<Emphasis Type="Italic">Susto</Emphasis> and<Emphasis Type="Italic"> Nervios</Emphasis>: Expressions for Stress and Depression

Folk illnesses that are cultural constructions of psychological distress offer a vehicle for the cross-cultural study of stress and stress-related morbidity. This study explores the relationship between the Latin American folk illnesses susto and nervios and mental health. We hypothesize that these folk illnesses are distinct and that there is a stronger association between current levels of stress and depressive symptoms with past experience of nervios than with susto, because the cultural constructions of these folk illnesses reflect chronic and acute concepts of distress, respectively. Interviews were conducted in Guadalajara, Mexico, where participants responded to questions about their socio-demographic characteristics, stress, depressive symptoms, and whether they had experienced susto or nervios. Susto and nervios are very prevalent and occur across sociodemographic subgroups, with the exception that nervios occurred more often in women (p < 0.05). Susto was significantly associated with stress and depressive symptoms (p < 0.05), but nervios had a much stronger association (p < 0.0001), even after controlling for gender. Susto and nervios were expressions of psychological distress; most of those with depression reported susto and/or nervios. This study validates the link between these folk illnesses and stress and depression and may, ultimately, facilitate cross-cultural research on stress.     

Explanatory Models and Mental Health Treatment: Is Vodou an Obstacle to Psychiatric Treatment in Rural Haiti?

Vodou as an explanatory framework for illness has been considered an impediment to biomedical psychiatric treatment in rural Haiti by some scholars and Haitian professionals. According to this perspective, attribution of mental illness to supernatural possession drives individuals to seek care from houngan-s (Vodou priests) and other folk practitioners, rather than physicians, psychologists, or psychiatrists. This study investigates whether explanatory models of mental illness invoking supernatural causation result in care-seeking from folk practitioners and resistance to biomedical treatment. The study comprised 31 semi-structured interviews with community leaders, traditional healers, religious leaders, and biomedical providers, 10 focus group discussions with community members, community health workers, health promoters, community leaders, and church members; and four in-depth case studies of individuals exhibiting mental illness symptoms conducted in Haiti's Central Plateau. Respondents invoked multiple explanatory models for mental illness and expressed willingness to receive treatment from both traditional and biomedical practitioners. Folk practitioners expressed a desire to collaborate with biomedical providers and often referred patients to hospitals. At the same time, respondents perceived the biomedical system as largely ineffective for treating mental health problems. Explanatory models rooted in Vodou ethnopsychology were not primary barriers to pursuing psychiatric treatment. Rather, structural factors including scarcity of treatment resources and lack of psychiatric training among health practitioners created the greatest impediments to biomedical care for mental health concerns in rural Haiti.     

Bodily Remembering: Memory,Place, and Understanding Latino Folk Illnesses among the Amuzgos Indians of Oaxaca,Mexico

This paper takes the theoretical construct of popular nosology of Latino folk illnesses and combines it with Edward Casey’s concept of bodily remembering in order to more fully describe the role of memory and place in the illness experiences of the Amuzgos Indians of Oaxaca, Mexico. I ethnographically describe, across time, the interrelated links among social events, physical symptoms, and illness narratives of Latino folk illness popular nosologies as they are contextualized in their unique, social topographies. This enlarged theoretical perspective implies a smallest unit of meaning that is ethnographically defined, but that will often encompass more than the individual sufferer and more than one illness. The research objective of this study was to understand Amuzgan illness experiences through the narratives of detailed case histories and ethnographic observations that were gathered during 18 months of qualitative research. The data show that Amuzgos experience Latino folk illnesses as bodily rememberings of illness events combined with negative interpersonal interactions. Healing these Latino folk illnesses implies curing bodies, households, social relationships, and living environments.     

Traditional Medicine and Childcare in Western Africa: Mothers’ Knowledge,Folk Illnesses,and Patterns of Healthcare-Seeking Behavior

Background

In spite of the strong role of traditional medicine in childcare in the pluralistic healthcare system in Western Africa, little information is known on mothers’ domestic plant knowledge. Identifying local perspectives and treatments of children’s illnesses, including folk illnesses, is essential to having a comprehensive understanding of how mothers make healthcare treatment decisions. We aimed to identify which infant illnesses Beninese and Gabonese mothers knew to treat with medicinal plants and for which illnesses they sought biomedical care or traditional healers.

