Christopher Dole, Living On: Psychiatry and the Future of Disaster in Turkey (Stanford University Press, 2025).
Jadaliyya (J): What made you write this book?
Christopher Dole (CD): An important impetus for the book grew from the 1999 Marmara earthquake itself. I was living in Ankara at the time and, within days of the earthquake, survivors began appearing in the neighborhood, stopping to visit relatives on the way to their family villages in central Turkey. The intensity of people’s loss and suffering that I encountered during this period would leave a deep mark on me. Six years after the earthquake, I returned to Turkey to begin work on an exploratory study about emerging models of community-based mental health care. I was interested in how a series of political and economic transformations—especially Turkey’s deepening integration into the global economy, the acceleration of neoliberal reforms, and the effects of the ongoing “EU harmonization” process—were playing out in the field of psychiatry. In dozens of interviews with psychiatrists and psychologists across the country, my questions were repeatedly and unexpectedly directed to the earthquake. If I wanted to understand the development of community mental health care in Turkey, I was told, I needed to go back to the earthquake. In fact, if I was interested in psychiatric innovation in Turkey more broadly, I needed to study the earthquake—both in terms of its psychopathological effects on the population and as a transformative event within the field of psychiatry. This would begin a decade-long effort to track the psychiatric response to and the living legacy of the Marmara Earthquake within the communities and lives of its survivors and among the Turkish mental health professionals who had responded to the disaster.
J: What particular topics, issues, and literatures does the book address?
CD: Living On weaves together two stories that span nearly twenty years. In the first, I examine the work of several groups of Turkish psychiatrists and psychologists as they struggle to intervene in the material, social, and psychological ruins of the Marmara earthquake. The second story, set outside of the urgency of disaster and in the temporality of what I call “living on,” follows the legacy of the disaster, and the psychiatric response it inspired, into the lives of people who lived through the earthquake to ask: What sorts of lives did this convergence of geological volatility and psychiatric expertise make possible?
Broadly speaking, Living On joins a growing number of scholars and writers who have argued for the necessity of forging new ways to tell stories about human flourishing in contexts of large-scale disaster and ecological transformation. Writing against the grain of conventional accounts of disaster, the book explores the earthquake as both an exceptional (and exceptionally destructive) event and the varied ways that everyday forms of chronic insecurity, inequality, and violence constituted people’s experiences of the earthquake and its long aftermath. I am especially interested in how psychiatry mediated these dynamics. Building on conversations about emerging global configurations of crisis, technology, and governance, Living On considers how and why psychiatric discourses would become so prominent in the aftermath of the Marmara earthquake, as well as the limits of the dominant frameworks through which the psychological effects of disaster are commonly rendered (e.g., psychological trauma and PTSD). In addition to engaging scholarly conversations around disaster and psychiatry, the book also offers a series of unique perspectives on Turkey's transformations over the opening decades of the twenty-first century.
J: How does this book connect to and/or depart from your previous work?
CD: While not obvious, this project grew quite organically out of my previous research on the aesthetics and politics of religious healing in Turkey. In the previous project, I conducted extended ethnographic research with practitioners of a range of healing traditions and individuals and families seeking their help. This work culminated in my first book, Healing Secular Life: Loss and Devotion in Modern Turkey (University of Pennsylvania Press, 2012). At a broad conceptual level, both projects share a common concern with therapeutic care and the subjective experience of affliction, as well as the larger historical and political economic contexts within which these form. At the same time, practically speaking, many of the people I interviewed during my earlier research were also seeking some sort of mental health care. This dimension of their therapeutic trajectories was beyond my first project. The project from which Living On emerged can be understood as filling in this missing dimension of my earlier work, albeit in a very different set of conditions.
Nevertheless, this project was a significant departure. The forms of therapeutic care were certainly different. With a turn to psychiatry, I was engaging a far more standardized and institutionalized field of technical expertise, one that was strikingly mobile and far less bound to or embedded within local contexts. These sorts of differences were predictable. What I did not anticipate was the way that the specificity of the earthquake would profoundly shift and expand my thinking. Whereas my early research was premised on a notion of the malleability of the world and people’s bodily relationship with it, the earthquake would cast these ideas into a very different light. My thinking about the world-making potentialities of healing seemed to speak to something altogether different from the world I felt moving under my feet during the Marmara earthquake. For me, the earthquake would drive a wedge between what I thought of as the world and the planet, between the worldly time of social intimacies and the planetary time of geological transformation. In certain regards, Living On is an extended effort to think through this.
