Towards the end of 2014, the New York Times ran an article highlighting India’s growing burden of mental health problems, citing its sky-high suicide rate and almost complete lack of psychiatric infrastructure as both evidence for this and as an area for urgent policy attention. Vikram Patel (2014), a leading figure in the Global Mental Health movement, has argued that a more challenging problem than the ‘treatment gap’ in developing world contexts like India is the ‘credibility gap’ – the ability of ‘modern’ mental health professionals to convince patients suffering from serious psychological problems and risk of suicide that they are in need of biomedical intervention. In recent years, anthropological studies of suicide, many of which focus on South Asia, have burgeoned, following something of a fifty-year hiatus across the discipline as a whole. Much of this work takes issue with the assumption that suicidal practices across different cultural contexts necessarily imply the presence of mental illness, focusing instead on the social and relational contexts of self-harm and self-inflicted death as practices, performances, and narratives laden with local meaning (Staples 2012; Staples & Widger 2012).
Jocelyn Chua’s In Pursuit of the Good Life: Aspiration and Suicide in Globalizing South India is a timely and important contribution to the emerging anthropological critique of ‘suicide’ as a kind of human behaviour and as an object for social and medical intervention. Drawing from long-term ethnographic fieldwork in the state of Kerala, India’s ‘suicide capital,’ In Pursuit of the Good Life documents, in fine-grained detail, middle-class narratives of self-harm and self-inflicted death. Thus, the subjects of Chua’s study are the policy-makers, psychiatrists, survivors, and relatives of suicide victims who live in Thiruvananthapuram, the state’s capital, and explores their understandings of suicide in terms of a particular class-bound view of Kerala’s rapid and positive economic development on the one hand, and the negative social consequences of that development on the other. At the start of the book, Chua stresses that she is not writing as an ‘anthropologist-as-sleuth,’ seeking to find out why people kill themselves in Thiruvananthapuram. Instead, she writes in that space characteristic of much contemporary anthropology, which joins Geertzian interpretivism and Foucaultian problematization with a literary style, telling how people’s stories of themselves and others come to be formed. Other than making for an enjoyable read (Chua takes time to note the ways city crowds bustle, afternoon light streams, and thick air stirs, often bringing the text closer to novel than scientific monograph), the result is a book that manages, in my mind at least, to combine the concerns of theoretical anthropology with a dataset rich enough to be of use to those looking for more practical insights.
In Pursuit of the Good Life is split in half, the first formed by three chapters tracing middle-class narratives of why Kerala seems to suffer so much from suicide, and the second formed by another three chapters exploring how Kerala’s suicide epidemic plays out in everyday life. The focus of the first half of the book is the apparent paradox lying at the heart of Kerala – its status as ‘India’s development miracle’ on the one hand, and ‘suicide capital’ on the other. Chua skilfully weaves together the ways in which this paradox threads through her informants’ accounts, being used by some to explain suicide, and by others to explain away suicide. In a particularly moving and illuminative case, ‘Ajith’s Memo,’ Chua reports how a father draws upon ‘bureaucratic categories, expert languages, and popular archetypes of suicide’ to systematically reject possible causes of his son’s death, and to rest on the conclusion he had not committed suicide at all. In this case, Chua shows us how bureaucratic and popular theories of suicide are thus generative of one another, speaking not to ‘evidence’ but instead to ‘ethos.’ As Chua explains, those vested with the educational and social capital to learn and retell bureaucratic categories of suicide gain the ability to re-categorise what ostensibly seems a categorical death. It is through acts such of these, of course, that ‘ethos’ comes to shape ‘evidence’ and produce particular traditions – social, medical, psychiatric – of suicide.
In the second part of the book, Chua moves this analysis forward to explore how the ever-present threat of suicide shapes middle-class life in Thiruvananthapuram. This is shown most interestingly in Chua’s description of ‘care-full’ acts – how women threaten or perform suicide as a kind of sacrificial act for the good of family. Chua’s drawing of a relationship here between the act of self-harm, the act of sacrifice, and the act of what Lawrence Cohen calls a ‘horizontal gift relationship,’ suggests an entirely novel way to conceptualise suicide, not just in Thiruvananthapuram but across South Asian contexts where similar traditions of gender, body, gift, and sacrifice might be found. Chua’s theorisation of suicide as a ‘care-full’ act provides a route to thinking more innovatively about how suicide not only infects everyday life and concerns in Thiruvananthapuram, but also sits within wider contexts of action and interaction between people. Suicide appears as a special kind of behaviour because it takes certain ideas of sacrificial gifts to their logical conclusion, but also normalises suicide within popular ideas of the everyday gift, perhaps helping to account for why suicide seems to ‘go without saying’ in South Asian culture. Not only does Chua’s discussion here help to further undermine any notion of ‘suicide’ as a naturalistic category or objective social fact, but also to suggest ways in which apparently unrelated expressions of ‘giving’ and ‘taking’ might have come together, historically and contemporaneously, to create something people in Kerala now understand as suicide.
