Idea Transcript
Cross-cultural Medicine
Curanderismo in Taos County New Mexico-A Possible Case of Anthropological Romanticism? NANCY SCHEPER-HUGHES, PhD, Berkeley, California, and DAVID STEWART, PhD, Marquette, Michigan
Interviews with 25 Spanish-Americans of Taos County, New Mexico, indicate that time and acculturation have greatly eroded the belief in and practice of curanderismo, the traditional folk medical system of the Southwest. Curanderismo in northern New Mexico today has moved from being a primary and important source of medical care to one used alternatively and very occasionally in cases of pediatric disorders, chronic illnesses and pain, and for those maladies still classified according to the traditional folk beliefs. Over-categorization is the commonest trick of the human mind. Given a thimbleful of facts we rush in to make generalizations as big as a tub. GORDON ALLPORT, 19581
Anthropologic treatment of Spanish- and MexicanAmerican* culture has recently come under powl erful attack by Hispanic social scientists and professionals.2 (See Romano 0, "Minorities, history and the cultural mystique," El Grito 1967 Fall, pp 10-1 1; see also Gutierrez JA's review of R Coles' Children of Crisis, Vol 4, in The Texas Observer, May 26, 1978, pp 20-21.) Boulette, for example, has decried the grossly stereotypic, culturally determinist and overly psychologic interpretations characteristic of much anthropologic analysis of Chicano social life and institutions.2 She singles out for particular criticism the anthropologic model of the Spanish-American family as "extraordinarily familistic, extended and patriarchal," and the exaggerated importance given to the dominant values of machismo, dignidad and fatalism, a pervasive religiosity, passivity and noncompetitiveness in Spanish-American culture. This interpretation has found its way into the psychiatric literature on ethnicity and family therapy, resulting in the presumption of an inherent pathology in Mexican-American family dynamics due to problems with individuation, *We use both terms in this paper to include those groups of people who claim descent from Mexico as well as those (especially in northern New Mexico) who claim descent directly from (colonial) Spain.
overinvolvement and enmeshment and sex-role stereotypes.3 But where the anthropologic "teleologic-culturaltribal-mystical" primitivist bias is most evident (for Boulette) is in the extensive ethnographic literature on curanderismo, the folk medical system of traditional Mexican- and Spanish-American communities. She cites the "poorly designed" and "anecdotal" early studies of Madsen (1964),4 Kiev (1968), Rubel (1966 ) 6and Warner (1977 ) that attributed to largely poor, rural, Mexican-American migrant workers widespread belief and participation in the folk alternative to biomedicine. And she contrasts Kiev's study5 of a half-dozen curanderos (folk practitioners) and their emotionally disturbed clients in a barrio of San Antonio, Texas (from which Kiev unfortunately generalized to the whole subculture), to more recent largescale surveys of health beliefs and practices among urban Mexican-Americans8 that indicate that folk healing has all but disappeared. The controversy concerning the prevalence of belief in and use of a folk medical system among Mexican- and Spanish-Americans has intensified in recent years as the number of physicians and psychiatrists interested in social medicine, medical anthropology and culturally sensitive family therapy has increased9'0 and professional societies promoting the integration of biomedical, anthropologic and psychologic concerns and insights have
proliferated.
Of all the alternative medical systems in the United
Refer to: Scheper-Hughes N, Stewart D: Curanderismo in Taos County, New Mexico-A possible case of anthropological romanticism? In Crosscultural medicine. West J Med 1983 Dec; 139:875-884. From the Department of Anthropology, University of California, Berkeley, and the Department of Sociology and Social Work, Northern Michigan
University, Marquette. Reprint requests to Nancy Scheper-Hughes, PhD, Department of Anthropology, University of California, Berkeley, CA 94720.
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States, perhaps none has been so extensively documented as Mexican-American curanderismo, studies of which span more than three decades and encompass geographically dispersed groups in Arizona, California, Colorado, New Mexico, Texas and the borderland counties on either side of Mexico and the United States (Table 1) 4-6,8,11-21 The gradual discovery of regional, class, educational and acculturational variations within both rural and urban Spanish-American populations of the West and Southwest has resulted in the exercise of much greater caution today than previously when generalizing about Spanish-American culture and, in particular, health beliefs and behavior. Yet, some cultural patterns appear stable across ruralurban and class lines, among these: the centrality and strength of the family (both nuclear and extended) and of fictive kinship (such as compadrazco, "godparenthood"); the maintenance (especially by women) of a religious over a secular world view and a historically justifiable mistrust and avoidance of Anglo authority, professionals and institutions. All three of these cultural tendencies contribute to the well-documented underuse of social, medical and psychiatric services by Mexican-Americans20'21'23'25 and a high degree of noncompliance to medical advice and interventions.'12'2 And these same cultural tendencies contribute to the maintenance (albeit in different forms and varying degrees of pervasiveness and intensity) of an alternative medical system in curanderismo.
The Research Problem In this paper we address the current debate on curanderismo by reporting on the extent to which a selected group of bilingual Spanish-Americans in rural Taos County, New Mexico, continue to support their traditional medical system, which was first described by Saunders in 19541" and which, to our knowledge, has not been restudied since. Rural Taos County offers a welcome contrast to the studies of Mexican-Americans especially in California and Texas where Chicanos most often represent a poor, migratory and economically exploited ethnic minority. The Spanish-Americans of northern New Mexico are in the majority and wield
cultural and political dominance over both the Indios (Pueblo Indians) and Anglos (non-Hispanic whites). The population of Taos County in 1978 was 18,816, of which 15,505 were Spanish-American, 1,621 were Anglos and 1,300 were Native-American residents of the Taos pueblo. The Spanish-Americans of Taos refer to themselves proudly as los primos (the first colonists), and they claim family ties to the land extending back as far as the 16th century. There is a widespread cultural fiction that the Spanish-American population of northern New Mexico has not been periodically replenished by Mexican-American migrant workers, who are said to settle only in the southern half of the state. Except among the highly politicized youth of Taos, there is no strong sense of kinship or solidarity with the newer wave of Mexican immigrants, and older Taosefios disdain the terms "Chicano" and La Raza, which they feel do not express their own special heritage and history in the Southwest. In all, cultural dominance, rather than discrimination and forced isolation, has contributed to the maintenance of indigenous traditions and institutions in Taos.
