Drugs exist that are meant to help people feel better. The doctors who prescribe them might believe that they work, while their patients do not. In explaining the drugs to their patients, should those doctors use the medical terminology they themselves use – which might not be immediately understandable to their patients – or should they translate the description into terms more comfortable and familiar to the patient? And what are the practical and ethical consequences of each decision? Stefan Ecks‘ new book carefully considers these problems in the context of health-related practices in modern Calcutta. Eating Drugs: Psychopharmaceutical Pluralism in India (NYU Press, 2013) looks successively at the different and overlapping medical and healing contexts that together make up a significant part of the medical marketplace in Calcutta. Ch. 1 treats popular notions that include the importance of the belly as the “somatic center of good health,” the power of the mind to regulate good health, and the connection between modernity and pollution as causes of illness. Ch. 2 looks at Ayurvedic practices in Calcutta. It reflects on some of the most important ways that Ayurveda is changing in India – especially at the levels of practitioner training, language, and the patient-physician relationship – despite the fact that the centrality of food and digestion has remained constant. Ch. 3 looks closely at homeopathy, the second most popular type of medicine in Bengal, and focuses on the principles, histories, and pluralities of homeopathic practices in Calcutta. Ch. 4 looks at the ways that Calcutta psychiatrists position themselves with respect to popular beliefs about psychopharmaceuticals, general physicians, practitioners of non-biomedical treatments, and the pharmaceutical industry. This chapter pays special attention to how Bengali doctors use metaphors to help patients understand and respond to psychiatric diagnoses, with comparisons to nature, the Ganges river, fairytales, everyday over-the-counter drugs, diabetes, and food. The conclusion explores a key argument of the book, proposing that “patients’ suspicions of psychopharmaceuticals are based on suspicions of biomedicine’s ‘magic bullet’ model of drug effects,” looking at the implications of this conclusion, and considering the possible broader impacts of this study beyond Calcutta. It’s a fascinating study of potential interest to historians and anthropologists of medicine and healing, as well as readers interested in learning more about the medical marketplace of modern India and anyone interested in modern psychopharmaceuticals.
Learn more about your ad choices. Visit megaphone.fm/adchoices
Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery
Are you a professional pillow fighter or a 9-to-5 low-cost time travel agent? Or maybe real estate sales on Mars is your profession? It doesn't matter. Whatever it is you do, however complex or intricate, monday.com can help you organize, work a straight, and make it more efficient. monday.com is the one centralized platform for everything work related. And with monday.com, work is just easier. monday.com for whatever you run. Go to monday.com to learn more. With Lulu Lemon, the real gift happens when they're living in it. When you give the fan favorite everywhere belt bag, the real gift is... And when the ultra soothing rest feel slides are the gift, you're really giving them... This holiday, Lulu Lemon makes it easy to give little luxuries that go beyond. Open the moment. Shop now at Lulu Lemon.com. Hello everybody. This is Marshall Poe. I'm the editor of the New Books Network. I want to tell you about a new book, Public Success Private Grief, an extraordinary personal account by Peter Cowley. It's about Peter's life of professional accomplishments alongside extreme personal tragedies, cancer, suicides among his closest family members, and alcoholism. Peter spoke about public success private grief on the NBN recently. Alas, Peter has been diagnosed with cancer, and I urge you to read this compelling book. It's open, honest, and filled with life lessons. Visit ps-pg.com to learn more and buy the book. Hi, I'm Carla Napi, and this is New Books in Science, Technology, and Society. Welcome, and thanks for joining us. I just finished talking with Stefan X about his new book, Eating Drugs, Psychopharmaceutical Pluralism in India. This came out with NYU Press in 2014, and even though it's a case study that's very firmly centered on India, on Calcutta specifically, the insights of the book extend more broadly to really how to understand what it is to have a body, and to use language, either visual, verbal, oral, to understand and to communicate about and with that body, and to use that understanding and kind of manage that understanding and that communication as a way to try to keep ourselves, make ourselves, make others healthy. What Stefan does is he takes us through various areas of the medical landscape in India and in Calcutta specifically, including Ayurveda, including homeopathy, biomedicine, as a way to give us an appreciation of the kind of landscape that patients and doctors are working in when they are trying to conceptualize and figure out how to communicate, how to treat mental illness, depression, some kind of illness of the mind. What winds up happening throughout the chapters of the book, as you'll hear, is that there's some major themes that recur throughout all of the areas of this landscape. Those themes include a concern with time and temporality, a concern with patient agency or lack thereof, a concern with the body and the belly specifically, and a relationship between food and medicine among many others. So it's a fascinating book. It's really, really interesting. It's very clearly written and I will let you get right to it because our conversation, because it's so fascinating, right? Our conversation was quite extensive. So thank you for listening. I hope you have a chance to get your hands on a copy of the book and to look through it, to have an appreciation of all the details that we skipped over, right, that are very much richly described in the book, and I hope you enjoy the conversation. Thanks for listening. I'm here today to talk with Stefan X about his new book, Eating Drugs. Welcome to new books in STS, Stefan, and thanks very much for making time to talk with me today. Thank you, Karla. It's great to be on the show. First, since Stefan, could you start us off by saying a little bit about how you came to the field and specifically what brought you to medical anthropology and to India in particular? Well, it was during my first two years as a student of anthropology. I took a course in medical anthropology and the textbook that we read back then was by Cecil Hellman, Culture, Health, and Illness, which is a classic textbook, and it just contained a whole huge number of case studies from around the world and all sorts of aspects of health and illness. But the one that really, really took me was on the question of somatization, which somatization is a kind of a cultural pattern of psychological and social distress that turns into physical symptoms. So, a classic case of somatization is if a patient comes to a clinic complaining about pain all over the body, or headaches, or weakness, and the doctor then does an investigation, finds no particular physical problems there, and then diagnoses a case of somatization, and very often that's depression or some other psychiatric diagnosis. And I found that the question of somatization extremely fascinating, because I couldn't understand how it was possible that the body could lie about the so-called two reasons of the distress and how there could be such a misrecognition also in a patient of psychological or interpersonal tensions that they would become real, felt physical pains and aches and discomforts. And it also fascinated me because it seemed to be a puzzle that medicine alone would not be able to solve, but something that really needed anthropological work as well because it required a lot of in-depth knowledge of a local culture, and because the expressions that were used are in local languages, so it needed this anthropological perspective on it. And I have to say that after all these years, many years later, I definitely have huge problems with how the cold question of somatization is laid out nowadays in the literature. And the book is also very much an engagement with this question of, is it really the case that what is a problem of the mind is being turned into a problem of the body by the patient and then properly accurately turned back into a problem of the mind by the doctors with the help also of psychopharmaceuticals in that case. But definitely, so that was the question that Fazim needed me enough to become a medical anthropologist. And what brought me to India was a series of accidents. I think most anthropologists will be very