The slippery and the sane: Decolonizing psychology through a study of the Indian girl-child

Priorities and problems of the MGMH

The Psy-disciplines, birthed in the Euro-American culture, are far from being a homogenous entity. Psychology itself is a deeply fragmented discipline with numerous schools of thought and hundreds of treatment approaches (Goldfried, 2019). Despite the internal conflict, what ties this discipline together as a coherent entity are its effects. Thus, while Euro-American Psychology as a discipline is heterogeneous, it helps in the creation of subjects who prioritize interiority, fetishize happiness (Teo, 2018), pathologize conflict (Dutta, 2018), and individualize suffering (Mills & Fernando, 2014). As everyday life becomes psychologized, the discipline’s most prevalent effect has been management of our thoughts and emotions in accordance with its underlying neoliberal ethics (Bhatia & Priya, 2018). Resultantly, like good neoliberal subjects, the subjects of Psychology chase well-being through productivity while historically problematizing idleness.

A child of this discipline, the MGMH claims that LMICs lack the human, technological, and financial resources to fight the battle against mental illness. This recognition often conflates mental distress with brain disease; despite its lip-service to sociological issues, it considers psycho-pharmaceuticals essential to treatment in these regions (Cohen et al., 2014). These priorities and prescriptions are oblivious to the critiques that Psychology is facing in the Global North itself: from accusations of spin in reporting of randomized control trials (Jellison et al., 2019) to concerns regarding the replication crisis where some of Psychology’s classic experiments failed to reproduce original results (Moshontz et al., 2018). The latter is a deadly blow to any science. A large replicability test (Camerer et al., 2018) of social science experiments published in respectable journals like Nature and Science between 2010 to 2015 “found significant effect in the same direction as the original study for 13 (62%) studies” (p. 637) while the effect size of the replications turned out to be only 50 percent of the original. Researchers in the Global North are beginning to pay attention to these calls for caution, for example, as the dangers of over-diagnosis and over-treatment are recognized (Mangin & Garfinkel, 2019), and there is a push to de-emphasize polypharmacy, now being called an iatrogenic epidemic. Additionally, the vast extent of industry influence on the healthcare sector is receiving rightful scrutiny as researchers expose the pharmaceutical industry’s reach over research, practice, and education (Moynihan et al., 2019). Psychiatry is especially under fire; there is a high correlation between psychiatric drugs and reduced life expectancy (Bracken et. al., 2012) and a meta-scientific review recently showed that the evidence underlying evidence-based treatments is not rigorous or consistent (Sakaluk, Williams, Kilshaw, & Rhyner, 2019). The attacks on the discipline are unrelenting, which is something most proponents of the MGMH have opted to ignore.

Some voices from the MGMH concede that studying cultural variability is important, just not important enough to delay responses towards what they consider an extensive need of the people in LMICs (Cohen et al., 2014). This urgency is evident in the inclusion of mental health in the United Nation’s Sustainable Development Goals. Problematizing this hurried inclusion, Lehmann (2019) has argued that the means used to achieve these goals are self-conflicting – the goal of citizen well-being is impossible when the suggested psychotropic drugs are related to higher heart disease, less mobility, painful withdrawal, and higher mortality (Lehmann, 2019). Others have addressed the MGMH’s superficial interest in acknowledging cultural variability by scrutinizing the 2018 Lancet Commission on Global Mental Health and Sustainable Development report. This report urged the developed world to assist LMICs in reaching mental health goals set by the Global North, and thus closing the purported “treatment gap” using Western forms of knowledge and intervention (Cosgrove et al., 2019). Critics point to internal inconsistencies between the initial priorities of the report (focusing on social determinants of health) and its suggestions to accomplish them (by essentializing human distress as mental disorders) (Cosgrove et al., 2019).

Other critiques of Psychology’s globalization have scrutinized its neoliberal roots; they expose how the discipline replaces existing values, identities, and even forms of human distress. Bhatia and Priya (2018) write that in these neoliberal forms of selfhood “self-narratives are fashioned through neoliberal discourses about happiness, optimism, well-being, creativity, and corporate forms of globalization that often encourage employees to embrace the tenets of ‘positive psychology’ for maximizing their productivity and efficiency” (p. 649). Similarly, Cosgrove and Karter (2018) assert that neoliberalism extends beyond its economic boundaries to hijack epistemology and subjectivity, which are then defined by the priorities of a free market. The individual is understood to be an entrepreneurial agent responsible for his/her happiness and health, irrespective of the structural and societal challenges facing him/her. The successful export of neoliberal narratives of selfhood is seen in the prevalence of the mental illness model and economic model of selfhood which calculates human worth in terms of its productivity in the Global South (Bhatia & Priya, 2018). Using indexes such as Disability-Adjusted Life Year (DALY), the medical model, built upon neoliberal ethics, problematizes human suffering (especially depression) as a global economic burden. As a result, complex humanitarian crises like the Syrian refugee crisis are reduced to helping refugees by making them talk about their “depression” to Western counsellors (Cosgrove & Karter, 2018).

