Book Review: Bhargavi V. Davar and T. K. Sundari Ravindran (Eds),Gendering Mental Health: Knowledges,Critiques and Institutions

The question of gendering mental health has remained marginal to both the pursuits of gender studies and mental health and illness in India. This is despite the pioneering work of one of the editors of this collection of papers, Bhargavi Davar, who has not only been a survivor but an activist and a scholar in the field. The book comprising papers from the proceedings of a seminar held in 2007 makes for thought-provoking reading, and is a much needed addition to the small but significant writing on this specific intersection.

The central concern of this work is expressed in the introduction where the editors state that the aim of providing appropriate mental health care for women is neither to ‘reform psychiatry from a gender perspective’ (p. 7), nor is it to ‘persuade disturbed women to join the women’s movement’. There is no pure discursive space within which the woman with mental illness fits. The contributions in this volume directly critique the medicalisation of mental illness, locating it within questions raised by the Convention on the Rights of Persons with Disabilities (CRPD). The CRPD, to which India is a signatory, has shifted the understanding of mental illness towards one that locates individual experience within a social setting. Renu Addlakha, writing in the volume, draws parallels between the experiences of two women, one living with a visual disability, and the other with a diagnosis of schizophrenia. Both diagnoses are disabling, producing women as lacking in femininity and unfit for womanly roles.

At the same time, other contributions to the volume raise questions about the very nature of diagnosis in mental illness. What is the ‘mental’ in mental illness? It seems evident that a critical engagement with questions of mental health and illness from a feminist perspective requires a rethinking of rationality. The idea of a separate but significant disembodied realm of mind has been critiqued by feminists from its inception. Feminist scholars have argued that Descartes’ rendering of the human as brute body and rational mind has located women, particularly in western science, as body-centred, ridden with desires, and hence uncontrollable. The result is a paradoxical overlapping of the categories of femininity and mental illness. Discussing the appearances and disappearances of the categories of hysteria and anorexia, Ranjita Biswas cogently argues that ‘there is a subversive, surreptitious trickling of the same cultural ideals’ of femininity into systems of diagnosis (p. 37). In the process the diagnostic systems produce both femininity and heteronormativity.

At another level, psychological discourses have been characterised by considerable ambivalence towards the concept of the mind. The problem is not easy to unravel. For many years, psychiatry and psychology, attempting to be sciences, struggled to eliminate the notion of the mind. However, the inability to find explanations of a purely materialistic nature has led to a gradual acknowledgement of the necessity for such a term. The mind has now been accepted to be either a term for the not yet understood features of the brain, or a functional entity in some not yet deciphered relationship with it. The latter has fitted well with the biomedical perspective. The discovery of links between genetics, neurochemistry and experience has resulted in the availability of pharmaceutical interventions. These have been found to reduce ‘symptoms’, such as hearing voices, and many of those who have felt troubled by these have found it possible to live in normative society with greater ease. However, the power of the biomedical discourse has resulted in a reductionist understanding. To hear voices is therefore to be ill and subject to a system of classification and diagnosis. Within such a model, one set of experiences results in a biomedical diagnosis that then stabilises the subjectivity of the ill into a category. At the outset, Ranjita Biswas pertinently asks how any kind of homogenisation of human differences is possible. At the same time, those diagnosed with mental illness have been given few rights to determine the course of their own treatment since, by definition, the deciding agent, the mind, has been classified as ill. The contributors to the volume address several of the questions that emerge in this context. These may be divided around three discursive elements. The volume begins by critiquing the binary of normality/pathology. A second section discusses narratives of women as they negotiate questions of identity. Finally, the question of women’s choice in the form of care they access is discussed.

