Sree Lekshmi M S emphasises the role of literary studies in critical medical humanities by examining the intersection of mental illness and substance use in Indian mental health memoirs. This piece is part of a collection of posts from attendees at the 2024 Medical Humanities International Summer School for PhD researchers in Vadstena, Sweden, coordinated by the Centre for Medical Humanities and Bioethics at Linköping University, in collaboration with the Institute for Medical Humanities at Durham University.
Literary studies in the critical medical humanities fosters an attentive engagement with the messiness of illness and life’s possibilities. As Angela Woods and James Rákóczi (2024, 374) argue: “What literary studies gives” to the critical medical humanities is a “fine ear for messiness and contradictions” which signals a departure from any straightforward notions of patient stories as healing and promises to “attune” to illness and life’s possibilities more thoroughly and attentively. This becomes particularly significant when analysing the intricate issues at the intersections of mental health conditions, societal perceptions, and legal frameworks. At this intersection, the complexities of lived experiences often defy linear narratives or reductionist interpretations, necessitating a framework that can engage with contradictions and ambiguities. Through “the use of literature as a discipline, the practice of (literary) criticism and the epistemology of the text” (Woods and Rákóczi 2024, 359), literary studies delves into the affective and symbolic dimensions of healthcare experiences, uncovering complexities overlooked by traditional biomedical models and deepening understanding of how narratives, culture, and medical systems shape illness.
My research, which is situated at the intersection of mental health patients’ memoirs with the vocabularies of pain and care, engages with the “messiness and contradictions” of illness narratives to investigate the layered experiences of individuals with bipolar disorder in India. By focusing on memoirs, I aim to explore the relationships between personal narrative, cultural context, and medical discourse that are often neglected in biomedical frameworks. This interdisciplinary approach led me to attend the Medical Humanities International Summer School 2024, where I sought to deepen my understanding of mental health’s social and cultural dimensions.
The summer school strongly emphasised interdisciplinary collaboration, bridging the humanities, social sciences, clinical practice, and biomedicine. Through discussions on the theoretical and practical conditions of interdisciplinary research, the epistemological challenges and issues of subjectivity and objectivity in medical humanities, I gained a more profound understanding of how literary studies can contribute to this field. The course literature further enriched this learning, with Woods and Rákóczi’s (2024) work, in particular, illuminating how literary studies in the critical medical humanities provides an interpretive toolbox that fosters emergent, context-sensitive thinking in collaborative health research. By contrasting the reflective depth of literary methods with the urgency of clinical and scientific work, this work underscores literature’s potential to mediate, subvert, and enrich interdisciplinary health conversations.
Following Woods and Rákóczi’s (2024) approach, I turn now to a close reading of two excerpts from Shreevatsa Nevatia’s memoir, How to Travel Light: My Memories of Madness and Melancholia (2017), to explore the complex intersection of mental illness and substance use in India. By engaging with the text’s nuanced portrayal of mental illness, I aim to demonstrate how literature, with its attentiveness to complexity, can deepen our understanding of mental health narratives and reveal the layered dimensions of these experiences.
Mental illness and substance (mis)use in India
In its definition of mental illness, the Mental Healthcare Act 2017 includes “mental conditions associated with the abuse of alcohol and drugs” (Mental Healthcare Act 2017, 7). This inclusion of alcohol and drug use in the state’s definition of mental illness raises complex questions about addiction and its treatment in India. For instance, does the Indian state view substance use as a cause or consequence of mental health conditions? How does this ambiguity shape mental health treatment, especially in institutional settings where addiction and mental illness often overlap? Mohan and Math (2019) point out that while the Act acknowledges mental health conditions associated with substance use, it leaves crucial aspects underdeveloped. The Act does not clarify whether all cases of substance use should be treated as mental illness or if certain thresholds must be met (Rao et al. 2019). This ambiguity in defining the directionality of the association between mental health conditions and substance use affects how addiction is addressed in mental health institutions, where specialist treatment is often required. Additionally, the overlap between addiction and other mental health conditions and the lack of a clear definition for terms like “abuse” raises questions about how the Act’s provisions for mental illness apply to cases of substance dependence, complicating the rights and treatment of those affected.
