S1E1 Supriya Subramani: Transcript

In this episode I speak with Dr Supriya Subramani. We discuss caste and contemporary music, resistance and poetry, and autonomy and participatory theatre.

Dr Supriya Subramania’s interest in morality and ethics has led her to explore morality, behaviour, and ethics in healthcare contexts. She has worked on the concepts of belonging, microinequities, moral habitus, the idea of the passive patient, and the social construction of incompetency and reflexivity.

Dr Supriya Subramani, thank you for joining Concept : Art.

Thank you, Pat. It’s a pleasure and it’s great to have this conversation with you.

Can you begin by telling us a little about yourself and how you came to be doing your academic work?

Ah, this is always challenging.

So, I identify myself more as like a social researcher who is interested in morality and ethics. I use sociological frameworks. I use anthropological understandings, of course, to look at these concepts and how the concepts were understood from different disciplinary backgrounds and then help me look through what it means to the larger ethics discipline.

And then I joined Wellcome Trust project and that’s how I started getting into the field of bioethics through the Wellcome Trust project back in India, in southern India. Question which we were exploring is on patient autonomy. And I was like, wait, let me Google what it is; you know basically that’s how exactly I started the project way back in 2012. And then I realised how do I value these concepts and how do I understand within the context which I was working with? Especially in Indian context, having patriarchy, having the caste dynamics which plays out; of course, gender.

So there’s so many intersectional factors which plays out. But at the same time making sense of the ethical questions was something which made me start my journey onto my PhD work, which I took a very common, taken-for-granted concept that is informed consent. By the end of my PhD, I realised it’s important to talk about respect, but more from the experiential point of view, so that was a switch for me.

That’s a really interesting kind of transition in some of your work. Has art influenced your academic work?

If I wanted to use reflexivity, yes, definitely.

I used to dance. I mean, I’m still a dancer. We used to go for competition with my group and things. So, body was very important for me in that sense.

For me, art, through my body, being involved in theatre, dance was very much part of how I started understanding, like, you know, lived experience. Part of from the– you know, being part of that community in that sense.

And then slowly I started reading literatures from Meena Kandasamy or Perumal Murugan‘s novels. These scholars, and of course, black feminist works very recently, for the last five years onwards, it made me reflect much more of what it means and how it influences me.

Whenever I see right now any art, literature or any visual art too: for example, like there is this photo and voice performer. She’s an amazing artist. Her name is Pushpamala N and she uses herself sometimes in the photos and the way she performs, herself. And she also looks at from the feminist gaze and how body can be played very significantly in your making sense of the world you live in and oppression, of course, to make sense of it.

For me, art as a sense of how it moves me as like my experience to make sense of it is what art has helped me through I feel. I’ve never written anywhere around how art has influenced directly, but it has always been part of my methodology in that sense.

It’s interesting hearing some of the direct influences and the, the less direct ones there. So you talked about body and community and you talked about caste. So I wonder if we could just kind of pause on caste and just talk a little bit more about how caste and artists who resist caste and some of those sort of social distinctions, how they might have influenced some of your work?

My dad and mom; so my dad is from a tribal community, which is again very questioned identity in itself. He’s from Badaga community: it’s a particular hill tribe community he’s from. Which is, because of colonial, you know, the categorisation of caste within India. That is we have this certain categories of scheduled caste, scheduled tribe and other backward community. So this Badaga community is very contested in itself. So the indigenous community identify themselves as indigenous community but, whereas, others would within that upper class community they don’t want to identify themselves as indigenous.

So basically my identity me being from my father’s, you know, perspective I would be seen as someone who is non-upper caste person and what that made me think through is the experience which is so much lived for me. Like you know whenever I used to go to meet my friends who are from upper caste. They were never allowing me inside the house. They used to make me stand in front of the– you know, everyone who has experienced this knows when I’m when I’m sharing this but not necessarily, people who don’t belong to this would agree with this, right?

Discrimination is part and parcel of the way I experience, of course gender, but also caste discrimination. So what that happened is whenever I was, you know, listening to the artist like The Casteless Collective, which is very rap, you know, like a very contemporary kind of a conversation. They use the lyrics, which is very local. There’s a Tamil, you know– in Tamil Nadu, the band is situated.

