More than a decade ago, the case of a young woman named Catarina entered the annals ofanthropology. Believed to be suffering from a psychosis, Catarina lived in an asylum in PortoAlegre, Brazil, when anthropologist João Biehl met her. Biehl’s ethnography (2005) describes howstate and family authorities colluded in designating Catarina as mentally ill, excluding her from thelife that she had previously led. Catarina’s existence, this ethnography shows, was shaped by a varietyof social, economic, and political factors. Of all these, domestic conditions played a particularlyimportant role in mediating how larger structural forces affected her mind and body, granting hercertain life chances while denying her others.This special issue ofMedical Anthropologycalls for more sustained anthropological attention tothe ways in which mental health conditions are embedded in domestic worlds. We use the term“domestic worlds”in a heuristic manner, referring to both families and households and treatingthese units as open structures that are fundamentally shaped by social and political economies. Eventhough the domestic–i.e., that which belongs to the house/the home–is a space of intimate day-to-day interaction, it is also a space of politics and economy (cf. Das, Ellen, and Leonard2008; DeLuca2017; Guyer1981; Yanagisako1979). In attaching importance to the domestic in mental healthresearch, we build on previous work in anthropology that has investigated how intimate others areoften intensely involved when an individual suffers psychological problems (for recent research, seeChua2014; Han2012; Jenkins2015; Luhrmann and Marrow2016; Segal2016; Yarris2017). In herclassic study on mental illness in rural Ireland, for instance, Scheper-Hughes (2001[1979]) linkedIreland’s high hospitalization rates for schizophrenia to the pressures placed on individuals by strictfamily norms and demands–demands that were shaped and intensified by structural transforma-tions such as changing patterns of migration and household composition. More recently, Das, Das,and Das (2012) have shown that the considerably higher levels of mental distress among womenthan men in Delhi, India are associated with adverse reproductive events in the women’s familiesand with a perceived inability to“maintain the domestic”(see also Gammeltoft2016[1999], Zabiliute2016). Exploring the lives of North Indian women who are undergoing psychiatrictreatment, Sarah Pinto’sDaughters of Parvati(2014) documents how familial and psychiatric careblend in ways that challenge conventional distinctions between abandonment and care, violence andsupport. And in her work on women living in Delhi slums, Claire Snell-Rood (2015) has shown howwomen’s sense of mental well-being is strongly dependent on the support that they receive fromintimate others–or not. These studies in anthropology, as well as our own fieldwork experiences,have compelled us to place domestic relations at the center of efforts to understand how mentalhealth conditions emerge and evolve
In this special issue, we bring together ethnographic research conducted in five different settings:Denmark, South Africa, the United Kingdom, the United States, and Vietnam. The authors exploredepression, trichotillomania (hair pulling, a form of body-focused repetitive behavior), the mentalhealth effects of torture, maternal mental health, and people identified by community members and/or community health workers as mentally disturbed. Three articles focus on relatively disadvantagedparts of the world: a low-income urban area in South Africa, a semi-urban area in Vietnam, and the
poor region of Appalachia in the United States; one is on Iraqi refugee women in Denmark; and thelast draws on research conducted both in Britain and the United States. In these articles, the authorsinvestigate experiences and expressions of mental health problems. In doing so, they highlight thedomestic sphere as a significant mediator between individual lives and larger social circumstances(such as war, poverty, and gender inequality) and attend to the role of local support initiatives andstructures in addressing some of these.The contributing authors provide vivid ethnographic documentation of the ways in which mentalhealth problems come to be experienced in particular ways through intimate engagements withindomestic worlds. Drawing on fieldwork conducted in widely varying settings, they highlight theintersubjective nature of mental health conditions, demonstrating how“individual”psychic states areinseparable from the states of mind of intimate others. Claire Snell-Rood, Richard Merkel, andNancy Schoenberg, for instance, describe the intertwining of women’s low moods and those of theirfamilies in rural Appalachia. For these women, the authors explain, depression is“a social processthat neither starts nor ends in themselves.”Similarly, Tine M. Gammeltoft’s research documents howthe mood problems experienced by pregnant women and new mothers living in northern Vietnamcoincide with the tense“domestic moods”that characterize their households. Domestic worlds andinner worlds tend to collapse; household tensions and inner