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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]

In seeking to explore the meaning of chronic and chronicity, the association with infertility is neither immediate nor evident. However, this paper explores this relationship by analyzing the idea of infertility in relation to chronicity. In the linkages that come forth the idea of chronic lifestyle emerging from certain ways of being and living, as well the imaginings associated with the chronic body become important nodes of exploring the relationship between infertility and chronicity. Most importantly, the role that time plays in marking the chronic state is seen to be especially potent in the practice of infertility treatment, and the narratives that emerge around its temporal inevitability. The rhetoric that marks the diagnosis and prescription of treatment is often based on the identification of the body as susceptible to reproductive decline and failure, due to the contingencies of modern living. This often translates into a more sustained involvement with ARTs, which may or may not fulfil the required desire for a child. In this paper I seek to analyse the ways in which practitioners of infertility medicine create an image of an affliction that borders on chronicity. In the process, I question the idea of both chronic diseases and chronicity by looking at how illness is imagined in narratives that IVF specialists create in public, and through the idea of a cure for infertility. By analysing data collected through ethnographic fieldwork, this paper aims to build on the idea of the chronic as inevitable within clinical discourse and practice. [ABSTRACT FROM AUTHOR]

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]

Laparoscopic tubal ligation is the most prevalent method of contraception amongst India's rural and urban poor. Drawing on 18 months of ethnographic fieldwork in rural Rajasthan in 2012–2013, this paper investigates how rural women's perceptions of a biomedical instrument—the laparoscope—influence their perceptions of sterilization, a procedure often entrenched in coercive, target- and incentive-driven population control programme. By investigating how a laparoscope is entangled in global exchanges, national policies, institutional arrangements, and local moral worlds, this paper demonstrates that while wider biomedical discourses perpetuate the narrative of safety and convenience, people's everyday lives inform their understandings of technology that is widely known but rarely seen. [ABSTRACT FROM AUTHOR]

Private primary care providers are usually the first site where afflictions come under institutional view. In the context of poverty, the relationship between illness and care is more complex than a simple division of responsibilities between various actors--with care given by kin, and diagnosis and treatment being the purview of providers. Since patients would often visit the provider with family members, providers are attuned to the patients' web of kinship. Providers would take patients' kinship arrangements into account when prescribing diagnostic tests and treatments. This paper terms this aspect of the clinical encounter as 'kin testing' to refer to situations/clinical encounters when providers take into consideration that care provided by kin was conditional. 'Kin testing' allowed providers to manage the episode of illness that had brought the patient to the clinic by relying on clinical judgment rather than confirmed laboratory tests. Furthermore, since complaints of poor health also were an idiom to communicate kin neglect, providers had to also discern how to negotiate diagnoses and treatments. Kinship determined whether the afflicted bodies brought to the clinics were diagnosed, whether medicines reached the body, and adherence maintained. The providers' actions make visible the difference that kinship made in how health is imagined in the clinic and in standardized protocols. Focusing on primary care clinics in Patna, India, we contribute to research that shows that kinship determines care and management of illnesses at home by showing that relatedness of patients gets folded in the clinic by providers as well. [ABSTRACT FROM AUTHOR]

Under the aegis of the World Health Organization, the Movement for Global Mental Health and an Indian Supreme Court ruling, biomedical psychiatric interventions have expanded in India augmenting biomedical hegemony in a place that is known for its variety of healing modalities. This occurs despite the fact that studies by the WHO show better outcomes in India for people suffering from schizophrenia and related diagnoses when compared to people in developed countries with greater access to biomedical psychiatry. Practitioners of ayurvedic medicine in Kerala have been mounting a claim for a significant role in public mental health in the face of this growing hegemony. This study examines efforts by ayurvedic practitioners to expand access to ayurvedic mental health services in Kerala, and profiles a rehabilitation center which combines biomedical and ayurvedic therapies and has been a key player in efforts to expand the use of Ayurveda for mental health. The paper argues for maintaining a pluralistic healing environment for treating mental illness rather than displacing other healing modalities in favor of a biomedical psychiatric approach. [ABSTRACT FROM AUTHOR]

Drawing on fieldwork with the veterinary staff at an Indian wildlife sanctuary, this paper examines the controversy surrounding an epizootic outbreak of tuberculosis among a population of sloth bears. As these bears fell ill and began to die, the veterinary staff asked whether they might be culled, inciting allegations of incompetence and cruelty from both the media and government bureaucrats. This paper works through a series of ethico-legal questions regarding the cullability of these tuberculous bears, which depended in part on how the bears were classified – as wild or domestic, captive or free, curable or incurable. As boundary-crossing figures, the bears confounded straightforward efforts at classification, rendering their fates open to debate. In treating them, the veterinary staff feared that they were only extending their suffering, producing a form of life that might be thought of as iatrogenic. In this light, this paper suggests that cruelty – both the cruelty of culling and that of treatment – might be figured as an unavoidable aspect of the relation of dependency between animals and their human caretakers. [ABSTRACT FROM AUTHOR]

