Justin E. H. Smith

In Harlem, ten years or so ago, I overheard two elderly ladies waiting for a bus underneath a billboard that read: “Depressed?  It’s Chemistry, Not Character.”  This slogan was followed by a 1-800 number which would put the caller in touch with a medical professional able to write a prescription for antidepressants, that is, to set the chemistry right by preventing the reuptake of serotonin.  The one lady said to the other: “I went to my doctor and he told me that’s what I got.  Depression.  I always knew it was something.”

I confess I feel tremendous inhibition at the thought of taking up the topic of reuptake inhibitors.  This is because it is, unlike my usual preoccupations (God, animals, language), by no means just an intellectual exercise for me.  Over the past 18 years I have been on at least six different kinds of SSRI, each one bearing a brand name that sounds more like a Lexus model than the last.  (Could I have been taking something called ‘Selexa’, or did I just see one parked outside of Starbuck’s?)  In the long run, they never quite do the trick, or if they do, then they do that plus a whole lot more one would rather avoid.  And so invariably I wind up back where I started: lucid yet burdened, supremely sane yet stalked by a particularly dark demon, my constant companion, my familiar. 

I have chosen to write about this condition not out of desperation –no, the drama of it was all played out years ago, and now I am nothing if not stable–, but rather out of a sort of calling, rare for me, to enter into identity politics.  I am tired of all the stupid things I hear said about my fellow depressives.  It was not so long ago that Jesse Helms, or perhaps Strom Thurmond, described Jean-Bertrand Aristide as a confirmed ‘psychotic’ when he learned of the Haitian president’s Prozac prescription.  My fellow philosophy professors thoughtlessly invoke ‘happiness pills’ as the easy way out for the philosophically lazy, while the general public seems to perceive antidepressants as a crutch for the frivolous, as a Hollywood indulgence, as a symptom of privileged frailty.  This moralistic condemnation is usually counterbalanced only be the equally unsubtle medicalistic reduction of our emotional lives to chemical imbalances.  I am neither crazy, nor lazy, nor is my state entirely explicable in terms of a certain disequilibrium of fluids.  I am a depressive, which is to say a person who experiences the world in a certain way.  Now I am every bit as materialist as the cynical doctors who paid for that billboard, yet I dare say that when I talk about my depression what I am talking about is nothing other than my ‘character’. 

There I go philosophizing again.  I had set out to tell a little something about myself, and before I know it I’m talking about the mind-body problem.  I will not claim that to know that black dog, as Churchill put it, in itself gives one insight into this deep and intractable riddle.  What I will claim is that reflection upon the nature of depression, and upon the actual (as opposed to commercial) virtues of antidepressants is for me a central part of the Socratic project of self-knowledge.  Some people take paper-making classes, others learn the ancient art of retreating to weekend wellness spas.  And some heed the oracle.  Chacun son passe-temps.

My particular diagnosis has generally been depression with obsessive-compulsive symptoms, a mixture often found, they say, in ‘high achievers’.  When I was an undergraduate I was so obsessed with obtaining top grades that I found myself symbolically swallowing every letter A I came across, and symbolically spitting out every B, C, D, and F.  If I accidentally swallowed while looking in the direction of a C or a D, I would have to quickly go in search of compensatory A’s to ingest.  I cannot describe the deep sense of dread that such a mistake was able to bring about.  There were times when I would inadvertently swallow looking at the wrong part of a sign along the freeway, and I was thereby compelled to exit at the next off-ramp, drive back to a point before the sign, turn around again, and drive back past, swallowing up the A’s, if there were any, or spitting out the low marks that I had inadvertently ingested on my first pass.  In reading books, if I came across a sentence with too many bad letters in it, I was compelled to look away from the book and to mouth any one of a stock of sentences containing no bad letters and plenty of A’s. “That’s not great, lovely man,” was for some reason the most therapeutic sentence I could conjure.  It was (I think?) meaningless, but phonetically very satisfying.  The ‘l’ sound was also very satisfying, and sometimes I would add it in where it did not belong just to make sure to get the needed relief: “That’s not great-l, lovely man-l.”

My compulsions were not just orthographic and phonetic, but numerological as well.  I could not tolerate odd numbers, and if when walking along my head was grazed by a leaf hanging from a tree, I was often compelled to turn back around and let it touch me a second time. At times I could not resist breaking pencils in half in order that one would become two, and each half, now a whole, would have its other.   