Ignoring these concerns, most proponents of the MGMH justify their initiatives by pointing to the detrimental effects of the stigma of mental illness in LMICs, stating that it interferes with care of those they deem ill. But they fail to consider that the stigma might be attached to a psychological diagnosis itself rather than the behaviors considered abnormal. This is supported by research that shows that stigma seems to increase once Psychology enters a geographical area, as seen in Turkey and Germany, and is not as prevalent in places where it has not established its roots (Watters, 2010). Researchers have showed that the “mental illness is like any other illness” approach tends to increase alienation and the punitive treatment of those considered sick (Mehta & Farina, 1997; Read et al., 2006), and it exacerbates assumptions about their otherness and dangerousness (Lebowitz & Appelbaum, 2019).

My research in rural Uttarakhand, India (Dhar, 2017), showed similar results. I studied the narratives of people responding to the prompt: “Have you, or anyone you know, heard voices or seen or felt things that other people around them don’t?” Everyone I met, without hesitation or shame, shared many personal stories psychologists would classify as mental disorders (psychosis, depression, mania). Instead of using Psychology’s language, the participants’ experiences were largely shaped by indigenous discourses and cultural stories involving deities, spirits, unhappy ancestors, and unruly desires. For example, one individual experienced “leg-lock”, a paralysis in one of his legs, every time he walked a certain trail in the mountains, and it took between two minutes to a couple of days for the paralysis to go away. While this could be classified as a psychosomatic symptom, he and his family attributed it to a woman’s unhappy spirit that walked on that trail. They understood this as something transient, as opposed to how mental illness is construed, and were nonchalant about it. It appears that stigma around mental illness is real and relevant, but often caused by the rhetoric of Psychology itself.

There are some proponents of the MGMH (Fisher et al., 2014) who have acknowledged the importance of structural and systemic problems of exploitation, discrimination, and poverty, especially in the field of women’s health. This is heartening, but these proponents forget that many of the Global North’s narratives have historically been the first to colonize women’s lives, as seen in the case of the sati practice (widow immolation) in colonial India. For British imperialists, protection of brown women’s bodies from brown men was an excuse for the civilizing mission (Spivak, 2010). Even Western feminism traditionally positioned and homogenized the third-world woman as an object (instead of a subject with agency) that was perpetually oppressed, ignorant, traditional, and backward (Mohanty, 1984). More recently, Adolfsson and Madsen (2019) found that, in rural Malawi, attempts by Non-Government Organizations (NGOs) from the Global North to introduce the concept of gender equality have backfired. NGO intervention caused further surveillance of the bodies of young girls, who then began to feel shame and feared the fiscal fine if they did not follow the standards of gender equality set by the NGOs (Adolfsson & Madsen, 2019).

Another example which reflects both the colonization of women’s bodies and indigenous discourses is the treatment of home-births in popular narratives. Studies have questioned the medicalization of birth which undermines the social mode of care (Luce et al., 2016) and criticized the skewed portrayal of mid-wives on American television (Kline, 2010), which shows women as incapable of giving birth without medical intervention. Non-medical practices are the constant targets of comical derision on television, as seen in the case of sit-coms like The Mindy Project, where white men co-opt forms of Eastern medicine, while the practices themselves are mocked. Many shows represent people opting for doulas as strange and irresponsible (Luce et al., 2016). In one sweep, many forms of indigenous knowledge are ridiculed, and women who dare to make alternative choices are shown as ignorant and dangerous.

Other proponents of the MGMH colonize women’s bodies with good intentions but flawed logic. They draw dubious causal inference from the positive correlation between post-Second World War improvement in maternal mortality in high-income countries and increased awareness of psychological effects of child-birth, and suggest further psycho-education and medicalization (Fisher et al., 2014). Thus, while there is a conversation around feminist issues of equality and mental health, the MGMH, by using the language of Psychology (“mental health”, “mental illness”, “disorders”), immediately limits what is said and what can be said about these concerns, in effect influencing what can be thought and done. The supporters of the MGMH might speak of structural violence and discrimination, thus attempting to assuage their feminist critics, but the words “major depression” or “bipolar disorder” point to organic dysfunction and not systemic changes or socio-cultural factors. This language inherently focuses on the interiority of an individual and conjures images of a broken person – whether in their brain or their psyche. The causal explanations it permits are neurotransmitter imbalance or childhood experiences, and it garbs the discipline in an aura of objectivity. This is problematic, especially since recent research undermines Psychology’s claims of objectivity by showing that diagnosis and treatment are both influenced by the socio-economic status, race, ethnicity, and gender of a patient (Diniz et al., 2020; Hansen, 2019).