Emergency Contraceptive Pills (ECPs) are increasingly available over the counter as a form of hormonal birth control in India. As use of ECPs is increasing over time, this paper draws on ethnographic research in Dehradun, in Uttarakhand (Northern State) to highlight the everyday material conditions under which women create narrative around choice and agency regarding these ECPs. Women viewed ECPs as better options than abortion, appreciated the sense of empowerment these provided them because they could be consumed in houses where women had limited 'space and privacy;' and finally that ECPs and their advertisements could act as 'agents of social change.' Feminist scholarship on reproduction demonstrates that choice is a form of agency that is enacted within certain constraints. Using this framework, the research here highlights how women create narratives about ideas of contraceptive choice and notions of 'empowerment' when talking about ECPs and their advertisements. In revisiting the dilemma about women's agency and choice, this paper builds on Rosalind Gill's concept of 'critical respect' to propose 'critical ethnographic respect' as an ethnographic tool to help read women's responses and respectfully contextualise the materiality from within which these narratives emerge. [ABSTRACT FROM AUTHOR]

The global rise of populism and concomitant polarizations across disenfranchised and marginalized groups has been magnified by so-called echo chambers, and a major public health crisis like the COVID-19 pandemic has only served to fuel these intergroup tensions. Media institutions disseminating information on ways to prevent the propagation of the virus have reactivated a specific discursive phenomenon previously observed in many epidemics: the construction of a defiled 'Other'. With anthropological lenses, discourse on defilement is an interesting path to understand the continuous emergence of pseudo-scientific forms of racism. In this paper, the authors focus on 'borderline racism', that is the use of an institutionally 'impartial' discourse to reaffirm the inferiority of another race. The authors employed inductive thematic analysis of 1200 social media comments reacting to articles and videos published by six media in three different countries (France, United States and India). Results delineate four major themes structuring defilement discourses: food (and the relationship to animals), religion, nationalism and gender. Media articles and videos portrayed Western and Eastern countries through contrasting images and elicited a range of reaction in readers and viewers. The discussion reflects on how borderline racism can be an appropriate concept to understand the appearance of hygienic othering of specific subgroups on social media. Theoretical implications and recommendations on a more culturally sensitive approach of media coverage of epidemics and pandemics are discussed. [ABSTRACT FROM AUTHOR]

This paper explores the capacity of yoga narratives and practices to contribute to and relate ideas about health. It adds theoretically to existing literature on yoga by introducing the concept of the 'health imaginary' as an analytic lens for considering yoga discourses in late modern times, where personal health care and spiritual ambitions are once again becoming blurred. With this perspective, the paper provides a thorough analysis of how yoga postures (asanas) are conceived to work therapeutically, in yoga's recent history and in present-day yoga therapy. Taking case studies from India and Germany, it is shown empirically how the application of asanas is rationalized differently in specific geographical and therapeutic environments – particularly regarding the presumed theory of the body. Thus, the concept of the health imaginary not only provides analytic space to explore the implicit logics and goals of healing in different contexts, but also offers clues about the distinct social, cultural/religious, and local influences that draw people into yoga and contribute to its selective appropriation across the globe. [ABSTRACT FROM AUTHOR]

Existing literature demonstrates agro-chemicals result in physical toxicity and damages human health, flora and fauna. However, little is known about how such ‘toxicity’ relates to mental well-being and social suffering. This paper aims to demonstrate how local, national and international vectors are interlinked to shape social distress among cotton farmers in India. Ethnographic interviews and focus group discussions were conducted in a cotton-growing village of the Warangal district, Telangana state, India. The results advance the concept of counter therapeutic spaces and hypothesise that toxic landscapes emerge through a dynamic interaction between dispersed agencies that interact and reconfigure agricultural spaces into socially toxic places. The paper argues that the disciplines of public health and agriculture suffer from a failure of imagination to forge vital interdisciplinary links that could address farmer suffering. Unpacking local ecologies of farmer suffering offer innovative ways for enhancing mental health policy and interventions in India. [ABSTRACT FROM AUTHOR]

The paper analyses the experiences with government sanctioned Ayurvedic college education of 14 young Ayurvedic doctors working at the Integrative Health Centre in Bangalore, India. Unfamiliarity with Ayurvedic logic and Indian natural philosophies, lack of clinical training and the mixing-up of Ayurvedic and biomedical notions are their main complaints. The 14 young Ayurvedic doctors also missed a convincing perspective on how to integrate Ayurvedic logic, modern scientific knowledge and biomedical diagnostics. Ayurvedic state sanctioned education seems to be caught between Ayurveda's natural philosophy of health and the techno-science of biomedicine. The Ayurvedic doctors under scrutiny face the danger of becoming ‘half-baked products’ when they do not learn to reflect on the tension between Indian traditional knowledge and biomedical learning. The paper argues that the logic of modern science and biomedicine's claim to value-free knowledge captivates Ayurvedic education and research. This hinders Ayurveda's development as a vibrant alterity to biomedicine. What is needed is a critical social science perspective on the construction of medical knowledge and India's hierarchical medical landscape. [ABSTRACT FROM AUTHOR]

