The Medicalisation of Incest and Abuse

Biomedical and Indigenous Perceptions in Rural Bolivia

Carolina Borda-Niño-Wildman

• Publisher: Routledge
• Year: 2017
• eBook ISBN:
  9781351810890
• Topic: Ciencias sociales
• Subtopic: Trabajo social

Combining biomedical, psychological, and anthropological approaches to intergenerational incestuous violence experienced by rural indigenous [and] peasant women in the Andean region, this book raises new questions surrounding humanness and the normalisation of sexual violence. Through original ethnographical research, the author analyses Andean understandings of incest, medical positivist practices, as well as the psychiatric 'treatment' of incestuous and gender-based violence.

The book examines the implications that psychiatric institutionalisation within the context of interethnic, gender, and class schemes, has on what it means to be human. It also draws on a theoretical framework in order to understand how discourses shape, and are simultaneously problematized by individual experiences of sexual violence and incest. Intergenerational incestuous violence against women is not necessarily an exceptional event, but can be an ordinary process, one where through the articulation of biomedical and indigenous medicine, as well as indigenous and mestizo forms of administration of political power, women as subjects can become possible.

This book will appeal to scholars and students with an interest in gender-based violence, as well as mental-health practitioners and academics in Latin American studies, anthropology, gender studies, and sociology.

1 Introduction

Sexual intercourse between persons who are not married is fornication and improper;

between persons who are married but not to each other is adultery and wrong;

between blood relatives is incest and prohibited;

between persons of the same sex is homosexuality and wrong;

with animals is sodomy [sic] and prohibited;

with one’s self is masturbation and wrong;

and with parts of the body other than the genitalia themselves is wrong.

All of these are defined as ‘unnatural sex acts’ and are morally,

and in some cases, legally, wrong in American culture.

(Schneider, 1980: 38)

The aim of this book, departing from Schneider’s exclusionary statement, is to show that intergenerational incestuous violence against women is not necessarily an exceptional event, but that it can be an ordinary process, one where through the non-orchestrated articulation of biomedical and indigenous medicine, as well as indigenous and mestizo forms of administration of political power, women as subjects can become possible. Andean ways of defining womanhood in relation to sexual violence within kinship relationships have as a constitutive element the naming of abject beings, even though the definition of such abjection is not given by individual actions but rather by the social conditions under which such violence can take place legitimately. In an interethnic country such as Bolivia, Andean concepts become intertwined with, rather than opposed to those formulated from a biomedical position. The result of this is that the place of condemnation for those “soulless” and “possessed” women who, within their communities, have been sexually abused by relatives, is a psychiatric institution, created to provide treatment for those whom are deemed unable to “experience” sexual violence given a purported organic deficiency.

No aspect of the administration of sexual exchanges and physical reproduction, as well as of the dynamics of ethnicity and class, which form the main axis of this work, is foreign to a process of negotiation between changing discourses on humanity and animality – natural and supernatural, physical and social, genetic and cultural. Qhencha (excess) as much as schizophrenia (lack) is, in Bolivia, a cornerstone of wider discourses on ethnicity, class, and gender, and not restricted to psychiatry or Quechua/Aymara medicine. Individuals who are categorised as qhencha, as schizophrenic, as mentally retarded, or as asustada (= frightened), are placed in a zone of indistinction that includes them in the realm of humanity by conditioning such belonging to a precarious bond, whose existence/recognition depends on the almost certain impossibility of obeying rules that are made to exclude them from the beginning. The research focuses on ethnographic findings in Bolivia, but its conclusions, as well as the analytical tools employed, can prove fruitful if situated into many other contexts.

This book presents an ethnography of violence against peasant and indigenous women in Bolivia as discourses and experiences produced within psychiatric settings. However, they are not solely related to a biomedical position. The locus of analysis is the relation that is constructed between biomedical and indigenous ways of representing humanness and the treatment of women who have survived sexual violence exercised through what is known in the anthropological literature as “incest”.

I proceed by investigating the ways in which apparently distant discourses can be complementary to each other, and be embodied (not without conflict) by women who have experienced incestuous violence. Apart from studying how psychiatric treatment is formulated for women under these circumstances, exploring traditional indigenous medicine’s and peasant communities’ stance in this respect, the research looks at how intrafamilial sexual violence is experienced by women of predominantly rural indigenous origin, who have been hospitalised in Bolivia’s major public psychiatric hospital. These experiences were considered in the context of a wider field of ethnic, class, and gender discourses produced in the Andean region in particular and Latin America in general.

