When migrant families from India arrive in UK mental health services, a profound disconnect often occurs. A British psychiatrist trained in biomedical models sits across from a patient whose understanding of mental distress involves karma, past lives, spirit possession, energy imbalances, or divine intervention. The clinician sees symptoms requiring medication. The patient sees a spiritual crisis requiring ritual, prayer, or traditional healing. Both leave frustrated, the patient feeling misunderstood and the clinician feeling ineffective. This cultural collision, repeated thousands of times across multicultural societies, was what drew British medical anthropologist Natalie Tobert to undertake the research that became "Spiritual Psychiatries."

Tobert spent years conducting fieldwork across India, from Pondicherry to Calcutta, interviewing forty people: psychiatrists, Hindu priests, Muslim clerics, Christian clergy, traditional healers, clairvoyants, patients, and family members. She wanted to understand how mental distress is actually understood and treated in India, where spiritual and medical approaches coexist rather than compete. What she discovered challenges fundamental assumptions underlying Western psychiatry. In India, practitioners don't see contradiction in combining psychiatric medication with temple rituals, astrological consultations, or visits to holy men. Suffering gets addressed through multiple frameworks simultaneously because no single model captures the complexity of human experience. The book argues that Western mental health services, particularly in multicultural societies like the UK, desperately need this kind of conceptual flexibility if they're going to serve diverse populations effectively.

One of Tobert's key findings is that India operates with what medical anthropologists call "medical pluralism" - the simultaneous use of multiple healing systems without seeing them as mutually exclusive. A person experiencing distressing voices might see a psychiatrist for medication, visit a temple for puja (ritual worship), consult an astrologer about planetary influences, and seek blessing from a holy man, all within the same week. Each practitioner offers a different explanatory model for what's happening and different interventions to address it. The psychiatrist might diagnose schizophrenia and prescribe antipsychotics. The priest might identify ancestral spirits requiring appeasement. The astrologer might point to Saturn's malefic influence. The holy man might see spiritual awakening requiring guidance.

What's crucial is that these aren't competing diagnoses where only one can be correct. They're complementary frameworks addressing different dimensions of a complex experience. The psychiatric model addresses brain chemistry and symptoms. The spiritual model addresses meaning, purpose, and relationship to the transcendent. The astrological model situates the individual within cosmic patterns. The ritual model engages community and tradition. A person might find all of these helpful in different ways. Tobert profiles Dr. Basu, a Calcutta psychiatrist thoroughly trained in Western medicine who routinely works alongside mystics and religious practitioners. His pragmatic approach recognizes that effective treatment means meeting people within their own explanatory frameworks rather than imposing a single biomedical narrative.

A central tension the book explores is how to distinguish spiritual experiences from psychiatric symptoms when they can look phenomenologically similar. Someone reporting visions of deities, hearing divine voices, or experiencing mystical states of consciousness might be having a genuine spiritual awakening, might be experiencing psychosis, or might be navigating something that doesn't fit neatly into either category. In India, Tobert found sophisticated cultural mechanisms for making these distinctions. Communities have long experience with spiritual emergence and can often recognize when someone is undergoing a legitimate spiritual process versus when they need medical intervention.

The criteria aren't always what Western psychiatry would use. Indian practitioners might assess whether the person maintains basic functioning, whether the experiences align with recognized spiritual traditions, whether a qualified guru or spiritual teacher validates the experiences, whether the person can integrate them into daily life, and whether the process moves toward greater wellbeing or deeper dysfunction. Someone might be having intense mystical experiences that would get diagnosed as psychosis in a Western setting, but if they're under guidance of a legitimate spiritual teacher, maintaining their responsibilities, and the experiences align with recognized stages of spiritual development described in yogic or tantric texts, the response is support rather than medication. Conversely, someone claiming spiritual experiences but becoming increasingly dysfunctional, isolated, grandiose, or dangerous might be recognized as needing psychiatric help even if they frame everything in spiritual language.

Tobert makes an implicit but powerful argument about the colonial dimensions of Western psychiatry's global dominance. When British mental health services dismiss Indian patients' spiritual frameworks as "superstition" or "cultural beliefs" that need to be overcome for proper treatment, they're reenacting colonial dynamics where Western knowledge is treated as universally valid and indigenous knowledge as primitive. This isn't just politically problematic; it's clinically ineffective. Patients whose experiences are systematically invalidated tend to disengage from services, leading to worse outcomes.

The book documents how colonial-era psychiatry explicitly pathologized non-Western spirituality. Religious experiences common in Hindu and Muslim traditions were reframed as symptoms of mental illness. Traditional healers were marginalized as quacks. Entire cultural frameworks for understanding consciousness, suffering, and healing were dismissed. This history hasn't been adequately reckoned with, and its legacy continues in how contemporary mental health services approach spiritual and cultural difference. Tobert argues for what she calls "cultural humility" - recognition that Western biomedical psychiatry is one framework among many, valuable but not uniquely true. Effective cross-cultural care requires practitioners to learn about patients' explanatory models rather than imposing their own, to recognize that spiritual experiences might be meaningful rather than pathological, and to support integration of multiple treatment approaches when that's what patients find helpful.

The book isn't just anthropological description; it's a practical blueprint for improving mental health care in multicultural societies. Tobert provides specific recommendations for UK mental health services serving diverse populations. First, training programs need to educate clinicians about different cultural and spiritual frameworks for understanding mental distress. A psychiatrist doesn't need to believe in spirit possession or karma to understand that these frameworks are meaningful to patients and shape how they experience and respond to treatment. Second, services should develop partnerships with community religious leaders and traditional healers rather than treating them as competitors. A coordinated approach might involve psychiatric medication for acute symptoms alongside spiritual counseling that helps the person make sense of their experience within their own worldview.

Third, assessment processes need to include questions about spiritual and religious beliefs and practices, not as risk factors but as potential resources for healing. Many patients find their faith communities, prayer practices, or spiritual frameworks profoundly stabilizing, yet clinicians often ignore or pathologize these resources. Fourth, services should employ cultural consultants or liaisons who can help bridge understanding between Western-trained clinicians and patients from diverse backgrounds. The book emphasizes that this isn't about abandoning evidence-based treatment but about recognizing that evidence itself is culturally situated. What counts as improvement, what treatment goals make sense, how success is measured - all of these depend on cultural and spiritual frameworks that Western psychiatry typically treats as irrelevant.

Ultimately, "Spiritual Psychiatries" calls for intellectual humility in how we approach mental health. The Western biomedical model has generated valuable knowledge about brain function, psychopharmacology, and evidence-based treatments. But it doesn't have a monopoly on understanding human suffering or promoting wellbeing. India's pluralistic approach, where multiple healing systems coexist and practitioners pragmatically combine whatever helps patients, offers an alternative to psychiatry's often rigid insistence on a single correct framework. This matters especially in increasingly diverse societies where mental health services serve people from hundreds of cultural and spiritual traditions.

Tobert's work has influenced medical education in the UK, where she now facilitates workshops for medical students and clinicians on cultural perspectives in mental health. The book serves both as ethnographic documentation of Indian mental health practices and as a call to action for Western services. It belongs on the shelf of anyone working in cross-cultural mental health, anyone interested in medical anthropology, and anyone who suspects that the reductionist biological psychiatry dominant in the West might be missing something essential about human experience. At a time when mental health crises are global and migration creates ever more diverse patient populations, the book's central message becomes more urgent: effective care requires meeting people within their own frameworks for understanding suffering, not forcing them to adopt ours.