Skip to main content
SpringerLink
Log in

Does “Susto” Really Exist? Indigenous Knowledge and Fright Disorders Among Q’eqchi’ Maya in Belize

  • Original Article
  • Published:
Culture, Medicine, and Psychiatry Aims and scope Submit manuscript

Abstract

Susto is one of the most common disorders referenced in the medical anthropological and cultural psychiatric literature. This article questions if “susto” as understood in cultural psychiatric terms, especially in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM), is in fact a single “cultural concept of distress.” There is extensive cross-cultural and intracultural variability regarding fright-related disorders in the ethnographic literature. What is often labeled “susto” may be in reality a variety of distinct disorders, or lacking in the two signature components found in the cultural psychiatric literature: the existence of a “fright,” and subsequent soul loss. There has been significant polysemic and geographical drift in the idiom label, the result of colonialism in Mesoamerica, which has overlayed but not necessarily supplanted local knowledge. Using data from fifteen years of research with Q’eqchi’ (Maya) healers and their patients, we demonstrate how important variability in signs, symptoms, diagnosis, treatment, and prognosis of fright-related disorders renders any simple declaration that this is a singular “susto” problematic. We argue for a careful consideration of the knowledge of Indigenous medical specialists charged with treating fright-related disorders and against the inclination to view variability as insignificant. Such consideration suggests that Indigenous forms of fright-related disorder are not susto as presented commonly in the DSM and cultural psychiatric literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Notes

  1. Low (1985) indicates that nerves or “nervios” is used among urban Ladino populations as a synonym for susto. Nervios is listed as a distinct “cultural concept of distress” in DSM-5 (APA 2013:835). This is further evidence of category drift.

  2. Diverse terminology, linguistic shortcuts, and seemingly (to the researcher) ambiguous or ill-defined concepts are a hallmark of many Indigenous medical systems, including that of Maya peoples (e.g., Redfield and Redfield 1940).

  3. The iloneleb’ in this study are identified in accordance with their wishes and Q’eqchi’ ethical principles. The honorific “Don,” borrowed from Spanish, represents a sign of respect and is typically used in conjunction with a first name.

  4. Utilizing an abductive narrative approach, xiw xiw and “thinking too much” have also been understood as representing distinct narrative genres (Hatala, Waldram, and Caal 2015). This demonstrates the potential confounding aspects of using both clinical presentation and patient experience to classify disorders in Indigenous medical systems.

References

  • Abimbola, Seye, and Madhukar Pai 2020 The Art of Medicine: Will Global Health Survive its Decolonisation? The Lancet 396:1627–1628

    Article  Google Scholar 

  • Alarcon, Renato D. 2014 Cultural Inroads in DSM-5. World Psychiatry 13(3):310–313

    Article  Google Scholar 

  • American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] Washington, DC: American Psychiatric Association

    Google Scholar 

  • American Psychiatric Association 2013 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-V] Arlington, VI: American Psychiatric Association

    Book  Google Scholar 

  • Astor-Aguilera, Miguel Angel 2010 The Maya World of Communicating Objects: Quadripartite Crosses, Trees, and Stones Albuquerque: University of New Mexico Press

    Google Scholar 

  • Austin, Alfredo Lopéz 1988 The Human Body and Ideology: Concepts of the Ancient Nahuas, I Salt Lake City: University of Utah Press

    Google Scholar 

  • Berlin, Elios Ann, and Brent Berlin 1966 Medical Ethnobiology of the Highland Maya of Chiapas, Mexico: The Gastrointestinal Diseases Princeton, New Jersey: Princeton University Press

    Google Scholar 

  • Bhurga, Dinesh, Rubens Dantas, and Antonio Ventriglio 2018 Culture-Bound Syndromes: Past, Current Status and Future. In Textbook of Cultural Psychiatry Dinesh Bhurgaand, and Kamaldeep Bhul, eds., Cambridge: Cambridge University Press.

