<Emphasis Type="Italic">Llaki</Emphasis> and <Emphasis Type="Italic">Ñakary</Emphasis>: Idioms of Distress and Suffering Among the Highland Quechua in the Peruvian Andes

This article examines some of the long-term health outcomes of extreme adversities and the ways in which social inequalities and idioms of distress are historically and socially produced in the Peruvian context. We describe how the highland Quechua of northern Ayacucho construct and experience expressions of distress and suffering such as pinsamientuwan (worrying thoughts, worries), ñakary (suffering) and llaki (sorrow, sadness), in a context of persistent social inequalities, social exclusion and a recent history of political violence. It is concluded that the multiple expressions of distress and suffering are closely related to past and current events, shaped by beliefs, core values and cultural norms and, in this process, transformed, recreated and invested with new meanings and attributions.     

Kiyang-yang,a West-African Postwar Idiom of Distress

In 1984, a healing cult for young barren women in southern Guinea Bissau developed into a movement, Kiyang-yang, that shook society to its foundations and had national repercussions. “Idiom of distress” is used here as a heuristic tool to understand how Kiyang-yang was able to link war and post-war-related traumatic stress and suffering on both individual and group levels. An individual experience born from a traumatic origin may be generalized into an idiom that diverse sectors of society could embrace for a range of related reasons. We argue that, for an idiom to be understood and appropriated by others, there has to be resonance at the level of symbolic language and shared experiences as well as at the level of the culturally mediated contingent emotions it communicates. We also argue that through its symbolic references to structural causes of suffering, an idiom of distress entails a danger for those in power. It can continue to exist only if its etiology is not exposed or the social suffering it articulates is not eliminated. We finally argue that idioms of distress are not to be understood as discrete diagnostic categories or as monodimensional expressions of “trauma” that can be addressed.     

Civil war and the non-linearity of time: approaching a Mozambican politics of irreconciliation

At least 1 million people died during the Mozambican civil war (1976/7-92). Unfolding after gaining independence from Portugal (1975) and alongside experiments with Afro-socialism in the 1980s, the war, despite its brutality, has not been subjected to global templates of reconciliation processes. Thus it comprises a unique case to probe what irreconciliation might mean – both as a political horizon and as an analytical concept. This text juxtaposes ethnographic material from rural, central Mozambique from the late 1990s and early 2000s emphasizing reconciliation with material from the same spaces from the 2010s onwards, where I identify what I term a ‘politics of irreconciliation’. I will make three arguments. First, informed by Hannah Arendt, I approach irreconciliation as fundamentally about the rejection of a world of violence in search of a world shared in common. Second, drawing on recent anthropological theorizing about temporal regimes and chronopolitics, I argue for the salience of a non-linear understanding of the politics of irreconciliation to grapple with the fact that civil war violence is understood as dangerously uncontained rather than nominally past. Third, within the context of Mozambique, forgiveness and its other, irreconciliation, are not only intimately tied to the temporally past or present; they are also, as I show, produced by a tangible and intense absence of a productive future.     

In memoriam: Gustaf Bolinder 19/12 1888–16/7 1957

Veena Das's work on suffering suggests that the appropriate approach to the subject is one that grounds research in social experience. To honor this pitch of anthropology, I examine the global mediatization of the trauma of political violence and its moral implications. I also describe the professional appropriation of suffering that transforms political economic conditions into medical realities. Because social experience is itself undergoing a profound alteration in the present period of disordered capitalism, the very phenomenological conditions that we have assumed as an ‘existential’ basis for responding to human misery are also being ominously transformed.     

``Terror's Talk: Fieldwork and War'

My purpose in this essay is to raise some questions about what isinvolved in research on political violence. Since 1995 I haveconducted ethnographic research in rural villages throughoutAyacucho, the region of Peru most heavily affected by the warbetween the guerrilla group Sendero Luminoso, the rondascampesinas (armed peasant patrols) and the Peruvian armed forces.A key factor motivating my research was a desire to write againstthe culture of violence arguments that were used to ``explain'the war. The concept of a ``culture of violence' or ``endemicviolence' has frequently been attributed to the Andean region,particularly to the rural peasants who inhabit the highlands.I wanted to understand how people make and unmake lethal violencein a particular social and historical context, and to explore thepositioning and responsibilities of an anthropologist who conductsresearch in the context of war.     

