Madness and Subjectivity

A Cross-Cultural Examination of Psychosis in the West and India

Ayurdhi Dhar

• Publisher: Routledge
• Year: 2019
• Print ISBN:
  9780367195694
• eBook ISBN:
  9780429515248
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

This crucial new work draws on empirical findings from rural North India in relation to madness and subjectivity, revealing the different structures of subjectivity underlying the narratives of schizophrenia, spirits, ghosts, and deities.

Unravelling the loose ends of madness, the author explores the cultural differences in understanding and experiencing madness to examine how modern insanity is treated as a clinical disorder, but historically it represents how we form knowledge and understand self-knowledge. The author begins by theoretically investigating how the schizophrenic personifies the fractures in modern Western thought to explain why, despite decades of intense contention, the category of schizophrenia is still alive. She then examines the narratives of people in the Himalayan Mountains of rural India to reveal the discursive conditions that animate their stories around what psychology calls psychosis, critiquing the monoculturalism in trauma theory and challenging the ongoing march of the Global Mental Health Movement in the Global South.

Examining what a study of madness reveals about two different cultures, and their ways of thinking and being, this is fascinating reading for students interested in mental health, critical psychology, and Indian culture.

1

INTRODUCTION

A 2001 article in a leading Indian newspaper The Hindu reported that India’s Union Ministry has decided to map out the various faith-healing sites while also initiating a 155-crore mental health project (“Faith healing centers”, 2001). Two days later, in a separate piece eerily reminiscent of Pinel’s legendary “unchaining of the mad”, The Hindu ran another article about the release and unchaining of 22 mentally ill patients in South India, complete with a photograph of a frail old woman being unchained by a man (“Patients freed”, 2001). The officials involved condemned the mistreatment of the inmates while the reporter wondered with some urgency about how “ironically, the accompanying relatives did not allow the chains to be removed even in the hospital as they believed that the shackle was sacred and healing” (“Patients freed”, 2001). The article further reported on the closure of 16 local sites, the now-required licensure of existing asylums, and the welcome introduction of other mental health programs. The stories of horrors at these faith-healing sites along with the bizarrely cruel behavior of accompanying relatives are a popular rhetoric for the educated, elite, upper-caste modern India that prides itself on its pro-science, pro-progress leanings. Experts insist that the irrational must be stamped out of our psyche and the superstitious explained away.

In 2010, National Public Radio (USA-based) ran an article with the headline “India’s Mentally Ill Turn to Faith, Not Medicine”. In classic NPR style, brimming with appropriate political correctness, the article never censures the East on their non-rational ways but instead presents a seemingly unbiased view of the dearth of mental health access – “only 1 psychiatrist for every 400,000 people” (Kennedy, 2010). The description of Dama Laxmi, “a tough, wiry woman in her 60s who talks nonstop, even as she slurps her plastic cup of chai while squatting on her haunches” (Kennedy, 2010), whose husband abandoned her and who is there to cure her daughter of spirit possession, delivers the perfect candidate ripe for mental health intervention – a wronged but strong woman seeking help for her child. The “women in trance” tableau is positioned against that of a well-meaning social worker who “spends hours trying to cajole the mentally ill to visit a nearby psychiatric clinic” where Dama Laxmi’s daughter promptly gets diagnosed as schizophrenic. The article quotes Oxford professor of psychiatry Chris Fairburn whose journey through rural hospitals along bumpy roads leads him to profess that to increase access to these countries with limited resources, the Western experts don’t have to approve or condone what we do, only acknowledge our existence. How kind.

Expecting any of these authors, reporters, or social workers to question the implicit assumptions behind concepts like “mental health” or “mental illness” would be foolish. They briefly allude to the subjective experience of the family and the individual; they marvel at their lack of chagrin at these terrible conditions and their strange complicity in these inhumane ways. The only thorn in their narrative of benevolence is that these assertions of abuse do not necessarily resonate with the population they deem as limited and wanting. Moreover, as we will later observe, the universalized understandings of mental illness and the validity of diagnoses like schizophrenia, are themselves under harsh scrutiny in the West. In my interviews with people who had experienced hearing voices in rural North India, the subjective experience of such phenomena was vastly heterogeneous – from fear and concern to celebration and boredom. One person noted how in response to hallucinations of a wedding procession (baraat), her mother would join the festivities and dance along. How are we to resolve the absence of their horror with the presence of our terror?