happy to admit that their projects are shaped by these happy coincidences. In my case, I've always been somehow interested in East Asia, Southeast Asia and back in my student days. I also just went on a long journey and around various places there. And from all the places I visited, India just fascinated me the most. And I really fell in love with the place and decided to do my PhD on it as well. But then this particular study came out from a very different angle. I was really more interested back then in how people experience the effects of environmental pollution onto their health. And so the initial stage of the project for my PhD was to go to a specialist clinic for lung diseases in Calcutta because I wanted to find out how people reflect on air pollution, causing respiratory problems. And also how that would make people reflect on the ill effects of modernization more broadly. That was the interest that I had. And in these interviews with people diagnosed with lung diseases, all they talked about more or less was their stomach, food, digestive imbalances. And I was also just taken by surprise by that this immense focus on what is actually going on in the belly basically. And even with patients who are diagnosed with lung diseases that they seem to be far more interested in talking about digestion than about breathing or anything like that. And it was this strong focus on everything having to do with food and with digestion that I then turned into the major part of the project as well. And then also later on I got really interested in this question of psychopharmaceuticals. And one the thing that really kick started me on this one was that I read about other anthropologists writing about the uses of antidepressants in the United States and how Prozac in the US would be such a well-known drug that people would be able to just say, "Yes, this is an antidepressant drug." And they would be able to say at least two or three people that there was no personally who are actually taking on the drug, who are on the drug at any moment in time. And that struck me also as so absolutely different from my experience in India where you wouldn't have any sort of public engagement with antidepressants or psychopharmaceuticals or really mental illnesses in any recognizable way. There's sort of the odd newspaper report maybe on it, but it doesn't have that public salience and discourse to it at all. And I was at the same time really struck by the fact that India is one of the world's largest producer of generic versions of these psychopharmaceuticals. And that seemed to be very odd to me, that India could be on the one hand producing all the drugs, but then it seemed also when you read WHO publications and then the whole literature and it seems to be that India is this place of yoga and meditation and no one in the world there has ever seen an antidepressant drug before. And that's this huge discrepancy brought me also to this question of the uses of antidepressants in India today. And in the book also then I tried to broaden this also to an anthropology of pharmaceuticals, which then kind of tries a comparison of not just biomedical and psychiatric medications, but also Ayurvedic and homeopathic medications and how all these different types of medications have different cosmologies underlying them and at the same time what kind of processes are going on that bring these types of medication in dialogue with each other and produce very new drug effects themselves. Great. Thank you. That's fabulous. And one of the things I'm just kind of incidentally taking a page from or taking off from what you just mentioned, one of the things that I really appreciated here as someone who's a historian of medicine and medical and sort of pharmaceutical culture in China specifically, I really appreciated the fact that you're emphasizing that these different medical cultures, right? These different that homeopathic and Ayurvedic and biomedical and popular medicines, they're distinct in some ways, but the boundaries are very, very blurry, right? These aren't distinct medical systems and sort of they're part of a conversation that's very much happening all the time and that's certainly happening throughout the book and you're bringing us into that conversation in a way that's I think a really beautiful reminder that for any individual body and person who is seeking medical or healing care, these are, this is a plural kind of environment, right? It's not necessarily a choice between one firmly delineated kind of medical system and another firmly delineated kind of medical system. So it's that blurriness that I think is really useful and generative and important to remember when we're reading your book and I thank you for that because I think you're making that point really compellingly here. So yeah, I think that you know for India it really is this situation of a much stronger competition between different kinds of medicines also than you would have in North America maybe or in Europe where biomedicine is so firmly established and in India partly also because people have to pay out of pocket most of the time for the treatments that they receive and so there is this situation that this choice also leads people into the medical practices of very different kinds of healers far more I think than in what we would be used to in Europe or North America and at the same time these healers are also dependent on the patients staying with them coming back to them they're dependent on their fee payments far more and so they even if they're in a very entrenched powerful position they have to actually listen to what the patients are interested in and when these patients pick up all sorts of ideas from one medical system and then bring them to the other medical system they have to the whoever the doctor the healer there has to respond to that as well and I think that's a situation that is very very powerfully present in India. So one of the things that the book does really beautifully from the very beginning is to show us the kinds of technologies that make of that transit and that movement across and through medical cultures and medical systems possible and one of those things that's happening is metaphor. So I want to ask you a little bit about that but I want to kind of contextualize this for listeners first. Okay so in order to get to a conversation about how and why metaphor is important let's back up a step and talk about sort of what the stakes are and what one of the key kind of problems is that the book explores. So a key problem explored in the book is described as in the way that I'll mention right now in the book there are drugs that are meant to help people feel better. The doctors who prescribe these drugs might believe that they work while their patients don't. So in explaining the drugs to their patients there's a dilemma that arises. Should the doctors use medical terminology that they themselves use which might be interpreted as more honest more straightforward by some people or should they translate the description into terms that are more comfortable and familiar to the patient which might be interpreted by some as obfuscation right as sort of changing the nature of what they're telling them. So and when we're considering this dilemma at the same time what are the practical and ethical consequences of each decision. So the book is going to explore this problem and explore this dilemma by leading us through the various layered and sort of interwoven ways that a patient is going to experience and explore and that healers are going to experience and explore. This is a very complicated and very plural medical landscape that you've just described to us a few minutes ago. Now one way of translating these especially psychopharmaceuticals right to a patient is by using metaphor. Now this is described at the beginning of the book is described at the end of the book and it's something that really helps motivate the title in getting drugs. One kind of translation and one kind of metaphor that's used specifically is to call psychopharmaceuticals mind food and at the very beginning of the book you take us into a kind of a psych ward where you're following a doctor, Dr. Roy, who makes the decision to conceptualize and describe pharmaceuticals as mind food. Okay so let's start there. For you what's important about metaphor specifically to what's going on in the book and why mind food specifically? So to start with mind food it's really the English translation of this Bengali expression "monar kavar" and "mon" is a Bengali term for mind but it's a really interesting term because it's not although it's etymologically related to English mind and "mon" and "mind" and "min" in Latin and so on. They are all from the same language group but in Bengali "mon" is a term that also means something like the heart mind. So it's not just about the cool rationally