J: Who do you hope will read this book, and what sort of impact would you like it to have?
CD: I imagined a broader readership for this book as compared to my first book. While there are some clearly defined scholarly audiences that will hopefully find this book useful (such as those interested in critical studies of humanitarianism, the psy-sciences, disaster studies, science and technology studies, and affect theory, to name a few), I am eager to reach readers who are in some way involved in what might be broadly called “disaster response.” This is a field that continues to be dominated by a narrow set of possibilities for imagining the effects and legacies of large-scale disaster. Among those developing mental health responses to disaster, for instance, a very specific formulation of trauma continues to shape post-disaster interventions. While this in some ways makes sense, it also blinds people to recognizing other ways that people can rebuild lives following overwhelming events. At its most ambitious, I see Living On as demonstrating how we might look to the experiences of those who have forged lives in the long wake of the Marmara earthquake for outlines of a model—however tentative, improvisational, and unfinished—for human flourishing amid dramatic environmental disruption.
The people who lived through the Marmara earthquake were also at the forefront of my thinking while I wrote this book. Despite the annual outpouring of messages on August 17 insisting that “we have not forgotten,” those who lived and survived the earthquake have been largely forgotten. While there may be little left that visibly marks this past, the continuing effects of the earthquake, more than two decades later, are very real. For those who care to spend time in the earthquake region, a vast expanse of lasting grief and pain continues to endure just below the surface of what might appear, to outsiders, as the unremarkable flow of everyday life. The extent to which they had been forgotten—and frequently instrumentalized to justify repressive policies, and as an alibi for the obscene profits being amassed by developers—would fuel in me a sense of obligation that I needed to see this project through.
J: What other projects are you working on now?
CD: I am in the very early stages of thinking about a project focused on medical debt. The extent to which people go into crushing debt due to fees associated with medical care is shocking. Developing a project that would not only document this, but also create opportunities to connect people together through their shared experiences of indebtedness, feels like something worth pursuing. It is too early to have much more to say, other than a sense that this project will take me in a very different direction.
J: In terms of your research, do you see any connections between the 1999 Marmara earthquake and the 2023 earthquakes along the border of Turkey and Syria?
CD: The 2023 earthquakes happened just as I was finishing the book, so I was only able to take this up in the epilogue. The short answer is yes, plenty. While there are of course important differences, which I detail in the book, the similarities were jarring. In terms of the focus of my research, geological volatility and psychiatric expertise would once again converge quickly. Yet the legacy of the psychiatric response to the Marmara earthquake—which had, in different ways, become institutionalized—meant that there was no need to build a post-disaster psychiatric infrastructure from scratch. The response also took shape within a public ethos less suspicious of psychological discourses and increasingly comfortable with a psychologically imbued therapeutic culture, which were themselves important legacies of the Marmara earthquake. Unlike 1999, however, the mental health response was overwhelmingly focused on what is called psychosocial care or psychosocial support, which reflects wider trends in global humanitarian action. I also think it is important to note that a large number of foreign humanitarian NGOs with considerable capacity in providing this sort of care had, in the years leading up to the earthquake, been expelled from the country following an attempted coup in 2016. As with so much, this can be read as the assertion of national autonomy and the realization of an anti-imperial psycho-politics, or a cynical ploy to consolidate power and suppress opposition at the expense of those in need. In either case, the state did not offer any meaningful response to the sorts of problems these NGOs were addressing. To date, there is no indication that the state will hold its own policies and agents accountable for the scale of death and destruction, which will only intensify and prolong the suffering of those “left behind.”
Excerpt from the book (from the Introduction, pages 29 to 31)
Writing the Disaster
Disasters are, by definition, exceptional events of such a magnitude that worlds and lives are dramatically overturned. Given the scale, complexity, and collective destructiveness of disasters such as the Marmara Earthquake, how does one convey to an audience the enormity of the destruction and loss it precipitated, and the innumerable ways—big and small—that it rippled through lives? How to describe a disaster in a way that captures both the contingent, open-endedness of its effects and the predictability of its destruction? Alternatively, how are we to square the idea of a disaster as an event that belongs to the historical coordinates of specific people and their social and singular lives, alongside an understanding of disaster that belongs to the temporal horizon of the planetary? Will tallying the dead convey something of the earthquake’s enormity? Enumerating its economic costs? Evoking what it felt like to experience the earthquake? I will try all these at different points in the following chapters. Each will prove inadequate. As the philosopher Maurice Blanchot long ago recognized, “The disaster . . . escapes the very possibility of experience— it is the limit of writing . . . the disaster describes.”