Methods

We conducted 81 questionnaires with mothers in Bénin and Gabon and made 800 botanical specimens of cited medicinal plants. We calculated the number of species cited per illness and the proportion of participants knowledgeable on at least one herbal remedy per illness. Using qualitative data, we described folk illnesses in each country and summarized responses on preferences for each of the three healthcare options.

Results

Participants from both countries were most knowledgeable on plants to treat respiratory illnesses, malaria, diarrhea, and intestinal ailments. Mothers also frequently mentioned the use of plants to encourage children to walk early, monitor the closure of fontanels, and apply herbal enemas. Major folk illnesses were atita and ka in Bénin and la rate and fesses rouges in Gabon. Traditional healers were reported to have specialized knowledge of cultural bound illnesses. Malaria was frequently cited as an illness for which mothers would directly seek biomedical treatment.

Conclusion

Mothers largely saw the three systems as complementary, seamlessly switching between different healing options until a remedy was found. Folk illnesses were found to give insight into local treatments and may reveal important neglected diseases. Due to high reported levels of knowledge on treating top statistical causes of infant mortality and folk illnesses, mothers’ medicinal plant knowledge should be included in the analysis of healthcare-seeking behavior for childcare.     

Explaining a complex disease process: talking to patients about Hansen's disease (leprosy) in Brazil

Patient explanatory models of Hansen's disease (leprosy) in Rio de Janeiro, Brazil, tend to be syntheses of folk models of illness and health, biomedical models to which patients are exposed at different stages in the treatment process, and individual patient experiences of illness. The sensitive presentation of biomedical information about Hansen's disease to patients has the potential to increase adherence to treatment programs and increase patient confidence in the biomedical system. Conversely, withholding or poor presentation of biomedical information can create misunderstanding and confusion for patients. In this article, I explore the ways in which people who are affected by Hansen's disease in Rio de Janeiro learn about different aspects of their illness and its treatment from health care professionals.     

'India Shopping': Indian Grocery Stores and Transnational Configurations of Belonging

The cost of health services within the USA has increased in recent years, limiting access for many Americans. In response, a growing number of Americans are traveling to medical border towns in Mexico to meet their needs. However, many US patients feel uncomfortable traveling to Mexico for healthcare because they are unsure how the system works and believe that Mexico is dangerous, unregulated, unsanitary, and premodern. To reconcile these beliefs with the need for quality medical care, Mexican medical providers appropriate aspects of the US medical system to encourage patronage and alleviate the concerns of patients. This paper examines how some Mexican dentists, pharmacists and physicians in the Mexican border town of Nuevo Progreso have broadened their appeal to American patients by (a) associating their procedures with US biomedical standards, (b) building facilities that shadow US counterparts, and (c) facilitating access to the Mexican medical system.     

Traditional zootherapeutic studies in India: a review

Background

The objective of the present study was to reveal patterns in the treatment of health conditions in a Quechua-speaking community in the Bolivian Andes based on plant use data from traditional healers and patient data from a primary health care (PHC) service, and to demonstrate similarities and differences between the type of illnesses treated with traditional and biomedical health care, respectively.

Methods

A secondary analysis of plant use data from semi-structured interviews with eight healers was conducted and diagnostic data was collected from 324 patients in the community PHC service. Health conditions were ranked according to: (A) the percentage of patients in the PHC service diagnosed with these conditions; and (B) the citation frequency of plant use reports to treat these conditions by healers. Healers were also queried about the payment modalities they offer to their patients.