These are the reasons that, while the MGMH is starting to pay attention to issues of poverty and exploitation, it still insists on therapy and psycho-pharmaceuticals as primary forms of interventions in LMICs. But feminist critiques now occupy more than just academic spaces; they claim that psychotherapy tends to individualize women rather than bring them together, and it focuses on what is wrong inside a person (concepts like “internalized misogyny”) as opposed to what can be collectively done outside her (Happonen, 2017). In adjusting herself to a situation, she forgets to ask if she should. These critiques are not new. Feminist therapists like Childs (1990) have scrutinized psychotherapy’s limitation when it comes to addressing the problems of women of color. Lerman and Porter (1990) have noted that the American Psychiatric Association’s code of ethics for therapists does not account for the realities of marginalized women (it is easy to prohibit overlapping relationships with the client but difficult to achieve this when you are a lesbian woman of color in a small town and you encounter the lone lesbian woman of color therapist at the pride parade). More harshly (and maybe aptly), McLellan (1999) has critiqued mainstream psychotherapy for prostituting itself to the values and agendas of the powerful and the dominant. All of them problematize psychotherapy’s, and by extension Psychology’s, obsession with the interior and its dismissal of external circumstances, and its prescription to adjust to those oppressive circumstances rather than bring change to them. Others contend that even feminist psychology has failed to sufficiently address the concept of socio-political power (Kitzinger, 1991) because the academic Psy-disciplines avoid the political in favor of the psychological (using “prejudice” vs “oppression”). Thus, Kitzinger notes that even when feminist psychology calls into focus the social and political, it overwhelmingly focuses on personal empowerment and change within the individual.

Decolonial responses to the MGMH

A powerful critique of the MGMH has come from decolonial theory. Just as some have asserted that neoliberalism captures people’s ways of being and thinking (Bhatia & Priya, 2018; Cosgrove & Karter, 2018), similarly, others contend that coloniality did not end with colonialism. According to Maldonado-Torres (2012), colonialism may have ended with achievement of self-governance in many Asian and African nations, but coloniality is a continued lived reality. It is a “matrix of knowledge, power, and being” (Maldonado-Torres, 2012, p. 2) which influences everything from labor relations to personal connections. Decolonization at its core is a form of resistance that subverts taken-for-granted ethical prescriptions and values. It involves re-structuring knowledge (and thus action and power relations) and re-analyzing our sense of aesthetics and spirituality (Maldonado-Torres, 2016). It aims to bring about an epistemic change that positions the colonized as not simply the victim but also a creator – a writer, a thinker, a questioner (Maldonado-Torres, 2016). Bulhan (2015) refers to this continuing coloniality as metacolonialism, defined as a contemporary form of colonialism which regulates the being, history, knowledge, thought, and behavior of the colonized people through its socio-political, cultural, and, most importantly, psychological systems.

To some readers, these emerging conversations around decolonization might appear to be a disciplinary trend. Metacolonialism’s ubiquity and insidiousness are imperceptible to most, including subjects of metacolonialism. A consequence of metacolonialism is what Santos (2015) calls epistemicides, “a murder of knowledge” (p. 92) caused by exploitative and unbalanced cultural exchanges leading to a demise of ways of knowing and, resultantly, a demise of the groups with that knowledge. More personally, I have witnessed metacolonialism in the colonized’s internalization of values through an occupation of language, causing a sense of inferiority and shame. My mother, who speaks three languages and understands four (including English), is shy while talking to my white American friends because she lacks fluency in the tongue of her colonizer, the British empire. The tongue of her colonizer and the color of his white skin have come to represent class and sophistication in India (a land of hundreds of languages), and fluency in English implies a moral and intellectual superiority. The colonization of my own mind is similarly evident. Recently, I found myself willing to discard a young Indian author’s article because I grew impatient with a few grammatical errors. As an Indian author writing about decolonization, I found myself willing to distrust a source because the author’s writing (in their second or third language), which was perfectly legible, had a few imperfections. Metacolonialism does not simply introduce self-doubt, which can be dealt with by a calming bath or a self-help book; it introduces a deep and insidious distrust of the ways of thinking of your people. These are the reasons why researchers across the globe have called for a re-structuring of knowledge, for example, decolonization of research (Teo, 2010), of social psychology in India (Sinha, 2016), and community psychology in the United States (Dutta, 2018).

More specifically, concerning the export of the bio-medical model of mental illness, the writings of Mills and Fernando (2014) and Davar (1999) have surveyed Psychology’s implicit assumptions and offered a scathing critique of its universalist ways of addressing human suffering. Mills and Fernando (2014) bring forth the underlying ethics of the MGMH, such as, essentializing mental health as an organic dysfunction. This conceptualization reduces socio-economic issues requiring systemic interventions into psychological problems to be resolved personally. Similarly, Bulhan (2015) points to the colonization of medicine and madness and contends that metacolonizers consider their forms of knowledge, which interiorize human distress, as scientific, and ignore the exploitative conditions of poverty they have created through globalization. Davar and Lokohare (2009) has raised concerns about eradication of local discourses of madness by universal ones, and Dutta (2018) cautions against the “helping” professions, since these have historically supported and benefited from knowledges that were racist, marginalizing, and colonial.

