Tapias Emotions intergenerational embodiment Social Suffering bolivia

Emotions and the Intergenerational Embodiment of Social Suffering in Rural BoliviaAuthor(s): Maria TapiasSource: Medical Anthropology Quarterly, New Series, Vol. 20, No. 3 (Sep., 2006), pp. 399-415Published by: Wiley on behalf of the American Anthropological AssociationStable URL: http://www.jstor.org/stable/3840535 .Accessed: 16/03/2014 07:20

Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .http://www.jstor.org/page/info/about/policies/terms.jsp

.

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range ofcontent in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new formsof scholarship. For more information about JSTOR, please contact [email protected].

.

Wiley and American Anthropological Association are collaborating with JSTOR to digitize, preserve andextend access to Medical Anthropology Quarterly.

http://www.jstor.org

This content downloaded from 143.117.16.36 on Sun, 16 Mar 2014 07:20:04 AMAll use subject to JSTOR Terms and Conditions

Maria Tapias Department of Anthropology Grinnell College

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. Keywords: [Emotions, embodiment, neoliberalism, social suffering, Bolivia]

Since the mid 1980s, Bolivia has undergone a series of neoliberal and structural adjustment reforms meant to modernize the economy. These reforms sought to improve the economy and reduce government spending by fostering free trade, stimulat- ing efforts to attract foreign investors, privatizing previously national basic services, and shrinking the welfare state. These economic changes have profoundly impacted social, community, and familial relations across class, gender, and ethnic lines (Agad- janian 2003; Gill 2000; Lind 2003), and also the health profiles of Bolivian citizens. Bolivia continues to rank among the Latin American countries with the highest infant mortality rates (66 per thousand) and lowest life expectancies (World Bank 2005).

The reforms have greatly constricted the options available to earn a living, particularly for the poor, generating widespread anxiety and uncertainty manifested through multiple health problems. Numerous anthropologists have examined the impact that structural violence, social suffering, and larger social and economic constraints have on health (Farmer 1996; Kleinman et al. 1997; Scheper-Hughes 1992). Strained social relations, emotions, and failed sociality have also been examined as sources of illness (Finkler 1994; Rebhun 1994, 1999).

In this article, I draw on an interpretive anthropology of affliction and the anthropology of emotions to examine the impacts of social suffering and distress on the next

Medical Anthropology Quarterly, Vol. 20, Number 3, pp. 399-415, ISSN 0745-5194, online ISSN 1548-1387. ? 2006 by the American Anthropological Association. All rights reserved. Permission to photocopy or reproduce article content via University of California Press Rights and Permissions, www.ucpress.edu/journals/rights.htm.

399


400 Medical Anthropology Quarterly

generation. I explore how mothers and the larger community in which I conducted fieldwork see the neoliberal reforms as causing distress in parents, particularly mothers, with short- and long-term health effects on their infants and children. Although some studies have focused on the impacts that poverty and social change have had directly on children (Gutmann 2001; Pribilsky 2001; Scheper-Hughes 1992), my focus is on how market- and working-class women in Bolivia perceive children's health to be affected through their mother's faulty emotional responses to distress and through their bodies. Women's bodies thus become the vectors for both transient and enduring ailments and debility in their children. Drawing on two case studies, I collected during ethnographic research undertaken in Punata, Bolivia, I examine how neoliberalism has affected embodiment across generations and how women make sense of the impacts of the distress that permeates their everyday lives.

Since the implementation of the economic reforms, governments promised im- proved economic conditions and opportunities for work. The opening of the markets made new products available on market shelves and unleashed new ambitions, expectations, and desires such as purchasing power, personal autonomy, success, and, by extension, community respect. Twenty years into their implementation, however, the pledges to alleviate poverty and unemployment have not been met. In fact, emigration rates have skyrocketed since the 1980s as people in rural areas (those hardest hit by poverty) migrated to other regions and countries in search of employment, leaving many women as heads of households and children in the care of grandparents and relatives.

The promises for economic prosperity and a place for Bolivian products in the global economy have, for the most part, failed-with one key exception. Bolivia is one of the top three producers of coca leaves, the raw product for the production of cocaine. Coca growing and coca stomping (a process needed to make cocaine paste) have employed thousands of indigenous and peasant farmers as well as former miners who lost their jobs when many mines were closed during the reforms. Simultaneously, there have been massive efforts to squelch this secondary economy through massive coca eradication programs, largely sponsored by the United States, that are considered key elements of the war against drugs (Sanabria 1993; Spedding 1989; Weatherford 1987).

Since 2003, two presidents have resigned following popular protests that resulted in confrontations with the army. Bolivia has the second largest reserves of gas in South America, after Venezuela, and the protests crystallized largely around the conditions under which the export of gas was to be conducted. In many ways, however, the protests also spoke to the widespread dissatisfaction with the economic reforms. Most of the media coverage on political turmoil in Bolivia has focused on strife in urban areas through images of the militarization of cities, roadblocks, and massive public marches, revealing one facet of the failure of the government to meet its promises to its citizens.l

In my research, I looked at everyday forms of this social suffering from the perspective of women in a small, semirural town nestled in a valley in the Andes. The numerous health problems and embodied manifestations of distress are another powerful lens from which to examine how people have experienced the impacts of these neoliberal reforms. During my fieldwork from 1996 to 1998 and a follow-up visit in 2003, I detected persistent small-scale protests as people complained and


Social Suffering in Rural Bolivia 401

embodied what Nancy Scheper-Hughes has called the violence of everyday life: the lack of jobs, of money and little hope for the future (Scheper-Hughes 1992). In Punata, emotions such as rage, sorrow, fright, pining, desire for goods, jealousy, and envy generated by economic hardship, domestic violence social conflict, and other forms of distress played a fundamental role in how people perceived not only their own health problems but also many of the health problems that affected their infants. My research thus examines how in the context of social change and radical political reforms people cope with and endure (or fail to endure) the minor and major emotional stresses of life, conflict, and economic hardship and how this distress manifests itself in multiple bodies and across generations.