A Mother’s Heart is Weighed Down with Stones: A Phenomenological Approach to the Experience of Transnational Motherhood

Although recent scholarship on transnational mothers has rigorously examined the effect of migration on gender constructs and ideologies, it neglects analysis of the lived experience of separated mothers and children. In privileging the exploration of transnational separations through the single analytical lens of gender, such research reduces the embodied distress of mothers and children to mere “gender false consciousness.” This paper calls upon anthropologists to redress this oversight by undertaking a phenomenological analysis of the lived experience of transnational motherhood. Eschewing an analysis of mothers and children as isolated social roles, I show that the suffering of mothers and children is profoundly relational. Through analysis of the narratives of undocumented Salvadoran mothers residing in the U.S., I show how the strain of such mothers’ undocumented status is lived and shouldered within the intersubjective space of the family.

Painful languages of the body: experiences of headache among women in two peruvian communities

This exploratory study focuses on the understandings of and experiences with headache in two settings in Peru: the Quechua-speaking district of Ayacucho, in southern Peru, and a poor urban district of Lima Metropolitana. More specifically, it explores the personal and collective meanings constructed around women’s headache experiences. Structured and open-ended interviews were administered to patients suffering headache to elicit interpretations of headache episodes. An analysis of the collected narratives suggests that headache is often comprehended in a polysemic framework, where meanings ascribed in bodily, emotional, family, and social terms articulate individual and shared notions of suffering within larger contexts of social dislocation. Often woven into experiences of solitude, headache accounts are lived and told in dynamic temporal spaces, and narrate dissolution of family ties and tensions associated with women’s roles. The results underscore the significance of patients’ subjective interpretations of painful experiences and underscore the connections between bodily and emotional pain and distress experienced at family, community, and larger social levels.     

Social support and distress among Q'eqchi' refugee women in Maya Tecún, Mexico

This article addresses issues of vulnerability and distress through an analysis of the relationship between social support networks and traumatic stress in a Q'eqchi' refugee community in southern Mexico. The sociopolitical violence, forced displacement, and encampment of Guatemalan Mayan populations resulted in the breakdown and dispersal of kin and community groups, leaving many Q'eqchi' women with weakened social support networks. Research involving testimonial interviews and traumatic stress and social support questionnaires revealed that Q'eqchi' refugee women with weak natal kin social support networks reported greater feelings of distress and symptoms of traumatic stress than did women with strong networks. In particular, a condition identified as muchkej emerged as one of the most significant symptoms reported by women with weak natal kin support networks. I critically consider muchkej as an idiom of distress and argue that aid organizations should consider the relationship between social support and traumatic stress, as expressed through such idioms, when attempting to identify vulnerable members of a refugee population.     

Epidemiology of violence and war

The magnitude of the threat that violence and war pose to the health, the quality of life, and the very survival of humanity is obvious. A number of scientific disciplines have provided, each through its own methodology, insights into the causation, genesis, and dynamics of violence and war. Although epidemiological and psychological methodologies received priority, the multidisciplinary approach to this problem seems to be the most appropriate. This essay attempts to approach holistically the study of epidemiology of violence and war and the ways of preventing these severe problems of the contemporary society. Conceptual models of the causative mechanisms and dynamics of violence and war, mapping the various psychic, social, and environmental factors, are presented. These models, besides advancing abstract ideas, also provide a concrete framework for determining and exploring the interactions and dynamics of the factors and processes which lead to violence and war. The types of interventions outlined for control and prevention are intended to make an impact upon "critical points" within the dynamics of the process which produces violence and war, and are conceived to be implemented on both the national and international level. The importance of family, community, and school influences is considered, but the role of international organizations, including the United Nations, and other governmental and non-governmental organizations is also stressed. Discussion is focused on the factors which favour peace and hamper aggression, on "internationalization" and global society versus xenophobia and nationalism. The conclusions state that there is sufficient knowhow to devise and implement a reasonable and effective international programme for the control and prevention of violence and war, provided there is adequate public and political willingness and support.     