Curanderismo: The Saunders Study Between 1958 and 1963 Saunders directed a fiveyear study on the medical beliefs and practices of Spanish-Americans in northern New Mexico, centered in Taos County."'26 The resulting report gives the impression of the existence of a long and well-established tradition of popular medicine that has been periodically replenished from various sources: European, AngloAmerican and Native American. Intrinsic to the system, however, was the elaborate and highly organized institutionalization of human-divine relations with regard to health and illness. God was viewed as the ultimate source of disease even as He was the ultimate wellspring of health and healing. A person accepted good health as a "gift of God," and sickness as an expression of the Divine Will. Chronic illness, which was part of one's fate (destino) was to be endured stoically and impassively; belief in destino was used to explain the low utilization of available health services by rural Spanish-Americans for conditions such
TABLE 1.-Representative Studies of Spanish-American Medical Beliefs and Practices* Study, Year
Research Locale
Saunders, 19541" ......... T.. aos, NM Clark, 195912 .............. San JcDse, Calif Holland, 1963" ............ Tucso.)n, Ariz Madsen, 1964' ............. Texas Rubel, 1966' .............. Texas Martinez & Martin, 19661" ... San A ntonio, Tex Kiev, 1968' ............... San A ntonio, Tex Jaco, 19691" ............... Texas Weaver, 196916 ............ OrangIe County, Calif Torrey, 196917 ............. Santa Clara County, Calif Edgerton, et al, 19708 ....... Los AiLngeles Kay, 197718 ............... Tucso n, Ariz Schreiber & Philpott, 19781 . Texas ;border counties Keefe, et al, 19792 .......... Santa Barbara, Calif Anderson, et al, 19822 ...... Corpuis Christi, Tex, and border counties
Population/Social Class
Rural/lower class Urban/lower class Urban/lower and middle class Rural/lower and middle class Rural/lower and middle class Urban/lower class Urban/lower class Rural-urban/mixed class Urban/lower and middle class Rural-urban/mixed class Urban/mixed class Urban/lower class Rural-urban/mixed class Urban/lower and middle class Urban-rural/lower class
Method
Ethnographic Ethnographic Survey Ethnographic Ethnographic Survey Clinical and ethnographic Epidemiologic Survey Clinical Survey Ethnographic Survey and ethnographic Survey Clinical and ethnographic
*Adapted from Schreiber and Homiak.22
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as a persistent, hacking cough, anemia and migraine headaches that by Anglo standards would require medical attention. A tendency to conceal illness, interpreted in men as a sign of weakness and lack of virility and in women as a sign of divine disfavor, also contributed to the characteristic stoicism. Saunders described SpanishAmericans as having little concern with health maintenance through basic preventive strategies such as well-care, periodic checkups, immunizations, special diets and the like due to a disabling present-time orientation and a belief that the future lay in God's hands. "Faith and fatalism," he concluded, "are the first ingredients in Spanish-American folk medicine."1(Pl52) Spanish-Americans subscribed to an elaborate system of folk beliefs that broadly classified physical and mental illnesses as "natural," "magical" or "psychologic" (interpersonal) in origin. Saunders attributed widespread popular belief in the following eight major folk ailments: Natural 1. Aigre or mal aire ("bad air"): nausea, vomiting, headaches, dizziness, earaches, facial paralysis or twitching of facial muscles caused by exposure to drafts and night air. 2. Empacho ("intestinal obstruction"): abdominal pain, constipation, loss of appetite or bloating caused by the adherence of food to the intestinal wall. 3. Mollera caida ("fallen fontanelle"): listlessness, colic, loss of appetite and an inability to suck in infants caused by the fontanelle caving in on the soft palate. Magical 4. Encono ("festering of wounds"): infection of an open wound or of a surgical scar by exposure to a person (called enconadores) who unintentionally or, less often, intentionally causes the wound to fester. 5. Mal ojo ("evil eye"): a sudden reversal in the physical or emotional well-being of an infant or young child resulting from the admiration (implicitly, the jealousy) of a person with "strong eyes." 6. Maleficio ("witchcraft"): any inexplicable physical or emotional disorder caused by the malevolent magic of a bruja (witch). Psychologic and Interpersonal 7. Melarchico ("melancholy"): depression, loss of appetite and insomnia caused by any change in the immediate environment, but especially by the loss of, or separation from, a loved one (especially a child from its mother). 8. Susto or mal de espanto ("fright," "shock"): general malaise, insomnia, irritability, depression, nightmares and wasting away caused by a fright or an emotional shock (especially the news of the death of a loved one). According to Saunders, uniting these diverse beliefs was a single, larger explanatory model of health as equilibrium (as in the balance of "hot" and "cold" elements and in the regulation and monitoring of expressed emotion). The traditional belief system did not DECEMBER 1983 * 139 * 6
clearly distinguish mental from organic ailments and lacked the Cartesian dualism fundamental to biomedicine.