This paper engages critically with the global assemblage framing sickle cell and thalassaemia disorders as a ‘global health crisis’; and the promise of genomics, largely DNA-based carrier/pre-conceptual screening, prenatal diagnosis with a view to terminations, deployed in framing a solution to these historically racialised spectrum of diseases as essentially preventable. Sickle cell and thalassaemia are recessively inherited, potentially life-threatening haemoglobin disorders with significant variation of severity, often needing life-long treatment. I argue that the re-classification of inherited blood disorders (IBDs) under ‘prevention and management of birth defects’ by the WHO in 2010 can be read as an ethical moment within the ‘globalising turn’ of IBDs and the use of genomics in addressing structural inequalities underpinning health in low- and middle-income countries. Using an Indian case study, the paper aims at first examining the language of risk through which genes and IBDs are mapped onto pre-existing populations (e.g. caste and tribe) as discrete, categories. Second, it discusses the likely social and ethical ramifications of classifying these recessive gene disorders as essentially preventable, despite cheaply available diagnostic tests and treatment options available in most countries in the South. [ABSTRACT FROM AUTHOR]

This paper critiques the category of possession-form dissociative identity disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) published in 2013 by the American Psychiatric Association (APA). The DSM as an index of psychiatry pathologises possession by categorising it as a form of dissociative identity disorder. Drawing upon ethnographic fieldwork, this paper argues that such a pathologisation medicalises possession, which is understood as a non-pathological condition in other contexts such as by those individuals who manifest possession at a temple in Kerala, South India. Through medicalising and further by creating distinctions between acceptable and pathological possession, the DSM converts a form of distress into a disease. This has both conceptual and pragmatic implications. The temple therefore becomes reduced to a culturally acceptable site for the manifestation of a mental illness in a form that is culturally available and possession is explained solely through a biomedical framework, denying alternative conceptualisations and theories which inform possession. By focussing on the DSM-5 classification of possession and the limitations of such a classification, this paper seeks to posit an alternative conceptualisation of possession by engaging with three primary areas which are significant in the DSM categorisation of possession: the DSM's conceptualisation of self in the singular, the distinction between pathological and non-pathological forms of possession, and the limitations of the DSM's equation of the condition of possession with the manifestation of possession. Finally, the paper briefly highlights alternative conceptualisations of possession, which emerged from the perspective of those seeking to heal possession at the Chottanikkara temple. [ABSTRACT FROM AUTHOR]

Within public health, investigations into the rise of metabolic syndrome disorders, such as obesity and type II diabetes, following on the heels of globalisation have tended to focus on the twin axes of diet and physical exercise. However, such a limited focus obscures wider transformations in bodily and health-related practices that emerge in response to globalisation. This paper is an exploration of public discourses about PCOS—a hormonal disorder that affects menstruation, is associated with obesity, heart disease, and type II diabetes, and has been on the rise in India since the liberalisation of its economy in 1991— and it examines the concerns regarding sociocultural, environmental, and political–economic changes brought by liberalisation that these discourses index. Attention to medical semantics, as revealed through public discourses about PCOS, can help counter the limited focus of diet and physical activity-centred models through an emphasis on the political ecology of health. Such engagement can reveal how an emerging relationship between the body and its environment, which is seen as characteristically modern, is implicated in the rise of metabolic disorders. It can also offer critical insights for biomedical and public health research into such disorders. [ABSTRACT FROM AUTHOR]

From research in central Chhattisgarh, this paper interprets the bearing that healthcare beliefs and practices may have in shaping maternal and child nutrition both in the light of biomedical recommendations and within the context and constraints of a rural village setting. It contends that health beliefs and practices that are at variance from biomedical recommendations appear to have few consequences for gestational nutrition and for child health in relation to pregnancy. In the postpartum however, health ideas at variance from biomedical recommendations appear to have an important bearing on maternal nutrition and infant feeding, and may put mothers and children at risk of nutritional deficiency. Maternal 'eating down' following a surgical procedure such as a caesarean delivery or tubectomy is especially noteworthy, since food intake quantity is reduced over an extended time frame. While caring practices are influenced by cultural formulations, they also reflect, perhaps, adaptations to health risks. [ABSTRACT FROM AUTHOR]

