1 00:00:08,280 --> 00:00:19,680 Good afternoon, I'll have to ask for your subra or patience, because I'm the what's between us and lunch and the hard act to follow. 2 00:00:19,680 --> 00:00:24,780 Returning you to more prosaic worlds of mental health, but with its own kind of frenzy, hopefully. 3 00:00:24,780 --> 00:00:30,090 But thank you so much, Professor Linda Pramila, for inviting me. 4 00:00:30,090 --> 00:00:35,790 And Claire for helping us with so much and being patient with us. 5 00:00:35,790 --> 00:00:37,290 And it's been a real honour. 6 00:00:37,290 --> 00:00:44,250 It is a real honour to be part of a conversation in which so many people doing such defining work on mental health in India, 7 00:00:44,250 --> 00:00:52,350 who had only ever either known of their work location of or only read or heard about, like Banyan Dr. Pataudi. 8 00:00:52,350 --> 00:00:57,510 So it's a great honour to be part of a conversation in which the people doing such amazing work. 9 00:00:57,510 --> 00:01:02,020 It was a real learning experience. Thank you. 10 00:01:02,020 --> 00:01:07,510 My talk is focussed on a theme that's often at the edges of mental health or mainstream mental health discourse, 11 00:01:07,510 --> 00:01:12,370 namely addiction, specifically heroin and opioid addiction. 12 00:01:12,370 --> 00:01:19,510 How does an issue come to be felt as urgent? Sometimes it's just a simply result of death tolls. 13 00:01:19,510 --> 00:01:24,310 Although there's often a politics of death in terms of what kinds of deaths count as newsworthy. 14 00:01:24,310 --> 00:01:31,390 So we then sort of transnational circuits of newsworthiness. Addiction has gone more into global consciousness in the last few years through what 15 00:01:31,390 --> 00:01:36,730 is called the opioid epidemic in the United States opioid related drug overdose, 16 00:01:36,730 --> 00:01:42,130 as many of us know as the highest cause of untimely or accidental deaths in the United States. 17 00:01:42,130 --> 00:01:46,060 And as the by now quite strong scholarly and popular literature in the US describes it, 18 00:01:46,060 --> 00:01:51,310 the opioid crisis came as a shock to middle class white America in the last decade or so, 19 00:01:51,310 --> 00:01:55,210 entering the body politic mostly through the route of opioid painkillers prescribed 20 00:01:55,210 --> 00:01:59,950 for conditions as innocuous as carpal tunnel syndrome and post-surgical recovery. 21 00:01:59,950 --> 00:02:02,470 After the legal supply was cut off by health insurance, 22 00:02:02,470 --> 00:02:08,500 large numbers of white American patients found themselves seeking out urban underworld in search of opioid substitutes, 23 00:02:08,500 --> 00:02:17,170 most often black dog heroin said to come from Mexico. Discussions on opioids so far remain quite nationally focussed and US centric, 24 00:02:17,170 --> 00:02:23,380 rather than comparative or global, which is what opioids potentially or actually are. 25 00:02:23,380 --> 00:02:28,450 As a first step towards a global conversation or understanding some kind of a map of the contemporary, 26 00:02:28,450 --> 00:02:31,960 we might remember that opioids are not inherently pathological. 27 00:02:31,960 --> 00:02:36,970 They are part of a spectrum of substances that are quite central to a kind of contemporary ecology 28 00:02:36,970 --> 00:02:43,390 of mind within larger world histories of the substance based management of pain and well-being. 29 00:02:43,390 --> 00:02:49,690 As the philosopher Jacques Derrida reminds us, the word pharma gone from which the word pharmaceutical comes is derived. 30 00:02:49,690 --> 00:02:53,080 It means both remedy and poison. 31 00:02:53,080 --> 00:03:01,270 When does the remedy turn into a poison in a biological or a social sense, rather than taking a position for or against pharmaceuticals, 32 00:03:01,270 --> 00:03:08,380 but say we might focus on particular substances and ask what kind of an object heroin or opioids are as distinct, 33 00:03:08,380 --> 00:03:14,680 say, from Prozac and other mood altering substances on which there has been rigorous philosophical discussion, 34 00:03:14,680 --> 00:03:20,960 or at least some philosophical discussion in terms of what the moral objection might be to pharmaceutical induced happiness. 