I do not do these things anymore.  Today, I do other things, generally so subtle as to go unnoticed even by me.  I am one of the fortunate ones: I’ve learned to channel my possession into socially acceptable, because socially invisible, directions.  One channels, but one never exorcises.  The symptoms mutate, but the state causing the symptoms remains, one single and monolithic constant, a lifetime’s fellow traveller, a Lebensgefährtin.  The woman always knew it was something.  It always was something.   

**

I am a materialist who nonetheless would be frightened in a graveyard by myself at night, and I am a good and intelligent reader of statistics who nonetheless gets sick with fear every time I am obliged to get into a goddamned airplane.  I believe in what Ernest Gellner described as “the world of regular, morally neutral, magically unmanipulable fact,” yet I go about my life as though the world were some sentient agent ready to take its vengeance upon me should I fail to follow its harsh and arbitrary commands.  This condition has led me to believe that the stupid things we do generally have nothing to do with false beliefs.  Would that it were that simple!  Superstition bubbles up from the unperceived depths, and enlightenment is no cure.  My beliefs are just fine, yet I am sick.

Perhaps we focus on false belief as the root of our problems simply because it is relatively easy to correct.  Ever since the Stoics, cognitive therapy has stood out as a promising path towards feeling good about one’s lot in life: belief modification, it has been thought, coming to live in the light of the truth, could free one from fearful superstition and thereby lead to emotional well-being.  And all without chemicals!  But I have been insisting that superstition is independent of belief, and that one’s character, the general way one fits with the world, has little to do with the descriptions one gives of it, with the list of things and forces in one’s ontology. 

Once one has solid first-person evidence of the futility of belief modification in the quest for happiness, chemical modification starts to seem like the best option.  If the eradication of false ideas changes nothing, then perhaps the simple accumulation of serotonin will help to make the universe a more charming place.  The genie of the future will not have to give a choice of wishes, for now we know that all of that stuff about finding love or treasure or gaining power was really just about stimulating the pleasure centers in the brain, and any  scientifically literate wisher would do better to just wish for that directly: constant and intense neural euphoria.  I can remember being on a new SSRI at a conference in Rome or New Orleans, or somewhere else one is supposed to want to go, and thinking: I’m just going to lie down there on that hotel bed and enjoy my brain.  Everything else –the Colosseum, the French Quarter, the entire world beyond my neurons– was superfluous.  My happiness, such as it was, did not come from making my thoughts fit the world, as the Stoics had counseled, but by cutting the world altogether out of the picture. 

**

Jede Krankheit ist eine Geisteskrankheit, said Novalis: Every illness is a mental illness. This inverts the billboard’s message, according to which every mental illness is an illness plain and simple.  For Novalis, it is not that the soul should be assimilated to the pancreas, but vice versa: that diseases of the body, like depression, have their meaning only in the way they are experienced. This is not to say that your illness is your own damned fault and that you are simply being punished for your failure, as was vividly imagined in Samuel Butler’s Erewhon.  It is to say that any illness, ‘physical’ or ‘mental’, is an illness at all only insofar as it is experienced by some subject.  A rusting bar does not suffer from the metallic equivalent of cancer. 

**

Whether we are going to speak about a tortured soul or about a defective brain seems to depend mostly on the rhetorical purpose at hand.  Students hoping to be excused from some responsibility or other have learned to talk the medical talk very skillfully: how can a mere Ph.D. in philosophy, they seem to be saying to me, possibly argue with a medical note from a real doctor?  We’re talking about an illness here, not some fleeting mood.  Doctors take on the social role of magicians, able to transfigure any procrastinating or hard-partying adolescent into a special kind of creature –a depressive, a manic-depressive, an obsessive compulsive, a sufferer from attention deficit disorder– usually with nothing more than the most perfunctory speech act.  I am not saying these categories do not exist (at least as far as the first three are concerned).  Indeed, I have claimed some of them for myself. But I doubt that their reduction to medical conditions like any other is what best helps us to understand them, or to live with them.

In the past several decades we have witnessed the encroachment of medical talk into nearly all domains of social life.  The refusal of some drivers to wear seatbelts is spoken of as a ‘public health problem’.  Of course, a smashed skull is truly a medical condition, but must that mean that every course of action that could lead to its smashing is also medical?  Similarly, is the undeniable existence of a chemical substratum to our conscious experience sufficient reason to conceptualize unpleasant or burdensome mental states as medical?

