Princeton University - Council of Science & Technology

POPE PRIZE

Essay 1
Losing the Race Against Time: Rebuilding the San Francisco-Oakland Bay Bridge
Christi C. Niehans

Essay 2
Chemical Weapons Burn in Arkansas
Brian D. Muegge

Essay 3
Mann's History
Melissa M. Galvez

Essays 4
Postpartum Cases: Tadoka and Mental Health
Amy B. Saltzman

Honorable Mention
Julia B. Saltz

Postpartum Cases: Tadoka and Mental Health

I spent the summer of 2004 conducting fieldwork in a village called Nahigatoka, located near the southwestern coast of Viti Levu, Fiji’s largest island. I went there to study experiences of motherhood and postpartum illness among ethnic Fijian women in the context of Fiji’s current economic and social change. Living with the village chief and her two granddaughters, I observed and participated in their everyday life. I conducted semistructured ethnographic interviews with a cohort of seventy-two mothers of all ages. I also explored the local public health care system. I observed everyday medical practices in the maternal child health and family planning divisions of local clinics and hospitals. Through informal conversations and formal interviews with doctors and nurses, I tried to get a sense of how they think about health, specifically maternal and mental health. Tadoka Around five in the evening I stopped by Sureti’s house to interview her about her experiences as a mother. Milly, my mentor’s research assistant who helped me contact mothers, had stopped by her house earlier in the day to set up the appointment. Since Milly had given me the go-ahead, I expected Sureti to invite me in, offer me tea, and gesture me to a relatively quiet corner of her home’s single room to talk. I was surprised when Sureti stopped me at the entrance to her house. The turquoise bandana she wore around her head and jaw, along with the grimace on her face, told me something was not right. She explained that she had a toothache and asked if I could please come back at nine-thirty the next morning. Of course I obliged and thought nothing of it. It was not until I got a chance to talk with Sureti the next morning that I realized in postponing our meeting, she was telling me about her experience of motherhood. In fact, through her pained presentation, she performed tadoka for me. Ethnic Fijians experience a postpartum illness called na tadoka ni vasucu (translated as “the flu of birth”), usually referred to as “tadoka” by the women with whom I spoke. The tadoka syndrome includes flu-like symptoms – headache, toothache, stomachache, joint pain – as well as a general lack of enthusiasm for interacting with people or caring for one’s baby or family. People attribute the condition to physical exertion or sexual intercourse too soon after delivery, though the former explanation is more common than the latter. Some of the mothers I talked with believe that it is fatal and told me that if left untreated, tadoka can turn into cavuka, a condition very similar to what American psychiatry defines as postpartum psychosis. However, physicians trained in biomedical techniques argue that the syndrome is “clinically insignificant.” There are mothers in all places and of all ethnicities who experience postpartum illness (Georgiopoulos 2004:105). Studies estimate that between 8% and 14% of women worldwide suffer from the depressed mood and loss of interest and hope that the Diagnostic and Stastical Manual of Mental Disorders, Fourth Edition (DSM-IV) categorizes as postpartum depression (Georgiopoulos 2004:107) and up to 50% experience maternity blues, a brief period of “heightened emotional reactivity” (Miller 2002:762) in the first three to seven days after giving birth. However, inconsistent diagnostic criteria, phenomenological differences, and methodological constraints have made many studies of the incidence of postpartum illness inconclusive (Georgiopoulos 2004:107). Furthermore, postpartum illness is experienced differently by women in different places. As a case in point, tadoka is phenomenologically distinct from what American psychiatry defines as postpartum depression (Becker 1998:432). Variance in social support, resultant levels of postpartum distress, understandings of illness, and beliefs about pregnancy influence new mothers’ experiences. Anne Becker is the only scholar who has published work on tadoka (Becker 1995, 1998), and she has combined psychiatric, epidemiological, and anthropological methods in its characterization. She reported that among a sample of 82 ethnic Fijian women in Fiji in 1994, the incidence of tadoka was 9% (1998:431), about the same as measurements of the cross-cultural incidence of postpartum depression (Georgiopoulos 2004:107). However, more notably, Becker found that a much larger percentage of mothers-to-be and new mothers were seriously concerned about developing tadoka: “It is immediately