Pia Noel
Job Title
PhD student
Research interests
Background
PhD Title
An ethnography of the mental health system, aid, and modern nation-building in post-earthquake and federalising Nepal.
Project description
Following a short-lived increase in funding and heightened attention on mental health in the aftermath of Nepal’s 2015 earthquakes, the actors and institutions within the country’s mental health system had to renegotiate their roles and responsibilities to ensure the ongoing availability of resources and interventions for mental health care.
Drawing on fourteen months of multi-sited ethnographic fieldwork conducted two years after the earthquakes, during a period of political transition towards a federal system, my thesis traces the remnants and rippling effects of short and mid-term care and funding for mental health at both the national and individual levels. It explores the key question of who is brokering and translating mental health efforts in post-earthquake and federalising Nepal, and why. In charting these rippling effects through the lens of mental health brokers and translators, my thesis not only provides ethnographic evidence of the process of implementing aid norms and policies and the state of Nepal’s mental health system but offers an understanding of the shifting landscape of aspirations and possibilities for social change in the country. I argue that the renegotiations between stakeholders to reshape the mental health system in accordance with the latest mandates for health systems strengthening presented transformation opportunities, not only for mental health care but also for local agendas and the aspirations of social change and modern nation-building.
The thesis is organised into three parts. Part I historicises and ethnographically introduces Nepal’s mental health system. I show that its history is intrinsically linked with wider national and international political, aid and development histories; that mental health is a contested object of care; and that the current mental health care landscape is characterized by fragmentation and multiplicity, reflecting broader market-oriented economic forces. Part II explores how mental health brokers and translators navigate and translate current aid norms. Specifically, I show that state and non-state institutions are mutually dependent on one another to perform “country ownership” of mental health efforts and display “good” statehood and NGO-hood. In addition, I shed light on how mental health NGOs broker the demand for evidence-based practice on the ground, and how this demand affects different NGOs inequitably - an inequity that hinges on local institutions’ epistemic orientations and their contingent networks. In so doing, this thesis challenges simplistic narratives of aid dependency, and emphasizes the agency of mental health brokers in translating constantly shifting aid norms and in shaping the mental health system. Part III shows how individuals with varying socioeconomic and gender positions engage in brokering psychological knowledge. I argue that local brokers have a central role in “Nepalising” psychological knowledge and that in framing it as being part of modernity it impacts their sense of self as well as society at large.
As whole, my thesis evidences the continuous negotiation of tensions arising between aspirations - encompassing policy, aid norms, and modernity - and lived realities experienced in practice. It contends that these tensions exist both at the national and individual levels, where the aspirations for rapid social change must coexist with the necessity of operating within slower-changing societal structures.
Supervisors
Funding
Wellcome Trust Society & Ethics Doctoral Studentship
Qualifications
2016 – present PhD Candidate in Social Anthropology, University of Edinburgh
2015 – 2016 MSc in Global Mental Health, University of Glasgow
2009 – 2013 MA Psychology & Social Anthropology, University of St Andrews
Publications
Susanty, D., Noel, P., Sabeh, M. S., & Jahoda, A. (2020). Benefits and cultural adaptations of psychosocial interventions for parents and their children with intellectual disabilities in low‐and middle‐income countries: A systematic review. Journal of Applied Research in Intellectual Disabilities.
Cork, C., White, R. G., Noel, P., & Bergin, N. (2018). Randomized Controlled Trials of Interventions Addressing Intimate Partner Violence in Sub-Saharan Africa: A Systematic Review. Trauma, Violence & Abuse.
Noel, P., Cork, C., & White, R. G. (2018). Social capital and mental health in post-disaster/conflict contexts: a systematic review. Disaster medicine and public health preparedness, 1-12.
Noel, P. (2018) [Review of the book The Patient Multiple: An Ethnography of Healthcare and Decision-making in Bhutan. Jonathan Taee, New York: Berghahn Press, 2017, 220 pp.] Medical Anthropology Quarterly DOI: 10.1111/maq.12425
Babalola, E., Noel, P., & White, R. (2017). The biopsychosocial approach and global mental health: Synergies and opportunities. Indian Journal of Social Psychiatry, 33(4), 291.