The Elephant Vanishes: impact of human-elephant conflict on people's well-being

Health & Place 18 (2012) 1356–1365

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The Elephant Vanishes: Impact of human–elephant conflicton people’s wellbeing

Sushrut Jadhav a,n, Maan Barua b

a UCL Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, Charles Bell House, 67-73 Riding House Street, London W1W 7EJ, UKb School of Geography and the Environment, University of Oxford, Dysons Perrins Building, South Parks Road, Oxford OX1 3QY, UK

a r t i c l e i n f o

Article history:

Received 12 April 2012

Received in revised form

21 June 2012

Accepted 29 June 2012Available online 8 July 2012

Keywords:

Clinical ethnography

Conservation

Human–elephant conflict

Mental health

Psychology

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x.doi.org/10.1016/j.healthplace.2012.06.019

esponding author. Tel.: þ44 2076792000.

ail address: [email protected] (S. Jadhav).

a b s t r a c t

Human-wildlife conflicts impact upon the wellbeing of marginalised people, worldwide. Although

tangible losses from such conflicts are well documented, hidden health consequences remain under-

researched. Based on preliminary clinical ethnographic inquiries and sustained fieldwork in Assam,

India, this paper documents mental health antecedents and consequences including severe untreated

psychiatric morbidity and substance abuse. The case studies presented make visible the hidden mental

health dimensions of human–elephant conflict. The paper illustrates how health impacts of conflicts

penetrate far deeper than immediate physical threat from elephants, worsens pre-existing mental

illness of marginalised people, and leads to newer psychiatric and social pathologies. These conflicts are

enacted and perpetuated in institutional spaces of inequality. The authors argue that both wildlife

conservation and community mental health disciplines would be enhanced by coordinated interven-

tion. The paper concludes by generating questions that are fundamental for a new interdisciplinary

paradigm that bridges ecology and the clinic.

Crown Copyright & 2012 Published by Elsevier Ltd. All rights reserved.

1. Introduction

Human–wildlife conflict is a phenomenon where wildlifenegatively impacts on human wellbeing or when the actions ofpeople are detrimental to the survival of wildlife (Madden, 2004).These conflicts are spatio-temporal events that disrupt the psy-chological and physical wellbeing of communities who co-habitspace with wildlife (Hill, 2000; Ogra, 2008). This is a frontlineenvironmental issue, affecting millions of people across the world(Inskip and Zimmermann, 2009; Rangarajan et al., 2010). Yet,academic engagement with how human–wildlife conflicts affectpsycho-social wellbeing, particularly of rural communities, issparse (Chowdhury et al., 2008). This paper examines the mentalhealth consequences of conflict between people and elephants. Itfocuses on the impact these conflicts have on the wellbeing ofrural communities in northeast India. Through ethnographicfieldwork, this paper identifies unreported, yet crucial hiddenfactors mediating human–wildlife conflict.

Whilst the disciplines of geography, conservation scienceand public health interface with human–wildlife conflict andits impact on wellbeing, several disciplinary constraints impairfurther investigation. First, the ‘cultural’ turn within geo-graphy until recently, has circumscribed the vitality and agency

012 Published by Elsevier Ltd. All

potentials of animals, consequently silencing their capacities andeffects in influencing ‘social’ outcomes (Hinchliffe et al., 2005;Latour, 2004a). An exception is the emergent scholarship inspiredby actor-network theory and ‘more-than-human’ geography(Lorimer, 2007, 2010; Whatmore and Thorne, 2000). Second,conservation science, which is the staple of academic approachesto human–wildlife conflict, remains focused on its immediate andvisible impacts such as loss of crops and livestock, propertydamage and physical injury (Inskip and Zimmermann, 2009;Nyhus et al., 2000). The psycho-social impacts of conflict remainperipheral to such enquiry. Third, the cultural premise andservice delivery of mental health, particularly in low-incomecountries, is largely confined to biomedical formulations ofsuffering (Jadhav, 2009). The cultural validity of existing inter-national psychiatric nosology such as the DSM and ICD remainunexamined for their relevance to local illness experience.Further, there is no dialogue bridging these three disciplines.Integrated approaches to human–wildlife conflict linking ecology,culture, and the clinic, though vital for examining health impactsof human–elephant conflict, are scant (Chowdhury and Jadhav,2012).

This paper draws upon the disciplines of human geography,conservation science and clinically applied anthropology toexamine the mental health and psycho-social consequences ofconflict between rural communities and elephants in India.The paper is in three parts. First, it provides a brief overviewof human–elephant conflict and documented psycho-social

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consequences to identify important research questions. Next, itdraws upon preliminary clinical and ethnographic enquiry intohuman–elephant conflict in Assam, northeast India to illustratehow impacts of conflict penetrate far deeper than immediatethreats from elephants. Data is presented through four casestudies that illustrate how conflict aggravates pre-existing socialand institutional inequality to generate significant and treatablepsychiatric morbidity. The paper identifies the role of mentalillness and substance abuse in mediating the relationshipbetween humans and elephants. It makes visible a missing-linkthat is significant toward both understanding and intervening toaddress the conflict. In conclusion, the paper argues for newerconnections between ecology, culture, and the clinic in order toarrive at a more comprehensive reformulation of existing chal-lenges to the problem of human–wildlife conflict.

2. Human–elephant conflict in India: an overview

In India, more than one person is killed every day by elephants.In turn, ca. 100 elephants are fatally injured every year throughretributive action by people. Currently ca. 500,000 families acrossthe country are affected by human–elephant conflict (Rangarajanet al., 2010). Whilst the Asian elephant (Elephas maximus) is anendangered species, with a global population of fewer than40,000 (Choudhury et al., 2008), 20% of the world’s humanpopulation lives alongside the elephant’s current geographicrange. This results in considerable conflict between people andelephants, and with institutions wanting to conserve elephants.Drivers of human–elephant conflict are manifold. Proximatecauses include loss of habitat and disruption of migratory routesdue to deforestation, expansion of agriculture and humanencroachment into protected areas (Sukumar, 2006). These dri-vers are underpinned by distal causes including large-scaledevelopment projects and poor environmental governance inelephant-bearing states (Barua, 2010).

Agricultural fields are the spaces in which most conflictsunfold. Crops such as cereals, millets and rice paddy consumedby elephants are analogues of what they eat in their naturalhabitat. Their superior nutritional attributes make them attractivefor elephants, and in some contexts constitute a significant part ofelephants’ diet (Sukumar, 1990). Such crop-raiding may increasewhen other food sources are depleted (Fernando et al., 2005).In India, documented loss of crops to elephants amount from0.8 to 1 million ha annually (Bist, 2006), constituting a substantialpart of agricultural output in certain states. On average, farm-ing families may lose about 15% of their annual produce(Madhusudan, 2003). Thus, conflict is an issue about sustenance,for both people and elephants.

Crop-raiding by elephants generally takes place at night, aschances of detection and human retaliation are lower (Sukumar,1991). Since losses are disproportionately high for individuals orcommunities to bear, farmers resort to nocturnal guarding of theirfields. This increases vulnerability to elephant attacks, as well asexposure to vectors of diseases such as Malaria (Dutta et al.,2010). Sleep loss and fatigue is considerable, with potentialeffects on morbidity. Crop-guarding also results in several oppor-tunity costs, including reduction in wage-earning activities andpoor school attendance (Hoare, 2000). Explorations of suchtemporally-delayed and social consequences of human–elephantconflict, though vital for understanding the deeper impacts ofconflict, remain unaddressed in the literature (Ogra, 2008).

Besides raiding standing crops, elephants also attempt to feedon harvested plants stored in granaries or in people’s homes byknocking down walls of mud or thatched houses (Sukumar, 2003).It is estimated that they damage 10,000–15,000 houses in India

annually (Bist, 2006). Another important factor that leads tohouse damage is alcohol. Elephants are fond of alcoholic liquor(Morris et al., 2006; Sukumar, 1993), and raid village distillerieswhere alcohol is brewed and stored (Sukumar, 2003). Popularreports of elephants raiding village breweries are widespread(Barua, 2010). Whilst such descriptions tend to anthropomorphiseelephant behaviour (Barua, 2010), they highlight the potentialrole alcohol plays in mediating such conflicts. The ways in whichalcohol binds people and elephants, and aggravates human–elephant conflict requires further investigation.