striking that na tadoka ni vasucu stirs a tremendous degree of cultural elaboration and general concern among postpartum women, when at clinical face value, it is a relatively benign and transient illness” (1998:435). Becker argues that a widespread discourse of worry about tadoka engenders the need to prevent it and thereby “scripts” postpartum customs and “encourag[es] extraordinary vigilance in buffering [new mothers] from physical exertion” (Becker 1998:436-437). Taking into account the Fijian notion of the body as a “social microcosm” (1998:432), Becker sees tadoka as a corporeal manifestation of socio-moral distress (usually arising out of social neglect) that can be ameliorated by “repairing the social rift” causing it (1998:432), usually by providing new mothers with greater social support. Thus, she acknowledges tadoka as a “rhetorical device for prescribing socio-moral responsibilities to the community” (Becker 1998:437) and a “strategy to illicit nurturance as antidote to the illness” (Becker 1998:436). Considering Becker’s insights on the social foundations of tadoka and aware of the political instability and increasing global flows to which Fiji has been subject for the past decade, I expected to find tadoka experiences significantly different from those described by Becker in 1994. Given the atmosphere of social uncertainty as younger generations contest older generations’ authority, long-standing forms of care lose currency to new forms of care, parents look forward in anticipation of the future, and individual autonomy increases with a new culture of rights, would the incidence of tadoka be higher in 2004 than it was ten years earlier? Of the 72 mothers I interviewed formally, 6 told me they had experienced or were currently experiencing tadoka, which suggests an incidence of roughly 8.3%. However, my determination of whether a woman had experienced tadoka was based only on self-reporting in a tenuous blend of broken English and Fijian, so its reliability was questionable. I was more interested in how women talked about tadoka than in establishing an accurate incidence rate. In fact, after listening to mothers’ concerns, I agree with Becker that the fear of tadoka is more significant than its existence. Most women who had never gone through tadoka could not explain to me what it would be like or how to prevent or treat it. Instead, their knowledge of tadoka seemed to come from vague but vehement warnings from female elders. Thus, I chose to track this pervasive fear of tadoka rather than focus on its occurrence. They say if you are not careful, tadoka can kill you. Women, eh? In childbirth. If you don’t protect yourself, you can get the tadoka. You have to… Just after birth, you sit, you comb your hair, you lift up all the heavy things. That thing can cause you tadoka. Mothers repeatedly explained to me that their mothers, mothers-in-law, and aunts warned them that if they got up from lying down too soon or worked too hard too early in the first postpartum year, then they would get sick. On the ground, I saw how the fear of tadoka got passed from generation to generation and thereby structured postpartum practices as well as the social support they provided. Many postpartum practices are carried out for the explicit purpose of preventing tadoka. According to a 53-year-old mother in Nahigatoka, “[tadoka] is why we keep [to] ourselves when we’re finished giving birth.” In the turbulence of questioned authorities, generational conflicts, and strategic negotiations of postpartum customs, it seems that tadoka is the cement that holds postpartum practices in place. Despite the recent influx of new authorities, the prospect of tadoka continues to push new mothers to conform to collective care; thereby, learned fear ensures social support. In addition to following a postpartum rest regimen, mothers take specific Fijian herbs to prevent and treat tadoka. Us Fijian ladies, after giving birth, we have to drink the Fijian medicine, right after birth. That’s a cure for tadoka. [It is made of] Fijian leaves. That Fijian medicine can protect you from getting tadoka. Almost all the mothers I interviewed told me that they took some type of Fijian herbal medicine, dranu, at some point during the postpartum period. Prevention and treatment plans vary considerably even within villages or groups of closely affiliated women. However, the key connection among various treatments described by my informants is that they were always carried out by a designated caretaker, whether a nurse, aunt, mother, mother-in-law, or husband. The act of taking care seemed to be the most important element of treatments for tadoka. The underlying message I got from mothers was that they need sufficient nurturing, whether in the form of preventative medicine, ameliorative medicine, or an extended allowance for rest during the