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The paper explores how chronicities and chronic relationships are fostered at a state-sponsored community psychiatry clinic that has been affiliated with a Sufi shrine in western India. The clinic provides free psychotropic treatment to patients, most of whom are pilgrims visiting the shrine. While the clinic has been lauded for its collaborative approach of blending 'medicine and prayer' in the provision of mental health care, observations of clinical encounters reflect the prevalence of a strongly medicalized perspective of mental illness, where local narratives of distress are reframed as globalized categories of mental disorder, thereby permitting pharmacological intervention. Importantly, in a context where free medicines are offered just as other freebies are in development initiatives in India, this results in the creation of long-term, 'chronic' relationships with patients who only seem to return for medicines, never recovering. This paper illustrates how 'chronicity', in many ways, is built into the project from the beginning itself. It becomes evident in the assumptions of the officials and psychiatrists that mental illness is chronic, in the case files of patients that record their consultation and medication histories, and in the clinical conversations about the importance of compliance to treatment. Given that historically, community mental health emerged in the context of reducing long hospital stays and deinstitutionalizing mental health care, it is important to reflect on how these policies and practices result in the creation of a cadre of chronic out-patients. [ABSTRACT FROM AUTHOR]

In response to the global call to upscale mental health services in low--income countries, mental health non-governmental organisations (MHNGOs) have sprung up in Kerala to address mental health needs by partnering with pre-existing locally grown, bottom-up, community-led pain and palliative clinics (PPCs) to increase access to mental health care through task-shifting. The MHNGOs mandate filtering only patients with 'severe mental disorders' from low socioeconomic backgrounds for their free services. This eligibility criterion mandated by the MHNGO is ruffling feathers within the palliative clinics that oppose such -classifications. They believe that suffering cuts across all divisions and should not be discriminated against based on economic background and severity of illnesses. When chronicity and suffering are held universal by the MHNGO and palliative care, respectively, it brings to the fore the enactment of two perspectives of care. Drawing on observations of clinical interactions between patients, MHNGO staff and mental health professionals and interviews with community volunteers of palliative care clinics in Kerala, this paper demonstrates how chronicity narrative promoted by MHNGOs based on biopsychiatric model gains hegemony, whereas the community care model loses traction progressively. The state, caught between these two narratives, frontstages development by submitting its health machinery to the MHNGOs flouting basic medical safety laws in its services to marginalised people like the tribal population. This paper argues that the rising dominance of chronicity narrative in community mental health clinics as well as in popular media discourses evolves out of power relations between the MHNGOs and the palliative clinics. [ABSTRACT FROM AUTHOR]

Drawing on ethnography of one family's life with diabetes in a poor settlement in Delhi's suburbs, this paper examines the relationship between emotional structures of care and kinship in the face of chronic illness. While anthropologists have argued for a relational understanding of care and discussed how, in India, modernity and social transformations have resulted in crises of familial care, less attention has been paid to the emotional terrains of care and its difficulties as they unfold in concrete relationships over time. This paper demonstrates how emotional intensities define the possibilities, limits, and ambivalence of kin care for the chronically ill. Described as care without heart, this mode of attention implies a continuation of care labour that maintains kinship ties and holds the possibility of kin futures, but is disinvested emotionally and feels unsatisfactory. The analytic of care without heart expresses a particular mode of care by which persons navigate dominant moral regimes around gendered family responsibilities and imperatives of love in relationships, but without fully subscribing to them. Care without heart at once signifies an inadequate form of care, invokes North Indian normative moral regimes around family care responsibilities and emotions, and acknowledges the shortcomings of these regimes and norms of relatedness. [ABSTRACT FROM AUTHOR]