Sree Lekshmi M S emphasises the position of literary research in essential medical humanities by analyzing the intersection of psychological sickness and substance use in Indian psychological well being memoirs.
Literary research within the essential medical humanities fosters an attentive engagement with the messiness of sickness and life’s prospects. As Angela Woods and James Rákóczi (2024, 374) argue: “What literary research provides” to the essential medical humanities is a “high quality ear for messiness and contradictions” which indicators a departure from any simple notions of affected person tales as therapeutic and guarantees to “attune” to sickness and life’s prospects extra totally and attentively. This turns into significantly important when analysing the intricate points on the intersections of psychological well being situations, societal perceptions, and authorized frameworks. At this intersection, the complexities of lived experiences typically defy linear narratives or reductionist interpretations, necessitating a framework that may interact with contradictions and ambiguities. By means of “using literature as a self-discipline, the follow of (literary) criticism and the epistemology of the textual content” (Woods and Rákóczi 2024, 359), literary research delves into the affective and symbolic dimensions of healthcare experiences, uncovering complexities ignored by conventional biomedical fashions and deepening understanding of how narratives, tradition, and medical methods form sickness.
My analysis, which is located on the intersection of psychological well being sufferers’ memoirs with the vocabularies of ache and care, engages with the “messiness and contradictions” of sickness narratives to research the layered experiences of people with bipolar dysfunction in India. By specializing in memoirs, I goal to discover the relationships between private narrative, cultural context, and medical discourse which are typically uncared for in biomedical frameworks. This interdisciplinary method led me to attend the Medical Humanities Worldwide Summer time College 2024, the place I sought to deepen my understanding of psychological well being’s social and cultural dimensions.
The summer time faculty strongly emphasised interdisciplinary collaboration, bridging the humanities, social sciences, scientific follow, and biomedicine. By means of discussions on the theoretical and sensible situations of interdisciplinary analysis, the epistemological challenges and problems with subjectivity and objectivity in medical humanities, I gained a extra profound understanding of how literary research can contribute to this area. The course literature additional enriched this studying, with Woods and Rákóczi’s (2024) work, specifically, illuminating how literary research within the essential medical humanities offers an interpretive toolbox that fosters emergent, context-sensitive considering in collaborative well being analysis. By contrasting the reflective depth of literary strategies with the urgency of scientific and scientific work, this work underscores literature’s potential to mediate, subvert, and enrich interdisciplinary well being conversations.
Following Woods and Rákóczi’s (2024) method, I flip now to a detailed studying of two excerpts from Shreevatsa Nevatia’s memoir, The way to Journey Mild: My Recollections of Insanity and Melancholia (2017), to discover the complicated intersection of psychological sickness and substance use in India. By partaking with the textual content’s nuanced portrayal of psychological sickness, I goal to exhibit how literature, with its attentiveness to complexity, can deepen our understanding of psychological well being narratives and reveal the layered dimensions of those experiences.
Psychological sickness and substance (mis)use in India
In its definition of psychological sickness, the Psychological Healthcare Act 2017 consists of “psychological situations related to the abuse of alcohol and medicines” (Psychological Healthcare Act 2017, 7). This inclusion of alcohol and drug use within the state’s definition of psychological sickness raises complicated questions on dependancy and its therapy in India. As an illustration, does the Indian state view substance use as a trigger or consequence of psychological well being situations? How does this ambiguity form psychological well being therapy, particularly in institutional settings the place dependancy and psychological sickness typically overlap? Mohan and Math (2019) level out that whereas the Act acknowledges psychological well being situations related to substance use, it leaves essential facets underdeveloped. The Act doesn’t make clear whether or not all circumstances of substance use needs to be handled as psychological sickness or if sure thresholds should be met (Rao et al. 2019). This ambiguity in defining the directionality of the affiliation between psychological well being situations and substance use impacts how dependancy is addressed in psychological well being establishments, the place specialist therapy is usually required. Moreover, the overlap between dependancy and different psychological well being situations and the dearth of a transparent definition for phrases like “abuse” raises questions on how the Act’s provisions for psychological sickness apply to circumstances of substance dependence, complicating the rights and therapy of these affected.