tensions blending into one dense feelingof worry and distress. Bridget Bradley and Stefan Ecks describe how people diagnosed withtrichotillomania find their experience of living with the condition to be deeply inflected by thenegative reactions they receive from parents and other family members. Drawing on Sahlins (2011)definition of kinship as a“mutuality of being,”they describe trichotillomania as sometimes“co-experienced”by parents and children: the condition is lived not only by individual sufferers but alsoby their intimate others. Hayley MacGregor shows the complexity and negotiable nature of domesticco-experiences of mental health disturbances. People appreciate that they might well require the careof kin at a future point, as they had relied on it with past illness. Yet the watchful eyes of kin canchafe, leading people with mental disturbances to feel infantilized. Lotte Buch Segal explores therelational aspects of mental health difficulties where men had been tortured during SaddamHussein’s regime and consequently suffered from severe mental and physical health problems. Thewomen married to these men, Segal shows, framed their personhood, fertility choices, and lifetrajectories as part of a shared, resented experience of torture.Domestic conditions and relations also play vital roles in shaping theexpressionof mental healthproblems. Among wives of torture survivors living in Denmark, for instance, long-term distress isarticulated socially in complex ways, ricocheting across lifeworlds (Segal). In South Africa, at times,persons with biomedically diagnosed illnesses work, take care of others, and are part of localcommunities. At other times, they are perceived to be manifestly ill, expressing their mental healthproblems in ways that are harmful to themselves or others, but the permanent denial of domesticadult privileges to which they are subject is felt as an unfair response to these temporary expressionsof mental distress (MacGregor). The Appalachian women made conscious and deliberate efforts tosilence and contain their sentiments, fearing that the open articulation of distress would add strainon already burdened families (Snell-Rood, Merkel, and Schoenberg). Similarly, people with tricho-tillomania, trying to prevent shaming and criticism, would often strive to conceal their conditionfrom others, in both public and domestic spheres (Bradley and Ecks). Such attempts to conceal andsilence mental health problems have obvious consequences for sufferers’capacities to seek and attainhelp
By attending to the minutiae of daily living, the articles in this collection also show how domesticarenas come to serve as mediating sites for larger structural forces. Societal conditions such aspolitical conflicts, economic shocks, limited employment possibilities, or constrained access to healthcare rarely affect individuals in an unmediated manner; rather, they are filtered through the socio-moral dynamics that characterize families and households. The importance of the domestic as a siteof mediation is particularly clear where the state’s contribution to health care and social protectionservices is limited. Cutbacks in state health and social-benefits provision both reduce support for534EDITORIAL
those suffering from mental health problems and leave families with the task of providing socialprotection and economic care for vulnerable individuals. As illustrated for Appalachia (Snell-Roodand colleagues), family members are expected to buffer one another against the depredations ofpoverty and scarce health care resources. Given prevailing gendered moral expectations, such tasksfall mainly to women; besides managing their own feelings of distress, Appalachian women alsostrive to live up to moral expectations by“being there”and“being strong”for distressed familymembers, providing and caring for them, particularly when adverse life events occur. In reflecting onthe immense importance of such moral expectations for women’s states of mind, the authorsencourage us to placekinship ethicsat the center of attempts to comprehend mental healthexperiences. Similarly, several of the pregnant women and new mothers in Gammeltoft’s researchin Vietnam found themselves in materially difficult situations, living in poverty with a disabledperson or experiencing general economic constraints. Household dynamics played important roles inmediating such financial and social adversity: often, structural pressures produced family conflictsover resources or authority, and these domestic conflicts turned women’s everyday living environ-ments into zones of intense stress and tension, a situation that had far-ranging emotional effects. Theparticular forms that domestic conflicts took were, Gammeltoft shows, fundamentally shaped bykinship norms and expectations–expectations that, as in the Appalachian case, placed particularpressures on women. MacGregor documents how, in a poor urban South African setting with highunemployment, people living with mental illness struggle to contribute to their households byearning an income or sharing a disability grant, thereby acting to counteract the household’sresource