35 00:03:20,960 --> 00:03:28,700 All the darling of pain. One objection to opioids is the propensity for abuse, overdose and death tolls. 36 00:03:28,700 --> 00:03:32,300 Contrary to popular misconception that people in the so-called non-Western more 37 00:03:32,300 --> 00:03:36,530 circumspect about consuming pharmaceuticals as distinct from people in the West, 38 00:03:36,530 --> 00:03:43,550 it's clear. And just to give you an example, over the last decade, India has emerged as the world's leading the highest consumer of antibiotics, 39 00:03:43,550 --> 00:03:51,650 according to the W.H.O. World Antibiotic Report, outpacing China and the United States in relation to prescription painkillers. 40 00:03:51,650 --> 00:03:58,610 The prognosis in India is quite worrying. Amongst other phenomena occurring under the radar of public scrutiny is likely. 41 00:03:58,610 --> 00:04:03,590 The Modi government has gradually been widening the domain of legally available prescription opioids, 42 00:04:03,590 --> 00:04:09,020 in particular by revisions to the National Drugs and Psychotropic Substances Act of 1985, 43 00:04:09,020 --> 00:04:17,360 amended in 2014 and in 2018, stating quote This is from Health Ministry, but not written by Kishore. 44 00:04:17,360 --> 00:04:24,530 Hopefully it was the need for pain relief is an important obligation of the government and quote. 45 00:04:24,530 --> 00:04:31,790 The revised Independence Act creates a list of essential narcotic drugs now available or gradually available with chemists, 46 00:04:31,790 --> 00:04:38,420 including fentanyl, oxycodone and codeine. Many of the key actors of the American opioid epidemic. 47 00:04:38,420 --> 00:04:45,830 And so we might ask, is India ready for or already going through an opioid epidemic? 48 00:04:45,830 --> 00:04:49,400 As an anthropologist, before I answer the question in as much as anthropologist, 49 00:04:49,400 --> 00:04:53,990 never answer the question directly, I should tell you my ethnographic context. 50 00:04:53,990 --> 00:04:56,420 I spent July 2015 to July, 51 00:04:56,420 --> 00:05:03,620 August 2016 as a visiting faculty member of the Department of Psychiatry of the All India Institute of Medical Sciences Ames in Delhi. 52 00:05:03,620 --> 00:05:06,560 And even for those who know if Ms. 53 00:05:06,560 --> 00:05:12,890 It may still be a source of surprise to consider that it is one of the few or last remaining democratic health care institutions, 54 00:05:12,890 --> 00:05:14,300 at least in North India, 55 00:05:14,300 --> 00:05:21,140 where as many patients will jokingly assert any one from a prime minister to a homeless person may be found seeking treatment. 56 00:05:21,140 --> 00:05:28,430 Ms Psychiatry also runs the National Drug Dependence Treatment Centre, the leading Centre for Addiction Psychiatry in North India. 57 00:05:28,430 --> 00:05:35,900 While it aims a key location of my ethnographic work with the urban poor neighbourhoods of property and then agri in East Delhi, 58 00:05:35,900 --> 00:05:41,990 where the AIM psychiatry department runs community clinics focussed primarily on heroin addiction, 59 00:05:41,990 --> 00:05:47,790 the body is particularly infamous in Delhi as a space of crime and smack or heroin addiction. 60 00:05:47,790 --> 00:05:53,360 It's remembered by many as the site of the highest death toll in the 1984 anti-Sikh riots and 61 00:05:53,360 --> 00:05:59,670 has had a major Hindu-Muslim ride as recently as 2014 and periodic skirmishes every few months. 62 00:05:59,670 --> 00:06:05,270 Also administratively to look for reasons and then agree what I call resettlement colonies. 