As a contribution to South Asian studies of suicide, then, In Pursuit of the Good Life marks out potentially fruitful directions for future study. For example, read in conjunction with my own ethnographic work in Sri Lanka, carried out at the same time as Chua’s study, In Pursuit of the Good Life suggests how a (south) Indian/Sri Lankan theory of suicide might be developed. This point of comparison is not just an exercise in self-promotion on my part, but also because of the striking similarities between how Chua and I have each come to theorise suicide as a social phenomenon. Sociocultural similarities between Kerala and Sri Lanka have long been observable, not least because of the heavy circulation of people between the two areas up until quite recently, as well as similar developmental trajectories including reliance on migration to the Gulf as a crucial source of foreign income. Thus the experiential foundations of both Chua’s and my own informants have been socioeconomic frustrations, failed romance, thwarted consumerism, educational and employment disappointments, and international migration, and it is along such lines that both our monographs have ultimately been structured. More than this, however, is the approach to suicide we both ultimately wish to take. It is no coincidence, I suggest, that both Chua and I have independently rested on a view of suicide not as an ‘anti-social’ act but rather as an act that ‘creates’ social life. Thus, Chua seeks to ‘fundamentally [reconceptualise] the clinical and sociological object of suicide, broadening our field of vision beyond the singularity of suicide as “event,” to consider how suicide…alters…ways of living.’ In a similar way, my own interest has been to chart how ‘through the “suicide process” social and moral personhood is “created” as it is “negated,” leading to new ways of living through agentive ways of dying’ (Widger 2015). We both urge that these approaches to suicide have a validity beyond our own specific ethnographic field sites, yet at the same time ‘something of the field’ seems to have shaped the approaches we advocate. What I suspect we have both rested upon is a view of suicide that descends from particular ontologies of life and death that span south India and Sri Lanka as a cultural zone.
These thoughts take me back to the introduction of this review, and also to my suggestion that despite Chua’s instance to the contrary, she has something ‘sleuth-like’ to say. In the face of the juggernaut of global psychiatry, anthropological approaches of the kind set out by Chua demonstrate the importance of pausing before simply extending Euro-American nosological frameworks for understanding suicide in other places. On one level, the book accomplishes, very well, the task Chua sets for herself, which is to account for how particular bureaucratic, clinical, and popular frames for understanding suicide come about, and how suicide shapes social life in Kerala’s contemporary moment. On another level, Chua has only accomplished this by recording in detail individual examples of suicidality, as both event and process, and in so doing reveals empiricists’ concerns of what, at the end of the day, it might be that encourages people to suicide. Thus, In Pursuit of the Good Life serves as both a warning to the New York Times’ reading of India’s suicide epidemic as a crisis of mental health care, and to the Global Mental Health advocates that the task is not so much convincing Indians and others that suicidal people are really mentally ill people, but rather that the idea of ‘suicide’ is generated from contexts of practice. As such, the book will be of interest to social scientists and humanities scholars of all stripes who have an interest in suicide, the history of medical classifications, and processes of medicalisation and psychiatrisation, as well as cross-cultural suicidologists and suicide prevention professionals.
Reviewed by Dr Tom Widger, who is currently a Wellcome Trust Research Fellow in the Department of Anthropology, Durham University. Tom gained his PhD in anthropology from the London School of Economics in 2009, and has since held positions at Brunel University and the University of Sussex. Tom is author of ‘Suicide in Sri Lanka: The anthropology of an epidemic’, and is currently conducting research for a book on the pesticide industry.
You can find Tom’s homepage here and follow him on Twitter @tomwidger.
Correspondence to Dr Tom Widger.
New York Times, Dec. 30th 2014. India’s Mental Health Crisis. http://www.nytimes.com/2014/12/31/opinion/indias-mental-health-crisis.html
Patel, V. (2014). Rethinking mental health care: Bridging the credibility gap. Intervention, 12, 15-20.
Staples, J. (2012). Suicide in South Asia: Ethnographic Perspectives. Special Issue of Contributions to Indian Sociology 46(1).
Staples, J., & Widger, T. (2012). Ethnographies of Suicide: Anthropological Approaches to Understanding Self-Harm and Self-Inflicted Death. Special issues of Culture, Medicine, and Psychiatry 36(2).
Widger, T. (2015). Suicide in Sri Lanka: The Anthropology of an Epidemic. London: Routledge.