PART ONE Ethnography of Psychiatry Part One is an ethnographic study of psychiatric practice based on participant observation in a general hospital psychiatry unit in Delhi (India), Chapter One situates the present research within the sub-disciplines of medical anthropology and sociology. This is followed by an analysis of the mental status examination, which is the main clinical tool of the psychiatrist. The transformation of problematic behaviour into the categories of the mental status examination and their inscription into the patient’s case record are ‘illustrated. The chapter ends with a discussion on different aspects of psychiatric treatment. Chapter Two examines the role of the family in general hospital psychiatry. In its multiple roles of legal guardian, reliable informant, nursing aide, and agent of surveillance, the patient’s family foregrounds psychiatric diagnosis, treatment, and follow-up. Chapter Three shifts the focus of discussion to problems of definition of the abnormal, which is the central concept of psychiatry. Drawing upon the available research and my observations of clinical practice, I seek to show that abnormality is not a universal given but a shifting, multilayered and context-dependent variable.Chapter One Psychiatric Practice Interface between Medicine, Culture, and Society Despite a predominantly biomedical orientation, cultural factors and local conditions have influenced the development of psychiatry in India in significant ways. Diagnostic categories have imbibed cultural elements, and therapeutic regimens have not escaped the influence of local conditions. Western approaches have undergone modifications before being applied to the Indian clinical setting. This work begins with an ethnographic account of routine psychiatric practice. In Chapter One, the role of cultural factors on the diagnostic and therapeutié-activities of the Psychiatry Department at the Lady Hardinge Medical College and Hospital (LHMCH), New Delhi is analysed. Analogous to the physical examination aimed at tracking physical ailments is the mental status or psychiatric examination, a systematic procedure aimed at arriving at a psychiatric diagnosis and treatment plan. The discourse analysis of psychiatry is based on a deconstruction of the mental status examination (MSE). The psychiatric examination transforms an individual from a person showing problematic behaviour into a psychiatric case requiring medical intervention. The bureaucratic product of this process is the psychiatric case record. The construction of a psychiatric case involves multi-level linguistic and cultural translation, i.e. translation between Hindi and English,’ translation between Western psychiatric theory and its cross-cultural practice, and46 Deconstructing Mental Illness translation between the world of Indian psychiatrists and their clients. Using actual cases, this chapter maps the chronology of events leading from psychiatric admission, construction of the case record, assignment of a diagnosis, ward treatment, and discharge. But before that, I would like to begin by familiarising the reader with certain theoretical trends leading to the transformation of biomedicine from an uncontested master discourse on the body and disease into an object of cultural analysis and interpretation, a transformation spearheaded by the disciplines of sociology and anthropology. Biomedicine: An Ethnomedical System of Western Society From a macro perspective, this study explores biomedicine as a socio-cultural system. A substantial body of work in the sociology of medicine and medical anthropology in Western society has demonstrated the role played by social structural and cultural variables in the constitution of biomedicine. Earlier, it was only in the study of ethnomedical systems, i.e. non-Western medical systems, such as ayurveda and unani, that the impact of the natural and socio-cultural environment on their epistemology and practice was considered relevant. The study of biomedicine was not a topic in the study of ethnomedical systems (Hahn and Gaines 1982; Hughes 1968; Lieban 1977). The reason given for this privileged status or exclusion was that biomedicine, or scientific medicine, was the explicit or implicit standard by which other ethnomedicines were measured. Biomedicine, the reasoning went, was scientific, while ethnomedical systems were cultural. Being scientific, biorhedicine was considered to be universal, value- free, and objective, and hence not analysable in the same terms as folk or traditional medical systems. There is now, however, a growing body of historical and social-anthropological research that problematises biomedicine itself and analyses it as an ethnomedical system of Western culture and society