    Google Scholar 

  • Bourbonnais-Spear, Natalie, Pedro Maquin, Rosalie Awad, Victor Cal, Luis Poveda, and John T. Arnason 2005 Plant Use by the Q’eqchi’ Maya of Belize in Ethnopsychiatry and Neurological Pathology. Economic Botany 59(4):326–336

    Article  Google Scholar 

  • Bourbonnais-Spear, Natalie, Rosalie Awad, Zul Merali, Pedro Maquin, Victor Cal, and John T. Arnason 2007 Ethnopharmacological Investigation of Plants Used to Treat Susto, a Folk Illness. Journal of Ethnopharmacology 109:380–387

    Article  Google Scholar 

  • Cassell, Eric J. 1991 The Nature of Suffering and the Goals of Medicine New York: Oxford University Press

    Google Scholar 

  • Castañeda, Xóchitl., Cecilia García, and Ana Langer 1996 Ethnography of Fertility and Menstruation in Rural Mexico. Social Science and Medicine 42(1):133–140

    Article  Google Scholar 

  • Chevalier, Jacques M., and Andrés Sánchez. Bain 2003 The Hot and the Cold: Ills of Humans and Maize in Native Mexico Toronto: University of Toronto Press

    Google Scholar 

  • Cook, Garrett W. 2000 Renewing the Maya World: Expressive Culture in a Highland Town Austin: University of Texas Press

    Book  Google Scholar 

  • Crandon, Libbet 1983 Why Susto? Ethnology 22(2):153–167

    Article  Google Scholar 

  • Dominguez, A.M. 1983 Illness and Medical Theory among the Guatemalan Indians. In Heritage of Conquest: Thirty Years Later Carl Kendall, John Hawkins, and Laurel Bossen, eds., Albuquerque: University of New Mexico Press.

    Google Scholar 

  • Echevarría García, J., and M. López Hérnandez 2013 La Expresión Corporal del Miedo Entre Los Antiguos Nahuas”. Anales De Antropolgía 47(1):143–166

    Article  Google Scholar 

  • Fabrega, Horatio, Jr., Duane Metzger, and Gerald Williams 1970 Psychiatric Implications of Health and Illness in a Maya Indian Group: A Preliminary Statement. Social Science and Medicine 3:609–626

    Article  Google Scholar 

  • Fabrega, Horatio, Jr., and Daniel Silver 1973 Illness and Shamanistic Curing in Zinacantan Stanford, California: Stanford University Press

    Google Scholar 

  • Fischer, Edward F. 1999 Cultural Logic and Maya Identity: Rethinking Constructivism and Essentialism. Current Anthropology 40(4):473–499

    Article  Google Scholar 

  • Fischer, Edward F., and Carol Hendrickson 2003 Tecpán Guatemala: A Modern Maya Town in Global and Local Context Boulder, CO: Westview Press

    Google Scholar 

  • Foster, George 1953 Relationships between Spanish and Spanish-American Folk Medicine. Journal of American Folklore 66(261):201–217

    Article  Google Scholar 

  • Foster, George 1985 How to Get Well in Tzintzuntzan. Social Science and Medicine 21(7):807–818

    Article  Google Scholar 

  • Frazier, Jeffrey B. 2015 Q’eqchi’ Mayan Dictionary,. 1st Edition. Mayaglot: Mayaglot.com

    Google Scholar 

  • Gillin, John 1955 Ethos Components in Modern Latin American Culture. American Anthropologist 57:488–500

    Article  Google Scholar 

  • Gonzales, Patrisia 2012 Red Medicine: Traditional Indigenous Rites of Birthing and Healing Tucson, Arizona: University of Arizona Press

    Google Scholar 

  • Groark, Kevin P. 1997 To Warm the Blood, to Warm the Flesh: The Role of the Steambath in Highland Maya (Tzeltal-Tzotzil) Ethnomedicine. Journal of Latin American Lore 20(1):3–96

    Google Scholar 

  • Groark, Kevin P. 2008 Social Opacity and the Dynamics of Empathic In-sight Among the Tzotzil Maya of Chiapas. Mexico. Ethos 36(4):427–448

    Article  Google Scholar 

  • Green, Linda 1994 Fear as a Way of Life. Cultural Anthropology 9(2):227–256

    Article  Google Scholar 

  • Hatala, Andrew R., and Tomas Caal 2020 Embodiment, Empathic Perception, and Spiritual Ontologies in Q’eqchi’ Maya Healing: An Ethnographic Exploration. Ethos 48(3):357–378

    Article  Google Scholar 

  • Hatala, Andrew R., James B. Waldram, and Tomas Caal 2015 Narrative Structures of Q’eqchi’ Maya Mental Disorders. Culture, Medicine and Psychiatry 39(3):449–486

    Article  Google Scholar 

  • Hatala, Andrew R., and James B. Waldram 2017 Diagnostic Emplotment in Q’eqchi Maya Medicine. Medical Anthropology 36(3):273–286

    Article  Google Scholar 

  • Herrera, Frida Jacobo, and David Orr 2020 Susto, the Anthropology of Fear and Critical Medical Anthropology in Mexico and Peru. In Critical Medical Anthropology: Perspectives in and from Latin America Jennie Gamlin, Sahra Gibbon, Paola M. Sesia, and Lina Berrío, eds., London: University College London Press.

