HEGEMONY AND NATIONAL MENTAL HEALTH PROGRAMME 61
mental health education, and orientation programmes for bureaucrats, politicians and social workers.13 Moreover, efforts may include special mental health education programmes for the village leaders and the application of pressure on them to facilitate the NMHP's work in the villages,14 and case-demonstrations (amongst the villagers of 'recovered* patients to prove the efficacy of the NMHP.15
However, the NMHP itself agrees—along with other concerned professionals and activists—that the people's participation in the NMHP is far from satisfactory. The reasons offered by the NMHP for such a performance are:- (i) lack of psychotropic drugs, funds, political will and professional involvement,16 (ii) inadequate recording and reporting,17 (iii) unavailability of doctors at the PHCs, and financial problems of the patients,18 (iv) lack of patients* privacy, storage facilities, and the unclear presentation of the motives of the NMHP to the people by the NMHP's personnel,19 and (v) the ignorance and superstitious cultural beliefs of the people.20
There is little doubt that these reasons are concrete problems for the NMHP. However, on their own they are inadequate to explain the problem of participation by the people. Besides being not specific to the NMHP—these reasons have often been repeated in the contexts of other community development programmes—these reasons are not organised into a coherent framework around what is the central motor of the NMHP, viz. hegemony.
The NMHP in India can be profitably seen as an attempt by the ruling class to establish its hegemony over other classes in a particular societal field, viz. mental health, with special reference to mental health services. This effort is part of the attempt continuously made by the ruling class in all societal sectors to 'translate its own world-view into a pervasive dominant ethos, guiding the patterns of daily life.121 Partha Chatterjee says that
'It is Gramsci's conception of the state as ""coercion plus hegemony" and of the struggle for power as "domination plus intellectual-moral leadership" which enabled the Indian critics to examine afresh the so-called "renaissance" in 19th century India in terms of the aspirations of a new class to assert its intellectual-moral leadership over a modernizing Indian nation and to stake its claim to power in opposition to its colonial masters. But the examination also demonstrated how, under the specific conditions of the economy and polity of a colonial country, this domination necessarily rests on extremely fragile foundations and the intellectual moral leadership of the dominant classes over the new nation remains fragmented.22
In the context of the Indian experience, therefore, this implies 'cultural hegemony', that is, a struggle not just to control the state but also to be in a position to determine the generic conditions under which