postpartum period. Thus, by creating a need for medicinal treatment, fear of tadoka or its early symptoms facilitates the provision of care to new mothers. Contemplating the work of tadoka, I began to consider how social uncertainty resulting from the contestation of older generations’ authority, the questioning of what constitutes care, and the emergence of a new culture of individual rights might be altering the way in which tadoka structures forms of care in the postpartum period. How do these factors influence the value systems and communities on which those forms of care are founded? It seems logical to assume that because tadoka is an “idiom of distress” in response to inadequate social support (Becker 1998:437), as social support and long-standing forms of care weaken with mothers’ decisions not to conform to postpartum customs, the incidence of tadoka would increase. However, such a direct cause-and-effect relationship does not reflect what is happening on the ground. While increasing “freedom,” individual autonomy, and willingness to negotiate with long-standing postpartum practices have in many cases moved mothers away from institutions that provide strong social support such as the extended postpartum rest period, postpartum practices like abstinence and food restrictions designed to protect new mothers in their vulnerable states, and the assignment of vigilant postpartum caretakers, mothers are not suffering as a result. Instead, they are both demanding and receiving new kinds of nurturance. Redefining care: tadoka as strategy [My father] just realized the number of kids that [my mother] had and that she had to deal with them alone, all this had affected her. [He] just got to realize now with my second baby. [Now] he is more careful. He is telling me, “You don’t do this. You don’t do this. You don’t do this.” And he is providing me more like food, more support for me. He never used to do that with the first baby, like he gave his clothes [to me to wash]. Everything I did in the house then. After that stage when he saw the effect [of my tadoka] on [my first baby], that he really didn’t grow up to be that well. He didn’t walk that early and he was sickly. My father really didn’t care what was happening with me then, but then when he saw the effect on my kid, [he cared]. These are the words of Asenaca. Her tadoka and its consequences on her son literally mobilized her father’s care, which had been absent when his wife was having children and when Asenaca had her first child. The most intriguing part of her father’s change in attitude was the fact that when he finally realized that he needed to find some way to support his daughter, he did it by contributing monetarily. My second baby, instead of me washing the clothes and doing all the housework, he pays someone to do it for me now. The thing I was trying to say was that it got to that stage where my father got to see her in that state and he realized how important it is to look after women in their very fragile state of just giving birth. Similarly, for Viema, a young mother in Nahigatoka, the ever-present threat of tadoka motivates money-mediated support. The fear of tadoka ensures her husband’s participation in postpartum care-giving: I just want to tell you that I was a really lucky lady because my husband is a very kind husband. He helped me a lot from my first baby to this time. Like some other ladies in the village, they have to go to the garden, to the plantation, go and get the food, but myself, no, I just stay home, look after the kids, and my husband goes to work and get the food. That’s why I say that I’m the luckiest woman. Her husband’s job as a court assistant allows the family to purchase everything they need rather than having to farm or catch it. Thus, she does not have to do physical labor at all; instead, she can stay at home and care for her children. In calling herself “the luckiest woman,” was Viema suggesting that she prefers her husband’s cash-mediated care over the care offered by her mother, mother-in-law, aunts, or sisters? Can she be seen as collaborating with the pervasive threat of tadoka to seek her husband’s monetary support? Even within this type of framework that allows mother substantial agency, women are not completely in control of their subjectivities or their own wellness and illness experiences. Referring to her tadoka experience, one mother reminded me of this: “It got me.” Mothers assert agency in a field of political and economic tensions. Tadoka might be a strategy of accessing certain (new) forms of care, but there are political and economic limitations on the work it can do. Given that many young mothers now live far away from female members of their extended families, male-provided, money-mediated support may be the only care to which they have access. At the same time, the sacrifices of time that