deprivation. Sufferers themselves see this as a way of establishing future obligations thatcan serve as sources of support in times of illness or other forms of misfortune.In addition to mediating larger structural forces, domestic settings interact with more immediatesocial fora such as health service delivery points and social support groups. Health services areobviously important for biomedical diagnosis, treatment, and care, which are all linked to domesticarrangements. Bradley and Ecks, MacGregor, and Segal all show how online and interpersonalsupport groups help members experiencing mental distress to renegotiate and reframe domesticand familial boundaries. Being part of a non-domestic intimate community can generate newinsights for discussing discrimination or isolation within families, aiding recovery and well-being.Interpersonal support groups can also play important roles in addressing the fluctuations thatcharacterize mental health problems. As MacGregor shows, periods during which people makeimportant contributions to families and communities can be interspersed with times when theyare ill, dependent, and tied to domestic settings. The unpredictability of mental health problemsdemands that those who share a home with an afflicted person possess capacity for improvisationand adaptation. In some situations, and particularly in resource-constrained settings, such capacityfor adaptation may be difficult to mobilize.The contributions to this special issue point to the crucial roles of intimate others in the shapingof psychic states and to the importance of domestic conditions for the emergence, experience, andexpression of mental health problems. Domestic settings have a double edge: people’s enmeshmentin intimate social networks may operate both as a source of sustenance and support and as acontributor to ill health and social exclusion. Ethnography, the articles show, has a unique con-tribution to make in understanding these intimate processes: it is through proximate living thatpeople come to experience, express, and respond to psychic imbalances in particular ways. Theethnographies presented here therefore also challenge conventional assumptions regarding theontology of mental health problems: rather than simply being located within individual bodiesand minds, the authors show, mental health conditions tend to collapse the individual and thesocial. Comprehending psychic states requires, therefore, long-term immersion in domestic worldsand the cultivation of languages that can help to capture this merging of individual and social bodies.Psychic well-being is a collective matter and must be addressed as such–in research, policy, andpractice
those suffering from mental health problems and leave families with the task of providing socialprotection and economic care for vulnerable individuals. As illustrated for Appalachia (Snell-Roodand colleagues), family members are expected to buffer one another against the depredations ofpoverty and scarce health care resources. Given prevailing gendered moral expectations, such tasksfall mainly to women; besides managing their own feelings of distress, Appalachian women alsostrive to live up to moral expectations by“being there”and“being strong”for distressed familymembers, providing and caring for them, particularly when adverse life events occur. In reflecting onthe immense importance of such moral expectations for women’s states of mind, the authorsencourage us to placekinship ethicsat the center of attempts to comprehend mental healthexperiences. Similarly, several of the pregnant women and new mothers in Gammeltoft’s researchin Vietnam found themselves in materially difficult situations, living in poverty with a disabledperson or experiencing general economic constraints. Household dynamics played important roles inmediating such financial and social adversity: often, structural pressures produced family conflictsover resources or authority, and these domestic conflicts turned women’s everyday living environ-ments into zones of intense stress and tension, a situation that had far-ranging emotional effects. Theparticular forms that domestic conflicts took were, Gammeltoft shows, fundamentally shaped bykinship norms and expectations–expectations that, as in the Appalachian case, placed particularpressures on women. MacGregor documents how, in a poor urban South African setting with highunemployment, people living with mental illness struggle to contribute to their households byearning an income or sharing a disability grant, thereby acting to counteract the household’sresource deprivation. Sufferers themselves see this as a way of establishing future obligations thatcan serve as sources of support in times of illness or other forms of misfortune.In addition to mediating larger structural forces, domestic settings interact with more immediatesocial fora such as health service delivery points and social support groups. Health services areobviously important for biomedical diagnosis, treatment, and care, which are all linked to domesticarrangements. Bradley and Ecks, MacGregor, and Segal all show how online and interpersonalsupport