Buffalo’s Milk and Camden Drink

By Zara Ahmad

Klebsiella Pneumonia. I’ve got a happy case of trigger finger, skipping past and not reading the explanation on my choice of question bank. Klebsiella - the bacteria implicated in cases of pneumonia involving alcohol use. It circles through my mind again. Red sputum. Lung abscess. 

No reference is needed to attest to the extent to which alcohol is prevalent in British social culture. Numerous phrases corroborate this: ‘a quick pint’, ‘a cheeky pint’ and the famed ‘I need a drink’. The border between light enjoyment of alcohol turning into a necessity is difficult to identify and, furthermore, to acknowledge. Yet our colloquial mannerisms indicate that a desire to drink as relaxation is the norm, whether it be to cope with the sensory stimulation of a club and raucous strangers, or to unwind with a well-acquainted selection of mates. 

Alcohol use is routinely quantified as part of eliciting a history when clerking patients*. In my short time on the wards of North London hospitals so far, alcohol units are often underestimated or portrayed as insignificant, even in cases when the patient being spoken with has an alcoholic fatty liver or cirrhosis. 

The Parliamentary Commission on Alcohol Harm’s 2020 report details that alcohol is linked to almost half of domestic violence cases. Posing a considerable burden on the public health sector, alcohol costs the NHS £3.5 billion, with 1.26 million admissions related to alcohol annually. 

Typically, once an activity becomes detrimental, the hope is that the occurrence causing the damage is stopped. Alcohol is an addictive substance, and as with any addiction, it is difficult to divulge. Yet the majority of people who drink alcohol are not dependent. So why is it so hard to have an honest conversation around alcohol? 

Charting the life of an individual born into a society much less endeared to the joys of drinking may illuminate the personal determinants of how and why high-risk drinking habits evolve and develop into alcohol dependence. Saadat Hasan Manto (1912 – 55) was an author, poet and playwright who was tried six times for the crime of obscenity and institutionalised for alcohol dependence. 

The son of a local judge and his second wife, Manto was born in colonial India, in a village situated in Punjab’s Ludhiana district. Manto’s daughter described in an interview how her grandfather was a man who would ‘belittle’ and compare Manto to the brothers born of his first wife, with reports that Manto had jumped off a roof when flying a kite to evade his father. 

Despite having no formal qualifications, Manto translated texts in English, Russian and French to Urdu, ranging from Oscar Wilde’s Vera; or, The Nihilists to Leo Tolstoy’s The Last Day of a Condemned Man, both sharing a despondent tone in their inherently tragic focus on mortality. Manto moved to Mumbai in 1942 (formerly Bombay), where he worked at the Bombay Talkies film studio with film stars of the time and also joined the Progressive Writers’ Association of India. Although he was considered Muslim, Manto likely drank alcohol at this point, though it did not appear to impact his daily living, ability to write and retain a job. 

Simultaneously, demands for the rule of the British Raj in India and the creation of a separate Muslim state were intensifying. With the British Empire financially drained by two World Wars, Independence was hastily arranged in 1947. Partition was the independence and schism into three territories of India, demarcated along faith-based populations by the Radcliffe lines. It is known as one of the bloodiest cross-border migrations in recorded history. Estimates for the casualties and victims of atrocities are contested to this day, with excess mortality numbers ranging from 1 to 3.4 million people. 

Manto’s Hindu friend told Manto, a Muslim man, that he could have killed him on account of his faith, regardless of their friendship. Manto emigrated from India to Pakistan, writing of the absurdly reductionist view of the time: 

“... not a Muslim, not a friend, but a human that you killed. If he was a bastard, it was not his bastardry but just him that you had killed. If he was a Muslim, then it was not his Muslimness but his life that you wiped out.” 

The curiously impersonal lens that this story, Sahay, is written in highlights the dissociation between the utopian vision of Independence and the bleak reality of the Partition’s ‘stain covered daybreak, this night-bitten dawn’, evocatively described by Faiz Ahmed Faiz (1911-84), fellow poet and Nobel prize for literature nominee. 

Relocated and unreconciled with a newly formed country, Manto penned Toba Tek Singh (1955) and Thanda Gosht (Cold flesh)(1950). These works cemented his reputation as a purveyor of graphic realism and isolated him from the Progressive Writers’ Association. 

Thanda Gosht occurs when a man meets his lover in a secluded domestic setting. He is unable to demonstrate his attraction for her, confessing that he intended to rape a girl, only to discover that it was her dead body that he had abducted, her Thanda Gosht. 

Manto was now without the support of his peers and navigating a foreign legal system. Murders, rapes and disappearances during Partition went untried for. But Manto was charged for obscenity in the case of Thanda Gosht and fined 300 rupees. He was likely plagued by a sense of injustice for this. 

A 2018 Drinkaware/YouGov survey of UK adults noted that 41% of the study population had alcohol to alleviate feeling nervous or anxious, with 38% having drank to forget their problems. Likewise, Manto was never a particularly wealthy man. He did not have our 

contemporary understanding of mental health and was reported to spend his salary on alcohol as soon as he was paid. This increased to binge drinking episodes and a total dependence on alcohol once he left Bombay. 