Response to Illness Saunders's study indicated that when Spanish-Americans became ill they relied on self-treatment and on an extensive lay-referral system-advice from family members and neighbors-before seeking professional medical care (whether folk or cosmopolitan). Biomedicine was poorly understood and viewed as one among several competing resources from which to draw. Diseases were divided into those common ailments shared by all people (colds, flus, accidents and so forth) and those illnesses specific to Spanish-Americans (the "folk" illnesses) and, therefore, best treated by one of the four classes of folk healers: curanderas or medicas-persons with extensive knowledge of diagnosis and folk healing, sobadoras-specialists in therapeutic massage and bone-setting, parteras-local midwives who also treated a variety of female disorders and albolarias-persons who treated the victims of witchcraft. Most commonly, however, illnesses were treated at home with a wide variety of herbs that were collected in the wild, grown at home or bought at a pharmacy in town. If these traditional and home remedies failed, a relative or neighbor (usually a senora, a respected and knowledgeable older woman) might be consulted. Only after repeated failure in the private and domestic sector would a professional folk healer be used. The strategy of last resort, according to Saunders's original study, was cosmopolitan or biomedicine. Research Questions, Methods and Interviewees Our specific research objectives were to assess the degree to which Saunders's findings were representative of the norms of health and illness beliefs of contemporary Taosefios and, further, to what extent ethnomedical beliefs actually influenced patterns of health care seeking. Consequently, our research questions reflect some of the major topics of Saunders's study: * Spanish-American definitions of health, illness and preventive medicine; perceptions of the stages of illness; * the extent of local knowledge of and belief in the traditional etiologic and healing system; * use of traditional home remedies and of folk practitioners, and * use of physicians, clinics and hospitals; assessment of biomedical health care delivery in the Taos area. Information on these questions was obtained during the summer of 1979 (with a brief return visit in the summer of 1983 by one of us [N.S.H.] to discuss aspects of this paper with representatives of the Taos community) through a standardized list of questions (Figure 1) followed by in-depth and open-ended interviews by the coauthors-both of whom are medical anthropologists-and two research assistants-one an anthropology graduate student, the other a social 877
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worker and native-born Taoseno. In addition to the interviews, one of us (N.S.H.) also conducted observations in various clinical settings in Taos County: the hospital, private and public clinics, drug stores, churches and a healing shrine. A total of 25 Spanish-Americans (20 women, 5 men) were interviewed in sessions lasting from a minimum of one hour to several repeated visits with the same key informant. The sample was an opportunistic one and whereas systematic sampling techniques were not used, there was an attempt to obtain heterogeneity of representation. Some of the respondents were contacted through casual encounters in the town plaza, library and pharmacy; others were reached with the helpful introductions of local priests, shopkeepers and bartenders, and two were relatives of our Taosenio assistant. In all, five rural hamlets plus the town of Taos were represented in the sample. The sex differencethat is, 20 women and 5 men-was partly the consequence of the greater availability of women for a rather time-consuming task during the day, but it was also intentional given the greater knowledge and responsibility of women in this culture with respect to the health and illness of family members, especially children. The respondents ranged in age from 16 to 79 and averaged 49 years. Seventeen of the respondents were currently married, four were widows, one was separated from her spouse and three were single; 22 of them had children. Fifteen were employed outside the home: four were professionals or paraprofessionals (a school teacher, a mental health worker, a social services worker and a licensed practical nurse); seven were employed in clerical, sales, service or domestic work, and four were laborers. They averaged nine years of education, although this ranged from 11 persons with less than eight years of school to three college graduates. All but three considered themselves Roman Catholics, and these three were fundamentalist Protestants. In all, 23 had been born in Taos County and, in most cases, claimed ancestry in northern New Mexico for several generations. All of the respondents were bilingual (though frequently fully literate only in English), with the exception of one elderly widow who spoke no English (at least with us).
Results Definition of Maintenance of Health Most respondents in our study defined health as feelings of mental and physical well-being and the ability to carry out normal role (and work) responsibilities. In this they differ little from Anglo norms. Rather than a passive or fatalistic attitude toward disease prevention, all bLut one of our respondents suggested a variety of behaviors or activities conducive to maintaining health, among these a diet rich in "natural" foods; relaxation techniques; adequate rest, and the avoidance of excess in all areas of life, including work, play, study, drinking and in emotions (especially envy, jealousy, fear and anger). Avoiding alcohol and tobacco ranked high on their list of illness prevention 878
strategies, as did avoiding excessive work. Only with respect to the still-prevalent belief in the pathogenic nature of strong emotions did our sample conform to Saunders's description.