Concerning indigenous forms of dealing with mental distress, many proponents of the MGMH (Cohen et al., 2014) insist that faith healing sites are dehumanizing places of abuse where families shun the troubled individual and chain them (Read et al., 2009). They insist on immediate closure of these sites, and assert that needs of these people should instead be addressed by the World Health Organization and the World Bank (Collins et al., 2011). In India, the specter of the dumped women, lying alone and unclaimed, still haunts Indian psychiatry (Pinto, 2014). The question is, how accurate are these images? What the MGMH ignores is that families of the troubled individual are a frequent sight in these places, and their presence is often deemed essential to treatment (Davar & Lohokare, 2009; Ranganathan, 2015). Even in psychiatric hospitals families often stay with the patient, caring for them with the staff (Pinto, 2014). In Uttarakhand, people were adamant that without the extended family and community, their healing rituals would always fail (Dhar, 2017). The comfort and familiarity of familial presence, however aggravating, can be inherently helpful (Davar & Lohokare, 2009; Ranganathan, 2014). Their presence is not simply good or bad, harmful or deleterious, but it is non-negotiable: “The role of families in patients’ lives and care is, like so much in Indian psychiatry, enormously variable, making different medical settings vastly different social scenes” (Pinto, 2014, p. 20).

This, however, is not true for mental health hospitals in the West where families are not allowed and the patient must live alone. Bulhan (2015) writes: “Cut off from society and inter-subjectivity with others, those identified as mad have become less accessible to ordinary human contact and social bonding” (p. 247). This is not surprising as Psychology has a history of pathologizing the family, such as the “schizophrenogenic mother” whose erratic love was blamed for one’s psychotic break.

Additionally, it is important to remember that patient abuse is equally, if not more, prevalent in psychiatric facilities of the Global North. Saks (2007) has written about the liberal use of restraints in American psychiatric hospitals. One recent study found that control interventions (mechanical/physical restraint, seclusion, acute control medication) are regularly used by mental health service providers in Ontario, Canada (Mah et al., 2015). Another investigation reported a threefold increase in use of chemical and physical restraint in parts of Scotland between 2016 and 2018 (Rodger, 2019). More distressing is how horrifyingly prevalent sexual assault is in psychiatric wards in the UK and the US (Berland & Guskin, 1994; Campbell, 2018). A recent meta-analysis and systematic review of publications between 1946 to 2016 (Chung et al., 2017) found that, compared to the global suicide rate, suicide risk post-hospitalization increases a hundred times over within three months following discharge. Others have shown links between adverse experience in psychiatric hospitals and suicide (Chung et al., 2016) or involuntary hospitalization and suicide (Jordan & McNeil, 2019). Moreover, hospitalization is linked with loss of family and financial support, stigma, humiliation, and actual violence in psychiatric facilities (Chung et al., 2016). Thus, these calls for closure of indigenous sites in the Global South seem hypocritical.

Faith healing sites are complex places – they can be exploitative and abusive, but also helpful and beneficial for those who use them. It is essential to not reduce them to one or the other. One study (Raguram et al., 2002) found that temple stayers at Muthuswamy temple in India showed a significant reduction in psychosis and delusional disorder. For Psychology to admit the efficacy of these sites and the self-sufficiency of the Global South would go against what Tuck (2009) calls “damage-centered research” which is only interested in marginalized groups as long as they are portrayed as damaged, defeated, and needing help. Thus, as Spivak (2010) had predicted, the voices of a heterogeneous group are homogenized (faith healing sites as abusive or exotic) to create a narrative of communities that are solely shown as victim or perpetrators. Resultantly, these communities “become spaces saturated in the fantasy of outsiders” (Tuck, 2009, p. 412).

Resistance to universalized understandings of psychopathology is evident in the way trauma theory is facing scrutiny for its homogenization of suffering as psychologically traumatic and its minimization of material conditions and local discourses. This tyranny of meaning, which is an excellent example of epistemicide (Santos, 2015), necessitates that resolution of suffering happen through verbalization. Borrowed from early psychoanalytic works on trauma (Young, 1997) which focus on an unassimilated traumatic memory, this construal of suffering requires that the traumatic memory be assimilated in meaning, which can only be achieved by talking about it. Craps (2010) and Young (1997), amongst others, have opposed this imposition of language. Craps (2010) writes about the monoculturalism of trauma theory and the inadequacies of the South African Truth and Reconciliation Commission in post-apartheid Africa. Both Craps (2010) and Young (1997) have shown that trauma theory is not ahistorical; instead, it emerged in the late 19th century, nourished by the discourses around industrialization and values of individualism. Its universalization thus assumes that what applied to one culture is relevant for everyone else, that trauma is a natural consequence of extreme suffering and can be assuaged only via verbalization – a classic example of ethnocentrism and monoculturalism. Sweis (2017) recently explored how Westernized trauma narratives further marginalized the street children in Cairo by pathologizing older boys’ masculinity as threatening. The same tough masculinity which helped older boys survive on the streets, in the eyes of Western psychologists, became a clinical symptom of instability, leading to over-diagnosis and over-medication. Similarly, Langa and Gone (2019) posit that the Diagnostic and Statistical Manual-V decontextualizes the experience of the Native American populations by using an “ego-centric” sense of self for its diagnostic conceptualizations rather than the “socio-centric” self. Human suffering might be universal but Post-Traumatic Stress Disorder with its characteristic symptom presentation is not.