Results

Plant use reports from healers yielded 1166 responses about 181 medicinal plant species, which are used to treat 67 different health conditions, ranging from general symptoms (e.g. fever and body pain), to more specific ailments, such as arthritis, biliary colic and pneumonia. The results show that treatment offered by traditional medicine overlaps with biomedical health care in the case of respiratory infections, wounds and bruises, fever and biliary colic/cholecystitis. Furthermore, traditional health care appears to be complementary to biomedical health care for chronic illnesses, especially arthritis, and for folk illnesses that are particularly relevant within the local cultural context. Payment from patients to healers included flexible, outcome contingent and non-monetary options.

Conclusion

Traditional medicine in the study area is adaptive because it corresponds well with local patterns of morbidity, health care needs in relation to chronic illnesses, cultural perceptions of health conditions and socio-economic aspects of health care. The quantitative analysis of plant use reports and patient data represents a novel approach to compare the contribution of traditional and biomedical health care to treatment of particular health conditions.     

Health Belief Systems and the Psychobiology of War

Belief systems overlie powerful biological and psychological forces that are root causes of war. Much as in medicine where an appreciation of health belief systems is necessary in the control of illness and disease, so the paths to the control of war may lie in an understanding of belief systems and ways to circumvent them. Such understanding gives strong theoretical support to many time-honored but underutilized international initiative and educational ventures. The effort of the medical community to educate the public about biomedical aspects of nuclear war should gain more balance and sophistication with an appreciation of belief systems in the psychobiology of war.     

A Visit With a Curandero

One author visited a Mexican-American folk healer in the Los Angeles area, not as a patient but as a fellow health professional. Information was obtained from this healer, a curandero, regarding his background, his clientele, the illnesses he treats, the therapeutic techniques he uses and his relationship with the official health care system. This information was generally consistent with statements about curanderismo that have appeared in the social sciences literature. It also provided additional insight into practices that have been alluded to in that literature but not described in detail. With few exceptions, curanderos would seem to be talented healers whose efforts often benefit their patients and whose continued popularity has important implications for physicians, especially those serving large numbers of people of Mexican descent.     

Naming and grouping illnesses in Feira (Brazil)

This paper examines the naming and grouping of illnesses in the popular medicine of Feira de Santana, a city in Northeastern Brazil, in a context of medical pluralism. It discusses the principles used to name illnesses in Feira and the semantic shifts evident in popular nomenclature; examines the grouping of illnesses in Feira; and shows the flexibility of these situationally negotiated categorizations. It also analyzes the place of symptoms in local nosological knowledge and examines three folk illnesses as an illustration of the discussion of illness classification.     

Psychiatric Morbidity and Referral on Two General Medical Wards

Psychiatric morbidity among 230 medical inpatients was determined by a two-stage screening procedure, using the General Health Questionnaire and Standardized Psychiatric Interview. Of these patients, 23% were considered psychiatrically ill, affective disorders being the commonest illnesses encountered; and 27 (12%) were psychiatrically referred. While referral was related to severity of psychiatric illness and previous psychiatric illness, the degree to which the psychiatric illness obtruded or created problems in management appeared more crucial in determining referral. In half of those with psychiatric illness the problems did not appear to have been detected or dealt with. It is suggested that medical clerking should routinely include questions about mood and psychological responses to illness.     

Susto, Coraje, and Abuse: Depression and Beliefs About Diabetes

Mexican immigrants in the US often incorporate folk beliefs into diabetes etiologies but little is known about the relationship between such beliefs and depression. This study examines the relationship of diabetes beliefs and depression among 404 first- and second-generation Mexican immigrants seeking diabetes care in safety-net clinics in Chicago and San Francisco. We used multivariate linear regression to compare the association of depression with beliefs that susto (fright), coraje (anger), and/or interpersonal abuse cause diabetes, adjusting for gender, age, income, education, diabetes duration, co-morbidities, language preference, and acculturation. We incorporated the belief that abuse causes diabetes based on previous ethnographic research. Individuals reporting belief that abuse contributes to diabetes were significantly more likely to report symptoms of depression before (β?=?1.37; p?相似文献   

