- Affliction: Health, Disease, Poverty by Veena Das
Affliction: Health, Disease, Poverty takes head-on the ambitious project of understanding, as author Veena Das says, “what is going on” (xi) with health, disease, and poverty in the low-income neighborhoods in Delhi where she has worked since 1999. This is no small task, and thanks to Das’s subtle and persistent attention to the details of life in this milieu, she largely succeeds. The work evocatively conveys what experiences of illness are like for the individuals and families profiled, and does not force resolutions to the often downright unresolvable circumstances of poverty in which her informants live. In Affliction, no answers or neat conclusions come easily; in fact, one of the book’s most important insights is that there is no tidy conclusion to be made about the persistent, unrelenting, and everyday suffering under which Das’s informants live.
Affliction comprises an introduction, seven body chapters, and a conclusion. The introduction and first chapter sketch the contours of the longitudinal morbidity study in three neighborhoods of Delhi that serves as the basis for the book. Readers familiar with Das’s other work (e.g., Das and Das 2007) will recognize the study to which she refers here, and it is indeed impressive in its design and scope. Chapters 2, 3, and 4 center around case studies of illness and loss from the perspective of individual sufferers, and Das does an excellent job of demonstrating how far beyond the individual an illness extends—dispersed over people, relationships, health practitioners, and technologies. Chapter 2 tells the story of a young boy who must cope with an uncertain future after his mother’s untimely death from multidrug-resistant tuberculosis. Chapter 3 profiles a young adult male with mental health problems, and Chapter 4 centers on a man who endures disturbing visitations from a goddess-like entity after [End Page 315] a succession of deaths in the family. These are the most-developed chapters in the book, and as a series of case studies, they hang together nicely.
The second half of the book includes three chapters that function less cohesively as a unit, but manage to cover quite a lot of territory. Chapters 5 and 6 address illness and suffering from healthcare providers’ perspectives, the former focusing exclusively on an amil (Muslim healer) with an unusual biography, and the latter focusing on a handful of practitioners with different forms of training. Chapter 6 is especially valuable for its explanation of the veritable constellation of medical degrees and certifications that a practitioner may possess in North India, a vital resource for those working on issues of health and illness in the Subcontinent. Chapter 7, the final and shortest chapter, moves outward in scale to bring some of the individual-, family-, and neighborhood-level analyses presented in the preceding chapters to bear on what Das refers to as the “expert discourses” (185) of global health. This foray into the applied facets of Das’s work is a welcome anchor to her prose, though it is less developed than it might be. It hints at (although does not fully do justice to) the elements of Das’s work that are more geared toward a public health audience.
Affliction reads in some ways like an intricate theoretical experiment. It is very much an extension of Das’s earlier work (Das 1996, 2007; Das and Das 2007) where she first began developing a theory of what she refers to as “everyday” or “unremarkable” suffering. In her typical style, Das draws widely on philosophy, psychology, economics, and even architectural references to make her points. This literary synesthesia establishes a sweeping theoretical framework that is able to tackle the complexities of everyday suffering at multiple structural levels. For instance, Chapter 3 (one of my favorites) introduces Swapan, a young adult male with probable bipolar disorder who becomes violent with his mother and younger sister. His mother explains his behavior as a form of bewitchment by their estranged affinal relatives or, perhaps, by a demon, while Swapan himself traces his outbursts to his...