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The Production And Reproduction Of Inequalities In South Asia

The 2007 meeting of the South Asia Anthropologists' Group will be hosted by the Department of Sociology at the University of Edinburgh on 4th and 5th September. The meeting will focus on aspects of inequality in South Asia, looking at the dynamic processes by which such inequalities are produced, reproduced, challenged and possibly overcome.

SAAG 2007 invites papers relating to the broad theme of: 'The Production and Reproduction of Inequalities'. We welcome either empirical or theoretical reflections on these themes in any part of South Asia. If we take as our point of departure the dismal socioeconomic legacy bequeathed to the newly independent (or, in the case of nations which were not directly colonised, more independent) governments, the question arises how deep and how comprehensive must the change to a new power constellation be before the major problems confronting the new nations could be effectively addressed. Is there, as Barrington-Moore, famously suggested, the need for a revolution in Asia? Are such revolutions occurring and what are the hindrances they face?

Whilst there is often a tendency to focus in on sociostructural accounts of inequality, we are operating with abroader conceptualisation of the term which encompasses social, cultural and political domains. The continuing struggle of homosexual men and women for recognition and parity; Adivasi and Dalit demands for cultural autonomy and respect; the shifting patterns of age-related discrimination; and continuing debates over religious nationalism and conversion; must stand alongside the more prevalent focus on caste, class and gender inequalities. The focus is on the procedures and social processes which constitute challenge and reconstitute multiple forms of disparity in an attempt to understand the shifting contours of marginality in South Asia.

Against the tendency to romanticise resistance, the 2007 SAAG conference should consider how marginalised groups may act within the field of power to reproduce their own marginality, as well as exploring the means by which such exclusion is reproduced, challenged, overcome or reinforced. We encourage papers that engage with various aspects of this 'social and economic exclusion in the midst of affluence and growth'. This could include, e.g., papers on ethnographic research on marginal groups (in the widest sense, including but not limited to Dalits, women, gays, hijras, Adivasis, etc); papers on how 'modernisation' has caused new forms of oppression and struggle, such as changes in the forms of bonded labour or gendered discrimination (such as female infanticide and female foeticide); papers on the developing middle classes that could discuss how the modernization has affected them and they have reacted to it ; papers on changing media representations of society and its characteristics in South Asia; papers on how popular culture is transformed in conditions of growing inequality; or papers on the transformations of NGOs and Government programmes that attempt to take account of these changes. We also invite papers on the methodological problems confronting those seeking to studying different forms of inequality, their reproduction, representation as well as strategies of resistance to exclusion and marginalisation.

All inquiries should be addressed to: Salla Sariola (salla.sariola@ed.ac.uk)

Tuesday 4th September 2007

10.00-11.45: Adivasis, Poverty & Development


‘Poverty, Inequality and Resistance: An Adivasi Reading of the Kerala Model of Social Development’
Ravi Raman (Manchester University)


The reproduction of inequality in a ‘model’ development state
Luisa Steur (Central European University, Budapest)


Health practices and development for the Paniyan Tribals of Wayanad, in Southern India
Sumant Badami (Macquarie University, Australia)


Discussants: Francis Watkins & Neil Thin


11.45-12.15: Tea/Coffee


12.15-1.15: Globalisation, Neoliberalism & Development - I


‘The Poverty of Markets and the Myth of the Entrepreneur: Indian Artisans Confront Globalization’
Timothy J Scrase (Centre for Asia Pacific Social Transformation Studies)


‘The Death of the Profession and the Birth of Big Business? The ambiguities of the medicine in Kerala’
Caroline Wilson (University of Sussex)


Discussant: Geert de Neve


1.15-2.15: Lunch


2.15-3.15: Caste, Gender and the Dalit Challenge


‘Dalit Civil Society at the Margins: Exploring Worldview Strategies and Challenges’
Suryakant Waghmore (Tata Institute of Social Science)


‘The Reproduction of Social Exclusion of Dalit Children in Primary Schools and the “Schools of Resistance” of the Dalit NGO Navsarjan in Gujarat’
Simone Holzwarth (University of Sussex)


Discussant: Karin Kapadia


3.15-3.45: Tea & Coffee


3.45-4.45: Dalit Mobility & Activism


Caste, Identity & Gender among Madigas in Coastal Andhra Pradesh
Clarinda Still (LSE)


In the Name of the ‘Poor & Marginalised’? Politics of NGO Activism with Dalit Women in Rural North India
Radhika Govinda (University of Cambridge)


