This ethnography examines clinical care at NIMHANS, India’s leading mental health institution, offering rich observations of patient-physician interactions alongside interviews with psychiatrists and neurologists. It explores how patterns of psychosocial causation, shaped by modernity’s pressures, frame key questions in psychiatric practice.

With hundreds of patients visiting NIMHANS’ outpatient department daily, time constraints affect both doctors and patients. The stigma surrounding mental illness leads families to seek quick pharmaceutical solutions, avoiding psychotherapy for fear of exposing their condition to wider social circles—an issue that limits treatment options.

Urban modernity has introduced new sociocultural changes, creating tensions that shape vulnerable identities. Evolving religious disciplines have hardened social boundaries, frustrating aspirations and manifesting as somatic illness or spiritual affliction. This phenomenon drives the resurfaced diagnosis of “hysteria,” a term with both descriptive and analytical weight, in opposition to neuro-genetic determinism.

The book further explores the growing rigidity in thinking about good versus evil and self versus other. It argues that contemporary political and religious narratives sharpen social divisions, reinforcing rigid identity attachments and exacerbating clinical symptoms. Ultimately, it suggests that the “madness” observed in these cases stems from the impossible demands for singular, fixed identities in modern life, suppressing more fluid subjectivities and the histories that shape them.

• Andrew C. Willford, Author

  Andrew C. Willford is professor of anthropology at Cornell University.