Sunday, May 24, 2015

Sushrut Jadhav, Sumeet Jain, Nanda Kannuri, Clement Bayetti, Maan Barua: Ecologies of Suffering: Mental Health in India

This article calls for a framework linking what happens in the “clinic” to wider ecological forces, both material and social. The aim is to enhance a crucial, yet neglected, aspect of India’s National Mental Health Programme (NMHP): that individual mental suffering is related to a wide range of local factors. The current India National Mental Health Policy, both radical and holistic (NMHP 2014), requires a cross-disciplinary approach to reinvigorate theory to bridge the gap between policy-makers and practice (Jain and Jadhav 2009). To ensure congruency between mental health policy and practice, a framework is required which integrates ecological, economic and social sciences as applied to mental health.

This article proposes an “ecology of suffering” (conceptualised as vectors, pathways or forces), which mediates between the sufferer and the “clinic.” Suffering is interrelated in a complex manner with the outside world. Each person’s suffering occurs within a specific “ecology,” a network of interrelated forces with variable directionality. The term “ecology” refers to the network of forces acting on and by the people suffering and those around him and her. It is chosen to stress the mix of “natural,” and “social” such as landscapes or air pollution. The term, “the clinic,” refers to what happens locally between the sufferer and mental health professionals attempting to actualise the NMHP.

The centre of any framework for India’s mental health, particularly in rural areas, needs to map and link the relation between locally specific forces, national politics, and international social and political forces; the so-called local/global dynamic. A map, or set of relationships will facilitate linkage between a policy decision and those forces identified by the clinic which profoundly affect the sufferers. The hope is that once the forces are named, and the ecology of local suffering drawn, policy-making can address local and more concrete aspects of suffering. In the following section, we describe three case studies linking clinically applied anthropology with local ecologies of suffering. We will first document what such factors are, how they play out, and the bearings they have upon mental health delivery. In the last section, we sketch out the broad parameters of what might an ecology of suffering entail, and its implication for theorising and delivering culturally responsive mental healthcare.

2 Ecologies of Suffering: Our work suggests that suffering is profoundly affected by ecological relations that are contingent on local particularities. This is contrary to conventional psychiatric formulations which emphasise the narrow focus of social stressors having an impact on the psyche as the primary site of morbidity (Kleinman et al 1997)…
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