Combining biomedical, psychological, and anthropological approaches to intergenerational incest experienced by rural indigenous women in the Andean region, this book raises new questions surrounding humanness and the normalisation of sexual violence. New ethnographical research and first-hand accounts from hospitalised indigenous and peasant women in Bolivia who have experienced intrafamilial sexual violence come together in an analysis of Andean understandings of incest, positivist medical practices, and the psychiatric ‘treatment’ of incest along with the implications such institutionalisation has on what it means to be human and, more specifically, a woman.

Under the category of intergenerational incest (from now on described as “incest”) I attempt to understand a certain range of sexual relationships that take place between male and female kin who belong to different generations (I focus on older men and younger women related to each other in a direct line by blood -consanguinity-, affinity, spiritual kinship, or adoption). These sexual encounters take place under four simultaneous conditions: the use of the body, the use of pleasure, the use of violence, and the presence of a certain kind of prohibition.

Although there is a variety of possible incestuous relations, I have chosen to work with heterosexual intergenerational incest where violence is exerted against women (who are younger than the men involved), as it allows me to analyse how social restrictions can be overcome and in turn used positively in the production of subjects. Also, because in this type of incest the interplay between discourses on victimhood and those on criminality and damnation is more clearly seen. In the nuances, I show how the construction of the subject “woman” is crossed by power and violence as much as by a constant need for subjects to respond to contradictory appellations.

Departure points

Gender violence

In the anthropological literature, gender and violence have been analytically linked through an analysis of power. In this book, and following a Foucauldian approach (Foucault, 1982), violence is understood in terms of its relationship, as an imposition, with power relations. The capacity to influence, that is, to structure the field of action of others (governmentality), cannot be understood without considering the exercise of finely, sometimes harshly executed forms of imposition of actions over others who may not resist them.

This complementarity between forms of action has been studied in relation to gender from different perspectives. Gender, in turn, is understood, in its dynamism and its sedimentations, as “the apparatus by which the production and normalisation of masculine and feminine take place along with the interstitial forms of hormonal, chromosomal, psychic, and performative that gender assumes” (Butler, 2004: 42). Hence, as Butler pointed out, it is not a normative definition, but one that allows for the inclusion of different forms of identity and materiality from the binary normative ones (Ibíd.). In this book, we focus on dynamics of violence against women, and inscribe this analysis within the wider field of studies on gender violence.

However general these definitions may appear to be, understanding how violence against women is defined and operates in specific contexts has made it challenging for any universal understanding to be applicable. One of such attempts is presented by Sally Merry, who studied global policy processes that tackle violence against women (2006). In her study of the tensions between global law and local justice regarding gender rights, Merry identifies the centrality that culture and religion have in determining the success of any human rights international law’s application in many contexts, and the importance that local framing of so-called universal terms has for increasing the possibility of international agreements being understood and shared, or at least less resisted, by citizens in specific contexts. The author analyses the role of NGOs’ human rights workers as mediators and “translators” between international organisations’ requests and local forms of administration of political power. Merry is adamant that universal human rights are not only possible, but that they can also be translated into local realities, and that cultural traditions and claims to ethnic sovereignty, which in her view often resist human rights discourses, should not be an obstacle to implementing initiatives that promote women’s rights discourses with “international legitimacy”.

One of those definitions which pretend to be universal is presented by Wies Agamben and Haldane in the introductory chapter of the edited book Anthropology at the Front Lines of Gender-Based Violence. The authors define gender-based violence as “violence against an individual or population based on gender identity or expression”, including violence against women, defined by the United Nations High Commissioner for Human Rights (1993) as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women” (2). Reflections provided by the volume’s authors have in common an analysis of global political-economic structures and processes to render visible the structural causes of violence. What is problematic here is that in the attempt to capture the generalities of a universal phenomenon, researchers, but also international organisations in charge of advocating women’s rights, take the risk of doing what Linda Alcoff warned against back in the 1980s in relation to poststructural feminism’s assumptions about “women’s nature”, namely “to reflect and reproduce dominant assumptions about women, which not only fail to represent the variety of women’s lives but promote unrealistic expectations about ‘normal’ female behaviour that most of us cannot satisfy” (1988: 413). The risk posed by universal assumptions about violence and gender, both as separate and linked categories, is that they can erase the spectrum of possible collective and individual experiences and discourses that might be valid from the viewpoint of many mixed-gender social groups (nations, ethnic groups, etc.), but also from that of women themselves. However, understanding the structural causes of dynamics that are described in the scholarship as violence against women allows for the openness of the field of interpretation of what is possible as a true statement, and of the origin of the different symbolic universes that practices originate from.