Despite decades of research on India's plural health care market, the practices of many local health traditions outside the allopathic and codified traditions are under-studied. Drawing on interview and observational data, this paper explores the space in which indigenous traditional Khasi healers in Meghalaya state, northeast India, practice. Khasi indigenous healers describe themselves as doktor sla, plant doctors, to distinguish themselves from doktor kot, or book doctors. This distinction operates as a rhetorical resource, utilised to carve a distinct sphere of expertise in relation to the allopathic sector, and to mark claims for the specifically local appropriateness of traditional practices within a shifting market of state-sponsored provision. Khasi healers are a heterogeneous group who treat a wide variety of conditions, including physical ailments which have no obvious correlates in biomedical systems, and musculoskeletal disorders, with which they have recognised expertise. In addition to claiming these discrete strengths, healers also present themselves as accommodating deficiencies in biomedicine, including inherent generic weaknesses of allopathic care as well as specific local gaps in rural health care provision. Thus, the expertise niches of traditional healers have evolved through their interactions with, and the needs of, the community, but also through managing a shifting boundary with biomedical practitioners, who are explicitly sceptical of their efficacy, but tacitly accepting of the ways in which they manage the gaps in biomedical provision. While codified non-biomedical traditions in India have engaged in universalising professionalising projects, in this setting at least, non-codified practitioners have instead utilised discourses of localism. [ABSTRACT FROM AUTHOR]

In this paper, the author traces two parallel movements of institutionalized Ayurvedic psychiatry, an emergent field of specialization in Kerala, India: the ‘work of purification’ and the ‘work of translation’ that Latour has described as characteristic of the ‘modern constitution.’ The author delineates these processes in terms of the relationship of Ayurvedic psychiatry to (1) allopathic psychiatry, (2) bhutavidya, a branch of textual Ayurveda dealing with spirits, and (3) occult violence. The aim is to offer a model of these open and hidden processes and of Ayurvedic psychiatry's positioning within a hierarchical mental health field characterized simultaneously by biopsychiatric hegemony and a persistent vernacular healing tradition. Through these processes, Ayurvedic psychiatry emerges as a relevant actor. It demarcates itself from both allopathic and vernacular epistemologies and ontologies while simultaneously drawing upon aspects of each, and, in this way, shows itself to be both deeply modern and highly pragmatic. [ABSTRACT FROM AUTHOR]

This paper presents three embedded episodes in the life of a polyherbal drug indicated as a preventative measure for hangovers. Invented and marketed in 2005 by a leading ayurvedic pharmaceutical company in India, PartySmart is a reformulated compound based on ayurvedic, biomedical and phytochemical sources. This creative process has involved multiple translations, resulting in hybrid pharmacological models, including, for instance, ayurvedic post-digestive tastes and biomedical effects on enzymatic activities. These modes of therapeutic action are conceptualizations of an active drug – i.e. a digested and metabolized drug. A problem arises, however, in the fact that the ingestion of this drug is linked to alcohol consumption in a country where it is widely considered in negative terms. For this reason, PartySmart was seen as an ambivalent presence in the firm's catalogue and thus a series of interventions aiming to uphold the image of this drug transformed both its social inscription and its materiality. This transformation also took a different, global trajectory as the drug gradually developed as a transnational pharmaceutical commodity and became a new object in new latitudes. By focusing on the social and material dimensions of this drug in these contexts, this paper calls upon science studies to expand the scope of pharmaceutical anthropology. It brings together various layers of analysis to offer new perspectives on contemporary herbal formulations as they traverse material cultures, medical epistemologies, sociopolitical borders, legal environments and social practices. [ABSTRACT FROM AUTHOR]

Despite the recent growth of social science literature concerning the traditional medicine industry in Asia, insights into the contemporary dynamics of so-called ‘classical formulae’ remain relatively scant, as do studies of small-scale, less capitally intensive and technologically advanced modes of production. This paper seeks to address these gaps by considering a single Sowa Rigpa (Tibetan medicine) formula known as Samphel Norbu, or ‘wish-fulfilling jewel’, which appears in numerous texts and is today among the most popular Tibetan medicines in the world. Drawing primarily upon long-term fieldwork in Himalayan India, the paper follows Samphel Norbu's rise from exclusivity to popularity and examines the ways it has been transformed in the process, both materially and in its economic, social and clinical significance. The paper shows how Samphel Norbu acts as a marker of inequality between different groups of healers, and examines the role the medicine played in the development of commercial pharmacy and the proliferation of complex medicines. Tracing out wide variations in the medicine's formulation, composition, mode of production and pattern of circulation places the issue of multiplicity at the centre of analysis, and leads to a questioning of the assumptions that underpin the category ‘classical formula’. The paper reflects upon the repositioning of such formulae within emergent configurations of knowledge, power, industry and market, and on their transformations and transformative effects both over time and in the present moment. [ABSTRACT FROM AUTHOR]