I do not want to take this line of questioning too far.  I have cited Novalis’s idealist motto as a counterbalance to the prevailing view that every illness, including mental ones, is a medical condition.  But I am not an idealist, as I believe the body is its own thing and there are plenty of context-independent facts about it.  I am willing to concede that chemotheraphy works on cancer cells in the same way whether one takes cancer to be the consequence of witchcraft or of environmental pollution; and an insulin shot will do the same good in a superstitious diabetic as in a scientistic one.  But SSRI’s have turned out to function in society rather less like medical insulin than like herbal infusions, yoga, or the cocaine that Freud once thought, not too long ago, would bring about a revolution in the treatment of mental illness: that is, they have vastly different effects depending on what is expected of them.  And this only shows that the well-being of the soul is something not nearly as easy to control with medicine as is blood-sugar level.   

Somewhere Lévi-Strauss discusses the magic-mushroom habit of the berserkers– i.e., those medieval Scandinavian warriors who put on the ‘bear shirt’ and were thereby transformed into bears during battle, giving them full license to rape and kill with extra ursine vigor. Now, those of you who have dabbled with psylocibin will probably agree that raping and killing were not foremost among your desires during your trip.  The trip was all-natural, indeed, as shroomers never tire of pointing out, yet it was strongly mediated by culture.  And this is why your reaction to mushrooms was different from that of a Viking warrior.  I can imagine, similarly, a culture that takes Zoloft before raiding coastal villages, and another that reserves it for monks in an ascetic order dedicated to knowing God, and perhaps another culture still, a tightly controlled millenarian sect, that distributes it to its initiates in preparation for mass suicide.  (This last case is not so far from reality, as antidepressants have been shown to increase the risk of suicide– a fact that should cause any thinking person to doubt the simple, reductionist belief in a cause-and-effect relation between the inhibition of serotonin reuptake and the qualitative experience of well-being.) 

Why is the experience of antidepressants so variable?  Medical anthropologists have known for a long time that medicines are not just taken by bodies; they are incorporated into cultures, that is to say into preexisting cosmologies that permit certain reponses to things ingested, encourage some, and exclude others.  There may be a single, context-neutral fact about what St. John’s Wort does in the body (as it happens, probably nothing); but there is no such fact about the role that said wort will play in a culture.  In our bodies, it brings about its minor effects and passes through; in our culture’s fantasies –and in our culture’s economy– it does a good deal more: it contributes to that nebulous condition we call ‘wellness’; it cleanses its consumer of vaguely defined toxins; it purges ‘free radicals’, whatever the hell those might be; it signals ‘consciousness’ to other consumers.  It is not to be mixed with gin or Diet Dr. Pepper.  Now of course consumers of St. John’s Wort are likely to be suspicious of chemical antidepressants, but many of the same considerations may be brought to bear in the one case as in the other.  For both, success in our culture depends upon the substance’s symbolic role in a system of oppositions.  Better living through mere chemistry is never enough; the pharmaceutical companies  understand that it is principally through marketing –that is, positioning some chemical or other in the desired social role– that that chemical comes to be perceived as a means to better living.

**

It should not be controversial for me to say that the reason for the existence of antidepressants is the profit of the pharmaceutical companies that produce them.  This is not to say they don’t work. People who are made happy by new products, who can invest their hopes in wellness accessories available for purchase in Skymall catalogs, people who get a wellness charge from St. John’s Wort or from hot stones strategically placed on the back, might also be made happy by the opportunity to take a new antidepressant (one of these, ‘Wellbutrin,’ has explicitly incorporated ‘wellness’ –a term that only caught on because those who stood to profit from it were unable to gain permission to make explicit health claims on their product labels– into its name.)  Things are rather more complicated for those of us who live under the black sun, as Julia Kristeva called it, but are nonetheless perfectly clear-sighted about our plights, and about the real prospects for escaping them.

Berlin, August 17, 2007

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For a comprehensive archive of Justin Smith’s writing, please visit www.jehsmith.com.   

Edward B. Rackley

Celebrate India. On second thought, maybe not. Such is the dilemma for many Indians as the country braces for its sixtieth anniversary this month. Politicos in New Delhi warn of extremist attacks. For August 15, Independence Day, workers are staying home, shops are closed and circulation is discouraged. India’s 1.12 billion citizens—one sixth of the world’s population—along with its far-flung global diaspora, are wondering what exactly the nation has made of itself in sixty years of freedom.