Mitigating human–elephant conflict is at the forefront of ele-phant conservation today. In India, the Ministry of Environment andForests (MoEF) is the primary body responsible for elephantconservation and conflict mitigation. In a recent report, the MoEFidentified installing barriers to elephant movement (e.g. trenches,fences), crop compensation and ex-gratia scheme as some measuresfor conflict mitigation (Rangarajan et al., 2010). However, compen-sation schemes in India have met with limited success. The poorhave to overcome several bureaucratic inadequacies to simplyproduce a claim (Saberwal et al., 1994). Pursuing compensationmay expose them to new spaces of institutional inequality (Ograand Badola, 2008). Therefore, how human–elephant conflict gener-ates newer forms of inequality demands analysis.

The MoEF report also emphasises implementation of bettergovernance models that involve local community participationand transparency. It recommends increasing five-year budgets forconflict mitigation from the current US$ 8.8 million to US$ 21million (Rangarajan et al., 2010). There are several barriers toimplementing these goals in practice, including prompting colla-borations across different government departments (Madhusudanand Sankaran, 2010), and ensuring adequate funds for compensa-tion travel from the centre to the ground (Williams, 2010a).However, the policy recommendations of the MoEF report arebased on the visible impacts of conflict. Hidden dimensions suchas opportunity costs, health and psycho-social impacts are unac-counted. Although there is an extant national and local ruralmental health policy (NMHP, 2012), ecological stressors are notfactored in. A policy framework addressing hidden impacts ofhuman–elephant conflict, and integrating them into currenthealth imperatives, is non-existent.

In summary, preliminary published literature suggests thathuman–elephant conflicts are followed by temporally-delayedimpacts that affect negatively upon the wellbeing of rural com-munities. However, a closer inspection of the cultural dynamics ofhow these impacts unfold, and potential frameworks for mitigat-ing them, is cursory in the literature. The following section drawsupon clinical and ethnographic enquiry into human–elephantconflicts in Assam, northeast India. It examines how conflicts(1) aggravate pre-existing social and institutional inequality and(2) generate significant psychiatric morbidity. The section paysclose attention to the role of alcohol, and postulates how it mightmediate human–elephant conflict.

3. Human–elephant conflict and its impact on people’swellbeing: case studies from Assam, northeast India

3.1. Study area

The state of Assam in northeast India (Fig. 1) exemplifies howhuman–elephant conflicts unfold amongst marginalised agricul-tural communities. Assam has nearly 20% (ca. 5200) of India’swild Asian elephants, with five major Elephant Reserves covering13% (10,967 km2) of the state’s area (Talukdar, 2010). It has adense human population (31.16 million), majority of whom areinvolved in agriculture which accounts for 69% of its workforce

Fig. 1. Map of Assam State, with case study locations in Sonitpur and Golaghat districts.

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(Census of India, 2001). Yet Assam remains a poorly developedstate. Its per capita income is 40% lower than the nationalaverage. Food grain production has been steadily declining overthe past five years. It is also a flood-prone state. These factorsplace local rural communities at high risk from both naturaldisasters and human–wildlife conflict.

Human–elephant conflict is high in the state. In the past 10years, 372 people have been killed by elephants in Assam(Talukdar, 2010). Crop-raiding is a major concern, with govern-ment documented damage of crops by elephants averaging US$110,000 each year. In one extreme scenario of conflict, 4000villagers belonging to 900 families fled their villages and tookshelter in relief camps set up by the government (Choudhury,2004). As many as 19 of the 27 districts in Assam are affected byconflict. This is particularly severe in the Sonitpur and Golaghatdistricts where the current research was conducted. Both districtshave important Elephant Reserves (Fig. 1), but high rates ofdeforestation have escalated human–elephant conflicts, resultingin over a hundred human deaths in the past decade (Gureja et al.,2002; Sarma et al., 2008). Several ethnic communities are presentin the area, the dominant social group comprising an Assamese-speaking Hindu community (Das, 1987; Census of India, 2001).

4. Methods

The four case studies and a group discussion detailed in the nextsection are based on clinical and ethnographic fieldwork conductedin Golaghat and Sonitpur districts, Assam. The first author (SJ) is apsychiatrist and medical anthropologist, trained in India and theUK, whilst the second author (MB) is a human geographer. Bothauthors are bilingual (SJ: Hindi & English; MB: Assamese & English).

Case Study 1 was identified in September 2010 during thecourse of fieldwork by MB. This research focused on the politicalecology of human–elephant relationships. The subject had devel-oped severe mental health problems and consulted local mentalhealth services following an elephant attack. Subsequently, hisclinical case notes were tracked down by SJ at the local mentalhealth clinic, and summarised as psychiatric formulation. MBelicited the ethnographic narrative.

Case Studies 2–4 were traced by SJ from a list of elephant fatalitiesover the past two years (2009–11), provided by local wildlifeconservationists. SJ met with each of the subjects at their homesbetween August–December, 2010 and included a follow up after four

months with case study 2. Following an assessment of their capacityto provide consent, all subjects were informally consented. An initialpsychiatric assessment and clinical diagnosis was formulated. Thiswas followed by an in-depth ethnographic interview to elicit acultural narrative of their suffering (Hammersley and Atkinson,1995). Interviews lasted from 1 to 8 h over the course of severalmeetings. Where appropriate, and based on clinical judgement, adecision to refer for further treatment was facilitated.

Data for all case studies is structured along two headings:(1) psychiatric formulation, (2) ethnographic narrative. Case studies3 and 4 are contextualised and presented under one heading as theinterviews were jointly conducted. All quotes are direct translationsof the interviews and case notes. As space limits unpacking ofindividual case studies, themes emerging have been pooled in asubsequent section addressing ecology and the clinic.

5. Findings

5.1. Case study 1

5.1.1. Psychiatric formulation

Ramu is a 26 year old married daily labourer who attended thelocal mental health out-patient clinic with his mother. Thefollowing information was detailed in his clinic case notes:

He had developed an acute onset, progressive illness that wasprecipitated when he ‘‘was present at a truck accident where he was

a helper, however not much hurt, one month ago.’’ The accident didnot lead to any major injury, seizures or loss of consciousness. Hispresenting symptoms, as reported by his mother, were mentionedas ‘‘disorganised behaviour’’, of three weeks duration. This com-prised ‘‘poor sleep, wandering away from home at midnight, dressing

and undressing repeatedly, micturating in front of others, suspicious

towards his wife and others, self muttering, spontaneous laughing

and crying, and gesticulating in the air.’’ There was no history ofpast medical or psychiatric illness. His family history was noted tobe ‘‘not significant.’’ Ramu’s pre-morbid personality was notdocumented. His drug and alcohol history concluded poly-sub-stance abuse including ganja, alcohol and tobacco for the past 3–5years. There was no history of substance dependence. On mentalstate examination, he was observed to be ‘‘conscious, dirty,hyperactive, irritable and suspicious.’’ His affect was blunted. Hisspeech ‘‘revealed occasional irrelevant talk.’’ Ironically, a sample toillustrate this was recorded in his case notes ‘‘I have come here to

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get a job.’’ He was oriented to time, place and person. Hisjudgement was impaired. Physical examination revealed no sig-nificant abnormality except for mild pallor.

A clinical diagnosis of Acute Schizophrenia-like Disorder (ICD-10,F 23.2), together with Multiple Drugs and other Substance Disorder(ICD-10, F 19.5), was made by the clinic psychiatrist. Ramu wasprescribed oral anti-psychotic medication, Olanzapine (20 mg daily);anti-Parkinsonian tablets; Procyclidine (2 mg daily); and multi-vitamins (1 tablet daily). The family was advised to attend follow-up after four weeks. The patient and his mother attended the follow-up. Clinic entry at this follow-up visit indicated an ‘‘improvement’’ inRamu’s mental state, with ‘‘no fresh complaints.’’ Significantly, thecase records stated that Ramu’s ‘‘irrelevant talk’’ continued, but withlesser intensity and frequency.