[Beef by The Casteless Collective]

Growing up most of the time was in Karnataka, which is a different state. There my way of navigating the caste was very different, so I couldn’t have a critical language. So I don’t know how to comprehend– I did not know what exact words to make sense of my experience. So it is actually very recently in that sense, like, only last 10 years of my life I’m able to even comprehend what was happening to me when I was young, making sense of these experiences.

Now when I listen to, like, Meena Kandasamy and also with listening to, you know, contemporary songs, which is like The Casteless Collective song by Arivu, it feels like, you know, hey, I know this feeling. I know this thing it’s resonates with me so strongly and also makes me much more like: okay– you can take this pain and oppression – whatever you want, experiences – and make it much more as a push or a drive to resist that caste, I feel.

And I think this is how I would interpret the way the anti-caste movements actually also in many ways at different stages of decades of anti-caste movements which is happening within India and these are very much ingrained in the society which has pain and also, but they use you know this pain to make sense. And then give solidarity feeling towards people who also experience. So that’s how I would see this and why the caste and my own experiences play a huge role in making sense of this current art movement, in that sense.

So I guess I’d pick out three different stages to that then: there’s the kind of connection and the resonance that you have with the, the works of art that deal with some of those issues that, you know, that parallel your experiences. There’s the new vocabulary that it kind of gives you. Kind of a hermeneutic justice sort of idea, I guess, giving you a new way to talk about your experience. And then there’s that sense of solidarity and that transformation to a form of activism. Umm, a, you know, a resistance that you can actually take on board and live. So I wonder if we could just zoom in on one of those works in English from one of those poets: Aggression by Meena Kandasamy. It’s not a long poem, so, would you mind reading it?

This is a poem written by Meena Kandasamy, Aggression.

Ours is a silence
that waits. Endlessly waits.

And then, unable to bear it
any further, it breaks into wails.

But not all suppressed reactions
end in our bemoaning the tragedy.

the outward signals
of inward struggles takes colossal forms
And the revolution happens because our dreams explode.

Most of the time:

Aggression is the best kind of trouble-shooting.

It’s a very powerful poem, and especially in light of the way that you’ve talked about your own experience there. But it’s also a poem which is about agency which is denied until aggression is the best way out. So the poem seems to me to speak to many of the subjects of your work. Do you think there’s a close connection between the idea of power in this poem and your writing on the idea of, say, the passive patient and the social construction of incompetence?

I mean, I was doing ethnographic work both in government hospital in the private hospital. It was not easy to get access in the first place. So when I did get access, the experiences which was happening like tailing. In my work on microinequities, I talk about how you know patients or patients’ caretakers who tail behind the doctors or in nurses who are in power positions, right?

So this kind of the power asymmetry within the hospital settings is something which resonated like, oh wait, this is something familiar. You know, this is what I used to feel. And whenever I used to be in school or when I even in my PhD programme, which I was doing. You know, whenever you talk to your people in power, they’re either professors, whether it’s people who are from, you know, elders in a certain community or within your own family. The way you act submissively, right? The way you have to behave in a certain, you know: wait, I don’t have power enough.

I mean, you shouldn’t even show with your body. I mean, the moment you show it’s basically a deviance, right? But sometimes you play that role, sometimes you resist that role, and going back to Meena Kandasmay’s work. I mean, I feel many of the patients in government hospital. We all resist in different, different ways and patients I have so many stories of how patients resist in different, different ways, especially from lower socioeconomic strata or lower, you know, class and caste category group of people.

It’s not aggression. I mean, even though the poem is, it’s about aggression, I feel it’s something which feels like you, you have this moral, moral rage, but you are trying to take it forward with you. You’re trying to resist the system and bring for change. So it’s a catalyst for change in that sense. But for people who are living there, you can’t question the doctor. You can’t question, “hey nurse, why are you behaving– you know, why are you shouting at me? Why are you yelling at me?”

The moment when you do that, it becomes so difficult. So, that’s why I feel that anger or the rage of helplessness at the system or because of your own positionality you can’t navigate around that, is, at least as a researcher when I trying to understand, “okay, this is a familiar; this is a normalised way of looking at the world.” But wait, it’s not normalised: it’s normalised for people with power and it’s normalised for people who are experiencing. But it doesn’t mean the agency is completely taken away.

They constantly navigate the system and then try to resist in different, different ways. Not necessarily always, but definitely they do, so in my book on the passive patient, that is something which I want to bring out.

The idea of passive patient it’s like, you know, how the system, the society in India, especially for people who are marginalised don’t value them as an agent, right? I mean, of course, this is more of active agents. I mean looking from bioethics perspective, “oh, this is the same, we know: it’s about autonomy.”

