Response

Hussain and Kar’s argument for a bio-psycho-socio-anthropological (BPSA) shift in psychiatry represents an important corrective step toward redressing the ‘biomedical dominance’ that so often narrows psychiatric care to biological determinism.^{Reference Hussain and Kar1} Although the authors compellingly advocate for mainstreaming anthropological tools, translating this model to the Global South – particularly in the Indian context – demands closer engagement with on-the-ground realities shaped by pluralistic healing systems, intersectional vulnerabilities and entrenched power imbalances, alongside the structural challenges that contribute to clinical misidentification.

To truly ‘operationalise anthropology at the point of care’, psychiatry must look beyond the clinic to the spiritual spaces where many patients and their families first seek meaning, relief and sanctuary. Established tools, such as Kleinman’s Explanatory Model interview and the DSM-5 Cultural Formulation Interview – especially the latter’s supplementary module on religious and spiritual orientations – offer practical ways to bridge biomedical and traditional healing systems.^{Reference Kleinman, Eisenberg and Good2,3} In India, distress is often interpreted through diverse cultural idioms, including spirit possession, the ‘evil eye’, ‘black magic’ or Jinn-related beliefs.^{Reference Uvais4} These are not merely ‘explanatory models’ to be documented: they are lived realities that shape pathways and hierarchies of help-seeking. A robust BPSA framework must therefore enable a ‘hospitable’ dialogue between statutory services and traditional healing systems – one that recognises faith healers as legitimate, relational and culturally embedded providers of care – in order to prevent erosion of trust and subsequent disengagement. As demonstrated in contexts where faith healers play pivotal roles in community safety – such as suicide prevention – incorporating these practitioners is essential for ethical engagement. To do otherwise is to engage in epistemic exclusion, where the psychiatric clinic functions as a gatekeeper that erases indigenous meanings in favour of biomedical hegemony.

Furthermore, integrating Frantz Fanon’s sociogenic approach is essential to the analysis of ‘structural power’ that the authors invite.^{Reference Fanon5} This can be clinically operationalised through the power–threat–meaning framework, which explores how systemic power and environmental threats shape a person’s distress and survival strategies.^{Reference Hussain and Kar1} Neglecting the intersectional layers of caste, religion and socioeconomic marginalisation risks invoking the Martha Mitchell Effect, wherein a patient’s accurate perceptions of systemic persecution may be misidentified as delusional due to a clinician’s limited ‘ethnographic sensibility’.^{Reference Seervi and Sharma6} This dynamic illustrates the weaponisation of diagnosis: a practice of structural violence where the clinician’s diagnostic power is used to pathologise legitimate social dissent and resistance. This critique is sharpened by ‘queering geopsychiatry’, a methodological intervention that resists fixed categories and normative assumptions to examine how psychiatric categorisation itself can be misused to erase cultural specificities.^{Reference Kar7} When such ‘geopsychiatric forces’ shaping a patient’s reality are overlooked, legitimate responses to structural oppression risk being pathologised, resistance misread as individual psychopathology and psychiatric categorisation itself may inadvertently function as an instrument of cultural erasure and social control.

This ethical tension is well captured by Jacques Derrida’s concept of hostipitality,^{Reference Uvais and Rahman8} which in clinical practice is navigated through therapeutic jurisprudence and the principle of least restrictive practice. These frameworks allow the clinician to balance their role as a ‘collaborative sense-maker’ with their statutory power, ensuring that legal detention remains a last resort that respects the therapeutic alliance. In India, although on paper the Mental Healthcare Act 2017 foregrounds individual rights, the absence of operational pathways often renders these protections illusory in practice.^{Reference Uvais9} Consequently, ethical care must be anchored in an appreciation of relational autonomy.^{Reference Uvais9} Since autonomy in non-Western contexts is negotiated within familial and communal frameworks, a ‘power-aware’ practice must engage these relational bonds as the primary site of clinical ethics while safeguarding individuals from coercion.

By uniting Frantz Fanon’s structural analysis with a Jacques Derridaian openness to the ‘spiritual wound’, psychiatry can move towards a practice that is not only culturally competent but ethically profound – one that attends to the lived suffering, meanings and relationships patients bring into the clinical encounter. The BPSA model should not merely ‘extend and contextualise’ biomedical science: it must re-centre the psychiatric encounter as a site of radical hospitality.