The indigenization of neurasthenia in Hong Kong

Despite its origin in Western psychiatry, neurasthenia has become a popular concept in Chinese folk medicine, referring to a variety of somatic and psychological symptoms. Review of Chinese medicinal materials and patent medicines shows that neurasthenia is associated more often with somatic symptoms in tonic type medicine and with psychological and psychosomatic symptoms in sedative and tranquilizer type medicine. Popular Chinese books on neurasthenia suggest that causes might be attributed to lifestyle, psychological factors, and health problems. Recommendations on treatment emphasize self-help approaches through changing lifestyle, examining attitudes, tonic care, and relaxation. As a broad term used loosely by professionals and the lay public in Hong Kong, neurasthenia serves the important function of destigmatizing psychiatric disorders. Psychosexual problems may also be conveyed discreetly through somatic presentation. The indigenization of neurasthenia exemplifies how an originally Western concept acquires cultural meaning. Implications of illness conceptualization and the medical paradigm are discussed.     

Breast feeding and lower respiratory tract illness in the first year of life. Group Health Medical Associates.

OBJECTIVE--To assess the relation between breast feeding and subsequent experience of lower respiratory tract illness. DESIGN--Prospective (from well child visits) and retrospective (from maternal recall) study of breast feeding and prospective assessment by paediatricians of lower respiratory tract illness in infants during first year of life. SETTING--Health maintenance organisation. PARTICIPANTS--Over 1000 infants who were healthy at birth and whose parents used the paediatricians of a local health maintenance organisation. MAIN OUTCOME MEASURES--Duration of breast feeding and type of lower respiratory tract illness (wheezing and non-wheezing) at different age intervals during the first year of life. RESULTS--Breast feeding was associated with a decreased incidence of wheezing illnesses only in the first four months of life. Interactions existed between breast feeding and sharing a room, being Mexican American, and being a boy. Multivariate techniques showed that after controlling for a variety of factors children who received minimal breast milk had a greater risk of early wheezing illnesses; the risk was further increased by simultaneous exposure to sharing a room. CONCLUSION--Breast feeding seems to protect against wheezing respiratory tract illnesses in the first four months of life, particularly when other risk factors are present.     

Understanding Interpretations of and Responses to Childhood Fever in the Chikhwawa District of Malawi

Background

Universal access to, and community uptake of malaria prevention and treatment strategies are critical to achieving current targets for malaria reduction. Each step in the treatment-seeking pathway must be considered in order to establish where opportunities for successful engagement and treatment occur. We describe local classifications of childhood febrile illnesses, present an overview of treatment-seeking, beginning with recognition of illness, and suggest how interventions could be used to target the barriers experienced.

Methods

Qualitative data were collected between September 2010 and February 2011. A total of 12 Focus Group Discussions and 22 Critical Incident Interviews were conducted with primary caregivers who had reported a recent febrile episode for one of their children.

Findings and Conclusion

The phrase ‘kutentha thupi’, or ‘hot body’ was used to describe fever, the most frequently mentioned causes of which were malungo (translated as ‘malaria’), mauka, nyankhwa and (m)tsempho. Differentiating the cause was challenging because these illnesses were described as having many similar non-specific symptoms, despite considerable differences in the perceived mechanisms of illness. Malungo was widely understood to be caused by mosquitoes. Commonly described symptoms included: fever, weakness, vomiting, diarrhoea and coughing. These symptoms matched well with the biomedical definition of malaria, although they also overlapped with symptoms of other illnesses in both the biomedical model and local illness classifications. In addition, malungo was used interchangeably to describe malaria and fever in general. Caregivers engaged in a three-phased approach to treatment seeking. Phase 1—Assessment; Phase 2—Seeking care outside the home; Phase 3—Evaluation of treatment response. Within this paper, the three-phased approach is explored to identify potential interventions to target barriers to appropriate treatment. Community engagement and health promotion, the provision of antimalarials at community level and better training health workers in the causes and treatment of non-malarial febrile illnesses may improve access to appropriate treatment and outcomes.     

