Grieving Severe Mental Illnesses in India: A Qualitative Study Combining Phenomenology and Critical Ethnography

Introduction: A prevalent understanding of grief in mental illness assumes meaning-reconstruction ability within the person. The mental healthcare system in India uses the psychopathology of severe mental illnesses to question people’s meaning-making abilities and justify its apathy, indifference, and disregard towards them. Grieving can be an alternative lens to biomedical apathy that can help in resituating SMI experiences within the lived, negotiated, and constructed realities of people.

Goals and Methods: This study utilized a constructivist-interpretive paradigm to explore the phenomenon of grieving in SMI. A combination of phenomenology and critical ethnography was utilized to get closer to people’s experiences and the social situatedness of grieving in SMI. Semi-structured interviews with 40 people accessing treatment/care at five different mental healthcare setups in India were analyzed using the Vancouver School of doing Phenomenology. Field observations, organizational documents, and prolonged fieldwork informed the socio-cultural insights about grieving in SMI.

Results: The findings revealed grieving to be a contextually situated meaning-making process that requires recognition of losses, reconstruction of a meaningful world, and reorientation towards a life beyond the losses due to SMI. Patriarchal norms render people’s grieving correct or incorrect based on how it aligned with social expectations and gender norms around grief. Furthermore, people’s position in the socioeconomic hierarchy and their economic resources shape how they grieved and recreated meaning in their lives.

Conclusions: Grieving in SMI emerges as an active, meaning-making, person-focused process which recognizes people living with SMI as meaning-making individuals. The findings of this study call for creating contextually relevant and intersectionality-informed mental health practices and policies.