5.1.2. Ethnographic narrative

Ramu is a 26 year old married truck driver from the Adivasi

caste community. He lives in a kuccha (mud) hut, together with hiswife, mother, and uncle and aunt. The family is landless, living at theedge of a corporate-owned tea estate. Without any cultivable land oftheir own, the family earns a living by working as temporarylabourers in the adjacent estate. About a year ago, three crop-raidingelephants broke into their home at night, having already demolishedtwelve other huts in the area. The entire family managed to fleewithout being hurt. Unfortunately, a burning kerosene lamp fell overat the time of the elephant attack, and their hut caught fire. In a fewmoments, the family home, together with all their possessionsincluding clothes, utensils, savings and Ramu’s paper truck driving

license were burned down.The family became homeless. They borrowed money from the

community and from a private moneylender at a steep interest rateto rebuild their hut. As temporary labourers, they were ineligible forcompensation from the tea estate owners. The women in the familycould not afford to buy new clothes, and felt humiliated. Ramu’swife was pregnant at the time. As they were illiterate, of low casteorigins, poor and unemployed, their social capital was extremelylimited. They were unable to procure a government-sanctioned‘Below Poverty Line Card’ that would have helped secure loans.They were unsuccessful in their repeated attempts to obtaingovernment compensation for the house damage. Ramu’s father,who at the time worked as a day labourer in a neighbouring state,returned home with some cash reserves. The family persuadedRamu’s father to stay back, as a result of which he was unable tocontinue his former job. This further stifled the family income.

Based on a narrative retelling by Ramu’s family members to MB,the incident deeply affected Ramu. In their words, he ‘‘became mad’’after the event. Ramu stopped eating, went into fits of rage,attempted to destroy the family’s rebuilt hut, as well as their bicycleand tube well. He was unable to work as a truck driver as his paperlicense was burnt during the elephant raid. Over time, Ramu becameincreasingly mute. On a few occasions, he attempted to throw hisnewborn child away. The family initially consulted a local healer(Oja) and borrowed money to pay for these consultations, with nobenefit. Three months after the house burned down, and followingan accidental fall whilst loading a truck, Ramu’s mother took him tothe local mental health services where he was assessed in the out-patient clinic. He was diagnosed with a mental condition, andprescribed medication. The family reported that Ramu showed adistinct improvement following the medication prescribed. Theyattended a follow-up visit to the clinic.

5.2. Case study 2

5.2.1. Psychiatric formulation

Praful Das was an Assamese rice farmer in his mid-thirties. Hewas fatally injured following an attack by a bull elephant whilst

guarding crops in his paddy field. Praful Das’s death led to seriouspsychiatric morbidity and a kinship rupture within his immediateand extended family members. His widow Lakshmi Das developedmoderate depression, whilst Smita Das, his 11 year old daughter,childhood depression. Praful’s 23 year old son, Apurba Das, from aprevious marriage, developed enduring personality changes andsecondary poly-substance abuse after this catastrophic experience.

Clinical assessment of his surviving family, took place 18months after Praful’s death. His widow Lakshmi Das revealedfeatures of disturbed sleep, pathological sadness, and frequentflashbacks of the quarrel and the sight of her wounded husband.Since his death, she had lost considerable weight and blamed herbrother-in-law and step-son for this calamity. She expressedsuicidal thoughts, but had not acted upon them as she claimedthis would lead to her daughter becoming an orphan. She had noprevious history of mental disorder. A clinical diagnosis ofModerate Depressive Episode (ICD-10, F 32.1) was made.

Ethical and clinical considerations of the situation required theauthors to intervene. Lakshmi was accompanied to a localprimary healthcare centre (PHC) for further treatment. Unfortu-nately, the PHC did not stock anti-depressants, nor did they haveexpertise for providing counselling. Subsequently, SJ referred herto the tertiary mental health services approximately 80 km away.She was also provided with a three-month course of oral anti-depressants (Flouxetine 20 mg daily), and three sessions ofcounselling by SJ. Lakshmi Das took the medication, felt betterand then stopped after her medication ran out. She did not attendthe tertiary centre as she felt ambivalent about visiting a mentalhealth clinic. A follow-up meeting by SJ, four months later,reassessed her clinical state and established a partial recoveryfrom her depressive disorder. Her symptoms of sadness, sleep andappetite had improved. However, Lakshmi continued to experi-ence severe anxiety centred on her deteriorating mental healthand diminishing prospects of her daughter’s marriage.

Clinical assessments of the deceased’s daughter Smita Das, 18months after her father’s death showed features of school refusal,poor appetite, withdrawn and clingy behaviour with minimal talkthat bordered on muteness. Smita lacked interest in activities thatshe earlier enjoyed. This included refusal of her favourite dishes. Herschool teacher knew the reasons for her school refusal, butexpressed helplessness in redressing this. Lakshmi Das related herown explanation: ‘‘Smita’s father would pick her up from school every

day, and on the way back stop over at several shops to buy her candies.’’In addition to this immediate explanation, her mother reported thatSmita was extremely attached to her father. The experience ofseeing her father severely injured, and having hugged him to saygoodbye on the fatal night, had a traumatic effect on Smita. Since hisdemise, Smita would repeatedly ask her mother about his return.Smita became increasingly house-bound, possibly feeling unsafe toventure out. She started clinging to her mother. There were nopsychotic symptoms. A clinical diagnosis of Childhood EmotionDisorder (ICD-10, F 93.9) was made. Her mother did not take herto the tertiary hospital psychology services.

Clinical assessment of Praful Das’s son, Apurba Das waslimited. He came once to meet with the authors. During thismeeting, Apurba expressed some guilt at being away at work inanother town when his father was killed. Information collatedfrom local informants, including his uncle Mukul Das, suggestedthat Apurba’s behaviour had worsened since his father’s death. Hedemanded a share of his father’s property. He had sold off whatthe uncle considered prime cultivable land, cattle and bicycle. Hebecame foul-mouthed and aggressive toward his community whotried to intervene. Apurba got labelled as ‘‘mad’’ by the villagers,and ‘‘bad’’ by his uncle and uncle’s family. The latter mentionedthat Apurba’s behaviour was a result of being ‘‘poor and had

nothing to eat.’’ Relationships with his stepmother Lakshmi Das

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deteriorated. He separated from her and his step sister, Smita Dasto live on his own. He started consuming alcohol and ganja inincreasing quantities. A definite clinical diagnosis could not bemade by SJ in view of the limited assessment. A tentativedifferential diagnosis of Enduring Personality Change after Cata-strophic Experience (ICD-10, F 62.0) with Secondary Poly-sub-stance Abuse (ICD-10, F 19.0) was considered.

5.2.2. Ethnographic narrative

Praful Das owned a small piece of paddy land, cattle and a bicycle.He lived in a kuccha hut adjacent to an elephant reserve, with histhird wife Lakshmi Das, 11 year old daughter Smita Das, and 2 sonsfrom his previous marriage, Apurba Das age 23, and Arabinda Dasaged 12. They lived in a village where crop-raiding by elephants wasfrequent. Praful Das’s older brother Mukul Das and his family lived afew hundred metres away in a pukka (cement) house. The latterwere relatively well-to-do, owned more land, with a better income.

One evening, following a quarrel with his wife in the paddyfield, Praful Das left home to join a friend at a local ‘illicit’distillery. Praful Das’s widow Lakshmi Das told the authors thatduring this quarrel, their meal in a rice bowl toppled over and thevermillion on her forehead got erased. Praful was known tofrequently abuse alcohol. That night, following a drinking boutwith his friend at a local distillery, they went to their tongi (crop-guarding shelter) in the paddy field to guard their crop. A bullelephant attacked the tongi around midnight. Praful was severelyinjured. His friend managed to escape, unharmed. In the middle ofthe night there was some delay in accessing transport for Praful tobe taken to hospital. Although seriously injured, Praful was ableto say goodbye to his 11 year old daughter.

