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 is intriguing, even more than the small percentage of people who requested 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.
* * *
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
