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Abstract
The Paniya tribe of Wayanad, Kerala, suffer from a range of health issues related to their experience of marginality. They have indigenous forms of healing; however, the use of biomedicine has increased. But, lack of time and resources means that the broader dimensions of health and well-being remain unaddressed. The socio-economic causes of illness are reconfigured into medical terms for management in the clinical setting. Ultimately, the struggles of the marginalized are rendered invisible, and primary medical aid has become a conduit through which ideology and modes of practice are transferred. However, the Paniya use biomedicine in an attempt to negotiate new forms of identity. Symbolic parallels between the ‘rituals’ of medicine and manthravady (black magic) facilitate movement between the two. However, specific practices within the manthravady ritual draw on deeply embedded cultural idioms that caution against the coercive influences of dominant groups and help the Paniya make sense of their place in the contemporary world.
Notes
1. While PHC is an acronym that is also used to describe the primary health centre, a unit of rural health-care provision in Kerala, in this context PHC will be used specifically to refer the primary health camp.
2. MOHFW, DMHP Operational Guidelines and SAMHSA, Mental Health.
3. Halliburton, ‘Just Some Spirits’.
4. I use ‘tactic’ in the same sense that de Certeau does in The Practice of Everyday Life.
5. Pigg, ‘The Credible and the Credulous’.
6. IIM, Wayanad Initiative; adivasis make up 18% of the population, or 136,062 people.
7. Jeffrey, ‘Introduction’.
8. IIM, Wayanad Initiative.
9. Ibid.
10. Ibid.
11. Aiyappan, The Paniyans.
12. Ibid., Thurston and Rangachari, ‘Paniyan’.
13. The Gownders are Kannada-speaking Jain cultivators, but it is inconclusive as to who first enslaved the Paniyas. It has also been suggested that the Urali Kurumas, the artisan adivasis of Wayanad, enslaved them, as Urali Kurumas were believed to be the only ones who made the kind of nets described in the creation story.
14. Aiyappan, The Paniyans and Kularani, ‘The Shrinking Livelihood Strategies of the Paniyar’.
15. Ibid.
16. Aiyappan, The Paniyans.
17. Ibid., Kularani, ‘The Shrinking Livelihood Strategies of the Paniyar’ and Mathur, Tribal Situation in Kerala.
18. Kularani, ‘The Shrinking Livelihood Strategies of the Paniyar’.
19. MOHFW, DMHP Operational Guidelines.
20. Ibid., 486.
21. I use the term ‘model’ to describe somatization as it is a theoretical paradigm, or abstraction, proposed by medical literature and policy documents.
22. DSM-IV-TR, ‘Somatoform Disorders’, 486
23. Murthy et al., Mental Health Care by Primary Care Doctors.
24. MOHFW, DMHP Operational Guidelines.
25. Murthy et al., Mental Health Care by Primary Care Doctors, 41; Ibid.
26. Interview conducted with the author, 19 August 2006, at the 16th Annual National Conference of the Indian Psychiatric Society, with the theme ‘Taking Psychiatry to the Masses’.
27. Brown and Timajchy, ‘Illness’.
28. Kleinman, ‘Problems and Prospects in Comparative Cross-Cultural Psychiatry’.
29. Brown and Timajchy, ‘Illness’.
30. NIMHANS, Psychosocial Care in Disaster Management and SAMHSA, Mental Health.
31. Taken from entries in the camp registers as well as the Kerala Department of Health Services ‘District Officer Letter’ for the month of January 2008.
32. Anaemia, stomach pains from low iron and dehydration.
33. Contagious diseases such as tuberculosis, scabies, respiratory infection, gastroenteritis, typhoid and parasitic worms, but also dental problems, chronic otitis and recurring fever.
34. Duodenal ulcer, oesophageal cancer and mouth cancer from chewing tobacco and pan (a mixture of betel leaf, areca nut, tobacco and quicklime), peripheral vascular disease from smoking, cirrhosis, high acidity, gastric ulcer and hypertension from drinking alcohol.
35. Juvenile diabetes and sickle cell anaemia.
36. Ecks and Sax, ‘The Ills of Marginality’.
37. Treatment for these symptoms came in the form of painkillers, vitamins, beta-blockers or anti-inflammatories, and was subject to the very limited resources of the PHC's pharmaceutical dispensary.
38. Low, ‘Embodied Metaphors’.
39. 144 interviews were conducted with Paniya respondents, over a 6-month period between September 2007 and February 2008.
40. Interview 3, conducted with KC, October 8, 2007.
41. Interview 4, conducted with BA, October 8, 2007.
42. Mehretu et al., ‘Social and Spatial Marginality’.
43. Lupton, ‘Foucault and the Medicalisation Critique’.
44. IIM, Wayanad Initiative.
45. The organizational structure of the Vivekananda Mission is divided equally between the hospital activities (which includes the PHCs) and the activities of the One-Teacher School Project. Here, the one-teacher school is not just a small aspect of the hospital; in many respects, the PHC often runs secondary to it.
46. All information on the OTSP is compiled from interviews and conversations with Dr. Anuj Singhal (PHC medical officer and head of OTSP), in discussion with the author, between October 2007 and February 2008.
47. Hackett, ‘Dr Sagdeo's Hospital’, 611.
48. Froerer, Religious Division and Social Conflict.
49. In this case, and in the case of Froerer's work, the political and religious institution is the RSS, specifically; however, I do not want to constrain my argument to the spread of Hindu nationalism alone. In the Wayanad context, Christian, Muslim and Communist organizations all compete for the ‘hearts and minds’ of the tribal population in a similar way. Limited space, however, prevents me from providing ethnographic material to illustrate this.
50. Halliburton, ‘Just Some Spirits’, 134.
51. Ibid.
52. Interview 4, conducted with BA, October 8, 2007.
53. Interview 6, conducted with SA, October 10, 2007.
54. Halliburton, ‘Just Some Spirits’.
55. Aiyappan, The Paniyans.
56. McCallum, ‘The Body that Knows’.
57. Gowndan and Gowndi, respectively, are the male and female names for the Gownders, who, as stated earlier, are Kannada-speaking Jains.
58. Respondent EK (Paniya elder), as told to the author, March 13, 2007.
59. KIRTADS, Scheduled Tribes of Kerala at a Glance, 27 and Mathur, Tribal Situation in Kerala.
60. Respondent TB, as told to the author, January 25, 2008.
61. As deemed by the atali or manthravady.
62. Aiyappan, The Paniyans.
63. Remembering that the stone and the ancestral spirit are one and the same.
64. Taken from the patient records of the manthravady.
65. SAMHSA, Mental Health.
66. Jackson, Minima Ethnographica.
67. Ibid.
68. Respondent TB, as told to the author, January 25, 2008.
69. Emirbayer and Mische, ‘What Is Agency’.
70. Lewis, Ecstatic Religion.
71. Emirbayer and Mische, ‘What Is Agency’.
72. Pigg, ‘The Credible and the Credulous’.