Interviews with the deceased’s brother Mukul Das and hisfamily, established that Mukul had become increasingly worriedafter his brother’s death. These worries centred on lack of labourto till the agricultural land, demands by his nephew Apurba Dasfor a share of property, and his own grief at the demise of hisbrother. To secure the future of his younger nephew ArabindaDas, lest the older nephew Apurba squandered their propertyaway, Mukul Das’s family kept control of his deceased brother’sland. Mukul Das developed physical symptoms of anxiety. He wassubsequently diagnosed to suffer from a gastric ulcer and under-went surgery at the local district hospital.

The family’s explanation about Praful’s death and psychosocialconsequences, centred upon the role of fate. On specific questioning,the elephant was viewed as one of the several reasons that generatedthe subsequent stresses for the Das family. Mukul Das deployed fateas an explanation. In his view Yama, the god of death, assumed theform of an elephant and took his brother away for his immoralbehaviour. This related to his multiple marriages and alcoholism. ‘‘He

probably had bad thoughts in his mind when the incident happened. He

was always in a violent mood.’’ Local community explanations ofPraful’s death differed. ‘‘They say that he was very sleepy, and the

elephant killed him.’’ Mukul’s wife explained: ‘‘Some said that he used a

lot of vulgar language, he swore at everyone. That’s why he was killed by

the elephant. Some villagers were pleased, they just kept watching.’’Lakshmi Das felt that the quarrel in the paddy field the night beforeforecasted the consequences that followed, particularly becausePraful had wiped off the vermillion on her forehead—a sign ofwidowhood in Hindu culture. In an earlier interview with MB soonafter Praful’s death, Mukul Das’s family blamed the elephant, sayingthese creatures were ‘‘becoming demonic day by day.’’

5.3. Case study 3 and 4

5.3.1. Context

Bina and Rupa, interviewed together, were two young widowsin their mid-twenties who had lost their husbands to elephant

attacks. Bina’s husband Ramen, died 24 months ago, whilst Rupa’shusband Dhiren had been killed 20 months prior to the interview.They were from the Kaivarta caste, i.e. fishing community,displaced following erosion of their land by the BrahmaputraRiver. The village to which they had relocated was establishedafter clearing forest land adjacent to an elephant reserve. Bothfamilies cultivated paddy for subsistence. Bina lived in a single-roomed kuccha hut with her four children. Her immediateneighbour Rupa also lived in a kuccha hut. Mid-way through theinterview, two other elderly women, six young men and fourchildren of Bina and Rupa joined the discussion. As this interviewtook place in a naturalistic setting, it was difficult to frame themeeting as a focus-group discussion. The interview moved from aone-to-one dialogue to a wider discussion of social and economicproblems that included human–elephant conflict, difficulties inaccessing and paying for health care, experience of extremepoverty, and lack of support from forest department officials. Inorder to examine the particularities that shape the suffering ofBina and Rupa, their case formulations are presented separately.

5.3.1.1. Psychiatric formulation; Bina. Bina was a conscious and co-operative lady, dressed in a white sari—a mark of widowhood.She looked anxious and worried. Her speech was normal. She hadbeen experiencing symptoms of disturbed sleep, tiredness andrepeated flashbacks of elephants attacking her hut. Over the pasttwo years, there had been several factual incidents whenelephants had come into their village. Bina often heard voices ofimaginary people chasing elephants, during the day, but shruggedthem off as her own imagination. At night, she was fearful ofsounds, and at times raised false alarms, held her childrentogether, lying still on the floor fearing that an elephant may beabout to break into their home. Bina experienced nightmares inwhich she visualised elephants attacking her hut and herchildren. She also expressed worries about their health as Bina’syoungest child was retarded in physical growth and had severescabies. A clinical diagnosis of Post-traumatic Stress Disorder(PTSD) with depressive features (ICD-10, F 43.1) was made. Aphysical examination was not carried out.

5.3.1.2. Ethnographic narrative; Bina. Bina’s husband Ramen was aqualified engineer. He used to work in the public governmentservice in an urban part of Assam. Several years ago, according toBina, when he was at his job ‘‘his associates took money and played

black magic on him. They set his gamosa (towel) afloat the local

river. After that he became like mad when he went to office. If

someone forcefully took him to his office, he would leave his papers

and run away.’’ He lost his job. Ramen never consulted, nor wasseen by any mental health professional. He often went missing forseveral days at a time. Several years later Ramen ended upworking as a rickshaw driver, which he pedalled for a livinguntil the fateful night when he did not return home. Bina was notconcerned at first, as Ramen would often drink and not returnhome. However, that night she got worried. After raisingconcerns, the villagers launched a search party. Ramen wasfound dead in a trench, ironically dug to keep elephants out ofthe village. His body was terribly mauled. A post-mortem reportconcluded he had been trampled by an elephant.

Bina explained that Ramen’s death was a result of his fate. Shesuggested that the elephant could have killed anyone else thatnight. Despite direct questioning, Bina did not think elephantswere to blame. She expressed anger at the local politicians andgovernment forest officials for not doing more to help. With fourchildren to look after, Bina took up a job as a daily manual workerin the paddy fields. Her youngest child developed a healthproblem, for which she had to pay to get medicines. This situationaggravated her poverty: ‘‘I have four children to feed and clothe.

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I haven0t got land. From that land you cannot eat. Without goats or

cows, you can understand under what conditions this house runs.

And thus we so existy I have no mother, no father. There is no

brother, younger or elder. I have five sisters, I am the youngest.’’ Shespent a considerable amount of money toward her son’s care,subsequently mortgaging the small paddy land bought fromcompensation provided by the forest department (Rs. 35,000,US$ 686) towards her husband’s death. She could not work longhours as her children attended the local government primaryschool and returned home early afternoon. Her eldest son (aged15 years), had started odd manual jobs to prop up the familyincome. Bina was aware of local government health facilities.However, she would not attend as this entailed long queues,prescription costs, and threat of losing her temporary manual job.

Bina told the authors that on one such occasion, she paid Rs.200 (US$ 3.9) for two tablets prescribed for her child’s illness. Shedid not think this was useful, as she had little money to feedherself and her children. Further, she expressed a general frustra-tion with the costs of health care. ‘‘This boy, I showed him for

weakness. And his head used to spin, and he falls. And blood comes

out of the nose. After showing all that, I bought two hundred rupees

of medicine – they gave only two tablets y.’’ When specificallyasked about help-seeking for her own psychological problems,she continued to discuss socio-economic issues relating tohealthcare: ‘‘Government hospital is there y say we go, but the

doctors don0t see us for nothing. We will have to buy a five-rupee

ticket (US$ 0.09). Even without a ticket, that five rupees will be

required. Then a ten rupee (US$ 0.18) bus fare will be required. And

then the medicine and all that, for which the doctor will prescribe

medicines. He will tell us to buy the medicines from the pharmacy.

Will it be suitable for us to go? The doctor he examines and will

prescribe medicines to be procured from the pharmacy. We need to

go to the subdivision hospital. And once we go, we have to pay the

driver and handyman, even if we do not buy the ticket. And as soon

as we return home, the children will come forward and say ‘Ma has

come’. For them also I must bring something in hand. Even the pipe

for the saline has to be bought.’’

