Neurochemistry and subjunctivities of depression in Kerala, South India

Abstract

The narrative of depression as a neurochemical imbalance in the brain or, more precisely, a deficiency of the neurotransmitters serotonin and norepinephrine – largely produced by commercial interests of the international and national pharmaceutical industry and spread globally by international diagnostic systems – has found its way into the offices of mainstream psychiatrists in Kerala. In the clinical encounters, social, economic and existential suffering is thus transformed into a medical condition, treatable with pharmacological means. On the one hand, the setting of a psychiatric outpatient department largely shapes the way depressive patients express their subjectivities. On the other hand, the diagnosis (and explanation) of depression as neurochemical imbalance and the prescription of drugs influences the way patients experience their suffering. Using two ethnographic examples, the aim of this paper is to analyze how subjectivities are construed and shaped in the process of negotiating depression in clinical encounters in mainstream psychiatric institutions in Kerala and how multiple framings and ontologies of affliction are assembled in them. Subjectivities of depression are, it will be argued, less coherent than ambigious and fractured, unstable and fragile. They engage, accentuate and sometimes merge different, often contradictory discourses. They should therefore better be referred to as ‘subjunctivities’. The idiom of depression often becomes a rhetorical device to emphasize affiliation to a scientific medical discourse or citizenship and is often a statement to emphasize ‘scientific temper’ and modernity and to demarcate oneself from backwardness and superstition.

Keywords:

• Depression
• psychiatry
• subjectivity
• India

Ethical approval

The research followed the ethical guidelines of the German Research Foundation and of the German Anthropological Association (GAA).

Acknowledgments

I am indebted to the organizers Serena Bindi and Sumeet Jain and participants of the panel ‘Constructing diagnosis in “mental health”: the negotiation of categories, the encounter of subjectivities in South Asia’ at the 23 European Conference on South Asian Studies, 23 to 26 July 2017, Zurich.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Morals are closely interconnected with physiology in the Indian context, which is why Marriott (1976) in his ethnosociological attempt to understand India through Hindu categories, advocates giving up the Cartesian distinction between mind and body and describes South Asian notions of the self as bio-moral or physio-moral selves. Similarly, Osella and Osella (1996) use the notion of sneham to demonstrate how bodies and morals are intertwined in Kerala. Sneham denotes both a cooling lubricating fluid within the body and love and care for others. It can therefore be understood as a bio-moral substance and as a prerequisite of well-being.

2 Reducing the number of dishes is a common idiom of distress through which Malayali women communicate their suffering to other family members.

3 Whenever English terms were used in Malayalam speech, these are set in italics.

4 Mantras or Qu’ranic verses written either on a piece of paper or on copper, which are then rolled and inserted into a small round silver or golden case and worn around the neck, waist, or upper arm.

5 Many compounds of houses and temples have a sarpa kavu, a piece of land for the snakes, left untouched and wild with one or several snake idols engraved in stone for worshipping and appeasing the serpent deities. A neglect of the serpent deities is said to lead to sarpa dosam, an affliction fault brought about by the wrath of the serpents.

6 Vastu shastra is an ancient Indian body of knowledge about sacred and profane architecture and its relationship to inhabitants (Chakrabarty 2013), which has experienced a dramatic revival in recent years through promotion in TV shows and newspaper articles.

Additional information

Funding

German Research Foundation [HE 2034/18-1 and LA 3225/1-1] and European Research Council [340510].