Advertisement

Blood, Sweat, and/or Tears: Comparing Nervios Symptom Descriptions in Honduras

  • Max J. SteinEmail author
Original Paper
  • 31 Downloads

Abstract

With the aim of advancing the cross-cultural investigation of the folk illness nervios, I conducted a dual-sited comparative study of symptom descriptions among two diverse research settings in Honduras. Baer et al. (Cult Med Psychiatry 27(3):315–337, 2003) used cultural consensus modeling (CCM) to confirm a core description of nervios among four Latino groups in the US, Mexico, and Guatemala, but observed that overall agreement and average competence in a shared illness model decreased along a gradient from presumably more-to-less economically developed sites. This has left unresolved whether such variation extends to other Latin American regions. This paper is an exploratory analysis of inter- and intracultural variation in nervios symptom descriptions by 50 Hondurans from the market town of Copán Ruinas (n = 25) and city of San Pedro Sula (n = 25). I performed CCM using a combination of free-listing, pile-sorting, and rating activities to establish if respondents across sites share a single model of nervios. I found consensus for the San Pedro Sula subsample, but not for Copán Ruinas or for the overall sample. Results suggest nervios is constitutive of differing forms of distress ranging from chronic illness to acute suffering, as well as anger- and panic-based manifestations that overlap with biomedical ideas about depression, anxiety, and panic disorder. This variation derives in part from demographic factors such as age, gender, and residence, but may also result from ethnic and regional diversity among subsamples. However, consensus only being present among San Pedro Sula respondents suggests their greater awareness of cultural distinctions between biomedical and folk medical knowledge, which is likely due to their exposure to manifold health frameworks in those settings.

Keywords

Nervios Cultural syndromes Idioms of distress Honduras Cultural consensus modeling 

Notes

Acknowledgements

Many thanks to Kathy Oths, Bill Dressler, Lesley Jo Weaver, Bonnie Kaiser, and Alexandre Tokovinine for helpful comments on earlier versions of this article.