Amidst the ambiguity of the legal framework in defining the link between mental illness and substance use, narratives by individuals with mental health conditions offer a valuable lens through which to explore the complexity of these overlapping conditions. Critical readings of these narratives help unravel the nuances of these intertwined issues. This underscores the need for an interdisciplinary approach to health and healthcare, which involves “admitting biases and challenging authorising discourses that have limited our understandings …” (Viney et al. 2015, 3). Memoirs of patients admitted to mental health institutions often reveal the conflicts and confusion that arise from the intersection of mental illness and substance use.
Memoirs as windows into personal experience
The day I was assigned a psychotherapist, I tried hard to explain to her that an emotional turbulence had often forced me back to marijuana. Internment, she reminded me, was the consequence of that action. The medicines I was being administered were enough to tackle my bipolarity. Drugs were evidence of volition. I was damnable because I had surrendered to temptation. (Nevatia 2017, 19)
This excerpt from Shreevatsa Nevatia’s memoir, How to Travel Light: My Memories of Madness and Melancholia (2017), reflects the intersection of mental illness, substance use, and psychiatric treatment, revealing the layered tensions between patient experience and medical authority. As Seng (2012) notes, people suffering from serious mental illness and substance use disorders are an oppressed and marginalised population, often overlooked or misunderstood in both societal and medical frameworks. Here, Nevatia’s use of the term “emotional turbulence” conveys a sense of chaos and desperation, suggesting that marijuana was not recreational but a coping mechanism for his mental state.
Moreover, there exists a comorbidity between drug use and mental illness, reflecting “both a high risk for drug use in subjects with mental illness and a high frequency of psychopathology triggered by drug use” (Volkow 2001, 1181). Nevatia’s perception of being “forced […] back” suggests compulsion rather than choice, revealing a lack of volition. This sets the stage for a critical confrontation between patient narrative and psychiatric discourse. Baumeister and Nadal (2017, 192) identify that addiction, especially concerning substance use, “entails a combination of wanting, liking, and doing, each of which contributes to the pull to continue indulging.” Also, “certain occasions, such as being under stress, may reduce one’s ability to resist the habit or desire while also increasing the appeal of the now-forbidden pleasure.” Such stress mirrors Nevatia’s emotional turbulence, which serves as both a trigger and a consequence of drug misuse.
The psychotherapist’s response, in the excerpt, is stark and authoritative. “Internment”—a term evoking imprisonment or forced confinement—marks a pivotal moment where the patient’s behaviour is pathologised and criminalised. By stating this as the “consequence of that action,” the therapist reduces Nevatia’s complex emotional struggles to a simplistic cause-and-effect scenario, framing substance use solely as a choice warranting punishment. The use of the verb “reminded” implies an indisputable fact, reinforcing a power dynamic where institutional rules override the patient’s subjective experiences. This response underscores the punitive nature of mental health care, where substance use is conflated with deviant behaviour necessitating control (Bennet et al. 2009; Shadakshari et al. 2021). Emotional turbulence, central to Nevatia’s account, is ignored, devalued, and subsumed under the label of wrongdoing. Addiction, rather than being treated as a symptom of deeper psychological distress, is framed as a behavioural flaw. Furthermore, the psychotherapist’s emphasis on “medicines” highlights the dominance of the biomedical model in mental health care. This rigid focus on pharmacological solutions sidelines the patient’s lived experiences and limits the therapeutic approach to a narrowly defined framework, ignoring the complexities of mental illness and addiction.
In this excerpt, Nevatia’s consumption of “drugs” (marijuana) is framed by the psychotherapist as a volitional act, disregarding the possibility that he may be using it as a form of self-medication to cope with overwhelming emotional distress. By reducing substance use to a matter of choice, the psychotherapist overlooks the complexities of addiction, where compulsion often outweighs free will. Within a biomedical framework, Nevatia exemplifies what Brüggemann (2020, 575) describes as a “difficult patient,” emerging from the “misfits” between dominant medical logics and the individual needs and lives of patients. In Nevatia’s case, his use of marijuana as a self-medication strategy, despite the prescribed psychiatric medication, places him in opposition to institutional expectations. Mental health frameworks in India, as mirrored in the Mental Healthcare Act 2017, tend to compartmentalise mental illness and substance use, failing to account for the nuances of individual lived experiences. This rigid approach often leads to the marginalisation of patients who defy the clear-cut categories set by biomedicine, rendering them “difficult” within institutional settings.
