I. The Psychiatrist Who Prescribed Food for the Mind
The Advaitananda Hospital in south-central Kolkata is a charitable general hospital whose outpatient hall is packed every morning with patients and relatives, and whose wards stay open at all hours because relatives are expected to feed the sick. A few beds upstairs are kept for acute psychiatric cases, and it was there, on a teaching round, that I first heard psychopharmaceuinticals called “mind food”.
Dr Roy, one of the city’s most successful psychiatrists, led an entourage of younger doctors to the bed of a sixty-three-year-old monk of the Ramakrishna Mission, whom his superiors had sent to the hospital during a severe episode of what the clinicians called manic depression. The swami sat upright in saffron robes, reading a small book by Vivekananda. He read out a passage from the “Lessons in Raja-Yoga” in which health is a right arrangement of the particles of the brain, illness their disarray, and recovery the work of a mind that remembers the ideal of health so that the body may “follow the brain”. Medicines, Vivekananda concluded, can only support a healing ruled by the mind: “There is only one power to cure the body, and that is in every man. Medicine only rouses this power” (Ecks 2014: 4–5). The monk wanted a disputation. Dr Roy smiled, told his followers to note the title, and asked whether the swami had been taking his medication, a mixture of drugs predominantly of fluoxetine and lithium, which the record showed he had not been taking regularly. Before discharging him, he urged him to keep to the prescription. “What is wrong with taking drugs?” The pills were simply nutritional supplements for the brain, and objecting to them was as unwise as refusing vitamin C during the flu. They were moner khabar, food eaten by the mon (Ecks 2014: 5).
The two men disagreed about what brings recovery, and the psychiatrist was trying to secure compliance. Yet both could speak intelligibly about therapy through nourishment, deficiency, and the restoring of capacities. Dr Roy’s phrase worked because eating, far from being an analogy borrowed from some unrelated activity, is the most familiar and least avoidable way in which living beings keep themselves going.
Eating Drugs (Ecks 2014) was written as a study of psychopharmaceutical pluralism: how patients and practitioners in Kolkata understand medicines, how popular practice, Ayurveda, homeopathy, and psychiatry explain their effects, and why doctors and patients disagree about treatment. Read again more than a decade later, the book documents something more extensive than drugs. People in its pages are continuously trying to remain capable of living. They eat, digest, worry, rest, pray, fast, take medicines, avoid foods, regulate their work, seek company, and adjust to the changing conditions of their lives, and psychopharmaceuticals are one possible contribution among many. The book had assembled the evidence for this continuity, and its conclusion already set humoral self-care against biomedical authority. What it lacked was a concept that could name the continuity itself.
This article supplies that concept and asks what ordinary Bengali expressions can tell us about how people sustain their capacities for further living, and what becomes visible when that sustaining work is disrupted. It makes two connected claims. First, expressions built on pet (belly), mon (heart-mind), shakti (strength), hajam (digestion), thanda (cool), and mon kharap (bad mind) articulate metabolic remediation across boundaries that medical disciplines treat as separate. Second, disruptions make the conditions of remediation explicit: hunger, exhaustion, disturbed digestion, worry, lack of money, irregular work, and missing rest disclose the practical difficulties of keeping living going. The ordinary language of metabolic remediation does more than describe illness, health, or cultural beliefs about the body. It articulates the continuous work through which living capacities are sustained, and its disruptions disclose where this work becomes difficult, unequal, or impossible.
II. Metabolic Remediation and the Language of Living
The objective condition
Metabolic remediation is the continuous coordination through which living beings maintain, recover, redistribute, or transform their capacities for further living. The four verbs keep the concept from shrinking into recovery after illness. Keeping digestion going through ordinary meals is remediation; so is recovering from a fever. When another person takes over exhausting household work, remediation has been redistributed, and learning to live with a permanent limitation may require it to be transformed. The concept names the coordination itself, whether or not any particular act within it turns out well.
Its necessity is objective. No living being escapes the requirement to sustain its capacities, although every living being may fail to meet it. Its realization is mesocosmic, carried out through continuous engagement across the five mediations of embodiment, being-with, dwelling, multimateriality, and multisymbolization. These mediations cannot be treated as independent variables. Food is embodied, but it depends on other people, on seasons and water, on stoves and money, and on the symbolic order of meals. Worry is felt in the body, but it is a response to possible futures, to other people’s actions, to material insecurity, and to obligations. A medicine is a material intervention whose consequences depend on how it is obtained, understood, paid for, taken, and fitted into a day. This is why neither physiology, psychology, economics, nor the anthropology of religion can claim metabolic remediation as its exclusive object.