References

  1. Baer, Roberta D., Susan C. Weller, Garcia de Alba Garcia, Javier, Mark Glazer, Mark Trotter, Lee Pachter, and Robert E. Klein 2003 A Cross-Cultural Approach to the Study of the Folk Illness Nervios. Culture, Medicine and Psychiatry 27(3):315-337.CrossRefGoogle Scholar
  2. Baer, Roberta D., Susan C. Weller, Garcia de Alba Garcia, Javier, and Ana L. Salcedo Rocha 2012 Ethnomedical and Biomedical Realities: Is There an Epidemiological Relationship Between Stress-Related Folk Illnesses and Type 2 Diabetes? Human Organization 71(4):339-347.CrossRefGoogle Scholar
  3. Blumhagen, Dan 1980 Hyper-Tension: a Folk Illness with a Medical Name. Culture, Medicine and Psychiatry 4(3):197-224.CrossRefGoogle Scholar
  4. Borgatti, Stephen P. 1996 Anthropac 4.983. Lexington, KY: Analytic Technologies.Google Scholar
  5. Borgatti, Stephen P. 1994 Cultural Domain Analysis. Journal of Quantitative Anthropology 4:261-278.Google Scholar
  6. Boster, James S., and Jeffrey C. Johnson 1989 Form or Function: a Comparison of Expert and Novice Judgements of Similarity Among Fish. American Anthropologist 91(4):866-889.CrossRefGoogle Scholar
  7. Brodzinsky, Sibylla 2013 Inside San Pedro Sula—the Most Violent City in the World. The Guardian.Google Scholar
  8. Cruz, José Miguel 2011 Criminal Violence and Democratization in Central America: the Survival of the Violent State. Latin American Politics and Society 53(4):1-33.CrossRefGoogle Scholar
  9. Dahlberg, Britt, Frances K. Barg, Joseph J. Gallo, and Marsha N. Wittink 2009 Bridging Psychiatric and Anthropological Approaches: the Case of “Nerves” in the United States. Ethos 37(3):282-313.CrossRefGoogle Scholar
  10. Durà-Vilà, Glòria, and Matthew Hodes 2012 Cross-Cultural Study of Idioms of Distress Among Spanish Nationals and Hispanic American Migrants: Susto, Nervios and Ataque De Nervios. Social Psychiatry and Psychiatric Epidemiology 47(10):1627-1637.CrossRefGoogle Scholar
  11. Finerman, Ruthbeth (1989) The Burden of Responsibility: Duty, Depression and Nervios in Andean Ecuador. In: D.L. Davis, S.M. Low (eds.) Gender, Health, and Illness: The Case of Nerves. New York: Hemisphere Publishing.Google Scholar
  12. Finkler, Kaja (1989) The Universality of Nerves. In: D.L. Davis and S.M. Low (eds.) Gender, Health, and Illness: the Case of Nerves. New York: Hemisphere Publishing.Google Scholar
  13. Fleming, Melissa 2016 The Other Refugee Crisis—Women on the Run from Central America. The Guardian.Google Scholar
  14. Gentry, J., and Brian E. Metz 2017 Adjusting Photovoice for Marginalized Indigenous Women: Eliciting Ch’Orti’ Maya Women’s Perspectives on Health in Guatemala. Human Organization 76(3):251-263.CrossRefGoogle Scholar
  15. Glazer, Mark, Roberta D. Baer, Susan C. Weller, Garcia de Alba Garcia, Javier, and Stephen W. Liebowitz 2004 Susto and Soul Loss in Mexicans and Mexican Americans. Cross-Cultural Research 38(3):270-288.CrossRefGoogle Scholar
  16. Good, Byron J. 1996 Culture and DSM-IV: Diagnosis, Knowledge and Power. Culture, Medicine and Psychiatry 20(2):127-132.CrossRefGoogle Scholar
  17. Guarnaccia, Peter J., Glorisa Canino, Maritza Rubio-Stipec, and Milagros Bravo 1993 The Prevalence of Ataques De Nervios in the Puerto Rico Disaster Study: the Role of Culture in Psychiatric Epidemiology. The Journal of Nervous and Mental Disease 181(3):157-165.CrossRefGoogle Scholar
  18. Guarnaccia, Peter J., and Pablo Farias 1988 The Social Meanings of Nervios: a Case Study of a Central American Woman. Social Science and Medicine 26(12):1223-1231.CrossRefGoogle Scholar
  19. Guarnaccia, Peter J., Roberto Lewis-Fernández, and Melissa Rivera Marano 2003 Toward a Puerto Rican Popular Nosology: Nervios and Ataque De Nervios. Culture, Medicine and Psychiatry 27(3):339-366.CrossRefGoogle Scholar
  20. Guarnaccia, Peter J., and Lloyd H. Rogler 1999 Research on Culture-Bound Syndromes: New Directions. The American Journal of Psychiatry 156(9):1322-1327.Google Scholar
  21. Guzmán Gutiérrez, S. Laura, Ricardo Reyes Chilpa, and Herlinda Bonilla Jaime 2014 Medicinal Plants for the Treatment of “Nervios”, Anxiety, and Depression in Mexican Traditional Medicine. Revista Brasileira De Farmacognosia 24(5):591-608.CrossRefGoogle Scholar
  22. Handwerker, W. Penn 2002 The Construct Validity of Culture: Cultural Diversity, Culture Theory, and a Method for Ethnography. American Anthropologist 104(1):106-122.CrossRefGoogle Scholar
  23. Hinton, Devon E., and Roberto Lewis-Fernández 2010 Idioms of Distress among Trauma Survivors: Subtypes and Clinical Utility. Culture, Medicine and Psychiatry 34(2):209-218.CrossRefGoogle Scholar