The system of diagnosis critiqued by Ranjita Biswas is only one of the spaces that produce mental illness. The intersections of biomedical discourse with law and markets have been developed in two other papers in the volume. In ‘Adjucating Mental Illness’, Vasudha Nagaraj provides a moving account of her defence of Gauri, accused of mental illness, fighting to retain custody of her child. The paper is based on a close reading of the trial as the author attempted to make the case ‘legible to the law’. The paper stands out for the reflexivity with which the author discusses the navigation of the trial within the nexus between psychiatry and law, the difficulty with diagnosis in the first place, and the use of diagnosis in a court of law already deeply biased against women. The article on the role of advertising in the production of the mentally ill woman by Jayshree Kalathil illustrates how advertisements for antidepressants depict violent men and caring women. Despite evidence to the contrary, men appear as psychotic, and women as neurotic. Women with mental illness are depicted as unable to perform domestic roles, with the drugs returning them to a state of normalcy. Men appear to be aggressive, and do not seem to be located in any sphere of activity. Kalathil points out that the medical fraternity is deeply influenced by the advertisements.

The next section comprises papers on lived experiences of difference. Ketaki Ranade and Yogita Hastak report research examining the mental health needs of women who identify as lesbians. There is very little writing on the developmental aspects of growing up with the experience of difference. The research highlights how the sense of being different was rendered difficult in a context where the two predominant experiences were of silent disavowal or violent abjection. In a similar vein, Renu Adlakha points to the different reality of disabled women who find that the imperfect body connotes the absence of femininity. Disabled women, excluded from femininity, long for traditional roles. They are desexualised and considered incapable of giving care. The last article in the section is yet another sensitive and nuanced attempt to describe the experiences of a researcher researching rape. Written in a deeply reflexive format in the best tradition of feminist writing, Shazneen Limjerwala gives a close account of her own journey that began with a fear of rape to the several unnerving encounters through which she travelled to become the researcher. Taken together these contributions fill a significant lacuna of empirical papers in the field highlighting the centrality of gender, yet emphasising the significance of intersectionality.

While the previous articles seem to suggest that the traumas associated with difference may contribute towards the experience of mental illness, the last two argue for choice-based treatments for women. The first of these follows from debates around traditional healing systems particularly, as they have emerged after the critical event at Erwadi. The Dargah there had been a faith healing site for many years before a fire leading to the death of 28 persons with mental illness. However, the public outcry against a system structured outside the logic of modern rationality has resulted in several legal responses delegitimising such spaces. Anubha Sood rexamines the question from the perspective of women users of these spaces. Legal action following events at Erwadi has framed women users of faith healing as ignorant victims without the choice or the capacity to select modern options of treatment. The push towards this rhetoric is strengthened further by international discourses on human rights.

The last chapter of the book appropriately looks at the relationship of ‘mentally disturbed women’ with institutions. Bhargavi Davar has based this chapter on her own experiences as a survivor as well as those of women at Sanchit, an oral history archive of women living with mental illness. Stories from Sanchit may be understood through three distinct gestalts. First, one set of stories articulates that social injustices are a causal factor in the development of mental illness. The women’s movement has sometimes emerged as a healing space enabling women to articulate the sources of oppression. However, political movements demand recourse to reason. A paradox faced by women with mental illness is that dissenting women are defined as insane, but the same process invalidates their political dissent. At the same time, many women feel the need to acknowledge their vulnerability, and demand a right to a cure. Here, Bhargavi Davar reiterates that there is no universal formulation by which all persons with mental illness can be explained. Women with mental illness need to be able to choose their preferred treatment. However, the right to exercise choice requires an acknowledgement of difference. While this enables the expression of vulnerability, creates the possibility of emotional links among like-minded others and embark upon a process of self-discovery, it often acts like a double-edged sword. Experts and community, alike, respond to the acknowledgement with what might at best be infantilisation; at worst, violence.

The central message of the volume, as a whole, is to legitimise the voice of survivors to deconstruct the dominant discourse of mental illness. Women with mental illness are subjected to gross human rights violations, particularly when they choose to live in ways that express disregard for the expectations of the family. However, while some aspects of treatment should be withdrawn, the volume leaves space for ambiguity in determining the best understanding of mental illness. Significantly, Davar would argue for greater voluntarism and choice of treatment options provided within a compassionate framework. The goal of mental health movements would be to enable a mindfully lived reality of the disturbed mind not as mental illness but the desire to find a self that is embodied, yet spiritual and connected. There has been some progress in this direction with the recent passing of the Mental Health Act. However, much more work is required to legitimise the variety of experiences of women described as mentally ill. This volume will be a valuable addition to the field and will hopefully be a precursor to other such collections.