Abstract
This thesis examines the growing number of claims filed with employee insurance companies for work-related mental health problems in Chile. It considers these claims at a specific moment in time—before and during the intense civil mobilisations in October 2019 known as the “estallido social” (social uprising). The dissertation analyses the emergence of these psychiatric health claims from a historical and political perspective, taking into account recent socio-political changes brought about by the estallido social. In particular, this thesis explores how low- to middle-income workers, especially women workers, confront and challenge various facets within their work environment. These include medical knowledge and practices, state bureaucracy, dominant epistemes, moral views about workers and workplaces, as well as entrenched class and gender-based work dynamics. In addition, this paper also studies how ‘psy’ specialists, state bureaucrats and representatives of workers' insurance companies (so-called mutualidades) create policies, procedures and tacit agreements in dealing with these claims. Using Chile as a case study, the dissertation explores the confluence of labour struggles, especially historical and everyday abusive and hierarchical relations in the workplace, with ‘psy’ and occupational health medicine in the context of an insecure (neoliberal) system and past and ongoing social injustices.This research is based on one year of fieldwork in Santiago, Chile, from April 2018 to May 2019, and a second two-week field trip in December 2019, two months after the start of the estallido social. Research methods included ethnographic fieldwork in two different hospitals run by employee insurance companies, interviews with experts and public officials, archival research, ethnographic research with workers/claimants, participant observation of the activities of ‘psy’ experts (workplace inspections), academic public events and civil gatherings on mental health. The thesis explores whether the increase in psychiatric claims could be a reaction to new forms of entitlement and citizenship in Chile and asks: (i) what are these mental health claims enacting in relation to historical and current labour issues in Chile and (ii) are the ‘psy’ specialists and the mutualidades just health care providers or are they key political actors in Chilean labour politics? To address these questions, the work draws on anthropological and science and technology studies on medicine, mental health and psychiatric expertise, as well as scholarly work on agency, citizenship and labour politics. The overarching argument is that by making and responding to psychiatric claims, the workers, insurers, experts, employers and government officials have co-produced what is referred to in this thesis as the ‘injured psyche’.
The injured psyche is threefold. First, it refers to a violation of rights that results in injury. An injury inflicted on the psyche may also affect the physical, but primarily relates to the affective and extra-material experience in the workplace. The thesis shows how the notion of an injured psyche has a collective meaning in the context of workplace injustice, as it is understood as reflecting and affecting social relations in the workplace and in Chilean society more broadly. Secondly, the concept of the injured psyche, suggesting a violation of rights, implies a sense of citizenship. This dissertation examines how, amid the ambiguity of workers' citizenship status in Chile, psychiatric demands not only facilitate access to
healthcare rights but also address entrenched power imbalances within the workplace. Additionally, the thesis delves into how workers, while navigating the state’s medico-legal bureaucracy, assert their agency by rejecting adherence to neoliberal expectations and historical class and gender-based work dynamics. It will be shown how a socially oriented health tradition forms the basis for these claims to become political, emphasizing individual and community vulnerability and harm, and the demand for improved mental well-being. Finally, the thesis examines the mechanisms by which ‘psy’ specialists and occupational health practitioners define socially legitimate and illegitimate claims of workplace struggles. Specifically, this research analyses the epistemological, legal and moral frameworks, as well as the difficulties and ethical problems that underlie the definition of work-related psychiatric illness and social risk.
In conclusion, this dissertation significantly contributes to the current landscape of anthropological research on medicine and ‘psy’ knowledge and practice. It does so by scrutinizing issues of morality and responsibility concerning illness, thereby introducing novel perspectives into discussions surrounding (bio)citizenship, agency, and bureaucracy within contexts marked by social insecurity and historical injustices. Furthermore, the thesis contributes to the field of anthropology of health and social medicine aiming to transcend dualisms and one-sided concepts by analyzing a particular concept of mental life that is synergistically linked to the social fabric. Ultimately, this dissertation offers a valuable lens for anthropologists, social scientists, and policymakers to contemplate the intricate relationships between mental health, gender and work dynamics, agency, and ongoing political struggles on both national and international scales.
| Date of Award | 1 Jun 2023 |
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| Original language | English |
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| Supervisor | Dominique Behague (Supervisor) & S Lochlann Jain (Supervisor) |