The severe stigma and marginalisation associated with drug misuse among mental health patients often lead to profound feelings of guilt within this population (Room 2001). Nevatia’s use of the word “damnable” carries the weight of guilt and punishment, echoing the societal stigma surrounding both mental illness and substance use. The phrasing evokes a sense of failure—falling prey to a “temptation” reminiscent of sin or weakness. The patient feels damnable, not just because they used marijuana, but because they “surrendered,” implying weakness in the face of emotional distress. This echoes the psychotherapist’s earlier framing of the patient’s substance use as an act of volition, revealing how deeply the patient has internalised the institutional message that their use of marijuana is not only a personal failing but a moral one. This excerpt from Nevatia’s illness memoir shows the fraught dynamics between patient agency and psychiatric authority. Revealing the internalisation of guilt and the moralising tone of medical discourse, Nevatia exposes the deeper emotional and psychological toll on patients who are left navigating the stigmatisation of both their mental health condition and their coping mechanisms.
Nevatia’s experiences with substance use also reveal a contradictory perspective, voicing the inherent complexities within illness narratives. Reflecting on his struggles elsewhere in the text, he notes, “Unable to cope with the pressures of work, and with marijuana exaggerating the volatility of chemicals in my brain, I had again become familiar with the aggression of mania” (Nevatia 2017, 96). Here, Nevatia offers a self-reflective account of navigating bipolar disorder and substance use, where the “volatility” of his mental state is shaped by the interaction of external pressures and internal chemical imbalances. Marijuana is not depicted as a mere indulgence; rather, it exacerbates his condition, adding layers to his narrative of mental illness, intertwined with substance use. In line with Woods and Rákóczi’s (2024, 374) aforementioned argument, this narrative resists the notion of a straightforward recovery, instead embracing the “messiness and contradictions” of illness. Nevatia’s portrayal underscores the dual role of marijuana—as both a coping mechanism and a trigger that intensifies his symptoms—capturing the challenges of managing his mental health.
This tension between self-medication, emotional distress, and psychiatric treatment complicates any reductive interpretations of his behaviour. Nevatia’s memoir disrupts the notion that patient narratives should conform to a healing arc or straightforward recovery. Instead, it presents a reality wherein emotional distress and substance use are tightly interwoven, resisting easy categorisation. This complexity underscores the importance, as highlighted by Woods and Rákóczi (2024), Billington (2016), and Felski (2011), of attuning to the lived experiences contained in illness stories. By focusing on the symbolic and affective dimensions of illness, literary studies, within the critical medical humanities, offers a valuable framework for understanding Nevatia’s experiences, without reducing them to moral judgments or simplistic biomedical explanations.
Conclusion
The intersection of mental illness and substance use, as revealed through Indian mental health memoirs like Shreevatsa Nevatia’s How to Travel Light, underscores the complex realities of living with mental health conditions. Nevatia’s narrative exposes the tensions between self-medication, emotional turbulence, and the rigid frameworks of psychiatric care, where addiction is often framed as a moral failure rather than a coping mechanism born of distress. The memoir challenges the biomedical compartmentalisation of mental illness and substance use, highlighting the limitations of purely pharmacological approaches. Nevatia’s account, rich in contradictions and emotional depth, mirrors the “messiness” that Woods and Rákóczi (2024) argue is inherent in illness narratives. This messiness, far from being a flaw, invites a more thorough and compassionate understanding of patient experiences that resists reductionist interpretations. Through the close reading techniques of literary studies, and the application of a critical medical humanities lens, these memoirs open up a space for interdisciplinary inquiry that acknowledges the complex interplay of mental health conditions, cultural stigma, and personal agency, urging a re-evaluation of how both mental illness and substance use are understood and treated within the Indian healthcare system.
About the author
Sree Lekshmi M S is a second-year doctoral candidate (English) working with Dr Aratrika Das in the School of Humanities and Social Sciences, Indian Institute of Technology, Indore. Her research focuses on the intersection of mental health memoirs with vocabularies of pain and care within the context of India. Her work has been published in Literature Compass, Economic and Political Weekly and The Polyphony: Conversations across the Medical Humanities.