Profiles of famous Indians born in 1947 abound in the newspapers as Independence Day approaches. These are India’s “Midnight’s Children,” a notion made famous by Salman Rushdie’s 1981 bestseller and since anchored into the national psyche. Newspaper pundits speculate on the causes for the different fates of India and Pakistan, the latter born of partition with India sixty years ago. [1]

Still a young nation by any standard, India’s youth belies its age as an ancient cultural manifold, claiming more than 5000 years of continuous existence. An effervescent, song-and-dance present cohabits with the deep humming of millennia past. As a modern state, cultural and political pluralism is the primary success story of the world’s largest democracy comprising more than two thousand ethnic groups. Every major religion is represented, with a bewildering number of religious sects and spiritual leaders, gurus and “god men.”

India-US relations are complex, and India is a steadfast member of the Non-Aligned Group. Western culture is particularly suspect. A recent national poll showed a majority of Indians blame “western influence for making sex and crime acceptable.” Like most westerners, Indians are gleeful consumers. To a foreign visitor, however, the presence of dreaded western culture is imperceptible; a fierce attachment to local traditions and culture prevails. I see very little to no western media, for instance, and nothing “western” is for sale (well, Pepsi in some big cities).

OK Tata Horn Please

Fifteen years have passed since my last visit. The information technology sector and the all-consuming Bollywood juggernaut (other cinematic forms have all but perished) have achieved global reach and recognition. A clutch of family-owned companies, now closely-guarded dynasties, continue to dominate entire sectors (Tata motors, Mittal steel, etc.) thanks to protectionist market policies aimed at nurturing a robust national economy. Hence the ubiquitous “OK Tata” stencil on the rear of every commercial carrier, inevitably followed by “Horn Please.” No one uses rear or side view mirrors, making the horn the sole means of communication in a throng of rabid lane-jockeys and oncoming daredevils.

India’s chaos is one that never ceases to surprise, seduce, unsettle. The road traffic, one confluence of noise, aggression and cooperation, coheres into flowing function—with regular tragedy, to be sure. The number of pedestrians and pilgrims killed on the roadside, for instance, figures prominently in newspaper headlines. With such wide shoulders on the roads, one asks, why do so many insist on walking in the middle of traffic? In a recent send-up of Indian mannerisms, one journalist solved the riddle: “This is why no one ever walks on the [sidewalks], even when there are no chai stalls or beggar families taking up the space. We walk in the middle of the road because that’s where all the other people are.” [2]

“Shit on your shoe, Sir!”

Caca Cola, Nike, Starbuck’s and McDonald’s do not haunt this place as they do in, say, mainland China. With manufactured goods mostly domestic, there is little globalized branding here. It’s all Durga’s Veg and Tiffin, Anand Vests and Briefs, the Bell Brand Umbrella Shop, the Raj Lucky Metal Store. Sounds quaint, but the Lords of Indian Industry have enjoyed market control by huge family-owned Indian brands in the absence of external competition. Naturally their political allies who perpetuate these lucrative regulations eat equally well, sleeping the slumber of giants.

“India the software superpower” is a source of pride to all Indians, but who acknowledges the staggering development challenges the country faces? The economy is firing all pistons, but nothing trickles down to the urban and rural poor. Eighty-hundred-and-fifty million Indians, or 70% of the country, survive on nine to twenty rupees per day (25 to 50 cents). [3]

Large-scale famines were common right up to the end of the Raj, and India has not produced a major famine since initiating multi-party democracy in 1947. Still, extreme suffering is on naked display here, as is the hand of human cruelty. Bigger child beggars beating up smaller child beggars in the midst of an indifferent traffic jam. A maimed, mangy puppy tied to a stake to die. A rogue shoe shine boy in New Delhi who surreptitiously flicked feces onto my sandals, then demanded to clean them for money, drove home the desperation of street survival. It’s in everyone’s face but no one seems to notice.

In New Delhi and Mumbai, basic municipal infrastructure is crumbling and many tax-funded public services are functionally inert—open sewers ferry human waste; no trash removal service exists. A half day of rain leaves the largest cities inundated and paralyzed. Drainage ditches are clogged by discarded plastic bags and mounds of garbage dumped at curbsides. Colonial building facades continue their path of poetic decay, determined to defy their final collapse into mute rubble.