    Chapter  Google Scholar 

  • Hinojosa, Servando Z. 2015 In this Body: Kaqchikel Maya and the Grounding of Spirit Albuquerque, New Mexico: University of New Mexico Press

    Google Scholar 

  • Hinojosa, Servando Z. 2018 The Limits of Conversion: Evangelical Experience and Enduring Maya Principles in Highland Guatemala. The Latin Americanist December:568–585.

  • Holland, William R., and Roland G. Tharp 1964 Highland Maya Psychotherapy. American Anthropologist 66(1):41–52

    Article  Google Scholar 

  • Hyman, S.E. 2010 The Diagnosis of Mental Disorders: The Problem of Reification. Annual Review of Clinical Psychology 6:155–179

    Article  Google Scholar 

  • Ingham, John M. 1970 On Mexican Folk Medicine. American Anthropologist 72:76–87

    Article  Google Scholar 

  • Juárez, Miguel S., Ernesto C. Cao, Cristanto X. Tec, Domingo C. Chen, and Pedro T. Pop 2003 Diccionario Q’eqchi’ Antigua, Guatemala: Proyecto Lingüístico Francisco Marroquín

    Google Scholar 

  • Kahn, Hilary E. 2006 Seeing and Being Seen: The Q’eqchi’ Maya of Livingston, Guatemala, and Beyond Austin: University of Texas Press

    Book  Google Scholar 

  • Kaiser, Bonnie M., Emily E. Haroz, Brandon A. Kort, Paul A. Bolton, Judith K. Bass, and Devon E. Hinton 2015 ‘Thinking Too Much’: A Systematic Review of a Common Idiom of Distress. Social Science and Medicine 147:170–183

    Article  Google Scholar 

  • Kaiser, Bonnie M., and Lesley Jo Weaver 2019 Culture-bound Syndromes, Idioms of Distress, and Cultural Concepts of Distress: New Directions for an Old Concept in Psychological Anthropology. Transcultural Psychiatry 56(4):589–598

    Article  Google Scholar 

  • Kockelman, Paul 2007 Inalienable Possession and Personhood in a Q’eqchi’-Mayan Community. Language in Society 36(3):343–369

    Article  Google Scholar 

  • Lewis-Fernández, Roberto, and Laurence J. Kirmayer 2019 Cultural Concepts of Distress and Psychiatric Disorders: Understanding Symptom Experience and Expression in Context. Transcultural Psychiatry 56(4):786–803

    Article  Google Scholar 

  • Lim, Russell F. 2014 Clinical Manual of Cultural Psychiatry Washington, DC: American Psychiatric Press

    Google Scholar 

  • Lipp, Frank J. 1987 The Study of Disease in Relation to Culture: The Susto Complexe among the Mixe of Oaxaco (Mexico). Dialectical Anthropology 12:435–442

  • Logan, Michael H. 1979 Variations regarding Susto Causality among the Cakchiquel of Guatemala. Culture, Medicine and Psychiatry 3(2):153–166

    Article  Google Scholar 

  • Logan, Michael H. 1993 Lines of Inquiry on the Illness of Susto. Medical Anthropology 15:189–200

    Article  Google Scholar 

  • Low, Setha 1985 Culturally Interpreted Symptoms of Culture-Bound Syndromes: A Cross-Cultural Review of Nerves. Social Sciences and Medicine 21(2):187–196

    Article  Google Scholar 

  • Mezzich, Juan E., Laurence Kirmayer, Arthur Kleinman, Horacio Fabrega, Delores Parron, Byron Good, Keh-Ming. Lin, and Spero Manson 1999 The Place of Culture in DSM-IV. Journal of Nervous and Mental Disease 187(8):457–464

    Article  Google Scholar 

  • Mysyk, Avis 1998 Susto: An Illness of the Poor. Dialectical Anthropology 23(2):187–202

    Article  Google Scholar 

  • Nash, June 1967 The Logic of Behavior: Curing in a Maya Indian Town. Human Organization 26(3):132–140

    Article  Google Scholar 

  • O’Nell, Carl W. 1975 An Investigation of Reported ‘Fright’ as a Factor in the Etiology of Susto, ‘Magical Fright.’ Ethos 3:41–63