Drawing on data collected during a 16-month ethnographic investigation, this paper explores practices around Indians’ and Pakistanis’ use of herbal medications for diabetes control. The ethnographic study was conducted among Indian and Pakistani migrants in Edinburgh, Scotland and included extended participant observation, six group discussions and 21 semi-structured interviews. Respondents showed great resistance in adhering to medication prescriptions for diabetes control due to their various side effects, especially within the stomach. In order to avoid such side effects, respondents decreased medication dosage and turned to non-allopathic remedies that usually consisted of herbal medications that, according to Indians and Pakistanis, did not cause side effects as medications did and tackled the cause of the disease rather than its symptoms. Such remedies however, were not only combined with allopathic ones but also eventually replaced without the doctor's consultation. [ABSTRACT FROM PUBLISHER]

Ethnographic inquiry into Ayurvedic commodification in Kerala revealed the prevalence of a distinct regional pharmaceutical market dominated by physician-manufacturers, oriented towards supplying classical medicines to Ayurvedic doctors. This stands in sharp contrast to mainstream Ayurveda that is observed to have undergone biomedicalization and pharmaceuticalization. This paper argues that Kerala's classical-medicine-centric pharmaceutical market constitutes an alternative modernity because it provided Kerala Ayurveda with a different route to modernization impervious to the biomedical regime, as well as endowing it with the institutional power to safeguard its regional identity. Although physician-entrepreneurs are its key architects, it is sustained by value regimes shaped by a unique regional medico-cultural milieu. Even when industrially produced, classical medicines remain embedded within Ayurveda's socio-technical network; unlike proprietary drugs sold as individual product-identities through non-Ayurvedic channels, they travel together as a pharmacopeia, distributed through exclusive doctor-mediated agencies. This clinic-centric distribution format is best conceptualized as an open-source business model as it made low-margin generics viable by packaging them with therapies and services. Besides ensuring better access and affordability, it provided resistance to pharmaceuticalization and intellectual property concentration. By keeping the doctor in the loop, it prevented medicines from degenerating into de-contextualized commodities; the service component of Ayurveda therein preserved went on become the unique selling point in the health-tourism market. The tourism-inspired proliferation of Brand Kerala eventually triggered a paradigm shift in mainstream Ayurveda – shifting focus from ‘pharmaceuticals’ to ‘services’ and from ‘illness’ to ‘wellness’. Furthermore, interacting with hybrid Ayurvedas in transnational markets, Kerala Ayurveda co-produces new alterities countervailing the structurally dominant biomedical paradigm. [ABSTRACT FROM PUBLISHER]

This paper examines the grid of sentiment that structures medical travel to India. In contrast to studies that render emotion as ancillary, the paper argues that affect is fundamental to medical travel's ability to ease the linked somatic, emotional, financial, and political injuries of being ill 'back home'. The ethnographic approach follows the scenes of medical travel within the Indian corporate hospital room, based on observations and interviews among foreign patients, caregivers, and hospital staff in Mumbai, New Delhi, Chennai, and Bangalore. Foreign patients conveyed diverse sentiments about their journey to India ranging from betrayal to gratitude, and their expressions of risk, healthcare costs, and cultural difference help sustain India's popularity as a medical travel destination. However, although the affective dimensions of medical travel promise a remedy for foreign patients, they also reveal the fault lines of market medicine in India. [ABSTRACT FROM AUTHOR]

Although for over a century Ayurvedic and Unani manufacturers have played a crucial role in the modernization of Indian medicine and influenced the way Indians look upon their medical traditions, this fact has been largely ignored by social scientists and historians working on Indian medicine. By looking through the lens of the industry and focusing on medicines, this study questions the notion that traditional medicine is largely beyond commerce and is highly sensitive to patients as individual subjects. The paper asks how the logic of the market has shaped, constrained and transformed two Indian medical traditions: Ayurvedic and Unani Tibb. What kind of indigenous medicines dominate the Indian market? To whom are these marketed and what are the images used by the industry to promote their products? How do large manufacturers construct the 'Indianness' of their commodities? Based on ethnographic research among large Ayurvedic and Unani manufacturers in India during the period 1996-2002, data for this paper was generated from open-ended interviews, conversations, observations, and company publications such as popular and semi-popular periodicals. Promotional materials and research reports were also used, as well as popular writings on Indian medicine such as articles in general newspapers and magazines. The paper concludes with a discussion of the effects of commoditization of Ayurvedic and Unani medicines for clinical practice and the consequences of this development for the poorer sections of Indian society. The paper highlights Indian medicine as a commercial activity. [ABSTRACT FROM AUTHOR]

