Chapter 8 consolidates themes from that emerge from chapters 6 and 7, addressing longstanding issues that have impacted on the engagement with mental health services by South Asian populations. One of the main stumbling blocks to progress has been the entrenched sense of stigma about mental health. The collectivism of South Asian societies contributed to the shared responsibility to preserve the reputation of the family in society. The exposure of mental health problems threatened this societal framework and hence they were marginalised or displaced. Many of the psychiatrists faced opposition to their specialism and even admitted to initially sharing some of these negative biases. Addressing beliefs and practices of South Asian religious and spiritual traditions is productive because it explains some of the longstanding attitudes and provides potential solutions and strategies of management. The conversations about the significance of South Asian religions in mental health care was both significant and symbolic of the need to combine systems beyond the biomedical model. The final consideration, one of greatest importance, is the seminal role that South Asian psychiatrists have in unpicking issues that explain cultural concerns within the groups in which they interact.

The discipline of cultural psychiatry is premised on the acknowledgement of white bias that has dogged the institution of psychiatry from its inception and, whilst this has led to the revision of ideas, objectives and practices, the implications for South Asian psychiatrists, of working within socially constructed white spaces has not been addressed. They have to contend with structural inequalities that may problematise their roles, in particular the power status within the therapeutic relationship – thereby increasing their challenges. They have to work harder to secure trust and cannot take for granted that they would be treated with the professionalism appropriate to their role. The conclusion addresses these issues, summarises the main points of the interviews and presents some recommendations for future research and practice.

This chapter gives an overview of the history of migration from South Asia to the UK, and develops ideas found in the interviews with the psychiatrists and subsequent analyses. It is not meant to be comprehensive but provides a contextual background from which to situate the experiences and life journeys of migrant South Asian doctors. The postwar migration of labour from commonwealth countries transformed UK’s cultural landscape. Migration is a complex, multifactorial process, that involved experiences of loss on different levels. Over the course of time stricter legislation has seen changes to patterns of migration on different bases. This needs to be viewed against globalisation which has a different bearing on migration. The growth of transnational, mobile identities means that migrants can interact in more networked worlds making travel and communication more accessible both for migrants and their extended family. It has made it possible to occupy different spaces and identities both locally and globally. South Asian doctors who come to the UK today have been impacted by a number of factors such as changes to immigration policies and the global effects of the Covid−19 pandemic. These factors have to be considered amongst others that influence choices about migration including economic opportunities, the provision of jobs, the growth of healthcare systems and development of infrastructure in their home countries.

Interviewee: I’m Farida Yousaf. I am an adult psychiatrist and have been a consultant since 1997. I actually retired from my post in July of this year [2021] but since then, I’ve been doing one and a half days in a slightly different role but still in adult psychiatry. I first took retirement in 2017 for personal reasons and then went back to the same job but worked for fewer hours. I continued with this until recently.

Chapter 7 turns attention to the clinical dimension, chiefly the therapeutic relationship, to look at the experiences that the psychiatrists had with patients from South Asian cultures for two reasons. One was to learn more about the ways in which they were able to relate and address the socio-cultural needs as a way to think about the significance of the therapeutic dyad. Of especial relevance was the use of South Asian languages, the identification of idioms of distress, and somatization. It was equally important to learn about the various challenges faced in these relationships and the measures taken by professionals to ensure boundaries were respected both inside and outside the institution. The existential realities experienced by the psychiatrists of both generations increased their receptivity to the needs of other ethnic minorities. Some reported how colleagues would consult with them or refer patients from ethnic minorities to them in the belief that their understanding of displacement, isolation and cognate factors would be helpful in understanding their needs.

Interviewee: My name’s Rupal Davé and I am a consultant psychiatrist in the psychiatry of intellectual disability and I work in NELFT, that’s North East London Foundation Trust in the borough of Waltham Forest.

