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The Practice of Care in Everyday Life in Northern Thailand Senses and Sensibilities: The Practice of Care in Everyday Life in Northern Thailand The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Aulino, Felicity. 2012. Senses and Sensibilities: The Practice of Care in Everyday Life in Northern Thailand. Doctoral dissertation, Harvard University. Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:9423078 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA © 2012, Felicity Aulino All rights reserved. Byron Good, Dissertation Chair Felicity Aulino Senses and Sensibilities: The Practice of Care in Everyday Life in Northern Thailand Abstract This is a dissertation about care. Based on over ten years of experience with Southeast Asia and sixteen months of ethnographic research for this project, I address the issue of caregiving primarily from the perspective of those providing care at home for elderly people in urban Northern Thailand and from the vantage point of national and international public health initiatives aimed at supporting such endeavors. In turn, I use the intimate experiences of caregivers to interrogate the politics of aging, long-term care, and national identity. What emerges is an understanding of caregiving different from that of liberal humanitarianism and biomedicine alike. With a focus on social relationships and embodied care practices, I show how forms of attention, obligation, giving, and receiving in urban Thai settings do not always equate with their counterparts in standard global health accounts. Instead, local values are put into action with significant ramifications for the performance and promotion of care. I examine local and global techniques of power and care embedded in the growing number of volunteer organizations directed at the elderly. With attention to class, religion, and history, I trace the interpersonal, social, and political influences reflected in caregiver subjectivity and propose a distinctly Thai logic of psychosocial support that underlies the experience of the caregivers and aid workers with whom I worked. Examining family dynamics and the stories people tell about the future, I trace a new imaginary for long-term care at play, apparent at both the individual and the institutional level. And I develop the concept of the “social body,” arguing that attention to and care of the collective is crucial for making sense not only of the disorienting varieties of volunteerism marking the shifting ground of long-term and end-of-life care in Thailand, but also of the larger scale political upheavals afoot in that country today. iii Table of Content Abstract iii Acknowledgements v Note on Transliteration and Pseudonyms ix Introduction 1 Chapter 1: The Ordinary and the Profound 16 Chapter 2: Volunteers and the Spirit of Caring for the Aged: A History of 66 Pity, Class, Gender, and Power in the City Chapter 3: Don’t Ask, Don’t Tell: A Thai Logic of Psychosocial Support 135 Chapter 4: Perceiving the Social Body: A “Practical” Phenomenology of 179 Care in Larger Context Chapter 5: Theodicy, Structural Violence, and Demographic Change in 229 Thailand’s “Aging Society” Chapter 6: Families, Futures, and Fantasies: Of a New Imaginary for Long- 269 Term Care Conclusion 303 Bibliography 307 Acknowledgements So many wonderful people made this project possible and have supported me through these years of research and writing. They tell me the acknowledgements cannot be longer than the dissertation itself, so here I will name but a few of the generous souls who have made this extraordinary time so very rich. My deepest thanks go to my friend and mentor, Linchong Pothiban, of Chiang Mai University’s Faculty of Nursing. I am forever indebted to her tireless support, and I cherish our friendship. Immense gratitude also goes to Sawang Kaewkantha, of Chiang Mai’s Foundation for the Development of Older Persons. He was a constant guide and ally, gave me a home base for my research, and opened up the world of elder care in Thailand to me. So inspired by and grateful to you both! This research was made possible by generous grant support. My thanks go to the Social Science Research Council for the International Dissertation Research Fellowship, to the Wenner- Gren Foundation for the Wenner-Gren Dissertation Fieldwork Grant, and to the Harvard Committee on General Scholarships for the Harvard Sinclair Kennedy Traveling Fellowship. My committee was simply amazing. My sincerest gratitude goes to all five of my professors: Mary-Jo DelVecchio Good, who has been my mentor since college and without whom none of this would have been possible; my chair, Byron Good, an intellectual interlocutor beyond compare and a wonderful friend; Arthur Kleinman, an incredible teacher and guide who, v with unbelievable generosity, read every word of this work multiple times; Michael Herzfeld, whose attention to detail and extensive knowledge of Thailand (including it’s incredible