Following the recognition that 'culture matters' in designing effective public health programs, this paper focuses on one refraction of culture within the so-called 'homosexual' community in India, to highlight how attention to local knowledge and its socio-economic underpinnings can impact the politics of health care. Drawing primarily on ethnographic fieldwork conducted from 1995-1997 and 2003 in the South Indian city of Hyderabad among hijras (the so-called third sex of India) as well as the wider community of MSM or 'men who have sex with men', the paper argues that public health framings of homosexuality often fail to pay attention to differential understandings of stigma and their socio-economic underpinnings, a failure that accounts in some measure for the ineffectiveness of prevention programs targeted at 'high risk' communities such as hijras and MSM. Focusing on the local moral economy of respect and shame as one pathway of stigma and contagion, and in particular on the differences in constructions of respect and shame between hijras and the wider community of MSM, this paper points at one small way in which understanding how culture matters can ultimately address the ineffectiveness of prevention programs and redress the inequalities in health outcomes between the various margins and centers of power. [ABSTRACT FROM AUTHOR]

Among practitioners of biomedicine, to speak of people as ‘marginalized’ often amounts to saying that they do not have access to medical substances. Thus conceived, the best way to remove marginality seems to be to give medicines to those deprived of them. The peculiar relationship between marginality and pharmaceuticals is especially poignant in the case of antidepressant drugs, as these drugs appear to bring the patient ‘back into society’, but not any society, but middle-class consumer society. What is now special about antidepressants is that there is nothing special about them: antidepressants are like consumer items among thousands of other consumer items. This paper explores the relations between medicines and marginality with reference to the marketing of antidepressant drugs in Kolkata (Calcutta), India. Drawing on ethnographic fieldwork in the Kolkata metropolitan area from July 1999 to December 2000 and in August/September 2003, this paper examines how people with depression are constituted as ‘marginal’ in the sense of ‘being deprived of medication’, and how the biomedical promise of an effective pharmacological treatment becomes a promise of ‘pharmaceutical citizenship’. In view of Bengali notions of mental health as a state of detachment, the paper asks if pharmacological demarginalization holds the same promise in the Indian context that it holds in the West. [ABSTRACT FROM AUTHOR]

Following the recognition that ‘culture matters’ in designing effective public health programs, this paper focuses on one refraction of culture within the so-called ‘homosexual’ community in India, to highlight how attention to local knowledge and its socio-economic underpinnings can impact the politics of health care. Drawing primarily on ethnographic fieldwork conducted from 1995–1997 and 2003 in the South Indian city of Hyderabad among hijras (the so-called third sex of India) as well as the wider community of MSM or ‘men who have sex with men’, the paper argues that public health framings of homosexuality often fail to pay attention to differential understandings of stigma and their socio-economic underpinnings, a failure that accounts in some measure for the ineffectiveness of prevention programs targeted at ‘high risk’ communities such as hijras and MSM. Focusing on the local moral economy of respect and shame as one pathway of stigma and contagion, and in particular on the differences in constructions of respect and shame between hijras and the wider community of MSM, this paper points at one small way in which understanding how culture matters can ultimately address the ineffectiveness of prevention programs and redress the inequalities in health outcomes between the various margins and centers of power. [ABSTRACT FROM AUTHOR]

Based on fieldwork and archival studies carried out since 1995, this paper is an analysis of the dialogue between the Jarwas and the outside world. The Jarwa tribal community on the Andaman Islands has a long history of voluntary isolation and pronounced hostility towards outsiders. This situation only started to change in the mid-1990s, when a young Jarwa was successfully treated at a local hospital. The Jarwas’ sudden fascination with modern medicine was less to do with its therapeutic powers than the fact that, on each visit, hospital staff gave them food, clothes, and various consumer items. This paper describes events in the Jarwas’ ‘junket to modernity’. Before discussing recent events, the paper first retraces the history of relations between the Jarwas and the outside world during the second half of the 19th century, when life on the Andaman Islands was dominated by a British Penal Settlement. In the face of epidemic outbreaks of pneumonia, malaria, and measles, tribal health has become a major concern for the Indian authorities. The paper discusses continuities and discontinuities in medical concerns with the tribal body, and argues that ‘marginalization’ must be understood as a practice of mutual constitution. [ABSTRACT FROM AUTHOR]

This paper poses a theoretical question: how, !f at all, can 'critical medical anthropology' and 'performance theory' be combined? More specifically, the author discusses the relative advantages and disadvantages of each, with respect to a healing cult in the Central Himalayas of North India. The paper has four parts: first, an ethnographic description of the cult itself second, a brief introduction to critical medical anthropology; third, a short discussion of the performative approach to healing rituals; and finally, an attempt to combine the two approaches. The author concludes that the two approaches can indeed combined, so long as one recognizes (1) that caste and gender are also appropriate objects for critical medical anthropology; and (2) that aesthetics is always already political. [ABSTRACT FROM AUTHOR]