Psychology made its way into the Indian culture and psyche by throwing down its colonial roots deeply and silently. While there is psychological literature that explores faith-healing sites, spontaneous psychosis/possession, and indigenous cures, their aggressive theoretical orientations usually distort descriptive narratives. Psychology has long bullied the language of the other – deity attacks become spontaneous psychosis and wandering spirits are just conversion symptoms. There is a perverse contortion of the descriptive to the interpretive, of the material to the mental, and of the appearance to the meaningful. There lacks a framework that neither reduces these experiences to interpretation, nor to superstition. This book responds to these fissures in knowledge and more, and it achieves this through a cross-cultural examination of the structure of subjectivity as revealed by a culture’s narratives and experiences concerning madness.

An interrogation of madness

The madman is proficient in laying bare the strangeness of the other; he reveals this other in all its absurdity – impossible to ignore, unbearable to contain. Madness has been romanticized through its associations with wisdom, creativity, and passions; madness has been demonized when positioned along irrationality, violence, and weakness. How can a single entity come to be associated with such drastically diverse experiences? We can tentatively guess that maybe madness exposes something essential about us, not some grand truth about the universe or hidden realities of the self; not even some profound intelligence that discerns what others cannot. Rather, madness can be compared to both weakness and strength, unreason and wisdom, deficiency and creativity, because even in its absurdity it is uniquely tethered to the structure of the subject. It thus permeates all great human experience – love, pain, violence, beauty, desire, suffering, rage. What is certain is that madness as a theme has occupied the minds of Sufi poets, English playwrights, priests, shamans, and doctors alike. It is as if this phenomenon that we repeatedly attempt to isolate in hospitals, temples, clinics, and couches, escapes each time, and shamelessly displays itself through our great sciences and sublime arts. This ubiquity of interest in insanity through the ages has been most famously charted by Michel Foucault (1967) who traces the trajectory of madness from a vice to a weakness, pointing to our desire to exclude and enclose it at the same time. He suggests that knowledge constituting madness might have changed in accordance with the epistemological matrices of different times, but its centrality in the modern world persists as strongly if not as openly as it always did; our interest in the mad changed in valence and quality, but its importance hasn’t faded.

At points in Western history, madmen were coupled with the poor, the criminal, and the “deficient” – the undesirables. They have been occasionally worshipped and strategically hunted. Despite this, the traditional documentation of historical shifts bursts with optimism pointing to progress. To survey this incongruence, any attempt to explore madness requires an acknowledgment of contributions by different discourses that have informed our comprehension, ranging from treatments that focused on moral control to a purely physiognomic understanding of insanity that reduced it to neural correlates. Thus, to understand our current conceptualizations, we have to place them in a historical context, which is a task I will undertake in the second chapter.

Amongst the numerous theories that literature points to, there are two significant iterations informing contemporary Western narrative around madness – a reductionist biological understanding that assumes there to be a neurotransmitter imbalance at the heart of the disorder which in turn is guided by preordained genetic structure, and a meaning-based model that relies heavily on trauma theory (Romme & Escher, 2012). Both of these models are profoundly guided by the Western historico-cultural context that assumes either significant life events or biology as the essential starting points of psychotic experiences. They thus ignore the effect of a socially constructed discourse of insanity on the meaning-making experience of an individual. What is left unexamined is whether the psychotic experience can hold its own ground without being pathologized to assuage the discomfort that it produces in the hearts of others. In short, most of our current understandings of psychosis require it to be a pathology (even if a meaningful one) and are equally value laden, and all phenomenological explorations to understand it begin with an assumption of distress, thus ensuring the need for a benevolent clinician. The clinician is neither benevolent nor very brilliant.

Why another book about madness?

To be able to legitimately interrogate the relation between madness and subjectivity, especially in an inter-cultural context, I must make clear my aims and rationale in order to render transparent my assumptions. The modus operandi of this book is to peel back at the raised edges of subjectivity, those raised edges being madness. While criticisms of modern madness (schizophrenia) are galore, few theorists analyze its resistance to extinction in a historical and epistemological framework. Most interest in schizophrenia is reserved to its position as a clinical entity waiting to be explained away by the flavor-of-the decade theory. Similarly, while there are writings that scrutinize academic imperialism and blind exports of knowledge, most remarkably the work of Bhargavi Davar, none look past socio-cultural variables and into the construction of subjectivity and the implicit styles of thinking that animate it.

