64 chapter
Statistical Manual (DSM) used by mental health professionals in the United
States. Th e ICD is allegedly an international, culturally-neutral version of
the DSM although medical anthropologists have long been skeptical of such
claims about the transportability of what they see as Western assumptions
about psychopathology to other parts of the world—and we have already
seen some cultural discrepancies in the application of biomedical practices in
Kerala.^19
Th is is not to imply that the ICD is not useful to psychiatrists in India or
to deny that there are resemblances in pathological behaviors across cultures.
In fact, changing patterns of sleep and relations to food are of keen interest to
both ayurvedic and allopathic psychiatrists in assessing the mental health of
their patients and in discerning diagnoses such as depression, vishadam, and
kaphotmadam.
After a psychiatrist assigns a tentative ICD diagnosis, he starts the patient
on a regimen of medication. Consistent with Nunley’s (1996) observation that
psychiatrists in India rely heavily on the use of drugs, medication was pre-
scribed for almost every allopathic patient I encountered, and the quantity
and strength of medicine given to some patients seemed excessive to some
clinical psychologists I spoke with in Kerala. Allopathy is popularly viewed
in India as a powerful and heating form of treatment.^20 Allopathic drugs are
reputed to have powerful, benefi cial eff ects, but as patients in Kerala show us,
this potency can also cause unpleasant and dangerous side eff ects that have led
some patients to seek less abrasive therapeutic alternatives.
Th e pharmacopeia employed by allopathic psychiatrists in Kerala is the
same as that used by psychiatrists in other parts of the world, although the
drugs used in India are manufactured by Indian companies under India’s
Patents Act, which in the case of medications permits the patenting of
processes but not the drug products themselves. Th is has allowed Indian
companies to “reverse engineer” drugs and sell them at a fraction of the
prices charged by multinational drug companies. However, the process
pa tent provision has been superseded by India’s 2005 Patents (Amendment)
Act, which was passed to conform to World Trade Organization require-
ments on patents and may soon prevent Indian companies from manufac-
turing cheap versions of drugs for which foreign companies hold patents.^21
Fluoxetine, which is produced under the brand name Prozac in the United
States, for example, is made by an Indian manufacturer and sold in India
under the brand name Fluex at a fraction of what the drug costs in the
United States.
Th e most frequently prescribed psychiatric medicine in Kerala and
throughout India, according to psychiatrists I spoke to, is haloperidol, which