food!) have been remarkably instructive (and delicious!); and Michael Puett, whose enthusiasm and scholastic prowess kept me going along the way and remain a true inspiration. Aba Cecile McHardy, the Friendly Dragon, has been a friend and guide in life and scholarship; her influence can be marked on every page. Michael M. J. Fischer has been a great teacher and has shown me what masterful scholarship looks like, and I thank him for his feedback on this project. Charles Hallisey has been an idol since college and I am grateful for the opportunities he has provided in recent years to discuss this work. I have also learned an enormous amount about global health practice and pedagogy from Societies of the World 25, which has greatly influenced my thinking here, and I would like to thank Paul Farmer, Anne Becker, Salmaan Keshavjee, and Arthur Kleinman for their dedication to that course and its staff. I would also like to thank all the teachers in the Harvard Anthropology Department and throughout the university with whom I have had the privilege of working, including Stanley J. Tambiah, who has been a good friend and through whom I have come to appreciate the power of history and the disorienting strength of radical egalitarianism. I use pseudonyms for most of my informants, though I am so deeply grateful for their every assistance, great and small. Words in fact cannot express the gratitude I feel for everyone who allowed me to occupy this strange role of anthropologist and to live and work in their midst. Particular thanks goes to my family in Nong Hoi. vi Thank you to everyone at FOPDEV and at HelpAge International: Ajarn Aphassree Cheikuna, Phannaphat Mam Phophaenna, Janevit Wisojsongkram, Saranyu Win Kaewkantha, P’ A, P’ Jeu, Sirinat Sonia Kasikam, X, Sirinapa O-way Eunjai, Usa Khierwrord, and Somporn Nok Kiokaew. Additional thanks to Way for her research assistance, along with Sukyunya Pornsopakul, Duen Heang, and the incomparable Saengwii Buu Bpaalan. Another particularly warm thanks goes to Tana Nilchaikovit, from whom I have learned so much on so many levels. Thanks too to Komatra Chuengsatiansup, who also continues to be a great mentor at home and abroad. Thanks go to the palliative care experts who taught me so much, including: Veeramonl Chantaradee, Dr. Issarang Nuchprayoon, Wasinee Wisesrith, and Dr. Mano Mettanando Laohavanich. Special thanks to the palliative care team at the Songklanagarind Hospital, Prince Songkla University, in Hat Yai, including: Temsak Phungrassami, Sakon Singha, P’Fong, and P’Yae. Thanks also to everyone at Khrư̄akhāi Phuthikā, including Phra Paisal Wisalo and Sui Wanna Jaarusombun. And thanks to Win Pop Mektri and to everyone at the Volunteer Spirit Network for generous access to the library. My gratitude to other scholars, policy makers, and practitioners for their time, work, and generosity, including: John Knodel, Wipada Kunaviktikul,Wichit Sisopan, Siriphan Sasat, Bprasaan Tangchai, Tanet Wongyanawa, Naret Songkrawsook, Khwanchai Visithanon, Virapun Wirojratana, Samrit Srithamrongsawat, Suriya Wongkongkratheep, Weerasak Muangpaisan, P’Kaek, and Usamard Siampukdee. vii Many thanks to additional colleagues, friends, and family (and all combinations thereof) for their immense instrumental support, great insight, and good humor: Adisorn Juntrasook, Jamie Burford, Saipin Suputtamongkol, Pote Videt, Non Arkaraprasertkul, Wirun Limsawart, Donald Swearer, Bob Bickner, all the wonderful Thai teachers and my fellow students in Madison, Peggy Aulino, Roseanne Carrara, Larry Ashmun, Mau Daw, Joe Harrison, Marilyn Goodrich, Scott Stonington, Bonnie Brereton, Nick Thomson, Addy and Nick Grossman, Gernot Huber, Marisa Guptarak, Barbara Barry, Kate Mason, Lisa Stevenson, Aroon Puritat, and everyone at the land foundation. I could write pages on each and every one of you; such warmth to you all! My Thai writing group is one of the greatest things that came out of this dissertation process. Claudio Sopranzetti, Benjamin Tausig, Eli Elinoff, and Malavika Reddy: many many thanks to you! Particular thanks go to Claudio, not only for setting us all up, but also for countless hours discussing, cooking, and playing with Ren. I learned a lot about caregiving as a result of this work – its mixtures of sacrifice and devotion and love and simple showing up – perhaps most vividly in my own home in Boston. I dedicate this dissertation to my parents – my mom, who spent 11 hours a day with us caring for baby Ren her first year, and to my dad, who endured so much time alone to let her go, believing in me and loving us all the entire time. And to my husband and our daughter, who magically turn all trials and travails into adventures. I love you so. With Gratitude, Felicity viii Note on Transliteration and Pseudonyms Unless otherwise noted, I use the Romanization scheme of the American Library Association – Library of Congress (ALA-LC) for transliteration of the Thai language.
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