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Library of Congress Cataloging-in-Publication Data
Das, Veena, author.
Affliction : health, disease, poverty / Veena Das. — First edition.
p. ; cm. — (Forms of living)
Includes bibliographical references and index.
Summary: “Affliction: Health, Disease, Poverty inaugurates a novel way of understanding the
trajectories of health and disease in the context of poverty. It traces the unfolding of illness within families,
local communities, neighborhood markets and in occult worlds. Privileging the experience of people living
in these neighborhoods it asks how can global health be made to take this experience into account rather
than escape from it?” — Provided by publisher.
ISBN 978-0-8232-6180-2 (cloth) — ISBN 978-0-8232-6181-9 (paper)
I. Title. II. Series: Forms of living.
[DNLM: 1. Delivery of Health Care—India. 2. Health Knowledge, Attitudes, Practice—India. 3.
Culture—India. 4. Family—India. 5. Poverty—India. 6. Stress, Psychological—India. W 84 JI4]
RA418.5.P6
362.1086’942—dc23
2014030233
Printed in the United States of America
17 16 15 5 4 3 2 1
First edition
For
Arthur Kleinman and Talal Asad
With whom my agreement runs much deeper
than agreement in opinions.
Thank you for your friendship.
CONTENTS
Acknowledgments
Affliction: An Introduction
1. How the Body Speaks
2. A Child Learns Illness and Learns Death
3. Mental Illness, Psychiatric Institutions, and the Singularity of Lives
4. Dangerous Liaisons: Technology, Kinship, and Wild Spirits
5. The Reluctant Healer and the Darkness of Our Times
6. Medicines, Markets, and Healing
7. Global Health Discourse and the View from Planet Earth
Conclusion: Thoughts for the Day after Tomorrow
References
Index
ACKNOWLEDGMENTS
This book was written over many years in small bits and pieces that came
together for me only recently. My main concern has been to understand “what
is going on” in the low-income neighborhoods in Delhi where I have worked
in different capacities for several years. I thank the following for their
generosity in sharing their lives and their thoughts and for letting me benefit
from their ungrudging criticisms and support.
To the people in the seven urban neighborhoods described here and to those
in the three others that were added later—you have given me reason to believe
in anthropology and in my capacity for friendship.
To the ISERDD members—Charu Nanda, Purshottam, Geeta, Rajan Singh,
and Simi Chaturvedi—your work and dedication sustains our common
endeavor, and your fierce commitment to the possibility of doing something for
those whom you meet in the course of your work is life-giving. To Devinder,
Bablu, Varun, Anand, and Roopa—and also to Pushpa and Zargham—thank
you for cheerfully accomplishing the various tasks that made the work at
ISERDD a pleasure.
To my colleagues at Johns Hopkins University and to our graduate students
—I thank you for sustaining a serious intellectual life despite all the travails of
the past few years.
To Clara Han, Naveeda Khan, and Aaron Goodfellow—thank you for the
care with which you have read some of these chapters and for your astute
comments.
To Ranendra Das, Jishnu Das, and Jeffrey Hammer—thank you for your
openness to anthropology, which has permitted me, in turn, to be open to
certain forms of economic reasoning.
To Saumya Das and Christiana Iyasere—thanks for clarifying my queries on
medical matters and being ever ready to engage even when we have vigorous
disagreements.
To Sanmay Das—I am ever grateful for the gentle way in which you raise
questions—they are never bouncers but rather like googlies that are oh-so-
beautiful.
To Manoj Mohanan, Brian Chan, Diana Tabak, Nomita Divi, and Grant
Miller—my gratitude for your active participation and enthusiasm for training
the next generation from different walks of life.
To Yasmeen Arif, Aditya Bharadwaj, Rita Brara, Pratiksha Baxi, Janet
Carsten, Roma Chatterji, Christopher Davis, Didier Fassin, Paola Maratti,
Deepak Mehta, Michael Moon, Sylvain Perdigon, Shalini Randeria, Bhrigupati
Singh, and, Jonathan Spencer—thank you for your engagement with my work.