Feminism and decolonial theory have fought similar battles with comparable goals. Both assert that mental well-being is not only dependent on one’s internal psychological life but is equally influenced by the challenges, systemic and personal, one faces in the world. Thus, focus must be shifted from a sole study of one’s interiority to an investigation of social and cultural factors. Both have historically fought against biological reductionism: feminist theory in the service of concepts like gender informing sex and decolonial psychology via maintaining that the bio-medical model over-simplifies the experience and explanation of human suffering. Both have worked hard to de-naturalize certain forms of knowledge, especially in Psychology: feminism by subverting simplistic ideas of natural gender differences and decolonial theory by upending theories of naturally occurring racial and ethnic differences. Feminist therapy which is informed by feminist theory is not simply psychotherapy conducted by some strong, independent woman who considers herself a feminist, although it has been confused with that, and similarly decolonial theory is not simply academic work produced by one whose culture has been subjected to colonization – these are both political phrases demanding socio-political action. They both aim to expose the role of socio-political oppression and exploitation in the lives of people experiencing distress and both consider mainstream Psychology to be party to, and supportive of, dominant power relations. Thus, both have worked tirelessly to reveal the intricate and incestuous relationship between power and knowledge, and resultantly, knowledge and subjectivity. Together the two can maintain checks and balances on each other which are essential to a nuanced dialogue. In other words, given their similar goals and values, they can help each other maintain reflexivity and remain relevant in a complex and increasingly globalized world.

The sub-categories inside the feminist movement itself show that the face of feminism is fast changing and ideas of what it meant to be a feminist just ten years ago are often ridiculed and considered archaic. One of the newer concerns of some sub-categories of feminism has been understanding forms of cultural oppression (e.g. appropriation) and colonial violence. The absence of these checks and balances can lead to a variety of issues. For example, the feminist movement was recently co-opted by psycho-pharmacology for its own gains. While many celebrated the recent FDA approval of female Viagra, independent bio-ethic institute The Hastings Center reported about the creation of a fake feminist group, “Even the Score”, whose goal was to get FDA approval for an anti-depressant turned female aphrodisiac, which on two earlier occasions had been rejected (Hogenmiller et al., 2017). Mohanty (1984) has suggested that feminist theory devoid of colonial awareness can homogenize diverse groups of people, attributing to them a misleading sense of cultural coherence. This especially involves Western feminists’ self-representation as secular, liberated, and in control of their lives, which is sustained by representations of the “third world woman” as a reductive, monolithic subject – something that is far from the truth. Similarly, many have pointed out that enthusiasts of decolonial theory can sometimes indulge in unthinking glorification of all things local and demonization of the universal (Dhar & Siddiqui, 2013). What should be encouraged are heterogeneous voices and complex debates, an example being the multi-faceted arguments around female genital circumcision in the past few years. This is what Spivak (2010) referred to when she said that if you listen to what the subaltern has to say, you will not get simple, singular, and comforting answers, but instead heterogeneous voices with disparate desires.

Needless to say, Psychology is in a time of turmoil. I will now show how what it considers a precursor to pathology (contradictions) and assumes to be a symptom of disorder (hallucinations) are phenomena that are experienced differently in parts of India because people are constituted through different discourses. I will briefly describe the historical linking of schizophrenia and contradictions, and then question the universality of this assertion. This will help make a case against unscrutinized applications of ahistocial forms of knowledge.

Contradictions and Psychology

Enlightenment thought embraces rationality and reason, and thus Psychology has historically problematized contradictory thinking as illogical. Aristotle’s law of non-contradiction forms the backbone of much of logical thinking and has a central place in Western philosophy (Heine, 2016). Paradoxical thinking is assumed to be a mark of naivety and even madness in psychological literature (Sass, 2007). Resultantly, theorizations around the relationship between schizophrenia and contradictions have been popular (Bateson et al., 1956). British colonizers often wrote about the Indian intellect as weak and feminine because of its ease with contradictions.

Whether it was the mother’s inconsistent messages (Bateson et al., 1956) or the presence of contradictory affect (Sass, 2007), ambiguity and paradoxical thinking are considered either precursors to or markers of pathology. As opposed to this, I had observed the Indian female subject to thrive in the discordant narratives that plagued her since birth. It was this fracture that eventually led me to theorize about the importance of decolonizing indigenous forms of knowledge because the differences existed not only in cultural contexts and sociological conditions, but they lay deep in the structure of subjectivity.

Bateson et al. (1956) in their influential paper placed the birth of schizophrenia in a mother’s contradictory meta-messages and communication. The abstract and contradictory nature of messages, coupled with the child’s inability to point out or escape this double-bind, was a cocktail for madness. While the Batesonian model is etiological, Sass (2007) remarks that the schizophrenic’s world is at the same time dull and harshly lit, that there is a contradiction between affective experience and expression. Sass’s writings and other autobiographical accounts (Barnes & Berke, 1971; Saks, 2007) reveal that the inner world of the schizophrenic does not correspond with his/her outer flat affect and incommunicative demeanor. Insensitivity and intense fragility can co-exist and so can hyper- and hypo-emotional states.

Sass (2007) and Bateson et al. (1956) both speak about the important link between schizophrenia and contradictions, but coming from a place that thrives in cognitive chaos and flourishes in affective ambiguities, these perspectives fell short for me. Indian scientists held small religious rituals before launching the Mars orbiter Mangalyaan and do so for most missions (ISRO scientists superstitious, 2019), and most Indians easily accept the co-existence of evolution and creationism. It was the Indian girl-child’s experience with contradictions that guided me towards a nuanced understanding of the hazards of our discipline.