The makeshift shelters of sticks and plastic bags densely clustered in camps outside the ubiquitous mountains of rubbish on the outskirts of towns and cities resemble the sprawling patchwork of African refugee camps. I’m told these are Dawit communities, outcasts, who scavenge and sift through mile-high mounds of human waste for re-sellable or edible goods, competing with goat herds and packs of wild dogs. Colleagues who’ve worked in India’s devastating floods of recent years tell of government officials refusing to allow helicopters to evacuate affected populations (they were Dawit), instead directing international monies to save local cows.

Holiness still has its virtues on this earth. Who decides who lives or which objects are holy, dignified and thus worth preserving? The decision seems arbitrary to an outsider. There is nothing rational about the blind force of faith and tradition. Sam Harris’ book The End of Faith is much on my mind here.

Houses of the Holy

As India turns sixty its social problems and poverty are mounting in direct correlation to the wealth amassed by its tiny elite. Fascinating perhaps, but that’s not why we came. We’re here for a quick sprint through India’s most famous temples and pilgrimage sites. We began in Varanasi, considered the most auspicious pilgrimage site for practicing Hindus. Many bring the bodies of loved ones to the banks of the Ganges for cremation. Varanasi claims to be one of the oldest living cities in the world, a center of Hindu learning and culture for over 2000 years. On a speaking tour in Varanasi before the end of British rule, Mark Twain captured the agelessness of the place, joking to a crowd that “[Varanasi] is older than history, older than tradition, older even than legend, and looks twice as old as all of them put together.”

We arrived during a Shiva festival, the deity presiding over the city. Fire ritual, hymns and incantations, or puja, were performed at sunset every evening at the bathing ghats, near where funeral pyres burned. One tourist we met had brought her father’s ashes from the US to be set afloat on a bed of candles and flowers, following a ceremony of prayers and chanting with a local Brahmin priest.

In infrastructural terms Varanasi is barely hanging on. No renewal or renovation projects are visible. One exception was the lodge/temple where we stayed, owned by a Brahmin priest. Tiny shrines to various deities could be found in corners throughout the house. He hired local temple craftsmen, particularly painters, to decorate the old house with murals from the Bhagavad Gita and Mahabarata. With no new temples being built and no old ones being renovated, the skills of these unique craftsmen are no longer in demand. The art of tempura mural and fresco painting in Varanasi is dying out.

In contrast to Varanasi, centers of Buddhist learning and culture in Bihar and Uttar Pradesh are in good repair, supported by large monastic communities from as far as Japan, Taiwan and South Korea. A steady stream of international tourists and cash from other Buddhist countries in the region keeps them afloat. Just off the Grand Trunk Road in Bihar, a sixteenth century highway running from Amritsar on the Pakistan border to Kolkata—often just a marathon of bone-shattering potholes, becoming a giant dustbowl or an open lake depending on time of year—lies Bodhgaya, site of the ancient Bodhi tree, under which the Buddha achieved enlightenment.

A Mecca of sorts, Bodhgaya is also the wintering station for the Dalai Lama and the Tibetan Buddhist community in exile. The serene grounds around the tree are filled with stupas of various shapes and sizes. Hundreds of pilgrims and monks visit daily to do prostrations, meditate and offer prayers.

But because it is in India, Bodhgaya is still a chaotic place. Outdoor eateries are ideal for taking in the passing parade of barefoot pilgrims. (See also: swerving rickshaws, lumbering horse-drawn passenger wagons, overloaded oxcarts, Tata trucks and battered buses with horns blaring, wayward cows and darting dogs). Stay too long in this tableau vivant of the entire Indian animal kingdom on the move and suffer industrial-strength deafness.

In a remote wooded valley sixty km north of Udaipur in Rajasthan stands the Chaumukha temple, one of the largest and most important Jain temples in the country. Built in 1439, it houses 29 halls supported by 1444 massive, intricately carved marble pillars; no two are alike. Only one in this “city of pillars,” according to our guide, is imperfectly crafted. Its maker “suffered from hubris” and thus failed to achieve perfection.

Female visitors were reminded that during their “moon cycle” they were not to enter the temple. Besides shoes, any leather belongings were left at the door. As I entered the inner sanctum of the breezy marble labyrinth, a small group of “maidens” were singing bhajans to Jain deities.

