There is a peculiar violence in being spoken about in the third person while one is still in the room. It is quiet, procedural, and almost courteous. A cluster of coats gathers at the foot of the bed; one of them reads from a chart – “thirty-six, bipolar, third admission, non-compliant” – and the person lying there, who hears every word, is not invited into the sentence.
The grammar has already decided that this person is its object, never its subject.
The belt and the shoelaces go first, then the clothes, then the name, then the right to decide when to sleep, when to eat, whom to telephone. What remains is a body to be dosed, observed, managed – and narrated by others.
On the round, a complaint becomes ‘lack of insight,’ a refusal becomes ‘non-compliance,’ and grief at one’s own dispossession becomes, with a flick of the pen, a deepening of the very disorder that brought her in.
The colonial clinic speaks a borrowed tongue, carrying borrowed pictures of what a healthy person should look like. The native who fails to resemble that picture is twice dispossessed – once of his reason, once of his world. We inherited those wards.
Across much of South Asia the diagnostic manual still lands like an import, and the patient is asked to recognise herself in a mirror manufactured somewhere far away, by people who never met her gods, kin, or lost ones.
And here is the question the ward cannot afford to ask: what if madness is not the deficit the chart records?
Consider a daughter in rural northern India whose mother saw, vividly and often, the processions of weddings that were not there – phantom music, phantom guests crowding the courtyard. Having been asked how her mother coped, the daughter did not reach for the language of medication or therapy. She said simply: what do you do when there is music? You dance. The hallucination was not an emptiness waiting for a drug; it was a fullness, an overflow, something the household had folded into the ordinary fabric of a life.
Pathology was not the first interpretation reached for, because it was not the only one on offer.
Could madness then not be the collapse of meaning but rather its excess – a surplus for which the ward keeps no syntax. The person who will not stop talking is not producing noise; she is producing more meaning than the room can metabolise.
The tragedy of the ward is not that it fails to understand. It is that it has decided, in advance, that there is nothing there to understand – only behaviour to be flattened toward a baseline.
I think often of the distance between being held and being handled.
As Winnicot said so aptly that the infant does not become a self in isolation; he becomes one inside the reliable arms of someone who can bear his states without retaliating and without fleeing – the holding environment. Bion gave it another name: the container, a mind that takes in another’s unbearable feelings, metabolises it through reverie, and hands it back in a form that can be lived with.
The ward too often does the reverse. It receives distress and returns a sedative; it ‘manages’ the affect rather than digesting it.
What is the way out? Not another protocol! The way out is smaller and far harder to standardise than any protocol, which is precisely why it resists the audit. It begins the moment someone on that ward looks at you, not through you, says “you” and then genuinely waits for the answer. Someone who knows that you do feel, you do understand and you will respond. Someone who has the sensitivity to treat you the way you would like to be treated – as a human being.
A nurse in a crowded government ward who, instead of asking a withdrawn young woman whether she was eating, asked what she used to cook at home. The woman, silent for days, described a fish curry – the exact cut, the souring agent, her grandmother’s hand on the ladle. She was in that moment not a case. She was an author. Nothing in the treatment plan changed. Everything in the room did.
To re-personalise is to return the witness: the patient’s own account, received as testimony rather than mined for symptoms.
It is a rhizomatic act, in Deleuze’s sense – a refusal of the arborescent chart with its tidy branching hierarchy of who may speak and who is merely spoken to. As opposed to this, the living root bridges of Meghalaya are grown, not built. The tribes nurture the living roots over huge periods of time and the tree itself becomes a bridge for people to cross. They roots are coaxed across the river over decades from the patient reaching of one tree toward the far bank.
Care, at its best, is grown the same way: slowly, relationally, by letting the ‘self’ extend itself across the gap, trusting that the other side is there.
The woman dances with her wedding procession. Somewhere, a chart records non-compliance. Both sentences are true. Only one of them stayed long enough to hear the music.
Amit Saraf
Amit Saraf, founder of Rhizome Lab is an electrical engineer, management graduate and is certified in psychoanalysis and astrology. He is a consultant, management trainer, chess mentor, editor and published poet based in Shillong. An alumnus of BIT Mesra, MDI Gurgaon and Livonics Institute, he combines analytical thinking with a deep interest in human behavior, learning, and personal growth. A former President of the Rotary Club and ex-Secretary of Chinmaya Mission, Shillong, Amit brings a unique interdisciplinary perspective to every endeavor he undertakes. He is particularly proud of his achievements and believes that life's rhizomatic outcomes redefine rigid thinking. He is a mental health survivor.