Violence and ill-health are inherently related concepts, especially when it comes to the experiences of marginalised population. My recent visit to India contributed to my reflections around this idea. I travelled there to participate in “Difficult Dialogues”, an event co-organized by UCL in Goa, and to give a lecture on “violence in post – colonial contexts” at the SNDT Women´s University, in Mumbai. While in the country, I also tried to travel around a bit, and to experience the local culture first-hand (although the only thing a couple of days could grant me was a short “taster” of the local landscape). After my trip, my perspective on health and illness as contextually shaped was enriched. In fact, a fundamental idea remains salient: structural and cultural violence are a crucial underlying cause of ill-health across cultures.
The implications of such idea are serious, and challenge orthodox systems of knowledge through which policy-makers, academia, professionals and communities deal with human misfortune. To reframe many experiences of illness as “violence” may be a necessary step needed to historicise and contextualise suffering in a way that is both intellectually and ethically meaningful. Discussions around this possibility will require a reflexive, and truly difficult dialogue, not only for India, but for Ecuador and the entire Global South.
But first of all: What do I mean by violence? And how does such concept play out in the “global south”? I am framing violence as conceptualised by Freire, Galtung and Martín-Baró: any avoidable situation that prevents people from fulfilling their basic needs of survival, well-being, identity and freedom. In this sense, any avoidable, or poorly treated illness constitutes violence. In places such as Ecuador or India, unfulfilled needs, and the use of physical and symbolic force, existed way before the Spanish and British colonisers arrived in the 16th and 17th centuries, respectively. However, the violence exerted by the powerful European rulers was unprecedented (e.g., massive assassination and repression; slavery; exploitation; racism; cultural alienation), and systematically exerted for three centuries. After independence, colonial violence did not vanish into thin air: it became embodied in institutions, sustained through ideology and internalised by local minds. Today, most of the former colonies from Asia, Latin America and Africa are described as the “third world”, or “developing” (formerly “underdeveloped”) low or middle-income countries. Related to the “core-periphery” notion, the “Global South” is a problematic, yet useful alternative category for referring to such regions. It stresses the historically and culturally constructed power asymmetries existing in our world, and the inequalities and suffering these have produced.
Despite notorious geographical and cultural differences, India and Ecuador seem to share crucial experiences of violence. Both nations have relegated territories (areas labelled as “slums”, “marginal” or “vulnerable”). In both nations, gender issues are pervasive. And while issues surrounding caste are embedded in the Indian social structure, something similar occurs in Ecuador with classism-racism. Students and lecturers in Mumbai told me how textbooks and standardised psychological tests are used in training (imported from Europe and USA). I wonder to what extent these theories and practices help alleviate the suffering of, for example, local population living in Dharavi (one of the largest “slums” in the world, located in the heart of Mumbai) or in Indian rural contexts.
Discussions in Goa stressed how many of these issues affect mental health care, especially if professionals are not properly trained to deal with them with enough reflexivity and cultural sensitivity. The key role of higher education was stressed, as to avoid two dangerous risks: reproducing a (neo) colonial education by uncritically importing foreign knowledge; and letting universities become bureaucratic institutions, based on routinely/mechanistic awarding of degrees and paying of academic´s salaries (producing mediocre teachers and students, who fail to produce meaningful and culturally valid knowledge that respond to local problems). It was quite interesting to listen to Indian voices expressing these ideas, which resonate with some of my observations in Ecuador. Maybe nations from the Global South have more in common than we might think.
My trip to India helped me to keep thinking about violence as a useful concept to understand many inter-subjective experiences of mental distress across cultures. Specially, although by no means exclusively, in the Global South. These ideas are not new. Psychiatrist Franz Fanon was already talking about this in the 1950s. Foucaldian views of psychiatry/psychology as a technology for social control emerged in the 1960s-70s. Also in this decade, Galtung and Freire put forward their context-sensitive concepts of violence. Much later, these were popularised by Paul Farmer, who focused on pathologies of power that shape illness (producing what Kleinman and his colleagues have called “social suffering”: poverty, racism, sexism, preventable diseases, among others). Facing such social pathologies, Martín-Baró and Latin American psychology of liberation have argued for the impossibility of neutrality: professionals need to identify violence, and take sides with the victims. In Ecuador, critical epidemiologists have made rather similar arguments, in an attempt to historicise and politicise collective health and illness. Today, our challenge is to find creative ways to engage in these theoretical, ethical and practical discussions. As highlighted in Goa, this will require ecological approaches (e.g., not only focusing on the victims, but also on the victimisers); bottom-up efforts (e.g., not only focusing on quantity and coverage, but on the quality and cultural validity of the care that is provided); and an emphasis in genuine empathy, trust and respect. To link health with violence (and more broadly, with culture and context) demands a difficult, yet urgent dialogue involving policy-makers, universities, professionals and communities. It is time to take this challenge seriously in India, Ecuador…and elsewhere.
A few resources:
Breilh, J. (2008). Latin American critical (’Social’) epidemiology: New settings for an old dream. International Journal of Epidemiology, 37, 745–750.
Capella, M., & Andrade, F. (2017). Hacia una psicología ecuatoriana: una argumentación intergeneracional sobre la importancia de la cultura y la glocalidad en la investigación [Towards an Ecuadorian psychology: An intergenerational argument about the importance of culture and glocality in research]. Teoría y crítica de la psicología. Accepted.
Chibber, V. (2013). Postcolonial theory and the specter of capital. New Dehli: Navayana.
Dados, N. & Connell, R. (2012). The Global South. Contexts (11),1, 12 – 13
Difficult Dialogues 2017: http://difficultdialogues.com/difficult-dialogues-2017/
Fanon, F. (2004). The wretched of the earth. New York: Grove Press.
Farmer, P. (2004). An anthropology of structural violence. Current Anthropology, 45(3), 305–325.
Freire, P. (1970). Pedagogy of the opressed. New York: Herder and Herder.
Jadhav, S., Jain, S., Kannuri, N., Bayetti, C., & Barua, M. (2015). Ecologies of Suffering. Mental Health in India. Economic and Political Weekly, L(20).
Kleinman, A., Das, V., & Lock, M. (1997). Social suffering. New Delhi: Oxford University Press.
Montero, M., & Sonn, C. (2013). Psychology of liberation: Theory and applications. New York: Springer.
Napier, A. D. (2015). Culture and health–Author’s reply. The Lancet, 385(9968), 602.
Roy, A. (2014). The doctor and the saint. In B.R. Ambedkar, Annihilation of caste: The annotated critical edition. London: Navayana.
SNDT Women´s University: https://sndt.ac.in/