many husbands must make to provide this monetary support may make them less able to provide care in the more customary hands-on sense. Sureti, who was experiencing tadoka at the time of her interview, attributed her poor health to the fact that her husband was away working on a government construction project. Such projects are a relatively new phenomenon in Fiji; traditionally men worked on the family’s or community’s farm. However, with economic growth, jobs offering more money with which to buy new commodities have become available and men have begun to work outside of the village. Mothers such as Sureti have to raise their children with less help from their husbands and other family members. In this case, Sureti is left to care for four children, the youngest three of whom are very close in age. When I asked about the bandage tied around her head, she explained that she felt “pressure” in her head, caused by her husband’s absence and a weak social support system. Here, Sureti’s tadoka seems to be a response to her husband’s absence and the “pressure” she faces in trying to raise a family on her own. Her parents live far away, and only a few of her husband’s extended family members live nearby. Her closest friend and sister-in-law lives next door and faces a similar situation. Neither woman has the high level of social support that many village women expect to receive. Both have suffered from tadoka. In fact, her sister-in-law, almost ten years her senior and a mother of five, is the one who gives Sureti advice on how to treat her tadoka. Perhaps Sureti’s tadoka is her way of demanding support from her sister-in-law. As a result, Sureti receives personal attention, commiseration, and recognition that she is overworked, all in the form of advice specific to her illness experience. In this sense, tadoka can be seen as a strategy for seeking a new kind of one-on-one social support. Mothers establish strategic “illness ties” to garner support they cannot access in the absence of extended family. Asenaca explained to me how she zeroed in on a single caretaker when she developed tadoka. At first she had been reluctant to ask her busy sister-in-law for help because she had her own family to care for and also worked as a teacher. As a result, Asenaca was overwhelmed with a variety of responsibilities in the postpartum period. However, tadoka called her sister-in-law into action: [My sickness] was just getting there [to the tadoka stage]. If I had not done anything with it, like discontinued on working and doing all that, I think it would have been there. But [my sister-in-law] was quick, like an old lady. She brought Fiji medicines like herbs. And then she massaged me, and she told me to have – what do you call this – just have the steam bath. Oh yeah, with garlic and lemon leaf [and] a cold shower. And she said, “You lie down.” And the headache… I don’t have headaches, so when it happens it is really painful. And it just took one day. It just took one day! The headache went away, so relatives do help. Because everyone in her close social network was busy with jobs outside of the home and a business her family runs out of the house, this mother had to find a way to demand social support from someone; tadoka was the medium through which she asserted that demand. In this case, that someone was not an older village woman accustomed to providing traditional forms of care; instead, she was a young suburban woman who had to reinterpret the ways of an “old lady” in order to deal with her sister-in-law’s tadoka. Here, postpartum care is re-imagined as something to be pursued quickly by forming strategic alliances when a mother realizes she has developed or is on the verge of developing tadoka. As indicated by Asenaca’s explanation that she was on the verge of getting tadoka but succeeded in stopping it in its course by accessing her sister-in-law’s care, tadoka is envisioned as something stoppable if caught and dealt with in its early stages. Even as tadoka, or the fear of it, allows mothers to demand new, more relevant forms of care, these young mothers are still often unsatisfied with the kinds of advice elders provide. Looking back to her postpartum period, one mother living near Suva described the kind of advice she would have liked to receive: You know, some of my experiences as a mother so far, I thought if some had told me this before when I was pregnant, or before I got pregnant, I would have been more…it would have been more helpful to me. Like after you give birth there’s… Like, especially physical changes. Like when you have stitches, like when you have bowel movements and there’s blood coming together with the stool. I was so worried about it. I was so worried, and it went for a while. I was thinking, “Why? Why am I still bleeding?” And then I began to ask people, [and they said], “Yes, that’s the way. When