psychological support, is that we do not know what that 11 percent think psychological support might do for them and for those around them.
Despite their omnipresent criticisms of their health posts, people are not rejecting medical care per se. Indeed, claiming trauma is in part a demand for services. Talking trauma is one way of constructing the intervenable subject—individually and collectively. There will be no projects providing elixirs for daño, no NGOs heading to the mountains with sacrifices for the apus. Interventions and their subjects must fit within a modernist paradigm: angry ancestors no, trauma yes. The modern subject of suffering is traumatized.
However, if the researcher listens to the concerns of survivors in these communities, then she must focus on social disorders, injustice, angry gods, witchcraft, poverty, and spiritual and moral confusion. The researcher must account for a social world that is dangerous and capable of producing affliction. Arthur Kleinman and Joan Kleinman have suggested that the ethnographer focus on what is at stake for particular people in particular situations in order to understand the social-psychological characteristics of life in local moral worlds.28 What is at stake in postwar contexts is the reconstruction of social relationships, moral communities, cultural forms, and economic networks, and the reinvention of ritual life that allows people to make sense of suffering endured and suffering inflicted.29
I oriented my research around a few basic questions: What do people suffer from? What aches and why? Whom do they hold responsible and what should be done with them? How do people talk about what is wrong with their world, and how might it be set right? These questions led to the theories Quechua speakers have developed about the body and memory, about emotions and illness, and about the qualities that constitute being human.
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Marcos was the promotor de salud (a layperson trained in first aid)30 in Carhuahurán. He came by early one morning, seeking assistance in writing a request for funds to establish a “soup kitchen” for children under the age of five. Marcos brought a clean sheet of white paper and the community’s rusty typewriter with him.
In the request, Marcos discussed how the political violence had severely affected Carhuahurán, prompting him to solicit funding to open the Children of Jesus Soup Kitchen. I suggested we strengthen the request by incorporating statistics from the health post indicating that 80 percent of the children in Carhuahurán and its eleven outlying annexes (pagos) suffered from chronic malnutrition. Marcos nodded emphatically: “Yes. You know, here we need to think of the violences,” emphasizing that chronic hunger and poverty would require us to speak of violence in its plural form.31 War and poverty had both assaulted his community, with various consequences. Violence is frequently described as senseless, which I accept with modification. Horrific violence destroys accepted meanings (while creating others) and assaults the sensory organs. Allen Feldman has referred to a “sensorium of violence” to capture how one’s perceptions are altered by armed conflict and fear.32 It is the overwhelming sentience of violence that stands out in my conversations with survivors of war. Survivors’ testimonies are punctuated with syllables imitating the bombs that fell and the whipping wind of the army helicopters. Many people insisted they had cried until they had lost their vision—insisted bodies that carry so much sadness are bodies that ache and age before their time.
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Byron Good has argued that one contribution anthropology offers to the study of psychopathology is a focus on phenomenological reality—the categories of experience associated with a particular phenomenon rather than symptom criteria presumed to reflect universal biological categories.33 Entering into the realm of meaning and experience allows us to grasp different understandings of etiology, as well as how health and illness are socially and historically produced. Thus we can move beyond stale debates regarding universality versus cultural specificity, combining an interest in human nature with a commitment to investigating human conditions.
Drawing upon phenomenology, Thomas Csordas has suggested “embodiment” as a methodological approach in which bodily experience is understood as the existential basis of culture and of the self.34 Embodiment begins with the assumption that all human experience is intrinsically embodied social experience, which involves a mode of presence and engagement in the world. From this perspective, the body in its various cultural configurations is used as a means of expressing emotions and states of being; what varies is how one learns both to be and to have a body as a member of any given culture.
I combine these approaches with one other: local biologies. Biology is in part a system of signs and meanings, subject to cultural transformation. For instance, Margaret Lock researched menopause in Japan and found that the end of menstruation was significantly different from what is frequently considered universal or “natural.” For Japanese women, menopause was not accompanied by the array of symptoms and medicalized responses that characterize the experiences of menopausal women in Canada and the United States. Lock combines her ethnographic research with epidemiological studies of differences in the distribution of heart disease, osteoporosis, and breast cancer in Japan and in the West, leading her to insist that “local biologies” are at work.35 These theoretical tools allow us to explore how a recent history of violence is embodied and expressed. There are local biologies of poverty, rage, fear, grief—and an array of responses that underscore the close ties between mental health, the administration of justice, and the micropolitics of reconciliation.
Local biologies mean that bodies are historical processes and historical sites. Memories sediment not only in the burned-out houses and churches that dotted the landscape when I began my work in Ayacucho but also in the bodies of the people with whom I have lived.36 As Paul Stoller insists, “the sentient body is culturally consumed by a world of forces, smells, textures, visions, sounds and flavors that unchain, all of them, cultural memories.”37 Violent experiences leave embodied traces. These traces persist in the stiffness of a neck, the burning of nerves, or the aching of a womb.
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It was midday when Dionisia came to my room, the folds of her skirts wrapped tightly in her hands. She called my name from the doorway and I looked up to see her unfolding the embroidered top layer to reveal two eggs her hens had laid earlier that morning. Dionisia’s chickens had somehow survived the long presence of the military base that had occupied the hill overlooking Carhuahurán. When at first I had asked people why there were so few chickens in the village, they looked puzzled by a question with so obvious a response: “We don’t have chickens. We have soldiers.” What initially sounded like a non sequitur in fact conveyed much about civil-military relations during Peru’s internal armed conflict.
I thanked her for the eggs, aware that any protein-rich food was scarce. I offered her a cup of miski yaku. I loved Dionisia. She was a storyteller, a self-proclaimed bocona y reclamona—a “big mouth” who was quite ready to voice her opinion but always with great humor. She had a crinkle-eyed laugh that made both her dangling earrings and me rock back and forth. When I was still a newcomer to the village and a source of tremendous concern and distrust, Dionisia was one of the first women to visit me. It was Dionisia who had convinced the other women that the large sack I carried with me when I went in search of kindling was not used to smuggle out their children in the depth of a moonless night.
She had come to get me so that we could walk down the mountain to her house, lay out in the sun, and talk. “Today I want to tell you about my son,” she said. My research assistant Madeleine and I gathered up a few of our things and we headed down to the patch of sun that fell behind her kitchen. She went into her house to grab some blankets and began shaking them out and placing them on the ground. Dionisia began to unwind her chumbi, the long woven belt that women use to wrap layers of skirts around their waists. I opened my bag and took out the massage lotion I used when talking with Dionisia. As with several other women, when the conversation turned to sadness and loss I would massage them, directing my hands to the part of their body that ached with the telling. I prepared to rub her lower back as I usually did, but she stopped me. “No, today I want to talk about my son who was killed.” She rolled onto her side and placed my hands on her abdomen: “This is where I hurt.”
I began to rub