Epistemic Injustice in Indian Mental Healthcare Across Generations

Indian mental health care is marked by an astonishing diversity, ranging from state-sanctioned therapy sessions to mobile phone applications and traditional modalities like temple rituals, spiritual healers, and family customs. As urban Gen Z populations increasingly engage with psychotherapy, spiritual models based on assumptions of karma, nazar ("evil eye"), or spirit possession remain influential on models of distress. These plural systems are in competition with one another, especially within clinical environments where biomedical models hold sway, creating epistemic injustice.

Fricker (2007) imagines epistemic injustice as unfair treatment of individuals as knowers. In medicine, it manifests in testimonial injustice (when the patient's testimony is questioned due to prejudice) and hermeneutical injustice (when people do not have the authorized language or map to express their suffering). In India, patients quite often present symptoms in religious or idiomatic terms, which are quite often pathologized or ignored by doctors. Halliburton's (2005) ethnography of South India shows how patients shift between psychiatrists and religious healers with ease, not due to ignorance but in a reflective pursuit of care that is sensitive to their lived lives. Clinical practices are seldom responsive to such mixed-up modes of explanation.

While it is common for patients in India to make sense of their symptoms in religious terms, and seek help from religious healers and clinicians alike, clinical practice can be unresponsive to the blending of these explanations.

This trend is carried over to the virtual realm. Sehgal et al. (2025) discovered Indian teenagers who used mental health chatbots preferred products that were culturally appropriate, anonymous, and personally tailored. Authors note computerized treatments, although promising, risk maintaining clinical hierarchies unless they keep in mind sociocultural backgrounds.

Gen Z is in an interesting position—most are receptive to therapy but still ensconced in families that adhere to traditional systems of faith. Between therapists and temples, they generally experience anxiety when mental health providers dismiss their models as unreasonable or unscientific, which undermines confidence and continues epistemic hierarchies.

While this discussion is being situated in India, the same dynamics occur everywhere. Minority and migrant communities in the UK and elsewhere have also reported exclusion when their belief systems are not compatible with Western clinical definitions. The Indian context thus provides a window with which to interrogate bigger questions: Whose knowledge is considered legitimate in mental health treatment? Who gets to say what's real or treatable suffering? 

Both Gen Z Indians and members of migrant communities might similarly feel adrift in a Western medical system that isn't compatible with their beliefs.

To resist epistemic injustice requires more than cultural sensitivity; it requires epistemic humility. Clinicians are required to work with, not supplant, patients' own explanatory models—religious, family, local. True healing is only available by acknowledging, not erasing, these multiple forms of knowing. 

Gen Z, standing at the crossroads of tradition and worldwide conversation about mental health, can possibly spearhead this transformation—given that their diverse experience is taken seriously. Listening to them is crucial towards the creation of an expansive and equitable system of mental healthcare.

Parinika Arora is based in New Delhi, India, and is a postgraduate student pursuing an MSc in Mental Health at the University of Birmingham, UK. With an undergraduate degree in Psychology from India, she has contributed to 7–8 academic book chapters exploring the intersections of psychology, AI, and mental health. She loves writing and sharing insights on mental health and psychology to reach a wider audience. Parinika also runs an Instagram page called PsyPrism focused on mental health awareness. Alongside her academic work, she serves as a director at Minus One Experiences Private Limited, an event management company based in India.