Classification and Cause of Illness All the persons in our sample clearly differentiated
physical from mental illness, just as they distinguished "scientific" or biomedical from "folk" ailments, which they referred to as Spanish illnesses or, among the skeptical, as "superstitions." Illness was uniformly viewed as an undesirable state that was defined as an inability to carry out ordinary functions or to enjoy life. Weakness, pain, malaise or irritability, loss of appetite and fever were, in that order, the most frequently listed symptoms of ill health. The immediate responses of informants to questions regarding the causes of physical illness would be indistinguishable from the prevailing causal beliefs of Anglo-Americans in Taos, with emphasis on contagion, infection and accidents. Susceptibility to illness was related to a weak constitution, bad habits such as smoking and drinking, unnecessary exposure to the elements and poor dietary habits. Several informants noted that a "poor outlook on life" or a "bad mental state" could contribute to illness. All but four of the respondents indicated that they knew of someone in their community who was mentally ill. While they entertained various theories of causality, the most frequently mentioned contributor to mental problems was family and interpersonal conflict. A third of the persons attributed mental illness to an innate weakness in either constitution (as in "feeblemindedness") or character (as in alcoholism, personality disorders or plain "craziness" or locura). Some persons, it was widely held, were simply unable to cope with normal difficulties or daily pressures. Among the younger respondents there was a tendency to attribute mental illness to the use of hallucinogens and other drugs, whereas among the older informants (in this case, five of them) the suggestion that a lack of faith in God and in His Divine Providence contributed to anxiety and depression. Only one elderly widow in the sample volunteered that witchcraft (maleficio) was behind some dramatic and violent cases of insanity. The Spanish-American mental health worker included in our sample, however, suggested that a belief in and fear of witchcraft, while not an uncommon "presenting symptom" among both Spanish-American and Pueblo Indian clients of the mental health clinic, was viewed generally by concerned family members and neighbors as disturbing and deviant behavior in a patient. There was broad agreement that mental problems constituted illnesses that were best treated by physicians. For severe or otherwise unmanageable cases of insanity, informants uniformly supported the placement of the patient in a mental hospital for custodial (protection of the community) as well as therapeutic reasons. None suggested pastoral counseling as THE WESTERN JOURNAL OF MEDICINE
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A. Demographic Informatlhn ADDRESS NAME OCCUPATION AGE Spouse's Age/Occupation Education (ego, spouse) Years/generations resident in Taos HOUSEHOLD CENSUS (relationships/ages of persons in household) B. Stages of Illness 1. How do you know that you are not well (what symptoms tell you that you are sick?) 2. Once you know you are not well what do you do? a. Do you seek advice from anyone first (spouse, relatives, neighbors?) b. Do you attempt to treat yourself first (how? any home remedies?) c. What kinds of symptoms concern you the most? d. In terms of loss of health, what is your greatest fear? (is there any particular kind of sickness, disability, affliction that you particularly fear?) e. How would you say you usually respond to pain? 3. How should a sick person behave? (stay in bed? try to work as much as possible? try to get around as much as
possible?) C. Illness Episodes 1. Has anyone in your family or household been sick over the past year? (who was sick, what was the illness, what did you do about it?) How about in the past few years? (same questions) D. Utilization and Evaluation of Medical Care 1. In the past year how often has someone in the household seen a doctor, nurse, or other health professional? (explain circumstances) 2. On a scale of 1 to 3 (1 is best) how would you rate the medical attention you have gotten this year? 3. When looking for a doctor (or nurse) what are the qualities you think are important? 4. On what basis do you finally decide which doctor to use? 5. Do you have a family doctor? (how do you get to his clinic, office?) 6. Have you ever not seen a doctor when you thought that you or a family member should have? (why?) 7. Are there any people other than medical professionals that people in the community consult when they are ill? (who?) 8. After you see a doctor do you generally follow the prescribed treatment? (are there any kinds of treatment you particularly object to?) 9. When do you know that you no longer need to be under a doctor's care? E. General Questions 1. What does being healthy mean to you? 2. What do you do to stay healthy? 3. What kinds of things are most harmful to people's health? 4. What does being sick mean to you? 5. Why does God allow sickness and suffering in the world? 6. What, in your own words, is the definition of a good life? 7. Do you have any views on death? (should people die at home? hospital?) 8. What does it mean to say that somebody is "crazy"? (or loco?) Do you think it is an illness? 9. Have you ever known anyone who was loco or mentally ill? 10. What do you think are some of the causes of mental illness? (can it be cured? do you think such people should be
hospitalized?) PROBES: Enquire about: the eight folk illnesses described by Saunders; herbal cures and home remedies; hot/cold qualities underlying illness and cure; religious beliefs and practices related to health, illness and healing; attitudes about other "alternative" medical systems in Taos: naturopathy, homeopathy; lay midwives. Figure 1.-Taos County Health Ethnography Interview Guide. DECEMBER 1983
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a therapeutic strategy in this otherwise strongly Catholic community. Traditional Beliefs Without probing during the initial interviews, only four of the 25 respondents mentioned any of the traditional Spanish-American folk ailments or beliefs. Interestingly, these were volunteered to one of the anthropologists and not to our Spanish-American assistant, who was perhaps the most curious about the extent of traditional beliefs and practices. This is not altogether surprising because ethnomedical beliefs constitute, especially among the Pueblos and Spanish-Americans of Taos, a sensitive area of investigation.* These beliefs and practices were often in the past ridiculed and suppressed by medical professionals and social workers who (regardless of their own ethnicity) were socialized into the professional orientations of Anglo culture.t Hence, without probing and demonstrating a knowledge of traditional beliefs, it is highly unlikely that much detailed information would be volunteered. At the end of the standardized list of questions, however, each of us did probe for traditional beliefs and practices, and this elicited a somewhat different picture. Religious Influences on Health and Illness When asked directly whether they thought that God or the saints had any influence over a person's health and well-being, 60% of the sample expressed the belief that God might cause illness for a variety of reasons, among them to punish sinners, to remind indifferent Catholics of His power and His existence, to bring lukewarm persons closer to Him, because "some people have to be sick to teach others a lesson" and because it is part of God's inscrutable plan. Three respondents (two of them Protestants) rejected God's role in sickness, two of them saying that illness was the work of the devil and the other saying that neither God nor the devil had anything to do with sickness. The remaining respondents subscribed to a more passive role of God in human affairs, saying that while He would not be the immediate cause of sickness, He certainly allowed it to happen. Both observations (in churches, chapel and at religious processions and festivals in Taos) and openended discussions revealed that dedication to the Catholic saints is very strong, and both private and public devotions in honor of particular patron saints are often linked to petitions or thanksgiving for the healing of physical and emotional illness. The fulfillment of vows (promesas) for "special intentions," often concerning miraculous cures, brought many Taosenios to pilgrimage sites in various parts of the state. Each *So sensitive an area is healing among the Pueblo Indians, for example, that an Anglo who married into and lived in one of the pueblos of northern New Mexico was not told by his own children (reared as Pueblos) the contents of their personal medicine bags that were always kept with them. tThe practice of curanderismno is outlawed in some states. The complete lack of cultural sensitivity of some clinicians toward ethnomedical practices was brought home to one of the authors who attended a pediatric conference in Texas where a paper was read on the traditional treatment of mollera caida (the infant held upside down and its head dipped into a dish of heated oil) as an illustration of what might be considered "potential" child abuse.