63 00:06:05,270 --> 00:06:11,360 Government answer settlements and with slum dwellers were forcibly or sometimes voluntarily removed from 64 00:06:11,360 --> 00:06:16,820 more gentrified parts of Delhi to small residential blocks in what was then the outskirts of the city, 65 00:06:16,820 --> 00:06:21,320 most famously in urban beautification drives during the period of Indian history, 66 00:06:21,320 --> 00:06:26,810 known as the emergency from nineteen seventy five to seventy seven when democratic rule was officially suspended. 67 00:06:26,810 --> 00:06:33,260 Although many would argue that the situation is now much worse when the Modi government in power in India. 68 00:06:33,260 --> 00:06:38,000 So to return to the question is India going through an opioid epidemic? 69 00:06:38,000 --> 00:06:43,850 In recent media reports in India and abroad, Punjab is often depicted with sensationally high figures, 70 00:06:43,850 --> 00:06:47,870 which have come to be disputed in Indian Addiction Psychiatry because it was founded 71 00:06:47,870 --> 00:06:51,780 to one empirical study on which these news reports are dramatic news reports. 72 00:06:51,780 --> 00:06:57,890 The best was in only three districts of Punjab said to be the drug epicentre of the state. 73 00:06:57,890 --> 00:07:04,880 Besides, number of overdose deaths nationwide are hard, harder to quantify because deaths, particularly amongst homeless in India, 74 00:07:04,880 --> 00:07:12,890 are often registered in mortuary records as calls unknown or with entries like death by exposure to cold or to heat, depending on the season. 75 00:07:12,890 --> 00:07:20,750 And we tried to track some of the mortuary records. But uncertainties notwithstanding, the numerical situation is not entirely unknown. 76 00:07:20,750 --> 00:07:24,930 There have been only two national surveys of heroin use in India so far. 77 00:07:24,930 --> 00:07:34,760 In 2014, a more recent study in 2019 that was overseen by one of my hosts and co-authors, Dr Ravindra Rao at Ames this this survey, the 2019 one, 78 00:07:34,760 --> 00:07:42,440 covered two hundred thousand randomly selected households in 186 districts across all 36 states and Union Territories, 79 00:07:42,440 --> 00:07:49,130 alongside interviews with 72000 drug addicts. Some of the findings of this 2019 survey are quite startling. 80 00:07:49,130 --> 00:07:53,360 The prevalence of opioid use in India is three times the global average. 81 00:07:53,360 --> 00:07:58,560 About 2.1 per cent of India's population use opioids more than Punjab. 82 00:07:58,560 --> 00:08:03,140 Whatever. This has the highest number of people in opioid use problems, 83 00:08:03,140 --> 00:08:09,630 although in terms of the percentage of population affected, the worst affected states are Mizoram and Nagaland. 84 00:08:09,630 --> 00:08:16,950 What kinds of diagnostics might anthropologists offer to these quantitative aggregate pictures of affliction? 85 00:08:16,950 --> 00:08:21,960 One straightforward question would be, for instance, what are the modes of production for heroin in India? 86 00:08:21,960 --> 00:08:29,430 The transformation of opium into heroin or smack is dated to the mid-1980s, when it first became available via Afghanistan. 87 00:08:29,430 --> 00:08:36,060 According to the narratives of all the addicts and sellers, many of whom I also interviewed and then gradually began to be produced locally, 88 00:08:36,060 --> 00:08:40,350 in particular in Uttar Pradesh, Rajasthan and Madhya Pradesh, the three states in India, 89 00:08:40,350 --> 00:08:44,160 historically where poppy can be grown legally for medicinal purposes. 90 00:08:44,160 --> 00:08:48,210 Part of the legal poppy harvest is then siphoned off for the production of heroin, 91 00:08:48,210 --> 00:08:52,890 which can be synthesised as it often is in North India in one room cottage industry type units. 92 00:08:52,890 --> 00:09:00,600 So it doesn't take a very large production unit beginning as what used to be called the hi fi nature or a foreign press. 93 00:09:00,600 --> 00:09:10,070 In the last two decades, heroin has emerged as the most common drug abused by the Indian urban poor, quite literally opium for the masses. 94 00:09:10,070 --> 00:09:15,200 Within the ecology of drug abuse in India, we might ask what are the available forms of treatment? 