But what I’m trying to say is we shouldn’t limit only to the discussions of capacity arguments or autonomy-based argument. Of course, that’s there, the autonomous conversation, of one’s own life and how they want to navigate. It’s important, I mean, that’s there. But then at the interaction level, the experiential aspect, right? The how people are treated with their bodily gestures, or the way the microinequities, the subtle ways, how people are treated disrespectfully. Something’s what I want to capture.

And it’s not just within the hospitals – that is, clinical practice level – but it’s also at law. Even within law, the judges when they’re, you know having these decisions. They think patients who are dumb, ignorant, incompetent that they openly say that in their judgement.

In India, patients are dumb, ignorant and incompetent, so, you need to trust doctors. So, basically paternalistic way of thinking, right? And this is this is not surprising for Indian context. Many Indian scholars would be, “yeah, we know the story we have, we– we constantly hear this.” And so, that’s what I want to talk about when we talk about the passive patient, it’s more about, “wait, I don’t even respect you as a person.” Then where do we even talk about? “I need to listen to your decision-making capacity” Or letting you make decisions, you know?

So this is the difference I felt a little bit, and I wanted to go deeper and then unpack it; what’s happening at ground level.

One of the difficult things about academia generally is that you’re never quite sure who your audience should be, whether you are speaking to the people who are, are responsible for committing the microinequities or whatever it might be, or whether you’re speaking to the people who are the, I guess, the subjects of those inequities. Also, that’s one of the– one of the challenges that I think that feminism, feminist thought, has been grappling with, has always grappled with, is how to empower the people that it sort of seeks to represent and or whose experiences it seeks to express.

So, feminism has tended to be – well, many things – but one might say that it has tried to reflect on lived realities rather than abstract and academic ideas. And power and community and anger, and also love have been central to feminist movements around the world. But I wonder if you could think with us or take us through how black feminism has helped you think about some of these issues from a different perspective?

Yeah. I think at personal level, like few years back, I think three years back, it was almost during the time of COVID actually, like the crisis at multiple levels which was hitting me and I started questioning about, “what is love?”

I was going to my own personal crisis and then somehow that whole crisis in itself made me think through, “wait: love is a choice.” You know, that switch happened. But at the same time I was trying to read so many works of, I mean about books around love, psychology books and philosophical works. I mean, that’s me being an academician or trying to make sense what am I going through kind of thing.

And then I ended up: I mean, I have read about Audre Lorde’s work and bell hooks works but then this was a time period where I was doing a deep dive into bell hooks. So basically I ended up reading so many of her works like, for example, All About Love, Communion and Belonging. So these are the works which I was trying to make sense of my experience like lived experience.

Me moving to Switzerland. You know, I was feeling lonely. I was also making sense of my own relationship with my partner and then making sense with my work. I mean, I started working on immigrants’ healthcare experiences, where I was interviewing, you know. I just had started and talking to other immigrants, me being an immigrant and itself making sense of how, I mean, how do we navigate this? And then I realise how bell hooks works is so— It’s deeply has moved me and influenced me in the sense of first, like many of the works within India, when I was reading up on feminist literature— I couldn’t completely grasp it in the sense – not all, of course, there are amazing works by Dalit scholars and also people like sociologists like Nivedita Menon or Sharmila Rege’s work on Dalit literature and feminist works.

But I think black feminist works, especially bell hooks’ works, spoke to me much more strongly. I don’t know how, to point out— Maybe that certain pain or the way one can understand the power asymmetry or even discussing their own, you know, personal life influencing their professional works. I think that made me much more deeply engaged with the works of bell hooks and that connected somehow to my own work right now on respect and belonging. I mean the way I feel I connected that is: one is about making sense of your anger; that is rage, right? I mean, at system and at so many levels, you are getting angry and you’re making sense of your trauma.

And, but the same time you as a researcher, you go to the field and trying to talk to other people who also went through a lot of trauma. Right? I mean I’m interviewing South Asian, African, you know, immigrants and also from Middle Eastern community members: especially, all of them are women. And each one having a different story, and the degree keeps changing with the colour, at the same time, within Zurich.