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year, for example, hundreds of Pueblo Indians and Spanish-Americans of Taos County visit the famous Santuario de Chimayo, a healing shrine some 30 mountainous miles from Taos, to pray to El Santo Nino (the Holy Child of Atocha), Sefior Santiago (the patron saint of Spain) or to Our Lord of Esquipulas (a miraculous image of the crucified "Black Christ"). The pilgrims partake of tierra bendita ("blessed earth"), a pit of healing mud found in a chamber to the left of the main altar. This mud is believed to possess many therapeutic qualities. It is said to cure (among other things) pains, rheumatism, sadness, anxiety, sore throat, paralysis and difficult childbirth. The pilgrims carry home small samples of the mud in bottles or handkerchiefs to give to friends and relatives at home. The blessed earth is dissolved in water and drunk or is smeared over the afflicted part of the body. In return the pilgrims and visitors leave small offerings and remembrances at the foot of the crucifix, statues and paintings of their patron saints: money, candles, pieces of handiwork, flowers, miniature hats, shoes and boots and even personal photos and identification papers. Likewise, within the home and the community at large, devotion to Christ, the Virgin and the saints is expressed through lay membership in religious fraternities (cofradias) and in penitential brotherhoods (penitentes), which concern themselves with physical as well as spiritual discipline, healing and wholeness. Virtually every Spanish-American home has a small altar with an image or images of the Sacred Heart, the Infant of Prague and other, more local, saints. Traditionally, the santos (wooden statues) offered protection against witchcraft. "A medal of San Ignacio," offered one informant, "is a good protection against harm from others through the evil eye, bad thoughts or bad wishes and harm through [poisoned] food." Another woman said that "in the old days" there were many "superstitions" about the household santos. Among these were the beliefs that if a statue fell it was a sure sign that someone in the household was going to die, and that if one wanted to prevent a bad neighbor from slandering or telling lies, one could simply cover the mouth of a statue of San Ramon. Today, these beliefs are viewed as quaint superstitions, but faith in the healing power of the santos remains intact. The Folk Illnesses In probing for knowledge of specific ethnomedical beliefs, two thirds of the sample could adequately describe most of the eight folk illnesses reported by Saunders, whereas the remaining respondents could identify (with assistance) only the most commonly cited "naturalistic" ailments: empacho, mollera caida and susto (sometimes referred to, in this area, as suspendido). The respondents in this sample, however, added four folk illnesses not recorded by Saunders: latido, insolacion (or asoleo), chincual and ajito. Each will be briefly described in turn. Mal de latido was described as severe and frightenTHE WESTERN JOURNAL OF MEDICINE
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ing "palpitations" in the stomach. Left untreated, latido can be fatal. Because physicians do not recognize this illness, cure is traditionally effected by a sobadora (masseuse and manipulator of broken bones or displaced organs) who would massage a person's joints. An alternative treatment was for an herbalist or a curandera to soak bread in alcohol and herbs and tie it down firmly on the pit of the stomach while reciting prayers. No one reported a case of latido, however, in any of the interviews. Insolacion (asoleo) was described as a kind of sunstroke causing the blood to "boil over" and "pound" in the head. The cure was to place a glass of water on a patient's head. When the water boiled (thus extracting the excess heat out of the body) the victim would recover. It was self-treated. Chincual is a serious, blistering diaper rash covering the genitals, buttocks and thighs of an afflicted infant. It is attributed to deficiencies or excesses in the mother's diet or to envious and malevolent feelings on the part of another adult. Three cases of chincual were reported in this sample and were treated by a medica and an albolaria. Finally, ajito was described as a cough or a cold in young children caused by allowing a child to run barefooted on a cold floor, which draws away natural body heat. Whereas there was no evidence of an overarching philosophy of health perceived as a balance of "hot" and "cold"'12"8 natural elements, nor any vestige of cures based on restoring equilibrium through a judicious balancing of "hot" and "cold" foods, herbs or other remedios, as described by Saunders,"'126 the logic underlying the folk illnesses insolacion and ajito is certainly that of temperature imbalance. In addition to these, it was believed to be foolhardy and tempting fate to gulp down large quantities of iced drinks when overheated, to iron clothes while barefooted or to go into the cold night air without a scarf or a wrap after working over a hot stove. In this last instance, a draft or gust of cold air can shock the body, resulting in temporary paralysis (aigre), freezing the mouth or the eye into a hideous position. Although 17 of the 25 respondents could identify most of the traditional maladies of curanderismo, only 12 indicated (on direct questioning) a belief in one or more of them. Whereas virtually all the respondents could recall over their lifetime people (often their own parents and grandparents) who were said to have been cured of one or more of the folk illnesses, only a third of the sample (nine persons) had either themselves or an immediate family member (excluding parents and grandparents) been afflicted by or treated for a traditional illness in recent years (see discussion under Treatment of Illness). The folk ailments that were most readily accepted by respondents as having some validity were those of "naturalistic" or "psychologic" origin, such as aigre, melarchico and mollera caida, or those that could be easily reinterpreted into biomedical or presumed sciDECEMBER 1983 * 139 * 6
entific terminology. Hence, aigre was sometimes referred to as "just a cold" or an earache caused by drafts; encono could be described as a "bad infection," and empacho and latido as constipation and indigestion, respectively. Melarchico and susto were often translated as depression or "nervousness." The traditional diseases of magical or supernatural origin-mal ojo and maleficio were the most likely candidates for a flat rejection and denial by our informants or were interpreted as mental derangement. As one informant phrased it, "You'd have to be loco to believe in any of that stuff." Nonetheless, mal ojo showed up about as frequently as other folk ailments in respondents' recollections of household illness episodes, and even those who flatly denied a belief in o0o or maleficio frequently qualified their statement with words to the effect that bad thoughts and feelings can adversely affect a person. As one young mother, a licensed practical nurse at the local hospital, put it: Of course, you don't want to really believe it, any of this nonsense. But inside you it just feels bad when you know that somebody wishes you ill. Just worrying about the jealousy or maldiciones [bad words, bad thoughts] of a friend or a neighbor is enough to make you sick.
