Patients and Agents

Book excerpt: Sylhet, the area of Bangladesh most closely associated with overseas migration, has seen an increase in remittances sent home from abroad, introducing new inequalities. Social change has also been mediated by the global forces of Western biomedicine and orthodox Islam. This book examines the effects of these modernizing trends on mental health and on local, traditional healing as the new inequalities have exacerbated existing social tensions and led to increased vulnerability to mental illness. It is the young women of Sylhet who are most affected. The global economy has increased competition for resources and led to marriage being seen as a route to economic advancement. Parents prefer to give their daughters in marriage to families that will widen their social contacts and enhance their economic and social standing. Accordingly, the young wife's outsider status (and hence vulnerability to mental illness) has increased as it is no longer customary to give daughters in marriage to local kin. Yet, patients and their families do not work out tensions passively. They are active agents in the construction of their own diagnosis. The extent to which patients act or are acted upon is an investigation that runs throughout the book. Alyson Callan is a psychiatrist and anthropologist. She currently works as a consultant psychiatrist in Brent for the Central and North West London NHS Foundation Trust.