thinking, calculating mind like in the Cartesian tradition but "mon" for Bengalis is a heart mind where also it's feelings and emotions and personal opinions are encapsulated in that. So that's one part of the expression "mon" and "kavar" is the other part and "kavar" means basically everyday edible meals, food, usually cooked food, what you would have on an everyday basis and again in Bengali language you have a huge range of terms for various kinds of food so it's in many ways much more differentiated in that regard than in English where you have food basically and then you would qualify that with some other terms but in Bengali if you say "kavar" then everyone means others to sort of the homely everyday food, it's not the food that you would offer deities, it's not the food that has been left over by someone, it's not the food from the day before, it's kind of your good everyday meal basically and what the, you know what I've observed the Calcutta psychiatrist doing when they explain the action of psychopharmaceuticals to patients and how they also try to convince patients that these are good to take, don't worry about them, it's everyday, it's easy, that's the expression that they would use is "mon" or "kavar", "minds" food and so what they do is you know with this work of metaphor that they're employing, they're just building, you know taking all the resistance and doubts and worries that a patient might have about for example the long-term intake of a drug or the worries of uncontrollable and unforeseeable side effects and things like that they take that and already try to mitigate for the sort of negative connotations of that by just calling it "kavar" and it's the food that the mind would take in and where this idea then emerges from the metaphor that they're using and also when patients would be asking for further details and they would say "well your mind is being starved of nutrients, there's something", you know the mind needs good nutrition to keep going and all that you're missing in your brain is good nutrition so what we're giving you here in the form of these tablets and pills and capsules is nothing other than just the sort of everyday wholesome nourishment of the mind and you know by them using this expression and really you could say that the entire book is an attempt to explain why mono-kavar as an expression in this particular context when used to a begoli speaking patient sort of makes such absolutely perfect sense somehow and it just seems to just check all boxes of why that would feel actually really good to take these drugs and you wouldn't need to have any fear for that and this is what fascinated me about metaphor basically is this incredible power that this expression can have in a doctor-patient relationship and how the very terminology that is being used maybe by a professional psychiatrist is transformed into also needs to be transformed into something more wholesome or acceptable for patients there's always of course the idea among the doctors that patients in India are as they say all the time again and again well most of the patients are illiterate they have no idea their education in this country is so bad what can we do you know if we would tell them about neurotransmitters and serotonin and all of these things they would not understand so it one way of making them understand and of of overcoming any sort of superstitions because the resistance against the psychopharmaceuticals is seen as a superstition from their side is just to transform them and the way you transform them is by by using these metaphors and I think that you know the mono-kavar as a particular metaphor is a particularly ingenious one there's a whole bunch of other metaphors and ways of explaining the action of these drugs to patients that are being used one of them very popular is also just to compare them to insulin in the treatment of diabetes so you know just that there is something missing in the body in some people in the case of diabetes and insulin is this drug that you need to take in from the outside on a regular basis probably until the rest of your life in order to make up for that shortcoming in your body and to rebalance the body and to nourish it in this particular kind of way and so that would be another metaphor that is very commonly used and popular anything that has to do with the nourishment but so it's really the bottom line is that the doctors expect such resistance against the for example the use of a psychopharmaceutical which is such a threatening scary term and you know which they see as the patients would never understand what this stuff is so basically we need to transform it metaphorically into something that they're happy to to eat to swallow and this is actually bringing out one of the key arguments of the book right is this argument that patients are suspicious in Calcutta of psychopharmaceuticals based on a kind of suspicion of this what do you call a magic bullet model of drug effect coming from psychopharmacology and so the book becomes very much this very detailed but very beautifully written exploration of how doctors are managing that suspicion and really by the time we get to the end of the book and we'll revisit this what the ethical consequences of those management techniques including metaphor right what the ethical consequences are and this has consequences not just for how we understand what's happening in this particular case but also more broadly I think how we understand what's happening given the global pharmaceutical environment beyond Calcutta so there's this the structure of the book is very very very well designed in terms of you know laying out the major stakes and the major problem and taking our hand and guiding us very carefully through this landscape to return to the question at the end in a way that makes it much more understandable than it would be otherwise right so this idea of mind food that you just described really helpfully thank you this is very much based on an overall notion and you take us into this in the first chapter of the belly as what you call the somatic center of good health now I won't ask you to talk too much about this because you've already described this really helpfully for us but I just want to flag this for listeners the first chapter is really a very detailed exploration of this notion the connection between the belly and health the relationship between this and mon right or mind and how patients navigate between in popular medicine the belly and the mind as kind of interacting forces in terms of the maintenance of good health and overall bodily wellness you also talk here about something we'll come back to later which is sort of the way that this is complicated by the particular kind of body that's produced by modernity and all the kinds of pollution and all the kinds of ways of being in the world that modernity has created now one of the things that's really interesting that comes up very much at the beginning and I'm going to follow this through is a concern with the kind of at least as I read it the kind of translation that needs to happen not just across language not just using metaphor but also in terms of time and experiences of time and in every single one of the chapters and this begins in chapter one but it's going to be something we see throughout there is an attentiveness to the temporalities of health and the ways that patients and their doctors in these different areas of the landscape are managing and are translating across those temporalities in the first chapter this takes a form of a concern with the temporality of drug effects right choosing between and managing fast versus slow working medicines how this correlates with or engages with the diet and we're going to see different ways that temporality and concerns and translations thereof recurs and manifests throughout the book now one of the temporalities that becomes really important is a concern with past and present and a concern with moving between historical and cosmological time and this is very much a concern that we see coming up in the second chapter the second chapter looks at Ayurvedic practices in Calcutta and I think probably the the most helpful thing for listeners would be to now hit this back to you you have a really wonderful account here of some of the most important ways that Ayurveda is changing in India in India and in Calcutta specifically for you what are some of the most important ways that Ayurveda and Ayurvedic practice in Calcutta have transformed and what are the consequences of those transformations that are particularly important for understanding the work that you're doing in this chapter so Ayurveda as the classic Indian system of medicine it's usually also called like the oldest it has these Sanskrit sources and yeah when you talk about Ayurveda you have to talk about history and and long long time spans almost invariably