Field Site and Methods I conducted the research during 25 continuous months of fieldwork from 1996 to 1998 and in a follow-up visit in 2003 to Punata, neighboring villages, and the city of Cochabamba. In 1996-98, I focused on examining the role of emotions in conceptualizations of illness. My follow-up visit in 2003 focused on breastfeeding women and how emotions such as rage and sorrow were seen as potentially harmful to infants.

Punata is a valley town of the Andes, in the province of the same name located an hour outside of Cochabamba, one of the main cities of Bolivia. The town of Punata (population 13,000), where I did most of this research, plays a major articulating role in the region, for it is host to one of the main regional markets and the main regional hospital. One important factor in my selection of this field site was the array of available health care options: healers, ritualists, doctors, coca readers, the parish priest, pharmacists, and clinics.

The town has a small upper-class elite that sees itself as superior to the middle- and working-class populations. This class structure does not neatly graft onto ethnic or racialized categories, although the elites are more likely to be perceived as mestizo and the middle and working classes are seen as having more Quechua ancestry.2 As individuals interact with one another, their behavior is shaped by many ethnic, linguistic, social, and age hierarchies (see also de la Cadena 1995, 1996; Weismantel 2001). Employment opportunities for local residents include agricultural work, the weekly regional market that links communities scattered around the province, the local daily market, the transportation industry, or the service industry that includes an array of restaurants and chicherias (corn beer halls), the local hospital, or the health care development project sponsored by a major European donor.

In the past 30 years, the local economy became increasingly tied to the Chapare, an adjacent tropical and coca-growing region situated just a mountain range away from Punata. The Chapare is a region of much conflict as the government tries to implement eradication programs. Many people in Punata have migrated to the Chapare in search of supplemental income, if not to grow coca themselves then to assist in the whole informal economy of the area. For example, many women migrated to sell lemonade or set up food stalls in the area; while many men, who traditionally drove taxis in the cities and the pueblos, realized they could make a lot more money driving people back and forth from the Chapare, or by transporting coca leaves or kerosene (needed for the elaboration of cocaine paste) from fields to



stomping camps. Unemployment also forced many people to emigrate to Argentina (before its own economic crisis) and more recently to Spain and Italy.

My analysis draws from participant observation and structured and unstructured conversational interviews with 130 men and women. These conversations took place with market-, working-, and lower-middle-class women, female secretary students, nurses, doctors, healers, herbalists, pharmacists, the parish priest, and rural health clinic workers. From this pool of interviewees, I collected more in-depth illness narratives from 26 market-, working-, and lower-middle-class Quechua- and Spanish- speaking women, ages 16-57. Portions of two of these narratives are described in this article.

Social Suffering, Emotions, and ILLness

My work builds on multiple bodies of literature. This includes the work of scholars such as Veena Das, Paul Farmer, Arthur Kleinman, and others who are committed to an interpretive anthropology of affliction and the work of scholars interested in the anthropology of emotions. An anthropology of affliction, by its close examination of local knowledge, allows for an understanding of how Quechua- and Spanish- speaking market- and working-class women conceptualize health, the body, and emotions and how these conceptualizations are intrinsically interlinked with the types of interactions between community members and larger economic and political factors beyond many people's control.

Arthur Kleinman and colleagues, Terrence Turner, and others argue for greater attention to the social nature of the body and suffering (Kleinman et al. 1997; Turner 1993). The body, they assert, is not independent of social relations and forces but continuously constituted by them. This is seen in Punata, where the many emotions linked to ill health are often the result of social conflict, economic scarcity, or "failed sociality": when the relationships one has traditionally relied on become faulty and unreliable; when one is not quite able to meet the social, emotional, and economic expectations people have of you; or perhaps when one exceeds them and people become resentful. In Punata, failed sociality often finds expression in an array of illnesses.

With few exceptions, scholarship on emotions and illness in Bolivia or the wider Andean region is fairly limited (see Hammer 1997). Some scholars have examined individual emotions and their effect on health (see Tousignant [1984] for sorrow in Ecuador and Alba [1989] for "pining" in Bolivia), and others have contributed to the extensive literature on nerves, susto (fright), and envy in Latin America (Davis and Low 1989; Rebhun 1993; Rubel 1984; Scheper-Hughes 1992; Taussig 1987). However, little effort has been made to comprehensively explore the variety of emotions that impact health or to understand and theorize the embodiment of emotions and the role they play in the construction of a conceptual framework to understand illness. Such an effort requires (1) an appreciation of the ethnotheories of the body that explain how emotions are locally experienced in the body and how this relates to susceptibility to illness and (2) a consideration of the contextual sociality of the body to discern how people internalize and embody the "externality" of social relations.

Two sets of literature informed my approach to emotions: the literature on the discursive facets of emotions and the scholarship on embodiment that sheds light on



how emotions are simultaneously experienced in the body and as social phenomena. Both sets have tended to acknowledge the contributions of the other, but there have been few attempts to bridge them. The data collected in Bolivia show such an articulation to better understand emotion-linked illnesses.

The anthropological interest in emotions has increased significantly in the last 30 years, as shown in numerous reviews and edited volumes, paralleling an increased interest in the body as a category of analysis. As the nonuniversality of Western medical notions of the body and illness has become a truism of medical anthropology (Csordas 1990; Lock 1993; Martin 1987; Scheper-Hughes and Lock 1987; Taussig 1980), the scholarship on emotions questioned the "universality" of emotions (Kitayama and Markus 1994; Lutz and White 1986). Extensive scholarship and several ethnographies have provided some outstanding examinations of the cross-cultural meanings, constructs, and "translatability" of emotion terms (Geertz 1973; Lutz 1986, 1988; Rebhun 1999; Rosaldo 1980); emotions and their relationship to personhood (Desjarlais 1992; Rosaldo 1984), social relations, and agency (Lutz and White 1986; Lyon and Barbalet 1994); and the sociopolitical dimensions of emotions (Abu-Lughod and Lutz 1990; Appadurai 1990).