When travelling to Karachi, for one of his many trials, he was accompanied by 12-15 bottles of beer to tolerate the journey. Lonely hours spent in anticipation, when alcohol may provide relief, is similar to the effect of COVID-19 lockdowns. According to the US National Institute of Health website (NIH) stipulates that approximately 25% of Americans drank more than before, with an almost 38% increase in the number of death certificates listing alcohol as a contribution. 

The COVID-19 pandemic and Partition are alike in the cocktail of factors that they assimilated in one fell swoop: loss of careers and subsequent financial challenges; inadequate mental and physical health provision; the complexities of loss of lives and liberty. 

Justice Javed Iqbal derided another of Manto’s works as making readers ‘tempted to become rapists too’. Justice Iqbal’s father, Mohammad Iqbal’s (popularly known by the honorific Illama, which translates as learned) philosophy is credited with unifying and promoting the creation of a state for the Muslims of India. 

Perhaps for Justice Iqbal, casting doubt on the new country of Pakistan carried a direct link to his father’s legacy. Family ties and home environment can influence moral values and customs. Should someone be raised in an environment where excess alcohol consumption is normalised, they may never identify that something is amiss. Conversely, graced by birth as the son of the National Poet of Pakistan, Justice Javed Iqbal capitalised on his fortunate position, eventually becoming a Supreme Court judge. 

By comparison Manto’s father was of no national veneration. Manto’s notoriety stemmed from the taboo. Hence, the rebellion of his alcohol use was in polar opposition to what was expected of him as a South Asian Muslim. He had been ostracised by the censorship imposed by his home countries. 

Similarly, the separation of the people from government can be seen in the ‘levelling up’ policy in the UK, that aimed to redistribute wealth across the country to previously underfunded areas. A 2021 survey found that in every region at least 20% of people believed the government cared less about their area. This figure jumps to above 60% in the North of England and Northern Ireland. In a society of ‘forgotten people’, it is difficult to expect individuals to actively seek help or investigate their alcohol use, especially if it is stigmatised or normalised as a barrier to accessing support. 

Functioning as someone isolated on the fringe of society, there appears little motivation for Manto to seek solace in companionship. The stigma attached to his work and his emigration sequestered him from his peers. In his eponymous film, Manto (2018), he is portrayed not replying to the letters of writer friends he left back in India and being subject to police raids. If government services, be they healthcare or the police, are seen in opposition to the common person then they will not be entrusted with sensitive truths that may yield great benefits. 

In 1953 Manto began experiencing hallucinations, possibly a symptom of alcohol-induced psychosis. He believed he was back in Bombay and was committed to an institution for alcohol dependence. There was an exchange of patients with mental health conditions between India and Pakistan in 1950, fictionalised in Toba Tek Singh. 

A patient becomes insistent on asking the location of Toba Tek Singh (a district in modern day Pakistan) so much so that he becomes known as Toba Tek Singh. Nobody clearly answers him. Singh is scheduled to be transported to India. During the exchange he is told that Toba Tek Singh is in Pakistan, when he has already been legally transferred into India. The story ends: 

‘There, behind barbed wire, on one side, lay India and behind more barbed wire, on the other side, lay Pakistan. In between, on a bit of Earth which had no name, lay Toba Tek Singh.’ 

Manto died of liver cirrhosis in January 1955, aged 42. 

Much comment has intrinsically linked Manto’s creative exploits to his alcohol-use disorder. It may be the case that alcohol exacerbated his emotional state, amplifying the intensity of his writings. However, Manto’s dependence on alcohol was likely multifactorial. The combination of a childhood spent at odds with his father; his perpetual estrangement from the law and his contemporaries; his grief about the violence of Partition and his permanent exclusion from his homeland all contributed. While seeming far removed from current British society, the inherent humanity in Manto’s struggles bear relevance today. 

It is common practice for all of us to live a little in denial of our problems. And when that is not possible alcohol may be the method of extinguishing unwelcome thoughts. Alcohol is not the problem, just a symptom. The indefinable utterance ‘treat the cause’ runs true. It is not possible to sift through time and repair the ills of the past. Tackling the sense of disillusionment, exclusion, lack of identity and belonging that lead some to develop an alcohol addiction is the way. 

Fostering better alcohol education in the curriculum about recommended units is a start. Optimising public services to work in partnership with trusting and respectful contact could minimise the gap between high risk alcohol use and seeking help. Destigmatising conversations surrounding dependence on alcohol through shifting the narrative is the ultimate goal. It’s not an alcohol problem, but a self-prescribed socially sanctioned treatment that is readily available. Once we get there, then we may finally be ready to have an honest conversation about alcohol. 

*Eliciting a history means to gather information from a person who has presented to a hospital about why they have come to a health care provider, their background of medical conditions and social circumstances. This process is known as clerking.