Critical global mental health and the hidden lives of Rajasthani women

Thesis

This thesis is a critical ethnography of Khushee Mamta (“Happy Motherhood”), a task-shared perinatal mental health intervention developed in rural Sri Ganganagar district, Rajasthan, and adapted from the WHO’s Thinking Healthy Programme. Based on eighteen months of fieldwork embedded within the intervention, it examines community mental health from the vantage point of care: through the women who received counseling, the non-specialist counselors who delivered it, and the rural social world in which both were situated. Rather than asking only whether the intervention reduced depressive symptoms, the thesis asks what task-sharing looked like in practice, what forms of suffering it brought into view, and what its limits reveal about the ethics and evidence of global mental health.

The ethnography shows that perinatal distress in this setting cannot be understood apart from caste hierarchy, agrarian precarity, gendered kinship, and the forms of dependence and abandonment that shape women’s lives. Across counseling encounters and life histories, I develop the concept of paraya—roughly, estrangement or belonging elsewhere—as an analytic of female subjectivity. Paraya names a lived condition of precarious belonging that runs through marriage, pregnancy, motherhood, widowhood, and other moments of rupture. It helps explain forms of suffering that exceed psychiatric categories and are often flattened by public health metrics. By following women’s stories closely, the thesis offers a relational account of patriarchy: one in which violence, obligation, affection, disappointment, and care are tightly entangled, and in which men’s own precarity can deepen women’s vulnerability without diminishing male power.

The thesis also argues that task-shared counseling can open meaningful forms of care. Khushee Mamta counselors became interpreters, mediators, and caregivers whose emotional labor, improvisation, and ethical judgment were central to the intervention’s effects. Their work reveals both the promise and the strain of task-sharing in conditions of structural inequality. The thesis therefore makes three linked contributions: it offers an ethnographic account of what care within global mental health actually looks like on the ground; it develops paraya as a feminist and anthropological analytic of women’s distress in rural North India; and it uses the intervention to rethink the ethics, evidence, and political aspirations of global mental health. I argue that if global mental health is to take suffering seriously, it must attend more closely to the social worlds in which care is given, the relationships through which it becomes possible, and the inequalities it cannot by itself resolve.

Authors: Brar, AS

• Alternative title: The hidden lives of Rajasthani women
• DOI: 10.5287/ora-qm1yrbre7
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: rural India; psychosocial interventions; India; alienation; medical anthropology; structural inequality; gender; paraya; Thinking Healthy Programme; ethnography; community mental health; kinship; Khushee Mamta programme; Rajasthan; women’s mental health; ordinary ethics; Mata Jai Kaur; counselling; care; caregiving; masculinity; perinatal mental health; global mental health; feminist anthropology; caste; task-sharing; subjectivity
• Subjects: Global health; World health; Medical anthropology; Global mental health; South Asia; Mental health; Gender; Critical ethnography; India; Anthropology; Women