and also for the Ayurvedic healers in Calcutta this sort of historical transformation is of enormous importance so it's something that they always reflect on and sort of comparing where they are now to what has been going on before and as you also rightly pointed out there's this often this flip from a kind of historical time frame where you would say this happened in the 19th century to something like almost like a cosmological time frame where Ayurvedic healers would also talk about you know the the days when it was possible for people to for example one of them talked about how people in the past almost like a cosmological age old past would be able to take the stomach out of their body wash it in the clear streams of the river and put it back in you know like that they had such a total control not just over their body but also over their mind basically that also would prevent them from having so many of the diseases that people today are suffering from the whole disturbance of the mind that people are suffering from today was different that you know one of the big transformations also that they see is in terms of the sheer range of Ayurvedic therapies that you can find in the classic sense pretty texts and also therapies such as Panchakarma which is one of these very famous for Ayurveda where you know the body would be subdued to all sorts of violence almost violent interventions you know purging and bloodletting and just sort of letting it all out somehow like you really sort of would turn the body upside down almost in these therapies and how the doctors that I talked to today would often perceive this as almost impossible because the ill effect of modernization have made people so weak and if feeble and so sensitive to pain and so on that they wouldn't even be able to apply the whole range of therapies that would once have been possible so there's this constant heart attack back off the healers to you know what was not just happening historically but but in almost a mythical time before and it has ramifications on all levels also for example that in earlier times the herbal remedies produced by Ayurveda would be far more powerful because the plant material that it was based on would be purer and not subject to pollution and you would have you know just much much more potent powerful medications there and again sort of under in modern times something like that it's not as easy anymore so yeah with the Ayurveda healers this is very striking general and constant comparison of almost like this degenerated if feeble moment of the present and the glorious times of the past and that includes you know Ayurveda is a discipline so against this notion that you know what I very much expect that that there is this global revival and resurgence and prominence of Ayurveda that you have today so that if you are coming from a western country you would think that Ayurveda is in full bloom and it's brilliant because if these clinics are opening up in London or New York then surely in India itself it must be even more so but the doctors that I talked to had this general sense of decline and that everything sort of went downhill really with modernity right so the chapter takes us into some of the very specific ways that these transformations happen right I mean there have been changes as you describe here in terms of training in terms of the language of Ayurveda in terms of patient physician relationships but throughout all these changes there has been one constant that you describe here and this is the centrality of food and digestion this digestion understood here variously it not necessarily in straight up anatomical terms now this becomes really important to the overall work that the book is doing because as you know we sort of go back to this idea of mind food the book is very much concerned with the ways that the belly and the stomach and food are related to concerns with and ways of managing psychological problems so you talk here about the liver right as a kind of head office and source of problems in Ayurveda and you talk about psychological problems as being one of many kinds of problems that are located in the liver so we're all these speaking this is a way to help us understand I think how digestion and psychology are related in this context and in this part of the book so I just love if you could talk a little bit about that sort of in this context of Ayurveda as it's practiced today as you have access to your ethnography what's the important connection between digestion and psychology and what are the consequences of that connection for what you're arguing in this part of the book? So basically for an Ayurvedic physician and you can see this also in all the consultations with patients it always starts with digestive health or not health so it's the starting point of everything basically and this comes from the notion that really people are you know nothing other there's this notion of a kind of fluid body that is constantly changing also it's porous it's changing with what kind of food you're eating and what kind of weather is going on at the moment and the quality is also of who you are eating with at a particular moment and if you eat slowly or fast or you know what what you're doing basically the food and the quality of your digestion makes you who you are and that's why the consultations always start with digestive you know the state of your digestion at a particular point in time and they take it from there so in that way if digestion and there's this very elaborate very beautiful really interesting Ayurvedic theory also on just how food when it's taken into the body is being transformed step by step through a whole series of digestive fire so it's like an alchemical process really and it's almost literally it's an alchemical process the way that it's imagined that you have one kind of gross nourishment and that is being refined by one digestive fire into the next higher level and higher level a higher level where is the gross product of that are sort of separated from that and just like in an alchemical process where you achieve where you can make gold basically from some lower grade metals in the same way in Ayurveda it's imagined that you can through the digestive process produce this highest level substance which is then you know usually translated as semen funnily enough so there's the whole section in the book also where I talk about this this very commonly described and what's being dubbed as sort of a culture-bound syndrome in India that which is semen loss and my point there being also that much of the literature that's been written by psychiatrists on this that phenomenon and then again we're back at somatization because that is just being subsumed as just another form of you know expressing something like depression for example but what that literature really totally misses out on is that semen in that way must be seen as a digestive product itself and you need to understand the whole cosmology of digestive processes that are going on there and then only does it make sense that losing semen for example is a form of a feeling weak or feeling tired and all that because what you're being deprived of is the most refined most powerful essence of the entire digestive process that has led to that and so if that's the basic idea of it and you can find that again in the classic scriptures but it's also something that I would think it's not you can't find a lot of people talk at any great in any great detail in a popular level about the same thing but the general notion of it I think is extremely widespread also and and the label in Calcutta would you know very easily talk about that as well so if you have that principle then it's a very small step also of thinking that anything that has to do with the mind is ultimately also based on some kind of digestive problem and is definitely connected to that and so you know it kind of ties back to what I'm laying out in the chapter on popular practices and experiences of the body sort of what this mind belly relationship is but also that you know there's there's the general dualism of the mind and the belly but also of course there are very strong interactions between them so but that's ultimately really it's about also that that that that Ayivita has absolutely no problems also in seeing the mind as amenable to being medicated in various ways because what you're doing with the medication is you're taking a particular kind of food into your body and it's being digested in this way and there's a very large and thriving part of the Ayurvedic drug manufacturing the Ayurvedic pharmaceuticals business in India which is basically about tonics for the mind so you see an awful lot of advertisements for you know give this particular tonic to your child and they will be superior in school or you see advertisements for tonics that are specifically for older people