk beliefs and religions. Many experienced psychiatrists working in non-Western cultures employ cultural constructs and local treatments in their practice. Although psychological constructs are easily incorporated, traditional physical therapies are seldom used owing to the poor understanding of their active principles. Only a minority of mental health professionals in low- and middle-income countries rigidly function within Western frameworks. The majority acknowledge the ethnocentricity of psychiatry and its treatment techniques and the equally effective traditional alternatives. An eclectic approach and a liberal framework will enable psychiatrists to incorporate local cultural beliefs and traditional psychological treatments in therapy, thus increasing the therapeutic armamentarium.