Qualitative analysis can be critical to such an enterprise by enabling consideration of meanings that are embodied by individuals and groups in relation to what could seem to be impenetrable dynamics to the external observer, whether the moral stance of the researcher is that these should be changed or not. Here, the voices of those people whose flesh is traversed by cultural, political, social, and economic dynamics that the observer is trying to give an account of what may come to the surface. Ideally, it is they who should take the decision and have the power to transform realities that they find unjust. A dilemma between relativism and universalism may seem to arise here. How to formulate interpretations that do not dismiss experiences of injustice and inequality that have so much in common and are so widespread?

We follow Alcoff’s stance, according to which the category Woman is defined as a “position from which a feminist politics can emerge rather than a set of attributes that are ‘objectively identifiable’” (op. cit.: 435). Founded upon positionality, what it means to become a woman is not predetermined, nor is it out of context or lacking history. Constraints and possibilities that produce such positions should be explained, so that we can not only understand how they become possible, but also how they can be transformed.

There exists in the literature a comprehensive array of studies that approach from different perspectives the structural and contingent dimensions of dynamics and discourses that in various geographical levels infringe upon women’s dignities. From an ethnographic perspective, we find examples such as Abraham’s work on South Asian women’s experiences of domestic violence and their trajectories within the American social, legal, economic, and other institutional systems, as well as within their own families and communities (2000). Counts, Brown, and Campbell (1992) present an edited volume, Sanctions and Sanctuary: Cultural Perspectives on the Beating of Wives, with articles that offer cross-cultural comparisons on how wife-beating becomes legitimate, and how it might be discouraged; cultural factors are analysed in both their commonalities and differences.

In another ethnographic account of the influence of discourses over practices, partially focused on state dynamics, Sarah Hautzinger studies the effects that the conflict between chauvinist ideas of masculinity, honour, and femininity, on one side, and women’s movements on the other, had on the transformation of the police’s approach to violence against women in Salvador de Bahia, Brazil (2007). An all-female police stations scheme was inaugurated to tackle increasing rates of intimate partner violence (IPV) in the city, as well as the growing disdain that citizens were expressing towards IPV survivors. Gender power struggles proved to be susceptible to change for the sake of a more equitable society. Whether the state embraced feminism or strategically integrated elements into its discourse is another matter.

A comparative approach to gender politics in Latin America is provided by Fiona Macaulay in her book Gender Politics in Brazil and Chile (2005). Looking at the Brazilian and Chilean case, the author analyses the importance that different degrees of concentration of power within a state’s administration, as well as ideological conflicts and corruption, can have on the recognition of rights for women and the legitimisation of violence against them.

An intermediate level of analysis is that of civil society organisations and their role as agents of vindication of the rights of women, as well as possible obstacles to improving women’s lives. In Sheltering Women: Negotiating Gender And Violence in Northern Italy, Sonja Plesset studies ethnographically a continuum of local perceptions of violence against women, and how they are incorporated into the support that local organisations with different ideological backgrounds provide to women survivors of domestic violence (2006). Plesset studies two shelters, one that qualifies as leftist, and the other as Catholic. The consideration of women’s experiences, of their individual rights, the place of traditional family values, and the purpose of civil organisations in relation to intervening in cases of IPV is varied; it reflects a diversity of values that have to do with contradictory views o...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures, map and photographs
• Acknowledgements
• Preface
• Prologue
• 1 Introduction
• 2 Gender, ethnicity, and class in Bolivia’s national psychiatric hospital
• 3 Humanness as a continuum
• 4 Las Condenadas: from indigenous traditional medicine to psychiatric biomedicine
• 5 Conclusions
• Appendix: photographs
• Index