UCLA

Based on 15 months of fieldwork in the only public psychiatric hospital in the state, this dissertation uses extended participant-observation, interviews, questionnaires, and the analysis of audio-recorded clinical visits to examine the beliefs and practices surrounding psychiatric healthcare in Puebla, Mexico. Each chapter provides insight into how patients and practitioners negotiate medical care in a resource poor setting, using direct recordings of clinical discourse and interaction as supporting evidence. Chapter 1 characterizes the geographic and historical landscape of psychiatric healthcare in Mexico, and it juxtaposes the significant investment in infrastructure and tourism found in the globalizing context of Puebla with the uneven distribution of psychiatric care across the state. Chapter 2 discusses political and economic processes and characterizes the texture of multiparty interaction during psychiatric care in Mexico. It argues that although psychiatric training and psychotropic medications have ben largely developed outside of Mexico, psychiatric providers use local expectations regarding the co-presence and involvement of kinfolk to recruit kin as informal translators and medication administrators as well as providers of social support. Chapter 3 reviews audio-taped psychiatric consultations to demonstrate how professional understandings of the nature and course of mental illness are presented to psychiatric patients, and it challenges the notion that psychiatrists rely on medication management above psychotherapy or other treatment recommendations in areas faced with structural, organizational, and resource limitations. It also identifies a strong divergence between an American belief that psychiatric medication is taken “for life” and the grounded treatment timelines that recommend a medication be taken for nine to eighteen months before evaluating the tapering or cessation of the drug. Chapter 4 emphasizes the value of non-clinical language for the experientially-based amelioration of distress and presents the phrase “estar m�s tranquilo” as a way for patients to manage both their internal emotional volatility and the volatility of their immediate surroundings. Chapter 5 of the dissertation presents case studies of two patients, one of whom ended treatment early and another who successfully followed their treatment plan, in order to underscore different subjective experiences of clinical care and its results. The dissertation concludes by arguing that adaptation and "tranquilidad" may provide the potential for a shift in how we understand chronic mental illness, and calling for more research on the spectrum of experience with various mental illnesses.