War, medicine and morality in Aceh : an ethnography of 'trauma' as an idiom of distress

Abstract

Despite long being surrounded by controversy, trauma remains a pervasive medical-moral discourse to explain suffering and distress. Anthropologists have often been critical of the globalisation of medicalised subjectivities such as trauma, yet few have sought to examine how the notion of trauma itself changes as it travels through different cultural and political milieu. This project is a grounded ethnographic study of how this globalised and vernacularised trauma construct has come to feature within the moral imagination in Aceh, Indonesia. The loanword 'trauma' has become a key idiom of distress through which Acehnese people understand illness and suffering and narrate the implications of a life lived through war. I argue that through this narrative work my interlocutors not only describe their experience but attempt to transform the medical-moral realm that trauma describes. The thesis begins by discussing the clinical and social history of trauma in its Indonesianised form. I show how trauma has been shaped not only by psychiatrists and international NGOs, but also by the media, the military, state officials and social movements who together produced and popularised trauma as a medical-moral idiom. I then move on to contemporary Aceh, showing how my interlocutors use trauma to reflect on the nature of history, suffering and bravery (Chapter Three). I explore how trauma has become integrated into spirit possession practices, and come to shape understandings of the body, illness and the limits of sensory experience (Chapter Four). In Chapter Five, I discuss understandings of death and destiny in relation to trauma, and explore the ways that the tsunami and the conflict shaped normative responses to suffering. In Chapter Six, I look at the question of stigma, showing how a diagnosis of trauma paradoxically enables Acehnese people to problematise madness and interject in the association between madness and colonisation. By making a shift to seeing trauma as an idiom of distress through which people think, rather than a disease from which people suffer, it becomes possible to see how trauma plays a significant role within Acehnese medical practice and political imaginaries. Trauma has become a salient medical-moral idiom in Aceh not only because of the political power of biomedical psychiatry but because the moral imaginary of medicine and the body has been reconstituted through Aceh's history of violent conflict. Bringing together critical medical anthropology with the anthropology of violence, this project is a case study of the ways through which medicine and illness become reimagined, challenged and reconfigured through the suffering of war.