A suit of silver meditation armor lay against a column beside the chanting girls. I gathered its symbolic purpose (it would suffocate or crush an actual wearer) was to ward off evil temptations of the flesh while meditating in hot pursuit of the divine. As I wandered the sprawling marble edifice I listened for some whisper of divinity. Crows cackled outside. I’d have settled for a cosmic brain thud, but none was offered. Jainism is famous for its deliberate lack of exegesis, and this temple’s secrets were the most impenetrable of any we visited.

A few kilometers north of Kanniyakumari, the southernmost tip of the subcontinent, stands the famous Hindu temple of Suchindram, built in the southern Dravidian style. It is dedicated to a representation of the combined forces of Siva, Vishnu and Brahman, the Hindu holy trinity. Like the Jain temple in Rajasthan, this was another stone labyrinth, though without reflective white marble or sufficient sunlight to illuminate its interior grottos. Thousands of tiny oil lamps glowed dimly in every stone recess, along every wall, before every stone carving of a deity. Bare-chested priests were scurrying about, performing ablutions of idols large and small carved from the stone walls, taking offerings from devout visitors, or chanting alone to themselves. Children laughed and played. The overall effect was not unlike a county fair minus the corndogs and sno-cones.

The air inside was cool, still and humid, much like a deep earth cave. Oil lamps illuminated the temple’s darker recesses. Highlights included a cluster of musical pillars (each with a different tone) played ably by our priest-guide, and a twenty foot stone statue of Hanuman, the monkey god and servant of Lord Ram. Ram is Vishnu’s most famous incarnation (along with Krishna) and the protagonist of the Mahabarata, a Hindu epic. With a muscular human frame and monkey’s head, Hanuman is typically worshipped by athletes (he often holds an iron dumbell), service industry folks and fanatics of Ram.

Hinduism gets a bad rap because devotees ritualistically clothe, bathe and make offerings to their idols as if they were Barbie dolls or voodoo effigies. Superstition is a problem among lay practitioners, and worship is aimed at “getting something” (fertility, worldly goods, liberation from the cycle of rebirth, etc.). Hinduism also lacks a succinct set of instructions to direct right action (as does Buddhism, for instance), although the lives of Ram and Krishna serve this purpose to some extent. Except for Catholicism, Hinduism is unique in accepting living deities, holy men and gurus to guide and counsel worshippers, ascetic monks and pilgrims. This seems to liberate the practice of Hinduism from reliance on a given holy text (“The Word of God”), which could explain why it feels more vibrant and alive to me, given my Christian background with its intensely scriptural orientation.

I finally got my encounter with divinity. I wandered too close to the giant grinning Hanuman just as a priest dumped a bucket of ghee and jasmine flowers over his head high above. I was splattered with the fragrant goo of warm ghee, the purified butter used in Indian food and as fuel in votive lamps. It certainly wasn’t shit on the shoe, nor was it a whisper from a deity frozen in stone. Did it mean anything at all? Sure, I realized as I picked up my shoes leaving the temple. At the very least, it showed the force of gravity was alive and well here in the frenzied midst of religious fervor. Some things are above the vagaries of human faith. That’s cosmic indeed.

——-

[1] When asked whether Pakistan and India can reunite, 34% said ‘never’, 22% said ‘probably’, and 16% said ‘yes’ (28% ‘can’t say’). In a similar vein, 43% perceive Pakistan as the major block in the peace process, 24% think it is the US. Only 13% blame India. The Week, Aug. 19, 2007: www.the-week.com 

[2] Scroll through the filter blog India Uncut www.indiauncut.com for a quick apercu into the cultural and political banter of Delhi’s chattering classes.

[3] States with the least amount of extreme poverty (e.g., where the majority are literate and employed but functionally poor, like Kerala) attribute their success not to the IT boom but to remittances sent home by migrant workers in Gulf countries like Dubai. In Kerala, unskilled labor is done by Indians from poor states like Bihar and Uttar Pradesh. They can earn 75 rupees or two dollars a day in Kerala, 2000 miles from home, where they make 15-20 a day (40-50 cents).

My brother in law (BIL) needs just enough sugar to sweeten his three cups of coffee a day. Beyond that he can do away with sugar.

But BIL, the hedge fund manager, has always chewed candy to relieve the woes of wealth. And lately, with gyrating Wall Street and the stress of possibly losing it all, he is on a hedge-fund-melt-down-candy-binge; he has a bowl of jellybeans on his office desk, a basket of coffee bon-bons in his family room and a box of butter fingers in his car.

