Ecks, S.Eating Drugs: Psychopharmaceutical Pluralism in India. New York: New York University Press. 2013. vii + 223pp £50 (hbk) ISBN 978‐0‐8147‐2476‐7

Abstract

Pharmaceutical pluralism has been embraced in India, from biomedical to Ayurvedic and homeopathic treatments. In Eating Drugs: Psychopharmaceutical Pluralism in India, Stefan Ecks argues that different approaches alter popular perceptions of drug use and their effects. Based on several years of research on India's pharmaceutical markets, Ecks explores how medications, especially mood medications, are understood and used in Kolkata. The reader is taken on an illuminating journey from biopsychiatric treatments to popular health practices, and alternative medicines prescribed in Ayurveda medicine, before returning to a discussion concerning psychiatry. A fundamental argument reiterated throughout the book is that patient's suspicions of psychopharmaceuticals are based on cynicism towards biomedicine's ‘magic bullet’ (p. 7) model of drug effects. The book has been written from ‘a position of doubt about the immediate and long-term side effects of biomedical psychopharmaceuticals’ (p. 187). Mistrust of biomedical drugs focus on their expense, the possibility of toxic side effects, and their superficial, ‘quick-fix’ results. There is the perception that modernity has spoiled health, hence biomedical psychopharmaceuticals are viewed with great skepticism, whilst many non-biomedical treatments are adopted. Alternative treatments include Ayurveda, the grand tradition of Hindu medicine which has been integrated into the Indian National Healthcare system. This is built on the idea that health comes from a robust and balanced diet, which harmonises individual's constitutions with the natural and social environment. Homeopathy is noted as the second most popular type of medicine in Bengal, and is also linked with food and experiences of digestion. Pharmaceutical association with food is a key theme. This is a particularly animated analogy that is brought to life extremely eloquently by Ecks. Within popular notions of health in India there is a focus on the centrality of the belly as the somatic centre of good health, leading to pharmaceuticals being described as food: ‘It is like a kitchen where food is cooked and refined’ (p. 21). Eck's analysis of Ayurvedic practices in Kolkata evidences how in traditional Indian medicine food is medicine and medicine is food. However, it is noted that this is a one-sided argument. Though food is used to make sense of drugs, drugs are not used to make sense of food. Furthermore, there is the risk that equating psychotropic drugs with food might make them appear banal. However, though this possibility is acknowledged, the argument is not fully explored in the book. Ecks provides a captivating narrative encapsulating the plethora of persuasive procedures employed by doctors to encourage patients to take their prescriptions. He discusses how cultural metaphors, which speak to a globalised anxiety about medications such as ‘mind food’ (p. 3), are used. However, whilst potentially increasing public acceptance of treatments, they obscure critical awareness of drug efficacy. In India ‘mood’ drugs and treatments of ‘the mind’ are routinely prescribed in their millions, and with limited public debate on psychopharmaceuticals, patients are confused by the notion that drugs can cure disturbances of the mind. There is friction between the competing sets of assumptions about drugs and how a metaphor like ‘mind food’ can distort crucial disparities. Such mass prescribing is also paradoxical; though more people are consuming treatments, the disorders they treat are also increasing. In analysing how Kolkattans perceive mood medicines and their efficacy for treating sadness and depression, Ecks provides a persuasive argument in identifying the need to address public anxieties about drugs via ‘a dialogue between anthropology of pharmaceuticals and a critical pharmacology of adverse drug effects’ (p.188). He notes that psychiatrists are trying to counter non-biomedical perceptions of drug effects and the bio-medical model of short-term targeted action. Even they discourage patients from discussing moods and mental states, and instead favour conversations about physical symptoms which expedite consultations between doctors and patients. The usefulness of using food metaphors for drugs is thoughtfully considered by Ecks. In a society where prescriptions are rapidly rising, and pharmaceutical companies give doctors strong incentives to write as many prescriptions as possible, Ecks suggests that the obscuring of the effects of drugs by Bengali psychiatrists is actually a positive outcome, as this has ramifications upon the marketing of pharmaceuticals. This may limit the growth of psychopharmaceutical sales in the future. Filled with anecdotal, vivid, and lively tales, this unique ethnography of pharmaceuticals in India will be of key interest to those in a range of disciplines, including the anthropology and sociology of medicine, pharmacology, mental health, bioethics, global health, and South Asian studies. It is a valuable contribution to debates about perceptions and attitudes towards medicine, and the different approaches towards treating depression.