Year of Publication

2020

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Arts and Sciences

Department

Anthropology

First Advisor

Dr. Erin Koch

Abstract

Since the early 2000s, Sri Lanka has made major gains in decentralizing and expanding state-based mental healthcare access and services outside of Colombo. However, little evidence exists related to on-the-ground experiences of Sri Lankans who access these services, the quality and sustainability of services, and the effects services have on individual therapy management of mental and emotional distress. In addition to an extensive historical review of mental health service provision, this dissertation explores strategic health-seeking practices among Tamil-speaking communities in eastern Sri Lanka—an area ravaged by high rates of poverty, 26 years of civil war, and the 2004 tsunami catastrophe. Across 21 months of ethnographic research, I observed psychiatric, traditional, and religious mental healthcare practices and client interactions with both doctors and healers. I also conducted 58 semi-structured interviews with clients, family members, mental health doctors and staff, and traditional healers. I analyze clients’ life histories, local pluralistic therapies, as well as socioeconomic changes in post-war eastern Sri Lanka shaping experiences of suffering, treatment practices, and accessibility to resources and knowledge. I document the origin of mental health services in the east, subsequent barriers associated with increased demand for services, organizational changes, and a significant decrease in resources. Such social changes led to a heavy reliance on inexpensive biomedical drugs to alleviate mental illness and emotional distress. Given these shifts, and stigma associated with state-based mental healthcare, clients find strategic ways to associated with psychiatric treatments. This research positions local expressions of distress as tied to South Asian cultural ideas about mental health, and social inequalities linked to changing gender roles, transnational labor, sexual morality, and family economic status. Evidence collected from this research builds on existing contextually-based analyses to inform global health campaigns aimed at improving access to mental healthcare. Research and practice must adopt a more nuanced view of historical features, cultural processes, and socioeconomic changes that present challenges and/or opportunities for doctors and residents seeking out mental healthcare in post-war settings.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2020.369

Funding Information

2019, Legacy Dissertation Writing Fellowship, Department of Anthropology, University of Kentucky, fall semester (tuition allowance and stipend)

2016-2017, U.S. Student Award for Research/Study, Institute of International Education Fulbright Program

2013, Susan Abbot-Jamieson Pre-Dissertation Grant, University of Kentucky, summer

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