Toxic disruptions: polycystic ovary syndrome in urban India

In Gauri Pathak’s ethnography on gender, toxicity and chronicity the impact of economic liberalization and its concomitant environmental/social decline is felt acutely. Polycystic ovarian syndrome or PCOS is a hormonal disorder affecting women during their reproductive life cycle, and manifesting itself through irregular menstrual cycles, hirsutism, subfertility and obesity, amongst other syndromes. PCOS emerges in India as a chronic state-of-being amongst women belonging to primarily urban, professional, middle-class segments. Pathak focuses on professional upper-middle class women living in Mumbai and suffering from PCOS to undertake an in-depth exploration of the lived manifestation of the disease.

The reported large numbers of Indian women impacted by PCOS are however marked by several important conversations on diet, lifestyles and the emergence of neoliberal capitalist consumerism. Pathak unravels each aspect of a chronic disease as seen from a historical, social and economic viewpoint. In the process, she engages with the idea of toxicity itself as a socio-medical moment.

Toxic locations need not just be tolerated with forbearance; they can also be actively intoxicating. I use the term “intoxicating” here in a dual sense of allowing entry to toxicants as well as to reference the potential for heady and addictive effects (126).

The intoxication of toxicity is referenced in the book through key discussions around lifestyles, public discourses, rise of companionate marriages and the social valuation/dismissal/negotiation around gender norms and roles. Historically, she places the rise and desire for “toxicity” with the introduction of economic liberalization in India in the early 1990s, when the Indian economy “opened up” to global capitalist economic intervention – ushering in new forms of trade and consumerism, as well as engagements with Western modernity. PCOS is also in conversation with modernity and tradition, as marked through the body of the Indian middle-class woman and her reproductive self (Chatterjee and Riley 2001).

Chapters 2 and 3 engage with the public discourse and informant conversations around PCOS and the rise of toxic lifestyles. The focus on lifestyles and chronic disease management is particularly fixated on the tussle between modernity and tradition – with compromised diets and value systems. This compromise is felt most in the case of women who are forced to juggle between “modern” aspirations of professional living, and traditional role fulfillment. Pathak finds social despair both in the mass media and in her interviews regarding the loss of control over one’s bodily well-being. Centered on the twin themes of rising obesity and type-II diabetes as well as irregular menstrual cycles, Pathak unpacks the structural and ideological conditions that have been responsible for the rise of chronicity amongst the Indian middle class.

In chapter 4, Pathak chronicles shifting meanings in treatment seeking for PCOS with interviews including gynecologists, dermatologists, endocrinologists, and dieticians – each located at varied stages of the chronicity interface. In critiquing the forms of biomedical interventions and ethico-moral diagnosis that each of these practitioners undertake, Pathak finds patients of PCOS gravitating toward other forms of intervention, such as homeopathy and Ayurveda.

In chapters 6 and 7, gendered expectations regarding pregnancy and motherhood impact the ways PCOS is felt and negotiated with. Yet, the threat of subfertility remains ever-present in the processes of “fashioning of the self” that middle-class professional women with PCOS undertake. It is in these two chapters, specifically, that Pathak lays down key elements of changing gender identity and negotiation with gender roles as a middle and upper-middle class conversation. Having a professional life has meant that educated urban Indian women have greater choice to redefine traditional gender roles regarding marriage and expected motherhood. Of course, agency and choice are themselves limited within particular spheres – thus, the rise of companionate marriages with male spouses who are willing to understand and “adjust” has become critical to living with PCOS. Pathak highlights the ways in which a chronic disease exists and is performed outside the medical space, through social negotiations around work and intimacy.

Toxic Disruptions has much to offer to emerging and existing studies on hormones and their compromised status, socially and medically. There is, however, a need to engage with how chronic conditions such as PCOS impact economically and socially disadvantaged groups – a concern the author echoes and flags for future research.