Another 50-year-old grandmother said: Some of the old people here still believe, like the Indians, in witches. I don't believe in that but I do know that some people have a power that is unavailable to others. Some will use this power for evil. I don't believe in the evil eye, myself, but there are people that have 'strong eyes' and can influence others with their looks. One is a young 'playboy' type who looks at innocent young girls in a way that they lose all will power against him. Another is an old man from Mexico. And right here in Rios there is a young woman who was beaten terribly by her mother all her life. I guess it was what they would call 'child abuse' today. Everyone knew about it, but no one interfered. It was a prominent family. Now the girl is grown up and is a mother herself. She is an evil-tempered person, and neighbors are afraid of her and her 'strong' eyes.
The old woman paused in the telling, and added with contemporary psychologic insight, "Perhaps they just feel guilty, and don't want to look her in the eyes." Overall, there was a tendency to view sickness and health in strongly personalistic and interpersonal terms. Human encounters can sicken a person, even unto death. Qualities of personal magnetism evidenced in the attraction between a stranger and a vulnerable infant (mal ojo), in sexual charisma and charm (that "bewitches" a lover) and in the extreme attachment of a child for its absent mother (melarchico) are strong pathogens within this system. Likewise, qualities of personal antagonism, hostility or simple physical incompatibility can result in illness. A shopkeeper from a small agricultural hamlet outside of Taos explained this quite succinctly: It's like this: when people meet sometimes they attract and sometimes they clash. One person can be like poison ivy to another one. There is a repulsion, something like an allergy, of one to the other. When they meet the blood of the weaker one overreacts and the person can break out in a rash, or hives, in an itch, or even worse, he can become badly infected. We say he has become enconado. I knew of a case where a selfish child was enjoying an ice cream cone in front of two of his 881
CURANDERISMO friends without even offering them so much as a lick. Well, the next day his mouth was covered with blisters. They fixed him! Sometimes you don't mean to do it; it just happens. That's why we take special precautions not to visit someone at home who has just recently returned from an operation. Even when we are invited we say, 'No, no it is still too soon for a visit. The wound has not yet healed.' We are afraid of starting an infection.
Of all the folk ailments discussed by our informants, only mollera caida ("fallen fontanelle") was accepted as a valid illness in its own traditional terms by most of those interviewed, with no attempt made to reinterpret the syndrome in medical or psychologic terms. As the young nurse cited above said: "I didn't believe in mollera caida until I saw so many cases in the hospital with my own eyes." This pediatric ailment continues to be a source of worry for the poorer young mothers of Taos County. Treatment of Illness In the course of respondents' answers to specific questions and in their more open-ended discussions of illness beliefs and practices, the 25 respondents discussed a total of 147 illness episodes experienced by themselves or a family member in recent years (excluding pregnancies and uncomplicated deliveries, despite the fact that many respondents viewed normal pregnancy as a kind of illness). It should be noted at the outset that the reporting of many of the illnesses occurred in the context of an interviewer probing for vestiges of folk illness beliefs and the practice of curanderismo. Hence, there was a decided bias toward informants' recalling the more deviant and dramatic incidents of folk illness. The respondents themselves roughly categorized the illnesses into mild or minor (those that were treated within the family and with over-the-counter drugs or home remedies) and severe or serious illnesses (conditions warranting a consultation with a medical specialist, either professional or
"folk"). In all, 64 illnesses were judged to be mild, 42 of which were described in standard lay terms and 22 using Spanish-American folk terms. Whereas each of the 25 respondents indicated at least one episode of a common "biomedical" ailment, only nine informants accounted for the 22 folk diagnoses (see Table 2). The most common remedios for these mild illnesses (whether standard or folk) were prepackaged overthe-counter drugs: aspirin, antacids, tonics, laxatives and vitamins. Only 11 of the respondents indicated that they occasionally used a home or herbal remedy. When they did, they were equally likely to use an herbal tea for a common cold as for aigre, and a poultice for a migraine headache as for encono. The most frequently mentioned herbal medicines in our sample were: altamisa (mountain mugwort) for colds and flu; cota (Navajo tea) as a diuretic and also to settle the stomach and purify the blood; alegria (amaranth) for mild heart disorders in old age; osha (porter's lovage) for bronchitis, colds, aigre or fever; chamiso (sagebrush) for flu, breaking a fever, stomach pain or empacho; poleo (brook mint) for feverish headaches, 882
TABLE 2.-Mild, Self-Treated Illnesses Standard Terms
(N = 42 illnesses in 25 households)
Upper respiratory tract disorders (colds, coughs, flus, etc) ... 17 .. 6 Sores, infections Gastrointestinal (diarrhea, stomach trouble, gas, etc) 6 Bleeding ..................... 6 ....
Fever . .............. 4 Heart trouble ..1.......... Arthritis .........1............ Insomnia ........1............