you have stitches, that’s what normally happens.” And I’d say, “Why didn’t anyone tell me that?” And I thought there was something wrong with me, this kind of thing. Especially mothers and relatives, when they advise you, they just advise you how to prevent yourself from getting tadoka, but they don’t really tell you how to treat yourself like that, you know? Her comments shed light on a significant gap between the advice desired by new mothers and that which they received. This gap suggests that different concepts of the body underlie old and young women’s renderings of motherhood. This mother needed advice applicable to her surgical, biomedical birth experience, but her family members could only provide recommendations on how to avoid tadoka by carrying out specific social practices. Might tadoka, as a technology of the self, be able to demand biotechnical advice? How would such a demand be executed? Would it require the recognition and treatment of tadoka in hospitals and clinics? Resisting medicalization Despite many young people’s understandings of birth as biomedically mediated, surprisingly, among my informants, I heard very little evidence that tadoka is being medicalized. While American psychiatric classifications distinguish tadoka from postpartum depression in that the former “does not bear phenomenologic resemblance to a postpartum depression with its primarily somatic presentation and transitory duration” (Becker 1998:432), there is potential for people to equate the two given that they both arise in the postpartum period (even though postpartum depression is technically defined as occurring within the first four weeks postpartum, while tadoka’s time of onset is less clearly delineated). However, only two of the mothers I spoke with associated tadoka with postpartum depression. Kara brought up tadoka immediately when I asked if she knew anything about postpartum depression: I think [tadoka and postpartum depression are the same thing] because it’s the stress in your mind that makes you feel that way, and when you have that state of mind, you’ll want to do [work], and if [the work that is done by others is] not up to your expectations, you’ll want to do it and sometimes you’ll get angry even. Similarly, Asenaca explained to me how she sees the movement of tadoka into the medical realm as only the beginning of an ongoing process: Asenaca: It’s yet to be seen [what is going to happen]. And I’m sure we’ll get to that stage like America, where you get to postpartum stress or whatever, that tadoka thing, it will be more worse. Amy: Do you think it will stay, just keep showing up as tadoka, or do you think it will turn up as something different as times change? Asenaca: It will turn out to be something different. As you’ve said, we need psychologists. Only when there are psychologists around then they can put a name to this… Put a name on it and it will be recognized. Amy: So maybe now it happens, but it’s not recognized? Or it doesn’t happen? Asenaca: It happens, but in a very mild form… But since you described it to me, I don’t feel it’s to that degree yet. Asenaca suggests that there is a latent need for psychiatric care. Postpartum mental illness is lurking in Fiji, but Fijian biomedical institutions lack the resources to detect it. Asenaca’s predictions indicate how thinking about tadoka and notions of psychiatric illness are beginning to intersect. Nevertheless, for the most part, even educated Fijians who think about mental illness in terms of psychiatric diagnostic categories see tadoka as disconnected from the biomedical realm. One college-educated mother in Suva described her mother’s post-hysterectomy cycles of aloof calm and hyper anxiety as “chemical” and attributed them to “the hormones,” but she did not think about tadoka as a chemically induced mental illness. She explained why tadoka is hardly ever mentioned in a clinical setting: Tadoka is maybe; it’s just maybe a Fijian experience. The Indians are really strong when they give birth, and the Chinese. Just a few days after they give birth, they’re like up and going. This mother sees tadoka as arising from some inherent quality in Fijian people. However, her explanation is far from biomedical and seems to grant validity to the traditional wisdom that requires Fijian postpartum women to rest for long periods of time in order to prevent illness. My conversation with Livia further convinced me that non-medical understandings of tadoka are very real for ethnic Fijian people. When I asked her if she could think of any reasons why the phenomenon of sadness I described as postpartum depression happens in America but not in Fiji, she said, “I think it might be a heart problem.” She went on to explain that Fijians have strong hearts, while people in the United States, as well as Indo-Fijians, have weak hearts: “[Strong hearts] for