Llaki and Ñakary: Idioms of Distress and Suffering Among the Highland Quechua in the Peruvian Andes

Pedersen, Duncan; Kienzler, Hanna; Gamarra, Jeffrey

doi:10.1007/s11013-010-9173-z

Cited by 54 publications

(37 citation statements)

References 30 publications

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“…Proximal stressor etiology (i.e., the specific event that precedes onset) and symptom counts are listed in Table 1. Stressor etiology varied, with some seeming to match DSM-5 Criterion A (e.g., witnessing the murder of relatives; Zarowsky, 1997), many related to chronic stressors that included but were not limited to Criterion A events (e.g., the Shining Path conflict in Peru; Pedersen, Kienzler, & Gamarra, 2010), and some related to the sufferer’s interaction with supernatural causes (e.g., not observing proper burial rituals; Englund, 1998). Two CCDs were without specific etiologic stressors altogether, but were reported as increasing following periods of trauma and increasing stressors.…”

Section: Resultsmentioning

confidence: 99%

Posttraumatic stress in emergency settings outside North America and Europe: A review of the emic literature

Rasmussen

Keatley

Joscelyne

2014

Social Science & Medicine

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Mental health professionals from North America and Europe have become common participants in postconflict and disaster relief efforts outside of North America and Europe. Consistent with their training, these practitioners focus primarily on posttraumatic stress disorder (PTSD) as their primary diagnostic concern. Most research that has accompanied humanitarian aid efforts has likewise originated in North America and Europe, has focused on PTSD, and in turn has reinforced practitioners’ assumptions about the universality of the diagnosis. In contrast, studies that have attempted to identify how local populations conceptualize posttrauma reactions portray a wide range of psychological states. We review this emic literature in order to examine differences and commonalities across local posttraumatic cultural concepts of distress (CCDs). We focus on symptoms to describe these constructs – i.e., using the dominant neo-Kraepelinian approach used in North American and European psychiatry – as opposed to focusing on explanatory models in order to examine whether positive comparisons of PTSD to CCDs meet criteria for face validity. Hierarchical clustering (Ward’s method) of symptoms within CCDs provides a portrait of the emic literature characterized by traumatic multifinality with several common themes. Global variety within the literature suggests that few disaster-affected populations have mental health nosologies that include PTSD-like syndromes. One reason for this seems to be the almost complete absence of avoidance as pathology. Many nosologies contain depression-like disorders. Relief efforts would benefit from mental health practitioners getting specific training in culture-bound posttrauma constructs when entering settings beyond the boundaries of the culture of their training and practice.

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Section: Resultsmentioning

confidence: 99%

Posttraumatic stress in emergency settings outside North America and Europe: A review of the emic literature

Rasmussen

Keatley

Joscelyne

2014

Social Science & Medicine

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“…Quechua of Peru, Pederson, Kienzler, and Gamarra (2010) found that the particular sadness and anxiety-like symptoms reported by the group were due to extreme adversity resulting from ''persistent social inequalities, social exclusion and a recent history of political violence' ' (2010, p. 279). The context-specific trauma syndromes experienced by this group are unlikely to be addressed by cognitive-behavioral or other purely psychological interventions.…”

Section: Fernando 403mentioning

confidence: 99%

The roads less traveled: Mapping some pathways on the global mental health research roadmap

Fernando

2012

Transcult Psychiatry

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The global mental health (GMH) research agenda should include both culture-general and culture-specific perspectives to ensure ecological validity of findings. Despite its title, the current GMH research agenda appears to be using a monocultural model that is individualistic, illness-oriented, and focused on intrapsychic processes. Ironically, issues of culture are prominently absent in many discussions of global mental health. This paper highlights some issues and concerns considered key to conducting ecologically valid and socially responsible GMH research. The concerns are particularly directed at researchers from dominant cultures who are working in low-income countries. Central to these issues is the balance between etic and emic perspectives in assessment, diagnosis, and intervention, as well as language, engagement of stakeholders and their agendas, and evaluation of the benefit of interventions to the community. New terminology is proposed that identifies broad cultural groups, and recommendations provided for a research agenda to encourage both basic and applied research that mutually benefits all stakeholders in the GMH research endeavor.

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“…Pinsamietuwan (worrying thoughts), ñakary (suffering) and llaki (sorrow/sadness) are idioms of distress and suffering expressed by the Quechua population, which believe are manifested from both past and current events. [11] Approximately one-fourth of the population has reported symptoms compatible with PTSD and two-fifths with anxiety and/or depression. [3] Research has revealed that after the administration of the Harvard Trauma Questionnaire to local communities in Ayacucho, all respondents reported experiencing a combat situation, varying reports of torture (80%), witnessing murders (40%), sexual abuse (30%), and having to defend one's life by killing (20%).…”

Section: Introductionmentioning

confidence: 99%

Making Strides Towards Better Mental Health Care in Peru: Results from a Primary Care Mental Health Training

Borba

Gelaye

Zayas

et al. 2015

Int. J. Clin. Psychiat. Ment. Health

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Our program attempted to improve attitudes and confidence of Peruvian primary care physicians (PCPs) providing mental health care. The training program underwent an evaluation to determine impact of sustained confidence in performing medical and psychiatric procedures, and application of learned skills. Fifty-two Peruvian primary care practitioners were trained at the Harvard Program in Refugee Trauma (HPRT) over a two-week period. There was significant improvement in PCPs’ confidence levels of performing psychiatric procedures (counseling, prescribing medications, psychiatric diagnosis, assessing the risk for violence, and treating trauma victims) when comparing baseline and post-two-week to one year follow-up. When comparing post-two-week and one-year follow-up quantitative measures, confidences levels went slightly down. This may be an implication that the frequency of trainings and supervisions are needed more frequently. In contrast, qualitative responses from the one-year follow-up revealed increase in victims of violence clinical care, advocacy, awareness, education, training, policy changes, accessibility of care, and sustainment of diagnostic tools. This study supports the feasibility of training PCP's in a culturally effective manner with sustainability over time.

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Llaki and Ñakary: Idioms of Distress and Suffering Among the Highland Quechua in the Peruvian Andes

Cited by 54 publications

References 30 publications

Posttraumatic stress in emergency settings outside North America and Europe: A review of the emic literature

Posttraumatic stress in emergency settings outside North America and Europe: A review of the emic literature

The roads less traveled: Mapping some pathways on the global mental health research roadmap

Making Strides Towards Better Mental Health Care in Peru: Results from a Primary Care Mental Health Training

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