Caring Practices in Thailand


A review of Senses and Sensibilities: The Practice of Care in Everyday Life in Northern Thailand, by Felicity Aulino.

The language of care pervades Thai society. We can “look after” [du lae] others, treat others with often almost painful “consideration” [kreng chai], “take others’ hearts and put them in ours” [ao chai khao, sai nai chai rao], or, borrowing from the English, simply “take care” [tek khae]. Care, the practice of perceiving and attending to others’ needs, becomes central to social life. One is always caring for others and being cared for by others.

Felicity Aulino’s dissertation, “Senses and Sensibilities: The Practice of Care in Everyday Life in Northern Thailand,” is ostensibly about end-of-life care in Chiang Mai. To label it thus, however, would be to do a disservice to the omnivorous way that Aulino draws upon various ethnographic moments and speaks to classic anthropological debates above and beyond the niches labeled “medical anthropology,” “voluntarism,” or “Thai studies” in which we might seek to put it. Instead, Aulino unpacks this idea of “care,” exploring the idea of caring for others as it plays out in settings as diverse as families, conference meetings, and within Theravada Buddhist notions of karma and merit. Ultimately, this dissertation contributes to a phenomenological approach to intersubjectivity – exactly what is suggested in that Thai phrase “put the heart of the other in our own” – how we theorize (or do not) others’ state of mind and seek to “care for” it.

Aulino’s work is rooted in the story of a family of women tending to their ill mother – work that is never referred to as “end-of-life” care by those providing it, despite the fact that their mother is bedridden, insensible, and unlikely to recover. Indeed, as Aulino points out, to say that someone is at this “end-of-life” stage is to presume that one knows that the end is near, a presumption that, as Aulino’s informants continually indicate, is not quite possible. One might recover (Thai speakers need only think of the frequent use of yang [still, not-yet]; a fifty-year-old childless woman might say “I don’t yet have children,” even when the likelihood is slim). Yet “Senses and Sensibilities” deals with issues far beyond such literal and physical notions of care, as Aulino explores “care” in contexts as varied as the eruption of political discussions to the management and negotiation of conflict in meeting-rooms. Through this data, she contributes to a number of classic anthropological discussions.

For Aulino’s informants, the physical act of “caring for” another, the bodily motions of dressing, changing, cleaning, feeding, etc., becomes a ritual.  Ying’s [Aulino’s key interlocutor] actions are work that is distant from the kind of shared physical and emotional experience that the international literature on care implies, but which is meaningful on another level, important for what they are, not necessarily for the internal changes that they would provoke in her or her mother’s psyche. As Ying and Aulino’s other interlocutors remind us, thoughts and emotions – inner states – are fleeting and transitory, unlike the physical action of care. Through this, she also contributes to anthropological debates on ritual, showing how the line between ritual and work becomes blurred in the Thai sense, and the lack of importance placed upon the internal state of the ritual performer (thoughts and emotions being, as they are, fleeting things).

With this in mind, NGOs, international and domestic, aiming to put into place a system of elder-care volunteers do so with a series of [mis]understandings. For one, voluntarism assumes an autonomous subject, disconnected from ties of obligation to the recipient of care (for instance: a child caring for an ill parent is not “voluntarism,” but a young stranger caring for an unrelated elder would be). But Aulino points out how such a framing of volunteer/recipient ignores the dynamics of class and power that underlie voluntarism (indeed, donation of any sort) in Thailand and the ways in which the volunteer-recipient interaction reinforces these: as one of Aulino’s interlocutors expresses it, voluntarism relies upon the feeling of “pity” for others, a relationship of dependency, something that implies a power differential between caregiver and recipient of care.

Other notions of “care” likewise present important differences between the assumptions of international organizations and that of Aulino’s interlocutors. “Caring for” others also implies caring about their mental states, helping them to avoid distress, something especially important as a person approaches death. This presents some surprising differences from notions of doctor-patient communication. Direct discussion of something unpleasant, like a poor prognosis, is avoided in order not to feed an unhealthy focus on death. For instance, Aulino presents a case of a patient being the only person in the room to not be explicitly told of her terminal cancer diagnosis. Additionally, Aulino herself shows fantastic ethnographic sensitivity to the question of whether or not (and how) her own probing questions about familial tension are violations of this attempt to intuit the mind of others and, in the process, avoid interactions that would cause pain (e.g. prompting someone to go into detail about a familial argument).

“Care,” then, is not solely the sort of physical care that Ying, Aulino’s key informant, shows her mother, but also care for the “social body,” that is, the attention to a group dynamic and to the role of members to preserve and maintain proper and harmonious social relations within it. Not allowing an argument to get out of hand is also “caring” for the social body, as is knowing one’s role in a particular time and place.

Aulino has a keen eye for the contradictions and ironies of such social “care.” Care, in this sense, involves perpetuating a particular hierarchy, allowing some to act as the “face” of the group, while others act as less auspicious body parts. Indeed, this is a metaphor that I also ran into during my own fieldwork in Chiang Mai: society as a body, one that runs functionally but that requires the subordination of some and the elevation of others. As Aulino puts it, such a system, “that elicits ‘care’ in the form of harmonious social relationships predicated on unequal social roles,” (p. 315) is founded upon structural violence. To learn how to operate in such a system is requires – just as learning to care for a terminally-ill old woman does – embodied, deeply-felt and habitual practices, a logic of sacrifice different from that of autonomous volunteer “caregivers” imagined by international care organizations.

“Senses and Sensibilities” is grounded in and contributes to a number of different bodies of theoretical knowledge, both in English and in Thai. Especially interesting here is how she points out moments of disjuncture in the literature, for instance, where Thai-language academic discussion of interpersonal connections and social “care” draws upon but fundamentally reinterprets earlier English-language discussions of “loose structure” (John F. Embree and and Hans-Dieter Evers, eds. Loosely Structured Social Systems: Thailand in Comparative Perspective. New Haven: Yale University Southeast Asia Studies, 1969; สนิท สมัครการ (Sanit Samarkangaan) เรื่อง “หน้า” ของคนไทย วิเคราะปห์ตามแนวคิดทางมานุษยวิทยาภาษาสาสตร์ (Concerning the “Face” of Thai People: Analysis According to the Linguistic Anthropology Approach). Thai Journal of Development Administration 15, no. 4 (1975): 492-505). Aulino applies this same level of care to her treatment of Scheper-Hughes and Lock’s notion of the “social body,” dealing with the body in a way that keeps space for subjectivity, something too often glossed over in many other ethnographies (“The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology.” Medical Anthropology Quarterly 1/1, 1987, pp. 6-41.). Ultimately, “Senses and Sensibilities,” as any good work of anthropology does, remains conflicted: pointing out the structural violence inherent in “care” but also questioning the assumptions of individualism that underlie such notions. Care, as Aulino evocatively put it, “binds people even as it sets them free” (p. 306).

Andrew Alan Johnson
Assistant Professor, Social Sciences
Yale-NUS College

Primary Sources

Thai government documents
NGO documents (Thai and international)

Dissertation Information

Harvard University. 2012. 325 pp. Primary Advisor: Byron Good.

Image: Photograph by author.

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