groups help members experiencing mental distress to renegotiate and reframe domesticand familial boundaries. Being part of a non-domestic intimate community can generate newinsights for discussing discrimination or isolation within families, aiding recovery and well-being.Interpersonal support groups can also play important roles in addressing the fluctuations thatcharacterize mental health problems. As MacGregor shows, periods during which people makeimportant contributions to families and communities can be interspersed with times when theyare ill, dependent, and tied to domestic settings. The unpredictability of mental health problemsdemands that those who share a home with an afflicted person possess capacity for improvisationand adaptation. In some situations, and particularly in resource-constrained settings, such capacityfor adaptation may be difficult to mobilize.The contributions to this special issue point to the crucial roles of intimate others in the shapingof psychic states and to the importance of domestic conditions for the emergence, experience, andexpression of mental health problems. Domestic settings have a double edge: people’s enmeshmentin intimate social networks may operate both as a source of sustenance and support and as acontributor to ill health and social exclusion. Ethnography, the articles show, has a unique con-tribution to make in understanding these intimate processes: it is through proximate living thatpeople come to experience, express, and respond to psychic imbalances in particular ways. Theethnographies presented here therefore also challenge conventional assumptions regarding theontology of mental health problems: rather than simply being located within individual bodiesand minds, the authors show, mental health conditions tend to collapse the individual and thesocial. Comprehending psychic states requires, therefore, long-term immersion in domestic worldsand the cultivation of languages that can help to capture this merging of individual and social bodies.Psychic well-being is a collective matter and must be addressed as such–in research, policy, andpractice
References
Biehl, J.2005 Vita: Life in a Zone of Social Abandonment. Berkeley, CA: University of California Press.Chua, J. L.2014 In Pursuit of the Good Life: Aspiration and Suicide in Globalizing South India. Berkeley, CA: University ofCalifornia Press.Das, J., R. K. Das, and V. Das2012 The mental health gender-gap in urban India: Patterns and narratives. Social Science & Medicine75:1660–1672. doi:10.1016/j.socscimed.2012.06.018.Das, V., J. M. Ellen, and L. Leonard2008 On the modalities of the domestic. Home Cultures: The Journal of Architecture, Design, and DomesticSpace 5(3):349–372. doi:10.2752/174063108X368355.DeLuca, E.2017 The Household. Correspondences. Cultural Anthropology website.https://culanth.org/fieldsights/1125-the-householdGammeltoft, T.2016 [1999] Women’s Bodies, Women’s Worries: Health and Family Planning in a Vietnamese Rural Community.London: Routledge.Guyer, J.1981 Household and community in African studies. African Studies Review 24(2):87–137. doi:10.2307/523903.Han, C.2012 Life in Debt: Times of Care and Violence in Neoliberal Chile. Berkeley, CA: University of California Press.Jenkins, J. H.2015 Extraordinary Conditions: Culture and Experience in Mental Illness. Berkeley, CA: University of CaliforniaPress.Luhrmann, T. M. and J. Marrow, eds.2016 Our Most Troubling Madness: Case Studies in Schizophrenia across Cultures. Berkeley, CA: University ofCalifornia Press.Pinto, S.2014 Daughters of Parvati: Women and Madness in Contemporary India. Philadelphia, PA: University ofPennsylvania Press.Sahlins, M.2011 What kinship is (part one). Journal of the Royal Anthropological Institute 17(1):2–19. doi:10.1111/jrai.2011.17.issue-1.Scheper-Hughes, N.2001 [1979] Saints, Scholars and Schizophrenics: Mental Illness in Rural Ireland. Twentieth Anniversary Edition.Berkeley, CA: University of California Press.Segal, L. B.2016 No Place for Grief: Martyrs, Prisoners and Mourning in Contemporary Palestine. Philadelphia, PA:University of Pennsylvania Press.Snell-Rood, C.2015 No One Will Let Her Live: Women’s Struggle for Well-Being in a Delhi Slum. Berkeley, CA: University ofCalifornia Press.536EDITORIAL
Yanagisako, S.1979 Family and household: The analysis of domestic groups. Annual Review of Anthropology 8:161–205.doi:10.1146/annurev.an.08.100179.001113.Yarris, K.2017 Care across Generations: Solidarity and Sacrifice in Transnational Families. Stanford, CA: StanfordUniversity Press.Zabiliute, E.2016 Living with others: Subjectivity, relatedness and health among urban poor in Delhi. Unpublished PhD thesis,Uni
Yanagisako, S.1979 Family and household: The analysis of domestic groups. Annual Review of Anthropology 8:161–205.doi:10.1146/annurev.an.08.100179.001113.Yarris, K.2017 Care across Generations: Solidarity and Sacrifice in Transnational Families. Stanford, CA: StanfordUniversity Press.Zabiliute, E.2016 Living with others: Subjectivity, relatedness and health among urban poor in Delhi. Unpublished PhD thesis,Uni
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