So I was trying to make sense of my own, I mean— And then sometimes I was questioning my own experience. Wait, I experienced public hate crimes in Zurich and then when I talked to a person from Zimbabwe and the, the lived reality and the discrimination which the person was experienced like: “Oh wow, this is like so painful.” So, I’m like, wait, there is this degree and variation of oppression, discrimination, but also we are all in it together. You know that kind of a feeling of that solidarity or allyship. But we need to be there for each other also played a very significant role for me to make sense. So in that sense, my own personal life, but also professional ways of my— As a researcher as— I mean, I’m not saying this is dichotomous because you end up, you know, having it same, right? So that happened to me. And black feminist work has incredibly influenced me both as a person, but also in my research works right now.

It’s really helpful to get a sense of how you’re identifying how we might build bridges between experiences, I guess, and develop that sense of solidarity that you were talking about before. There’s also, within communities, building a sense of community and a sense of empowerment. And one of the things that that you mentioned to me was Theatre of the Oppressed. So, I wonder if you could tell us a bit more about Theatre of the Oppressed and what’s sometimes called, I think it’s called in India: Forum Theatre.

Yeah, yeah, this was started with the conversations, Brazilian scholar Augusta Boal. So he used theatre, especially a participatory method, that’s– It’s more of a participatory method of theatre. You go into the, into the community, you start enacting a skit or a play. And then you bring each participant in to own that play and want to make changes subtly, so it’s like a way of very active participation to bring social change at theatre, but also making a person reflective of the larger social issues.

Again going back to the how body plays a huge role, you know? And then your emotions; so body and emotions, it’s of course not disconnected, right? And definitely we can’t go back to the Cartesian dualistic understanding of mind versus body. If we use that approach then theatre – that is Forum Theatre – that influenced me so much, and also my Master’s in youth empowerment, right? I was a facilitator, so I used to go for, you know, training young people in community, like villages and certain rural communities, to train them for sexual and reproductive rights. So all these conversations and the training is always there for me, and I think it’s because people can sit with the emotions, with their body and then think through and reflect, which is so important I think.

Even for teaching, not just research, teaching and research, but also community participation and building solidarity. I think this is a great method I feel and in my classes I do, at least in India, whenever I have the chances I used to use this.

We were just talking about emotions with a postgraduate students, medical students in India in one of the training sessions. And then one of the doctor was saying, “who, umm, I mean, I don’t know if I should cry”. You know, he’s a male doctor; he was saying, “like when a patient is crying, what should I do? Should I be crying? Should I be leaving the space? I don’t know how to deal with this.”

You know, as simple as this, but this is something which is very common, right? Whenever with medical students or even with doctors. How do we grapple, navigate and even negotiate the particular space and then our emotions with the others’ emotions? So I think this theatre based approach could help us reflect on this. And maybe take away to our, let’s say, moving beyond the classroom setting to our everyday realities.

I think it’s really interesting that you attended so much in that discussion of Forum Theatre to embodiment and embodied reality. That’s a bit of a through-line with this conversation, I guess. So Forum Theatre, I guess, is partly inspired by critiques of traditional theatre which have spectators and audiences who are excluded from performance and, and are kind-of, they’re absorbing this, you know, pre-scripted – some might say – propaganda.

And some might also make this critique of some traditional pedagogy and teaching practices, and I guess that’s the point that you’re – well, if I hear you right – that’s the point you’re making is that: instead of thinking about teaching as this kind of dealing in the realm of abstract ideas and taking away some kind-of lessons that you will then struggle to apply in reality, if we think about teaching differently, if we think about it as a more embodied experience, and if we enable people to be, you know, perhaps vulnerable or have to confront some of their emotions in the situations which we’re trying to rehearse in front of them.

So some of the scholars may not agree, right? I mean, being vulnerable means it’s not great way to talk about all these rich, idealistic abstract theories. So, “why do I make myself vulnerable?” is a big question. Like, at least, whenever I do talk to some of the philosophers or some scholars from positivist where they say, “I don’t want to talk about my identity, I don’t want to talk about my personal stories, I don’t want to talk about all this.” And that is something is a big question even for me. Like how do, I mean, I see, I position reflexivity as something is an epistemological, but also the way you see the world that is ontological in itself, and the way you do your research – that means it’s also methodological, a way of getting things done in– when you do ethics research.

But also it makes us question of: what kind of facilitator or a researcher or a person in a way, you open up to, or you’re– are you willing to open up to? I feel this is something that just pushes the boundaries, I want to put it as also.

You’ve talked about microinequities a few times and we said that was one of the kind of areas of your research and, and interest. Can you explain what microinequities are?