References
Baumeister, Roy F., and Amber Cazzell Nadal. 2017. “Addiction: Motivation, action control, and habits of pleasure.” Motivation Science 3 (3): 179–95. https://doi.org/10.1037/mot0000069.
Bennett, Trevor, and Katy Holloway. 2009. “The causal connection between drug misuse and crime.” The British Journal of Criminology 49: 513–31.
Billington, Josie. 2016. Is Literature Healthy? Oxford: Oxford University Press.
Felski, Rita. 2011. Uses of Literature. New York: John Wiley & Sons.
Brüggemann, Jelmer, Lisa Guntram, and Ann-Charlotte Nedlund. 2023. “The ‘Difficult Patient’: Dominant Logics and Misfits.” In Handbook of Social Sciences and Global Public Health, edited by Pranee Liamputtong, 1–14. Cham, Switzerland: Springer Nature.
Ministry of Law and Justice. 2017. “The Mental Healthcare Act, 2017.” The Gazette of India, Extraordinary Part II, Section I, No. 10. New Delhi: Government of India Press. https://www.indiacode.nic.in/bitstream/123456789/2249/1/A2017-10.pdf.
Mohan, Ashwin, and Suresh Bada Math. 2019. “Mental Healthcare Act 2017: Impact on addiction and addiction services.” Indian Journal of Psychiatry 61 (Suppl 4): S744–49. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_114_19.
Nevatia, Shreevatsa. 2017. How to Travel Light: My Memories of Madness and Melancholia. Haryana: Penguin Random House India.
Rao, Ravindra, Mohit Varshney, Shalini Singh, Alok Agrawal, and Atul Ambekar. 2019. “Mental Healthcare Act, 2017, and addiction treatment: Potential pitfalls and trepidations.” Indian Journal of Psychiatry 61 (2): 208–12. https://doi.org/https://doi.org/10.4103/psychiatry.IndianJPsychiatry_463_18.
Room, Robin, Jürgen Rehm, Robert T. Trotter, Angela Paglia, and T. Beirhan Üstün. 2001. “Cross-Cultural Views on Stigma, Valuation, Parity and Societal Values Towards Disability.” In Disability and Culture: Universalism and Diversity, edited by T. Beirhan Üstün, Somnath Chatterji, Jerome E. Bickenbach, Robert T. Trotter II, Robin Room, Jürgen Rehm, and Shekahr Saxena, 247–91. Seattle, WA: Hogrefe & Huber.
Seng, Julia S., William D. Lopez, Mickey Sperlich, Lydia Hamama, and Caroline D. Reed Meldrum. 2012. “Marginalized identities, discrimination burden, and mental health: Empirical exploration of an interpersonal-level approach to modeling intersectionality.” Social Science & Medicine 75 (12): 2437–45. https://doi.org/10.1016/j.socscimed.2012.09.023.
Shadakshari, Darshan, Bhavika Vajawat, Barikar C. Malathesh, Dinakaran Damodharan, Guru S. Gowda, Seshagiri D. V., Channaveerachari Naveen Kumar, and Suresh Bada Math. 2021. “The Interface of Clinical, Legal, and Rehabilitative Aspects of Patients with a Neuropsychiatric Disorder in Forensic Psychiatry Setting in India: A Systematic Approach.” Indian Journal of Psychological Medicine 44 (6): 607–11. https://doi.org/10.1177/02537176211008564.
Viney, William, Felicity Callard, and Angela Woods. 2015. “Critical medical humanities: embracing entanglement, taking risks.” Medical Humanities 41 (1): 2–7. https://doi.org/10.1136/medhum-2015-010692.
Volkow, Nora D. 2001. “Drug Abuse and Mental Illness: Progress in Understanding Comorbidity.” American Journal of Psychiatry, 158 (8): 1181–83. https://doi.org/10.1176/appi.ajp.158.8.1181.
Woods, Angela, and James Rákóczi. 2024. “Literature in Collaboration: The Work of Literature in the Critical Medical Humanities.” In Literature and Medicine, edited by Anna Magdalena Elsner and Monika Pietrzak-Franger, 357–74. Cambridge University Press. https://doi.org/10.1017/9781009300070.025.
