The Medicalisation of Incest and Abuse is an insightful exploration of sexual violence in Bolivia, a country where sexual abuse is considered widespread, and there are no official data of the extent to which it affects minors (but see Jelke Boesten, ‘Sexual Violence against Minors in Latin America’, Directorate-General for External Policies, European Parliament, 2016: http://www.europarl.europa.eu/RegData/etudes/STUD/2016/578023/EXPO_STU(2016)578023_EN.pdf, last access 3 April 2019). Carolina Borda-Niño-Wildman focuses on the role of psychiatry and mysticism in making this type of violence invisible. Her approach is innovative as sexual violence is seldom studied in relation to psychiatry, and the psychiatric literature in and on Bolivia has left sexual violence undiscussed. The book provides a detailed account of the treatment given to female victims of incest and incestual relationships (how they are discussed and diagnosed and how the victims are cared for) in Bolivia's National Psychiatric Hospital and within indigenous rural communities in the country.

During her research, Borda-Niño-Wildman participated in everyday activities in the psychiatric hospital for ten months and visited the families and communities of origin of two of the hospitalised women in the Female Intermediate/Chronic Unit. By carrying out in-depth interviews, participatory observation and historical and documentary analysis, the author intertwines the narratives of eight women (patients and staff) with theory to re-construct a complex institutional and social system of hierarchisation and domination that make invisible the episodes of sexual violence in the female patients’ life. Borda-Niño-Wildman's work is essential to understanding both the under-reporting of sexual violence in Bolivia, especially in rural indigenous areas, and the negligence present in medical care when the victim/patient is poor, rural, indigenous and female. She uncovers how indigenous and biomedical ‘diagnoses’ of ‘abnormal behaviour’ after cases of sexual abuse lead to hiding incest and sexual violence by categorising the victims as ill. The diagnosis obscures the abuse by making violence into a medical or mystical issue and, therefore, leads to questioning the credibility of the victim and discarding the relevance of the harm done (p. 105).

The book is an ethnographic account of the devastating journey of the eight main research participants, from girls growing up in an abusive environment to women expelled from their communities and ‘imprisoned’ in a hospital. The research uncovers and explores three main findings. The first is the effect of gender and ethnic discrimination in the diagnosis and medical care of female patients in a psychiatric hospital. Borda-Niño-Wildman describes the institutional incapacity and unwillingness to take into account cultural differences and practical limitations such as language (the institution worked in Spanish, while some women were Aymara or Quechua speakers) in the diagnosis of indigenous women patients, categorising them as illiterate or even ‘retarded’ (p. 71). The author describes how women are deprived of the possibility of telling their own story, with the narration of their testimonies forced into versions formulated by men (Spanish speakers) and doctors, and any opportunity for providing their own perspective on their condition and receiving appropriate treatment reduced or eliminated. As for medical care, Borda-Niño-Wildman describes life in the psychiatric institution as another scenario for ethnic, gender and class discrimination, where violence is used to construct and maintain formal and imaginary hierarchies between and among staff (religious, medical and non-medical) and ‘inmates’.

The second finding highlights the role of violence in women's lives from childhood until they become inmates in the psychiatric hospital. Borda-Niño-Wildman describes the infliction and invisibility of sexual abuse in two scenarios: the indigenous community and the psychiatric hospital. In the first case, she unpacks terms such as ‘qhencha’, which means both ‘misfortune’ and ‘disgrace’, and at the same time ‘a curse to fall on a person who has done something deplorable’ (p. 117). The word is used within indigenous communities to refer to the unusual behaviour of a woman following sexual abuse, as if it was a sign that she had been punished for allowing the abuse to happen (p. 177). Borda-Niño-Wildman goes further and suggests that ‘sexual violence inflicted upon girls by relatives is potentially one of the events that make the becoming of a woman possible’ (p. 170), as this type of violence is not necessarily detrimental to kinship reproduction and does not endanger social networks within the community if it is endured silently; that is to say, ‘successfully’ (p. 168). As for the psychiatric hospital, she found that sexual violence was seldom mentioned in its clinical records and doctors would use discriminating biological criteria to explain how ‘not all women who have been survivors of sexual violence would be suitable for psychotherapy’ (p. 115), as some women are stronger than others and ‘women are always more sentimental than men’ (p. 116). Borda-Niño-Wildman is at her best in showing the similarities in how an indigenous community and a biomedical institution tend to neglect violence against women by relating it the ‘biological and social weaknesses’ of women, making abuse a matter of the victim only. The final finding analyses the life stories of the abuse victims and the narrative that transforms them from victims into psychiatric inmates. Borda-Niño-Wildman explains both the indigenous and biomedical categories that transform the female abuse victims into outcasts and malfunctioning organisms, justifying the treatment given to them by depicting their bodies as animalistic – without hope of being cured, but that need to be contained.

The book also contributes to questioning the existing idea, supported primarily by Claude Lévi-Strauss’ incest theory in his book The Elementary Structures of Kinship (Beacon Press, 1969 [1949], p. 9), that the incest prohibition is universal and has been present since the beginning of society. Borda-Niño-Wildman postulates that to think the ‘political economy of sexual exchange is based on prohibition, and that its contrary is but a sign of anomy and pre-anti-sociality, is mistaken’ (p. 205) as it could also be an active part of society to reproduce hierarchies. Regarding methodology, Borda-Niño-Wildman questions the academic tendency to ‘demonstrate the universality of categories that are supposedly created to help us understand diverse realities’ (p. 206). In the case of incest, she calls for a move beyond the idea that incest can be explained only as prohibited and abnormal, but to explore the meaning given to it by diverse groups to avoid minimising or denying the complexity of the experience lived by women.

This book is an essential read for students, activists and policymakers interested in further understanding and tackling gender inequality and violence against women, girls and children more broadly, and, of course, the possibly widespread, but still primarily hidden, prevalence of incest.