What really is the nature of suffering? Three problems with Eric Cassell’s concept of distress

Eric Cassell famously defined suffering as a person’s severe distress at a threat to their personal integrity. This article draws attention to some problems with the concept of distress in this theory. In particular, I argue that Cassell’s theory turns on distress but does not define it, which, in light of the complexity of distress, problematizes suffering in three ways: first, suffering becomes too equivocal to apply in at least some cases that Cassell nevertheless identifies as suffering; second, Cassell’s account does not explain what sort of experience suffering is, resulting in theoretical and practical difficulties in distinguishing it from other medical conditions; third, there is good reason to believe that, in medical contexts, ‘distress’ just means ‘suffering’ or some cognate concept not yet distinguished from it, rendering Cassell’s theory circular. I consider a rebuttal to my objections and reply, concluding that Cassell’s theory of suffering needs a definition of distress to settle what the nature of suffering really is.     

“Pensando Mucho” (“Thinking Too Much”): Embodied Distress Among Grandmothers in Nicaraguan Transnational Families

In this paper, I describe an embodied form of emotional distress expressed by Nicaraguan grandmothers caring for children of migrant mothers, “pensando mucho” (“thinking too much”). I draw on ethnographic fieldwork and semi-structured exploratory interviews about pensando mucho conducted with grandmother heads-of-household to show the cultural significance of this complaint within the context of women’s social roles as caregivers in transnational families. Adopting an interpretive and meaning-centered approach, I analyze the cultural significance of pensando mucho as expressed through women’s narratives about the impacts of mother outmigration on their personal and family lives. I show how women use pensando mucho to express the moral ambivalence of economic remittances and the uncertainty surrounding migration, particularly given cultural values for “unity” and “solidarity” in Nicaraguan family life. I also discuss the relationship between pensando mucho and dolor de cerebro (“brainache”) as a way of documenting the relationship between body/mind, emotional distress, and somatic suffering. The findings presented here suggest that further research on “thinking too much” is needed to assess whether this idiom is used by women of the grandmother generation in other cultural contexts to express embodied distress in relation to broader social transformations.     

Beyond Critique: Rethinking Roles for the Anthropology of Mental Health

The current supremacy of the ‘bio-bio-bio’ model within the discipline of psychiatry has progressively marginalized social science approaches to mental health. This situation begs the question, what role is there for the anthropology of mental health? In this essay, I contend that there are three essential roles for the anthropology of mental health in an era of biological psychiatry. These roles are to (i) provide a meaningful critique of practices, beliefs, and movements within current psychiatry; (ii) illuminate the socio-cultural, clinical, and familial context of suffering and healing regarding emotional distress/mental illness; and (iii) act as a catalyst for positive change regarding healing, services and provisions for people with emotional distress/mental illness. My argument is unified by my contention that a credible anthropology of mental health intending to make a societal contribution should offer no opposition without proposition. In other words, any critique must be counter-balanced by the detailing of solutions and proposals for change. This will ensure that the anthropology of mental health continues to contribute critical knowledge to the understanding of mental suffering, distress, and healing. Such social and cultural approaches are becoming especially important given the widespread disenchantment with an increasingly dominant biological psychiatry.     

Warfare in an evolutionary perspective

The importance of warfare for human evolution is hotly debated in anthropology. Some authors hypothesize that warfare emerged at least 200,000–100,000 years BP, was frequent, and significantly shaped human social evolution. Other authors claim that warfare is a recent phenomenon, linked to the emergence of agriculture, and mostly explained by cultural rather than evolutionary forces. Here I highlight and critically evaluate six controversial points on the evolutionary bases of warfare. I argue that cultural and evolutionary explanations on the emergence of warfare are not alternative but analyze biological diversity at two distinct levels. An evolved propensity to act aggressively toward outgroup individuals may emerge irrespective of whether warfare appeared early/late during human evolution. Finally, I argue that lethal violence and aggression toward outgroup individuals are two linked but distinct phenomena, and that war and peace are complementary and should not always be treated as two mutually exclusive behavioral responses.     