so that they remember very well and that their mind keeps on functioning on the same sort of level and so basically for Ayurveda there's no problem in also thinking that the mind can be medicated through these substances. Great thank you so much and I think one of the themes that has been coming up repeatedly and certainly comes up in this part of the book is this blurry distinction between food and medicine and this is important I think just to mark in this chapter in part because one of the quotations that makes up part of the title of this chapter you are the medicine right so if part of what you as a patient are doing in your everyday life to eat and to sort of nourish yourself is very much bound up in the notion of what you're doing to medicate yourself right medicine is food and food is medicine this brings up an important aspect of another overarching theme throughout the book which is patient agency and patient responsibility so one of the concerns I think in a lot of the chapters in different ways is the extent to which patients are made responsible or held responsible for their own health psychiatric and otherwise or psychological and otherwise through their daily practices because food and medicine are so blurly kind of grating into one another but also the agency of patients to actually have some say and what's you know what's happening in this medical landscape and the ways that kind different kinds of physicians are assuming or precluding the possibility of that agency so that's something that I just want to kind of mention because it very much comes up here and it's something that we'll see coming up throughout the chapters and really again recurring is a focus at the end of the book so we've talked up to now about these different areas of the medical landscape right we talked about popular practice we talked about Ayurveda and in each case the connections between the mind and the belly between psychological health and something having to do with food and digestion and this is also something that comes up in the next chapter which takes us into the next area of this medical landscape now this is a chapter that looks very closely at homeopathy this is the second most popular type of medicine in Bengal now I won't ask you to talk at any length about the nature of homeopathy right listeners can go to the chapter for that there's a very detailed description here of the kind of history of homeopathy this was invented by a German physician Samuel Hanuman and there's descriptions of why it's become so successful in Indian and Calcutta specifically and also why it's received comparatively little attention from medical anthropologists now this is a kind of practice very very broadly speaking right just to kind of touch on some major elements that you bring up here that is based in terms of its drug remedies on a principle of like cures like the kind of the principle that patients should receive very low doses of homeopathic drugs is very important and you talk about the importance of a certain way of thinking about and prescribing symbols right individual substances as a way to nourish and help keep sort of help keep the patients vital force as healthy as it can be so one of the to kind of link this up to the overall thread of the book you focus here on the ways that homeopathic physicians are then dealing with psychiatric problems how they are conceptualizing the root of mental health and the ways to treat and manage that aspect of mental health through the particular kinds of remedies that are used by homeopathic doctors so let's just focus on that can you tell us a little bit about that what's important for you about the ways that homeopathic doctors are conceptualizing and treating psychiatric or psychological issues in terms of fitting this with the overall argument of the book yeah I was really really fascinated by homeopathy again because I didn't expect this at all you know from my readings before I set off to do field work in India I thought everyone was running to an are you very killer all the time and I didn't have home capital of homeopathy also and that there are more doctors there more hospitals national institute homeopathy is there than anywhere else so this is a very very very important medical practice and also something that people practice in their homes and as you said you know it has this really interesting history reaching back to the 19th century where you can say that homeopathy has been in India for as long basically as it has been in in Europe so it's not something that was imported at a very late stage but you can find the first traces of homeopathic practice in the first half of the 19th century in in India and I found that so incredibly fascinating and I also found fascinating just to realize at some point that you know when you are in India everyone talks about alopathy and I'm going to go to an alopath and I had never really heard that term as such you know I would think I'm going to a doctor assuming that really that's what you know you mean that that you know biomedical doctor basically that's the person you're going to but not an alopath and just realize that actually alopathy and the alopath are terms that come from homeopathic criticisms of biomedicine as it was practiced during the 18th or 19th century it has been coined by Hanuman the inventor of homeopathy and that it was actually a very derogatory term that is being used to homeopathy being the science of curing life with like and that's the good way and the rational way of doing it whereas alopathy is sort of built up this this opposition to the body and the symptoms and it's always at war basically and therefore it has all of these these terrible side effects and is a medicine that is ultimately irrational from their point of view so that this term also alopathy has taken total root in in everyday language and also that's the Indian doctors the biomedical doctors would always refer to themselves as as alopath and what they're doing alopathy so the impact and the cultural general salience of homeopathy I think can hardly be overestimated and you can also find all of these traces of how people make sense of alopathic medications as an opposition as a foil as the opposite of alopathic medications so for example if an alopathic medicine is like a quick fix it works very fast and the homeopathic cure is slow but the alopathic drug only has a superficial effect on it it might just sort of cut off the leaves of the plant whereas the homeopathic drug takes out the roots of the plant as you know the diseases being imagined so homeopathy is just incredibly important and what always struck me about homeopathy is also is this enormous self-confidence that the doctors have there so quite opposite to the Ayurvedic healers who were always like oh we had this golden day before and now it's all down hill the homeopaths by contrast they feel like they're totally on an upswing that's what they're doing is absolutely great it's getting better all the time in some ways and not in all ways but overall that that homeopathy has this very established place and part of that is going back to your question really is this confidence in just being able to treat absolutely everything because the way that the homeopathic drugs would work are never you know this is sort of through the dilution process on the potentization of the drugs already the drug is so ethereal so fine so subtle that's it when you take it into your body you don't even need to swallow it you can just rub it on your skin or you might just inhale it for example and it will still do the work that it does because it's so fine and that is also again seen as the reason why for a homeopath that's absolutely no problem in treating all sorts of mental problems with homeopathic medications because you know there's no opposition even between the mind gross mind and the sorry the you know the defined mind and the gross body as such because all of the medications really work on the mind and you know this what they call the vital force which is this again sort of very old homeopathic concept from Hanuman but you know having all sorts of really interesting connotations in the history of medicine there in in Germany but anyhow it's something that they don't have a fear of treating anything so as one of the doctors who is a very very prominent homeopath and who has a role in shaping national policies also in in Delhi on homeopathy he was like in an interview with me he was like you look homeopathy can treat the ill effects of pollution there's a child not learning well in school and there's a husband who is an alcoholic you know whatever it is we've got some kind of treatment for it there's no boundary for what homeopathy can do and there's really interesting just to kind of touch on and highlight the recurring theme of time and temporality is right there's just really interesting