A Plea for an Activated Conscience
There is a photograph that exists only in the mind’s eye, never taken. My mother, approaching ninety, largely confined to a bed – her body finally conceding what her will refused to – surrounded not by flowers or grandchildren or the gentle blur of television, but by papers. Draft proposals. Correspondence. Notes for her next call. The body horizontal. The mind perfectly, furiously, vertical.
Her life has delivered her a series of cruel blows; personal losses that would debilitate most of us. She converted each into an agenda for action. Then a year ago, debilitating fractures to hip and thigh, followed by surgery, rendered her mostly bed ridden. For a woman who spent decades on her feet among the most vulnerable communities in India, being immobilized after a life in service is not rest. It is torment. But she does not appear tormented. She appears busy.
Dr. Saraswathi Sankaran founded DESH, the Deepam Educational Society for Health, in 1991. Over the next four decades, the organisation she built touched more than 4.2 million vulnerable lives directly. Her model was simple, almost elegant: identify a small group within a vulnerable community, empower them through awareness and roleplay into a different way of thinking, have them become ambassadors within their own community, expand the circle, repeat. She called it Mental Vaccination. Long before AIDS acquired its name in India’s public vocabulary, she had positioned her organisation among those most at risk — sex workers, same-sex partners, truck drivers, needle users, blood banks — working in the spaces that “respectable” society preferred not to name. Beyond AIDS came Reproductive and Child Health. Then the recognition that basic health awareness itself was the missing pre-condition. Then substance abuse, long before it became a declared scourge. Independent assessors found that her programmes worked. Donor audits found her accounts as clean as a clear conscience.
Before her hips gave way, she designed and piloted a programme addressing substance abuse among the young – tested in over 700 schools in Maharashtra, validated by TISS. The results were unambiguous: a measurable drop in the percentage of children who experimented with substances. She presented the programme to governments, donors, and corporations. The response was uniform in its bewildering consistency. Everyone agreed it was an epidemic. Everyone agreed it was urgent. Everyone agreed that doing nothing would be catastrophic.
And then everyone did nothing.
When nearly a third of young people between 10 and 24 report substance use; two-thirds of them begin before they are twenty. Some begin at ten. The cost of inaction is terrible. Or as she puts it, it is offensive; innocent lives are being compromised for every day of inaction. She did not wait to confront the challenge of AIDS, RCH, and health awareness. She built, proved, and presented. What she is waiting for now is not permission to tackle the scourge of substance abuse; it is for the world to do its part. And the world resourced, ambulatory, and institutionally mandated to act has not yet found the moment. The question her life poses, not politely, not rhetorically, is the question this essay has to answer: what exactly is it that the rest of us are waiting for?
The pattern my mother ran into has several names. The bystander effect: when a problem is large and public, individuals assume someone better resourced or more legitimate is handling it. Everyone waits. No one moves. Compounding it is the institutional immune response – the tendency of established bodies to treat a validated new initiative as a foreign object to be neutralised rather than incorporated. Pilot programmes are admired. Scale is deferred. The wheel of deliberation turns smoothly, producing nothing but its own rotation. This is not brain death. It is rational cowardice wearing the costume of responsibility.
These are not pathologies unique to India’s drug crisis; they are the operating system of every large, slow-moving failure of our time. Climate change: the science settled for decades, the emissions continuing to rise. Inequality: the data unambiguous, the political will insufficient. Artificial intelligence: the trajectory of harm described with precision while governance frameworks remain embryonic. What connects these is a failure of activated conscience – the capacity to translate moral recognition into coordinated action before the crisis makes action unavoidable.
My mother’s life is an argument against that failure. But it raises an older and harder problem : the concept of adaptive preference. People learn, with extraordinary efficiency, to want what their circumstances make available. The woman who has internalised her own subordination, or the child initiated into substance abuse at twelve in a neighbourhood where this is simply ‘what happens,’ may report genuine contentment. They have no frame for what else they might have been.
This creates an uncomfortable problem for anyone writing from a position of reflective privilege, the privilege of standing on a bank high enough to see multiple rivers at once. Most people are in the river. From inside it, the current feels less like a path to the ocean than like the only water there is. The temptation, once this is acknowledged, is silence or endless qualification. But this is just the bystander effect dressed in philosophical clothing. The children continue to be lost while the adults deliberate about the epistemological propriety of intervening.
This is where my mother becomes the answer to the essay’s hardest question. She did not solve the problem of reflective privilege philosophically; she solved it practically. She did not go to vulnerable communities with answers. She went with a methodology that created the infrastructure for communities to develop their own capacity to think, act, and then to teach. She understood the difference between the privileged voice that arrives with conclusions and the privileged voice that creates conditions for others to reach their own. That distinction is the difference between charity and respect.
There is one honest test for whether a preference is freely chosen: was the alternative genuinely available – actually, without prohibitive penalty? In most cases, the answer is no. This makes their contentment a ‘constrained truth.’ Constrained truths deserve to be named as such – not to condemn those who hold them, but to identify where the constraint lies and what it would take to remove it. That naming and the practical work of removal is what my mother spent her life doing.
Honesty requires naming the limits of this framework. The analytical lens hits its ceiling when faced with traditions that lead away from reflection rather than through it. The Sufi mystic in fana, the Zen practitioner and his koan, or the woman who chooses a traditional structure not because she lacks information, but because it contains a texture of daily meaning the reforming gaze cannot see. This is a specifically modern activist conceit to assume reflection is the only door to dignity. The inability to distinguish between false consciousness and genuine considered choice is a significant limitation.
Finally: the call to sit at the table assumes the table is worth sitting at. Sometimes it is not. The most important interventions in history have often come from people who looked at the table and built a different one elsewhere. My mother did not reform the institutions that ignored her. She worked around them. That too is a form of action the essay’s call to action must capture.
None of this invalidates the obligation to act. We are skilled at understanding problems and reluctant to pay the present cost of addressing them, a feature of temporal discounting. But evolutionary heritage is not destiny. What overcomes it is not better arguments, but the example of someone who refuses to accept institutional paralysis.
My mother, lying in her bed, summoning people and making calls, is not unaware of the irony: an old, largely immobile woman doing what rooms full of healthy, resourced people will not. The vigour is in whatever keeps the compass needle pointing even when the instrument case is falling apart. She is not haranguing; she is demonstrating. That is the oldest and most effective form of persuasion – the example.
She is asking a question of everyone who hears her story. Not a rhetorical question. A real one: What are you waiting for?
The children being lost to substance abuse today will not be recovered by a future argument about whether it was epistemologically appropriate to intervene. The women living constrained truths will not be freed by an essay too careful about its own privilege to say anything. Someone has to begin. It might as well be now. It might as well, in whatever way possible, be you.
DESH — the Deepam Educational Society for Health — continues to operate. Its founder’s programme for substance abuse among young people remains validated, proven, and waiting. If this essay has persuaded you of anything, consider whether your answer to her question might include a raised hand. To lead, to fund, or simply to begin.