Contradictions and the Indian subject

Few, if any, have examined the life of the Indian girl-child and how she seamlessly mitigates the contradictory messages that inundate her early years. Most writings in the social sciences investigate her exploitation, but that unbalanced approach creates the picture of a subject that is deserving of pity and in need of rescue; the reality is far more complex. Ashis Nandy (1976) has written about the Indian female subjectivity and its complications. He writes that the female subject faces a challenge in re-defining herself, and that she does this by “de-emphasizing some aspects of her role in the family and society and emphasizing others, so that she may widen her identity without breaking totally from its cultural definition or becoming disjunctive with its psycho-biological distinctiveness” (p. 313). Pinto (2014) similarly speaks of the complex and multi-layered relationship that women in India have with madness, and with psychiatry. Pinto argues there is an incoherence in the Indian woman’s “case”, a constant unraveling that eludes stability and definition; even the spaces she seeks help from are multiple, from government hospitals to posh clinics, local healers, and distant saints. Pinto (2014) focuses on the dissolution of connections (meaning) and suggests that the Indian woman exists in the margins as a psychiatric subject while consistently evading even that position of eternal subjugation; Nandy (1976) hints at one of the ways Indian women navigate contradictions in their lives. I will instead describe the place of paradoxes in her psyche, but more importantly, my focus is the girl-child and not a grown woman.

On one hand the girl-child has to come to terms with the realization of her body as a liability. The horrid realities of female feticide, dowry deaths, and sexual violence surround her. Some estimates suggest that, given the realities of son preference, as many as 35 million girls are “missing” from the population (Agnivesh et al., 2005). From a very young age the girl-child knows that she is unwanted, if not by her own family then by the community. As billboards scream “Don’t kill the girl-child” and public service announcements beg people not to burn brides for dowry, even those who grow up in loving households realize that prohibition implies desire. Furthermore, Indian families are porous and include extended families and the community. The girl-child becomes aware that she is unwanted, helpless, and fragile. These messages of undesirability are ubiquitous and unrelenting.

The girl-child’s experience of undesirability and helplessness is complicated by a contradictory realization: that she is wanted, respected, and powerful. This power is displayed in goddess worship festivals, yearly rituals, and mythical stories; she can demolish the family name and community honor with a careless glance or a scandalous word. The birth of a girl is considered a curse and also celebrated as the arrival of Laxmi (goddess of prosperity) – at the same time. Hinduism occupies a subtle space in India where, even when it is not practiced as a religion, it still exists as a reality, its gods and stories making their way into people’s psyche in the quietest of ways. The girl child observes other women to be both subservient yet feared; most sanctions on the little girl’s body are made by older powerful women. Female feticide and being unwanted are a constant part of her reality, but so are the stories of the power and rampage of Kali and festivals that worship the little girl and wash her tiny feet.

The collective terror around the devouring power of the female body can be seen in the discourse around sati, a now-illegal practice where the widow immolated herself on her husband’s funeral pyre. Proponents of sati (both men and women) believed that she experiences no pain; they saw “the widow as a woman with special powers to curse or bless, as one who feels no pain … the contention that the heroic sati feels no pain in death” (Loomba, 1993, p. 209). An unclaimed woman’s body, a widow, exerts such anxiety concerning her unrestrained, almost super-natural power (feels no pain while she is burning), that she has be amputated from the system altogether. The girl-child is a dangerous object: undesired but also worshipped, helpless but also powerful. Born amidst the stories of terrifying powerful and omnipresent goddess images, she becomes a subject. This brings us to the question, given the prevalence of these contradictions which are problematized by many Western theorists, what type of subjectivity precludes the psychotic structure?

For my dissertation research I collected data in rural Uttarakhand (Dhar, 2017). I had talked to chai sellers on edges of mountain cliffs and women who ran restaurants serving only omelets. Individual interviews often turned into focus groups as friends and family joined to share their own stories. They were all Hindus of lower to middle class background, and I conducted a thematic analysis on their stories, and then a Foucauldian Archaeological Analysis on those themes.

Structural differences and need for decolonization

In attempting to solve the mystery of how the girl-child avoids a psychotic structure, I discovered that as a subject she is not only made up of different discourses, but that she is made differently. This was a theoretical realization, but after my empirical work in rural Uttarakhand, I found that it held true for most Indian subjects (Dhar, 2017). Over the next few years my research on people’s experience of “hearing voices and seeing things” revealed that they all shared this attribute: slippery subjectivity (Dhar, 2017).

India is a land of the ambiguous and the equivocal. Strict non-porous categories like self/other, male/female, heterosexual/homosexual, and family/community are hard to find, but becoming increasingly common in cosmopolitan cities. Renowned psychoanalyst Girindrasekhar Bose (1949) presented clinical vignettes where male patients could imagine shifting between genders and assuming the desires of women to ease their neurosis. Pinto (2014) has written about the existence of numerous paradoxes when it comes to mad women in India, the simultaneous presence and practice of abandonment and care, and agency and interdependence. The Indian culture, which is intensely heterogeneous, creates space for contradictions and allows for ambiguity. It produces the “slippery subjectivity” which inherently occupies multiple positions and is not fixed but instead shifting. In other words, the subject’s inner structure is shifting and unfrazzled by contradictory narratives (Dhar, 2017).