discussion in this chapter where you are taking on something that you just mentioned a little bit earlier this idea of that kind of the the long time that it can take for homeopathic therapies to work right relative to allopathic medicines and therapies and the ways that doctors are managing patient expectations while at the same time staying true to what they feel are the efficacious you know results of this long-term very subtle homeopathic therapy and you talk about their use of placebos as a way to manage patient expectations and also administer drugs in a way that is attentive to these very different temporalities and ways of experiencing the body and time that patients are coming to them with and that have to accord with the therapeutic effects of these drugs so again placebos and the kind of bodies and time are really really interesting aspects of what's happening in this chapter for listeners who are specifically looking for discussions of that kind of issue now as we move through the book you know of course there's a lot more about homeopathy that we can talk about it's a fascinating chapter but you know there's also another chapter that comes after this that takes us into yet again another aspect of this medical landscape and medical marketplace that patients are navigating as they are dealing with the engagement between food medicine and psychology in the mind and that is psychiatry so chapter four takes us into the ways that calcutta psychiatrists are positioning themselves with respect to popular beliefs about psychopharmaceuticals general physicians practitioners of non-biomedical treatments and the pharmaceutical industry so this is taking us right back to the beginning in a way where we were first introduced to this doctor Roy at the beginning of the book who's using this metaphor of mind food to explain pharmaceuticals and now that we've learned about you know the other aspect of the landscape that he is helping his patients navigate by using this kind of metaphor now we can come back to that case and the overall context in which he's working and really understand it in a new way so you've already and we've already talked a little bit about some of the things that are happening in this part of the book right the pharmaceutical industry in india um you talk here in this book as well about the ways that pharmaceutical corporations are working to shape popular notions of depression in order to market and to sell pharmaceuticals so there's a really interesting discussion of that in this chapter but to bring us back to this overarching theme that is you know really throughout the book the connection between the food the belly the stomach and the mind let's talk a little bit about that point of intersection as it manifests here and here you talk about something called Bengali bowel obsession right so this is something that you introduced to us as a way of helping us understand the kind of the centrality of the bowels the centrality of the belly and of digestion two patients who are coming to psychiatrists like dr roy and others um and sort of the ways that these calcutta doctors are dealing with that language those expectations when they're trying to help patients deal with and treat um mental health issues so let's talk about that Bengali bowel obsession and the ways um for you that are most interesting for these doctors to navigate the somatic the belly and the mind what do you find most interesting about what's going on here well again it's the doctors basically uh and the psychiatrists are basically saying exactly the same as all of the other I also did research on other forms of uh you know other fields of biomidicin including castranterology in uh calcutta and uh there's this very general notion that basically all of the biomedical doctors have of the Bengali patients being so incredibly bowel obsessed and basically that's just their way of making sense of you know this this focus on digestion that we talked about so much um so far already so for them it's just like this weirdly uh traditional long standing um focus on the bowels and on food and digestion is sort of what makes uh what is so typical for them for the Bengali patient and like they had endless examples of how uh patients would come into their practice and then sort of when they had a very clear case of something that was uh psychiatric problem or uh some other maybe physical problem but it was always that uh ultimately it had to be in the mind of the patients it had to be um to do had to do with uh digestion and and how basically the doctors are trying to make sense of that themselves and also how um you know they then as as psychiatrists had to deal with that on a daily basis so uh you know making fun of it was a large part of that or also another psychiatrist sort of saying uh you know like you know whenever a patient starts again with uh their belly this and their belly that or um there's another very common expression um which is gas so there's this notion of gas somehow traveling all over the body and it kind of gas goes up uh to your brain and puts pressure on your brain and that's where you get the headaches from or the gas is doing something else and that sort of makes you sad um that um you know the psychiatrist would just say you know if you even start with this you know i'm not gonna have any of that you know i'm uh just shut up on that i'm not gonna listen to you so you know it's trying to make sense of how this particular group of doctors who themselves of course are uh almost entirely Bengalis so something that they themselves have grown up with are in the making sense from why the patients are talking in that way and also this is of course very important for understanding then you know how they would deal creatively or deceptively or however you want to put it with these notions that the patients bring to them and how they have to or they feel they have to transform it in order to you know to get to the truth of what is going on and the truth in their mind is really that uh this particular patient does not suffer from some kind of digestive imbalance but this is a clear case of depression and if they give if they manage to give that antidepressant drug for example to the patient then uh this this whole uh bowel case will just clear up as if by magic. Now we've already talked a little bit about um the use of metaphor here right so I won't bring that up again in any detail except to just mention that in addition to this idea of mind food and to likening um psych psychopharmaceuticals to nutritional supplements right the likening um the kind of supplementary use of psychopharmaceuticals to diabetes to insulin you also describe other kinds of metaphorical um means of management here and that includes comparisons to nature to the Ganges River to fairy tales to every day over the counter drugs now you you know kind of managing patient worries and whether you you've mentioned sort of you might call this deception you might call it something else well the book does take a position on this right and as we come to the end of the book we come to a really useful discussion of some of the ethical consequences of this now you start the book telling us straight up um explicitly that the book is written from a position of doubt about psychopharmaceuticals and as we come to the end of the book we come to a very straightforward um very frank discussion of some of the consequences of this behavior right um so we've talked already a little bit about this um but I just want to kind of ask you as we come to the conclusion here um if you'd like to talk a little bit more about it right this use of metaphor um is in a way that you describe it um in the conclusion a kind of deception you call uh Indian doctors who call psychopharmaceuticals mind food um or a moncaba right plain liars potentially and talk about the dangers here of as you call it fudging the difference between self-care and the commodification of health in the form of biomedical drug taking so there is a kind of position right an ethical position that the it we see it seems to me that the final chapter is taking so can you talk about that a little bit for you what are some of the most important lessons that we might take um from this positioning and from this study in terms of understanding how to move forward um and what the consequences of that might be well yeah I mean what I always had huge problems with um the whole time I was uh studying uh things in India is this generalized assumption of the doctors that patients are steeped in superstition and uneducated so it's something that pops up almost everywhere also where I would think that you know if you just did the proper ethnographic study in it you would see that the patients for example when they come to a psychiatrist uh and that they would present something like the belly aches as as a key uh problem rather than saying