recounted the training she had received from the team that arrived from Lima: “The trainers told us that campesinos are very imaginative, and they would tell us all sorts of fabulous things. We were warned not to fall for all of that. Susto [soul loss due to fright], llakis [painful memories that fill the body and torment the soul], irritation of the heart—they told us those things were inconceivable. They don’t exist.”
I was baffled. “So what were you told to do when you were working on the relatos?”
“Well, they asked us to describe some of the symptoms—fearful, loss of appetite, painful memories. They said some things could be malnutrition, but most of it was trauma. They told us that people were suffering from trauma.”
“So in the relatos, you categorized these ailments as trauma?”
Sandra nodded. “Yeah, these problems were coded as trauma [estar traumado].”
Coding for Trauma
Among neighbors, among family members—we killed each other here. Jesúcristo, even now I still don’t understand.
—Moises, Tiquihua, 2003
The violence in Peru frequently involved people who lived in the same social worlds and knew each other well—or at least thought they did. In many communities, these same people find themselves forced to share spaces that were recently scenes of intimate, lethal violence. When a woman continues to live across the street from her rapist, or a son crosses paths each week at the market with the men who murdered his father, what does it mean to work on mental health? How can we best understand and respond to the psychological aftermath of war?
The discourse of trauma—and the psychiatric diagnosis of post-traumatic stress disorder (PTSD)—plays a prominent role in postconflict and humanitarian conceptions of suffering. This diagnosis was first included in the American catalogue of psychiatric disorders in 1980 with specific reference to Vietnam-era American war veterans. Over the past three decades the range of application of this diagnosis has expanded dramatically, and concepts of traumatic memory have become the dominant framework for medical engagement with social suffering both domestically and internationally.1 There is an enormous market for trauma and an industry of trauma experts deployed to postwar countries to detect symptoms of PTSD via the use of “culturally sensitive” questionnaires. In the process of globalizing the discourse of trauma through humanitarian and postconflict interventions, the trauma narrative itself has become increasingly normative, making it difficult to think otherwise about violent events and their legacies. From Holocaust survivors to U.S. soldiers in Vietnam, from battered women in Latin America to child soldiers in the Congo and survivors of rape in the Balkans, mainstream trauma theories beguile with their alleged capacity to encompass vastly divergent experiences fraught with etiological and moral complexity.2
Parallel with the growth of the trauma industry, however, has been a debate regarding the diagnostic category PTSD and its underlying assumptions. The literature questioning the utility of PTSD in “non-Western” or nonclinical settings—for example, in postwar contexts—is abundant, and I will not rehearse a well-worn series of debates.3 There is, however, a gap between academic critique and the “on the ground” world in which battles are waged over funding priorities, service design, and delivery. When I worked with the PTRC in Ayacucho, it became clear that nongovernmental organizations would be jockeying for position to work on mental health, with mental health concerns frequently reduced to “trauma.” A scant three years later, many people would accuse those same NGOs of “trafficking with the blood and the pain of the people” in their efforts to secure funding during the “mental health boom.”4
A caveat. One hackneyed anthropological move is to speak “our” cultural relativism to “their” (read: psychiatry’s) universalism via a litany of examples that at times resemble a compendium of exotica.5 I am not interested in assembling a list of sundry illness categories, pinned to the page like so many colorful butterfly wings. Rather, my aims are twofold. First, I want to question an enduring juxtaposition and its consequences: some people and groups have “theory” and others have “beliefs”; some people and groups export categories of knowledge, while others remain resolutely “culture bound.” One problem with the increasingly normative trauma discourse and models such as PTSD is their pretentious scope, reducing other theories (generally called “beliefs and customs”) to little more than local deviations of a universal truth. From this perspective, there would be little or nothing to learn from the sophisticated theories Quechua speakers have elaborated about violence and its effects, about social life and their struggle to rebuild it.
Second, I want to investigate the social and moral implications of framing violence and its legacies in terms of trauma.6 I am troubled less by the relativist concern with the imposition of “Western categories” and more by what the discourse of trauma allows people to say and do. Approaching these topics in terms of the “West and the rest” is not useful, descriptively or analytically.7 “Western categories” elide the complex ways in which people engage with global institutions and obscure how place-based engagements with these institutions involve complex, unpredictable negotiations and outcomes. Rather than assuming a “traumatized” population that homogenizes victims and perpetrators into a morally elastic category, there are more interesting and complicated stories to tell. These stories might, in turn, teach us a great deal about the individual and collective consequences of lethal, intimate violence and what is involved in reconstructing both people and place in the aftermath of war.
In this chapter and the next, I explore the discourse of trauma and how it moves in local social and political fields.8 Trauma is, in part, a technology of commensuration designed to yield scientifically authorized categories of harm across vastly divergent lifeworlds. I discuss the implications of the PTRC’s coding process and what was lost in translation. I then move on to the theories Quechua speakers have about health, illness, and healing, exploring the crucial links between the body and memory, between emotions and illness, between ethnopsychological concepts of the human and what these reveal about processes of punishment, atonement, and, at times, redemption.
* * *
I was proud to work with the Peruvian TRC, and their Final Report is rigorous and politically important. However, certain methodological aspects troubled me. “Coding for trauma” was one of them. How can interventions help people rebuild their lives without understanding locally salient theories of illness, health, agency, and social repair? How do we respond to the needs of survivors of war without understanding the local forms and logics of social ties and their transformation? Without understanding what makes a being human, and to whom that status is conferred or denied?
In his analysis of the data coding process employed by the South African TRC, Richard Wilson found that the desire to create legally defensible findings led to the development of an elaborate classification scheme that broke each testimony down into a series of forty-eight categories of violation. Wilson argues that “The integrity of the narrative at the data processing stage was destroyed as processors deconstructed the single narrative and ‘captured’ discrete acts and the details of victims, witnesses and perpetrators.”9 The creation of legally defensible findings thus came at the expense of victims’ experience of telling their stories, which in turn led to the “Final Report [being] little more than a chronicle of wrong acts.”10
Although the PTRC’s Final Report moves far beyond a mere chronicle of human rights violations, I share Wilson’s concerns about the systematic distortions involved in converting testimonies into evidence. Truth commissions are aware they are producing final reports for various audiences. One audience is the “international community,” and this is an incentive to employ key diacritics of veracity: linear chronologies, tables and charts, quantifiable violations, dates, times—and trauma. As a technology of commensuration, the discourse of trauma is globally recognized and can “authorize the real.”11 Thus locally salient categories of affliction, which may reference radically different understandings of etiology, are coded as trauma. This entails important semantic shifts. It also simplifies complex moral and political situations.12