Between desperation and explanation: madness, meaning, and the quest for cure among Quechua-speaking peasants in the southern Peruvian Andes

Following the conflict between Shining Path and the state, trauma-related mental disorders among the peasant population of Peru received an unprecedented level of attention, but for all that, relatively little is known about the situation of other forms of mental illness. Using data gathered from participant observation and formal interviews, this study explores the situation of mentally ill peasants and their families in Paucartambo, a province in the southern Andes. Foregrounding the confusion and multiple explanations that surround such conditions, I examine the semantic networks employed in speaking about them and reveal that they cannot be understood apart from distinctively Andean conceptions of relatedness and expectations of normal social interaction. Not only does mental illness manifest as a disturbance in patterns of relatedness, but such patterns may also be seen to have caused it. When it comes to seeking healing, such local meanings of madness jostle with other interpretations provided by vernacular healers, psychiatrists and evangelical churchmen. The vernacular healers, known as yachaqs in Quechua, continue to be the most influential 'experts' in sufferers' communities, and so considerable attention is given to what a sample of these practitioners have to say about mental illness. But I argue that it is only when analysis keeps in play the indecision and contingency that so dominate for families dealing with the stark reality of madness in a close relative, that it becomes possible to understand such concepts as 'soul loss', or how families choose where to seek help. I compare the different healing options and show that some familiar theories of medical pluralism are inadequate to account for the choices made by the peasants of Paucartambo, before putting forward suggestions to shed light on their patterns of consultation and the implications for the different forms of care they receive