Anthropologists arguing for a constructivist approach to emotions view them not as "natural" or "precultural" phenomena but as ones that are culturally con- structed and that have local meanings and effects (Abu-Lughod and Lutz 1990; Lutz 1986,1988; Rebhun 1993, 1994; Rosaldo 1984; Scheper-Hughes 1992). Following Abu-Lughod and Lutz (1990), my research demonstrates that emotions must be un- derstood as aspects of sociality and social relations rather than as natural internal biological states. Drawing from Foucault, these authors highlight the discursive dimensions of emotions focusing in particular on issues of power (Abu-Lughod and Lutz 1990:14). From this perspective, emotions come to be seen as the product of social processes.

Lyon and Barbalet also undertake an examination of the body and emotions but critique Foucault's discursive approach with its emphasis on how societal power is inscribed on bodies, for its inability to address bodies as social agents and for its lack of recognition of the role emotion plays in social life (Lyon and Barbalet 1994:49). These authors draw from the literature on embodiment that has also proliferated within the sphere of medical and psychological anthropology (Csordas 1990, 1994; Lock 1993). Scholars focusing their analytical lenses on embodiment argue that an understanding of culture should begin with an examination of the lived-in body, because one knows, feels, and thinks about the social world through the body. They also call for a scrutiny of how people experience and carry their daily activities from within their bodies and an examination of how one's body relates to other bodies.

Similarly, I argue that people are not passive receptors of the dictates of social power. As people interact with others in their social milieu, emotions guide and prepare subjects for social action and enable an expression of agency, even if that agency initially entails not outwardly expressing emotions or taking action at all. Lyon and Barbalet argue that emotions not only are embodied but are the mediating factor between the body and the social world. Emotion, they propose, is the "experience of embodied sociality" (1994:48). Authors who focus on the discursive aspects of emotion recognize that emotions are also embodied experiences that involve the whole person. Following their assertion that "emotion can be studied as embodied



discourse only after its social and cultural-its discursive-character has been fully accepted" (Abu-Lughod and Lutz 1990:13), my research stresses the need to attend to both dimensions. This article couples the above-mentioned approaches by examining who holds power to express emotion, what emotions can be expressed and under what circumstances, and how emotions are experienced in the body.

For the analysis at hand, I concentrate on two working-class women who, in many ways, are representative of narratives evoked by other women. My focus on the intricacies of these women's experiences enables me to examine the entanglement of the politics of emotional expression, gender relations, and the impacts of the economic reforms at a local level. The first case is that of a woman who suffers domestic violence and the second looks at the distress experienced by a woman who lost her life savings in a bank scam. Their suffering, although clearly experienced at the individual level, is also seen to pass to their infants through their bodies. In the first case, the distress felt by a woman named Elisa was passed on to her infant through her breast milk, resulting in a syndrome locally known as arrebato. In the second case, the distress experienced by a mother named Rosalia made its way to her infant while he was in utero, causing enduring health consequences.

Through these cases, I begin to unpack how people live in their bodies and experience the world around them in the face of the economic reforms and how this is related to the emergence of emotion-related illnesses. A few focal points can help us understand the experiences of Elisa, Rosalia, and their children: (1) how emotions are conceptualized and how emotional expression and power relations figure into illness narratives; and (2) how breast-fed infants and those developing in the uterus are seen as particularly vulnerable to the emotions of their mothers resulting in short- and long-term health effects.

The Physicality of Emotions and the Predicament of Expression In Punata, emotions are considered a principal etiological agent in the onset of numerous illnesses and symptoms in men, women, and children. During my extended fieldwork, people spoke of emotions such as rage and sorrow (two emotions most commonly linked to ill health) as if they were "fluids" or substances that accumulated in the body or were transformed into other harmful substances. Rebhun mentions that the women she worked with in Brazil viewed emotions as "energy" that acted according to the "same physical properties as water" (1994:366, 1999). In Punata, both the etiological explanations for how emotions made people sick and the treatments people administer attests to this physicality. For instance, emotions are said to accumulate in the body when they are not expressed and can pose noxious effects on the body, as the following quotes from three market women explain:

I get angry, get angry, get angry (reniego, reniego, reniego) and it accumulates in me. It accumulates, accumulates, I get angry, I get angry and it accumulates and that's it, that embolio [stroke] wants to get me (ese embolio me quiere dar). Sometimes it's not necessary that you have strong rage. Sometimes, without even noticing it, you get angry, and you get sick. For example, you get angry, but you didn't really even notice that you got angry but sure enough,



shortly after, your stomach starts to hurt. In this case it was already accumulated.... When one keeps getting angry, getting angry, it accumulates and then when one little insignificant offensive remark comes your way, it's enough to [make you sick].

Holding in the rage one feels worse. Because if you can't "undrown" yourself (si no te desahogas), you know, when you are angry.... Well, if one is angry and undrowns oneself, then at least it goes away. But if you retain it inside you and you don't undrown yourself, that is when the pain starts.3

The women I interviewed concurred that it was not only feeling emotions that automatically rendered people sick. Indeed, notions of health maintenance-their own and those of their infants-were linked to the constraints individuals faced regarding their ability to express their emotions (see also Rebhun 1993). In cases of rage and sorrow, the ability to orchestrate these emotions (whether expressed or not) was directly linked to negotiating the intricate webs of power relations (between genders, ethnic groups, class, and age) and assessing the possible risks that could result from such expressions (Abu-Lughod and Lutz 1990). Where a conflict took place, with whom, and over what shaped how a person expressed and addressed emotions. The expression of emotions is not always possible or good, particularly in public places where people worry that others will see and criticize them (Clark 1989:113; Dunk 1989; Glass-Coffin 1992; Krieger 1989). Thus, the articulation of different facets of one's identity to the context of the crisis ultimately renders "emotional privileges" to certain members of the population while denying them to others. Abu-Lughod and Lutz aptly assert that expression thus hinges on "power relations that determine what can, cannot or must be said about self and emotions, what is taken to be true or false about them and what only some individuals can say about them" (1990:14). So, when a particular social context proved inappropriate for expression, a person might "hold in" their emotions, an act perceived as harmful to the body.4 The damage, however, did not always manifest itself in the bodies of the individuals experiencing the emotions. In pregnant and lactating women, the harm could be passed on to infants. In each situation the effects on health are different, as the following sections demonstrate.