Deleuze and Guattari (1983) investigated the arrangements of desire in a capitalistic social formation and how that leads to an “illegitimate synthesis of desire” and consequently different subject structures. But our subject is born in a familial-community matrix which produces permutations of desire vastly different than a capitalist society with nuclear families. The Indian subject is not forced to make binary choices and “in the absence of this triangulation (mommy-daddy-me), the fixed subject whose desire is captured in a reified configuration and who is asked to make an impossible choice, is nowhere to be found” (Dhar, 2020, p. 132). Instead this familial-community matrix consists of one’s immediate family and extended family who share a house (aunts, uncles, cousins), and the whole village. A friend once admitted that until she was four, she was unsure of who her mother was because in their house you called every woman “ma”. Many of them breast-fed her, and all of them took care of her, which involved disciplining her.

This type of socio-familial set-up creates external and extensive connections of desire, connecting with numerous partial objects (Dhar, 2020). The people I interviewed, those that the MGMH accuses of shunning their troubled, were vehement about the importance of the family to explain why someone would experience hallucinations, and asserted that family and community were essential to treatment. According to one participant:

Through whom it has happened and to whom it has happened, and his own family, and someone else’s family. You will have them also, that family. These things happen in the way, these things happen together because if they only tried to do it on their own, they will also get infected by it, if they do it alone, because it’s the same family … Here people actually come together. Everybody has to come. (Dhar, 2017, p. 183)

Here, the afflictions themselves and the people they affect are both shifting, and this is made reasonable by a type of subjectivity that allows such movement between self and others. There is no distinction between self and others of the kind we talk about in Psychology – a gap where inter-relational and inter-subjective theories operate. Pinto (2014) similarly suggests that the problem of mad women in North India often presents itself in intimate spaces and through troubled relations, a disintegration of connections rather than solely inside the individual; she also suggests that mad women keep escaping stability and categorization. While giving a lecture on this subject in the United States, a student had asked whether this means that Indians had better integration between the self and the society, and I had to remind her that there is no integration because there is little separation in the first place. This absence is what makes arranged marriages reasonable to most Indians and appalling to many Westerners. It is also why many in the West are horrified when they find that Indian families (and many other cultures) regularly hide a patient’s terminal diagnosis from them while they care for the individual. Asserting your right over another (hakk jatana) is often a sign of intimacy rather than disrespect.

Even the emotional experience of what we call psychosis was different for my participants. One participant talked about her mother having a visual and auditory hallucination of a wedding procession, a baraat, while working in the field. She said:

My mother can actually see it clearly … Like when a wedding procession comes to someone’s house (baraat) … there’s a lot of music and band, those are the kind of sounds that she hears. And her heart is into it, she feels like … like she sees people dancing and she says that she also feels like dancing with them. Nobody else can see anything. (Dhar, 2017, p. 162)

It was the girl-child and her gendered subjectivity that forced me to pay attention to the local narratives of hallucinatory phenomena and reach the conclusion that my participants’ discourse, the very style of thinking that animated their meaning-making processes was different than that of the subject of Psychology. These differences were not only socio-cultural; the discrepancies lied in the structure of the subjects and their implicit discourses. My participants’ stories were marked by the implicit discourse of “radical enmeshment”, which is the idea that everyone is constituted through everyone else materially, and “sticky affect”, which refers to the ability of affect and intention to have physical consequences (Dhar, 2017). Radical enmeshment is reflected in one participant’s assertion that “through whom it has happened and to whom it has happened, and his own family, and someone else’s family” everyone is involved and implicated in the explanation and the solution of all afflictions. Time, space, and death do not impose their limits, as the ill-will of one jealous neighbor can lead to infertility in another and then, after his death, move on to afflict the jealous neighbor’s granddaughter, causing her to encounter financial ruin or voice hearing. In other words, what people were made of or built through or pinned by were not simply different meaning-making systems which explained phenomena via spirits and dead ancestors. Building those meaning systems are conditions of thought and knowledge that understand a person to be materially and physically formed by the others – the body of the other, the affect and intention of the other, the action of the other, and the desire of the other. Not psychologically or internally, but viscerally and physiologically. Not just relationally or intersubjectively, but radically and materially, people are built and structured through each other, and through other material structures like mountains and stars. The other is not in me, but on me, with me, as me. No wonder they can slip into multiple positions; no wonder Bose’s patients could be helped by asking them to shift their gender; no wonder the gods and goddesses shift shapes, species, forms, and genders; no wonder deception can often be care.

Similarly, “stickiness of affect” also points to shifting materiality – that intense affect (fright, desire, envy, suffering) have a stickiness to them that can attach itself to places, things, and objects. One participant, while talking about the unfulfilled desire of unhappy ancestors, said that their tears stick/attach to you (Dhar, 2017). The language is important here; Psychology might twist these narratives into psychosomatic symptoms, and say radical enmeshment is simply community support, but that interpretation colonizes a narrative where the interior is inconsequential. The spirits, deities, or affect don’t enter people to possess them; they stick to people (uspe lag jaata hai).

