The Role of Psychiatrists in a Pandemic Social Emergency


I am sure we will recognise that there are some things in our society, some things in our world to which we should never be adjusted. There are some things concerning which we must always be maladjusted if we are to be people of good will.  We must never adjust ourselves to religious bigotry. We must never adjust ourselves to economic conditions that take necessities from the many to give luxuries to the few, and leave millions of people perishing on a lonely island of poverty in the midst of a vast ocean of prosperity. We must never adjust ourselves to the madness of militarism, and to the self-defeating effects of physical violence. There are some things that I never intend to become adjusted to, and I call upon you to continue to be maladjusted.

                                                                                                    — Martin Luther King. Jr1

The announcement of the lockdown on the 24th of March, and complete shutdown of the state transport without any proper contingency plans saw the mass exodus of millions of migrant workers. Chronicled as the worst displacement since Partition,2 the migrants who were stranded in their work place without proper shelter and food started their journey back home, for some this was their last. With very city and town, which was built by the blood and sweat of these workers turning a blind eye and  landlords harassing them for unpaid rent and contractors denying their rightful pay, for the migrants the exodus was a choice forced upon them.

There were unfinished stories of pain, anguish,  betrayal, humiliation, abuse, torture, some dying of hunger and exhaustion, more so with heavy heart and broken spirit after they were left hapless and struggling alone with their lives branded as not worth saving. The Prime Minister’s populist apology and the narratives on the war against COVID-19  ‘necessitating him to take hard decisions’3, had no allusions to the migrant workers exodus in his radio talk. The task and duty of saving one’s family and one-self was enforced upon the individual.

Litigations were filed in the highest court of law4 to fight for provision of basic facilities and shelter homes in the respective states. When the poor and voiceless are stripped of their dignity and hope, what else could they do to survive but walk silently, violating the rules of curfew.

The health ministry had issued orders to psychiatrists to counsel5 the migrant workers who were apprehensive and tried to walk all the way home from their respective work places, and  also those who were in shelter homes. The stranded migrant workers in Surat6 were protesting against the prevailing conditions, lack of food, water, demanded their salary dues and permission to go back home.  The announcement of lockdown 2.0 stirred widespread protests in Bandra, Mumbra, Surat,7 Hyderabad, and Ahmedabad , the core issues being lack of basic facilities, unpaid salaries and the workers request to be transported back home.

Some days ago the migrant workers were asked to pay for their train journey back home  and in gross violation of human rights , migrant workers in Karnataka8 were forcibly detained against travelling back home so that their labour can be used by the profit making real estate barons.

Recently sixteen migrant workers were crushed to death while they were resting on a  railway track in Aurangabad9. They had walked for more than forty five kilometres in a futile journey back home, over 1000 plus kilometres away. Their bodies draped in white cotton sheets reached home safely  bundled with their unfulfilled dreams, their  dream of returning home safely, the dream of seeing their loved ones. We live in a country where even dreaming is a luxury for many, the sixteen migrant workers were no exception. Many of those who died belonged to socio-economically vulnerable tribal communities, who left their village and parched lands to escape hunger and poverty.

The death of sixteen migrant workers  from Shahdol and Umaria districts of Madhya Pradesh cannot be brushed aside as a discrete accident on the railway track. It is  a social murder due to the  structural violence, unleashed on the vulnerable rural poor, failed crops, and weakening of MNREGA10, forcing them to migrate in a long drawn battle against poverty and hunger. The lock down 3.0  was the last straw for these migrant workers who were battling hunger, exploited and  betrayed by the contractor, forsaken by the state forcing them to take desperate measures.

The health department will call upon the psychiatrists to counsel the grieved relatives , and also the millions of restless migrants who return home. Not too long ago, psychiatrists were engaged by the Indian government to counsel thousands of anti-nuke protestors in Koodankulam.11

The trauma unleashed by the lockdown, the long lonely walk back home, unemployment and uncertain future will definitely have an impact on the psyche of migrant workers all over India. The Indian Psychiatric Society has  been conducting an online survey on the ‘psycho-social impact of lockdown due to covid-19 pandemic’,12 to understand the impact of lockdown on the mental health.

