Mental Health in India: Purity, Pollution, Caste, and Mental Health
Photo: Karan Madhok
In India, our approach and understanding of mental health concerns are often further complicated by the historical weight of the caste-system and a yearning for cultural ‘purity’.
The ‘Mental Health in India’ series on The Chakkar will look at various gaps in conversation regarding mental health issues in the country, from the effects of history, to current cultural speed-bumps, solutions for coherent policies for the future, and much more.
In a shocking 2018 survey by The Live Love Laugh Foundation (TLLLF), 60 percent of the respondents in India believed that mentally unhealthy people should have their own groups so as to not contaminate healthy people. A large number also agreed with the statement that “Sitting with/talking to a mentally unhealthy person could lead to deterioration of the mental health of a healthy person”. Quite a few agreed to having feelings of disgust for those affected by mental health concerns.
It is no surprise that there is immense stigma towards mental health concerns in India. To this day, someone facing those might be told to “be positive” and “have discipline”, pointing to the fact that there still isn’t an appreciation for the fact that mental health concerns are caused by various factors and can’t be done away with simplistic solutions. There is also an inkling of “getting contaminated” and “feeling disgusted” as if mental health concerns are something contagious that can get passed on by touching.
One explanation of stigma is the industrialisation hypothesis. This explanation suggests that cities that are industrialised tend to be fragmented, lifestyle factors are poor, life is competitive and so, this not only worsens the mental health of people, but blames people for their situational factors and mental health problems—and therefore, the stigma is higher in such places. This hypothesis, however, still doesn’t fully explain stigma in the Indian setup.
This is perhaps where our cultural ideas of purity and pollution come into play. These ideas originate within the caste system, which often stresses that the higher casters (brahmins) are the purest, and as one goes towards the lower castes, the ‘pollution’ increases. In order to keep this pollution away, it is important to not marry outside one’s caste, and to keep producing ‘pure’ children. On his piece regarding purity and pollution for Fair Observer, Praveen Kishore traces how the idea of dirtiness or pollution enters all our ideas, including concepts of shoes, food and sex. He says, “Ironically, the civilization that gave birth to the Kamasutra has denigrated lovemaking into a sordid activity. It is a necessary evil for begetting children, and it pollutes, not purifies.”
Since caste pervades all areas of our mental and social lives, any condition that comes in the way of being a contributor to society in the ways designed by the caste system—including staying in your own caste-based occupation, or increasing lineage by producing children—is seen as a “problem”. Thus, the idea of dirtiness which is assigned to sex, is also assigned to any natural/structural variation—that is, mental health concerns, neurodivergence or disability.
In a 2019 article, Andrew Wilson of the University of Melbourne wrote about how Hindu caste system beliefs affect our understanding of disabilities such that we might think disability is a fruit of ones’ karma or past sin. It indicates a malicious nature, or the wrath for trying to pollute the caste system.
Does this mindset still pervade today? It would seem so. In an episode of the Desi, Chill, and Mentally Ill podcast, it was noted that, “Doctors are probably the biggest deterrent in getting mental health care in India. Male doctors have a tendency to project ideas about womanhood onto their patients. The sexism and bias in psychiatry make it harder for neurodivergent women to get a diagnosis.”
Further research shows that the caste system does affect labour relations and ideas of productivity. Any ‘condition’—neurodivergence, mental health issues, having an LGBTQ identity or having a disability—is either seen as something polluting or contaminating, and thus, many people prefer to keep a distance, making integration a challenge at the workplace. Or, it is often seen that the affected people are deserving of their condition, attributed with malice or laziness.
Since caste pervades all areas of our mental and social lives, any condition that comes in the way of being a contributor to society in the ways designed by the caste system—including staying in your own caste-based occupation, or increasing lineage by producing children—is seen as a “problem”.
These attitudes do largely reflect caste system-based understanding, and have also pervaded our medical systems. Because ones’ dharma is seen to be to produce and contribute to the economy and lineage, ideas of productivity and fertility get internalised for us, to the degree that we start tormenting ourselves if we cannot meet these ideals. This would perhaps explain the popularity of influencers, motivational speakers and religious gurus in India who locate mental health distress inside the person and chide them, instead of seeing structural, systemic and collective causes.
Apart from affecting how mental health distress and other variation is viewed, the experience of caste system and discrimination is also now being viewed as cultural and intergenerational trauma. Shaima Ahammed writes:
Thus, even as caste victims’ trauma has not been a focus of academic discourse in India, the lived subjective traumatic experiences and memories are beginning to emerge in these poetic and autobiographical narratives which often echo several symptoms of trauma such as anxiety, sadness, guilt, anger, grief, fatigue, pain, despair, shame, chaos, loss of trust and so on.
Ahammed also beautifully illustrates how culturally relevant practices like that of Theyyam can help alleviate the collective and intergenerational trauma and open up pathways of healing.
However, if caste is so important as both a contributor to mental health issues as well as the ways in which we see natural variations, disability and mental health concerns, why does it not take up more space in our popular literature as well as curriculum? Dalit psychiatrist Sushrut Jadhav explains, “We continue to remain in a state of what Ashis Nandy once described as a post-colonial paralysis of the Indian psyche,” and later adds, “As a discipline, psychiatry remains largely culture blind to its own local and yet crucial forms of suffering”. Jadhav posits that our curriculum and popular understanding still centralises western ideas and fails to address local problems and come up with local solutions. India has a rich tradition of collective and arts-based healing which can be centred over western models.
Caste already is a big contributor to health inequities in India. It affects access to healthcare, how doctors treat the patient, and so on. However, newer research is starting to fill this gap for mental health literature too, where both the impact of caste in contribution of mental health distress as well as its role in perception building is being studied. One study published in 2020, for example, is looking at the role of being of Scheduled Caste or Muslim, in India and how that affects a person’s mental health.
Lastly, noted psychoanalyst Sudhir Kakkar contends that we need “the other” (the other caste, the other religion, the other gender) to form our own sense of self, in contrast. However, this in addition to the idea of dirtiness being ascribed to certain castes and religions can lead to politically-motivated violence.
It’s imperative to increase tolerance for ‘the other’, as well as question our ideas of purity and pollution—not only for our mental peace, but also communal peace. If not, we may keep projecting this impurity as belonging to others and “cleansing” it—and sometimes, doing so by violent means. We need a revived understanding of our inner and outer worlds if we are to live in harmony with our own experiences as well as with the other members of our country.
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Sadaf Vidha (she/her) is a therapist and researcher with five years of experience. She is interested in cross-disciplinary understanding of human behavior at the intersections of mental health, sociology, social justice and economics. In her free time, she likes to read, paint, bake and play with her cats. You can find her on Instagram: @shrinkfemale and Twitter: @randomwhiz.
