It is necessary to mention that the idiosyncrasy of the villagers makes it difficult to carry out the activities of health professionals. This is due to the still persistent taboos, myths and other customs of the community, as well as other sociological factors.20
There is a tendency to assume that cosmopolitan medicine—that is, biomedical models—are outside of culture, transparently reflecting a universal biology without cultural mediation. From this perspective, culture is something belonging to the “other” and serves as an obstacle to the advance of science and its double, modernity. In my interviews with personnel in rural health posts, the “beliefs” and baja cultura of the campesinos were frequently cited as barriers to service provision and compliance. As the sign hanging in that waiting room proclaims, “abandon your myths and taboos at the doorstep, all ye who enter here.”
This thinking infuses program design and delivery. For instance, the government agency established to coordinate postwar reconstruction efforts—the Programa de Apoyo al Repoblamiento (PAR)—compiled the results of focus groups held throughout Ayacucho on the theme of sequelae and reparations.21 On page 68 of the report, the authors assert it was a great “advance” that participants in their focus groups spoke of “being traumatized” and located mental health within their priorities.
The assertion that this is an “advance” is perplexing. Evidently, if before campesinos had their taboos and myths, now they were suffering in scientific style. If campesinos say they need elixirs for daño, offerings for the apus, qayapa (“calling the soul”) for susto, perhaps they have not suffered, or perhaps their suffering is simply inconceivable.
One day during the TRC process I discussed my research project with a group of young men in Uchuraccay. They were dressed in tennis shoes, jeans, and cheap ski jackets; baseball caps sat snugly atop the brightly colored chullos they wore to keep their ears warm. Older people, particularly the women, referred to these young men as moderña warmakuna (modern young people). Often as not, the term was a lament! Several of these moderña warmakuna had spent part of their lives in the city, just children when their parents packed up what they could and fled during the internal armed conflict.
I discussed some of the themes that had surfaced in the research, such as daño and llakis, and was interested in hearing what they thought about these ailments. They laughed a bit, kicking the ground with their tennis shoes. Julian, one of the moderña warmakuna, shook his head and scoffed: “You know, I’ve studied in the city. I lived there and I went to school. Daño, llakis—all that’s just belief. Only the ignorant and illiterate believe all that. I studied in the city and I know what we have is trauma.”22
How one is ill both reflects and establishes social status.23 With the influx of state and NGO interventions throughout Ayacucho, campesinos learned to express suffering in a language that could make their suffering legible to the experts, to “outsiders.” Talking trauma legitimates their pain in the face of those who discard their afflictions as mere superstition or survivals from some distant past. One motivation for talking trauma is recognition—recognition for being someone just as capable of suffering as the person sitting on the other side of the desk in the health post, or holding a clipboard and pen, poised to complete the PTRC’s questionnaire.24
Veena Das and Ranendra Das’s comments on medical pluralism echo here: “Although biomedical categories and therapies have reached different parts of the world in very different ways, the condition of medical diversity or medical pluralism is now universal. The fact raises significant questions about how concepts of health and illness travel. How are these concepts translated, and how do people deal with different expert cultures in making intimate bodily experiences available for therapeutic intervention?”25 In addition to asking how people translate illness categories and what sorts of claims are expressed via the identities and social dynamics these categories construct, it is worth exploring how people understand what interventions, in this case psychological services, can do.
“Too Much Memory”
One morning Edgar, the guard in the TRC’s Ayacucho office, peered around my door. “Doctora Kimberly, there’s someone here to see you. He says he’s from Hualla.”
Both Edith and I headed out to see who it was. The man standing just inside the enormous wooden portal was unknown to us, at least until he introduced himself: Hernán Pariona. Edith and I exchanged a furtive glance and anticipation tickled the back of my neck. We had never met Hernán, but we had heard so much about him from people in Hualla. He had been one of the key Shining Path militants in town and, depending upon the speaker’s allegiance during the war, he was alternately described with admiration, hatred, or fear.
We invited him into our office and began some small talk as Nescafé crystals slowly dissolved in our cups of hot water. Hernán had been living in Ica for a few years, returning occasionally to Hualla to tend to the land he owned. On this trip he had come straight from Hualla to our office because he had been told about our research team.
“People said you were working on mental health, and that’s what we need,” he explained. “We need psychological treatment in Hualla.”
I was struck by his request. It was the first time someone had placed psychological treatment on the list of needs they discussed with me. I quickly replayed some conversations in my mind. Several people in Hualla had assured us theirs was a “traumatized pueblo,” describing the bitter conflicts that surfaced when people were drinking. I recalled one of José Carlos’s field note entries: Several people had complained to him about how tense Hualla was. “People start insulting each other, calling each other terrucos [slang for “terrorists,” referring to members of Shining Path]. They say, ‘I know what you did.’ Others threaten, reminding us just who we’re living with.”
I hesitated for a moment. “Hernán, tell me a bit more about the psychological treatment you want in Hualla.”
He shifted in his chair and exhaled his frustration. “Life in Hualla is impossible! People argue all the time. Before we can even think about reconciliation, we need psychological treatment.”
“And what is it about psychological treatment in particular that would help?” I wondered.
“Well, everybody keeps remembering everything. They keep insulting each other, especially when they’re drunk. It’s one big fight. If we could have professional attention—therapy with a professional—we could forget everything that happened.”
“So, therapy would be necessary so you could live together again?”
Hernán nodded. “That’s right. You know what the big problem in Hualla is? There’s too much memory—way too much memory,” repeating the line for emphasis. “With psychological treatment, we could forget everything. That way we could live together again—peacefully,” he added.
Hernán’s understanding of therapy and what it might achieve is fascinating. Somehow professional attention could erase the memories and assist people in achieving a state of forgetfulness. This is certainly at odds with the redemptive vision of memory that characterizes contemporary memory politics. Even more interesting was the person soliciting the therapy: a former Shining Path cadre who later assured me that ex-Senderistas were marginalized and mal visto (negatively viewed) in Hualla by those who blame them for the devastation of the internal armed conflict. Too much memory indeed.26
Returning to the section of the PTRC’s Final Report in which the mental health team analyzed the 401 testimonies, there is a finding that bears upon this discussion: “Despite the lack of mental health services in the country, which carries with it a lack of information on the part of the population about the type of attention and help they could receive from this sort of service, eleven percent of the [401] testimonies analyzed registered explicit requests for psychological support to respond to the effects of the political violence.”27 What