5.3.1.3. Psychiatric formulation; Rupa. On clinical assessment,Rupa came across as a sad young lady, dressed in white whichmarked her widowhood. She made good eye contact and wasmore vocal than Bina in expressing her distress. She reportedsleep difficulties, dizziness and flashbacks of events centring onher husband’s death. She had numerous sleep-walking episodes.On such occasions, she hurt her head running into walls at night.She expressed hopelessness over her future and humiliation ather condition: ‘‘Is there any worth in living? Live not for our own

purpose. Instead of being displayed and arranged like rabbits, it is

better to die. It seems that we are just occupying space.’’ On furtherprobing, Rupa said she would not kill herself as it was her duty tolook after her children. She regularly experienced panic attacks inthe form of palpitations, dizzy spells and a sense of foreboding.Rupa revealed a depressed mood that preceded her flashbacks. Aclinical diagnosis of Dysthymia (ICD-10, F 34.1) was made. Aphysical examination was not conducted, although she did notappear physically ill or malnourished.

5.3.1.4. Ethnographic narrative; Rupa. Rupa’s husband Dhiren waskilled in a tongi in the paddy fields whilst guarding his crops fromelephants at night. Following his death, Rupa spent a considerableamount of time seeking to get documentation to claimgovernment compensation. This included a post-mortem reportand residency certificates. The compensation was still beingprocessed at the time of this interview. She worked at a localstone quarry as a temporary labourer. She could only work

limited hours, as she had two young sons and needed to behome when they returned from school. Following Dhiren’s death,with no other source of financial support, Rupa was living insevere poverty. She said that at the time of her husband’s death,the forest officials gave her a small amount of money to conductDhiren’s last rites, and ten kilogrammes of rice to feed the family.

Since then, numerous journalists from the local press and‘‘foreign’’ journalists, and forest officials had visited, taken photo-graphs and asked her many questions. Frustrated at the delay,Rupa together with thirty other women, petitioned the localelected Member of the State Legislative Assembly. He directedthem to meet the forest officials. The forest officials reassuredRupa that her claim would be processed. To date, she has notheard any further. She repeatedly talked about not having a manin her home, the financial consequence of her widowhood, andher illiterate identity that made it difficult to engage with moreformal bureaucratic procedures for claiming compensation.

5.3.2. Group discussion

An extended group discussion ensued when other neighboursjoined Bina and Rupa. The discussion touched on concerns aboutthe elephant menace, their poverty-stricken condition, the insen-sitivity of visiting government officials, and their own futurepredicament. When specifically asked what made them feelunsafe, the group mentioned the lack of electricity, non-avail-ability of torches, and absence of forest guards to regularly patroltheir villages and paddy fields. They said that their village wasoriginally land where elephants lived and that these animals weredisplaced when people moved in. Both elephants and the peoplehad ‘‘hungry stomachs’’ for which they seemed to be no clearsolution: ‘‘The elephants did not come to attack us. Elephant has

come for his stomach, just like we do for our stomach.’’ When askedwhy elephants threatened their village, Rupa said: ‘‘We are

bothering them, we are disturbing them, we are staying in their

place.’’ Another elderly lady joined in: ‘‘Till we are alive this will

carry on. Till man will be man, animal will be animal, till such time

this will carry on. Till we are alive we must carry on like this. Human

numbers will increase. You cannot take humans and put them

somewhere. And elephants, you cannot chase and put them some-

where.’’ Later, when discussing personal hardships, an elderlywoman said ‘‘We think having given birth to children in our life,there has been no happiness? Isn0t it? In our life, will there be

happiness? Happiness will not come. But these children that we have

given birth to, we should be there to guard. With the difficulty we

gave birth to them, raising them is our duty. To help them study 2–3classes [in school]. That is our duty. After they grow up, whether they

feed us or not is up to them.’’ Young men, who were relatives ofBina and Rupa talked about the daily guarding of crops at nightand consequent tiredness during the daytime. They looked tiredand expressed several symptoms including fatigue, body achesand pain. They mentioned alcohol as one way of coping with thisstress. The men seemed glad to share their problems and ownviews about the elephant menace. They were unanimous inexpressing their daily hardship, fear, anger and frustration withtheir lives.

6. The elephant vanishes: ecology and the clinic

All of the four case studies above suggest that both mentalhealth and psycho-social dimensions of human–elephant conflictcannot be simply understood as a straightforward linear outcomeof human–elephant encounters. The authors argue that conflictsaggravate pre-existing problems such as poverty and mental poorhealth. Fatality from elephant attacks result in domino effectsthat multiply extant family conflicts and untreated mental

S. Jadhav, M. Barua / Health & Place 18 (2012) 1356–13651362

disorders including alcoholism. They generate newer psychiatricmorbidities and impact on maternal health. Further, explanationsmarshalled to understand human–elephant conflict by the studysubjects are diverse and transitory, shaped by individual andsocial circumstances.

Case study 1 illustrates how such events stifle existingincomes, increase debts and expose the poor and disenfranchisedto new spaces of institutional inequality. Both Ramu and hisfather’s wage-earning activities were severely hampered; theformer because of the loss of his driving license, the latter forhaving to leave his job and return to rebuild the family home.Similarly, Case study 3 and 4 show how subsequent poverty shiftsburdens and additional responsibilities onto women. Both Binaand Rupa had to carry out manual labour in addition to providingchildcare, leaving them exhausted with poor capacity to cope.Case study 2 illustrates the complex role of property ownershipand dispute, as well as kinship strains that emerge as a conse-quence of conflicts. The elephant’s fatal attack appears to havebrought about a deep rupture in the social and psychologicalfabric of an otherwise well-to-do family who arguably had somestability in their kinship relations, occupation, and health prior tothe attack.

An important finding is the role of alcohol as a mediator inhuman–elephant conflict. Alcohol seems to draw both humansand elephants together and lead to newer social and psychiatricpathologies. For humans, it has differential mediating effects asillustrated in three of the four case studies. In Case study 1, thesubject was known to abuse illicit substances including alcohol. Itis unclear if his consumption increased after the elephant attack.In Case study 2, the deceased was drunk at an ‘illicit’ liquordistillery following a marital row just prior to the fatal event. Thedeceased husband of the Case study 3 subject appears to havesuffered from a severe, untreated mental disorder. The deteriora-tion of his mental functioning is likely to have predisposed him toalcohol abuse. We hypothesise that the immediate causes of

Fig. 2. Posters printed by WWF (ca. 2006–2007) making people aware of the dangers of

any and every where, then for elephant harassment do prepare’’ (left), ‘‘After a few drin

(right). & WWF/AREAS Elephant Conservation Programme.

deaths in Case study 2 and 3 following an encounter withelephants may have resulted from impaired judgement due toalcohol intoxication. Finally, the group discussion and MB’sethnographic fieldwork suggests that men often resort to alcoholto cope with the added stress that crop-guarding poses. Farmersdo intensive labour during the daytime, and loss of sleep due toguarding fields at night leads to considerable stress. As a con-sequence, alcohol consumption is both heavy and frequent.Moreover, several farmers reported that alcohol gave them thecourage to chase elephants, an activity that is dangerous andinvolves taking considerable risk.

So far, agency in human–elephant conflict has been attributedto humans, and to a lesser extent elephants (Jepson et al., 2011).This is in contrast to the present study findings which suggestthat alcohol has agency in influencing these interactions. Alcoholenters these local political ecologies and binds people andelephants together in unforeseen and complex ways. This studydoes not establish a firm causal link between human–elephantconflict and substance abuse, but substantiates the relationshipbetween alcohol consumption and crop guarding (Barua, 2010;Sukumar, 2003). This relationship is symmetrical as elephants arealso drawn into villages because of alcohol, where they break into‘illicit’ village distilleries. The agency of alcohol was noted by theWorld Wide Fund for Nature (WWF), a conservation NGO workingon human–elephant conflict mitigation in and around the studydistricts. The organisation printed two posters (Fig. 2), whichstated that people should stop brewing alcohol at home, orwander alone in the dark after drinking, as they would bevulnerable to elephant attacks. Such locally-rooted and organicobservations of the problem could be enhanced by addinginformation for help with alcoholism. This may be achieved byconservationists collaborating with mental health services toprovide culturally-sensitive substance abuse interventions.

