Patterns of persistence amidst medical pluralism: pathways toward cure in the southern Peruvian Andes.

When mental illness and related conditions strike among the Quechua-speaking peasant population of southern Peru, they open wide the question of who is best placed to offer the healing that families seek for their afflicted relative. Biomedical doctors and the traditional healers known as yachaqs are the two most commonly consulted sources of help. Yet most families show different patterns of persistence with each; they frequently give up on biomedical assistance after the initial intervention but continue to consult a succession of yachaqs over considerable periods of time, even if the former has had some limited success and the latter virtually none. I draw on ethnographic fieldwork to show that explanations based on inaccessibility, cultural incongruence between patient and clinician, or stigma are ultimately inadequate; rather, it is necessary to delve into fundamental differences in how the two fields of healing are conceptualized by those negotiating them.