All forms of human suffering involves layers of personal history, embedded in a nexus of  meaningful relationships  that are in turn embedded in cultural and political systems13. Mental health, distress and disorder occurs in a particular socio- economic-political context and not in a vacuum. Psychiatry guided by the dominant reductionistic technological paradigm, and the causal models for understanding distress and framing of psychiatric care as discrete interventions needs to be critiqued.

By viewing people’s distress through a biomedical lens , decontextualizing the symptoms, and by medicalising it psychiatry depoliticizes the sufferings of individuals. Psychiatric labels for distress will shift the responsibility of the state for structural violence and transfer the pathology and burden onto the individuals. The disparate environments under which anxiety, depression, and common mental disorders now exist are brought together as many strands, decontextualized and unified into disease labels.14

 Capitalism constructs a place for people to experience their economic distress as a psychological problem and to look into themselves as if they were the cause of social ills.15

The use of symptom counts sans context to diagnose mental disorders, results in people with normal reactions to stress and those who cannot cope with the complex demands of life, receiving psychiatric labels.14

Social change and stress adversely affect the most vulnerable sections of the population that necessitates the need to examine mental health and illness from a sociological and social psychiatry perspective to study the impact of social change on mental health, distress, illness, and disease. To argue that social change affects people living in diverse parts of the world differently, without focusing on the social context, is naive at best and denies the humanity of the people at worst.14

On the ideological and political nature of professional work16 Jeff Schmidt said

“Treating sick individuals is a more politically conservative framework than is treating individuals  troubled in a sick and oppressive society. Evidently it is not the place of the clinicians to question the health of the society to which the patient must be adjusted. Their legitimate concern is how best to bring about the adjustment. But attempting to adjust people to the unhealthy society that caused their problems in the first place may not always be the healthiest approach for either the individual or society.

A simple alternative would be to help troubled individuals bring out, clarify and sharpen their implicit critique to strengthen them for the struggle in which they are engaged instead of removing them from it, because the struggle can be both therapeutic for the individual and beneficial to society.”

Martin Luther King Jr in his address to the American Psychological Association Annual Convention spoke about creative maladjustment. He said “There are some things in the social system that we need to be maladjusted to, It is through such a maladjustment that we will be able to emerge from the bleak and desolate midnight of man’s inhumanity to man to the bright and glittering daybreak of freedom, equality and justice.”1

Rather than adjusting individuals into this oppressive and  sick society, what we need is creative maladjustment.

Dr. Aravindan Sivakumar is a Psychiatrist, email:[email protected]


References :

1.King’s challenge to the nation’s social scientists :

  1. India racked by greatest exodus since partition due to coronavirus:

3.Modi seeks ‘forgiveness’ from India’s poor over COVID-19 lockdown :

4.Coronavirus lockdown: SC to hear PIL on mass exodus of migrant workers via video conference on Monday :

  1. Govt wants institutes like NIMHANS to work on mental health of migrants displaced by Covid
  1. ‘Want to go home’ : Migrant workers protest in Surat, over 60 held :


  1. Lockdown 2.0: From Bandra to Surat, migrant crisis across India makes coronavirus fight tougher :

India’s Lockdown extension sparks migrant workers protest :

  1. To Appease Builders’ Lobby, Karnataka Cancels Trains for Migrant Workers:

  2. Migrant Workers Run Over by Train in Aurangabad, Exhaustion After 45km Walk Made Them Rest on Tracks :

  3. Migrant workers | Maharashtra train accident victims were battling hunger:

  4. Engaging Psychiatrists to Counsel Anti-Nuke Protesters is an Abuse of Our Science: Statement from I.   Indian doctors for peace and development:

  5. IPS Mental Health Survey on Psycho-social Impact of Lock-down due to COVID-19 Pandemic:


13.Psychiatry beyond the current paradigm: Pat Bracken; The British Journal of Psychiatry 2012; 201,430-434


  1. Social Context and Mental Health, Distress and Illness: Critical Yet Disregarded by Psychiatric Diagnosis and Classification : K.S. Jacob ; Indian J Soc Psychiatry 2016;32:243-8.
  1. Psychoanalytic Culture: Psychoanalytic Discourse in Western Society: Ian Parker

16.Disciplined Minds : Jeff Schmidt;2012



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