Abstract
Reviewed by: Megha Sharma Sehdev, Mellon Sawyer Seminar Postdoctoral Fellow, Center for the Humanities Center for the Study of Race and Democracy, Tufts University, Medford, MA megha.sehdev@tufts.edu
Daughters of Parvati is a masterful ethnographic account of psychiatry and gender in Northern India. Pinto launches by departing from the Foucauldian view of the asylum and its normalizing gaze. Indian psychiatry, she shows, does not subject individuals to an overarching body of expertise and categorization. Moreover, categories of liberal ethics, such as freedom versus constraint, and abandonment versus care — all of which accompany global discourses of psychiatry — fail to capture women's mental health experiences in the North Indian clinical landscape. Instead, women's worlds are defined by a constant turning between belonging and uncertainty in kinship — a condition exacerbated by mental illness. Indian psychiatric care attends precisely to women's relations along this axis of mutable knowledge. Pinto coins the term “ethics of dissolution” to describe how institutions do not shore up, but rather attend to, the twin processes of “falling apart” and “patching together” experienced by women with dissociative disorder, schizophrenia, personality disorders, and other complex undiagnosed mental illness. For an institution to be gripped by breakdown would, in many contexts, signal an abdication of responsibility. In Daughters of Parvati, however, the effect is an absence of norms and instead, an ephemeral, dance-like motion of truths. Writing in the time and mood of crisis, Pinto narrates, throughout, her own sense of dissolution as a recently separated, single mother. She triangulates these moments with case studies, and rigorous institutional observation.
The crisis of the Indian mental health care system is one of non-standardization. A series of policy interventions since the 1960s sought to de-institutionalize care, replacing specialized psychiatry with primary and “community based” approaches. The transition, however, has remained incomplete. In the current era, only a handful of government-run psychiatric units offer in-patient stays, with most wards seeing hundreds of outpatients per day. Policies of de-institutionalization have ended up shifting the burden of caregiving onto families. At the same time, they have led to a free-market terrain of poorly regulated private institutions that admit patients based on “voluntary” commitment. Popular discourse describes private hospitals as “dumping grounds” for women abandoned by families no longer willing to care for them. Pinto observes that, indeed, private institutions become de facto sites of long-term custodial care. They collect women, however, who are not entirely abandoned nor entirely part of families, and who continue to live at the interstices of kinship.
In the absence of linear narratives about women's experiences, and of standardized therapies suited to the Indian context, private institutions dabble in ad hoc treatment. Pinto describes the world of the private clinic as marked by variable pharmaceutical regimes, delays in releasing patients, and an indifference to clinical truths. What emerges is a dance refracted through women's pain and delirium, and through the ongoing lives of their families. As kinship continues to change (for instance, husbands divorce and re-marry, children grow up, and lovers fade and re-appear), its pasts and potentials are not severed, but cling to the present. The psychiatric institution mediates such crises of kinship without arriving at conclusions. Instead of arriving at definitive meanings, clinical narratives act in other ways; they coalesce around relations that are volatile – sometimes performing truth and at other times extending explanations, comfort, or pacification to patients. As in any other clinical setting, these moments offer possibilities both of violence and of care.
Instead of treating women’s cases as unusual, Pinto’s own experience of separation reveals that all families live in constant crisis. Madness does not break kinship as much as elaborate its fault-lines. Rather than pointing to the abnormal, Pinto reveals the uncanniness of kinship itself. Psychiatry “lands precisely on this space where kinship falls apart for women, and attends to, as well as creates, different ways of inhabiting that kinship” (27).
While the book's first half takes place in a cloistered private hospital, the second shifts to a government facility bursting with patients and families. The psychiatric unit at Nehru Hospital sees many women suffering from dissociative identity disorder, or hysteria. Considered an “obsolete diagnosis” in the West due to its gendered charge and lack of precision, hysteria remains an actively used diagnosis in India. In the West, hysteria was seen as a fuzzy, performative condition enacted primarily by women, and was subsequently biologized into more “objective” models of trauma, such as PTSD. In the Indian context, by contrast, clinicians continue to validate women's hysterical expressions that collapse pain and desire. Crises of “truth telling” are seen to stand for the contradictory and irreconcilable social orders that women inhabit. Similiarly, clinicians who treat hysteria dramatize control, and its shading into constraint and care. In other words, relations are shown for their inherent multiplicity.
In the last chapter, Pinto focuses on a woman named Lata, who presents symptoms of hypersexuality, grandiosity and childlike behaviour. Lata's appearance at the hospital is related to a legal case. Lata is “happily married,” but her mental condition appears to have precluded consent. While Lata shows signs of histrionic personality disorder, the hospital ultimately fails to produce a diagnosis showing that her judgment is clouded enough to annul her marriage. Potential sexual abuse from Lata's past could have diagnosed her with “something.” Paradoxically, this information would also cause stigma and threaten her standing in the social order. Moreover, the law is less interested in Lata's hazy past and its possible treatment, than a current diagnosis that could legally reconstitute relations by pushing Lata back into her natal family. Pinto argues that Lata, in her circulation across institutions, exposes the fissure between distinct knowledge practices — clinical and legal. Lata bears, painfully, their respective grids of opacity, legibility, kinship-making and kinship-dissolving — that together reveal gendered relations to be multiple and knotted. In elaborating these dueling institutional repertoires, Pinto calls into question the genre of the “case study” and its authoritative mode of knowledge production, subject as it is to undoing.
Daughters of Parvati is stunning ethnography and a major contribution to feminist studies, South Asian studies, medical anthropology. Practitioners of transcultural psychiatry will find Daughters of Parvati useful for its meticulous attention to women's voices and personhood. Relatedly, Pinto mobilizes her own projections vis-à-vis the women she studies. Finally, the book showcases the best of anthropological “thick description,” illustrating how Indian models of care depart radically from Western psychiatric practice.