95 00:09:15,200 --> 00:09:22,460 Perhaps the least repressive form of pharmacological treatment is what is offered by MS and Gizzi in their community clinics in the locality, 96 00:09:22,460 --> 00:09:29,720 and some then agree a form of treatment globally known as opioid substitution therapy or steam treatment, 97 00:09:29,720 --> 00:09:37,940 a form of treatment where a heroin addict is given a regular dose of a less addictive and more economically manageable substitute opioid. 98 00:09:37,940 --> 00:09:45,680 Strange as it may sound to substitute one opioid for another, OCD treatment can literally be lifesaving for individuals and for households, 99 00:09:45,680 --> 00:09:51,950 even with the accompanying danger of OCD medications being resold in open markets as narcotics, 100 00:09:51,950 --> 00:09:55,100 which is often a suspicion in India and many other parts of the world. 101 00:09:55,100 --> 00:10:06,260 The first OCD clinic in India began at Ames in 1990, funded by the W.H.O. Ministry of Health and Macko that present only 215 OCD clinics in India. 102 00:10:06,260 --> 00:10:09,710 In contrast to the treatment that are outpatient based, 103 00:10:09,710 --> 00:10:16,970 a much more worrying phenomena across urban India that's emerging is the mushrooming across Indian cities of unregulated, 104 00:10:16,970 --> 00:10:22,340 private and national thinking. The addiction centres, which many of you are familiar with Indian cityscapes, 105 00:10:22,340 --> 00:10:26,810 might have seen or almost not noticed because it's so common that most often these are 106 00:10:26,810 --> 00:10:30,770 advertised on walls of public spaces with little more than just a cell phone number. 107 00:10:30,770 --> 00:10:36,230 And there's a reason why there's just a cell phone number. These centres are mostly just spaces of incarceration. 108 00:10:36,230 --> 00:10:44,570 One would often hear of the sudden deaths of young men in these centres or relapsed soon after release with no recourse except for incarceration, 109 00:10:44,570 --> 00:10:50,440 usually at a very high monthly payment by the family members of a heroin addict. 110 00:10:50,440 --> 00:10:58,330 Alongside statistical aggregates and emerging institutional technologies, what might an anthropology of addiction look like in the case of India, 111 00:10:58,330 --> 00:11:02,110 which as many of us know is a well-developed sub field in other parts of the world? 112 00:11:02,110 --> 00:11:06,640 And these are some of the well-known books in the anthropology of addiction. 113 00:11:06,640 --> 00:11:10,960 And what could enhance value of addiction offer to broader conversations like these? 114 00:11:10,960 --> 00:11:16,060 If in the social sciences we are to offer questions and methods and specific and 115 00:11:16,060 --> 00:11:21,010 rigorous yesterday as I quantitatively driven our city oriented colleagues. 116 00:11:21,010 --> 00:11:27,520 So methodologically, if we were to try and give you problems and that like the problems you give us, 117 00:11:27,520 --> 00:11:30,490 I'll offer one ethnographic puzzle from my own fieldwork, 118 00:11:30,490 --> 00:11:38,590 which offers the kind of research agenda in better understanding the at times strikingly sharp variations in patterns of drug abuse in seemingly 119 00:11:38,590 --> 00:11:46,900 contiguous areas and particular forms of life and death linked to a substance like heroin in India and in many other parts of the world. 120 00:11:46,900 --> 00:11:51,400 The instance I'm giving you draws on two chapters of the book I am currently writing. 121 00:11:51,400 --> 00:11:55,660 Some parts of it may seem very theoretical and philosophical, so I'm happy to clarify both of the chapters. 122 00:11:55,660 --> 00:12:01,180 I'm drawing on a collection of neighbourhood fall sick and heroes and heroine. 123 00:12:01,180 --> 00:12:06,950 The first of these chapters focuses on a seemingly local difference between two locally and Swindon agree. 124 00:12:06,950 --> 00:12:13,330 Whereas I said MS Also-rans or SD community clinics. Initially, I focussed for many months only on three local reason. 