William S. Sax

The Ills of Marginality: New Perspectives on Health in South Asia

Social marginality and ill health can form an unholy dyad: firstly, groups who suffer from chronic or infectious diseases often find themselves pushed to the margins. Secondly, people who are already on the edge of society tend to suffer more from illness than those at the centre. In development discourse, marginal people are defined as those who are ‘not yet’ on the same level as the developed mainstream and are in urgent need of aid from the centre. The papers in this special issue take a different approach by insisting that marginality is a radically relational concept: the centre and its margins constitute each other, and the boundaries between them are constantly shifting. The papers show that there are many types of marginality (based on geography, class, caste, sex/gender, ethnicity, etc.), and that each of them has different effects on the health of a particular group. Yet instead of speaking of a plurality of unrelated ‘group identities’, marginality preserves a sharp sense of unequal power relations between groups. The specific ethnographic contribution to the study of marginality comes from its attention to the point of view of marginal people. This is of critical importance since marginality puts health most under stress when it is clearly and steadily perceived in everyday life. This, in turn, makes it possible to show that living on the margins is not always and everywhere bad for health. While all of the papers present South Asian case studies, the insights and questions are relevant for the study of the ills of marginality in a global perspective.

Ritual healing and mental health in India

Ritual healing is very widespread in the Indian state of Uttarakhand, and is by far the most common option for those with serious behavioral disturbances. Although ritual healing thus accounts for a very large part of the actual health care system, the state and its regulatory agencies have, for the most part, been structurally blind to its existence. A decade of research on in this region, along with a number of shorter research trips to healing shrines and specialists elsewhere in the subcontinent, and a thorough study of the literature, suggest that such techniques are often therapeutically effective. However, several considerations suggest that ritual healing may not be usefully combined with mainstream “Western” psychiatry: (a) psychiatry is deeply influenced by the ideology of individualism, which is incompatible with South Asian understandings of the person; (b) social asymmetries between religious healers and health professionals are too great to allow a truly respectful relationship between them; and (c) neither the science of psychiatry nor the regulatory apparatus of the state can or will acknowledge the validity of “ritual therapy”—and even if they did so, regulation would most likely destroy what is most valuable about ritual healing. This suggests that it is best if the state maintain its structural blindness to ritual healing.

State Policy and Local Performance: Pasture Use and Pastoral Practices in the Kumaon Himalaya

In the Kumaon Himalaya, British colonial administrators as well as agents of the independent Indian Union intervened heavily in pasture use by adopting rationally governed and scientifically sanctioned development schemes. These measures mostly originated from outside and largely ignored local cultural logics through which a pastoral life also takes its form. We use the case of the Bhotiyas of the Kumaon Himalaya to explicate this interaction of state policy and local performance. On the one hand, we analyse recent development trends that occurred after India started to liberalise its market in the early 1990s. On the other hand, we describe a ritual practice through which the Bhotiyas channel emerging power relations and conflicts towards the outside of their migratory cycle. We conclude by suggesting an interdisciplinary perspective on pastoral practices in the Himalayan region.