The sequelae of political violence: Assessing trauma, suffering and dislocation in the Peruvian highlands

Abstract

In this article, we begin with a qualitative mapping of the multiple ways indigenous peoples in the Peruvian highlands construct their emotions, symptoms and specific disorders when confronted with an adverse environment of sustained political violence, multiple stressors and massive exposure to traumatic experiences. Second, we address the issue of magnitude (point prevalence) and distribution of mental health problems such as depression and anxiety, and sequelae of exposure to violence-related stressors as reported in the selected populations, by reviewing the quantitative results of a cross-sectional survey. Third, we examine the pathways and linkages between the social context (drawn from ethnography and secondary sources) and the collective experience, such as massive exodus, forced displacement, resilience and accommodation strategies for coping and survival. When assessing the overall mental health impact of exposure to protracted forms of extreme violence in civilian populations, we argue for the need to move beyond the limited notion of post-traumatic stress disorder, which is a useful but restrictive medical category failing to encompass the myriad of signals of distress, suffering and affliction, as well as other culture bound trauma-related disorders and long-term sequelae of traumatic experiences. Lastly, following the concluding remarks, we discuss some implications the results of the study may have at various levels, not only for the victims and survivors of massive exposure to traumatic events, but also their families and communities, as well as for interventions carried out by humanitarian and emergency relief organizations, and specialised agencies engaged in the promotion of social justice, prevention of human rights abuses, and mental health rehabilitation programs at both national and international levels.

Introduction

It is well established that war and armed conflict have been major causes of suffering, general ill health, and increased mortality rates throughout human history (Murray, King, Lopez, Tomijima, & Krug, 2002). In recent decades, the number of victims and survivors of traumatic events has significantly increased as war, armed conflict, and political upheaval engulf civilian populations worldwide (Pedersen, 2002), thus contributing to a lingering additional burden of disease, death and disability (Ghobarah et al., 2003, Gustafson et al., 2001, Roberts et al., 2001).

Until recently, insufficient attention had been paid to assessing the long term impact and additional burden of disease, death, and disability caused by political violence and wars amongst civilian populations in Latin America and the Caribbean, in spite of the widespread armed conflict and organised violence in the region (Pedersen, 1999). Many of the studies carried out in South and Central America have centred on the most direct consequences of the guerra sucia (dirty war), on families of the desaparecidos and victims of torture and/or survivors of atrocities committed by military dictatorships, such as the cases of Argentina and Chile in the 1970s and 1980s (Lira, 1991, Suarez Orozco, 1990, Suárez-Orozco, 1992). In countries like Guatemala, Nicaragua and El Salvador, studies were conducted to assess the short-term psychosocial impact of political violence among local, indigenous and refugee populations (see, for example, Dickson-Gomez, 2002, Garfield and Williams, 1989, Lundgren and Lang, 1989, Martin-Baró, 1989, Martín-Baró, 1990, Miller, 1996, Summerfield and Toser, 1991). Additionally, reports from Americas Watch and Physicians for Human Rights, 1991, Amnesty International, 2001, Amnesty International, 2004, Human Rights Watch, 1997, the UN High Commissioner for Refugees (UNHCR, 1997) and other governmental and nongovernmental agencies such as the Oficina de Derechos Humanos del Arzobispado in Guatemala (ODHAG, 1998), and more recently the Comisión de la Verdad y Reconciliación in Peru (CVR, 2003), have also documented the consequences of political violence, torture, and war in the civilian population of the region. In Peru, important contributions have been made over the last two decades (Coronel Aguirre, 2003, Degregori, 1985, Degregori, 1999, Degregori, 2003, Gorriti, 1990, Hernández, 1993, Manrique, 1995, Del Pino, 1999, Portocarrero, 1990, Raffo et al., 2004, Rodríguez Rabanal, 1995), illustrating the wide range of disciplinary approaches used by Peruvian researchers and scholars in addressing the issue of political violence and its consequences.