125 00:12:13,330 --> 00:12:20,410 That's the primary field site for my next book. But an additional ethnographic imperative was posed to me with some urgency by my horse. 126 00:12:20,410 --> 00:12:25,180 Psychiatry faculty and residents at Ms. Say you have to visit our other clinic. 127 00:12:25,180 --> 00:12:31,600 Many of them would soon do a study to tell us why it's so different from this one, from local look different in what we asked. 128 00:12:31,600 --> 00:12:38,260 It's much more dangerous, they said. Intriguingly, this other, more dangerous clinic was Swindon, then agreed 12 kilometres away, 129 00:12:38,260 --> 00:12:43,060 also settled in the same year as the opening during the emergency in 1975 76. 130 00:12:43,060 --> 00:12:47,800 Demographically quite similar as our household surveys in 100 households in each of the 131 00:12:47,800 --> 00:12:52,090 two neighbourhoods also seemed to show a demographically quite similar settlement. 132 00:12:52,090 --> 00:12:57,370 Quite similar on first impressions. The Swindon clinic did have a much edgier atmosphere. 133 00:12:57,370 --> 00:13:02,950 Fights would break out more often. Patients often threatened the doctors and staff mobility with knives. 134 00:13:02,950 --> 00:13:07,900 The patients, all male, were gone to and had hollow are more ghostly eyes of the kind. 135 00:13:07,900 --> 00:13:12,430 I hadn't seen interlock pretty. There were much fewer accompanying mothers and wives, 136 00:13:12,430 --> 00:13:19,900 one often encountered intellectually rather than only a psychiatrist by our knowledge, construction of risk and normalcy in time, 137 00:13:19,900 --> 00:13:23,230 I found that the difference between these two neighbourhoods would also be 138 00:13:23,230 --> 00:13:28,060 posed in more importance in the language and experience of addicts themselves. 139 00:13:28,060 --> 00:13:35,560 So as most national bars or smack addicts will describe it or tell you anywhere in the world, there are three ways in which you can ingest heroin. 140 00:13:35,560 --> 00:13:41,860 You can smoke it, which is relatively expensive about 250 rupees a piece in India. 141 00:13:41,860 --> 00:13:47,620 Or you can chase it on a foil or pani, which is about a little cheaper 200 rupees. 142 00:13:47,620 --> 00:13:54,730 And after that, in a downward hierarchy that most addicts can form in a different category from smokers and Jesus Gandhi 143 00:13:54,730 --> 00:14:00,280 inject injectors with sweet injections and she-she bottles with heroin and pharmaceutical cocktails, 144 00:14:00,280 --> 00:14:08,470 which you would get from a chemist and not from a smack dealer. And this swishes sect, as it's called you would get four rupees, 40 or less. 145 00:14:08,470 --> 00:14:16,990 That is one-fifth the price of the smoker or Chaser's habit, as most addicts and psychiatrists will put it. 146 00:14:16,990 --> 00:14:23,110 But addicts often tell you that Jesus life is Daniel's long and injected life is two years at most. 147 00:14:23,110 --> 00:14:29,650 Addiction psychiatrist would agree, pointing to various vulnerabilities for injectors, including most prominently from a global health perspective. 148 00:14:29,650 --> 00:14:33,970 The risk of contracting HIV or hepatitis B through shared needles. 149 00:14:33,970 --> 00:14:38,200 So what we have are two different, sharply different modes of heroin consumption. 150 00:14:38,200 --> 00:14:42,460 Smokers and j cells on the one hand and injectors on the other hand, 151 00:14:42,460 --> 00:14:46,600 methodologically based on repeat interviews over the last few years and patient files 152 00:14:46,600 --> 00:14:50,410 and days and nights that I spent in both neighbourhoods with frequency cause addicts, 153 00:14:50,410 --> 00:14:54,280 male and female residents, as well as household surveys in both neighbourhoods. 