Eating Drugs: Psychopharmaceutical Pluralism in India

by Stefan Ecks

New York University Press, 2013. 233 pp.

 

In Stefan Ecks’ poignant ethnography, he illuminates the relationship between digestive health and mental health in Calcutta, paying particular attention to the contributions this relationship has made to a pharmaceuticalized India. He traces three medical systems––Ayurvedic, homeopathic and allopathic––as they each locate the belly as the somatic center in Bengali society.  In doing so, Ecks offers reflections on the role psychopharmaceuticals play in daily life in Calcutta, including the resistance from patients these drugs evoke, the doubt they instill in non-allopathic practitioners, and the way they are framed by psychiatrists as familiar, essential, and nutritious.

Eating Drugs opens by establishing the ethnographic context. In India, and Calcutta in particular, psychopharmaceuticals have been signified metaphorically as “moner khabar” which translates from Bengali into “food (khabar) eaten by the mind (mon)” (2). Ecks argues that this semiotic association eases the ideological discomfort of consuming synthetic substances by bringing psychiatric medications into the fold of the everyday, namely in relationship to food. Thus, likening psychopharmaceuticals to something as familiar as food serves to naturalize medications in the minds of patients and helps practitioners build rapport on the grounds of common experience. Psychopharmaceuticals as “mind food” bind sentiment toward food with the activities of bio-psychiatry and drug consumption through a mimetic relationship.  Not surprising, Ecks argues that such an association raises some concern; not only does the rhetorical strategy naturalize “drugs” as efficient and potent treatment but the association of food and psychopharmaceuticals also lends undue stability to the medical encounter (9).

Through close fieldwork, Ecks shows how psychopharmaceuticals work within the logic of Ayurvedic and homeopathic traditions to create meaningful plurality within Indian society, especially in the treatment of psychiatric conditions.  To demonstrate the scope of this plurality, Ecks is principally considered with language––and with metaphor in particular­­––as a way of illuminating the “popular perceptions of mind, body, and different medications” that Bengalis hold (18).  Ecks maps a semiotic network that travels between traditional Indian practitioners and their respective medicines and psychopharmaceuticals. While these practitioners may not encourage their patients to generally seek treatment in allopathic settings, “almost everything they say lends support to a biopolitical regime that sees mental illnesses in urgent need of medication” (195), resulting in three formerly separate systems of beliefs convening around the use of pharmaceuticals.

Ecks’ discussion begins with the idea of the belly as a place of cooking, refinement and gestation, where the body processes food and nutrients. Because humoral balance is one of the keys to good health for many Bengalis, keeping one’s center of digestion perfectly balanced is crucial––and if this balance isn’t maintained, it can disrupt the mind as well. Ecks illustrates the analytical tension between the belly and the mind, suggesting, “where the belly constantly threatens a person’s self-control, the mon is the part of the body that can bring self-control,” thus instantiating a form of integration, however antagonistic, between the two.  Ecks is primarily concerned with mon kharap (bad mind) (28), and for his interlocutors, a preoccupied mind hinders digestion, placing one’s whole state of health at risk. Just as digestion is often the center of medical discourse in India, the mind is also a concern in daily life, as it “feels” or “thinks” and works to express the self while maintaining health and control (26). Just as the right amount of heat keeps the belly functioning optimally, or “cooking” properly, the humoral temperature of the mind is also essential for good health.

Ecks delves deep into Ayurveda and homeopathy, revealing the ways in which India’s most prevalent forms of medicine have (perhaps inadvertently) influenced the spread of allopathic medicine, and pharmaceutically dominated forms of allopathic or bio- medicine in particular.  Ecks argues––again with thoughtful attention to language––that biomedicine has increasingly undermined Ayurveda through a discourse of modernity: “Ayurvedic drugs would work in a pure and simple body, but in the modern, complicated, polluted body, they are weak” (82). The relationship between digestion and health in the Ayurvedic tradition––namely good digestion as the seat of good health, putting “responsibility for health into the hands of the individual” (74)––has been overwritten by the prescriptive nourishment provided by “mind food.”

Homeopathy also plays a significant role in the pharmaceutical transformation Ecks describes.  Although there are more Ayurvedic than homeopathic practitioners in India, homeopathy is by far more prevalent in West Bengal (108). Despite this fact, homeopathy has received relatively little attention in the anthropological literature, something Ecks attributes to the difficulty of analyzing it using categories such as “traditional/modern” or “Indian/Western” (110). Without the seduction of such dichotomies, the appeal of making homeopathy an object of study fades. However Ecks manages to parse out the significant differences between homeopathic and allopathic traditions without applying any sense of absolute divergence. His homeopathic practitioner participants tell him that their form of therapy differs fundamentally from allopathy insomuch as its approach to healing is subtle, long-term and carries with it the precept that “likes cures like” (116). Homoeopathic remedies are said to take effect in the mind and as homeopaths “emphasize the vital force as a spiritual power that directs the material body”, they have the potential to “advance the plausibility of mind medications” (194). Discursively contrasting the defense metaphors of allopathy (“magic bullets,” fighting foreign entities like cancers and germs) with the understated claims of homeopathy might lead one to conclude that the latter is weaker in the globalized Indian health care market.  However its practitioners argue otherwise, suggesting that homeopathy espouses an “ideology of enlightened rationalism” (110) and depicting it as a “hypermodern medicine” (110). Here is where Ecks presents homeopathic practitioners as indirect advocates of psychopharmaceuticals, through their efforts to promote a modern form of medicine.

Despite the evidence of thriving Ayurvedic and homeopathic industries that connect mental health with digestive health, Ecks found that allopathic psychiatry has established a prominent place in Indian mental health care. Dr. Roy, one of Ecks’ psychiatrist participants, expressed a desire to see psychopharmaceuticals help India’s citizens contribute to the dual project of nation-building and self-building, reaching an optimal mode of functioning through chemical enhancement (153). Through awareness campaigns and discursive paralleling of drugs with daily nutrition, Dr. Roy and other psychiatrist participants advocate for a “psychiatric enlightenment” (156). And yet these psychiatrists see the Bengali gut obsession as a possible impediment to this enlightenment, as they “interpret(ed) most—or even all—illness symptoms as caused by disturbed digestion” (157). Again we see the conflict of biomedicine as modernity with the Ayurvedic humoral tradition, which in turn becomes the archetype of how those who seek Ayurvedic treatment lack rationality (157). By linking these prevailing forms of medical practice and the attitudes held by the respective practitioners, Ecks is able to demonstrate the circulating discourses on health, digestion, and mental illness in Bengali society.  Ecks argues that bio-psychiatry “blurs the boundaries between medical ‘things’ and one’s authentic ‘self’, yet they are marketed as one more consumer commodity” (187). The potentially destructive force of psychopharmaceuticals justifies what Ecks calls a “globalized anxiety about drugs” (187). In his close analysis, Ecks attends to the mechanisms and metaphors through which psychopharmaceuticals influence self-concepts, and demonstrates a broader extension of modernity into the lives of Bengalis. Whether this modernity is a cause for the use of psychopharmaceuticals or a product of the economic motives of the industry remains an open question. What is clear is that mental health in Bengali society is the site of conflicted therapeutic philosophies that all draw on the importance of digestion and, perhaps unintentionally, contribute to a new psychopharmaceutical era in India.

 

Erica Rockhold is a Masters student in Anthropology at Northern Arizona University where her interests lie in emotion, language and medicine.