Recursivity and the interview
The five recursivity levels explain why ordinary expressions become most revealing during disruption. At L1 remediation proceeds without explicit recognition: a person eats when hungry, moves into the shade, lies down after lunch. At L2 coordination becomes noticeably difficult: hunger sharpens, the stomach burns, worry keeps sleep away. At L3 the misalignment is articulated: the stomach is bad, the mind is troubled, there is no strength left. At L4 such articulations are stabilized into theories and regimens, that cool food calms the temper, that fast medicines suppress what slow ones uproot, that tension dries the body. At L5 they become institutional classifications and codes: psychiatric diagnoses, treatment protocols, drug regulation, and the official distinctions between recognized systems of medicine.
The ethnographic interview itself pushes people toward articulation. A labourer who eats panta bhat, last night’s rice kept in water, without a thought may be asked why it is good for him, and his answer, that rice “keeps the stomach cool” and “gives you stamina”, is an L3 or L4 reconstruction of something that ordinarily happens without comment. Interviews therefore give no direct access to L1 living, but they are good evidence of how people articulate it, above all when it has become difficult.
Language as part of remediation
Ordinary language also does more than stand outside living and represent its demands, because it takes part in meeting them. Saying that one is hungry can recruit food; saying that one is unwell can interrupt work; explaining that one needs medicine can mobilize relatives and neighbours; telling one’s troubles to Ma Kali can itself bring relief. Language thus has two analytically distinct roles. It is evidence of how people understand remediation, and it is one of the activities through which remediation is carried out. The object of this article is therefore the changing coordination in which a vocabulary becomes consequential, and a dictionary of Bengali health terms would miss it.
The evidence
The analysis draws on my Kolkata fieldwork. Its core is a set of ninety-five interviews on digestion, medicines, and religious practice, most of them recorded in south Kolkata, around Kalighat and Tollygunge; seventy-nine were with Bengali speakers and sixteen with people from other groups, seventy-eight with Hindus, fourteen with Muslims, and three with Christians (Ecks 2014: 17). Alongside them are clinical observations and interviews with nearly sixty practitioners of psychiatry, Ayurveda, and homeopathy (Ecks 2014: 15), and a separate neighbourhood survey of forty Bengali Hindus about mon kharap (Ecks 2014: 28–30). Some interviews were conducted in Hindi and English, some were translated or survive only in summary, and the questions strongly foregrounded food and digestion. What follows is an ethnographic analysis of how particular people in Kolkata articulated living, and it claims no exhaustive account of the Bengali language or of a uniform Bengali speech community.
III. Pet and Mon: The Linguistic Continuity of Remediation
Pet: from the digestive organ to the viability of living*
The basic Bengali word for the belly is pet, which means stomach, belly, and, in women, womb (Ecks 2014: 21). Its range extends far beyond anatomy. A middle-class woman whom I asked about belly idioms began with the obvious: “the stomach is our most important part. We first have to fill our stomach, that’s essential.” She then corrected the literalism of my question. In many expressions, she said, pet does not mean stomach at all; in peter jonyo, “for the sake of the stomach”, it means “one’s whole being”.
A single organ comes to stand for the practical question whether living can continue. The common way of asking someone about their job is “What are you doing to keep your stomach going?” (tomar pet cale ki kare?), and work that pays only enough for one person’s meals is “belly food” (pet bhat) (Ecks 2014: 39–40). Someone who does humiliating work for small pay can explain that it is “for my belly’s burning” (peter jvalay). “To eat one’s belly full, the back tolerates anything” (pete khele pithe soy). Losing one’s livelihood is having one’s belly killed (pete mara), and “Don’t kick my stomach!” means “Don’t take away my living” (Ecks 2014: 39–42). A rickshaw puller who had lived thirty years in the same slum explained why he and so many others had left their villages: “There’s always work here, no matter what work... Here you can eat your stomach full, but not in the village.”
To fill the stomach in these expressions is also to have earned enough, to have met the household’s obligations, and to have kept the capacity to work. The stomach articulates a continuity between embodiment, economic activity, dwelling, and being-with. It would be a mistake, however, to read pet as a metaphor for something more abstract. Its bodily significance remains literal. People really do need to eat, and hunger or gastric illness really can undermine their ability to work. What matters is that the practical stakes of digestion are already continuous with the other dimensions of living, and the language registers that continuity without having to argue for it.
Digestion as the transformation of capacities
The capacity at issue is digestive power. Dr Sengupta, an elderly kaviraj, used the everyday phrase: “For a proper stomach, you need good digestive power (hajam kara shakti). In Ayurveda language, we say agni. How we cook our rice, with the fire, in the stomach we also have that type of fire” (Ecks 2014: 75). The belly is a kitchen, a place of cooking (pakasthali), a digestive fire (jatharagni) that must neither blaze nor die down (Ecks 2014: 21–22). Younger people called it a machine, a factory, or an engine: “everything goes inside the engine”, and “if your machine works properly, there is no gastric” (Ecks 2014: 36). A young man boasted that his stomach was “like a go-down”, a warehouse into which anything could be poured.