The death of George Floyd in 2020 spurred the Black Lives Matter movement and generated widespread social consciousness about the persistence of institutional racism in its many forms and the impact it has had in creating disparities in healthcare, education and criminal justice. One significant response was in the push for educational reforms, particularly in North America and parts of Europe, to decolonise. This book continues the decolonising work done in the pioneering field of cultural psychiatry, focusing on the UK context. Cultural psychiatry has made headway in decolonising former traditions of psychiatry. A gap that needs to be addressed with some urgency, however, is the representation of views of non-white psychiatrists. An assumption when discussing therapeutic relationships is that the patient is from an ethnic minority background, often from a BAME group, and by implication, the psychiatrist is white and from the majority group. The second part of this assumption overlooks the experiences of psychiatrists from non-white ethnicities, and it is this that defines the scope of the book. Elicited through interview, the accounts explored the lived experiences of South Asian psychiatrists in the UK, negotiating the shifts between their cultural identities especially framed as the culture of their ethnicity and British culture.

This chapter examines the predicament outlined in the previous chapter, of the non-white body showing up in white spaces. Whilst a staunch objective of postwar black cultural politics, and of this book itself, is to portray the heterogeneity of the cultural identity of non-white ethnic minorities, in reality what happens in the lived experience is that the individual is interpreted through their racial characteristics, chiefly skin colour, which skews a holistic understanding of the person. The ‘historico-racial schema’ devised by Fanon that defines the restrictions faced by the non-white body in space, is explored in more widely and is theorised in Sara Ahmed’s insights in her study of the phenomenology of whiteness where she conveys the precarious situation of non-white bodies inhabiting white spaces. When they fit in, they are rendered invisible, and when they don’t and ‘stand out’ and ‘stand apart’, they are ‘hypervisible’ (2007, 159). Either way, visibility is not permitted in their own terms. In the interviews that followed the psychiatrists did not enjoy white privilege and there were times when they were made to feel different, a theme that was explored within the context of acculturation and other factors.

The interview questions were designed to enable the psychiatrists to reflect on their lived experiences, that is their personal knowledge about the world gained through direct, first-hand experience. This standard definition emphasises the subjective knowledge that individuals form through direct encounters, interactions and observations. The authors were particularly interested in learning about how the negotiation between South Asian and British cultures played out in the course of their working lives at the level of the lived experience rather than abstractly. Frantz Fanon’s existential-phenomenology is used as an example of an approach known as ‘critical phenomenology’ understood as a form of politically engaged practice capable of reflecting the concrete conditions of existence. Fanon’s significance within this context is heightened, given his credentials as a psychiatrist and his method of the lived experience as the route to learning about difference. Living through the era of French colonialism, he examined the devastating impact of colonialism and its concomitant effects on the self, on himself, as the colonised but also as the psychiatrist, and had a greater understanding of and empathy with his patients because of their shared experiences. Through powerful phenomenological description, he described his own feelings of being othered and displaced, and how this precarious sense of selfhood had lasting effects on his sense of identity.

Interviewee: My name is Neta Chada. I am a consultant psychiatrist. I have worked as a psychiatrist for thirty years. I’ve recently retired from the NHS and I now do some medico-legal work, which is mostly defence work. I do some work for hospital trusts and other public bodies and organisations who for whatever reason are involved in proceedings. So, I suppose that’s what I primarily do at present.

Interviewee: My name is Dr Iqbal Mohiuddin. I work as a consultant psychiatrist, mainly in private practice, and part-time NHS. I’ve been a psychiatrist since 2000, and I’ve been working and training locally in Bedfordshire and Luton. I’ve been working as a consultant since 2008 and increased my private practice over the years. I still work in the NHS for the local crisis team. I’ve got special interests in psychotherapy, addictions and Adult ADHD. I’m pretty busy at the moment, especially in the past year it’s got really, really hectic.

Interviewee: I am Dr Vidya Giri Shankar. I am currently a higher speciality trainee (a specialist registrar) at the Maudsley Hospital in South London. I am currently training in a dual specialism of old age psychiatry and general adult psychiatry. I am almost halfway through my training. So, I will finish in a couple of years to become a consultant.