Accessing health care that is locally relevant and culturallysensitive has been argued to be the cornerstone of mental health

alcohol in conflict-affected villages. Captions in Assamese state: ‘‘If you brew liquor

ks the drunkard roams alone, in the dark elephants trample and crush his bones’’

S. Jadhav, M. Barua / Health & Place 18 (2012) 1356–1365 1363

care in low income countries (Desjarlais, 1996; Kleinman andBenson, 2006). Both international and national policies argue forservice provision and care to move away from mental hospitals tothe community. Most national health programmes and policiesinclude templates that echo this insight. However, as the casestudies presented illustrate, they stop short of making explicithow this should be clinically operationalized in more concreteterms that are particular to local geographies. For example, incase study 1, the family obtained a small loan at high interestrates to travel to the nearest mental hospital, following unpro-ductive consultations with local healers. In case study 2, despiteoffers for transport and an escort, the family did not attend thelocal tertiary services. This might be due to the stigma associatedwith such institutions, as reported in an earlier study conductedin the region (Jadhav et al., 2007). Case studies 3 and 4 show thatmany may not construe their problem as a mental health concern.In fact, they had access to a local primary healthcare team thatvisited the nearby village. However, they explained these clinicshad long queues and required spending an entire day for amedical consultation. In addition, payments for medication andtravel costs further prohibited utilisation of health care, despiteIndia’s stated mental health policy of free treatment and care forits citizens (NMHP, 2012). These issues strike at the very heart ofIndia’s mental health policy and training, and indeed the ‘GlobalMental Health’ movement.

A conflict akin to that between elephants and humans forterritory, home, and food is also played out in the interactionsthat take place in a sanitized clinic. Local ecology is edited out bythe clinic. For instance, the Case study 1 illustrates how thereframing of Ramu’s narrative into a psychiatric formulationedits out the ecological landscape, including important stressfulcircumstances such as poverty, loss of occupation and hishome destroyed by elephants. In addition, by selecting out the‘accidental fall’ from his truck as a precipitating factor, anddetailing a range of substance abuse, the clinic reframes asuffering initiated by human–elephant conflict into an organicnarrative. Such clinical reformulations both justify and legitimisea biological set of antecedents considered causal to Ramu’s illness.In an earlier paper, the authors have demonstrated that pills atthe clinic are the sole exchanges between rural Indians andclinicians at primary health care centres. Clinicians are trainedto acquire a lens that systematically marginalises local moral andsocial concerns of their patients (Jain and Jadhav, 2009). Thisresults in a clean fit with Western-derived theory and classifica-tion, at the cost of excluding local ecological stressors. One mightargue that such a selective extraction of patient experienceestablishes and reifies a sanitized clinical gaze. As a consequence,the elephant vanishes.

In a similar vein, conservation practice may also generateadditional spaces of suffering. Landscapes inhabited by peopleand elephants are riven with asymmetry, where the socio-economic costs and benefits of living with elephants areunequally shared between people and organisations wanting toconserve elephants (Lorimer, 2010). Elephants are importantsymbols for the Global North and are mobilised by powerfulinstitutional actors to create protected areas free of humansettlement (Barua et al., 2010). Such conservation practiceexcludes people from access to resources and significantlyimpacts on the livelihoods of the poor (Adams and Hutton,2007; Moore, 2011). Assam has five elephant reserves, some ofwhich have been infringed upon by communities displaced byfloods or ethnic conflict (Talukdar, 2010). Bina and Rupa werefrom one such flood-displaced community. These settlers oftenget framed as ‘illegal encroachers’. In the past they have beenevicted from elephant reserves by the government whose respon-sibility it is to maintain these spaces free of human settlement

(Saikia, 2008). In addition to bearing the brunt of human–elephant conflict, escalated through incursion of people intoelephant habitat (Sukumar, 2006), there is a new corporealcontest over home, territory and food. Men in Bina and Rupa’svillage told the authors: ‘‘Elephant has come for his stomach, just

like we do for our stomach.’’Claiming compensation for fatality, crop and house damage is

yet another facet through which the disenfranchised get exposedto institutional bureaucracy. There is consequent amplification ofthe conflict. Processes of verification, determination of fair valuesfor losses, payments and settlements do not take place in a timelyand transparent fashion. In many instances these may be linked toissues of fraud and corruption (Madhusudan, 2003; Saberwalet al., 1994). Further, transaction costs are incurred with prepar-ing and filing applications, as rural farmers often have to sacrificepaid work and travel considerable distances to governmentoffices to register a complaint. Evidence from other parts of Indiaalso suggests that the poor and marginalised are less likely to fileclaims or receive compensation (Ogra and Badola, 2008). ForRamu’s family, the lack of social capital to mobilise compensationpayments led to a borrowing of money at high interest rates,generating further debt. In Bina and Rupa’s case, their illiteracyand lack of male support undermined efforts to make claims.There was a significant disparity between the actual loss andofficial compensation. These transaction costs may in the firstinstance be material or economic, but over time they prolongsuffering and impact upon other areas of wellbeing that remainundocumented.

In parallel to ecological stressors being edited out from themental health clinic, there is a similar dynamic operating in theconservation discourse on human–elephant conflict. Conserva-tionists’ deployment of the term ‘conflict’ in the context ofhuman–wildlife relationships frame issues in a manner thatemphasise material and visible impacts of the problem(Peterson et al., 2010). Discursive use of the term, often alignedwith metaphors of war and peace-making (Barua, 2010), legit-imise actions such as ‘intervention’, ‘mitigation’ and conflict‘resolution’. However, such action is directed toward visibleimpacts of conflict (e.g. crop loss, house damage). Crucial psy-cho-social dimensions that impact upon human wellbeing, asillustrated in this paper, remain invisible. A more immediateexplanation for this impasse is that a sustained interactionbetween conservationists and public health professionals is lack-ing. The authors hypothesise that people’s narratives of sufferingare edited out because conservation organisations portray ele-phants in a manner that resonate with Western donors. Affection-ate and companionate aspects of human–elephant relationships arehighlighted, whilst aggressive behaviour and psycho-social impactsof conflict are silenced.

Geographers have long argued that landscapes can be shapedand refashioned into ‘healing spaces’ for people and communitiesto recover from a range of illnesses. Such spaces are articulatedthrough the concept of ‘therapeutic landscapes’ (Conradson,2005; Williams, 2010b). The authors of this paper argue that inaddition to shaping landscapes as therapeutic and health-promot-ing, asymmetric interactions between people, elephants andinstitutions as revealed through this research, generate land-scapes that are actively ‘counter-therapeutic’ to both people andelephants. For instance, state policies of policing boundariesbetween people and elephants and segregating them into purifiedspaces are often designed without regard to the wellbeing ofeither. Both people and wildlife are vilified (Wilbert, 2006).The domino effects that result from human–elephant conflictdisrupt the development of personal skills and strong communityaction, factors that are essential to fashioning health-enhancingspaces (Williams, 2010b). Further, the clinic by shrinking its gaze,

S. Jadhav, M. Barua / Health & Place 18 (2012) 1356–13651364

edits out the ecological context of suffering and limits thepotential for creating supportive environments. The proposition,that landscapes can be counter-therapeutic, enriches the growingscholarship on the impact of place and ecology on health.The authors argue that the concept of counter-therapeutic land-scapes differs from the more passive notion of ‘non-therapeutic’landscapes (Williams, 2010b), as it actively scapes spaces thatgenerate morbidity.

7. Reclaiming the elephant: connecting ecology, culture andthe clinic

Through a clinical and ethnographic enquiry into human–elephant conflict, this paper illustrates how psycho-social con-sequences of human–wildlife conflicts unfold and significantlyimpact upon people’s wellbeing. As made evident throughout thepaper, disciplinary constraints and absence of a dialogue betweenhuman geography, conservation science and public health aremajor reasons why such consequences are poorly documentedand policies to redress them are wanting. This paper is a modestattempt to initiate a vital interdisciplinary dialogue. The authorssuggest that several advances are necessary to arrive at a morecomprehensive reformulation of existing challenges to the pro-blem of human–wildlife conflict.