love. Like we have more loloma than Indians [and Americans]. We have more love, loloma. Indians [and Americans], they have weak [hearts].” My questions were much more rational and technical than Livia’s conceptualization of vulnerability to postpartum illness and her notion of a “good heart.” For Livia, as for many Fijians, what rational technical taxonomy might define as mental illness is not at all illness but rather simply a way of being in the world. Mental health is a matter of heart. As I searched for an elusive truth, Livia clearly told me that interrelations of care, both caring and being cared for, make up a person. Reflecting on Livia’s association of strong hearts with ethnic Fijians and weak hearts with Indo-Fijians, I wondered how care in this context relates to money. How do money and class play into her understanding of a good heart and subsequent mental health? Thinking back to a friend’s moralized characterization of Indians as freed from the constraints of communal obligations and therefore able to pursue material wealth on an individual basis, I began to think that Livia’s distinction between good and bad hearts had to do with that same moralization. To Livia, ethnic Fijians who uphold communal obligations and refrain from individualism and materialism consider themselves to be morally higher than Indo-Fijians who pursue material wealth through individual achievement. According to ethnic Fijians, somehow this moral stature protects them against postpartum depression. They get tadoka but not postpartum depression because they have stronger hearts than Americans or Indo-Fijians. As I listened and observed, I found that tadoka is separate from the biomedical realm not only in terms of how its etiology is understood, but spatially, as well. Neither Sister Lynn, who is in charge of the Maternal Child Health unit at the Sigatoka Health Centre, nor the two Indian doctors whom I interviewed had ever heard of tadoka, not even Dr. Shishram Narayan, the head psychiatrist in Fiji. Moreover, the many ethnic Fijian nurses with whom I spoke did not talk about tadoka within the walls of the hospital or clinic. They no doubt knew about tadoka and may even have experienced it themselves as Fijian mothers, but as nurses playing the role of state-instructed and state-funded health care workers, they adhered to the rational technical discourse of biomedicine. The nurses, employees of the state, rarely test the rules of patient care set by the Ministry of Health. Even the zone nurses tend to steer conversation away from personal, non-medical experiences such as tadoka and more toward measurable and easily identifiable conditions such as the baby’s growth and hypertension. One can see that tadoka is rather detached from the biomedical realm in thought and space. Although the global flows of psychiatric terminology and pharmaceuticals threaten to medicalize local nosologies worldwide, in the case of tadoka, illness experiences seem to be resisting medicalization. What about tadoka prevents commonsense understandings of its etiology from being translated into rational technical terms and ideas (Biehl, Good, and Kleinman 2005)? What time- and location-specific “ecological niche” (Hacking 2002) allows tadoka to resist medicalization and remain an everyday way of being? Mechanisms of resistance Fiji is not part of the global market of pharmaceuticals, and its exclusion from that market may help explain tadoka’s resistance to medicalization. The dynamic restructuring of social ties and devaluation of suffering carried out by global flows of pharmaceuticals (Biehl 2004a) are absent in Fiji. According to Dr. Narayan, the Ministry of Health only has access to the psychiatric drugs designated as “essential” by the World Health Organization; thus, the it is left to treat the masses with simple medical procedures, outdated pharmaceuticals, and generic acetaminophen. Because it does not have effective pharmaceutical treatments for mental illness, its administrators want to keep intractable cases (both those that can only be treated through culturally specific care and those that require advanced pharmaceuticals) away from hospitals and clinics. Humbly yet proudly, one of the zone nurses explained how she performs triage to prevent untreatable cases from showing up to the understaffed, under-funded hospitals: Like, we’re the one most important people to stop sick people from going to hospital. We have to. If we’re not going our work, then there would be a lot of admissions in hospital. Over here, they don’t have any doctors, eh, just nurses. Every month, we have to monitor our patient, eh? Because we go out, and the doctor says, once you go out, you educate the communities about their health, what to do; only come to hospital when there’s emergency. One could argue that the Ministry of Health, excluded from the global