    Article  Google Scholar 

  • Orellana, Sandra L. 1987 Indian Medicine in Highland Guatemala: The Pre-Hispanic and Colonial Periods Albuquerque: University of New Mexico Press

    Google Scholar 

  • Ortiz de Montellano, Bernard 1987 Caida de Mollera: Aztec Sources for a Mesoamerican Disease of Alleged Spanish Origin. Ethnohistory 34(4):381–399

    Article  Google Scholar 

  • Paul, Benjamin 1950 Symbolic Sibling Rivalry in a Guatemalan Indian Village. American Anthropologist 52:205–218

    Article  Google Scholar 

  • Permanto, Stefan 2015 The Elders and the Hills: Animism and Cosmological re-Creation among the Q’eqchi’ Maya in Chisec, Guatemala. PhD thesis. Gothenburg, Sweden: University of Gothenburg.

  • Press, Irwin 1971 The Urban Curandero. American Anthropologist 73:741–756

    Article  Google Scholar 

  • Redfield, Robert, and Margaret Park Redfield 1940 Disease and Its Treatment in Dzitas, Yucatan. Contributions to American Anthropology and History No. 32. Washington, DC: Carnegie Institute of Washington.

  • Rubel, Arthur J. 1960 Concepts of Disease in Mexican-American Culture. American Anthropologist 62:795–814

    Article  Google Scholar 

  • Rubel, Arthur J. 1964 The Epidemiology of a Folk Illness: Susto in Hispanic America. Ethnology 3(3):268–283

    Article  Google Scholar 

  • Rubel, Arthur J., Carl W. O’Nell, and Rolando Collado-Ardón 1984 Susto, A Folk Illness Berkeley: University of California Press

    Book  Google Scholar 

  • Rubel, Arthur J., Carl W. O’Nell, and Rolando Collado 1985 The Folk Illness Called Susto. In The Culture-Bound Syndromes: Folk Illnesses of Psychiatric and Anthropological Interest Ronald C. Simons, and Charles C. Hughes, eds., Dordrecht, Holland: D. Reidel.

    Chapter  Google Scholar 

  • Seijas, Haydee 1970 Algunos Aspectos de la Ethnomedicina de los Sibundoy de Columbia. Abridged translation by Clarissa Scott. Medical Anthropology Newsletter 2(1):9–10

    Google Scholar 

  • Simons, Ronald C. 1996 Boo! Culture, Experience, and the Startle Reflex. New York and Oxford: Oxford University Press

    Google Scholar 

  • Simons, Ronald C., and Charles H. Hughes, eds. 1985 The Culture-Bound Syndromes: Folk Illnesses of Psychiatric and Anthropological Interest. Dordrecht, Holland: D. Reidel.

    Google Scholar 

  • Smith, Frank Dylan 2016 Feeling the Boundaries of Normality—‘Tristeza’ and the Restitution of Community in the Aftermath of Violence. Journal of Latin American Cultural Studies 25(2):237–251

    Article  Google Scholar 

  • Taub, Bonnie 1992 Calling the Soul Back to the Heart: Soul Loss, Depression, and Healing among Indigenous Mexicans. Unpublished PhD dissertation, University of California at Los Angeles

  • Tenzel, James H. 1970 Shamanism and Concepts of Disease in a Mayan Indian Community. Psychiatry 33(3):372–380

    Article  Google Scholar 

  • Tousignant, Michel 1979 Espanto: A Dialogue with the Gods. Culture, Medicine and Psychiatry 3:347–361

    Article  Google Scholar 

  • Trotter, Robert 1982 Susto: The Context of Community Morbidity Patterns. Ethnology 21(3):215–226

    Article  Google Scholar 

  • Trotter, Robert T, and Juan Antonio Chavira (1997) 1981. Curanderismo: Mexican American Folk Healing. Athens, Georgia: University of Georgia Press

  • Trotter, Robert T., II., Bernard Ortiz de Montellano, and Michael Logan 1989 Fallen Fontanelle in the American Southwest: Its Origin, Epidemiology and Possible Organic Causes. Medical Anthropology 10:211–221

    Article  Google Scholar 

  • Tseng, Wen-Shing. 2006 From Peculiar Psychiatric Disorders through Culture-Bound Syndromes to Culture-Related Specific Syndromes. Transcultural Psychiatry 43(4):554–576

    Article  Google Scholar 

  • Vogt, Evan Z. 1969 Zinacantan: A Maya Community in the Highlands of Chiapas Cambridge, MA: Harvard University Press