Moreover, the Indian subjectivity, despite an incredible heterogeneity in its practices, cultural habits, healing traditions, religions, power dynamics, and legal structures (Pinto, 2014), differs from the subject of Psychology in more ways than one. Whether it is the absence of a focus on interiority and its contents, an exterior and multi-directional trajectory of desire, absence of distress in the face of psychosis, or the ability to sustain non-binary choices and multiple-positions, the structure of this subject begs us not to uncritically import forms of knowledge that are inapplicable and potentially dangerous. Is it sensible, let alone ethical, to force antipsychotics down the throat of a woman who is dancing with her visual hallucination? What if she is functional and contributing to the society? What if it creates no distress, danger, or dysfunction – is deviance enough to warrant psychiatric intervention? Stories of the people I met were replete with hallucinatory phenomena but devoid of a psychiatric illness narrative that prescribed fear and panic.

In light of these differences, should we export psychiatric knowledge despite its lip service to cultural variation in Psychology? My answer would have to be: no. This knowledge of the Psy-disciplines has prescribed closure of faith healing sites while there is evidence of abuse in psychiatric hospitals. It has co-opted issues of systemic discrimination and violence for the discourse of internal change. It has specifically turned women’s experience into pathological states by ridiculing indigenous forms of childbirth while prioritizing scientific (read Western) narratives of post-partum depression and pre-menstrual dysmorphic disorder (PMDD). These disorders themselves have been embroiled in controversy for a long time; for example, 83 percent of DSM-IV panel members for PMDD had linkages to pharmaceutical companies (Cosgrove et al., 2006).

Psychology is founded on Western values like meritocracy, individualism, and assumptions of scarcity; it naturalizes modern stress and personalizes concepts like resilience (Mustakova-Possardt et al., 2014). With Psychology’s recent replication crisis and an abysmal history of alleviating suffering even in its own birthplace, the discipline has little to offer to others. It can, as Davar (1999) has stated, decimate local forms of understanding, which while imperfect and sometimes dangerous, also serve a function. It would be wise to remember that many participants spoke about absence of distress and most of full functionality in the face of hallucinatory phenomena. Their experience was not marred by stigma and decades of hospitalization which was the reality of patients I observed during my clinical internship in a psychiatric facility in India.

I had travelled to places like the healing/haunted temple of Mehendipur Balaji where women and some men fling themselves at walls, tear their clothes off, shout out filthy words, and put hot coals in their mouth when in a trance state – many of them come there after getting a psychiatric diagnosis. I had talked to people who said that a sign of abnormality/spirit possession in their village was when a young girl locked herself in a room, because here privacy was not a birthright and considered absurd, especially when it was the desire of a woman. It would be easy to classify places such as Balaji as spaces of subversion, and states of madness in women as forms of revolt, but it immediately positions these women as otherwise subjugated individuals in need of rescue. It would also be convenient to romanticize these places and practices as markers of some pre-colonial time of bliss where families were unbroken and communities always supportive. They are neither. A feminist-decolonial lens stops me from reducing these complex practices and heterogeneous spaces, so instead of forcing second-order narratives (Kendall & Wickham, 1998) onto them, I could instead look for conditions of thought and knowledge. Had it not been for these two lenses, I could have easily interpreted community presence during rituals to mean emotional support and psychological relief.

Conclusion

Theorizing about women and their lives allows us to examine the life of a marginal subject. In exploring them we may understand the experience of others on the periphery. This is what happened in this case. The feminist perspective implores us to study the historically ignored experience of people on the margins; we know that until recently women’s heart attack symptoms were not studied and their expression of physical pain is still devalued. Researchers only investigated the experience of men and extrapolated it to that of women, and these errors have cost women their well-being, and maybe even their lives (Anand et al., 2005). Psychological research is riddled with bias as most of it, despite years of calls for change, is still conducted on Western industrialized nations (Nielsen et al., 2017). Historically, despite evidence of socio-cultural causes, the experience of women and minorities has been essentialized – for example, the diagnosis of schizophrenia for black men who took part in the civil rights protests (Metzl, 2009) or the claims that women were naturally less variable than men, thus no female Edisons according to Thorndike (Hollingworth, 1914). It is the same logic that applies Psychology’s export to the Global South. If the feminist examination of science has taught us anything, it is that critique cannot be an afterthought, and that seemingly apolitical forms of knowledge like medicine are also riddled with issues of power and exploitation. The call for decolonization must not be half-hearted where teaching cultural psychology fulfils some kind of diversity commitment and where theories birthed in one place are modified for others. It is ridiculous and insulting to suggest that cultural research is important, just not important enough to wait for it to happen; a true critique is not only a critique of non-contextual Psychology but of all ahistorical and apolitical forms of knowledge. We have to ask some difficult questions like whether a focus on interiority and a preoccupation with psyche’s contents is universal, and if not, should we attempt to make it so? Is there really a need to turn the gaze inward and attend to one’s past history or internal experience? Our answers might require us to chart through uncomfortable and uncertain places, both geographically and intellectually.