conclusion: pleasure, health and speed 201
and Ivan Illich (1976), who linked modern standards of health and illness
to life and work conditions under capitalism, and the not-yet-realized World
Health Organization (1978) defi nition of health as not simply the absence of
disease but also the presence of a state of well-being. People suff ering men-
tal problems in Kerala reveal a continuum of dispensations including the
intriguing possibility of going beyond a cure and achieving an auspicious state
of transformation that is more enhanced than their pre-illness state. Th e latter
orientation ultimately diff ers from the WHO ideal of health as the presence
of well-being, which itself may be on the wane.^4 While the WHO position
is more positive than the absence-of-pathology view of health, it retains the
sense of health as a state of stasis, as achieving and then maintaining a state
of well-being. For some patients in Kerala and in Alter’s (1999) interpretation
of ayurvedic texts, health is a process of constant improvement or constant
growth. With such a defi nition, however, “health” begins to lose its adequacy
as a description of the aspirations involved, and perhaps we are considering
broader goals of life which can be achieved, in part, through therapy. Ajit
alludes to a goal that transcends our usual sense of health, healing and what
is accomplished in medical realms when he claims that ayurveda can help one
attain a “supreme aim in life.” Similarly, Lakshmi asserts she has “been getting
aiśvaryam [wealth/glory] and abhivriddhi [prosperity] continuously” through
her relationship with the goddess at Chottanikkara.
Th ese are of course heady ideals for health and the quality of life. Perhaps
Lakshmi and Ajit will have trouble maintaining these aspirations. Perhaps
they will relapse and struggle again to fi nd some “change,” as many do in cop-
ing with mental adversity. Th ey and others experiencing mental distress at
least expose us to orientations to “health” that many of us who live in a more
medically homogeneous society remain unaware of since we are attuned to our
common-sense assumptions, which are shaped by biomedical discourses and
practices. Having had the chance to compare diff erent psychiatric treatments,
people in Kerala know that there are multiple options and multiple dilemmas:
some therapies are more pleasant than others, some are faster than others and
some claim they can help one aim for another level of health.
Marcus and Fischer (1999) assert that one of the primary purposes of anthro-
pology should be cultural critique. One should be able to use the insights from
comparing cultural practices to critically re-evaluate one’s own cultural assump-
tions (the culture to be critiqued in their examples is the “West,” or roughly
European and North American ideologies and practices). People who live in
a medically pluralistic environment are essentially natural anthropologists of
medical practice due to their experience comparing and critiquing approaches
to healing. Th is development of an evaluative, critical perspective is inevitable