Discussant: Hugo Gorringe


Wednesday 5th September 2007


9.00-9.30: Tea/Coffee


9.30-10.30: Marginalised Sexualities


Production and reproduction of marginality of sex workers in Chennai, Tamil Nadu
Salla Sariola (University of Edinburgh)


Gendered Space and Sexual Intent: Difference, conformity and resistance in the public practices of men who have sex with men in Calcutta
Paul Boyce (University of London)


Discussant: Akshay Khanna


10.30-10.45: Break


10.45-11.45: Representations of Inequality


Four Notions of Haq: The politics of individual rights in North Western India.
Sumi Madhok (SOAS)


‘Crime and Candyfloss: The New Face of Global Bollywood’
Mallarika Sinha Roy (IDS, University of Oxford)


Discussant: Ben Campbell


11.45-12.15: Tea/Coffee


12.15-1.15: Social Agency, Religion and Caste Change


Religious transformation and marginality: an exploration from Hindu central India
Amit Desai (LSE)


‘Life has returned to normal’: Managing peace in a town in central Gujarat
Caroline Heitmeyer (LSE)


Discussant: Prema Kumari da Silva


1.15-2.15: Lunch


2.15-3.15: Pills, Poverty & Policy


Social Inequality and the Affordability of Pharmaceuticals: Ethnographic Perspectives from South Asia
Stefan Ecks, Ian Harper, Patricia Jeffery, Roger Jeffery (University of Edinburgh)


Pills that embody policy: India’s National Mental Health Program
Sumeet Jain & Sushrut Jadhav (University College London)


Discussant: Bob Simpson (Durham)


3.15-3.45: Closing Discussion and Plans for Next Year



SAAG 2007 Abstracts


Poverty, Inequality and Resistance: An Adivasi Reading of the Kerala Model of Social Development


K Ravi Raman (Manchester University)


The state of Kerala in the Indian south with its unique development experience has always fascinated scholars: universal literacy, a low birth rate, high life expectancy, low infant mortality and a low level of poverty, almost all the indicators being comparable to the West. The success of the state in terms of such a consistently high human development index is often attributed to "public action" as also to a high degree of democratisation of the state and through progressive land reforms (UN-CDS 1975, Ratcliffe 1978; Drez & Sen 1989; Sen 1999, George 1999, Frank & Chasin 1991; Olle 2002). The state thus was designated progressive and democratic with social justice being its developmental agenda. However, the dominant narratives on the Kerala Model of Social Development (KMSD) have thus far undertheorised its invisible yet unseemly dimensions of production and reproduction of inequality among social groups and the associated resistance/movements by the excluded/marginalised. Even when applauding the KMSD, social scientists have failed to ask just how social it has been and in this paper, we ask this question, from the perspective of the adivasis – the only ethnic minority in the state. The paper explores the social landscape of Kerala which is replete with examples of poverty and inequality and resistance, with a focus on the marginality of the adivasis and their assertions towards a just society.


The reproduction of inequality in a ‘model’ development state: A study of adivasi politics in Kerala


Luisa Steur (Central European University)


The rise to political prominence of the Adivasi Gothra Maha Sabha (AGMS or Grand Clan Council of First People), a movement calling for adivasi land rights in the Indian state of Kerala, is often interpreted as the sign that a new wave of self-awareness and emancipation has come to Kerala’s adivasis--a group of people who have been unaffected by the social development achievement Kerala in general is otherwise so often celebrated for, even to the extent of being hailed as a ‘model’. I argue that this reading, however, does not take full account of the processes underlying the political trajectory of the AGMS. Actually, the rise of the AGMS to the forefront of political activism in Kerala is, on closer inspection, not only a sign that existing relations of power are being challenged—it is also a sign that some of the most basic mechanisms whereby marginality has been reproduced in Kerala, which I provisionally conceptualize as ‘paternalist politics’, continue to function and in certain ways have been reinforced by the impact of global processes of liberalization for ‘economic growth’. Though I do not wish to downplay the empowering impact of the AGMS, my research in Kerala makes me have serious doubts about the extent to which the reproduction of inequality and social exclusion can be reversed under conditions of economic restructuring for global competitiveness.