oh I'm sad or focusing on on on their moods or on emotions that that's not from a position of uh of a lack of education or being some kind of country bumpkins who cannot express themselves but uh you know if you would delve deeper in it you would see that you know why the patients have this idea that surely a biomedical doctor will not be interested in listening to them talk about moods and of course they could do it and all of these things so this is generalized since among the doctors that I found very problematic that the patients are somehow you know just illiterate and and uneducated and they're taking this notion also to their patients understandings of of medications and somehow always assuming that they will not be able to understand there's no point in trying to explaining anything uh you're just running into all sorts of obstacles and so that the very best way is just to fudge it you know if it really if you even have to explain anything because most of the time the doctor would just write a prescription and not even bother to um explain anything about it and why you know this particular mind food uh metaphor you know on the one hand I think it's absolutely genius of the doctors uh to use it but at the same time it also creates a lot of uh potential problems and one of them is um about you know maybe creating in uh patients mind that yet this stuff is like food and as I uh also explain in in the book where um there's this very strong culture in just sharing medications in Calcutta for example so you would have uh there's a family meal and uh at the end of the meal um you would just have a basket of medications being uh passed around and uh you know these would be most of the time might be prescribed but very often they would just be not be prescribed they might have just been bought over the counter and then people would say oh try this you know for that and if you have a notion that where these drugs are just uh mind food then people might get started on drugs that uh you know are actually really really bad for them and they have even no idea this is actually one of the things that really also got me started with this study in the first place um which is you know I got going with this research on um for example floroxetine floroxetine is the you know the the sort of stuff name of uh the the active ingredient of uh prozac so it's that uh term so prozac is the brand name the u.s brand name and then in in india uh you know since it's all generic there's all proliferation of brand names and um but floroxetine is the substance so I kind of went to Calcutta and uh I met up with old friends and uh they asked me so great uh that you're back uh so what are you going to study uh this time and I said oh I'm really interested in um you know in these antidepressant drugs that I heard about from North America in particular oh okay so what's what kind of what what is that oh well there's one for example which is called floroxetine and then uh one of my friends said ah well you got this all wrong floroxetine that's not that's not an antidepressant I'm on floroxetine for the past five years um and uh I'm taking this but it has nothing to do with um depression and in his case it was that he went to a doctor and uh he said that um he often has problems sleeping through the night basically and uh the doctor just gave him this prescription for um floroxetine and he's been using this ever since and he was absolutely convinced that it absolutely has nothing to do with depression so there's there's basically millions of people running around in India who are actually prescribed with antidepressants of various kinds of pharmaceuticals and who don't even know anything about them they they they don't even know that what they are taking would generally be class psychopharmaceuticals now there's also a lot of arguments that you could make that really you know one should judge these drugs by what they do rather than by how they're classed and I take that on board as well so so that floroxetine might in the end actually not might be misclassified as an antidepressant and there's a very good argument that the whole notion of an anti-depress is actually misleading so I am I'm fine with that as well but still I have a huge problem with so many people in India being prescribed these drugs uh that are you know they've been diagnosed by a GP most of the time uh as having some kind of mental illness basically and they're taking these drugs and they don't even know about it and I think that when the psychiatrists are using this language of the monarchabar and and mind food that it's just sort of perpetuating that kind of notion of the illiterate patient and you know systematically keeping them in the dark about something that they should really know much more about so that's why I in the end of say well as ingenious as as it is that this is a very problematic thing and it would be probably much better if the patients would be taken more seriously and not that they were given any prescription that on the assumption that no one needs to explain it to them you know because they wouldn't understand it anyway and another irony in all of this is that no the way that the psychiatrists are advertising these drugs as as monarchabar as as food for the mind and rebalancing the mind and also you know the notion that they're having of what these drugs do in in the body are based on this idea that there is uh that there's um neurotransmitters and they're communicating with each other with these uh sorry that the neurotransmitters are the way that the brain communicates chemically between the synapses and that's what this drug prozac does is sort of the selective serotonin reuptake inhibitor so it kind of modulates the reuptake of these neurotransmitters in in the brain effectively and that's how it actually works when it's been proven more or less conclusively since the 1970s that this is not how the drugs work so the doctors are accusing the patients of being kind of uneducated and at the same time they're perpetuating a model of the drug effects which in the proper scientific literature is even distorted and I think that is also just highly programmatic. Great well Stefan thank you so much and I think it's probably very clear to listeners that a lot of what you just said and the kinds of concerns raised by these assumptions and these problematic equations are very much applicable writer or instructive for us to keep in mind as we think well beyond the case of these doctors in Calcutta and sort of more broadly to the environment we're all living and working and making our choices about what to put into our bodies and how to think about metaphorize our bodies in right so Stefan there's a ton of material that we haven't had a chance to talk about right the book is exceptionally rich and we only just scratched the surface but given that is there anything in particular that you'd like to mention for listeners that we didn't have a chance to talk about? Well I would like to you know generally I think what would be important to me is to find ways also of making ethnographic work more relevant to policy interventions as well and one of the things that I've been frustrated by for many years now is for example how the entire strategy of the World Health Organization when it comes to global mental health is also you know based on a lot of assumptions that are not necessarily based on the actual research in the localities where all of these policies are then supposed to be applied and you know one of the big things that I've been trying to bring out is for example that you know this image of India as a place where no one is really using these drugs or that's that there's this huge treatment gap as the WHO calls it that's you know what the Indians and everyone else in the developing countries are really suffering from is this lack of proper treatment and in my opinion you know this is based on a real oversight of just how much is going on in the private sector entirely off the radar of the WHO and in you know just how incredibly widespread these psychopharmaceuticals actually are and they're not being used necessarily in the government sector that's true but they're being used by all sorts of private practitioners and you know to see policies being formulated on the assumption that surely we need to basically bring antidepressants to India just seems to be so wrong headed to me and it's this kind of thing about you know what can you contribute as an anthropologist and of course you know in my engagements with people from that side you know you often hear oh well it's also interesting what you found in Calcutta but it's still just anecdotal evidence isn't it so it's does it really count and I think that you know I hope that a book really that sort of shows all the nuances and how the drug manufacturing interacts with distribution with how people's understandings