Maternal Emotions, Breastfeeding, and Infant Illness

Among lactating women, accumulated emotions were said to find release through breast milk and cause illness-not in the mothers themselves, but in their nursing infants in the form of arrebato. This ailment, whose symptoms include stomachaches, incessant crying, severe diarrhea, and vomiting, was primarily connected in people's minds and experience to a mother's inability to shelter her child from the accumu- lation of her rage or sorrow. In extreme cases, arrebato could be fatal. In fact, along with susto, arrebato was listed by the women I interviewed as one of the main causes of infant death. However, if properly treated in a timely manner, it could also be cured. The effects of the mother's emotions passing to her infant were thus short term.

A mother had the potential to transmit "poisonous" or tainted breast milk to her infant, particularly when she was under social or economic distress (see also



Farmer 1988; Mull 1992). Domestic violence, economic hardship, social conflicts, and mistreatment can affect the physical and nutritional qualities of a mother's milk. Once the mother returned to a state of emotional tranquility, the milk returned to normal as well. Thus, not only negative emotions such as rage and sorrow were transmitted through breast milk, but also what might be considered more positive emotions, such as happiness and tranquility.

These notions of emotions and the power differentials prevalent in expression are clearly described below in the case of an infant who developed arrebato from his mother's breast milk after her husband battered her.

Case 1: Elisa and the Predicaments of Expression Attentive to the impact their own emotions can have on their breastfeeding babies, mothers often take great care after a conflict to discard the first few drops of breast milk so that their rage or sorrow does not pass on to their infants. They say, however, that this preventive practice does not always work. Such was the case of Elisa's child who developed arrebato through Elisa's breast milk.

Elisa and her husband Juan owned a small plot of land on which they grew carrots and carnations to sell in the local market. Juan had once been a taxicab driver who made regular trips to the Chapare, taking Punatenos back and forth and occasionally helping transport coca leaves. Since the crackdown on coca growing, there was a lot more risk involved in working in the Chapare and fewer people, including Juan, were taking up jobs there. Furthermore, after passing a law that forbade anyone from possessing large quantities of coca or kerosene without a permit, imprisonments related to these charges grew exponentially. The lack of this income meant Juan could no longer meet the transportation union dues and had been unemployed for several months.

In an effort to raise some money to invest in his small farm, he decided to sell his 15-year-old car. The buyer, a close neighbor, paid a small down payment and took the car but was late in subsequent payments. After a heated confrontation with the buyer, Juan came home intoxicated one evening. He took out his frustration on his wife and beat her severely. In conversing with Elisa the next day, she explained she did not want to argue with her husband as he was "outside himself" and was hurting her. In fact, Elisa was regularly treated at the local health clinic for injuries related to domestic violence. Elisa went on to say, though, that on other occasions when he was not drunk she would likely argue back. Many other women I interviewed who found themselves in arguments with their intoxicated husbands said the same thing.

A few hours after her husband hit her, Elisa carefully removed the first drops of milk from her breast and discarded it on the pounded dirt floor of her one-room home in an effort to remove the tainted milk from her breasts. She proceeded to feed her son. Within hours, the infant's nails, mouth, and feet became purple and he had severe diarrhea.

To Elisa, her child became sick with arrebato because she had been unable to express her emotions and confront Juan, fearing further violence from him. Even though she had taken care to remove the first drops of her breast milk, this was not enough. The emotions had passed into her breast milk and the baby had sucked out her rage and sorrow and became sick himself.



At the local level, the degree to which arrebato was a threat to Elisa and her infant was directly related to her social position, how she dealt with her emotions, and the self-monitoring processes that she enacted to protect her child's health. At a larger level, however, we see that Juan took out his distress physically on his wife. The economic and political reforms operating at the level of the nation state come to be experienced in very localized ways and present women with difficult predicaments.

Other women interviewed consistently agreed that if a woman was unable to express her emotions but breastfed, she was less likely to get sick from emotions because her infant would suck and draw them out of her. The embodied dangers of breastfeeding a child when angry or sad were explained to me as follows: "If a mother gives her breast to her child when she is angry the child can die because of all that rage she is passing in her breast. She does not get sick, doesn't feel indisposed, she transmits everything. The baby sucks out all that rage."

Although women knew that expressing their rage or sorrow could prevent arrebato, in certain contexts they might refrain from such expression if it entailed the possible loss of her job, fueled an argument with her husband, or resulted in tensions with fellow community members. Social roles and statuses are reinforced through the expression of emotions, and women attempted to carefully balance the double- edged sword of expression. On the one hand, if they expressed their emotions they ran the risk of being criticized or harmed by those who could yield power over them; on the other hand, if they did not express their emotions they could endanger their infant's health.

Elisa, for example, refrained from confronting her husband (thus, expressing her rage) because she feared further battering from her husband. Within minutes of the onset of her child's arrebato, Elisa bathed her infant in herbs that were intended to draw out the rage from his small body. The treatment succeeded and the child recuperated completely. A mother whose child develops a grave case of arrebato is often blamed for the child's ailment by family or community members for her inability to "control" her emotions. Elisa was able to avoid the blame that accompanies arrebato, and her mothering skills were never in question. Although the child fell ill, she had taken the necessary precautions to shelter him from harm. She tried to remove the tainted milk from her breasts and when this failed she treated the child with herbal remedies (for a more in-depth examination of breastfeeding, infant illness, and mother blame, see Tapias 2006).