The Idioms of Health and Well-Being for the Paniyans of Wayanad


Sumant Badami (Macquarie University)


The Paniyans of Wayanad, in India, are an ex-slave, tribal community who have faced vast social, political and economic exclusion. However, despite over thirty years of development initiatives in the area, their situation has not changed. The reality of tribal life for the Paniyans paints a picture of administrative obstruction, misappropriation of funds and aid programs which are conditionally tied to specific ideological perspectives. Today, ‘tribal’ identity in Wayanad, especially amongst the Paniyans, is fraught with complications and contradictions. Apart from rampant racism and prejudice, tribal identity is being contained and defined in a static way to suit the motives of political institutions, religious organisations and tourist endeavours that are using the romanticised notion of the ‘primitive’ and ‘helpless’ tribal to drive their involvement in the area. I am interested in the way in which social exclusion and stigma have contributed to the Paniyans’ sense of self. Within the broad parameters of this enquiry, I am focussing particularly on the idioms of health and well-being as they are configured in the development context. What fascinates me is the extent to which Paniyan identity can be negotiated, on their own terms, within the complex interplay of socio-political and bio-political subjectification. If health is an indicator of development, then the implementation of tribal health in Wayanad helps us to uncover some interesting things about the symbolic nature of health care and the changing face of this process as a result of medical practice, political and religious influences, vast social and economic changes and increased exposure to mainstream cultures. And by including the perspectives of the Paniyans themselves, rather than relying solely on the perspectives of those who are traditionally authorised to comment on modern development discourse, we can open up our spheres of inquiry to allow for more responsible notions of identity and development, which are able to cope with the possibility of change, convergence and dynamic reinterpretation.


From Marginalized Artisan to Impoverished Entrepreneur: Indian Artisans Confront Globalization


Tim Scrase (Centre for Asia Pacific Social Transformation Studies (CAPSTRANS), University of Wollongong)


The globalization of production in the world economy has opened-up the markets of Asia to global competition and exchange, with the result that many workers have become displaced, or else exploited in casualized, insecure jobs manufacturing, tourism or construction sectors. Artisans and craft workers have not been immune to the effects of these global economic changes, with many losing their traditional jobs and becoming displaced, unemployed and impoverished. Based on fieldwork conducted in New Delhi, the first aim of this paper is to describe and analyze the numerous problems encountered each day by artisans and to document the various survival strategies they employ in order to continue making a living. Their problems are universal, as the research briefly analysed portrays. Interviews with artisans reveal several problems ranging from corruption and labour exploitation, to the copying of designs and crafts. The second aim of the paper, based on focus group interviews with middle class consumers conducted in New Delhi, together with content analysis of various websites devoted to selling Indian crafts, is to present a critical analysis of the marketing and selling of crafts. For example, “ethnic branding” is an important marketing feature of a craft item as are the use of highly contentious terms like “traditional”, “natural” and “primitive”. Underlying my analysis and interpretation is the notion of the commodification of poverty – the ways marginalised labour, and peoples themselves, are exploited for commercial gain. The paper thus highlights the contentious and problematic relationship between the globalization of markets, the marketing of third world craft goods in terms of “fair” trade, and consumption practices more generally.


The Death of the Profession and the Birth of Big Business: The Ambiguities of Medicine in Kerala


Caroline Wilson (University of Sussex)


Over the last thirty years private healthcare in India has been transformed from its origins in small-scale private nursing homes and community based private practices, which supplemented ailing government services, to large corporate hospitals, locally known in Kerala as super-speciality or ‘5 star hospitals,’ in which profit is a major driving force of the institutional ethos. The paper explores the inherent contradictions between business and professional ethics in medicine and the impact of the commercialisation of healthcare on the relationship between the State, the medical profession, and the wider public. The paper emphasises that the rise of market forces, has further threatened a weak professional ethics. The ethics of institutions and the values of money and technology in wider society are the determining context of medical practice. Furthermore as hospitals compete for patients on the basis of high costs, luxury and most notably technology, the ethos of charity is medicine is significantly under threat. The paper reveals the ambiguities of contemporary medical practice as doctors negotiate the conflicts between the doctor as a professional and the emerging identity of the doctor as a businessman.