Folk Illnesses (N =22 illnesses in 9 households)
A igre ....... Encono. Mal ojo. Susto ....... Melarchico Empacho Chincual . Insolacion
6 4 3 3 2 2 1 1
dizziness, colic and mal ojo in infants; malva (cheeseplant) for sore throat, skin rash and chincual, also as a douche and to help expel the afterbirth; peyote for anxiety; ruda (rue) to stimulate menstruation when delayed and as an abortifacient, and the SpanishAmerican herbal aspirin, manzanilla (chamomile) for colds, fever, stomach problems, menstrual cramps and earache. With the exception of peyote, these most common herbs and dozens more are available in the back of a pharmacy in the Taos town plaza. Many were sold out at the time one of us (N.S.H.) purchased samples in the summer of 1983 and the pharmacist volunteered that business in prepackaged and dried herbs was brisk. Also available at the pharmacy was a helpful booklet on the use of traditional herbs, flowers, roots, barks and gum.27 In all, 83 conditions or illnesses were described by the respondents as serious, resulting in a consultation with a physician, dentist, nurse-practitioner or traditional healer. In all cases our respondents, at least initially, took their serious nonfolk illnesses to a physician or medical clinic. All but three of the 25 respondents had a regular family physician whom they consulted when they were feeling more than mildly ill. By contrast, none of the respondents considered themselves the "regular patient" of a specific traditional curer. Physicians, clinics and hospitals constituted the respondents' primary sources of medical care. In evaluating local medical services, respondents were, with two exceptions, enthusiastically favorable about the quality of care received. In discussing recent episodes of serious illnesses in 52 of the 83 episodes reported, treatment began and ended at a medical clinic, physician's office or hospital under the care of a standard medical practitioner (Table 3). The general impression received by the field-workers was of a relatively self-sufficient rural population, most of whom respected physicians and standard medical care, but who tended to reserve medical consultations for relatively serious or chronically bothersome disorders. While each of the 25 respondents volunteered at least one recent household illness serious enough to warrant a medical consultation, nine of the 25 had also, in recent years, consulted a traditional healer for a member of the household. Of the 31 consultations THE WESTERN JOURNAL OF MEDICINE
CURANDERISMO
reported (Table 4), 21
were
for serious
or
persis-
tent cases of a folk illness and 10 were for nervous-
ness, aches and pains and bronchitis. More than a third of the visits to a folk practitioner concerned childhood illnesses. The practice of curanderismo in this region is of a pragmatic and naturalistic bent in which the use of herbs, the regulation of diet, massage and the manipulation of bones and joints predominate over the use of charms, incantations and magical cures. Rather than folk psychiatrists who treat only psychogenic disorders (and folk illnesses), as has been previously suggested,57"17 the medicas and curanderas of Taos can be more accurately described as general folk practitioners or possibly as folk pediatricians who treat a broad spectrum of acute and chronic ills.
TABLE 3.-Conditions Treated by a Physician or Health Professional* (N=52 Illnesses in 25 Households)
Operations .................... Pain/headaches ................ Accident related ................ Upper respiratory tract disorders Gastrointestinal problems ........ Dental work ................... Cardiovascular problems ........ Diabetes mellitus ............... Tension, "nerves" .............. "Real sick" .................... "Fevers" ...................... Mollera caida .................. Susto ......................... Aigre ......................... Allergy ....................... Sore eyes .....................
8 6 5 5
4 4 3 3 3 2 2 2 2 1 1 1
TABLE 4.-Consultations With Folk Practitioners in Taos County* (N=31 Illnesses in 9 Households) Practitioner Consulted Sobadora MWdica/ (Traditional Curanderat Masseuse (Folk and Albolaria Healer) Bone-setter) (Herbalist)
Illness ......
5
........
Empacho ........ ......... 3 Muscle aches and pains ....... Witchcraft cure .............. Susto .... 3 Mal
... 2 ... 2 ... .. Encono 1 ... Aigre .... 1 ... 1 pain ..1.. Migraine headaches .... 1 Earache . ... 1
ojo
2 1
.
.
2
.
Bronchitis Abdominal
TOTALS
.
...............
21
7
3
*Excluding parteras (midwives). tThe feminine form of the names is used because at the time of the study all of the Spanish-American folk healers in Taos County were
women.
DECEMBER 1983
*
139
*
6
massage with warm olive oil and she put a paste of raisins and cinnamon in the navel to prevent further "drafts." The baby's condition improved in a few days. Somewhat surprisingly, there was no correlation between age, education, social status or occupation and use or nonuse of a folk practitioner. The nine respondents who had, or whose family member had, made some use of a traditional healer averaged 44 years of age (range, 16 to 79), slightly younger than the sample at large, included one man, and represented a variety of occupations that included full-time student, social worker, housewife and mother, religion teacher, typist, day-care teacher and maid. One factor, however, was significantly correlated with the use of a folk practitioner. In all the cases reported here the client knew the healer in other nonmedical social contexts. Often the medica was a relative, neighbor or fellow parishioner. Relations through godparenthood linked some persons to curanderas and in at least one case coparent ties brought a Spanish-American client to treatment by a Pueblo Indian medicine man living at the Taos
in Santa Fe for her chronic case of susto. Another, a young mother, explained that it was not necessary to take an infant suffering from mollera caida to an "oldfashioned" me'dica when there was nearby a SpanishAmerican physician who knew exactly how to push up on the soft palate to bring it back into place, while also prescribing necessary medicine for the child. Similarly, not all the curanderas and medicas men-
tioned
by respondents
were Spanish-American. One judged by some respondents to have an exceptionally broad knowledge of local healing herbs is an Anglo lay midwife, while another medico
young curandera
local Pueblo Indian medicine man. Finally, a black woman healer from Albuquerque had been visited on several occasions by one respondent. The climate of cultural tolerance appears to have affected the self-selection of the 22 physicians practicing then (1979) in Taos County, most of whom were, like the curanderas, general practitioners rather than specialists. A few of these worked rather closely with members of the Taos County Midwives Association, a group of largely self-trained and countercultural lay midwives. Other physicians have integrated aspects of homeopathy, naturopathy, Native American spiritualism and Eastern mysticism into their practice of biomedicine. These are a small but very visible minority of the physicians. Possibly because the traditional Spanishwas a
4
.