The negative effects of maternal emotions on infants are not always temporary as they were in the case of Elisa's child. Sometimes, the impacts on the child can have lifelong effects, as happened with Rosalia's son.

Maternal Emotions and Illness Susceptibility in Infants When pregnant, a mother's distress and emotions could reach their children through the placenta. These emotions were seen as the cause of generalized debility among children. Such prenatal exposure rendered these children continuously susceptible to illness throughout their lives. This susceptibility was referred to as debilidad.5 Debil- ity was compared to another conceptual framework referred to as fuerza (strength) and helped describe the constitution of a person or their past histories of distress and illness.



The tropes of debilidad and fuerza permeate many social spheres. Debilidad not only refers to someone's constitution or state of health, but one could also describe land as being d6bil, infertile, and unable to bear good fruits; or the economy or a nation could be debil-too dependent on foreign aid, unable to compete or stand up to the demands made by the world market. One can also speak of moral debilidad or fuerza, particularly with regard to sexuality and will power or to a caracter debil o fuerte regarding different types of personalities that explain some life trajectories.

With regard to health, debilidad and fuerza are states or conditions that under- lie the health-illness continuum. Debilidad predisposes certain individuals to illness often related to emotions, or it can be a condition that results from ongoing illness and suffering (see also Larme 1998; Miles 2003). This relationship is not unidirec- tional; rather, there is a circularity of influence between the two. "One never heals the same, one is always left more debil" was a repeated comment made by women and men in Punata. These two conceptual categories are not in an either-or binary relationship to one another. That is, a person is not either debil or fuerte but can have different degrees of these qualities in different contextual moments. A person might be sick, for instance, and thus in a potential state of debilidad, but if he or she can carry on with normal activities, then he or she is fuerte in the ability to endure the illness.

Debilidad also helps Punatefas explain why certain people are more vulnerable to illness than others. Certain illnesses are often thought of as having a will and agency of their own. They saunter around the environment, sometimes waiting behind closed doors or around corners, awaiting the right moment and target on which to land. Such illnesses have the most chance of flourishing in the person with debilidad, the person with a history of illness, or the person least able to manage his or her emotions. Although adults can develop debilidad at any time over the life course, in this article I explore the case of children left with a "constitutional" debilidad resulting from exposure to their mother's emotions while in the womb. Gestating babies have porous bodies that are particularly vulnerable to the suffering of their mothers. The story of a nine-year-old boy named Fernando illustrates this point and also links debilidad to a particular economic crisis that affected the community.

Case 2. Intersections of the Local and the Global: Rosalia's Sorrow and Fernando's Debilidad Rosalia was a 33-year-old bilingual Spanish- and Quechua-speaking hospital janitor. She was married and had two children: Marcela, age 12, and Fernando, who was nine years old at the time of our interview. She had been working in the hospital for two years and earned 520 bolivianos a month, which at the time was worth approximately $90. Prior to her job in the hospital, she used to knit sweaters for sale. She claimed she never got sick while she worked independently, but since working in the hospital she suffered continuously from headaches. Mistreatment and arguments with the doctors and nurses on staff were regular parts of her quotidian life.

Rosalia's life was also marked by a financial crisis with long-term consequences for the family's economic future. Pregnant at the time of the crisis, Rosalia believed



that her own emotional turmoil resulted in her son Fernando's debilidad. Rosalia described her son as someone who was very nervous, irascible, short tempered, and susceptible to illnesses:

This son of mine, he is a very nervous and irritable child. He gets sick easily from rage and when he gets angry he turns purple. When he was just a baby and cried he would turn all purple, his whole body and his mouth for instance went from red to purple. And he went growing up that way; he is very affectionate but when he gets angry? God spare us! He is unbearable, sometimes his nose even bleeds from the rage that he feels.

Rosalia had a clear sense of how her son Fernando developed debilidad. The rage and sorrow she felt when she lost her life's savings in a bank scam in the late 1980s, coupled with marital distress, translated into her son's vulnerability to illness, his likelihood to suffer from numerous physical symptoms, and his enduring debilidad.

Some contextual background for this particular case is crucial. During the 1980s, economic reforms and the free market that it fostered reduced the presence and inter- vention of the state in businesses. Within this new economic context, a fertile ground was provided for the emergence of companies known as inmobiliarias throughout the country and particularly in Cochabamba. Inmobiliarias were essentially "building societies" that accepted small-scale investments from thousands of people and offered annual interest rates of 60-70 percent, as opposed to the 14 percent interest rates at private banks (CEDOIN 1990).

The inmobiliarias were rumored to be places where profits from the cocaine industry were laundered. Relocated miners, former coca growers (compensated in dollars for eradicating their fields), teachers, market women, professionals, students, and even wealthy investors from abroad deposited their funds in these inmobiliarias in efforts to maximize their profits. The building societies acted as unofficial, non- regulated banks that not only allegedly laundered cocaine profits but also made daily life more bearable for the un- and underemployed. The inmobiliarias were renowned for their timely payment of interests each month and in many ways filled the lacunas left by the state as they helped ease many of the social costs of the economic reforms, particularly for the poorer populations (CEDOIN 1990:9).

Many people in Punata eagerly deposited their money in hopes of maximizing their earnings. What investors did not know was that when collecting the "interest" on their capital, they were actually withdrawing their own principal, thus literally depleting their own savings. Millions of dollars were embezzled by the inmobiliarias, leaving thousands of investors bankrupt. Because these societies were to a certain degree illegal and not required to comply with any regular banking laws, the state offered no protection to those who lost their capital.

