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UNIVERSITY of CALIFORNIA Los Angeles the Work Of UNIVERSITY OF CALIFORNIA Los Angeles The Work of Disaster: Events of Affliction, Care, and Intervention in Nepal A dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Philosophy in Anthropology by Aidan Seale-Feldman 2018 Ó Copyright by Aidan Seale-Feldman 2018 ABSTRACT OF THE DISSERTATION The Work of Disaster: Events of Affliction, Care, and Intervention in Nepal by Aidan Seale-Feldman Doctor of Philosophy in Anthropology University of California, Los Angeles, 2018 Professor Christopher J. Throop, Chair This dissertation offers an ethnographic account of mental health governance, psychosocial interventions, and forms of shared affliction in Nepal before and after the 2015 earthquakes. By thinking with theories of event and crisis through the lens of critical phenomenology, I ask the following questions: How can ethnography approach emergent phenomena? How does an affliction become knowable through a particular concept and made into an object of intervention? How is evidence for therapeutic efficacy made visible in the midst of a psychosocial encounter? What are the local/global historical, political, and socioeconomic forces that have brought about the emergence of mental health governance in Nepal? Based on 24 months of field research, I conducted participant observation, interviews, focus groups, household surveys, and followed psychosocial counselors in the field to respond to these questions. In the first part of the dissertation I outline the history of mental health governance in Nepal in relation to the emergence of the Global Mental Health movement. In the second part I examine cases of adolescent “mass hysteria” ii as they were conceptualized as “conversion disorder,” “hysteria,” chhopne, and bhut/pret, pissach laagne. In the third and final part I track the humanitarian mental health response in the aftermath of the disaster and its ramifications. In order to address the ethical question of the possibilities and impossibilities of field research under situations of emergency, I discuss how new forms of ethnographic engagement were needed to respond to the unfolding disaster. As a conclusion, I conceptualize what I call the work of disaster as a way to frame what was generated through the event of disaster and what was destroyed, what was accomplished through various narratives of crisis and what was foreclosed, the processes by which affliction was made visible or rendered invisible, and the historical contexts that created the possibility for these formations. iii This dissertation of Aidan Seale-Feldman is approved. Sherry B. Ortner Douglas W. Hollan Jeffrey Prager Christopher J. Throop, Committee Chair University of California, Los Angeles 2018 iv This dissertation is dedicated to those who lost so much on April 25 and May 12, 2015 v TABLE OF CONTENTS PROLOGUE: Ethnography in Times of Disaster ................................................................................ 1 INTRODUCTION ........................................................................................................................................ 3 Conceptual Framework ................................................................................................................................ 4 Nepal ............................................................................................................................................................... 5 Theorizing Events ......................................................................................................................................... 8 Intersubjectivity ........................................................................................................................................... 12 Dissertation Summary ................................................................................................................................ 13 Methods ........................................................................................................................................................ 15 PART I: HISTORIES CHAPTER 1: A History of Intervention ................................................................................................ 20 Nepal as Nation State (1768-1951) ........................................................................................................... 20 Revolution, “Development,” and the Eradication of Infectious Disease (1951-1960) .................... 23 Primary Health Care under the Panchayat (1960-1990) ........................................................................ 26 The People’s War and the Rise of Mental Health NGOs (1990-2006) .............................................. 30 Humanitarian Mental Health Interventions and Psychosocial Support (MHPSS) ........................... 35 Global Mental Health in Post-Conflict Nepal (2007-present) ............................................................. 37 Mental Health as New “Global Development Priority” ....................................................................... 39 Subjects of Intervention ............................................................................................................................. 40 PART II: CONCEPTS CHAPTER 2: The Problem of “Conversion Disorder” ..................................................................... 45 Images ........................................................................................................................................................... 48 Survival .......................................................................................................................................................... 50 “False Belief”: Constellation Therapy for a Psychosocial Counselor ................................................. 57 A Psychosocial Intervention ...................................................................................................................... 64 CHAPTER 3: Fragments of a Transient Affliction ............................................................................ 73 Nomadic Tactics .......................................................................................................................................... 75 Naming .......................................................................................................................................................... 76 Idioms ........................................................................................................................................................... 79 Entanglements ............................................................................................................................................. 81 Indebted Relations ...................................................................................................................................... 83 Thinking with Fragments ........................................................................................................................... 88 The Girls ..................................................................................................................................................... 112 A Theory of Transfer ................................................................................................................................ 114 vi PART III: CRISIS CHAPTER 4: Writing Disaster ............................................................................................................... 123 Fieldnotes .................................................................................................................................................... 123 Sounds on the Radio ................................................................................................................................. 136 CHAPTER 5: Humanitarianism as Development ............................................................................ 139 A New “Mental Health Crisis” ................................................................................................................ 140 Coordinating Care ..................................................................................................................................... 143 Crisis, Humanitarianism, and Disaster Development .......................................................................... 148 “Building Back Better” ............................................................................................................................. 150 Collaboration .............................................................................................................................................. 154 CHAPTER 6: Transient Care .................................................................................................................. 159 Psychosocial Interventions ...................................................................................................................... 166 Transient Care ............................................................................................................................................ 167 Three Counselors ...................................................................................................................................... 170 Reaching the Clients .................................................................................................................................. 176 “When I look in the mirror, I see my own ghost” ..............................................................................
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