Dalit Civil Society at the Periphery: Exploring Worldview Strategies and Challenges


Suryakant Waghmore (Centre for Social Justice and Governance, Tata Institute of Social Sciences)


The emergence of NGOs and various grassroots social movements in the post 60s was seen by scholars as an outcome of the impasse that development process and discourse had reached (Munck). These micro formations and protest movements were seen as an alternative to the foundationalism that had hegemonised various social science disciplines and discourses, largely influenced by Gandhian and Marxian ideology and the leadership role played by the middle class upper castes. Scholar termed these new political actors as Non Party Political Formations (Joseph: 2006). On the other hand various grassroots based dalit protest movement emerged in the post-Ambedkarite phase however their role and contribution in the realm of civil society has been under-researched. Current paper is an effort to locate dalit civil society (in periphery) in the domain of civil society and grassroots social movements’ vis-à-vis social transformation. It will explore through Manavi Haq Abhiyan (MHA) some emerging specificities of dalit worldview and strategies which distinguish it from other civil society actors in India.


The Reproduction of Social Exclusion of Dalit Children in Primary Schools and the “Schools of Resistance” of the Dalit NGO Navsarjan in Gujarat


Simone Holzwarth (Humboldt University, Berlin)


The paper is based on data collected during fieldwork in Gujarat in summer 2006 for Unicef India in cooperation with the Indian Institute for Dalit Studies, Delhi. It has been documented that Dalit parents see education as a vehicle of social mobility and therefore are eager to send their children to school. However, statistics show that Dalits are over-represented amongst out-of school children. On this background the aim of the study is to get an insight into the situation of 10-13 year old Dalit children and to document their experiences of caste-based discrimination in primary schools. The study takes the approach to look at school in the wider context of the "universe" of the children's life in their community and family. The first part of the paper shows that social exclusion is not simply solved through educational inclusion. After identifying the forms of discrimination found, the study shows the dynamics and connections between them. Processes of discrimination accumulate to social exclusion where the school is only one of the social spaces in the village where children experience the reproduction of their social stigma. The results of the study suggest that schools do have the potential of being spaces for rethinking social hierarchies. However, this role is limited by the fact that government teachers lack the skills required. Additionally in small villages the omnipresence of members of dominant castes and the pressure on teachers makes it difficult for them to act as these agents of social change. Furthermore the study reveals that there is a transformation from overt forms towards more subtle forms. The second part of the paper goes one step further and shows the reaction of the Dalit NGO Navsarjan to this situation of persisting discrimination in the state school system. Navsarjan has started to develop a parallel education system that specifically targets Dalit children. In the view of the NGO, education is the only way to transform a hierarchical society and to fight against oppression against Dalits. On this background the paper rises broader questions on the role of schools as spaces of reproduction of exclusion on the one hand and as a means of transforming society on the other hand.


Caste, Identity and Gender among Madigas in Coastal Andhra Pradesh


Clarinda Still (LSE)


The theme of production and reproduction of inequalities finds fertile ground on the subject of Dalit women. Dalit women are known to be one of the poorest and most disadvantaged social groups in India and have been described as bearing a ‘double’ or even ‘triple burden’ of caste, class and gender inequality. Several authors have recently drawn attention to the way in which modern social and economic changes affect Dalit men and women in different ways, sometimes disfavouring women. Taking up this theme, this paper explores the way in which competitive status seeking among families within a rural Dalit community in Andhra Pradesh has had a detrimental effect on women. Using a detailed case study of an elopement and subsequent marriage, I show how women, who were previously less obsessed with female virtue than their upper caste counterparts, increasingly bear the burden of producing family ‘honour’. Daughters’ ‘virtue’ as well as their withdrawal from manual labour and education have become important strategies for upward class mobility. In the final analysis, I suggest that it is not that Dalit women move from a position of traditional equality to modern inequality but merely from one kind of inequality to yet another.


Politics of NGO Activism with Dalit Women in Rural North India


Radhika Govinda (University of Cambridge)


There has been a growing awareness among Dalit (ex-untouchable) castes that the traditional Hindu social order with its caste hierarchy cannot ensure social justice for them. Dalit female consciousness has also been high. However, it has been argued that their voices and perspectives have been marginalised in both Dalit and women’s movements (Rao 2003). This paper examines the engagement of a rural women’s NGO called Vanangana with Dalit women in Uttar Pradesh, north India. The NGO emerged as a product of a partially state-sponsored women’s empowerment programme whose mandate had been to mobilise “poor and marginalised” rural women. The paper specifically explores the politics of NGO funding and mobilisation of Dalit women: How far can NGO activism go in enabling Dalit women’s empowerment? Does NGO activism dilute the transformative agenda of Dalit and women’s movements? What implication does having roots in a state-sponsored initiative have for the NGO? Does accepting funding from government and international donor agencies necessarily change the character of activism with Dalit women? The paper is based on a series of interviews, observations and documentation collected and analysed as part of Vanangana’s case study, over the past two years, towards my doctoral research on Indian women’s movements.