The theoretical assertions and critical stances presented in this book will of course attract those who find mainstream psychology alienating, but they are also vital to our understanding in the West so that we may make strange the familiar, gain appreciation for the historicity of knowledge, and understand that “culturally sensitive psychology” is at times just as problematic, even if it sounds ethical enough. To truly contextualize knowledge without necessarily invalidating it, we must move past arguments restricted to the sociological, cultural, and personal, and begin to analyze the very constitution of the subject – the institutional and the discursive. These concerns are imminent and must be addressed before critique of the discipline feels like an afterthought and phrases like “cultural fair assessment” begin to sound practical.

Throughout these endeavors Michel Foucault’s writing will be a constant companion to provide framework, theoretical support, and methodological tools. My choice to lean on Foucault’s work is partly based on his exhaustive investigations of madness and Western subjectivity and in part because he skillfully collapses the artificial binaries of individual psyche and social influences in his nuanced presentation of epistemic shifts, the power/knowledge dynamic, and the interdependence of discourse and subjectivity. Despite his vast qualifications to speak on the subject of knowledge and madness, Foucault never really formulated a concrete theory of subjectivity. Thus, later in the project I will rely on Gilles Deleuze and Félix Guattari’s writings to help conceptualize a tentative account of how different subjects are structured in relation to the procedures of desire. To be clear, I will not simply import Deleuze and Guattari’s theoretical formulations, but instead use their work concerning forms and permutations of desire generated through non-nuclear family matrices to point at something possibly similar in our population. Further, I will build on Louis Sass’s (1994) assertions based on his phenomenological study of schizophrenia, and Foucault’s (1994) determinations about the defining epistemological features of the modern era to explore how schizophrenia is not only a modern product but also an odd and radical form of modern subjectivity which has been co-opted by the human sciences to be presented as a disease entity. It is important to note that while Sass has already contributed to this discussion, his unique focus is on a thorough analysis of modern literature and art; I, on the other hand, develop a dialogue about schizophrenia and modern forms knowledge, knowing, and self-knowing.

Throughout the book I will critically observe the discourse of the Global Mental Health Movement, trauma theory, and the bio-medical model. The diagnosis of schizophrenia which is increasingly being used by mental health examiners in India is under scrutiny across the world (Bentall, 1993). In light of this import of psycho-pharmacological treatment that has witnessed an astronomical rise in Indian cities but is concurrently under attack in Europe for its ineffectiveness and life-threatening side effects, these concerns are deeply relevant. Even psychoanalytic and humanistic traditions which delve into the content of psychosis eventually focus on the distress that it seems to necessitate, but cross-cultural studies show that this isn’t applicable to many across the world – definitions of distress are culture-centric and suffering is molded by the horizon of our social perception.

While critical theory and social constructionism have questioned the ahistorical and apolitical nature of mental illness in the West and brought to light its contextual conditionality, one has to be cautious with their application beyond a Euro-centric context. As Gayatri Spivak (1988) has brilliantly articulated in her canonical work “Can the Subaltern Speak?”, even radical theories of subjectivity (her critique is directed at post-structuralist French thinkers like Michel Foucault and Gilles Deleuze) create the colonized world as its Other – as Europe’s Other, and can never speak about the post-colonial subaltern subject without instead speaking for them. Spivak asserts that, irrespective of how revolutionary and radical an idea is, it is still in the service of bolstering the Western subject, or the West as a subject. More importantly, she declares that the most oppressed, the subaltern, have no voice and no place in revisionist history, and that there is a lack of a structure where this voice can emerge. Her warnings ring true, as I observe that, in psychological research across India, it is mostly the upper-caste, educated Hindu subject that is the object of most examination and theoretical formulations. This is unsurprising because, as is true for this book, the researcher himself/herself tends to be from a similar background; this makes it especially important to maintain a descriptive level of analysis.

As I unravel the relevance of Global Mental Health Movement, attempt to discover the implicit discourses behind the indigenous stories of spirits and psychosis, and unpack some of the structural conditions that inform ways of speaking – Spivak’s warnings caution me to not place my understanding where the other’s voice could be, which with my caste and class background are easy traps to fall in. At the same time, her writings also encourage me to exploit my position as a post-liberalization, post-colonial Indian subject, a woman, a researcher, a reluctant academic, and a Harry Potter fan to take up the “circumscribed task” that I must not “disown with a flourish” (p. 104).