Amidst the paradox of the authorized framework in defining the hyperlink between psychological sickness and substance use, narratives by people with psychological well being situations supply a beneficial lens by way of which to discover the complexity of those overlapping situations. Essential readings of those narratives assist unravel the nuances of those intertwined points. This underscores the necessity for an interdisciplinary method to well being and healthcare, which entails “admitting biases and difficult authorising discourses which have restricted our understandings …” (Viney et al. 2015, 3). Memoirs of sufferers admitted to psychological well being establishments typically reveal the conflicts and confusion that come up from the intersection of psychological sickness and substance use.
Memoirs as home windows into private expertise
The day I used to be assigned a psychotherapist, I attempted laborious to clarify to her that an emotional turbulence had typically pressured me again to marijuana. Internment, she jogged my memory, was the consequence of that motion. The medicines I used to be being administered have been sufficient to sort out my bipolarity. Medicine have been proof of volition. I used to be damnable as a result of I had surrendered to temptation. (Nevatia 2017, 19)
This excerpt from Shreevatsa Nevatia’s memoir, The way to Journey Mild: My Recollections of Insanity and Melancholia (2017), displays the intersection of psychological sickness, substance use, and psychiatric therapy, revealing the layered tensions between affected person expertise and medical authority. As Seng (2012) notes, folks affected by critical psychological sickness and substance use issues are an oppressed and marginalised inhabitants, typically ignored or misunderstood in each societal and medical frameworks. Right here, Nevatia’s use of the time period “emotional turbulence” conveys a way of chaos and desperation, suggesting that marijuana was not leisure however a coping mechanism for his psychological state.
Furthermore, there exists a comorbidity between drug use and psychological sickness, reflecting “each a excessive danger for drug use in topics with psychological sickness and a excessive frequency of psychopathology triggered by drug use” (Volkow 2001, 1181). Nevatia’s notion of being “pressured […] again” suggests compulsion relatively than alternative, revealing an absence of volition. This units the stage for a essential confrontation between affected person narrative and psychiatric discourse. Baumeister and Nadal (2017, 192) determine that dependancy, particularly regarding substance use, “entails a mixture of wanting, liking, and doing, every of which contributes to the pull to proceed indulging.” Additionally, “sure events, akin to being beneath stress, might cut back one’s capability to withstand the behavior or want whereas additionally growing the enchantment of the now-forbidden pleasure.” Such stress mirrors Nevatia’s emotional turbulence, which serves as each a set off and a consequence of drug misuse.
The psychotherapist’s response, within the excerpt, is stark and authoritative. “Internment”—a time period evoking imprisonment or pressured confinement—marks a pivotal second the place the affected person’s behaviour is pathologised and criminalised. By stating this because the “consequence of that motion,” the therapist reduces Nevatia’s complicated emotional struggles to a simplistic cause-and-effect state of affairs, framing substance use solely as a alternative warranting punishment. Using the verb “reminded” implies an undeniable fact, reinforcing an influence dynamic the place institutional guidelines override the affected person’s subjective experiences. This response underscores the punitive nature of psychological well being care, the place substance use is conflated with deviant behaviour necessitating management (Bennet et al. 2009; Shadakshari et al. 2021). Emotional turbulence, central to Nevatia’s account, is ignored, devalued, and subsumed beneath the label of wrongdoing. Habit, relatively than being handled as a symptom of deeper psychological misery, is framed as a behavioural flaw. Moreover, the psychotherapist’s emphasis on “medicines” highlights the dominance of the biomedical mannequin in psychological well being care. This inflexible deal with pharmacological options sidelines the affected person’s lived experiences and limits the therapeutic method to a narrowly outlined framework, ignoring the complexities of psychological sickness and dependancy.
On this excerpt, Nevatia’s consumption of “medication” (marijuana) is framed by the psychotherapist as a volitional act, disregarding the chance that he could also be utilizing it as a type of self-medication to deal with overwhelming emotional misery. By lowering substance use to a matter of alternative, the psychotherapist overlooks the complexities of dependancy, the place compulsion typically outweighs free will. Inside a biomedical framework, Nevatia exemplifies what Brüggemann (2020, 575) describes as a “tough affected person,” rising from the “misfits” between dominant medical logics and the person wants and lives of sufferers. In Nevatia’s case, his use of marijuana as a self-medication technique, regardless of the prescribed psychiatric treatment, locations him in opposition to institutional expectations. Psychological well being frameworks in India, as mirrored within the Psychological Healthcare Act 2017, are likely to compartmentalise psychological sickness and substance use, failing to account for the nuances of particular person lived experiences. This inflexible method typically results in the marginalisation of sufferers who defy the clear-cut classes set by biomedicine, rendering them “tough” inside institutional settings.
