Paper short abstract:

This paper probes the contested realms of mind sciences from perspectives of social justice and human empowerment. Drawing insights from medical history-sociology-anthropology, the paper analyzes mental health concerns against the conspectus of south Asia. Analyzing different psychological tenets, legislation and practices, the paper argues for capability concerns in achieving good mental health.

Paper long abstract:

The modern disciplines of psychiatry, psychology and mental health emerged and consolidated throughout the nineteenth and twentieth centuries across the globe. Not only that the disciplines of psych-sciences share some common history with colonialism, they often served the interests (ideological as well as material) of the modern empires of the Western powers. Psychiatry is often regarded as a tool of the empire in justifying the discriminatory practices of the colonizers in countries of Africa, Asia and Latin America. Yet, from a transnational perspective, global emergence and professionalization of the psych-disciplines across the clinics and universities in the modern era is a phenomenon that does not need to be located solely in the empire-colony binary. This paper probes the conceptual as well as practical implications of the disciplinary developments of mind sciences and mental health provisions, practices and policies, on shaping the social choice of its subjects. Following a critical note on the epistemic challenges in the emergence of the concept of modern psyche in south Asia, this paper argues that there remains a yet uncharted vast domain of possibilities and challenges in the un-making of the psych-disciplines, a task that is urgently needed to relocate its subject populations, who until now are being lost in the epidemiologies, nosologies and phenomenologies of modern biostatistic sciences. The work also questions the psychiatrization of the world and commodification of mental health in recent decades with the emergence of the notion of Global Mental Health (GMH) championed by the World Health Organization (WHO), which is also sponsored by the World Bank and has been so readily embraced by the Indian government backed by its experts (specialists and bureaucrats).

This work aims to probe the scope of change that is needed to squarely ground the mentally ill persons in their strives towards freedom: ‘In terms of the medieval distinction between "the patient" and "the agent," this freedom-centered understanding of economics and of the process of development is very much an agent-oriented view. With adequate social opportunities, individuals can effectively shape their own destiny and help each other. They need not be seen primarily as passive recipients of the benefits of cunning development programs. There is indeed a strong rationale for recognizing the positive role of free and sustainable agency and even of constructive impatience’, argues Amartya Sen. The issue of agency and autonomy are much more contentious for those mentally ill, who just like the children are often considered incapable or less capable to voice their ‘true’ needs and concerns, another trope that this paper seeks to refute. This paper thus probes the two dependent areas of the mental health disciplines, viz., (a) the conceptual categories, approaches and making of such disciplines, and (b) the practices and policies drawn upon such disciplines, directly impacting the quality of living and social choices of the related subjects.

This work engages critically with the conceptual categories, justifications, doctrines and arguments of present day psych-disciplines in action in south Asia, tracing their development at one end in the postcolonial quest for disciplinary recognition and professionalism, and on the other end, in their contested (and at times tacit) relationships with the universalizing and homogenizing bio-medical categories of the scientifically advanced modern West. Of special attention to this work is the scrutiny of the Indian Mental Healthcare Act of 2017. It seeks to contextualize the act (and its previous acts, drafts and provisions) against the background of wider neo-liberal policy reforms and consumerist developments in healthcare in recent decades, as well as against the chequered history of mental healthcare in the subcontinent. It seeks to probe whether the new act as well as the National Mental Health Policy of 2014 (with much advocacy, advertisements and tumults by their protagonist mental health professionals and survivor led NGOs), have actually helped the patients, and/or what did they aim to achieve in principle? Cursory readings of the policy as well as the act appear to suggest that these might have aimed to sub-serve the emerging needs of the professional communities, complaisant to the neo-liberal market economy. The work seeks to disentangle professionals’ interests from policy matters, as well as to privilege patients’ voices as means of increasing democratic choices and freedom-centric measures, and thus increasing their capabilities.

Mental health seems to be a major concern in India, not only because major depressive disorder is the leading cause of years lived with disability, and anxiety the ninth leading cause, but more importantly, in mental health major socio-economic realities of the day seem to have had been transformed. It has been observed that many of the recent priorities of mental healthcare are shaped by prevailing neo-liberal market values and structures naturalised as unassailable realities of rampant consumerism. Modern psychiatric tenets regarding normalcy and disease, with increasing pathologization of social constraints and medicalization of everyday experiences, could be argued to have echoed market expectations and norms regarding productivity and functionality, equating happiness with success in the competitive marketplace. To add to this epistemic biases, increasing professionalization and consolidation of modern psych-disciplines over the past few decades have only distanced itself from those with mental afflictions, albeit at the same time securing prestige within the medical fraternities and scientific communities. With respect to institutional psychiatry, even today, corruptly co-opting the process of psychiatric admissions within families and for political advantage remain a problem throughout the world, and especially in India. The UN Convention on Rights of Persons with Disabilities (2006) and the Indian Mental Healthcare Act of 2017 are examples of efforts to acknowledge and respond to such problems, though with outcomes yet to be measured. This work seeks to problematize such policies and practices in the postcolonial years by critically decoding them, together with the epistemic scrutiny of the disciplinary discourses implicit therein. There seems much to build from the epistemic unmaking of the psych-disciplines.

Keywords:

Mental health, intersectional inequalities, psych-disciplines, public policy, capability approach, structural competency