In the closing decades of the 20th century, media and media narratives in India have become powerful rhetorical devices. The journalistic narratives on science in India through the 1980s and the 1990s have tended to oscillate between the 'awe and mistrust' and 'marvel of science' frame, resulting in the creation of genre of popular science journalism that has assumed the form of an 'institutional advertisement'. This 'institutional advertisement' approach to scientific knowledge has played a central role in normalising assisted conception in India. Drawing on extensive media narratives on infertile patients and assisted conception practitioners, this paper attempts to show how the stories told in these accounts have resulted in the 'narrativisation of infertility' as a big problem. Undertaking a narrative analysis, the paper tries to show how the media narratives are publicity driven 'institutional advertisements' and have succeeded in creating a credible image of the medical expertise/experts in an iniquitous disregard for code of good medical practice in India. [ABSTRACT FROM AUTHOR]

The paper discusses the many forms and representations ofcyavanaprāsh, Ayurveda's best-selling medicine, already mentioned in Caraka's Compendium (c. 200 CE). The medicine's compositions, applications, and meanings, change over time and from locality to locality. Cyavanaprāshis, for example, a patriotic formula, a booster of the immune system, a modern geriatric drug, and one of the elements in canonical Ayurvedic treatments. In the beginning of the 19th centurycyavanaprāshwas a patriotic formula for fortifying Indian bodies and the nascent Indian nation. Nowadays the medicine is a Fast Moving Consumer Good (FMCG) and a money maker for Dabur India Ltd., the world largest Ayurvedic manufacturer. Instead of vitalising the nation its consumption now promises to make urban middle class consumers effectively modern. Branding and modern science must make Dabur Chyawanprash attractive in the eyes of these consumers. Ayurveda and cyavanaprāshare also part of a global counter culture marked by neo-Orientalism and Ayurvedic medicines as facilitators of spirituality. The marketing ofcyavanaprāshby India's largest Ayurvedic manufacturer is used as a case study for discussing the proliferation of Ayurvedic brands and its critics. The imaging of Ayurvedic brands such as Dabur Chyawanprash threatens to obscure the fact that Ayurveda represents a unique way of looking upon health, disease and the human body. The proliferation of brands also makes Ayurvedic medicines more expensive and puts pressure on the natural environment as the main supplier of Ayurvedic ingredients. [ABSTRACT FROM AUTHOR]

The paper discusses different positions by psychiatrists and anthropologists taken towards ‘folk’ mental health care and summarizes what has been said in favour of the folk sector. Further, examples indicating a changing relationship between the Indian state and the folk sector are outlined, including the impacts of the fire tragedy at the dargah of Erwadi in 2001. On this basis it is argued that a prevailing ignorance of the folk sector has provided it with some autonomy, while at the same time, recent attempts at collaboration tend to utilize folk practitioners rather than valuing their positive elements in their own right. [ABSTRACT FROM PUBLISHER]

In this study the author analyzes the relationship between the individual body and the body politic in a region of the north Indian state of Uttarakhand, in connection with social changes occurring at the local and trans-local level, which are impacting the status of the different healing systems. By investigating these issues, this paper aims to shed light on some of the complex ways in which practitioners and patients who take part in a local method of healing, in this case ritual healing through possession, respond to the expansion of biomedicine. [ABSTRACT FROM AUTHOR]

This paper is based on a research on medical integration and health seeking in Mysore, South India. It explores the use of Ayurvedic services, the impact of biomedicine on Ayurvedic practices and the meaning of instruments with respect to the expectations of patients and healers. The research was done during 2002 and 2003. The empirical data are derived from interviews, participant observation and survey material. Participant observation was carried out in two hospitals and nine clinics offering Ayurvedic services; 25 Ayurvedic practitioners and 30 patients were interviewed. A total of 233 respondents were surveyed in the University of Mysore and on trains and buses between Mysore and Bangalore. Results suggest that Ayurvedic medicine serves as a health reserve in urban Mysore. For the majority of informants biomedical treatment was an obvious choice of treatment, a form of therapy that was taken for granted, if compared with the preference for Ayurvedic services, which were usually utilized because of the failure of biomedicine. Regarding the position of Ayurveda, three issues are vital: first, the lack of experience and first-hand knowledge of Ayurveda on the part of health seekers, secondly, the significance of instruments, tools and technology as regards the expectations of proper consultation, and thirdly, the impact of medical integration, which seems to be critical for modern Ayurveda to thrive in the health market. In short, in order to gain popularity in an urban context, Ayurvedic practitioners favour institutional integration and adoption of items and practices particular to biomedicine. [ABSTRACT FROM AUTHOR]

Perceived marginality can have a great impact on people's well-being. Using ethnographic material from three different low-caste villages in the Central Himalayas of North India, and based on a survey of Garhwali women conducted in 2002–03, this paper illustrates that marginality and well-being are never absolute but always relative. Discussing anthropological aspects of the bodily experience of oppression, and Public Health studies of the effects of social inequalities on health, it will be argued that the relative marginality of low-caste people within their villages affects their well-being much more than the absolute caste status on the district or state level. [ABSTRACT FROM AUTHOR]