Rosalia had been among the thousands of people in Cochabamba who lost their savings in the scam. Rosalia had dreamed of owning her own house one day, but when she lost the money (nearly one thousand dollars) the dream became a remote possibility. Her suffering was further accentuated by domestic violence. "My husband never let up and kept telling me how stupid I had been for putting the money in that inmobiliaria. He made me 'eat' that day and night [me hacia comer eso dia y



noche] and he mistreated me a lot." It had been Rosalia who convinced her husband to invest the money, arguing they could live off the interest and continue to increase their savings.

"How was it," I asked, "that you didn't get sick during such rage and sorrow?" Placing her hand on her stomach Rosalia replied:

I was pregnant at the time with my youngest son. I say that maybe all of my rage and sorrow, I passed on to him because all I did was cry-I ate lunch, I cried, I ate breakfast, I cried, I'd go out, I'd cry.... I was so upset I just kept losing weight and then my son was born.... I suffered from preoccupation a lot back then.... I didn't have a single piece of bread to eat and that was my main preoccupation. Rosalia was weakened by the emotional and financial stress she was under. She

noted, however, that at the time of her losses she was strong enough so as to not have a miscarriage-a common occurrence in pregnant women who feel intense rage or sorrow, according to many women I interviewed. Her son, however, came to suffer from debilidad and his was seen as a constitutional debilidad developed when Rosalia passed all her suffering on to him. After Rosalia exhausted all possibilities of gaining her money back, she felt helpless and desperate. Although the sorrow and despair that she experienced did not make her sick, she believed that it had permanently affected her child. That she did not fall ill indicates the strength of her own body but underscores the vulnerability of the child inside her who received the brunt of the stress. Unlike Elisa, who could treat her infant and deflect blame for the child's onset of arrebato, Rosalia's child's debilidad had no therapeutic solution-no medicines would ever alleviate his condition. Fernando was permanently affected with debilidad while in the womb. Just as Rosalia was helpless in the face of the bank scam, no solution could help her protect her child from the long-term effects of her suffering.

One additional factor must be taken into account in trying to understand the salience of discourses of debilidad. Debilidad is a social marker. When a person was pointed out to me as debil, there was an implicit understanding that this person suffered and had a hard life, was let down, neglected, or mistreated (often unfairly in the eyes of the sufferer) by family, community members, or life. When an infant was pointed out as debil, however, it marked a mother's past suffering. As such, she might not be as harshly criticized for her inability to adequately address her child's ailments and susceptibility.

Conclusions In this article, I have explored the impact that maternal emotions have on infant health in Punata, Bolivia. Articulating a discursive and embodied approach to emotions permit a more comprehensive understanding of how emotions affect health in Bolivia. To just examine power relations and the expression of emotions and their impacts on health does not help us understand the mechanisms through which emotions are embodied. Similarly, to divorce an understanding of embodiment from the social and political contexts in which emotions are constituted presents a myopic understanding of distress and health.



My analysis of short- and long-term effects of maternal emotions on infant health as seen in the manifestation of debilidad and arrebato reveal that these ailments signal tensions in the social landscape: among neighbors, family members, coworkers, or as a result of failed efforts to improve one's economic conditions. Debilidad and arrebato are salient and exacerbated during times of social crisis, community or familial conflicts, and economic hardship. The problems surrounding individuals, households, and communities with root causes in the materiality of poverty, unemployment, domestic violence, high rates of alcoholism, economic recession, or increased migration leaving many women as heads of households are only a few of the factors that lead to debilidad and arrebato in infants.

The body and its ailments communicate polysemous messages of disappointment, neglect, economic scarcity, marital, or household conflict. Many of these messages are imbued with moral value. Furthermore, these ailments and symptoms may help structure social obligations, social roles, and the relationship between people. In evoking a particular illness category, people might receive greater empathy and sup- port from those around them. To say a child has arrebato is to signal that the mother may be suffering from economic hardship or from domestic violence. To claim a child has debilidad can signal past maternal distress, deflecting blame from current dif- ficulties in caring for one's children. Such signals, in turn, can lead to community interference: perhaps a husband is told not to be so harsh on his wife; perhaps neighbors will share their crops with those who did not fare so well in a particular season. In other instances, the same diagnosis affecting infants can unleash an intricate politics of mother blame that can be negotiated and contested by women. To evoke a particular infant illness term communicates not only an array of symptoms but also hints at some of the emotional origins of these symptoms and ailments and indicates who might be at "fault" for these emotions in the first place, such as faltering banks, a delinquent car buyer, or a mother with "uncontrollable" emotions.

Notes

Acknowledgments. I would like to thank Denise Roth Allen, Gina Bessa, Xavier Escandell and the anonymous reviewers of Medical Anthropology Quarterly for their constructive and thoughtful feedback on earlier drafts. In Bolivia, I am indebted to Juana Rojas for her valu- able assistance in the field and the many women who graciously agreed to be interviewed. This research was made possible by generous grants from the Fulbright Foundation (Inter- national Institute of Education), the Social Science Research Council, and Grinnell College faculty research funds.

1. More recently in 2005, Evo Morales, a left-wing, indigenous leader won the presi- dential elections, promising to dismantle the neoliberal economy.

2. Census data for 1992 showed that 5 percent of the population was monolingual Spanish speakers, 71 percent was bilingual in Quechua and Spanish, and approximately 24 percent was monolingual Quechua speaking.

3. My translation of desahogar as "undrown" is literal. The verb ahogar means to drown. When the expression desahogarse is used, it means "to have an emotional release, an unburdening; to get things off your chest." I use the literal translation in my text to highlight the fluidity of the expression for the English reader.