These images do not agree about how digestion works. The kitchen cooks, the engine burns fuel, the warehouse stores. What they share is the question of how ingested substances become capacities for further activity, and of how that transformation can be strengthened, weakened, habituated, or exhausted. A Kalighat guide explained that people who grow up eating stale food are not harmed by it, while those used to good food fall sick when they eat it: “We have to adjust ourselves.” A pujari dismissed the bad eye and located all stomach trouble in the eater: “That must be because you don’t have digestive power.”
Here the observable stake must be kept apart from the explanatory model. It is reasonable to treat digestion as necessary for continued living and as a capacity that varies between persons and over a life. It does not follow that the digestive fire, the humoral account of heat and cooling, or the theory that slum bodies are toughened by stale rice are correct accounts of physiology. Taking ordinary language seriously as evidence of what people are trying to accomplish does not require romanticizing its explanations.
Mon: the capacities of feeling, thinking, wanting, and continuing*
Mon is the Bengali term for mind, heart, mood, affection, memory, desire, concentration, and opinion. It is distinct from both the brain (dimak) and the head (matha), and when people use it they point to the solar plexus, to the forehead, or move a hand between the two (Ecks 2014: 3). Its scope is a capacity for engagement rather than a separate mental domain. A peaceful mind (moner shanti), a cool mind (thanda mon), and a still mind (mon thaka) are the precondition for achieving anything, from passing an exam to coming close to the gods (Ecks 2014: 46). Mind-strength (moner jor) can overcome all ills (Ecks 2014: 22). The mind can catch fire (moner agun), and the mind’s fire can smoulder for years like a dried coconut shell. It can feel pain (moner byatha), break (mon bhanga), or die (mon mora). What is in the mind, moner katha, consists of true feelings that will need to come out sooner or later (Ecks 2014: 27–28).
Each of these expressions describes a condition or transformation of the person’s capacity to engage with living. A troubled mon makes eating difficult and keeps sleep away; a calm one makes hard circumstances bearable. Eating, praying, company, and changes of activity can in turn improve it. A young saleswoman put it as a regimen: “You should keep your mon hard, strong, tension-free. Then you’ll be good and strong (shakti thakbe). If you are tensed, you’ll always be sick.”
The cool belly and the cool head
The saying bhudi thanda thakle, mudi thanda thake, “if the belly stays cool, the head stays cool”, makes the continuity unusually explicit (Ecks 2014: 22). Bhudi is a colloquial word for a fat tummy, mudi for the head, and the two appear together in the jingle mudi-bhudi. A Kolkata woman explained it: “If food properly is digested, all health will be good. Also: If someone is hungry, he gets irritated. He gets annoyed quickly. His mood changes. When appetite is satisfied, the mood cools down.” The reverse direction is stated in another saying: mon kharap lagle, sharir kharap lage, “if the mind is bad, the body is ill” (Ecks 2014: 22).
These expressions do not begin by assigning the phenomenon to physiology or to psychology. They register that disturbed digestion contributes to disturbed feeling and that disturbed feeling contributes to bodily illness. Their causal pathways remain unverified, and the recognition that consequences are interconnected must be kept apart from any particular claim about how. The question here is whether ordinary language recognizes that maintaining living capacities requires coordination across processes that the sciences classify separately, and that question has nothing to do with whether Bengali humoralism anticipated contemporary physiology.
A revealing contradiction
The same language also contains hierarchy and contradiction. In everyday conversation the belly and the mon are antagonists. The belly is hot, hungry, moving, and greedy; the ideal mon is cool, still, and takes in as little as possible (Ecks 2014: 26). The model I extracted from dozens of interviews held that mind and body are separate, that they interact, that the interaction is good when the mind rules and bad when the body does, and that only a weak mind is affected by the qualities of food (Ecks 2014: 24–25).
So the language offers no seamless picture of unified living. Its explicit theory, at L4, preserves a strong and hierarchical dualism of mind over belly. Its practical articulations, at L3, move continuously across that dualism: hunger irritates the mood, worry burns the stomach, a meal cools the head. The continuity of metabolic remediation does not depend on a consistent theory of that continuity. People coordinate and describe living across the five mediations while explaining its mechanisms through partly contradictory models, and the contradictions become most audible when coordination fails.