The discussions with each of you over the themes explored here took place in
various settings—in a kitchen, a café, a classroom, during a walk, in a seminar
room, on the phone—but each discussion left an indelible mark.
To the four anonymous reviewers for the Press—I thank you for the care
with which you read the manuscript and your criticisms, which were crucial to
my revisions of the text. I hope you recognize your imprint on the final text.
To the Institute of Advanced Study, Paris, thank you for a fellowship in
2009 and the opportunity to present my work in several thought-provoking
sessions, and to Claude Imbert and Carlo Severi for helping me fine-tune the
philosophical implications of my arguments.
To Anne Lovell, Stefania Pandolfo, Sandra Laugier, Pierre-Henri Castel,
and Richard Rechtman—your generosity in sustaining discussions on the theme
of madness has been crucial for me to think of the ordinary in new ways.
To the participants in the Critical Global Health Seminar—thank you for the
opportunity to look at themes in global health from a fresh perspective.
To the graduate students in my proseminar class in 2013—Ghazal Asif,
Swayam Bagaria, Önder Çelik, and Mac Skelton—thank you for the semester-
long discussion that is reflected in several chapters of the book.
To Andrew Brandel—thank for your intellectual enthusiasm as well as for
your help with the logistics of bringing the book to completion.
To the members of the Governing Board of ISERDD—Ranendra Das, Roma
Chatterji, Kuriakose Mamkoottam, Amitabh Mukhopadyay, Deepak Mehta—
thank you for your vigilance and your support.
To the staff of Fordham University Press and especially Thomas Lay, Eric
Newman, and Teresa Jesionowski—I thank you for your careful editing and
attention to detail. It is a treat to work with you.
To the late Helen Tartar—your words echo and echo in more ways than I
can say. I miss your delicacy of touch.
To the late Harry Marks, whose presence at Johns Hopkins was like the
pure gift—I thank you for the most memorable discussions on whichever
subject our fancy took us to.
To Audrey Cantlie, who sadly passed away in the ninety-first year of her
life when she was in the middle of writing a book on Wilfred Bion and Jacques
Lacan—your intellectual spirit and your love for learning have sustained me
since we first met in 1978. I was blessed to have your friendship.
To Nayan, Lucas, Uma, Ayla, Lalita, Kiran, and Uma Jaan—thank you for
just being there.
Finally to Stanley Cavell—your words live in my work in whatever way I
can receive them—they give it life.
The author wishes to acknowledge the following publishers for generously
granting permission to reproduce revised versions of chapters originally
published in their respective journals and books and to co-authors for agreeing
to let me publish the papers jointly written under my name.
“How the Body Speaks” (chapter 1) is a revised version of the chapter
written jointly with Ranendra K. Das titled “How the Body Speaks: Illness and
Lifeworld among the Urban Poor.” In Subjectivity: Ethnographic
Investigations, edited by João Biehl, Byron Good, and Arthur Kleinman, 66–
97. Berkeley: University of California Press, 2007.
“Mental Illness, Psychiatric Institutions, and the Singularity of Life”
(chapter 3) is a revised version of “Mental illness and the Urban Poor:
Psychiatric Institutions and the Singularity of Life” (written with the assistance
of Rajan Bhandari and Simi Bajaj), published in Enchantments of Modernity:
Empire, Nation, Globalization, edited by Saurabh Dube, 402–28. New Delhi:
Rout-ledge, 2009.
“Dangerous Liaisons: Technology, Kinship, and Wild Spirits” (chapter 4) is
a revised version of “The Life of Humans and the Life of Roaming Spirits,”
published in Rethinking the Human, edited by J. Michelle Molina and Donald.
K. Swearer, 31–50. Cambridge, Mass.: Center for the Study of World
Religions, Harvard Divinity School, 2010.
“The Reluctant Healer and the Darkness of Our Times” (chapter 5) was
previously published as “The Dreamed Guru: The Entangled Lives of the Amil
and the Anthropologist,” in The Guru in South Asia, edited by Jacob Copeman
and Aya Ikegama, 133–55. Abingdon, UK: Routledge, 2012.
Veena Das
Delhi, 2013
