Affliction: Health, Disease, Poverty

Affliction: Health, Disease, Poverty

Veena Das
Copyright Date: 2015
Published by: Fordham University Press
Pages: 272
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  • Book Info
    Affliction: Health, Disease, Poverty
    Book Description:

    Affliction inaugurates a novel way of understanding the trajectories of health and disease in the context of poverty. Focusing on low-income neighborhoods in Delhi, it stitches together three different sets of issues. First, it examines the different trajectories of illness: What are the circumstances under which illness is absorbed within the normal and when does it exceed the normal putting resources, relationships, and even one's world into jeopardy? A second set of issues involves how different healers understand their own practices. The astonishing range of practitioners found in the local markets in the poor neighborhoods of Delhi shows how the magical and the technical are knotted together in the therapeutic experience of healers and patients. The book asks: What is expert knowledge? What is it that the practitioner knows and what does the patient know? How are these different forms of knowledge brought together in the clinical encounter, broadly defined? How does this event of everyday life bear the traces of larger policies at the national and global levels? Finally, the book interrogates the models of disease prevalence and global programming that emphasize surveillance over care and deflect attention away from the specificities of local worlds. Yet the analysis offered retains an openness to different ways of conceptualizing "what is happening" and stimulates a conversation between different disciplinary orientations to health, disease, and poverty. Most studies of health and disease focus on the encounter between patient and practitioner within the space of the clinic. This book instead privileges the networks of relations, institutions, and knowledge over which the experience of illness is dispersed. Instead of thinking of illness as an event set apart from everyday life, it shows the texture of everyday life, the political economy of neighborhoods, as well as the dark side of care. It helps us see how illness is bound by the contexts in which it occurs, while also showing how illness transcends these contexts to say something about the nature of everyday life and the making of subjects.

    eISBN: 978-0-8232-6184-0
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-viii)
  2. Table of Contents
    (pp. ix-x)
    (pp. xi-xvi)
    Veena Das
  4. Affliction: An Introduction
    (pp. 1-25)

    To arrive at a mode of writing that would allow a world to be disclosed, a world in which life pulsates with the beats of suffering and also with the small pleasures of everyday life, is a daunting challenge. Such suffering as I seek to describe in this book is often absorbed in the everyday and yet scars it with a sense of things being not quite right, even a sense of suffocation and foreboding. Over the years, I have learned how to be attentive to the manner in which ordinary moments might contain within them memories of great violence...

  5. ONE How the Body Speaks
    (pp. 26-58)

    In this chapter I describe the ways in which illness is made knowable in the course of clinical and social transactions in one of the neighborhoods, Bhagwanpur Kheda in East Delhi. As discussed in the introduction, illnesses might be seen as examples of quasi events that get inserted within the routines of everyday life but that can also morph into critical or catastrophic events that can rupture ongoing relations. This interplay between the ordinary and the catastrophic, the normal and the critical, vital norms and social norms is what concerns me in this chapter.

    As is well known, the “illness...

  6. TWO A Child Learns Illness and Learns Death
    (pp. 59-81)

    In the section on therapeutic failure in the previous chapter we briefly met Meena, who suffered from tuberculosis and died despite multiple rounds of first-line therapy. This chapter looks at Meena’s illness and her subsequent death through the eyes of her son Mukesh. Georges Canguilhem’s (1991) characterization of disease as an experiment with life provides a powerful framework not only for understanding the life of the individual organism in relation to its environment, but also the relationships within which the organism is embedded and which shape the course of illness as much as they are shaped by it. In my...

  7. THREE Mental Illness, Psychiatric Institutions, and the Singularity of Lives
    (pp. 82-112)

    The relation between madness and modernity is a classic space for exploring an ensemble of questions relating to the place of madness in popular culture and the biopolitical state. As astute observers of modernity have noted, there are two poles on which attitudes to madness seem to configure: On the one side there is the stigma attached to madness, while on the other side there is a fascination with madness for its potential to provide a critique of normality and as the site of creativity par excellence. The stigmatization and the ill treatment meted out to those who are defined...

  8. FOUR Dangerous Liaisons: Technology, Kinship, and Wild Spirits
    (pp. 113-132)

    As the illness biographies in the last two chapters show, the severity and the course of illness are strongly influenced by conditions of poverty and by the local ecologies of the neighborhoods in which the poor live. However, it is also the case that the existential pressure that illness exerts on the person suffering, and on the caregivers too, goes beyond issues of poverty and resource constraints, though these conditions can never be simply bracketed. Swapan’s case brings home forcefully the fact that in such cases as that of madness, we are faced not with the epistemic question as to...

  9. FIVE The Reluctant Healer and the Darkness of Our Times
    (pp. 133-158)

    The national newspaper theIndian Expressreported on September 24, 2003, that a minister of state for human resource development, Dr. Sanjay Paswan, had honored fifty “traditional healers” in a function in Patna, capital of Bihar in east India. Wearing two coiled cobras around his neck, Sanjay Paswan is reported to have danced onstage and walked on fire to the rhythm of beating drums and ritual chanting. In explaining his actions, he said, “This is all futuristic science and hence needs promotion by the state, media and the civil society,” and he added, “I am saying this with conviction, not politics on...

  10. SIX Medicines, Markets, and Healing
    (pp. 159-180)

    Although much public health discussion on India has focused on access to medical care, studies show that in both urban and rural areas (despite some exceptions pertaining to remote areas) quality of medical care poses a more pressing problem than access to medical care. For instance, based on a systematic survey of a random sample of households in one district in every state in India, authors of a recent study find that an average household in rural India can access 3.2 private and 2.3 public paramedical staff within their village (see MAQARI, Medical Advice Quality and Availability in Rural India,...

  11. SEVEN Global Health Discourse and the View from Planet Earth
    (pp. 181-202)

    A new consensus on health as a global public good has emerged since the 1990s with international organizations taking a major role in redefining health. Thus a programmatic statement from the World Health Organization states the following:

    As globalization progresses, it is becoming clear in many areas that matters which were once confined to national policy are now issues of global impact and concern. For example, carbon emissions and global warming not only affect the nation involved in their production, but also impact significantly on other nations; yet no one nation necessarily has the ability, or the incentive, to address...

  12. Conclusion: Thoughts for the Day after Tomorrow
    (pp. 203-228)

    In this concluding chapter I reflect on the themes that stitch the different parts of this book together. To recapitulate the movement of the text—chapters I through 4 started with the clinical encounters between patients and practitioners and then moved to the biography of different illnesses in terms of their dispersal over networks of institutions and relationships. Although three of the chapters on illness are individual case studies, as we saw, the focus is not so much on individual protagonists as is common in the literary genre of illness narratives often written in the first person. Rather, it is...

    (pp. 229-248)
  14. INDEX
    (pp. 249-255)
  15. Back Matter
    (pp. 256-256)