Production and reproduction of marginality of sex workers in Chennai, Tamil Nadu


Salla Sariola (University of Edinburgh)


In this paper I discuss how HIV prevention that focuses on sex workers in Tamil Nadu has reinforced their marginality. I do not attempt to talk about sex workers and their agency per se, but the discursive forms that affect how HIV prevention is done and what kind of an impact it has had on the sex workers. I give examples from my field work in Chennai in 2004-2005 that serve as examples how ‘sex worker’ has become an epidemiological term. NGOs that work in HIV prevention have created new forms of governmentality over the sex workers. Moreover, focus on sex workers as a health problem, not in order to improve their human rights. In this paper I argue that the reason why this is so, has historical roots and ideological resonances. Blaming the sex workers for the spread of HIV resonates the colonial blaming of prostitutes for the spread of venereal diseases among soldiers, and nationalist/Tamil Self-Respect movement ideas about idolised motherhood whose binary opposite was the impure whore. I argue that due to these socio-cultural understandings that underlie the HIV prevention, the HIV prevention largely fails.


Gendered Space and Sexual Intent: Difference, conformity and resistance in the public practices of men who have sex with men in Calcutta


Paul Boyce (Thomas Coram Research Unit, University of London)


Male-to-male sexuality in India has been portrayed in research as occurring in geographically marginal spaces. Addressing this representation this paper considers sexual space as phenomenologically apprehended – conceived in interplay between subject’s perceptions, structural environment and embodied presence. Exploring this stance in respect of the public practices of men who have sex with men in Calcutta, India, male-to-male sexuality appears as implicit in the production of mainstream gendered space. This perspective complicates understandings of masculinity, with same-sex sexual intent emerging in sites of otherwise more culturally orthodox male public dominance. Conceiving men who have sex with men as other than structurally sub-dominant raises critical questions for praxis. Crucially, ostensibly heteronormative practices may enable same-sex sexuality as much as they repress it. Simultaneously this means that oppression of same-sex sexual subjects may be invisibilized amidst representations of ‘normative’ gender relations.


Five Notions of Haq: Meanings, politics and Rights in North-western India


Sumi Madhok (SOAS, University of London)


So what are the range of meanings that can be standardly accorded to a literal term at any given time? Furthermore, what justificatory premises do these different meanings trace their source to? And finally, what do these meanings tell us about the prevailing ideas, beliefs and traditions at the time? In this paper, I isolate five different justificatory premises for haq and explore the range and reference of meanings associated with these. While historians of ideas have been embroiled in a fierce debate over the appropriate way to study historical text including literal terms and how to recover historically obscure meanings of words and concepts, this paper while utilising some of the insights gained from these debates, focuses on recovering different meanings of haq ethnographically rather through a wholly textual analysis. Consequently, in this paper I present five different meanings of haq, the principal Arabic/Urdu term to denote a right in order to examine the different understandings of rights and citizenship that underpin these. In this paper, I first provide the context of the ethnography of haq, outline a brief etymological genealogy of haq and finally I put forward five different meanings of haq which exist in the ‘social imaginary’ in a particular geographical area and given time slice. These five different justifications for haq are legal, republican, moral, ancestral or cosmological and religious.


Crime and Candyfloss: The New Face of Global Bollywood


Mallarika Sinha Roy (International Development Studies, University of Oxford)


In the context of the increasing euphoria over India’s economic liberalisation, the Hindi film industry or Bollywood has grown into the global face of ‘India Shining’ and has transformed from an essentially Indian entity to an industry with international market. The dream-factories of Mumbai have acquired a significant position in representing the ‘Indian society’ to the Indian as well as the international audience. The Bollywood representations of different social sections and realities reflect the desires of beneficiaries of economic liberalisation. These representations are indeed multiple because Bollywood is one of the most prolific film industries in the world. Its susceptibility to the ubiquitous ‘market’, however, rarely allows it to veer from catering to the ‘mainstream’. This paper is concerned with two distinctive trends of mainstream films in the last decade, termed as ‘crime’ and ‘candyfloss’, and examines how inequalities between ‘middle-class’ and ‘poor’ are articulated through these films. The candyfloss films are big-budget song-and-dance fantasies with presumably ‘social’ messages but avoid unattractive realities of poverty. The crime films often deal with the ‘underworld’ where the realism of poverty becomes the synonym for the realism of crime and the poor from squalid slums swell the rank and files of organised crime. The growing rates of multiplex and middle-class aspirations have resulted into criminalisation of the poor in one of the biggest ‘brands’ of post-liberalisation India – the global Bollywood.


