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Emotions and the Intergenerational Embodiment of Social Suffering in Rural Bolivia Author(s): Maria Tapias Source: Medical Anthropology

Quarterly, New Series, Vol. 20, No. 3 (Sep., 2006), pp. 399-415 Published by: Wiley on behalf of the American Anthropological Association Stable URL: http://www.jstor.org/stable/3840535 . Accessed: 16/03/2014 07:20
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Maria Tapias of Anthropology Department Grinnell College

Emotionsand the Intergenerational Embodiment of Social Sufferingin RuralBolivia


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, stimulating 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 (Agadjanian 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.

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generation.I explore how mothersand the largercommunityin which I conducted mothfieldworksee the neoliberalreformsas causingdistressin parents,particularly ers, with short- and long-termhealth effectson their infantsand children.Although some studies have focused on the impactsthat poverty and social change have had 1992), my directly on children (Gutmann2001; Pribilsky2001; Scheper-Hughes focus is on how market- and working-classwomen in Bolivia perceivechildren's health to be affected through their mother'sfaulty emotional responsesto distress and throughtheirbodies.Women'sbodiesthus becomethe vectorsfor bothtransient and enduringailmentsand debility in their children.Drawingon two case studies, I collected during ethnographicresearchundertakenin Punata,Bolivia, I examine how neoliberalismhas affected embodimentacross generationsand how women make sense of the impactsof the distressthat permeatestheir everydaylives. Since the implementationof the economic reforms, governmentspromisedimfor work. The openingof the markets provedeconomicconditionsand opportunities made new productsavailableon marketshelves and unleashednew ambitions,expectations,and desiressuch as purchasingpower,personalautonomy,success,and, by extension, community respect. Twenty years into their implementation,however,the pledgesto alleviatepoverty and unemploymenthave not been met. In fact, emigrationrates have skyrocketedsince the 1980s as people in rural areas (those hardesthit by poverty) migratedto other regions and countries in search of employment,leavingmany women as heads of householdsand childrenin the care of and relatives. grandparents The promises for economic prosperityand a place for Bolivian productsin the global economy have, for the most part, failed-with one key exception. Boliviais one of the top three producersof coca leaves, the raw product for the production of cocaine. Coca growing and coca stomping (a process needed to make cocaine paste) have employedthousands of indigenousand peasant farmersas well as former minerswho lost their jobs when many mines were closed during the reforms. there have been massiveefforts to squelchthis secondaryeconomy Simultaneously, throughmassivecoca eradicationprograms,largelysponsoredby the UnitedStates, that are consideredkey elementsof the war againstdrugs(Sanabria1993; Spedding 1989; Weatherford1987). Since2003, two presidentshave resignedfollowing popularproteststhatresulted in confrontationswith the army. Bolivia has the second largest reservesof gas in South America, after Venezuela,and the protests crystallizedlargely around the conditions under which the export of gas was to be conducted. In many ways, with the economic however,the protestsalso spoketo the widespreaddissatisfaction reforms.Most of the media coverageon political turmoil in Bolivia has focusedon strife in urbanareasthroughimages of the militarizationof cities, roadblocks,and massivepublic marches,revealingone facet of the failureof the governmentto meet its promisesto its citizens.l In my research, I looked at everyday forms of this social suffering from the perspectiveof women in a small, semiruraltown nestled in a valley in the Andes. of distressareanother The numeroushealthproblemsand embodiedmanifestations powerful lens from which to examine how people have experiencedthe impactsof these neoliberalreforms.Duringmy fieldworkfrom 1996 to 1998 and a follow-up visit in 2003, I detected persistentsmall-scaleprotests as people complainedand

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embodiedwhat Nancy Scheper-Hughes has called the violence of everydaylife: 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 generatedby economic hardship, domestic violence social conflict, and other forms of distressplayed a fundamentalrole in how people perceivednot only their own health problemsbut also many of the health problemsthat affectedtheir infants.My researchthus examineshow in the context of social change and radical politicalreformspeoplecope with and endure(or fail to endure)the minorand major emotional stresses of life, conflict, and economic hardship and how this distress manifestsitself in multiplebodies and across generations. FieldSite 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

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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 Spanishspeaking 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 Spanishspeaking 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

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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 constructed 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 understood 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

