Bronson, Paula; (2025) " My bones become like old trees": coping and resilience building with people with chronic pain in Sindhupalchok, Nepal. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This research investigates how villagers living with chronic pain navigated and coped within the setting of a Nepali farming community recovering from the earthquakes of 2015. The work examines these strategies within the emergent milieu of the multifaceted social landscape within the rapid changes of emigration, natural disaster, recent political events, the local spirit world and Indigenous medical practices, and the hardship of physical accessibility. Anthropology of pain is under-investigated in medical anthropology in recent years, and this research has brought new insights to the foreground. Chronic pain is complex, often confounding biomedical professionals since organic causes and biomarkers are rarely apparent. Many pain professionals agree that the standard, most widely practiced model of diagnosis and care, the biopsychosocial model (BPSM), although originally conceived as a useful approach, has not shown to be deployed as was intended. Practice has tended to remain biomedically reductionist and psychosocial factors have not been adequately integrated. To develop a less fragmented application of the BPSM, with less emphasis on the biomedical, this research applies Coninx and Stilwell’s (2021) conception of a hybrid enactivist/ecological framework within the field of chronic pain studies, which has the view that an understanding of the complexities of chronic pain would benefit from more developed models of the interrelatedness of the three domains, through the addition of the concept of ‘fields of affordances’. This ethnographic research in Nepal contributes to the argument that a more “holistic, integrative, and dynamic” (Coninx and Stilwell 2021, 7844) understanding of pain is crucial for care. My research has as its central aim to introduce the experience of people living with pain within the construct of ‘idioms of resilience’ (Kim et al. 2019), as supplementing and filling the spaces where the BPSM does not stretch. The participants’ primary coping strategy was that their resilience was not a show of strength or grit, but a transformative process as seen through these approaches.

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