154 00:14:54,280 --> 00:15:03,550 The initially intuitive difference emerged more sharply. The luxury had barely a single injector, and I say this after visiting every smack dealer, 155 00:15:03,550 --> 00:15:07,900 every hot, hot spot as it's called in the neighbourhood where addicts would hang out. 156 00:15:07,900 --> 00:15:11,890 In contrast, and then agree, used injections could be found everywhere, 157 00:15:11,890 --> 00:15:15,910 strewn in ordinary neighbourhood spaces such as box all over the neighbourhood. 158 00:15:15,910 --> 00:15:18,070 Numerically, the difference is quite stark. 159 00:15:18,070 --> 00:15:24,940 According to clinic figures, out of three thousand one hundred thirty eight patients in the locality that only four injecting drug users, 160 00:15:24,940 --> 00:15:30,160 as they call it, use or VW IDs and six HIV positive patients. 161 00:15:30,160 --> 00:15:34,360 In contrast, in an aggregate of a total of one thousand seven hundred seventy three patients, 162 00:15:34,360 --> 00:15:39,190 300 are ideas and 137 on HIV positive on a national scale. 163 00:15:39,190 --> 00:15:48,160 Ideas show a much higher rate of HIV even than commercial sex workers, often assumed to be the primary drivers for the spread of HIV. 164 00:15:48,160 --> 00:15:54,070 As I put it, a Jesus, life is 10 years long and inject us life is two years at most. 165 00:15:54,070 --> 00:15:59,260 Conceptually, we might rephrase the question in relation to one of the founding texts of social theory. 166 00:15:59,260 --> 00:16:03,790 Emil Durkheim suicide, which had compared contiguous districts in Europe. 167 00:16:03,790 --> 00:16:09,850 To ask, I quote how a definite number of people killed themselves in a particular way repeatedly over time, 168 00:16:09,850 --> 00:16:15,550 and how these forms of death vary, sometimes quite sharply between seemingly proximate areas. 169 00:16:15,550 --> 00:16:22,030 Interestingly, these sharp regional variations in opioid consumption exist across different geographies across the world, 170 00:16:22,030 --> 00:16:26,440 for instance, across neighbouring states, in the United, in the U.S. and in the northeast of India, 171 00:16:26,440 --> 00:16:34,300 where similar social conditions yield sharply differing differing forms of addictive vitality, objection and death. 172 00:16:34,300 --> 00:16:42,720 So how did this happen? In a presentation of this land, I promised you an interesting question, but not necessarily an answer, 173 00:16:42,720 --> 00:16:47,880 but I can at least offer a few hints in the case of Re-look Pourrions and then agreeing the difference, 174 00:16:47,880 --> 00:16:51,570 as with many things in South Asia, is partly or quite crucially, 175 00:16:51,570 --> 00:16:56,280 to do with cost and the different occupational composition of these two neighbourhoods. 176 00:16:56,280 --> 00:17:02,430 Mostly salaried Valmiki origin, as Gandhi had called it, the government employed sanitation workers. 177 00:17:02,430 --> 00:17:09,450 In the case of trilogue, Puri, who can sort of afford the more slightly more expensive mode of consumption of geosynchronous smack, 178 00:17:09,450 --> 00:17:16,200 as opposed to the much more unstable, informal economy of southern agri that tends towards the cheaper option of injecting. 179 00:17:16,200 --> 00:17:24,090 But that is only part of the answer because there is also a spiritual or metaphysical factor involved that is not only economically determined. 180 00:17:24,090 --> 00:17:30,660 For instance, the very different forms of death and mourning that I found across these two neighbourhoods in relation to heroin. 181 00:17:30,660 --> 00:17:40,010 I'll end with a contrast between these two forms of death and mourning. Amongst former addicts, interlock Puri. 182 00:17:40,010 --> 00:17:44,000 I'm the person I'm closest to is popularly known as Asif Kabbalah. 183 00:17:44,000 --> 00:17:50,360 CNN's very well-known kebab shop in Block 27, which is the Muslim god of the heart of the local artists. 184 00:17:50,360 --> 00:17:54,860 Younger brother Sultani died of an injection overdose in January 2008, 185 00:17:54,860 --> 00:17:59,630 as did his closest friend and neighbour Irrfan, nearly every member of his family. 