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discourseonly after its social and cultural-its discursive-character has been fully and Lutz 1990:13), my researchstressesthe needto attend accepted"(Abu-Lughod to both dimensions.This articlecouples the above-mentionedapproachesby examining who holds power to express emotion, what emotions can be expressedand underwhat circumstances, and how emotions are experiencedin the body. For the analysis at hand, I concentrateon two working-classwomen who, in of narrativesevoked by other women. My focus on many ways, are representative the intricaciesof thesewomen'sexperiences enablesme to examinethe 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 domesticviolence and the second looks at the distressexperiencedby a womanwho lost her life savings in a bank scam. Their suffering,although clearly experienced at the individuallevel, is also seen to pass to their infants through their bodies. In the firstcase, the distressfelt by a woman named Elisa was passed on to her infant throughher breastmilk, resultingin a syndromelocally known as arrebato.In the second case, the distressexperiencedby a mother named Rosalia made its way to her infant while he was in utero, causingenduringhealth consequences. Through these cases, I begin to unpackhow people live in their bodies and experiencethe world around them in the face of the economic reformsand how this is relatedto the emergenceof emotion-related illnesses.A few focal points can help us understandthe experiencesof Elisa, Rosalia, and their children:(1) how emotions are conceptualizedand how emotional expressionand power relationsfigure into illness narratives;and (2) how breast-fedinfants and those developingin the uterusare seen as particularly vulnerableto the emotions of their mothersresulting in short- and long-termhealth effects. The Physicalityof Emotionsand the Predicament of Expression In Punata,emotions are considereda principaletiological agent in the onset of numerousillnessesand symptomsin men, women, and children.Duringmy 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 substancesthat accumulated in the body or were transformedinto other harmfulsubstances.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,

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shortlyafter,your stomach startsto hurt. In this case it was alreadyaccumulated.... When one keepsgettingangry,gettingangry,it accumulates and then when one little insignificantoffensiveremarkcomes your way, it's enough to [makeyou sick]. Holding in the rage one feels worse. Becauseif you can't "undrown"yourself (si no te desahogas),you know, when you are angry.... Well, if one is angry and undrownsoneself, then at least it goes away. But if you retain it inside you and you don't undrownyourself,that is when the pain starts.3 The women I interviewedconcurredthat it was not only feeling emotions that automaticallyrenderedpeople sick. Indeed, notions of health maintenance-their own and those of their infants-were linked to the constraints individualsfaced regardingtheir ability to express their emotions (see also Rebhun 1993). In cases of rage and sorrow,the abilityto orchestratethese emotions (whetherexpressedor not) was directlylinkedto negotiatingthe intricatewebs of power relations(between genders, ethnic groups, class, and age) and assessing the possible risks that could result from such expressions (Abu-Lughodand Lutz 1990). Where a conflict took place, with whom, and over what shaped how a person expressed and addressed emotions. The expressionof emotions is not always possible or good, particularly in public places where people worry that others will see and criticizethem (Clark 1989:113; Dunk 1989; Glass-Coffin1992; Krieger 1989). Thus, the articulation of differentfacets of one's identity to the context of the crisis ultimatelyrenders "emotionalprivileges"to certainmembersof the populationwhile denyingthem to others. Abu-Lughodand Lutz aptly assert that expression thus hinges on "power relationsthat determinewhat can, cannot or must be said about self and emotions, what is taken to be true or false about them and what only some individualscan say about them" (1990:14). So, when a particularsocial context proved inappropriate for expression,a personmight "holdin" theiremotions, an act perceivedas harmful to the body.4The damage,however,did not alwaysmanifestitselfin the bodiesof the individualsexperiencingthe emotions. In pregnantand lactatingwomen, 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 lactatingwomen, accumulatedemotions were said to find release through breastmilk and cause illness-not in the mothersthemselves,but in theirnursinginfants in the form of arrebato.This ailment,whose symptomsincludestomachaches, incessantcrying,severediarrhea,and vomiting,was primarilyconnectedin people's minds and experienceto a mother'sinabilityto shelterher child from the accumulation of her rage or sorrow.In extremecases, arrebatocould be fatal. In fact, along with susto, arrebatowas listedby the women I interviewedas one of the main causes of infant death. However, if properlytreated in a timely manner,it could also be cured.The effectsof the mother's emotionspassingto herinfantwerethus shortterm. A mother had the potential to transmit "poisonous" or tainted breast milk to her infant, particularlywhen she was under social or economic distress (see also

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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: Elisaand 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.