4. If emotions are not expressed, there are other means through which they can "come out" and not accumulate in the body. One way is through vomiting, another is through their transformation into other substances such as bile that can also be eliminated through



vomiting. Therapeutic extraction can also facilitate the elimination of emotions. Punatefia market women commonly wore tiny coca leaves or fava bean halves adhered to their tem- ples. These small objects were said to "suck" out rage or sorrow from a person's head and thus alleviate some of the symptoms resulting from rage or sorrow.

5. Many scholars have examined notions of debilidad in the Andes, including Bastien 1987, Hammer 1997, Larme 1998, and Oths 1999.

References Cited

Abu-Lughod, Lila, and Catherine A. Lutz 1990 Introduction: Emotion, Discourse, and the Politics of Everyday Life. In Language

and the Politics of Emotions. Catherine A. Lutz and Lila Abu-Lughod, eds. Pp. 1-23. Cambridge: Cambridge University Press.

Agadjanian, Victor 2003 Competition and Cooperation among Working Women in the Context of Struc-

tural Adjustment: The Case of Street Vendors in La Paz-El Alto, Bolivia. In Through the Eyes of Women: Gender, Social Networks, Family, and Structural Change in Latin America and the Caribbean. Cecilia Menjivar, ed. Pp. 262-288. Willowdale, Ontario: de Sitter Publications.

Alba, Juan Jose 1989 La Tirisia. Una Nueva Interpretaci6n Psicoanalitica. Busqueda 1(1):31-54. Uni-

versidad Mayor de San Sim6n, Cochabamba, Bolivia. Appadurai, Arjun

1990 Topographies of Self: Praise and Emotion in Hindu India. In Language and the Politics of Emotion. Catherine A. Lutz and Lila Abu-Lughod, eds. Pp. 24-45. Cam- bridge: Cambridge University Press.

Bastien, Joseph 1987 Healers of the Andes. Salt Lake City: University of Utah Press.

Centro de Documentacion y Informacion (CEDOIN) 1990 Inmobiliarias: La Estafa de Siglo. La Paz: CEDOIN.

Clark, Mari H. 1989 Nerva in a Greek Village: Idiom, Metaphor, Symptom or Disorder? In Gender,

Health, and Illness: The Case of Nerves. Donna L. Davis and Setha M. Low, eds. Pp. xi-xv. New York: Hemisphere Publishing.

Csordas, Thomas 1990 Embodiment as a Paradigm for Anthropology. Ethos 18(1):5-47.

Csordas, Thomas, ed. 1994 Embodiment and Experience: The Existential Ground of Culture and Self. Cam-

bridge: Cambridge University Press. Davis, Dona L., and Setha M. Low

1989 Preface. In Gender, Health, and Illness: The Case of Nerves. Dona L. Davis and Setha M. Low, eds. Pp. xi-xv. New York: Hemisphere Publishing.

de la Cadena, Marisol 1995 "Women Are More Indian": Ethnicity and Gender in a Community near Cusco.

In Ethnicity, Markets and Migration in the Andes: At the Crossroads of History and Anthropology. Brooke Larson and Olivia Harris, eds. Pp. 329-348. Durham, NC: Duke University Press.

1996 The Political Tensions of Representations and Misrepresentations: Intellectu- als and Mestizas in Cusco (1919-1990). Journal of Latin American Anthropology 2(1):112-147.



Desjarlais, Robert R. 1992 Body and Emotion: The Aesthetics of Illness and Healing in the Nepal Himalayas.

Philadelphia: University of Pennsylvania Press. Dunk, Pamela

1989 Greek Women and Broken Nerves in Montreal. Medical Anthropology 11(1):29- 45.

Farmer, Paul 1988 Bad Blood, Spoiled Milk: Bodily Fluids as Moral Barometers in Rural Haiti.

American Ethnologist 15(1):62-83. 1996 On Suffering and Structural Violence. Daedalus 125(1):261-283.

Finkler, Kaja 1994 Women in Pain: Gender and Morbidity in Mexico. Philadelphia: University of

Pennsylvania Press. Geertz, Clifford

1973 The Interpretation of Cultures. New York: Basic Books. Gill, Lesley

2000 Teetering on the Rim. New York: Columbia University Press. Glass-Coffin, Bonnie

1992 Discourse, Dano and Healing in North Coastal Peru. In Anthropological Ap- proaches to the Study of Ethnomedicine. Mark Nichter, ed. Pp. 33-57. Philadelphia: Gordon and Breach Science Publishers.

Gutmann, Matthew 2001 Mamitis and the Traumas of Development in a Colonia Popular of Mexico City.

In Gendered Modernities. Dorothy Hodgson, ed. Pp. 149-172. New York: Palgrave Press.

Hammer, Patricia 1997 "To Be a Woman Is to Suffer." The Interplay of Illness, Emotion and the Body

in Quechua Women's Experiences. Ph.D. dissertation, Department of Anthropology, University of Illinois, Urbana-Champaign.

Kitayama, S., and H. R. Markus 1994 Emotion and Culture: Empirical Studies of Mutual Influence. Washington, DC:

American Psychological Association. Kleinman, Arthur, Veena Das, and Margaret Lock

1997 Social Suffering. Berkeley: University of California Press. Krieger, Laurie

1989 Nerves and Psychosomatic Illness: The Case of Um Ramadan. In Gender, Health, and Illness: The Case of Nerves. Dona L. Davis and Setha M. Low, eds. Pp. xi-xv. New York: Hemisphere Publishing.

Larme, Anne 1998 Environment, Vulnerability, and Gender in Andean Ethnomedicine. Social Science

and Medicine 47(8):1005-1015. Lind, Amy

2003 Making Feminist Sense of Neoliberalism: The Institutionalization of Women's Struggles for Survival in Ecuador and Bolivia. In Through the Eyes of Women. Cecilia Menjivar, ed. Pp. 262-288. Willowdale, Ontario: de Sitter Publications.