186 00:17:59,630 --> 00:18:04,460 Separately, in separate interviews, his father, mother and brother had described these deaths to me. 187 00:18:04,460 --> 00:18:09,590 We detail that as I heard, it constituted a kind of mourning satanic screams the night before, 188 00:18:09,590 --> 00:18:16,400 with 210 breaking the word for heroin withdrawal, 100 rupees that his father gave him, unable to bear his screams. 189 00:18:16,400 --> 00:18:23,980 All this happened two days before OEB, all that was cooked for EDTA. The two days with Sultani disappeared how he died in a garbage dump. 190 00:18:23,980 --> 00:18:31,190 I have heard about his death from the whispers of smack addicts in another public bathroom, how they rushed to the hospital to claim Sultan his body, 191 00:18:31,190 --> 00:18:36,740 how his body was about to be cremated in the Hindu way when they reached the morgue just in time. 192 00:18:36,740 --> 00:18:45,470 A few months later, Asif gave up Ganja and SMAC and became part of a gang that beat up the remaining injectors in parks and public spaces. 193 00:18:45,470 --> 00:18:52,870 The dental opening by 2009, just a year after Sultan, is that there was not a single injector left interlock puri. 194 00:18:52,870 --> 00:18:54,920 That said, even now, 10 years later, 195 00:18:54,920 --> 00:19:01,660 Arthur still comes to collect his bi-weekly twice a week buprenorphine or doors from the three luxury AIDS clinic, 196 00:19:01,660 --> 00:19:04,840 Sudan agrees also saw a number of such deaths. 197 00:19:04,840 --> 00:19:12,460 And while outreach tracked treatment dropouts over time, I found that they'd been much more of these deaths in Sudan agree the deaths. 198 00:19:12,460 --> 00:19:18,310 The high heroin related death toll in some degree is much higher than three of the deaths in Sudan agreed were not unmarked, 199 00:19:18,310 --> 00:19:25,300 but living companions continued along a different trajectory of compulsion and forms of life and death. 200 00:19:25,300 --> 00:19:29,500 For example, I became quite fond of Imtiaz and Injector, and some don't agree. 201 00:19:29,500 --> 00:19:34,630 Twenty years old said to be a very talented pickpocket adept at stealing cell phones, 202 00:19:34,630 --> 00:19:40,930 usually working with two friends, Waseem and Jordan, both of whom died during the course of my fieldwork. 203 00:19:40,930 --> 00:19:44,680 The most common occupation for heroin addicts in Delhi, 204 00:19:44,680 --> 00:19:49,360 even in clinic when they have to say occupation, the most common occupation is listed as pickpocket. 205 00:19:49,360 --> 00:19:57,100 Although it's an effort by its practitioners, by the more euphemistic term trash pockets such in the code language spoken 206 00:19:57,100 --> 00:20:04,570 by pickpockets in Delhi is known as Farsi and a team is known as a company. 207 00:20:04,570 --> 00:20:11,350 Jorhat amongst India's Waseem Johar was the machine or head of the gang, and Imtiaz Admiringly described it. 208 00:20:11,350 --> 00:20:17,410 Jihad would only on come on. It's hard to pick what only on quality items like. 209 00:20:17,410 --> 00:20:22,270 If it was a small mobile phone, you would throw it back on the ground and tell the person they dropped their mobile. 210 00:20:22,270 --> 00:20:30,010 He was a real artist. Contrary to resumptions of familial abandonment, Imtiaz and Johar both had relatively supportive families. 211 00:20:30,010 --> 00:20:35,290 They tried almost every legal occupation possible instant an angry waiter, electrician, 212 00:20:35,290 --> 00:20:40,570 shop assistant, etc. In these jobs, they carried on about 150 rupees a day. 213 00:20:40,570 --> 00:20:48,490 In contrast to hours on the road and one cell phone could bring 10000 rupees or more, depending on the resale value of the phone. 214 00:20:48,490 --> 00:20:54,700 In 2015, Imtiaz, his parents, made a major attempt to get him out of all this and to separate him from the game. 215 00:20:54,700 --> 00:20:58,510 They took a loan of 80000 rupees and bought him in order to accept that was stolen. 