Terror Warfare and the Medicine of Peace

Terror warfare's goal is to defeat political opposition by controlling populations through the fear of brutality. Mozambique's 1976–92 war stands as a prime example of this military strategy: over one million people, the vast majority of whom were civilians, were killed. Half of these casualties were children. Fully one-half of the population was directly affected by the war, and one-quarter had to flee their homes. As devastating as terror warfare is, it is destined to fail. People ultimately resist, and they do so in complex and creative ways. Rebuilding war-destroyed worlds, healing the wounds of violence, and crafting concepts of self-identity based on resistance to aggression become powerful conflict-resolution strategies among the average citizenry. The creative resources that Mozambicans developed to survive and end a very brutal war are among the most sophisticated I have seen anywhere in the world. Their war was against violence itself. [War, healing, creativity, conflict resolution, Mozambique]     

Emotions and the intergenerational embodiment of social suffering in rural Bolivia

In this article, I take the embodied manifestations of distress across generations as the lens from which to illustrate the subtle articulations between the political restructuring of the Bolivian state and the private anxieties women experience under enduring political and economic instability. Emotions such as rage and sorrow generated by economic hardship, domestic violence, and social conflict played a fundamental role in how market- and working-class women perceived not only their own health problems but also many of the health problems that affected their infants. Mother's bodies and emotions are seen as the vectors through which gestating babies and breastfeeding infants develop transient and enduring ailments and debility.     

Reflections on Teaching Social Violence in an Age of Genocide and a Time of War

This article is a reflection by a teacher and a student on "structural-violence pedagogy," the process of teaching and learning about the structures of inequality implicated in various forms of social violence, including those of everyday life, massacre, and genocide. Using a case study of an undergraduate course in anthropology, we explore the complexity and emotionally charged nature of this field, some innovative teaching strategies, and contributions of anthropology to understanding a world marked and marred by war, genocide, racialization, and structural poverty. The teacher shapes a course of study informed by critical pedagogy and theories about violence and power. The student draws on her personal experiences, her intellectual interests, and her yearning for fuller answers to deeper questions as she seeks to reciprocate what is being taught to her. Together, teacher and student explore the promise in the power of teaching for understanding the world as it does exist.     

The life and death of a street boy in East Africa: everyday violence in the time of AIDS

This article focuses on the life history of a single street boy in northwestern Tanzania, whom I name Juma. I suggest that Juma's experiences and the life trajectory of himself and of significant individuals around him (particularly his mother) were structured by everyday violence. I describe everyday violence in terms of a conjuncture between macrostructural forces in East Africa (including a history of failed development schemes and the contemporary political economy of neoliberalism) and the lived experience of individuals as they negotiate local, contextual factors (including land-tenure practices, the power dynamics between immediate and extended kin, life on the streets, and constructions of gender and sexuality). I suggest that AIDS and its many impacts on Juma's life course can only be understood in a broader context of everyday violence. From this basis, I draw several general conclusions regarding AIDS prevention and intervention strategies.     

Suffering at the end of life

In the end‐of‐life context, alleviation of the suffering of a distressed patient is usually seen as a, if not the, central goal for the medical personnel treating her. Yet it has also been argued that suffering should be seen as a part of good dying. More precisely, it has been maintained that alleviating a dying patient’s suffering can make her unable to take care of practical end‐of‐life matters, deprive her of an opportunity to ask questions about and find meaning in and for her existence, and detach her from reality. In this article, I argue that the aims referred to either do not support suffering or are better served by alleviating it. When the aims would be equally well served by enduring suffering and relieving it, the latter appears to be the preferable option, given that the distress a patient experiences has no positive intrinsic value. Indeed, as the suffering can be very distressing, it may not be worth bearing even if that was the best way to achieve the aims: the distress can sometimes be bad enough to outbalance the worth of achieving the goals. Having considered an objection to the effect that a patient can have a self‐regarding moral duty to endure the distress she faces at the end of life, I conclude that the burden of proof is on the side of those who maintain that the suffering experienced at the end of life ought to be endured as a part of dying well.     

Torture by Cieng: ethical theory meets social practice among the Dinka Agaar of south Sudan

Here I detail violence in South Sudan by first discussing a specific Dinka Agaar practice alongside existing discourses on the social aspects of violence and universal human rights, then I show how these acts had meaning and purpose using data from personal accounts of violence. I posit that the violence described was consistent with Dinka Agaar concepts of justice and basic human rights and that it cannot be judged against any universal human rights standard, devoid of local context or of an overarching metanarrative. These events highlight conflicting subjectivities, ethical norms, and the painful difficulties inherent to advocacy in areas of conflict. Viewed from the perspective of the larger social unit, it is easy to see how violence was required to end violence. However, witnessing punitive violence purposefully enacted on innocent individuals to achieve peace has the potential to create conflicting positions that modern anthropological discourse cannot reconcile.