Religious transformation and marginality: an exploration from Hindu central India


Amit Desai (LSE)


This paper examines the implications of an approach which puts motivation for religious action at the centre of its analysis. In doing so, it suggests possible reinterpretations of ways of thinking about the relationships between power, marginality, and religiosity, and offers, by way of raw material, processes of religious transformation among people in an Adivasi area of central India. In particular, I examine how and why these marginal people, all poor members of low status groups, are attracted to a Hindu religious sect, the Mahanubhav Panth, and the consequences of their new-found devotionalism.

‘Life has returned to normal’: Managing peace in a town in central Gujarat


Carrie Heitmeyer (London School of Economics)


Many studies on the impact of the 2002 pogrom in Gujarat are focused on urban centres, many of which have a long history of communal violence. One of the ways in which the 2002 pogrom distinguished itself from previous instances of communal violence in Gujarat is the extent to which rural and semi-rural areas of the state suffered massive casualties and property loss (predominantly at the expense of the Muslim minority). My paper will focus on one town in central Gujarat for which the 2002 riots constituted the first incident of communal violence in approximately fifty years. I will argue that despite the still vivid memories and trauma experienced during that time, long-standing social, economic and political relations between Muslims and Hindus continue to bind the two communities on an everyday level. While the 2002 violence did succeed in forging a greater, albeit temporary, unity between different factions of the local Muslim community, religious identity, while still salient, does not necessarily trump other forms of identity based on caste, class, gender and occupation. My paper will look at why in this instance polarisation between the Hindu and Muslim communities has failed to develop in the aftermath of 2002 and focus on the many ways in which the fault lines between ‘Hindu’ and ‘Muslim’ remain porous.


Social Inequality and the Affordability of Pharmaceuticals: Ethnographic Perspectives from South Asia


Stefan Ecks, Ian Harper, Patricia Jeffery, Roger Jeffery (University of Edinburgh
)


Debates on social inequality in South Asia are increasingly concerned with access to health care. Evidence from many studies suggests that the major reason for households falling into poverty is the expense associated with major illnesses. Consequently the affordability of pharmaceuticals is an everyday concern. India's recent implementation of the World Trade Organization's (WTO) rules on pharmaceutical patent protection is widely feared to deepen this problem, and struggles around the "Trade-Related Aspects of Intellectual Property Rights" (TRIPS) are generating new forms of social activism. Based on initial results from our ESRC/DfID-funded research project "Tracing Pharmaceuticals in South Asia," this paper argues that pharmaceutical patents are indeed raising prices, but that this does not fully account for key links between social inequality and pharmaceuticals. What has not yet been studied in detail by social scientists is how pharmaceuticals are distributed: who are the major players in the distribution chain, and who is making profits from pharmaceutical sales beyond patent-holding corporations? As this paper will argue, the complex ways in which pharmaceuticals are distributed has tremendous effects on their affordability.


Pills that swallow policy: India’s National Mental Health Program


Sumeet Jain and Sushrut Jadhav (Centre for Behavioural and Social Sciences in Medicine, University College London)


India’s National Mental Health Program (NMHP) was initiated in 1982 with objectives of promoting community participation and accessible mental health services. A key component involves Central government calculation and funding for psycho-tropic medication. Based on ethnography of a community psychiatry program in north India, this paper traces the biosocial journey of psycho-tropic pills from the Centre to the Periphery. As the pill journeys from the Ministry of Health to the clinic, its symbolic meaning transforms from an emphasis on accessibility and participation to administration of ‘treatment’. At its final destination of delivery in the rural health centre, the pill becomes central to professional monologues on compliance that mute the voices of patients and families. Additionally, popular perceptions of government medication as weak and unreliable create an ambivalent public attitude towards psychiatric services. Instead of embodying participation and access, the pill achieves the opposite: silencing community voices, re-enforcing existing barriers to care, and promoting chemical solutions for social problems. The symbolic inscription of NMHP policies on the pill fail because these are contested by more powerful meanings generated from local social and cultural contexts. The authors argue this understanding is critical for development of policy that can more effectively address local mental health concerns in rural India.
Group of workers about to start the next shift