The first relates to developing a new interdisciplinary para-digm that integrates ecology, culture and the clinic. Humangeography has made significant advances in blurring the dividebetween nature and culture. It formulates a more inclusivepolitical ecology that takes into account the influence of nonhu-man animals and materials in social and political outcomes(Braun and Whatmore, 2010; Latour, 2004b; Whatmore, 2002).The field of psychiatric geography, which focuses on the spatialdistributions and environmental correlations of mental ill-health,has theorized the entangled relations of mental health, society,space and environment (Curtis, 2010; Kearns and Moon, 2002;Philo, 2005). Similarly, clinically-applied anthropology and cul-tural psychiatry have sought to establish links between cultureand psychiatric diagnosis. They seek to demonstrate the culturalconstruction of suffering (Jadhav, 2001; Jain and Jadhav, 2008).Integrating these strands of enquiry will enable newer and moreholistic understanding of issues at the forefront of human well-being in the 21st century: food security, poverty alleviation, andhealth. Further, it would enhance current attempts to thwartglobal decline in biodiversity. The interdisciplinary rapproche-ment offered by this paper, linking human geography, wildlifeconservation and public health, can be viewed as one of thestarting points toward developing such a paradigm.

To advance this line of enquiry, (1) new ethnographies ofhuman–animal relationships and (2) studies measuring the scaleand extent of health morbidity and psycho-social consequences ofhuman–wildlife conflict are urgently needed. The former couldcombine methods emerging from novel ‘multispecies ethnogra-phy’ approaches that seek to conduct research in a symmetricalfashion, paying close attention to both animals and the humancommunities that engage with them (Kirksey and Helmreich,2010), together with clinical ethnographies that investigate rela-tionships between public health and local communities (Jain andJadhav, 2009). This paper, by illustrating how social suffering isshaped by a range of actants including nonhuman animals(elephants), materials (alcohol) and institutions (bureaucracy)interwoven into the cultural and political fabric, provides cuesfor how such methods can be developed. For example, tigersin the Indian Sundarban and feral dogs in urban spaces, bothknown to generate mental and physical pathologies (Chowdhuryet al., 2008; Srinivasan, 2012), are potential candidates to

extend this research enquiry into other human–wildlife conflictspaces. Examination of the extent and scale of psycho-socialconsequences of human–wildlife conflict would require develop-ment of culturally-valid research instruments followed by theirdeployment towards systematic cultural epidemiological studies.At present, there are no such instruments to measure social andhealth impacts of human–wildlife conflict. This would also implyestablishing baseline data on social demographic relationshipswith health morbidity, including risk factors such as poverty andalcoholism, and cost-benefit analysis. This data could then beused to compare affected and non-affected communities in orderto target testable interventions.

These interventions have implications for developing coordi-nated conservation and flexible health policies sensitive to localgeography. At a policy-making level, it is critical that a dialoguebetween health professionals, conservationists and governmentpolicy-makers is initiated. This would allow for both training(i.e. sensitising clinicians to local ecology, and conservationiststo health consequences), and institution of an integrated servicedelivery. Such efforts could be enhanced by policy-drivenresearch that investigates where health service delivery shouldinterface with wildlife conservation, the nature of expertiseneeded to staff it, and how they should be trained and resourced.These inquiries should involve conflict-affected communities,their vernacular and embodied knowledges to arrive at locally-appropriate solutions. This would provide substantial scope forinnovation in efforts to improve the wellbeing of the rural poor.Until then, the marginalised continue to remain vulnerable to theimpact of human–elephant conflict.

Acknowledgements

The title of this paper was inspired by Haruki Murakami’sshort story The Elephant Vanishes. The authors would like to thankthe study subjects who shared their imagination and stories ofsuffering. In Assam, Jatin Tamuly, Nekib Ali, Anupam Sarmah,Dhruba Jyoti Das, Alexandra Zimmerman, and the Assam HaathiProject facilitated fieldwork. Dr. S. K. Deuri, Director LGBRIMH,Assam, for assistance. Manju Barua transcribed the interviews andchecked the translations. Leela Jadhav and Mallika Sekhar pro-vided generous hospitality. Earlier versions of this paper werepresented at: UCL Medical Anthropology Seminars, ACES confer-ence at the University of Aberdeen, Human–Wildlife ConflictSymposium at the University of Oxford. MB’s DPhil researchwas supported by the University of Oxford Clarendon Fund, Felixand Wingate Scholarships, and a grant from Elephant Family. Theauthors are grateful to several colleagues who have stimulatedand encouraged earlier versions of this paper: two anonymousreviewers and the Editor of Health & Place, Shonil Bhagwat,Arabinda Chowdhury, Sumeet Jain, Paul Jepson, Nanda Kannuri,and Roland Littlewood.

References

Adams, W.M., Hutton, J., 2007. People, parks and poverty: political ecology andbiodiversity conservation. Conservation and Society 5, 147–183.

Barua, M., 2010. Whose issue? representations of human–elephant conflict inindian and international media. Science Communication 32, 55–75.

Barua, M., Tamuly, J., Ahmed, R.A., 2010. Mutiny or clear sailing? examining therole of the Asian elephant as a flagship species. Human Dimensions of Wildlife15, 145–160.

Bist, S.S., 2006. Elephant conservation in India—an overview. Gajah 25, 27–35.Braun, B., Whatmore, S., 2010. Political Matter: Technoscience, Democracy, and

Public Life. University of Minnesota Press, Minneapolis, MN.Census of India, 2001. /www.censusindia.netS.Choudhury, A., Lahiri-Choudhury, D.K., Desai, A., Duckworth, J.W., Easa, P.S.,

Johnsingh, A.J.T., Fernando, P., Hedges, S., Gunawardena, M., Karanth, U., Lister,

S. Jadhav, M. Barua / Health & Place 18 (2012) 1356–1365 1365

A., Menon, V., Riddle, H., Rubel, A., Wikramanayake, E., 2008. Elephas maximus.IUCN Red List of Threat Version 2010.2. /www.iucnredlist.orgS.

Choudhury, A.U., 2004. Human–elephant conflicts in Northeast India. HumanDimensions of Wildlife 9, 261–270.

Chowdhury, A.N., Jadhav, S., 2012. Ecopsychiatry: culture, mental health andecology with special reference to India. In: Chavan, B.S., Gupta, N., Arun, P.,Sidana, A., Jadhav, S. (Eds.), Community Mental Health in India. JaypeeBrothers Medical Publishers, New Delhi, pp. 522–542.

Chowdhury, A.N., Mondal, R., Brahma, A., Biswas, M.K., 2008. Eco-psychiatry andenvironmental conservation: study from Sundarban Delta, India. Environmen-tal Health Insights 2, 61–76.

Conradson, D., 2005. Landscape care and the relational self: therapeutic encoun-ters in rural England. Health and Place 11, 337–348.

Curtis, S., 2010. Space, Place and Mental Health. Ashgate, Farnham, Surrey.Das, B.M., 1987. The people of Assam. Gian Publishing, New Delhi.Desjarlais, R., 1996. World Mental Health: Problems and Priorities in Low-Income

Countries. Oxford University Press, Oxford.Dutta, P., Khan, S., Bhattarcharyya, D., Khan, A., Sharma, C., Mahanta, J., 2010.

Studies on the breeding habitats of the vector mosquito Anopheles baimai andits relationship to malaria incidence in Northeastern region of India. Eco-Health, 1–9.

Fernando, P., Wikramanayake, E., Weerakon, D., Jayasinghe, L.K.A., Gunawardene,M., Janaka, H.K., 2005. Perceptions and patterns of human-elephant conflict inold and new settlements in Sri Lanka: insights for mitigation and manage-ment. Biodiversity and Conservation 14, 2465–2481.

Gureja, N., Menon, V., Sarkar, P., Kyarong, S.S., 2002. Ganesha to Bin Laden:Human–elephant conflict in Sonitpur District of Assam. Wildlife Trust of India,New Delhi, p. 45.

