Patterns of Persistence amidst Medical Pluralism: Pathways toward Cure in the Southern Peruvian Andes

Abstract

When mental illness and related conditions strike among the Quechua-speaking peasant population of southern Peru, they open wide the question of who is best placed to offer the healing that families seek for their afflicted relative. Biomedical doctors and the traditional healers known as yachaqs are the two most commonly consulted sources of help. Yet most families show different patterns of persistence with each; they frequently give up on biomedical assistance after the initial intervention but continue to consult a succession of yachaqs over considerable periods of time, even if the former has had some limited success and the latter virtually none. I draw on ethnographic fieldwork to show that explanations based on inaccessibility, cultural incongruence between patient and clinician, or stigma are ultimately inadequate; rather, it is necessary to delve into fundamental differences in how the two fields of healing are conceptualized by those negotiating them.

Keywords:

• Andes
• ethnography
• medical pluralism
• mental illness
• Peru
• psychiatry

ACKNOWLEDGMENTS

I am grateful to the UK Economic and Social Research Council for funding this study (grant PTA-031-2005-00358). Different versions of this paper have been presented at the 2009 Society for Latin American Studies conference and the 2010 European Association of Social Anthropologists conference, as well as in research seminars at McGill and Concordia universities, Montreal, and I benefited greatly from the insightful comments of participants at these events. Well-deserved thanks are also due to Roland Littlewood, Grimanesa Toledo, Walter Vignatti, my informants in Paucartambo, and the three anonymous reviewers who commented on this article.

Notes

Soul loss is usually the result of a fright causing the soul to start out of the body. Its symptoms and outcomes vary widely (see Greenway 1998), partly depending on what has happened to the soul after its departure; different yachaqs often held widely diverging opinions on this. Healing involves a ritual ‘calling’ for the soul to return, but may also require offerings to apus or other entities so that they assist or permit the soul to come.

The earth is conceived by Andeans as a sentient being with both benevolent and malevolent aspects. Certain places are said to manifest ‘wild’ or ‘hungry earth,’ and may seize the vital energies of those unfortunate enough to be there, causing grave sickness (as happened to Basilia) or death (see Allen 2002:32–33).

Some doctors, aware of the institutional racism in much of Peruvian health care, now make considered efforts to communicate more inclusively with their campesino patients. Bastien too noted a shift in attitudes among medical staff in neighbouring Bolivia (2003:180), even before the recent health reforms there.

As a general rule, the more heavily the yachaq's cure relies on herbal or apothecarial treatment, the longer patients are willing to wait for it to take effect.

‘Therapeutic impatience’ may be behind the frequency with which campesinos told me that their afflicted relative had needed ‘an operation,’ which had been sadly unaffordable, even when no operation would normally have been indicated by the condition in question (manic depression, for example). For serious conditions, an operation often seems to be symbolically desirable, perhaps partly because it represents a powerful ‘quick fix’ in a way that medication taken over long periods does not.

The contrast with urban mestizo families, for whom the effort to identify a good doctor who stands out from his peers is often central to help-seeking, is instructive. Exchanges of advice in this regard are characteristic of many discussions of health in that milieu.

Doctors from overseas are perceived as more competent still. However, they are rarely accessible to Paucartambinos.

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David M. R. Orr

DAVID M. R. ORR is Lecturer in the School of Education and Social Work at the University of Sussex, United Kingdom. He received his PhD in social anthropology from University College London. This research focused on understandings of the person, madness, relatedness, and forms of healing in the Andes. His main research interests include mental illness, cosmologies of healing, aging, social and health care education, and the anthropology of the Andes.