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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 doubleedged 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.

Emotionsand Illness Susceptibilityin Infants Maternal


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 Debility 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.

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The tropes of debilidadand fuerzapermeatemany social spheres.Debilidadnot only refersto someone'sconstitutionor 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 dependenton foreignaid, unableto competeor standup to the demandsmade by the world market.One can also speak of moral debilidad or fuerza,particularly with regardto sexualityand will power or to a caracterdebil o fuerteregardingdifferenttypes of personalitiesthat explain some life trajectories. With regardto health, debilidadand fuerzaare states or conditions that underlie the health-illnesscontinuum.Debilidadpredisposescertainindividualsto illness often relatedto emotions, or it can be a condition that resultsfrom ongoing illness and suffering(see also Larme1998; Miles 2003). This relationshipis not unidirectional; rather,there is a circularityof influencebetween the two. "One neverheals the same, one is always left more debil" was a repeatedcommentmade by women and men in Punata.These two conceptualcategoriesare not in an either-orbinary to one another.That is, a personis not eitherdebilor fuertebut can have relationship differentdegreesof these qualitiesin differentcontextual moments.A personmight be sick, for instance, and thus in a potential state of debilidad,but if he or she can carryon with normal activities,then he or she is fuerte in the ability to endurethe illness. Debilidadalso helps Punatefasexplainwhy certainpeople aremorevulnerable to illnessthan others. Certainillnessesare often thought of as havinga 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. Suchillnesseshave the most chanceof flourishing in the personwith debilidad, the person with a history of illness, or the person least able to manage his or her emotions. Although adults can develop debilidadat any time over the life course, in this article I explore the case of children left with a "constitutional"debilidad resultingfrom exposure to their mother'semotions while in the womb. Gestating babies have porous bodies that are particularlyvulnerableto the sufferingof their mothers.The story of a nine-year-old boy namedFernandoillustratesthis point and also links debilidadto a particulareconomic crisis that affectedthe community.

Case 2. Intersections of the Localand the Global:Rosalia'sSorrow and Fernando's Debilidad Rosaliawas a 33-year-oldbilingualSpanish-and Quechua-speaking hospitaljanitor. She was marriedand 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 $90. Priorto herjob in the hospital,she used to knit sweatersfor sale. approximately Sheclaimedshe nevergot sick while she workedindependently, but sinceworkingin the hospitalshe sufferedcontinuouslyfromheadaches.Mistreatment and arguments with the doctors and nurseson staff were regularparts of her quotidianlife. Rosalia'slife was also markedby a financialcrisis with long-termconsequences for the family'seconomic future.Pregnantat the time of the crisis, Rosalia believed

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that her own emotional turmoil resultedin her son Fernando'sdebilidad.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 intervention 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, nonregulated 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

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noche] and he mistreatedme a lot." It had been Rosaliawho convincedher husband to investthe money,arguingthey could live off the interestand continueto increase their savings. "How was it," I asked, "thatyou didn'tget sick duringsuch rage and sorrow?" Placingher hand on her stomach Rosalia replied: I was pregnantat the time with my youngest son. I say that maybe all of my rage and sorrow,I passed on to him becauseall 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 sufferedfrom preoccupationa lot back then.... I didn'thave a single piece of breadto eat and that was my main preoccupation. Rosalia was weakened by the emotional and financialstress 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 occurrencein pregnant women who feel intense rage or sorrow,accordingto many women I interviewed.Her son, however,cameto sufferfrom debilidadand his was seen as a constitutionaldebilidaddevelopedwhen Rosalia passed all her sufferingon to him. After Rosalia exhaustedall possibilities of gaining her money back, she felt helpless and desperate.Although the sorrow and despair that she experienceddid not make her sick, she believed that it had permanentlyaffectedher child. That she did not fall ill indicatesthe strengthof her own body but underscores the vulnerability of the child inside her who receivedthe bruntof the stress.UnlikeElisa,who could treather infantand deflectblamefor the child'sonset of arrebato,Rosalia'schild'sdebilidadhad no therapeutic solution-no medicineswould ever alleviate his condition. Fernandowas permanentlyaffected with debilidadwhile 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-termeffects of her suffering. One additional factor must be taken into account in trying to understandthe salienceof discoursesof debilidad.Debilidadis a social marker. When a personwas pointed out to me as debil, there was an implicit understandingthat this person sufferedand had a hard life, was let down, neglected,or mistreated(often unfairly in the eyes of the sufferer)by family,communitymembers,or life. When an infant was pointed out as debil, however,it markeda mother'spast suffering.As such, she might not be as harshlycriticizedfor her inabilityto adequatelyaddressher child's ailmentsand susceptibility. Conclusions In this article, I have explored the impact that maternalemotions have on infant health in Punata,Bolivia.Articulatinga discursiveand embodiedapproachto emotions permita more comprehensive of how emotions affect healthin understanding Bolivia. To just examine power relations and the expressionof emotions and their the mechanisms impactson healthdoes not help us understand throughwhich emotions are embodied.Similarly, to divorcean understanding of embodimentfrom the social and political contexts in which emotions are constitutedpresents a myopic of distressand health. understanding