IV. The Language of Disruption: Hunger, Tension, Exhaustion, and Work
A remediative demand has to be distinguished from the inability to meet it. Hunger is an ordinary metabolic demand and in itself disrupts nothing. Being unable to obtain food, having to work despite hunger, or repeatedly missing meals because of work disrupts the coordination through which that demand is ordinarily met. Tiredness ordinarily leads to rest; disruption begins when rest is unavailable, insufficient, or displaced by other demands. Without this distinction, metabolic remediation would collapse into the absence of unpleasant feelings, which it has never been.
When working prevents eating
A man who was angry about the state of the country said that one real problem was “the food timings. Long gaps between one meal and the next. I have long gaps between meals, 10 hours, 12 hours. From breakfast to lunch, from lunch to dinner... Often I also just forget, because my pressure is on the job. I have to work.” Work is ordinarily one of the means through which a person obtains food. Here the same work prevents him from eating. The activity through which future remediation is secured disrupts present remediation, and the consequences reach beyond the stomach into the management of time, discomfort, workplace demands, and uncertainty about income.
Metabolic remediation is disrupted, then, both when an essential resource is absent and when the activities needed to secure one capacity interfere with the maintenance of another. “Pressure of the job” is in this case more than a psychological description. It identifies a coordination in which work, time, and digestion have become incompatible.
Cinta and the tension of survival*
The same man drew a distinction that recurs throughout the corpus. Gastric trouble and heart attacks, he said, came “because of the tension. Tension of survival, not tension of work. People should have a proper place to work. If you don’t have, then the tension grows. So far I have survived, but what about the next hour? It’s a struggle, it’s a struggle all through.” The English word “tension”, used alongside Bengali cinta (thought, worry), names here an articulation of uncertain continuation rather than an internal psychological state. Food, wages, household obligations, employment, and bodily capacity are all implicated in the question of the next hour. Bengali has an idiom for this too: a lazy person living off others can be asked, “Are you not having any belly worries?” (tumi peter cinta karana?) (Ecks 2014: 40). The worry that matters is worry for the stomach.
The temporal argument follows. Metabolic remediation is never concerned only with the present condition, because people continuously anticipate what they will need next. An activity that gets someone through the afternoon at the cost of tomorrow’s capacity has an ambiguous remediative value, and worry about tomorrow can undermine the capacity to eat or sleep today. A kaviraj advised his patients, “Don’t think on Sunday about what you will do on Monday” (Ecks 2014: 87), advice that presupposes a life in which Monday can look after itself. What his phrase captures is the recursive consequence of an uncertain future for present living coordination, which the word “stress” leaves out.
Mon kharap as a disturbance of living coordination*
The neighbourhood survey approached mon kharap without mentioning depression, beginning instead with physical illness, appetite, and sleep (Ecks 2014: 28). Of the forty respondents, twenty-four reported mon kharap in the previous month. Anxiety was the most common complaint (twenty-eight), followed by mon kharap and physical illness (twenty-four each) and gastric trouble (twenty-two); fourteen reported mon kharap and gastric trouble in the same month (Ecks 2014: 29). The survey could not establish causes or prevalence and was never meant to. What it showed was the company the expression keeps: bodily discomfort, worry, bad sleep, exhaustion, lost concentration, joylessness, and difficulty continuing ordinary activities.
The responses that people thought would ease a mon kharap tell the same story. Twenty-seven of forty mentioned prayer, twenty-one withdrawing oneself, nineteen family support, seventeen thinking positively, sixteen visiting a temple, fifteen fasting, and fourteen the help of friends; five mentioned an allopathic doctor and two a “mental health doctor”. “What has a doctor got to do with mon kharap?” one woman replied (Ecks 2014: 30). Translating mon kharap as depression loses this field. The more revealing question is what has become difficult for the person: eating, sleeping, concentrating, working, enjoying company, continuing a familiar routine. Without naming metabolic remediation in its entirety, the expression articulates a disruption that falls under no single disciplinary classification, and the remedies people propose for it are drawn from the whole field of remediation.
The impossibility of rest
At Kalighat the goddess is given food and two periods of rest every day. A guide who took pilgrims through the temple explained it simply: “after food we give rest to Her, once in the afternoon, once at night. Just the way in which we take rest.” The same man described his own working day: “From 9 a.m. to 9 p.m. every day I work. No leave.” He had no salary; whatever he earned came as gifts from the visitors he guided, so that a day off was a day without income, and he took one only if his boss arranged for someone else to cover.
The contrast is no evidence of hypocrisy or of a lack of awareness of one’s own needs, and what it shows is more basic. This man understood the requirement for rest well enough to organize the goddess’s timetable around it, while his own working conditions allowed him no regular relief. The demand for remediation is recognized; the capacity to satisfy it is unequally distributed. The absence of successful remediation cannot therefore be explained by an absence of knowledge. More often the conditions that would make remediation possible are missing.
Disruption is multidimensional and recursive
Hunger interferes with work and work with eating. Worry about income keeps people awake, and poor sleep undermines their earning. Illness requires expenditure that cuts the household’s food. Instead of separate disturbances awaiting separate solutions, these form sequences of mutually intensifying disruption, and attempts to remediate one problem may generate another. Efforts to sustain immediate living can compromise the conditions of future continuation, and this recursive structure is the defining feature of disrupted metabolic remediation.
V. Eating Medicines: Recovery under Constraints
Medical pluralism can be reread in this light as a set of remediative possibilities encountered within ongoing living, rather than as the coexistence of separate therapeutic systems. The systems make different causal claims and their treatments differ in efficacy. The point is to shift attention to what patients are trying to accomplish when they move among them.
Eating medicines
Bengali uses one verb, khaoya, to eat, for taking food and taking medicine: osudh khaoya, “taking medications”, is indistinguishable from “eating medications” (Ecks 2014: 3). The verb also covers drinking and smoking (Ecks 2014: 37). Food and medicine are not made equivalent in every respect, but they share an everyday vocabulary of ingestion, and the sharing is more than metaphorical. Both are swallowed, both must be obtained, both can be tolerated or rejected, and both alter the person’s capacities.
This everyday range of khaoya has to be distinguished from Dr Roy’s moner khabar. Mon and khabar are both common words, but the combination is a neologism, coined by psychiatrists to make psychotropic drugs acceptable to those hesitant to take them, and not an expression of general parlance (Ecks 2014: 2–3, 6). One is an established practice of speaking; the other is a deliberate professional attempt to use that practice.
Quick recovery and lasting recovery
Nearly everyone distinguished allopathy from homeopathy by speed. A shop assistant explained the choice: “We are workers, so it’s not possible to wait for the medicines to work in ‘their’ time. If we don’t work, we won’t get paid. We want our illness to go away soon, and we want to start working again and looking after our family” (Ecks 2014: 62). A young man who worked six days a week said: “Homeo takes its time. That doesn’t work for me, because I’m a working boy, have to get well soon, so take allopathy. We want immediate result... If you do homeo, it will take out the illness from the body. The illness won’t come back again” (see Ecks 2014: 62–63).
This is his understanding, and it is no evidence that homeopathy produces lasting cures. What the statement reveals is a distinction between two temporal stakes: restoring enough capacity to resume work at once, and achieving a recovery that will last. For the working boy the desirable long-term option, as he understands it, is inaccessible because of his dependence on a daily wage. Poorer people, as I put it at the time, suffer from “time famine” and have to buy time with drugs (Ecks 2014: 62; Vuckovic 1999). The choice of medicine is made within the conditions under which a person can go on earning, eating, and sustaining a household.
Food and medicine as mutually dependent and competing
Two cases from the streets around Kalighat belong side by side. The wife of a rickshaw puller, living with him under a plastic sheet beside the temple wall, massaged his legs while she described the fever that came every afternoon and the strong medicine a doctor had given him. “He takes food before eating the medicine. Without food, how can the medicine work? If he take medicine on an empty stomach, it won’t work.” A Muslim woman who collected food from house to house each morning reasoned the other way. Asked what she would do if her husband earned fifty rupees and a medicine cost fifty, she answered: “What I’ll do? I buy the medicine. Nothing is bigger than life (jibon theke boro kicchu nei)... The food, I can go anywhere and arrange for it” (see Ecks 2014: 60–61). She also had a phrase for why spoiled food should be thrown away: “We don’t want to buy illness” (rog kinte caina).
In the first case food is a condition of successful medication. In the second, food and medicine are competing claims on scarce money, and the competition is resolved by the fact that one of them can be begged. The same two activities can be complementary or competitive depending on the coordination in which they occur. Classifying the first as a dietary belief and the second as a health expenditure decision would miss what both express, namely the practical stakes of remediation under constraint.
The redistributions reach further. “For our health, we could sell our house! First we have to take medicine, to live,” said one interviewee. A salesman had lost his business because “all my business money” went on his family’s medicines and hospital bills, and he now worked in someone else’s shop. The effects of illness are not confined to the sick body; they are distributed across the capacities and futures of other people.
Clinical stabilizations
The three medical traditions in Eating Drugs stabilize such articulations at L4 and L5 in different ways. Kolkata kavirajs began every account of health with digestion and quoted Caraka’s three pillars of health, “food, sleep, and a chaste life”; one of them summed up Ayurvedic self-care in the saying “You are the medicine” (Ecks 2014: 74, 87). Homeopaths presented their remedies as reaching the root of illness, where allopathy merely suppressed symptoms that would return. Psychiatrists described targeted drugs for neurochemical imbalances and, in some consultations, borrowed nutritional language to justify long-term medication. These are distinct therapeutic theories and they are not equally supported by evidence. Their relevance here lies in how each stabilizes a particular account of what will restore living capacities. Medical pluralism is a historically specific organization of possible responses to the disruptions of living, and the living it responds to is the underlying phenomenon.
The double significance of moner khabar**
Dr Roy’s phrase therefore illustrates two processes at once. It shows, first, the practical intelligibility of metabolic continuity. A psychiatrist can explain a drug meant to alter mood by invoking nourishment, because food already provides the most powerful model of sustained capacity. Patients without education might not understand the comparison with insulin, one of his followers explained, “But moner khabar is the most effective. They can very easily accept” (Ecks 2014: 4). It shows, second, how professional authority can exploit that intelligibility. Likening psychotropics to food makes them look innocuous. Food is not associated with toxic side effects, addiction, overdose, or withdrawal, while these drugs carry serious side effects, can increase the risk of suicide in some patients, produce withdrawal symptoms, and should never be experimented with as one might with vitamins (Ecks 2014: 188–189, 195–196). Calling them food invites patients to raise or lower doses at will, and it obscures the difference between autonomous self-care and submission to a prescription (Ecks 2014: 193, 197).
The continuity of metabolic remediation does not make all proposed remedies equivalent, and the practical success of a metaphor does not validate the causal account attached to it. A phrase can recognize a real continuity of living while advancing a misleading explanation of a particular intervention. Ordinary understanding, professional therapeutic claims, and the living phenomenon itself have to be kept analytically apart, and moner khabar is the case in which their separation is easiest to see.
VI. Distributed Remediation: Households, Strangers, and Gods
Keeping other people going
Almost no remediation in the Kolkata material was accomplished alone. The rickshaw puller’s wife massaged his legs through his fever. Daughters controlled their diabetic parents’ diets. Neighbours, slum dwellers, and a doctor who took no fees paid for the treatment of a man who had fallen under a bus, so that, as his wife said with gratitude still in her voice, “not a single paisa has gone from our pockets”. Cousins cooked when a mother was in intensive care, and nuns and a mosque fund distributed medicines and help.
Such activities are usually grouped under care. A more precise description treats them as contributions to metabolic remediation, which can be remediative without being motivated by affection or ethical concern. People contribute out of obligation, dependence, expectation, reciprocity, institutional duty, or economic necessity. The question is what their contributions actually make possible for continued living.
Remediation is never distributed equally
Filling the belly is deeply gendered. Men traditionally receive the more expensive food; where there is one piece of fish, the male head of the family eats it, on the reasoning that he must be strong enough to fill the family’s bellies, and boys are hand-fed by their mothers for years longer than girls (Ecks 2014: 39–40). A woman whose household I visited often wanted to do yoga exercises for a leg damaged by polio in childhood but had neither the time nor the money, since her son’s tuition fees came first. A household can continue to function because one member repeatedly absorbs its demands. Its continuity is not the same as the equal sustainability of every member’s living, and the success of a living coordination must be investigated in relation to the capacities of every living being whose activity contributes to it. This is a further reason why metabolic remediation cannot be equated with care. It can involve unequal burdens, coercion, sacrifice, and predation.
What people cannot say when they depend on others
The woman who begged for food explained why she never complained when it made her ill: “We are begging food. On top of that we cannot blame the person who gives us food.” She gave several reasons. She might have eaten something else that was spoiled, or her own stomach might be bad; to lie would be to answer for it to Allah; and “if I blame the other person, he won’t give me food the next day. If I buy anything and eat, then I can go and tell them... If you don’t pay for food, you shouldn’t open your mouth.” Her remedy was to smell every item and throw away what was bad.
The capacity to articulate a disruption is itself affected by the circumstances of remediation. She knew perfectly well that food could make her sick. Her silence is no evidence that the problem went unrecognized; it is a condition of obtaining food tomorrow. Articulation could also be withheld on behalf of another. When a man’s father was diagnosed with cancer, the doctor told only the son, and both agreed that the father should not know, because he would become “tense” (cinta pare yabe) and weaker still. The family could not afford the treatment, and the father went to the temple every day (Ecks 2014: 61). Three things have to be distinguished here: felt disruption, articulated disruption, and permitted articulation. Not every L2 misalignment becomes an L3 expression, and not every available expression can safely be used. Ordinary language preserves practical possibilities, but their use is unevenly enabled and constrained.
The goddess who eats and rests
At Kalighat the goddess is dressed, bathed, and fed like a high-status person, and the doors of the inner sanctum are closed while she eats (Ecks 2014: 49). Devotees explained the closure through comparisons with mothers, workers, and machines. A pujari said: “Suppose your mother works from morning onwards, does all the work. In the afternoon, when she takes rest, if anyone comes to visit her, will she not be angry?” Her food returns to worshippers as prasad, which many described as working like medicine, though usually “along with” medicine rather than instead of it.
Divine and human remediation are coordinated through the same practical arrangements. Food has to be prepared and offered, doors closed, visitors held back, and working time arranged around the deity’s schedule. In one story, a pundit who could not reach home for his nightly offering telephoned his wife to make it for him; she fell asleep in front of the television, and at the wedding he was conducting he began to recite the mantras for the dead until, his wife having been woken and the offering made, he “felt in his mon that Ma Kali had accepted the puja” and calmed down (Ecks 2014: 50). None of this establishes the physical reality of divine eating or its efficacy as treatment. It shows that devotees organize important parts of their living through these understandings, and how far the practices of metabolic remediation extend beyond anything a science of human physiology would recognize as its object.
The recursive reversal
The guide who explained that the goddess is given rest “just the way in which we take rest” worked twelve hours a day without leave. He also described what he did with his own troubles. “Anything tension I have, any problem, if any bad time comes, when I go inside I talk to Ma Kali... Today I didn’t get much money, I didn’t earn, please send some tourists to me.” The goddess listens, he said, “but She cannot answer me. She cannot give me an answer by opening Her mouth. But I feel that my mon is satisfied. I get relief when I tell all this to Ma Kali.”
The same man who sustains the goddess’s remediative routine has difficulty maintaining his own, and he remedies the lack by speaking to the one whose rest he guards. Beyond any contrast between religious belief and material reality, this reveals a living coordination in which capacities, obligations, and possibilities of recovery are distributed unequally, and in which the less favoured party still finds a remedy within it. Since he clearly possesses an adequate concept of rest, the question becomes why his circumstances make regular rest difficult for him while guaranteeing it to the goddess he serves.
VII. From Idioms of Distress to Idioms of Disrupted Remediation
What the idiom of distress captures
Medical anthropology has long recognized that people express difficulties through locally meaningful terms. Nichter (1981) showed how complaints about the body in South India could articulate psychosocial adversity, and Kirmayer and Sartorius (2007: 835) proposed that culture-bound syndromes be understood as “cultural idioms of distress”, culturally prescribed ways of narrating health problems and broader personal and social concerns. A bodily complaint can express dissatisfaction with living conditions or legitimate difficulty in performing social roles. The concept prevents researchers from treating clinical categories as transparent translations of everyday suffering, and the survey of mon kharap was conceived in that spirit (Ecks 2005; Ecks 2014: 19, 28–30). The conclusion of Eating Drugs already resisted one use of the concept, insisting that Bengali anxieties about chronic medication, heating effects, and disturbed digestion should not be “shrugged off as local idioms of distress” but taken as the starting point for a critical pharmacology (Ecks 2014: 188). Two questions remain open. Why begin with distress? And what exactly is being disrupted?
Distress articulates a disturbance
An analysis in terms of metabolic remediation begins one level earlier. People do not ordinarily organize their lives around expressing distress; they organize their activities through continuing remediation, much of it at L1. Distress becomes salient when that coordination is threatened, and its expression can therefore reveal the arrangements that were sustaining living before the problem emerged. Stomach trouble can disclose a previously workable coordination of meals, employment, and bodily effort that has come apart. A troubled mon can disclose disruptions in relationships, expectations, sleep, or the capacity to concentrate. The language discloses which capacities are becoming difficult to sustain, which is more than encoding a symptom. The order of inquiry should be reversed. Instead of starting with distress and then looking for its social or cultural meanings, research should start with ongoing metabolic remediation and investigate the circumstances under which its disruption becomes felt and articulated. This also frees medical anthropology from making illness and suffering its primary object.
Idioms of disrupted remediation
An idiom of disrupted remediation is an ordinary expression through which speakers articulate a difficulty in sustaining, recovering, redistributing, or transforming capacities for further living. The formulation is analytical and names no established Bengali category. Its defining feature is that it identifies or communicates a practical difficulty in continuation, whatever unhappiness it may also express. The Kolkata material contains several forms. There are expressions of unmet demand, such as the empty belly (khali pet), the belly’s burning, or the inability to eat one’s stomach full. There are expressions of impaired capacity, such as weakness (durbol), lost digestive power, or a broken or bad mon. There are expressions of interference, such as work that prevents meals or worry that prevents sleep. There are expressions of constrained choice, such as the working boy’s need for immediate medicine because his wage permits no period of recovery. And there are expressions of threatened future continuity, such as the tension of not knowing what will happen in the next hour. These are analytical distinctions that help identify what speakers are doing with ordinary language, and they make no claim to be five Bengali lexical classes.