Hammersley, M., Atkinson, P., 1995. Ethnography: Principles in Practice, 2nd ed.Routledge, London.

Hill, C.M., 2000. Conflict of interest between people and baboons: crop raiding inUganda. International Journal of Primatology 21, 299–315.

Hinchliffe, S., Kearnes, M.B., Degen, M., Whatmore, S., 2005. Urban wild things: acosmopolitical experiment. Environment and Planning D: Society and Space23, 643–658.

Hoare, R., 2000. African elephants and humans in conflict: the outlook for co-existence. Oryx 34, 34–38.

Inskip, C., Zimmermann, A., 2009. Human-felid conflict: a review of patterns andpriorities worldwide. Oryx 43, 18–34.

Jadhav, S., 2001. Community psychiatry and clinical anthropology. In: Yilmaz, A.T.,Reicher-Rossler, A., Weiss, M. (Eds.), Cultural Psychiatry: Euro-internationalperspectives. Karger, Verlag, Basel, pp. 141–154.

Jadhav, S., 2009. What is cultural validity and why is it ignored? The case ofexpressed emotion in research in South Asia. In: van der Geest, S., Tankink, M.(Eds.), Theory and Action: Essays for an Anthropologist. Uitgeverij AMB,Diemen.

Jadhav, S., Littlewood, R., Ryder, A.G., Chakraborty, A., Jain, S., Barua, M., 2007.Stigmatization of severe mental illness in India: Against the simple industrialhypothesis. Indian Journal of Psychiatry 49, 189–194.

Jain, S., Jadhav, S., 2008. A cultural critique of community psychiatry in India.International Journal of Health Services 38, 561–584.

Jain, S., Jadhav, S., 2009. Pills that swallow policy: clinical ethnography of acommunity mental health program in Northern India. Transcultural Psychiatry46, 60–85.

Jepson, P., Barua, M., Buckingham, K., 2011. What is a conservation actor?Conservation and Society 9, 229–235.

Kearns, R., Moon, G., 2002. From medical to health geography: novelty, place andtheory after a decade of change. Progress in Human Geography 26, 605–625.

Kirksey, S.E., Helmreich, S., 2010. The emergence of multispecies ethnography.Cultural Anthropology 25, 545–576.

Kleinman, A., Benson, P., 2006. Anthropology in the clinic: the problem of culturalcompetency and how to fix it? Plos Medicine 3, e294.

Latour, B., 2004a. How to talk about the body? The normative dimension of sciencestudies. Body and Society 10, 205–229.

Latour, B., 2004b. Politics of Nature. How to Bring the Sciences into Democracy,Cambridge, Massachusetts. Harvard University Press.

Lorimer, J., 2007. Non-human charisma. Environment and Planning D: Society andSpace 25, 911–932.

Lorimer, J., 2010. Elephants as companion species: the lively biogeographies ofAsian elephant conservation in Sri Lanka. Transactions of the Institute ofBritish Geographers 35, 491–506.

Madden, F., 2004. Creating coexistence between humans and wildlife: globalperspectives on local efforts to address human-wildlife conflict. HumanDimensions of Wildlife 9, 247–257.

Madhusudan, M.D., 2003. Living amidst large wildlife: livestock and crop depre-dation by large mammals in the interior villages of Bhadra Tiger reserve, SouthIndia. Environmental Management 31, 466–475.

Madhusudan, M.D., Sankaran, P., 2010. Seeing the elephant in the room: human–elephant conflict and the ETF report. Economic and Political Weekly XLV,29–31.

Moore, L., 2011. The neoliberal elephant: exploring the impacts of the trade ban inivory on the commodification and neoliberalisation of elephants. Geoforum42, 51–60.

Morris, S., Humphreys, D., Reynolds, D., 2006. Myth, marula, and elephant: anassessment of voluntary ethanol intoxication of the African elephant(Loxodonta africana) follwing feeding on the fruit of the marula tree(Sclerocarya birrea). Physiological and Biochemical Zoology 79, 363–369.

NMHP, 2012. National Mental Health Programme. National Institute of Health andFamily Welfare. /http://www.nihfw.org/NDC/DocumentationServices/NationalHealthProgramme/NATIONALMENTALHEALTHPROGRAMME.htmlS.

Nyhus, P.J., Tilson, R., Sumianto, 2000. Crop-raiding elephants and conservationimplications at Way Kambas National Park, Sumatra, Indonesia. Oryx 34,262–274.

Ogra, M., Badola, R., 2008. Compensating human–wildlife conflict in protected areacommunities: ground-level perspectives from Uttarakhand, India. HumanEcology 36, 717–729.

Ogra, M.V., 2008. Human-wildlife conflict and gender in protected area border-lands: a case study of costs, perceptions, and vulnerabilities from Uttarakhand(Uttaranchal), India. Geoforum 39, 1408–1422.

Peterson, M.N., Birckhead, J.L., Leong, K., Peterson, M.J., Peterson, T.R., 2010.Rearticulating the myth of human-wildlife conflict. Conservation Letters 3,74–82.

Philo, C., 2005. The geography of mental health: an established field? CurrentOpinion in Psychiatry 2005, 585–591.

Rangarajan, M., Desai, A., Sukumar, R., Easa, P.S., Menon, V., Vincent, S., Ganguly, S.,Talukdar, B.K., Singh, B., Mudappa, D., Chowdhary, S., Prasad, A.N., 2010. Gajah:Securing the future for elephants in India. Ministry of Environment andForests, Government of India, New Delhi.

Saberwal, V.K., Gibbs, J.P., Chellam, R., Johnsingh, A.J.T., 1994. Lion–human conflictin the Gir Forest, India. Conservation Biology 8, 501–507.

Saikia, A., 2008. Forest land and peasant struggles in Assam, 2002–2007. TheJournal of Peasant Studies 35, 39–59.

Sarma, P.K., Talukdar, B.K., Baruah, J.K., Lahkar, B.P., Hazarika, N., 2008. A Geo-spatial assessment of habitat loss of Asian elephants in Golaghat district ofAssam. Gajah 28, 25–30.

Srinivasan, K., 2012. The biopolitics of animal being and welfare: dog control andcare in the UK and India. Transactions of the Institute of British Geographersdoi: 10.1111/j.1475-5661.2012.00501.x.

Sukumar, R., 1990. Ecology of the Asian Elephant in Southern India. II. Feedinghabits and crop raiding patterns. Journal of Tropical Ecology 6, 33–53.

Sukumar, R., 1991. The management of large mammals in relation to malestrategies and conflict with people. Biological Conservation 55, 93–102.

Sukumar, R., 1993. The Asian Elephant: Ecology and Management. CambridgeUniversity Press, Cambridge.

Sukumar, R., 2003. The Living Elephants: Evolutionary Ecology, Behaviour andConservation. Oxford University Press, Oxford.

Sukumar, R., 2006. A brief review of the status, distribution and biology of wildAsian elephants Elephas maximus. International Zoo Yearbook 40, 1–8.

Talukdar, B.N., 2010. Elephants in Assam. Forest Department of Assam, Govern-ment of India, Guwahati.

Whatmore, S., 2002. Hybrid Geographies: Natures, Cultures, Spaces. Sage, London.Whatmore, S., Thorne, L., 2000. Elephants on the move: spatial formations of

wildlife exchange. Environment and Planning D: Society and Space 18,185–203.

Wilbert, C., 2006. What Is Doing the Killing? Animal Attacks, Man-Eaters, andShifting Boundaries and Flows of Human-Animal Relations. In: Group, A.S.(Ed.), Killing Animals. University of Illinois Press, Urbana and Chicago,pp. 30–49.

Williams, A.C., 2010a. Did the Task Force Get it Right? Economic and PoliticalWeekly XLV, 35–39.

Williams, A.M., 2010b. Therapeutic landscapes as health promoting places. In:Brown, T., McLafferty, S., Moon, G. (Eds.), A Companion to Health and MedicalGeography. Blackwell Publishing Ltd., Oxford, pp. 207–223.