The extreme stigma and marginalisation related to drug misuse amongst psychological well being sufferers typically result in profound emotions of guilt inside this inhabitants (Room 2001). Nevatia’s use of the phrase “damnable” carries the burden of guilt and punishment, echoing the societal stigma surrounding each psychological sickness and substance use. The phrasing evokes a way of failure—falling prey to a “temptation” harking back to sin or weak point. The affected person feels damnable, not simply because they used marijuana, however as a result of they “surrendered,” implying weak point within the face of emotional misery. This echoes the psychotherapist’s earlier framing of the affected person’s substance use as an act of volition, revealing how deeply the affected person has internalised the institutional message that their use of marijuana will not be solely a private failing however an ethical one. This excerpt from Nevatia’s sickness memoir exhibits the fraught dynamics between affected person company and psychiatric authority. Revealing the internalisation of guilt and the moralising tone of medical discourse, Nevatia exposes the deeper emotional and psychological toll on sufferers who’re left navigating the stigmatisation of each their psychological well being situation and their coping mechanisms.
Nevatia’s experiences with substance use additionally reveal a contradictory perspective, voicing the inherent complexities inside sickness narratives. Reflecting on his struggles elsewhere within the textual content, he notes, “Unable to deal with the pressures of labor, and with marijuana exaggerating the volatility of chemical compounds in my mind, I had once more grow to be conversant in the aggression of mania” (Nevatia 2017, 96). Right here, Nevatia gives a self-reflective account of navigating bipolar dysfunction and substance use, the place the “volatility” of his psychological state is formed by the interplay of exterior pressures and inside chemical imbalances. Marijuana will not be depicted as a mere indulgence; relatively, it exacerbates his situation, including layers to his narrative of psychological sickness, intertwined with substance use. Consistent with Woods and Rákóczi’s (2024, 374) aforementioned argument, this narrative resists the notion of an easy restoration, as an alternative embracing the “messiness and contradictions” of sickness. Nevatia’s portrayal underscores the twin position of marijuana—as each a coping mechanism and a set off that intensifies his signs—capturing the challenges of managing his psychological well being.
This pressure between self-medication, emotional misery, and psychiatric therapy complicates any reductive interpretations of his behaviour. Nevatia’s memoir disrupts the notion that affected person narratives ought to conform to a therapeutic arc or simple restoration. As an alternative, it presents a actuality whereby emotional misery and substance use are tightly interwoven, resisting straightforward categorisation. This complexity underscores the significance, as highlighted by Woods and Rákóczi (2024), Billington (2016), and Felski (2011), of attuning to the lived experiences contained in sickness tales. By specializing in the symbolic and affective dimensions of sickness, literary research, throughout the essential medical humanities, gives a beneficial framework for understanding Nevatia’s experiences, with out lowering them to ethical judgments or simplistic biomedical explanations.
Conclusion
The intersection of psychological sickness and substance use, as revealed by way of Indian psychological well being memoirs like Shreevatsa Nevatia’s The way to Journey Mild, underscores the complicated realities of residing with psychological well being situations. Nevatia’s narrative exposes the tensions between self-medication, emotional turbulence, and the inflexible frameworks of psychiatric care, the place dependancy is usually framed as an ethical failure relatively than a coping mechanism born of misery. The memoir challenges the biomedical compartmentalisation of psychological sickness and substance use, highlighting the restrictions of purely pharmacological approaches. Nevatia’s account, wealthy in contradictions and emotional depth, mirrors the “messiness” that Woods and Rákóczi (2024) argue is inherent in sickness narratives. This messiness, removed from being a flaw, invitations a extra thorough and compassionate understanding of affected person experiences that resists reductionist interpretations. By means of the shut studying methods of literary research, and the appliance of a essential medical humanities lens, these memoirs open up an area for interdisciplinary inquiry that acknowledges the complicated interaction of psychological well being situations, cultural stigma, and private company, urging a re-evaluation of how each psychological sickness and substance use are understood and handled throughout the Indian healthcare system.
Concerning the writer
Sree Lekshmi M S is a second-year doctoral candidate (English) working with Dr Aratrika Das within the College of Humanities and Social Sciences, Indian Institute of Know-how, Indore. Her analysis focuses on the intersection of psychological well being memoirs with vocabularies of ache and care throughout the context of India. Her work has been revealed in Literature Compass, Financial and Political Weekly and The Polyphony: Conversations throughout the Medical Humanities.