The scope of the book

This book begins by observing the rise of modern madness “schizophrenia” in the West, the historical conditions that sustained it, the contentious nature of its conceptualizations, and its strange resilience in the face of constant criticism. I will firstly engage with Foucault’s analysis of the history of madness to reveal social conditions that made a certain type of knowledge possible. I will then move through a succinct history of schizophrenia where focus will be laid on conditions of possibilities that created and managed schizophrenia from its conception until now. As we observe the revolutions in language, classification, and science around the concept, it will be glaringly evident how schizophrenia is not only the most problematic diagnostic category in psychiatry, but also critical to maintaining the continued authority of the discipline (Woods, 2011). At the same time, one mustn’t assume that its weed-like persistence to survive in the face of consistent and harsh critique means that the historical forces supporting it were only deliberate and diabolical. Instead, the schizophrenic subject, as I would demonstrate, is an almost organic, if extreme, product of the modern episteme.

In Chapter 3 I will attempt to explain this resilience by positioning schizophrenia as an epistemic emergence, one that was imminent and that makes absurd the fractures within the modern turn in knowledge. In other words, this book will investigate schizophrenia, its emergence, possible decline, and dependence on modern Western epistemology. I will undertake a theoretical investigation of the discursive history of schizophrenia and its relation with these forms of knowledge to answer what, if any, is the relation between the tensions of modern epistemology and the schizophrenic subject?

I will then take a geographical leap to examine the dialogue around madness in rural North India, to observe if there is a relation between event trauma and psychotic symptoms, and eventually excavate the implicit discourses that inform these discussions. Through an examination of styles of thought that animate the narrative around madness, I will explore the corresponding subject positions and contributing institutions in rural North India. I chose Uttarakhand as the area of research because it is rural and remote enough to preserve the uncontaminated indigenous discourse around psychosis, and also because mountains in India are popular for their stories of the anomalous and the exceptional. It did not hurt that the breathtaking beauty of the Himalayan range made data collection feel like a vacation.

The mainstream understanding of psychosis has a narrow focus on finding its causes and correlates with neurological dysfunction, sometimes causing a psychiatric dehumanization of the psychotic. But my attempt is to take the psychotic episode on its own terms – not as a symptom, not as a metaphor. An examination of the local forms of meaning construction brings forth cultural discourses and traces how they influence the experience, course, and content of psychosis. How does this understanding effect the treatment, prognosis, or the lack of it? How does this way of thinking inform people’s subjective experiences of distress? Using Foucauldian archaeological analysis on these narratives of madness I answer the question: What conditions – discursive, cultural, epistemological, social, or hermeneutic – make the rural Indian subject possible?

This empirical analysis allows me to thoroughly inspect the peculiarities of the rural Indian “psychotic” subject, what conditions make him possible, and how they preclude his downfall into full-blown schizophrenia. I will partially carry out this deconstruction through an exploration of the Indian female subject as I reveal her split position built through incongruous social and familial messages – how does she not sacrifice her sanity while decoding this communicative discordance as Gregory Bateson’s double-bind would predict? Overall, towards the end, this book will respond to the question: What does the discourse around madness in India reveal about the structure of the subject and how are these two co-constituted? Chapter 5 then aims to bring together these conceptualizations around madness to inform a tentative theory of subjectivity, that is, if and how the modern Western and post-colonial rural Indian subject vary in their structures, and the implications this difference has for an unthinking import of Global Mental Health Movement. The works of Sigmund Freud, Jacques Lacan, Gilles Deleuze, and Félix Guattari will help to theorize about the structure of the subject of Western thought, the arrival of the unthought, the cut of the symbolic, and the different trajectories of desire.

The theoretical and empirical investigation provides us with sufficient evidence to subvert ideas suggesting inherent distress in psychotic experiences, and we can then begin to question the aims and efficacy of the Global Mental Health Movement. One of the central aims of this book i...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• Preface
• 1. Introduction
• 2. Inside schizophrenia: a house of mirrors
• 3. The “unalienated” alien: the schizophrenic as a hyper-modern subject
• 4. Deities and desire: an analysis
• 5. The slip and the sane: an analysis of subjectivity
• 6. Case and point: the girl-child’s story
• 7. No country for psychology
• References
• Index