Lock, Margaret 1993 Cultivating the Body: Anthropology and Epistemologies of Bodily Practice and

Knowledge. Annual Review of Anthropology 22:133-155. Lutz, Catherine A.

1986 Emotion, Thought, and Estrangement: Emotion as a Cultural Category. Cultural Anthropology 1(3):287-309.



1988 Unnatural Emotions: Everyday Sentiments on a Micronesian Atoll and Their Challenge to Western Theory. Chicago: University of Chicago Press.

Lutz, Catherine A., and Geoffrey M. White 1986 The Anthropology of Emotions. Annual Review of Anthropology 15:405-

436. Lyon, M. L., and J. M. Barbalet

1994 Society's Body: Emotion and the "Somatization" of Social Theory. In Embodiment and Experience: The Existential Ground of Culture and Self. Thomas Csordas, ed. Pp. 48-66. Cambridge: Cambridge University Press.

Martin, Emily 1987 The Woman in the Body: A Cultural Analysis of Reproduction. Boston: Beacon

Press. Miles, Ann

2003 Healers as Entrepreneurs: Constructing an Image of Legitimized Potency in Urban Ecuador. In Medical Pluralism in the Andes. Joan D. Kiss-Chioino, Thomas Leather- man, and Christine Greenway, eds. Pp. 107-128. New York: Routledge Press.

Mull, D. 1992 Mothers Milk and Pseudoscientific Breastmilk Testing in Pakistan. Social Science

and Medicine 34(11):1277-1290. Oths, Kathryn S.

1999 Debilidad: A Biocultural Assessment of an Embodied Andean Illness. Medical Anthropology Quarterly 13(3):286-315.

Pribilsky, Jason 2001 Nervios and "Modern" Childhood: Migration and Changing Contexts of Child

Life in the Ecuadorian Andes. Childhood: A Global Journal of Child Research 8(2):251-273.

Rebhun, Linda 1993 Nerves and Emotional Play in Northeast Brazil. Medical Anthropology Quarterly

7(2):131-151. 1994 Swallowing Frogs: Anger and Illness in Northeast Brazil. Medical Anthropology

Quarterly 8(4):360-382. 1999 The Heart Is Unknown Country: Love in the Changing Economy of Northeast

Brazil. Stanford: Stanford University Press. Rosaldo, Michelle

1980 Knowledge and Passion: Ilongot Notions of Self and Social Life. Cambridge: Cambridge University Press.

1984 Toward an Anthropology of Self and Feeling. In Culture Theory: Essays on Mind, Self, and Emotion. Richard A. Shweder and Robert A. LeVine, eds. Pp. 137-157. Cambridge: Cambridge University Press.

Rubel, Arthur 1984 Susto, a Folk Illness. Berkeley: University of California Press.

Sanabria, Harry 1993 The Coca Boom and Rural Social Change in Bolivia. Ann Arbor: University of

Michigan Press. Scheper-Hughes, Nancy

1992 Death without Weeping. Berkeley: University of California Press. Scheper-Hughes, Nancy, and Margaret Lock

1987 The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology. Medical Anthropology Quarterly 1(1):6-41.

Spedding, Alison L. 1989 Coca Eradication: A Remedy for Independence?-With a Postscript. Anthropol-

ogy Today 5(5):4-9.



Tapias, Maria 2006 "Always Ready and Always Clean?" Competing Discourses of Breast-Feeding,

Infant Illness and the Politics of Mother-Blame in Bolivia. Body and Society 12(2):83- 108.

Taussig, Michael 1980 Reification and the Consciousness of the Patient. Social Science and Medicine

14B:3-13. 1987 Shamanism, Colonialism, and the Wild Man: A Study in Terror and Healing.

Chicago: University of Chicago Press. Tousignant, Michael

1984 Pena in the Ecuadorian Sierra: A Psychoanthropological Analysis of Sadness. Culture, Medicine and Psychiatry 8(4):381-398.

Turner, Terence 1993 Bodies and Anti-Bodies: Flesh and Fetish in Contemporary Social Theory. In

Embodiment and Experience: The Existential Ground of Culture and Self. Thomas Csordas, ed. Pp. 27-47. Cambridge: Cambridge University Press.

Weatherford, Jack 1987 Cocaine and the Economic Deterioration of Bolivia. In Conformity and Conflict.

James P. Spradley and David W. McCurdy, eds. Pp. 412-423. Boston: Little, Brown. Weismantel, Mary

2001 Cholas and Pishtacos: Stories of Race and Sex in the Andes. Chicago: University of Chicago Press.

World Bank 2005 Regional Fact Sheet from the World Development Indicators 2005. Latin America

and Caribbean. Electronic document, http://www.worldbank.org/data/databytopic/ lac_wdi.pdf, accessed on March 12, 2006.


Article Contentsp. 399p. 400p. 401p. 402p. 403p. 404p. 405p. 406p. 407p. 408p. 409p. 410p. 411p. 412p. 413p. 414p. 415

Issue Table of ContentsMedical Anthropology Quarterly, New Series, Vol. 20, No. 3 (Sep., 2006), pp. 279-418Front MatterLife-Course Observations of Alcohol Use among Navajo Indians: Natural History or Careers? [pp. 279-296]The Social Life of Emergency Contraception in the United States: Disciplining Pharmaceutical Use, Disciplining Sexuality, and Constructing Zygotic Bodies [pp. 297-320]"Mixing" as an Ethnoetiology of HIV/AIDS in Malaysia's Multinational Factories [pp. 321-344]Defining Women's Health: A Dozen Messages from More than 150 Ethnographies [pp. 345-378]Violence and the Body: Somatic Expressions of Trauma and Vulnerability during War [pp. 379-398]Emotions and the Intergenerational Embodiment of Social Suffering in Rural Bolivia [pp. 399-415]Book ReviewReview: untitled [pp. 416-418]

Back Matter

Documents

Tapias Emotions intergenerational embodiment Social Suffering bolivia