are based on that the impact of marketing all of these things actually come together to create something that you know you can't really call that anecdotal although so much of what you know so the individual bits of them of course there are anecdotes but you know I think and I hope that the sum is uh is greater than the the parts of it isn't that interesting itself sort of thinking about how we describe metaphorically or not phenomena more broadly and like as we call certain ways of making an argument anecdotal you know that sets up a particular kind of expectation whereas you know I think more and more where we are right now as people who study things and try to understand things broadly is you know we've moved away from haven't we any kind of assumption that of you know kind of universal explanations and universal knowledge and comprehensiveness and toward more of a model of curation and juxtaposition and constellation and sort of moments and you know as a way to understand and sort of generate arguments and so if you call it anecdotal it seems like well and it's it's merely anecdotal whereas if you call it you know something else like moments and episodes that are illustrative of a larger phenomenon it's you know you're describing the same thing but just the terms that you use have set up very different expectations so I think the insight um is what I'm saying the insight that you're bringing to the use of and the description of pharmaceuticals psychopharmaceutical drugs is an insight that we can extend more broadly to understand even how work like this is discussed and what the consequences of that are so speaking of work like this now that the book is out and congratulations and I've kept you way too long to talk up and thank you for your time but can you say just a little bit about what you're working on now now that the book is out what's currently inspiring you and what's next for you? Well I've just completed field work for a new project which I'm doing with colleagues from the University of Chicago and that's on basically the rollout of various kinds of health insurance schemes in India so so far you've had basically just the opposition of the government sector on the one hand and private sector hospitals on the other and middle class and richer people abandoning more or less the government sector and if you can pay for quality health care in the private sector basically you do it and the choice that poorer people have is basically either you're going to go for the government sector or you also pay out of pocket for private health care which then made a lot of families fall into poverty and creating an awful lot of financial problems so what has started to change the landscape in India quite a bit now is the rollout of these schemes which allow people to go to private hospitals and get the money covered by you know to up to a certain point by these schemes which are ultimately paid by the government so the government almost sort of saying well we realize that the government hospitals are not doing everything that they're supposed to do and we recognize that often there's better care to be had in the private sector and we are supporting that and it's very fascinating but also extremely paradoxical situation that's emerging and I've just been really interested in all the problems also that are emerging from this so for example that the schemes would pay a good amount of the costs that people are incurring but when they go to a hospital there's a lot of other costs that are not covered by the schemes and so you know part of the whole in the idea of making people to go to a private hospital without falling into debt and without incurring huge financial expenses is sort of almost annihilated by you know all of these hidden costs that people didn't realize would come their way when they would actually go to a private hospital so that's one project that I'm more or less finishing off and another project that I'm preparing for is really taking this whole interest in psychiatry back to Germany and because I realized that which is and and you as a historian might be really fascinated by this as well there's you know in the history of psychiatry Germany has a very prominent place and some of the founding people like Emil Trepeline and Grazinger and so on the you know it's sort of the emergence of modern psychiatry is often very much sort of seen as somewhere in in Germany or definitely that it had a major major role to play and so in the history of psychiatry Germany has this this very prominent role and at the same time there's absolutely no current social science research on the practice of psychiatry in Germany whatsoever I mean it is absolutely astounding and I only realized this just recently you know when I was going on about how little has been written about psychiatric practices in India you know and oh there's only two articles this and that you know and to actually realize how incredibly little there is on Germany was was a real shock and at the same time I thought oh this surely someone has to do something about that and I think one of the attractions also of thinking about doing a project in Germany is you know we talk so much about metaphor and you know I want to be able to push this work with language at the subtleties of expressing yourself even further and I think that I'll be able to do this much better when I'm in Germany and German is my mother tongue and I think I'll and I hope that I'll be able to do certain things in the research also drawing on archival sources and doing a little bit of historical work if you want that wouldn't be you know would be far harder for me to do that in Bengali where in the language that worked them so far so that's the kind of next project that I have in mind well best of luck with that work both of those projects and awesome I'll look forward to reading them and thank you again so much Stefan for making time to talk with me today I really appreciated it thank you Karla it was an absolute pleasure being on your show you've been listening to new books in science technology and society thanks very much for joining us and we'll see you next time [BLANK_AUDIO]
Drugs exist that are meant to help people feel better. The doctors who prescribe them might believe that they work, while their patients do not. In explaining the drugs to their patients, should those doctors use the medical terminology they themselves use – which might not be immediately understandable to their patients – or should they translate the description into terms more comfortable and familiar to the patient? And what are the practical and ethical consequences of each decision? Stefan Ecks‘ new book carefully considers these problems in the context of health-related practices in modern Calcutta. Eating Drugs: Psychopharmaceutical Pluralism in India (NYU Press, 2013) looks successively at the different and overlapping medical and healing contexts that together make up a significant part of the medical marketplace in Calcutta. Ch. 1 treats popular notions that include the importance of the belly as the “somatic center of good health,” the power of the mind to regulate good health, and the connection between modernity and pollution as causes of illness. Ch. 2 looks at Ayurvedic practices in Calcutta. It reflects on some of the most important ways that Ayurveda is changing in India – especially at the levels of practitioner training, language, and the patient-physician relationship – despite the fact that the centrality of food and digestion has remained constant. Ch. 3 looks closely at homeopathy, the second most popular type of medicine in Bengal, and focuses on the principles, histories, and pluralities of homeopathic practices in Calcutta. Ch. 4 looks at the ways that Calcutta psychiatrists position themselves with respect to popular beliefs about psychopharmaceuticals, general physicians, practitioners of non-biomedical treatments, and the pharmaceutical industry. This chapter pays special attention to how Bengali doctors use metaphors to help patients understand and respond to psychiatric diagnoses, with comparisons to nature, the Ganges river, fairytales, everyday over-the-counter drugs, diabetes, and food. The conclusion explores a key argument of the book, proposing that “patients’ suspicions of psychopharmaceuticals are based on suspicions of biomedicine’s ‘magic bullet’ model of drug effects,” looking at the implications of this conclusion, and considering the possible broader impacts of this study beyond Calcutta. It’s a fascinating study of potential interest to historians and anthropologists of medicine and healing, as well as readers interested in learning more about the medical marketplace of modern India and anyone interested in modern psychopharmaceuticals.
Learn more about your ad choices. Visit megaphone.fm/adchoices
Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery
