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Book Review
Eating Drugs: Psychopharmaceutical Pluralism in India, Stefan Ecks, New York University
Press, 2014, 223pp, (Hardback), £44.00 ISBN 978-0-8147-2476-7
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 Calcutta. The reader
is taken on an illuminating journey from biopsychiatric treaments, to popular health
practices, and alternative medicines prescribed in Ayurveda, 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 bio-medical drugs focus on their expense, the possibility of them being full 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 suspicion, 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 balanced diet, which harmonizes 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, it is the somatic centre of good health,
leading to pharmaceuticals described as ‘food’: “It is like a kitchen where food is cooked and
refined” (p.21). Eck’s analysis of Ayurvedic practices in Calcutta 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 globalized 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 Calcuttans 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 both
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, 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.
Lisa Sugiura
[email protected]
Teaching Fellow in Criminology
University of Southampton