pharmaceutical market, actually depends on local nosologies such as tadoka to differentiate what is biomedically manageable with the few pharmaceuticals available from what is better dealt with in the village setting in order to preserve its limited resources. Relegated to the household and village, tadoka stays outside of clinical spaces, helping to prevent biomedically untreatable cases from entering the hospital or clinic. Nevertheless, thinking back to the earlier discussion of blurred boundaries in Chapter One, it seems that the borders between clinical and village spaces are getting obscured by the increasing portability of biomedical technologies; zone nurses bring scales, blood pressure cuffs, and blood sugar monitors, and biomedical terminology into villages. Furthermore, Dr. Narayan is trying to introduce psychiatric understandings of mental health and mental illness to the public by setting up a new divisional system of mental health care executed by zone nurses. In doing so, he is most likely paving the way for the psychopharmaceutical market. In the blurriness of the borders between clinical and village spaces lies the potential for future medicalization of tadoka. Comparing the postpartum experiences of women in the United States to those of ethnic Fijian women in Fiji, Maria explains how circumstances determine which inner processes get problematized and thus reveals another possible explanation of tadoka’s resistance to medicalization: In Fiji, talk keeps postpartum worries from becoming distress. In America, when [a husband and wife] get married, they live on their own. Everything they have to control. There’s no help from both sides, the husband’s parents or the girl’s parents. They control their own life. Soon after they have their baby, they’re thinking of so many things. They go back home. They have to look after their baby. The husband goes to work; she’s also a working mother. Worry about paying someone to come look after them, the house, the baby, everything. All the worry goes on the ladies. You don’t live next door to one another, you don’t talk to the next door to share your problem. Where as in here, when I have problem, I share it with Tai Una. Everybody talks about the problem here, so you don’t worry about the problem. It comes and goes. Whereas there [in America], there’s no relief. As Maria sees it, in the United States, money, financial concerns, and an abundance of choices actually tear families apart. Wealth and individual autonomy add new challenges to the alleviation of postpartum distress, a process which, in Fiji, is facilitated through tadoka. In this state of separation, people cannot and do not talk; forms of care, such as those which in Fiji prevent and deal with tadoka, are not realizable. According to Maria, without communication, “there’s no relief,” and worries become problematic. Perhaps in describing the situation in America, Maria is also anticipating one possible version of Fiji’s future in which the circumstances that predispose one to tadoka are exacerbated. This may be the way in which tadoka becomes medicalized in the future and takes on a form resembling the postpartum mood disorders defined by American psychiatry. In this hypothetical version of Fiji’s future, as in the United States, the fundamental question is how to find ways of caring that produce “relief.” Lessons for understanding mental health Through Fijian experiences of tadoka, we can learn something about mental illness, and perhaps even more importantly, about life and health. Tadoka can be contemplated as a technique of healing that adjusts to changing household set-ups and the contestation of customs in order to demand social support and legitimate forms of care for new mothers. Through tadoka, ethnic Fijians maintain the possibility of “shar[ing] your problem” and the relief that comes with it. Like Fijians, people elsewhere experience distress that does not fit into distinct biomedical categories. However, unlike Fijians, bound by our biomedical models, we lack the opportunities to experience and channels to communicate uncategorized distress. We have created words and treatments for suffering; our diagnostic categories foreclose its possibilities. Thus, the important question to ask when we define an experience as “mental illness” is what are we not saying? Looking at it this way, it seems that what Dr. Narayan might call the “backwardness” of ethnic Fijians in mental health care actually puts them at a mental health advantage. As my informants lived the tensions between biomedical categories of experience and lived realities, they communicated to me what makes up their mental health. Mental health is contingent on communication unrestricted by biomedical classification. As Maria told me, “Everybody talks about the problem here, so you don’t worry about the problem. It comes and goes.”