Ecologies of Suffering: Mental Health in India

This paper calls for a framework linking what happens in the “clinic” to wider ecological forces, both material and social. The aim is to enhance a crucial, yet neglected, aspect of India’s National Mental Health Programme: that individual mental suffering is related to a wide range of local factors. The current India National Mental Health Policy, both radical and holistic (NHMP 2014) requires a cross-disciplinary approach to reinvigorate theory to bridge the gap between policy makers and practice (Jain and Jadhav, 2009). To ensure congruency between mental health policy and practice, a framework is required which integrates ecological, economic and social sciences as applied to mental health.
The paper proposes an “ecology of suffering” (conceptualised as vectors, pathways or forces), which mediate between the sufferer and the “clinic”. Suffering is complexly inter-related with the outside world. Each person’s suffering occurs within a specific “ecology”, a network of interrelated forces with variable directionality. The term “ecology”' refers to the network of forces acting on and by the people suffering and those around him and her. It is chosen to stress the mix of “natural”, and “social” such as landscapes or air pollution. The term, “the clinic”, refers to what happens locally between the sufferer and mental health professionals attempting to actualise the National Mental Health Policy. The centre of any framework for India mental health, particularly in rural areas, needs to map and link the relation between locally specific forces, national politics, and international social and political forces; the so-called Local/Global dynamic. A map, or set of relationships will facilitate linkage between a policy decision and those forces identified by the “clinic” which profoundly affect the sufferers. The hope is that once the forces are named, and the ecology of local suffering drawn, policy making can address local and more concrete aspects of suffering. In the following section of the paper, we describe three case studies linking clinically applied anthropology with local ecologies of suffering. We will first document what such factors are, how they play out, and the bearings they have upon mental health delivery. In the last section, we sketch out the broad parameters of what might an “ecology of suffering” entail, and its implication for theorizing and delivering culturally responsive mental health care.