References
Baumeister, Roy F., and Amber Cazzell Nadal. 2017. “Habit: Motivation, motion management, and habits of delight.” Motivation Science 3 (3): 179–95. https://doi.org/10.1037/mot0000069.
Bennett, Trevor, and Katy Holloway. 2009. “The causal connection between drug misuse and crime.” The British Journal of Criminology 49: 513–31.
Billington, Josie. 2016. Is Literature Wholesome? Oxford: Oxford College Press.
Felski, Rita. 2011. Makes use of of Literature. New York: John Wiley & Sons.
Brüggemann, Jelmer, Lisa Guntram, and Ann-Charlotte Nedlund. 2023. “The ‘Troublesome Affected person’: Dominant Logics and Misfits.” In Handbook of Social Sciences and International Public Well being, edited by Pranee Liamputtong, 1–14. Cham, Switzerland: Springer Nature.
Ministry of Legislation and Justice. 2017. “The Psychological Healthcare Act, 2017.” The Gazette of India, Extraordinary Half II, Part I, No. 10. New Delhi: Authorities of India Press. https://www.indiacode.nic.in/bitstream/123456789/2249/1/A2017-10.pdf.
Mohan, Ashwin, and Suresh Bada Math. 2019. “Psychological Healthcare Act 2017: Affect on dependancy and dependancy companies.” Indian Journal of Psychiatry 61 (Suppl 4): S744–49. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_114_19.
Nevatia, Shreevatsa. 2017. The way to Journey Mild: My Recollections of Insanity and Melancholia. Haryana: Penguin Random Home India.
Rao, Ravindra, Mohit Varshney, Shalini Singh, Alok Agrawal, and Atul Ambekar. 2019. “Psychological Healthcare Act, 2017, and dependancy therapy: Potential pitfalls and trepidations.” Indian Journal of Psychiatry 61 (2): 208–12. https://doi.org/https://doi.org/10.4103/psychiatry.IndianJPsychiatry_463_18.
Room, Robin, Jürgen Rehm, Robert T. Trotter, Angela Paglia, and T. Beirhan Üstün. 2001. “Cross-Cultural Views on Stigma, Valuation, Parity and Societal Values In the direction of Incapacity.” In Incapacity and Tradition: Universalism and Range, edited by T. Beirhan Üstün, Somnath Chatterji, Jerome E. Bickenbach, Robert T. Trotter II, Robin Room, Jürgen Rehm, and Shekahr Saxena, 247–91. Seattle, WA: Hogrefe & Huber.
Seng, Julia S., William D. Lopez, Mickey Sperlich, Lydia Hamama, and Caroline D. Reed Meldrum. 2012. “Marginalized identities, discrimination burden, and psychological well being: Empirical exploration of an interpersonal-level method to modeling intersectionality.” Social Science & Medication 75 (12): 2437–45. https://doi.org/10.1016/j.socscimed.2012.09.023.
Shadakshari, Darshan, Bhavika Vajawat, Barikar C. Malathesh, Dinakaran Damodharan, Guru S. Gowda, Seshagiri D. V., Channaveerachari Naveen Kumar, and Suresh Bada Math. 2021. “The Interface of Medical, Authorized, and Rehabilitative Facets of Sufferers with a Neuropsychiatric Dysfunction in Forensic Psychiatry Setting in India: A Systematic Method.” Indian Journal of Psychological Medication 44 (6): 607–11. https://doi.org/10.1177/02537176211008564.
Viney, William, Felicity Callard, and Angela Woods. 2015. “Essential medical humanities: embracing entanglement, taking dangers.” Medical Humanities 41 (1): 2–7. https://doi.org/10.1136/medhum-2015-010692.
Volkow, Nora D. 2001. “Drug Abuse and Psychological Sickness: Progress in Understanding Comorbidity.” American Journal of Psychiatry, 158 (8): 1181–83. https://doi.org/10.1176/appi.ajp.158.8.1181.
Woods, Angela, and James Rákóczi. 2024. “Literature in Collaboration: The Work of Literature within the Essential Medical Humanities.” In Literature and Medication, edited by Anna Magdalena Elsner and Monika Pietrzak-Franger, 357–74. Cambridge College Press. https://doi.org/10.1017/9781009300070.025.