Over the years, his waist has expanded, the leather belt has slid down to his pubis and his blubber belly hangs over it. How did the sugar travel from the lips to settle on his hips?

Chemically speaking, BIL is in love with sucrose or saccharose – a sweet, water-soluble carbohydrate – commonly called sugar. The plants acquire their sweetness mainly from three carbohydrates: saccharose, fructose and glucose. The sweeteners often exist in combination; honey, for example, is a combination of all these three sugars. As sweetness goes, fructose is the sweetest of them all; about 173% percent sweeter than glucose while lactose is only 16% as sweet. Several hundred less sweet carbohydrates exist in plants, but none is of commercial value.

Edible carbohydrates generally occur in nature as a combination of two or more molecules. Sucrose is glucose plus fructose; lactose is glucose plus galactose. BIL also eats multi-molecular carbohydrates like starch and glycogen besides many others of more complex structure.

The digestive enzymes break the ingested carbohydrates into absorbable molecules; the enzymes in BIL’s saliva, stomach, pancreas and intestines cleave the carbohydrates into simpler single molecules, which the cells of intestinal lining transport into the blood stream. Next stop is the liver; which under the spell of floating chemicals can convert absorbed carbohydrates into glucose, amino acids and fats. Liver also stores glucose as glycogen, which is a readily available to maintain a steady glucose level in the blood.

Glucose, the final transformed form of almost all absorbed carbohydrates, is the main energy source for muscular activity and cellular metabolism. The tissues pick up glucose from the blood and utilize it in the presence of oxygen (aerobic) or sometimes in its absence (anaerobic) as during prolonged strenuous exercise. The metabolism of glucose produces energy rich phosphate bonds of ATP (adenosine triphosphate).

While fats can substitute as the energy provider for some organs, brain functions only on glucose. Its depletion can damage the brain. For survival, maintaining the blood glucose level with in a narrow range is the result of many interacting hormones. Insulin and glucagon take the lead in this balancing act. Pancreas secrets insulin in response to high blood glucose levels, which brings the sugar level down by pushing it into cells and also converting it into fat. Low blood sugar stimulates the pancreas to secret glucagons. Other hormones like ACTH and growth hormone from the pituitary, steroids from the adrenals interfere with the uptake of glucose by various tissues, thus maintaining the blood sugar level.

If BIL continues to binge, his insulin will fail to clear the blood of excess glucose – termed ‘insulin resistance’- which will trigger his pancreas to produce excessive amount of insulin, which may still not push the glucose into the cells. Now BIL has diabetes.

With continued over indulgence of calories, BIL progresses into a full-blown metabolic syndrome – a deadly combination of high cholesterol, diabetes, hypertension and obesity. It is likely his abdominal circumference will be more than forty inches, which classifies him as a veritable time bomb, ready to implode with stroke, heart attack or cancer.

BIL has to choose between debility and health. The simplest choice is to eat less, give up his job and join an NGO dealing with world hunger. But that also is the most difficult choice.

The other choice BIL can make is to substitute artificial sweeteners, which is useless unless he reduces eating all carbohydrates and other calories; sugar substitutes offer a false psychological comfort in the absence of reduced intake of calories. Cakes and cookies made with artificial sweeteners still carry a load of other carbohydrates. BIL should not worry about their safety. Common sugar substitutes, aspartame (NutraSweet, Equal), Saccharin (Sweet’N Low, SugarTwin), acesulfame K (Sunett, Sweet One) and sucralose (Splenda) are harmless in moderate amounts as suggested by the FDA.

BIL could make an extreme choice. What happens if BIL starves? In this unlikely and not-advisable scenario, he will not die – not right away – if he hydrates himself daily with about 3 liters of water. During the first 48 hours of starvation his liver will pump out glucose from stored glycogen; in about 72 hours he will start using accumulated fat as the primary source of energy. Utilization of fat will produce ketones, which will give him mild nausea and suppress his appetite. But the brain needs glucose, so he will break down his muscle protein and amino acids like alanine to manufacture new glucose. BIL has a reasonable chance to last a few weeks if he behaves like an IRA prisoner who starved himself to martyrdom in 37 days.

There will be one visible benefit, if he survives the ordeal: his belt will be a few inches tighter and it will move up where it really belonged.