    Book  Google Scholar 

  • Vrettas, Demi 2020 Searching for a Cure: Health Care Behaviour among the Q’eqchi’ Maya in Southern Belize. Master of Arts Thesis, Archaeology and Anthropology. Saskatoon: University of Saskatchewan

  • Waldram, James B. 2004 Revenge of the Windigo: The Construction of the Mind and Mental Health of North American Aboriginal Peoples Toronto: University of Toronto Press, Anthropological Horizons

    Book  Google Scholar 

  • Waldram, James B. 2015 “I Don’t Know the Words He Uses”: Therapeutic Communication among Q’eqchi Maya Healers and Their Patients. Medical Anthropology Quarterly 29(3):279–297

    Article  Google Scholar 

  • Waldram, James B. 2020 An Imperative to Cure: Principles and Practice of Q’eqchi’ Maya Medicine in Belize Albuquerque: University of New Mexico Press

    Google Scholar 

  • Waldram, James B., and Andrew R. Hatala 2015 Latent and Manifest Empiricism in Q’eqchi’ Maya Healing: A Case Study of HIV/AIDS. Social Science and Medicine 126:9–16

    Article  Google Scholar 

  • Weller, Susan C., Roberta D. Baer, Javier Garcia do Alba Garcia, Mark Glazer, Robert Trotter, Lee Pachter, and Robert E. Klein 2002 Regional Variation in Latino Descriptions of Susto. Culture, Medicine and Psychiatry 26:449–472

    Article  Google Scholar 

  • Wilson, Richard 1993 Anchored Communities: Identity and History of the Maya-Q’eqchi’. Man (N.S.) 28(1):121–138

    Article  Google Scholar 

  • Wilson, Richard 1995 Maya Resurgence in Guatemala: Q’eqchi’ Experiences Norman, OK: University of Oklahoma Press

    Google Scholar 

  • Yarris, Kristen Elizabeth 2011 The Pain of ‘“Thinking too Much”’: Dolor de Cerebro and the Embodiment of Social Hardship among Nicaraguan Women”. Ethos 39(2):226–248

    Article  Google Scholar 

Download references

Acknowledgments

We wish to acknowledge the assistance of Victor Cal, coordinator of the Maya Healer’s Association, all members of the Healers' Association cited in this article, and interpreters involved over the years: Pedro Makin, Fercia Makin, Rosy Makin, Lydia Makin, Rey Makin, and Federico Caal. We would also like to offer special acknowledgment to Tomas Caal who served as the main translator, language expert, and cultural guide for the duration of this research and accompanied the authors during many interviews. Importantly, Tomas Caal also served as a cultural broker and ethical advisor by ensuring respect for the traditions and patients’ privacy and adherence to local ethical protocols. The research has been funded by the Social Sciences and Humanities Research Council of Canada, with supplemental funding and other supports from the University of Saskatchewan. The research received ethical approval from both the University of Saskatchewan Behavioral Research Ethics Board and the National Institute of Culture and History (NICH) of the Government of Belize. Thanks to Nigel Encalada and Rolando Cocom of NICH for their on-going support. We also wish to thank the reviewers who provided useful insight, feedback, and comments on earlier drafts of the manuscript.

Funding

Funding for this research has been provided by the Social Sciences and Humanities Research Council of Canada, and the University of Saskatchewan.

Author information

Authors and Affiliations

  1. Department of Archaeology and Anthropology, University of Saskatchewan, Saskatoon, SK, S7N 5B1, Canada

    James B. Waldram

  2. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada

    Andrew R. Hatala

Authors
  1. James B. Waldram
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew R. Hatala
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Both authors contributed to the study conception and design, including data collection and analysis. The first draft of the manuscript was written by James B. Waldram and both authors commented on and revised versions of the manuscript before submission. Both authors read and approved the final manuscript.

Corresponding author

Correspondence to James B. Waldram.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no conflict of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethical Approval

The research was approved by the University of Saskatchewan Research Ethics Board- Behavioural, the National Institute of Culture and History (Belize), and the members of the Maya Healer’s Association of Belize.

Informed Consent

All participants fully and voluntarily consented to this research and its publication and dissemination. Verbal informed consent was obtained prior to the interview. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Waldram, J.B., Hatala, A.R. Does “Susto” Really Exist? Indigenous Knowledge and Fright Disorders Among Q’eqchi’ Maya in Belize. Cult Med Psychiatry 47, 372–401 (2023). https://doi.org/10.1007/s11013-022-09777-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11013-022-09777-2

Keywords

Search

Navigation