Search

In the context of neoliberalism and increasing globalization, technocratization, and scientification of mental health care, people suffering from socio-politico-economic problems ranging from poverty to structural violence are often transmogrified into "patients" with mental health problems to be "treated" with psychopharmaceuticals and individualized psychological therapies. Drawing from three socio-political issues India witnessed in the past 3 years, concerning three marginalized sections, namely, farmers, LGBTQIA+ people, and migrant workers, I illustrate the silence of mainstream mental health disciplines in India on sheer instances of structural violence and social suffering. Deflection of attention from human rights violations by mainstream mental health systems raises critical questions about the ethics and politics of mental health disciplines. The social, political, and material contexts that are central to lived experiences are almost always unaccounted in mental health academia, research, and practice. Engaging people with lived experiences advances equity by breaking down power dynamics, establishing collaborative decision-making, and improving equitable outcomes. Thus, knowledge production in mental health becomes irrelevant to political action and transformative policies that are crucial for positive mental health outcomes. By ignoring and thus implicitly sanctioning discriminatory, exploitive neoliberal architecture, mental health systems maintain the very upstream factors that cultivate and sustain mental distress. In this way, mainstream mental health practice in India fails to undertake world-making , raising deeper questions in public mental health ethics. [ABSTRACT FROM AUTHOR]

Community mental health programmes (CMHPs) have proliferated in both governmental and non-governmental sectors in recent times in India. Although CMHPs are mandated to work in close collaboration with the community, the operationalization of community is fraught with exclusionary tendencies, particularly concerning non-cis-heteronormative sexual subjects. Mental health professionals trained in the mainstream western biopsychiatric paradigm are largely silent on the lesbian, gay, bisexual, transgender, queer, intersex and asexual identity discourses as they institute pathological and reductive conceptualization about sexualities, psychosocial disabilities and resultant sufferings. Drawing on ethnographic fieldwork carried out at two non-governmental and a governmental CMHP in Kerala, south India, I illustrate the lack of a human rights–based approach to sex and sexual orientation and gender identity, due to which pressing concerns of sexual life are mis/overdiagnosed as mental 'disorders' to be treated within a biomedical framework. The lack of an intersectional approach fails the marginalized sexual subjects to exert their agency, develop critical consciousness and recognize sexuality as a political issue—all vital for transformative social change. The consequence is a dehumanized mental health care system that fails to 'archive feelings' that are pivotal in making invisibilized worlds observable to tell 'unwelcome truths' that induce psychic pain. Collaborative alliances among other marginalised sections like Queer, Dalit, tribal and Crip (disability) groups are vital in resisting intra-individual prescriptions by increasingly commercializing mental health practice in a country beset by a host of social problems including poverty, discrimination and rising inequalities. It is crucial to understand systems of power (imbalance) that operate as major (social) determinants of (sexual) mental health. [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]

Ongoing farmers' protests have once again brought back the spotlight on the agrarian crisis in India. Even though upstream factors that perpetuate farmers' suffering, including the role of the state in promoting agrocapitalism, have been discussed extensively by scholars and activists across the spectrum, mental health discourses almost always frame it as a mental health problem to be addressed by increasing access to psychopharmaceuticals. Drawing on developments around farmers' protests and analysis of articles published in flagship journals of largest professional bodies of clinical psychologists and psychiatrists in India, I highlight the intimate relationship between neoliberal state and farmers' distress to which the mental health system shuts its ears and eyes obscuring and downplaying socio-structural determinants of farmers' mental health. [ABSTRACT FROM AUTHOR]

This commentary examines the space-attitude-administrative complex of mainstream mental health systems with regard to its responses to decriminalisation of non-heteronormative sexual identities. Even though the Supreme Court, in its 2018 order, instructed governments to disseminate its judgment widely, there has been no such attempt till date. None of the government-run mental health institutions has initiated an LGBTQIA+ rights-based awareness campaign on the judgment, considering that lack of awareness about sexualities in itself remains a critical factor for a non-inclusive environment that forces queer individuals to end their lives. That the State did not come up with any awareness campaign as mandated in the landmark judgment reflects an attitude of queerphobia in the State. Drawing on the concept of "biocommunicability", analysing the public interfaces of state-run mental health institutions, and the responses of mental health systems to the death by suicide of a queer student, I illustrate how mental health institutions function to further anti-LGBTQIA+ sentiments of the state by churning out customer-patients out of structural violence and systemic inequalities, benefitting the mental health economy at the cost of queer citizens on whom curative violence is practised.

In 2018, a day before the Supreme Court of India commenced hearing the curative petition on Section 377 of the Indian Penal Code (which criminalised carnal intercourse against the order of nature), the Indian Psychiatric Society (IPS) issued an official statement that homosexuality is not a mental pathology. In 2014, a year after the top court recriminalised homosexuality, the then IPS president had termed it as a pathology requiring treatment. By examining articles on LGBTQIA+ rights published in two flagship Indian journals in psychiatry and clinical psychology, position statements by professional bodies, and international and national developments in human rights mechanisms, we argue that psychiatry's voice for human rights protection of the marginalised has been akin to whispering sweet nothings in tune with the juridico-penal system. In turn, clinical psychology appears to huddle with biomedical psychiatry without raising its voice against coercive and traumatising practices within mainstream technocratic psychiatry. We seek to explore the troubled relationship between mainstream psy disciplines and LGBTQIA+ persons characterised by psychological evasion: failure of mainstream psy disciplines to take up sensitive, socio-political issues like same sex love in a broader human rights framework leading to individualisation- pathologisation complex which further side-lines persons living on the margins of society.