Why this is more than a new label for suffering
The concept draws attention to capacities as well as symptoms. It connects present problems with previous arrangements and future possibilities, identifies the part played by other living beings, material conditions, and environments, and allows researchers to examine how attempts at recovery create new disruptions. It also recognizes that language can be part of the attempt to restore coordination: the guide who tells Ma Kali his troubles is doing something with his utterance that a framework concerned only with the representation of distress may miss, and the shift from L2 to L3 changes the coordination being described.
What the original research now makes possible
Eating Drugs examined popular understandings of body and mind, three medical traditions, therapeutic metaphors, and disputes about the efficacy of medicines. These findings can be reorganized around a more fundamental phenomenon, so that pet, mon, mon kharap, digestive power, tension, food, medicine, prayer, and rest become different articulations of continuous metabolic remediation and its disruptions. The main change concerns the unit of analysis. The book was organized by the distinction between popular practice, Ayurveda, homeopathy, and psychiatry. The present analysis begins from the ongoing living coordination that those classifications divide. This also explains why so much of the original evidence kept crossing the boundaries between medical traditions. The continuity was not produced by the researcher’s juxtaposition of traditions; it was already present in the practical activities through which people sustained their lives.
The limits of linguistic evidence
Ordinary expressions are not true accounts of causation merely because they are ordinary, and their semantic breadth cannot show that people succeed in remediation. An interview can show what a person says about recovery, but it cannot by itself establish what caused the recovery. The relative frequency of expressions in a corpus depends on what was asked, of whom, and how the answers were translated, and in this corpus the questions themselves were about food. A science of metabolic remediation must therefore distinguish the linguistic articulation of a demand, the actual coordination through which people respond, and the consequences of that response. The value of ordinary language lies in the access it gives researchers to how living beings identify and negotiate the practical stakes of continuation, and it offers no infallible theory. Even that access is incomplete, because the most valuable remediative arrangements may remain largely unsymbolized for as long as they continue to work.
VIII. Conclusion: The Living Work That Language Reveals
Dr Roy’s moner khabar now looks different. It was a psychiatrist’s attempt to make psychopharmaceuticals appear familiar by comparing them to nourishment, and it was intelligible because Bengali ordinary language already provided many ways of speaking about the interdependence of eating, digestion, strength, feeling, attention, and the possibility of continuing. Rather than introducing metabolic remediation into a world that had failed to understand it, the psychiatrist drew on an established practical field of understanding. The same phrase also obscured the differences between food and psychiatric drugs, above all their risks and the authority of the prescriber. Ordinary language can preserve the continuity of living without providing a correct causal explanation of every intervention, and scientific medicine can establish useful causal relationships without recognizing the living coordination into which its interventions enter.
The Kolkata material shows a further and more consequential distinction. People knew that they needed food, rest, medicine, relief from worry, and other people’s help, and they had rich ways of saying so. Their capacity to meet these needs was profoundly unequal. Some had to work through fevers. Some could not afford the time that a lasting recovery would take. Some depended on others for food and could not safely complain about it. Some postponed their own treatment to sustain their families. At Kalighat the goddess was fed and given rest by people who struggled to obtain those things themselves. What distinguishes more and less successful metabolic remediation, then, is not only the sophistication of the language in which its requirements are understood but also the practical possibility of coordinating the activities and circumstances through which they can be met.
Most metabolic remediation takes place without scientific recognition, explicit articulation, or economic valuation. Living beings sustain their capacities through innumerable acts that attract little attention until they fail. This work is valuable because of what it accomplishes for living, whether or not a medical discipline classifies it, an institution records it, or a market prices it. Ordinary Bengali expressions offer glimpses of the work, and the moments of disruption make some of its otherwise unnoticed conditions visible.
Bengalis do not need a theory of metabolic remediation to know that their stomachs must be filled, their minds relieved, their strength replenished, and their lives kept going. Their language articulates these demands, but their living must accomplish them. It is in the distance between what people know they need and what their circumstances allow them to do that the disruptions of metabolic remediation become most clearly visible.
Selected References
Ecks, Stefan. 2005. “Pharmaceutical Citizenship: Antidepressant Marketing and the Promise of Demarginalization in India.” Anthropology and Medicine 12 (3): 239–255.
Ecks, Stefan. 2014. Eating Drugs: Psychopharmaceutical Pluralism in India. New York: New York University Press.
Kirmayer, Laurence J., and Norman Sartorius. 2007. “Cultural Models and Somatic Syndromes.” Psychosomatic Medicine 69 (9): 832–840.
Nichter, Mark. 1981. “Idioms of Distress: Alternatives in the Expression of Psychosocial Distress. A Case Study from South India.” Culture, Medicine and Psychiatry 5 (4): 379–408.
Vuckovic, Nancy. 1999. “Fast Relief: Buying Time with Medications.” Medical Anthropology Quarterly 13 (1): 51–68.