Given these challenges, it should come as no surprise that the catastrophic has long been a theme through which thinkers, especially within European philosophical and clinical traditions, have explored (and imagined) the limits of meaning, reason, and rationality. From Immanuel Kant’s reflections on the incomprehensibility of the mathematical sublime, to Blanchot’s writings on the unrepresentability of disaster, to innumerable variations on a psychoanalytic conception of the unspeakability of trauma, the catastrophic has long functioned as a foil for conceptualizing the constitution of subjects, politics, and aesthetics. As Janet Roitman has argued, “Crisis serves as a transcendental placeholder because it is a means for signifying contingency; it is a term that allegedly allows one to think the ‘otherwise.’” Anthropology, too, has long been animated by the catastrophic. The rush of anthropologists to rapidly colonizing spaces across the nineteenth and twentieth centuries in anticipation of the irretrievable loss of cultures, languages, and worlds at the joined hands of colonialism and capitalism could be read as an extended, complicitous anthropological reflection on the catastrophic. “Salvage anthropology” was, in this regard, already postapocalyptic. […] This body of work has been formative in my own thinking and writing about the legacy of the Marmara Earthquake, even as the arguments developed in this book at times look beyond modern European philosophical genealogies for theoretical inspiration.
Reflecting the fragmented and extended nature of my research, Living On moves through a series of scenes, encounters, and moments that date, roughly, from the time of the Marmara Earthquake through its twentieth anniversary. Part 1 begins the work of contextualizing the earthquake by situating a series of experiential accounts of the earthquake within the historical and material conditions that made them possible, especially those forces that conspired to render particular people and communities vulnerable to the earthquake’s destructiveness. Part 2 focuses on the psychiatric infrastructure that took form within the earthquake’s immediate aftermath. The chapters that constitute this section follow the work of several groups of volunteer psychiatrists and psychologists as they struggle, amid extraordinary loss and upheaval, to transform the earthquake’s aftermath into a site of therapeutic care. I consider, in turn, their efforts to reimagine the scalability of their psychiatric expertise, rework their assumptions about the psychological subject of disaster, and weave therapeutic techniques into the everyday lives of suspicious communities. Exploring these emergent entanglements of disaster and psychiatry not only offers an account of how an improvised and decentralized post-disaster psychiatric infrastructure would, in time, touch thousands of lives, but also brings into view emergent arrangements of psychiatry, disaster, and security forming in the region over the same period.
Part 3 shifts into the temporality of “living on” to explore the ways this convergence of geological volatility and psychiatric expertise continue to shape lives decades into the earthquake’s future. Grounded in long-term ethnographic research conducted throughout the region, the chapters in this part offer an account of the varied forms and formations of loss and possibility taking shape in the extended aftermath of disaster. Set against a recognition of the limits of trauma-focused approaches to disaster, I explore a set of pervasive moods, sensibilities, and affects that continue to unsettle inner and outer worlds—what I regard as disaster’s “minor feelings”—and stories of enduring grief that articulate what I characterize as an “optimistic” relationship between past loss and livable futures. In writing against the grain of conventional accounts of disaster, this part also offers a series of ethnographic reflections on shifting arrangements of disability, citizenship, and expertise that the earthquake gave rise to, as well as the ways that the psychiatric response to the earthquake provided new idioms for political protest and occasions for people to be born anew out of experiences of catastrophic loss.
Just as I was completing this book, Turkey experienced another series of massive earthquakes, this time along its southern border with Syria. The scale of death and destruction was extraordinary. Although nearly twenty-five years had passed since the Marmara Earthquake, the scenes streaming from the region—of city blocks reduced to piles of concrete and rebar, of desperate residents digging through rubble in search of survivors, of tent settlements quickly filling cleared fields and emptied stadiums—were so familiar. While the similarities were impossible to ignore, much had also changed in the time between these two disasters. I return in the book’s epilogue to a short reflection on how the legacy of the Marmara Earthquake, and especially the psychiatric response it inspired, would extend into this new disastrous present.