Chincual Nervousness
pragmatic approach is reflected in one woman's of the successful treatment of her infant son's serious bout of colic by a me'dica who diagnosed the problem as aigre, too much air entering through the baby's navel. The me'dica suggested frequent abdominal
pueblo. The degree of medical pluralism within this culturally heterogeneous region is reflected in the five respondents who preferred the care of a physician to a traditional curer for isolated cases of susto, mollera caida and aigre. One middle-aged woman, for example, praised the weekly injections given her by an Anglo physician
*Excluding obstetric visits, diagnostic examinations and checkups.
Mollera caida
The
account
883
CURANDERISMO
American practitioners are elderly and do not actively seek it, there was no ongoing referral system between physicians and medicas, though me'dicas in Taos (as recorded elsewhere in the West and Southwest) frequently refuse cases that they believe should be handled by a physician. With the help of key informants we were able to identify six Spanish-American traditional practitioners: two medicas, one sobadora, one albolaria and two parteras. However, with the exception of the nine persons whose families had occasionally used them in the past, most of our sample could not identify more than one or two of them by name. And, while home birth with a midwife is becoming increasingly popular among Anglo residents of the Taos area, Spanish-American mothers prefer the privacy and accommodations of Holy Cross Hospital in Taos. Only four women of the 20 in our sample had consulted a traditional partera for the birth of any of their children, and these women were all middle-aged or older, representatives of the prehospital era of rural Taos County.28 The home birth ethos of the young Anglos who have recently migrated to Taos29 was uniformly rejected as backward and primitive by the several young Spanish-American mothers in our sample.
Conclusions .... All the poor sick people waitin'. So many ways of being sick. TILLIE OLSEN, 197430
The findings of this exploratory study are compatible with those of other recent studies of the state of Spanish-American folk medicine in the West and Southwest today.8.183' Time and acculturation seem to have greatly eroded the belief in and practice of curanderismo that was posited as the predominant medical system of Spanish-Americans in New Mexico, California and Texas just two or three decades ago.6"1',12 Nonetheless, the recent criticism of the romantic "primitivism" of anthropologic studies of Spanish and Mexican-American culture and social institutions is perhaps overstated. While we could infer from our findings that most Spanish-Americans of Taos County rely primarily on the same explanatory model as Anglos with regard to the definition of health and illness, the perception and meaning of symptoms and lay theories of disease causation, at least some elements of curanderismo are supported by the population. Among these we would list a strong religious interpretation of the meaning of sickness, a belief in the pathogenic nature of strong emotion, a tendency to attribute unexplained physical or emotional malaise to troublesome or malevolent interpersonal relations and a belief in the salutary effects of balance and moderation in behavior, feelings and human relations. In contrast, however, to Saunders's generalizations about the strength and pervasiveness of Spanish-American folk medicine in Taos County, we would have to conclude that curanderismo in northern New Mexico 884
today has moved from being a primary and important source of medical care to an alternative and very occasional source in cases of chronic pain and illness or for those puzzling psychosomatic and stress-related afflictions for which biomedicine has little respect and virtually no cure and therefore for which it has none of the creative names and faces that the folk medical system readily supplies. As long as this medical vacuum exists, we predict it will be filled by alternative systems such as curanderismo. In addition, the cultural heterogeneity of Taos County, the characteristic blending of old and new traditions and the enormous pride of its residents-Spanish-American, Native American and Anglo-in the distinctiveness of Taos from the rest of America, virtually assure that curanderismo will survive the 20th century. REFERENCES 1. Allport G: The Nature of Prejudice. Garden City, NJ, Doubleday, 1958 2. 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Arch Gen Psychiatry 1969; 20:365-375 18. Kay M: Health and illness in a Mexican-American barrio, In Spicer E (Ed): Ethnic Medicine in the Southwest. Tucson, University of Arizona Press, 1977 19. Schreiber J, Philpott L: Who is a legitimate health care professional? Changes in the practice of midwifery in the lower Grande Valley, In Velimirovic B (Ed): Pan American Health Organization Scientific publication No. 359, 1978 20. Keefe S, Padilla A, Carlos M: The Mexican-American family as an emotional support system. Hum Organ 1979; 38:144-152 21. Anderson B, Toledo R, Hazam N: An approach to the resolution of Mexican-American resistance to diagnostic and remedial pediatric heart care, In Chrisman N, Maretski T (Eds): Clinically Applied Anthropology. Dordrecht, Netherlands, D. Reidel Publishine, 1982 22. Schreiber J, Homiak J: Mexican-Americans, In Harwood A (Ed): Ethnicity and Medical Care. Cambridge, Mass, Harvard University Press, 1981 23. Karno M. Edgerton R: Perceptions of mental illness in a MexicanAmerican community. Arch Gen Psychiatry 1969; 20:233-238 24. Flores J: The utilization of a community mental health service by Mexican-Americans. Int J Soc Psychiatry 1978; 24:271-275 25. Trevino F, Bush J, Bunce H: Utilization of community mental health services in a Texas-Mexico border city. Soc Sci Med 1979; 13A: 331-334 26. SauLnders L: Handbook for Public Health Nurses Working With Spanish-Americans. US Dept of Health, Education, and Welfare publication No. CH-0009-05 (RG-5615). Government Printing Office, 1968 27. Moore M: Los Remedios de la Gente. Santa Fe, NM, Herbs, Etc, 1977 28. Van der Eerden ML: Maternity Care in a Spanish-American Community of New Mexico. Catholic University of America Anthropological Series. Washington DC, Catholic University of America Press, 1948 29. Majors C: Fusion of Tradition and Technology: Contemporary Home Birth in Taos, New Mexico, unpublished paper. Dallas, Tex, Southern Methodist University, 1979 30. Olsen T: Yonnondio: From the Thirties. New York, Delta, 1974 31. Keefe S: Folk medicine among urban Mexican-Americans: Cultural persistence, change and displacement. Hisp J Behav Sci 1981; 2:41-58
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