Letting the Air Out: <Emphasis Type="Italic">Aire</Emphasis> as an Empty Signifier in Oaxacan Understandings of Illness

“Air (aire, also aigre) in the body” is a frequent explanation of illness according to the traditional medical beliefs in Mexico. Anthropologists have generally scrutinized aire in the context of other common folk illnesses treated by traditional healers (curanderas). However, drawing on my research in the communities of Northern Oaxaca I suggest that aire occupies a more distinct position in the folk medical cosmology than it has usually been credited with. This distinction rests on the notion’s exceptional ambivalence and openness to multiple interpretations. “Air” is recurred to as the cause of illness mainly in situations where every other explanation, either “traditional” or “biomedical,” seems to be inadequate. The physical properties of air—its transparency, invisibility, apparent immateriality, near omnipresence, and virtual “nothingness”—render it a suitable explanation of the last resort. Local understandings of what aire “is” are often vague and elusive, and in many respects the term functions in folk medical discourse as an “empty signifier.”     

Cross-cultural perspectives on physician and lay models of the common cold

We compare physicians and laypeople within and across cultures, focusing on similarities and differences across samples, to determine whether cultural differences or lay-professional differences have a greater effect on explanatory models of the common cold. Data on explanatory models for the common cold were collected from physicians and laypeople in South Texas and Guadalajara, Mexico. Structured interview materials were developed on the basis of open-ended interviews with samples of lay informants at each locale. A structured questionnaire was used to collect information from each sample on causes, symptoms, and treatments for the common cold. Consensus analysis was used to estimate the cultural beliefs for each sample. Instead of systematic differences between samples based on nationality or level of professional training, all four samples largely shared a single-explanatory model of the common cold, with some differences on subthemes, such as the role of hot and cold forces in the etiology of the common cold. An evaluation of our findings indicates that, although there has been conjecture about whether cultural or lay-professional differences are of greater importance in understanding variation in explanatory models of disease and illness, systematic data collected on community and professional beliefs indicate that such differences may be a function of the specific illness. Further generalizations about lay-professional differences need to be based on detailed data for a variety of illnesses, to discern patterns that may be present. Finally, a systematic approach indicates that agreement across individual explanatory models is sufficient to allow for a community-level explanatory model of the common cold.     

Why psychiatric conditions are special: an evolutionary and cross-cultural perspective

In non-Western and premodern societies, approaches to sickness involved moral considerations laden with existential and spiritual implications. Healers and physicians had access to this aspect of their patient's lives, were expected to use it constructively, and often did so. The contemporary biomedical theory of disease no longer assigns to illness such metaphysical connotations. While general physicians are permitted - perhaps even advised - to avoid involvement in morally laden dialogues tied to illness and the self, such dilemmas are more prominent and qualitatively different in psychiatry, as psychiatric conditions often entail changes in self-conception, psychological disaffection, unacceptable behavior, and untoward personal reactions to social circumstances. Manifestations of psychiatric conditions can overwhelm an individual's control in areas of cognition, emotion, autonomy, social responsibility, behavior, and body functions - exactly those matters that "modern" individualistic minds are supposed to master. Consequently, psychiatric conditions challenge basic presuppositions of the modern, secular credo about personhood, disease, and behavior. They comprise a species of human problems ontologically distinct from the conditions handled by other medical disciplines.     

On euthanasia: exploring psychological meaning and attitudes in a sample of Mexican physicians and medical students

Euthanasia has become the subject of ethical and political debate in many countries including Mexico. Since many physicians are deeply concerned about euthanasia, due to their crucial participation in its decision and implementation, it is important to know the psychological meaning that the term 'euthanasia' has for them, as well as their attitudes toward this practice. This study explores psychological meaning and attitudes toward euthanasia in 546 Mexican subjects, either medical students or physicians, who were divided into three groups: a) beginning students, b) advanced students, and c) physicians. We used the semantic networks technique, which analyzed the words the participants associated with the term 'euthanasia'. Positive psychological meaning, as well as positive attitudes, prevailed among advanced students and physicians when defining euthanasia, whereas both positive and negative psychological meaning together with more ambivalent attitudes toward euthanasia predominated in beginning students. The findings are discussed in the context of a current debate on a bill proposing active euthanasia in Mexico City.