Microinequities is something which is subtle acts or dispositions which make a person feel like, “wait was it something wrong? Was it something happened to me or there is, is there? It’s unfair. Is it injustice?” This, you know all these questions, but also there’s an underlying theme of did it happen to me? Was this discrimination did happen because of my identity, because of my, you know, gender, any kind of intersectional factors, right? I mean who you are – is that the reason why this person is behaving like this with me or treating me like this? – questions. And that doesn’t happen very explicitly, and that’s the reason why this, why the terminology is microinequity. It’s a very subtle ways. And many of the feminist scholars have worked within microaggression and the framework of the term; you know, the concepts around microaggressions very much.

I use microinequities because microaggression is one among it. There are many ways the discriminatory experiences in the subtle ways can happen, but it can. For example, a silence can be a microinequity, but also can be a microaggression in certain, you know, relationships, certain healthcare encounters. So it depends on the context, of course.

And this is something which I started noticing in my government hospital ethnographic research, which I was doing like in India, my PhD work. When I was sitting on the corridors and then, you know, just think observing and then sometimes I used to talk to, you know, caretakers around. And, every time when I see them, I mean I could see through the corridors like the doctors or the nurses who are sitting through and talking to them. When they’re talking to a particular patients where they’re having the social markers, who are not from a well-off or relatively well-off, I could see this you know the rationing of how much time I need to talk to whom?

But, also how much importance I would give through my bodily dispositions. Like should I do eye contact or do I give importance? Do I pay attention? And this one it’s an epistemic violence. It’s an epistemic injustice because you’re not valuing the person who is able to, you know– Wait, you’re not taking them seriously or not giving them attention. But it’s happening at such a subtle level a person is made to question, so it’s another double layer there, and the second is it is also an affective injustice, I would put it as. Because many of the conversations when I was listening most of the patients were saying, “whenever I talk about, I’m over-anxious. I mean, you know, when I’m saying I’m anxious or I’m saying stressed out or I’m not sure whether I’m nervous.” You know, whenever they share this, even their certain emotions or affects to, you know, doctors or nurses, the doctors have, whenever you see, interview them. They used to say, “oh these people are always like this. These people are always over-anxious. These people make some, you know, out of nothing so much.” So they are also dismissing their emotions and affects, like pain especially is very common, especially when you’re talking about women, right, within particular group of community too.

But for me, as a social researcher, that’s where the cap I use. It is a subtle thing, because within that particular, you know, the context, a woman who is from marginalised community cannot question the doctor: “wait, you did not do this eye contact or your, your eye rolling, your…” You know, you can’t pick a fight on this tiny, tiny aspect.

And so that’s where it becomes a microinequity in that sense. My larger theory, which I developed from capturing this microinequities to the experiential of, you know, experiential aspect of respect for person is about how it targets one’s self-respect and it humiliates a person; that humiliation targets self-respect.

Many of the doctors did say that whenever I was talking to them, “oh, but we don’t have time and resources. How can I actually give time and, you know, make them feel valued or give importance?” But my concern was that given the same amount of time which they used to spend on a particular patient, but they used to ration it differently because of the social markers and that’s where I feel one needs to acknowledge that, yeah. I think theatre definitely, theatre approach, Forum Theatre-based, you know, pedagogical training definitely plays a huge role and also the second is acknowledging emotions.

In certain ways, for example, when a person is joking, you know certain embodied ways of sharing the joke. But as a person who is giving, you know, playing out, or performing at that particular time needs to reflect on whether it would actually be perceived this way. Because many times in the clinical care settings joke can be also, can be very humiliating experience for people who are at the receiving end when it is not taken. So these are the ways I think theatre definitely can make us reflect and think through much more strongly. And I mean to address microinequities.

Well, this has been a big conversation Supriya; thank you very much.

What are you currently working on?

Currently I’m working on two projects. One is on breastfeeding: if it is an embodied experience, why should lived experience matter to public health ethics? The other key work which is my own post-doctoral project which I was talking about immigrants’ healthcare experiences in Switzerland and Zurich on ethics of belonging.

And of course, listeners can find links to Dr Subramani’s work and some of the art and artworks that we’ve discussed today in the show notes and on the Concept : Art website.

You’ve been very generous with your time. Thanks very much Dr Supriya Subramani for joining Concept : Art.

Concept : Art is produced on muwinina Country, lutruwita Tasmania. Always was, always will be Aboriginal land.


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