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My analysisof short-and long-termeffectsof maternalemotionson infanthealth as seen in the manifestationof debilidadand arrebatorevealthat these ailmentssignal tensions in the social landscape:among neighbors,family members,coworkers, or as a resultof failed efforts to improveone's economic conditions. Debilidadand arrebato are salient and exacerbatedduring times of social crisis, community or familial conflicts, and economic hardship.The problems surroundingindividuals, households, and communitieswith root causes in the materialityof poverty, unemployment,domestic violence, high rates of alcoholism, economic recession, or increasedmigrationleavingmany women as heads of households are only a few of the factors that lead to debilidadand arrebatoin infants. The body and its ailmentscommunicate polysemousmessagesof disappointment, or household conflict. Many of these messages economic scarcity,marital, neglect, these ailmentsand symptomsmay help are imbuedwith moral value. Furthermore, structuresocial obligations, social roles, and the relationship between people. In evoking a particularillnesscategory,people might receivegreaterempathyand support fromthose aroundthem. To say a child has arrebatois to signalthat the mother may be sufferingfromeconomichardshipor fromdomesticviolence.To claima child has debilidadcan signal past maternaldistress,deflectingblame from currentdifficulties in caring for one's children.Such signals, in turn, can lead to community interference: perhapsa husbandis told not to be so harshon his wife; perhapsneighbors will sharetheircrops with those who did not fare so well in a particularseason. In other instances,the same diagnosisaffectinginfantscan unleashan intricatepolitics of mother blame that can be negotiatedand contested by women. To evoke a particularinfant illness termcommunicatesnot only an arrayof symptomsbut also hints at some of the emotionaloriginsof these symptomsand ailmentsand 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 thoughtful feedbackon earlierdrafts.In Bolivia, I am indebtedto Juana Rojas for her valuable assistance in the field and the many women who graciously agreed to be interviewed. This researchwas made possible by generous grants from the FulbrightFoundation (International Instituteof Education),the Social ScienceResearchCouncil, and GrinnellCollege faculty researchfunds. 1. More recently in 2005, Evo Morales, a left-wing, indigenous leader won the presidential elections, promising to dismantlethe neoliberal economy. 2. Census data for 1992 showed that 5 percent of the population was monolingual Spanishspeakers,71 percentwas bilingualin Quechua and Spanish,and approximately24 percent was monolingual Quechua speaking. 3. My translation of desahogar as "undrown" is literal. The verb ahogar means to drown. When the expression desahogarseis 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 Englishreader. 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 transformationinto other substancessuch as bile that can also be eliminatedthrough
and the anonymous reviewers of Medical Anthropology Quarterly for their constructive and

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vomiting. Therapeuticextraction can also facilitate the elimination of emotions. Punatefia marketwomen commonly wore tiny coca leaves or fava bean halves adheredto their temples. These small objects were said to "suck"out rage or sorrow from a person'shead and thus alleviate some of the symptoms resultingfrom rage or sorrow. 5. Many scholars have examined notions of debilidad in the Andes, includingBastien 1987, Hammer 1997, Larme 1998, and Oths 1999.

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