This paper examines the supernatural beliefs of najar (evil eye) and bhut (ghost) and their roles in illness causation in Gujarati families in Britain today. The data arose unexpectedly in an ethnography of child rearing patterns carried out in Harrow, North West London and a short period of observation in Ahmedabad, India. I used anthropological methods of participant observation and unstructured interviews, which were transcribed using pseudonyms. The study group involved 70 Hindu and Jain Gujarati households with children and the fieldwork was conducted over a period of four years. Many of the individuals studied had migrated from India to East Africa before coming to the UK in the 1970s, but maintain links with both countries through kinship ties, marriage and rituals. I set out to study the continuity of women's roles in the transmission of religious and moral values, the rituals of childhood, views about infant feeding, and parenting relationships within joint families. The beliefs of najar and bhut in poor, rural settings in India have been described, but these Gujarati beliefs in Britain have not been well documented. This study indicates that najar and bhut continue to be a concern of women in most Gujarati families in Britain today and across all socio-economic groups, not confined to those on the 'bread-line', as have been previously suggested. These beliefs align themselves with Hindu ideas of the soul and reincarnation: powerful forces residing outside the body. An understanding of these beliefs could be informative to health professionals working with Gujarati communities in the UK. [ABSTRACT FROM AUTHOR]

Despite its large number of practitioners, medical anthropology has given little attention to Indian homeopathy. In historical accounts, homeopathy's popularity is explained by its position as a modern, yet non-colonial form of medicine, which became indigenized during the last ISO years. Other scholars argue that homeopathic concepts converge with Indian ideas on healing. However,few empirical data have been gathered on homeopathic practice in contemporary India. In this paper, we explore the perspectives of college-trained homeopaths in urban West Bengal. How strongly do they feel indebted to classical and canonical homeopathic writings? Can we observe attempts of indigenizing homeopathy by blending it with common ideas of Indian medical culture? While the homeopaths in our study report practising an orthodox version of homeopathy, we can also identify creative solutions when they are responding to their patients' expectations: conforming to the idea of single-remedy prescription by simultaneous use of placebos, short-cut homeopathic anamnesis, complementing homeopathic drugs with therapeutic nutritional advice, and developing a system of seasonal drugs are all evidence for silent hybridization of homeopathic and local ideas. In the homeopathic consultation, time pressure becomes a significant challenge and Bengali homeopaths grasp the most important homeopathic symptoms quickly. [ABSTRACT FROM AUTHOR]

Despite the thought-provoking theological and philosophical implications of the adage urging the healer to heal him/herself medical anthropology has, with some notable exceptions, given relatively little attention to the problems of well-being experienced by healers themselves, as distinct from those of their patients. This paper focuses on the conflicts experienced by men and women who become healers and how they try to resolve them. The case taken is of the Angami people of Nagaland, northeastern India. There are broadly two kinds of healer, each of whom is subject to contrasting pressures and conflicts. Shamans depend on tutelary spirits who may at various points control the shaman him or herself who may have been initially reluctant to become a shaman. Other healers such as herbalists and masseurs may sometimes use but do not rely on tutelary spirits and draw instead on their own non-divinational skills. An increasing number of such healers have become Christian and are obliged to adapt their practices accordingly, including the divinity of a new God, sometimes denying a previous personal or family connection with shamanism. At issue in both cases is a struggle between human and divine agency, which, writ large. is a struggle between human self-determination and external forces of control, this being possibly reflected in the fact that Nagaland has for many years been the scene of an armed struggle against the Indian government for political autonomy. [ABSTRACT FROM AUTHOR]

Though rates of depression are comparable across cultures, similar rates may obscure the diversity of the experience and meaning of depression and related behaviour. Appreciation of the social and cultural contexts is crucial in developing culturally sensitive intervention strategies to reduce the burden and disability of depression. Data are required not just to elucidate biological or cognitive understandings of the disorder, but also its social and cultural contexts, especially in non-Western settings. This paper reports cultural epidemiological research studying depression-related experience, meaning, and behaviour with the EMIC in the psychiatric outpatient clinic at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India. Patients spontaneously emphasized somatic symptoms when asked about the problems that brought them to seek help, but on further probing, they acknowledged feelings of depression and sadness, which they related to various social problems and interpersonal issues. The personal significance and meaning of the symptoms were shaped by cultural notions concerning the human body in health and in sickness. Culturally salient symbols (like heat and cold) and ethnophysiological concepts like nara (nerves) figured prominently as causative factors in their accounts. Patients were dissatisfied and disappointed with allopathic physicians whom they had previously consulted for their problems, who seemed to them not to appreciate their needs and expectations in treatment. Findings show that it is important that clinicians attend not only to questions of diagnosis and clinical formulation according to professional concepts, but also to the experience and meaning of their patients' problems. A cultural epidemiological framework facilitates this process by integrating emic and etic perspectives. [ABSTRACT FROM AUTHOR]