Structural violence and emotional health: a message from Easington, a former mining community in northern England.

This discussion paper, written by a UK general practitioner and graduate student of anthropology, explores the uncomfortable relationship between institutionalised inequalities of wealth and opportunities, and emotional health, in a disadvantaged community in the north-east of England. The author begins by locating the thesis in the corpus of anthropological literature which acknowledges human suffering and refuses to adopt a position of cultural relativism. The complex and elusive phenomenon of structural violence is unpacked, followed by a description of the setting and the author's methodology. Clinical observations are presented as contextualised narratives located around three themes: alcohol misuse; gendered violence; and inter-generational violence. The vignettes portray how the consequences of institutionalised inequalities are manifest in the embodied and emotional lives of many who live in economically marginalised communities. The author concludes with a discussion of the dilemma at the heart of a morally engaged practitioner's clinical practice as one who eschews the dominant ideology of individual responsibility for health and recognises that agency is compromised by structural violence.