216 00:20:58,510 --> 00:21:02,140 A few days later, and Imtiaz relapsed the day after Georgia's death. 217 00:21:02,140 --> 00:21:07,570 After shedding tears with me and others in the clinic, Imtiaz rejoined an older injector called Chatah, 218 00:21:07,570 --> 00:21:12,310 whom he had distanced himself from after Jadeja had left him bleeding in a ditch to be rescued by the police. 219 00:21:12,310 --> 00:21:20,620 Six months ago? I hesitate to call this death without weeping as Nancy Shepherd, you call it famously in another context. 220 00:21:20,620 --> 00:21:22,960 Maybe there is no way to compare impulses, 221 00:21:22,960 --> 00:21:28,930 deals with ourselves or what others might have become had he lived in Swindon agree, rather than to look boring. 222 00:21:28,930 --> 00:21:35,800 Instead, we might say that they're forms of life and forms of debt that we become part of, depending on a local ecology. 223 00:21:35,800 --> 00:21:42,340 These local differences can be nationally significant, as we saw earlier with the figures for HIV in India and similarly sharp variations, 224 00:21:42,340 --> 00:21:49,240 as I'm saying, exists globally in ways that would require an emotion in other kinds of ecological detail. 225 00:21:49,240 --> 00:21:54,340 Anthropology, we might say, is addicted to the pursuit of this kind of local detail, 226 00:21:54,340 --> 00:21:58,330 which are not irrelevant at all to the so-called larger conceptual picture. 227 00:21:58,330 --> 00:22:05,800 For instance, the concept of an epidemic may not be the best done with which to understand the spread and contagion of opioids, 228 00:22:05,800 --> 00:22:13,210 since the spread may be sharply differentiated as I'm across neighbouring regions in India and in the United States and many, many places. 229 00:22:13,210 --> 00:22:18,010 Also crucial would be to think about four strategies of intervention in relation 230 00:22:18,010 --> 00:22:21,460 to yesterday's discussion on ecology and also trying to think of the ways 231 00:22:21,460 --> 00:22:25,900 in which the idea of a neighbourhood might be significant as a unit of analysis 232 00:22:25,900 --> 00:22:30,860 in an ecology of mind or Gregory Beetson had called an ecology of mind. 233 00:22:30,860 --> 00:22:36,040 A specific ecologist will offer more differentiated routes into questions. 234 00:22:36,040 --> 00:22:41,890 Also, as I am suggesting of global health, such as Is there an opioid epidemic in India? 235 00:22:41,890 --> 00:22:46,210 My answer yes. Will it get worse? Probably much worse. 236 00:22:46,210 --> 00:22:48,160 What can be done? At the very least, 237 00:22:48,160 --> 00:22:57,200 there is a need for better regulation of these so-called national addiction centres that approve proliferating across Indian cities at the moment. 238 00:22:57,200 --> 00:23:02,390 Conceptually, what is the rise of opioids mean globally as a map of the contemporary? 239 00:23:02,390 --> 00:23:05,480 What kind of psychic distress is being expressed here? What is it? 240 00:23:05,480 --> 00:23:15,470 A symptom of the usual answer in the anthropology of addiction is to gesture to some variation of alienation, objection and neoliberal abandonment. 241 00:23:15,470 --> 00:23:20,780 But if that were the case, then we wouldn't see such sharp variation within so-called neoliberal culture. 242 00:23:20,780 --> 00:23:26,120 And further, in the long run philosophical and ethnographic consideration of heroin in my book, 243 00:23:26,120 --> 00:23:32,720 which is too long and complex to describe just quickly about how heroin relates to its root word heroin. 244 00:23:32,720 --> 00:23:37,220 The German word heroic as an experiment with vitality. 245 00:23:37,220 --> 00:23:40,220 Happy to talk more about that, but that is for another occasion. 246 00:23:40,220 --> 00:23:45,110 For now, I hope you have emphasised both the global scale of the question concerning opioids, 247 00:23:45,110 --> 00:23:53,300 but also the enduring and logical fascination with the variation and the anthropological field that the world is not flat. 248 00:23:53,300 --> 00:24:01,536 Thank you.