  24. Hubert, L., and J. Schultz 1976 Quadratic Assignment as a General Data Analysis Strategy. British Journal of Math, Statistics and Psychology 29:190-241.CrossRefGoogle Scholar
  25. Instituto Nacional de Estadística (INE) 2016 Censo de XVII Población y Vi Vivienda 2013. http://www.ine.gob.hn/index.php/component/content/article?id=81, accessed December 14, 2016.
  26. Jenkins, Janis H. 1988 Ethnopsychiatric Interpretations of Schizophrenic Illness: the Problem of Nervios within Mexican-American Families. Culture, Medicine and Psychiatry 12(3):301-329.CrossRefGoogle Scholar
  27. Jenkins, Janis H., and Martha Valiente 1994 Bodily Transactions of the Passions: El Calor Among Salvadoran Women Refugees. In: Thomas J. Csordas (ed.) Embodiment and Experience: the Existential Ground of Culture and Self, pp. 163-182. New York: Cambridge University Press.Google Scholar
  28. Kirmayer, Laurence J. 1984 Culture, Affect and Somatization: Part I. Transcultural Psychiatry 21:159-188.CrossRefGoogle Scholar
  29. Kohrt, Brandon A., Emily Mendenhall, and Peter J. Brown 2016 How Anthropological Theory and Methods Can Advance Global Mental Health. Lancet Psychiatry 3(5):396-398.CrossRefGoogle Scholar
  30. Liebowitz, Michael R., Ester Salmán, Carlos M. Jusino, Robin Garfinkel, Linda Street, Dora L. Cárdenas, Joao Silvestre, Abby J. Fyer, José L. Carrasco, Sharon Davies, Peter Guarnaccia, and Donald F. Klein 1994 Ataque De Nervios and Panic Disorder. The American Journal of Psychiatry 151(6):871-875.CrossRefGoogle Scholar
  31. Livanis, Andrew, and Georgiana Shick Tyron 2010 The Development of the Adolescent Nervios Scale: Preliminary Findings. Cultural Diversity and Ethnic Minority Psychology 16(1):9-15.CrossRefGoogle Scholar
  32. Low, Setha M. (1989) Gender, Emotion, and Nervios in Urban Guatemala. In: DL Davis and SM Low (eds.) Gender, Health, and Illness: the Case of Nerves. New York: Hemisphere Publishing.Google Scholar
  33. Low, Setha M. 1985 Culturally Interpreted Symptoms Or Culture-Bound Syndromes: a Cross-Cultural Review of Nerves. Social Science and Medicine 21(2):187-196.CrossRefGoogle Scholar
  34. Maupin, Jonathan N., Robert Ross, and Catherine A. Timura 2011 Gendered Experiences of Migration and Conceptual Knowledge of Illness. Journal of Immigrant and Minority Health 13(3):600-608.CrossRefGoogle Scholar
  35. Metz, Brian E. 2006 Ch’Orti’-Maya Survival in Eastern Guatemala: Indigeneity in Transition. Albuquerque: University of New Mexico Press.Google Scholar
  36. Metz, Brian E., Cameron L. McNeil, and Kerry M. Hull, eds. 2009 The Ch’Orti’ Maya Area: Past and Present. Gainesville, FL: University Press of Florida.Google Scholar
  37. Miroff, Nick 2011 Grim Toll as Cocaine Trade Expands in Honduras. The Washington Post.Google Scholar
  38. Natid MK, Camino LA, Walker FB (1988) ‘Nerves’: Folk Idiom for Anxiety and Depression? Social Science and Medicine 26(12):1245-1259.CrossRefGoogle Scholar
  39. Nevins, Joseph 2016 The US Policy in Honduras Has Set the Stage for Today’s Mass Migration. http://www.businessinsider.com/us-policy-in-honduras-led-to-mass-migration-2016-11, accessed November 29, 2016.
  40. Nichter, Mark 2010 Idioms of Distress Revisited. Culture, Medicine and Psychiatry 34(2):401-416.CrossRefGoogle Scholar
  41. Nogueira, Bruno Limá, Jair De Jesus Mari, and Denise Razzouk 2015 Culture-Bound Syndromes in Spanish Speaking Latin America: the Case of Nervios, Susto and Ataques De Nervios. Archive of Clinical Psychiatry 42(6):171-178.Google Scholar
  42. Quesada, James 2009 The Vicissitudes of Structural Violence: Nicaragua at the Turn of the Twenty-First Century. In: Paul Farmer, Linda Whiteford and Barbara Ryko-Bauer (eds.) Global Health in a Time of War, pp. 157-180. Santa Fe, NM: School of American Research.Google Scholar
  43. Quesada, James 1998 Suffering Child: an Embodiment of War and Its Aftermath in Post-Sandinista Nicaragua. Medical Anthropology Quarterly 12(1):51-73.CrossRefGoogle Scholar
  44. Rivas, Álvaro, and Pablo Enrique Avendaño 2010 The Municipal Territorial Management and Multi-Functionality: Analysis of a Bilateral International Project in Copa (Honduras). Agronomía Colombiana 28(3):559-566.Google Scholar
  45. Rodriguez-Mejia, Fredy 2016 Articulations of Identity through Struggle among the Ch’Orti’ Maya of Copan, Honduras. PhD dissertation.Google Scholar
  46. Rogler, Lloyd H., and August Hollingshead 1965 Trapped: Families and Schizophrenia. New York: Wiley.Google Scholar
  47. Romney, A. Kimball, Susan C. Weller, and William H. Batchelder 1986 Culture as Consensus: a Theory of Culture and Informant Accuracy. American Anthropologist 88(2):313-338.CrossRefGoogle Scholar
  48. Rubel, Arthur J. 1964 The Epidemiology of a Folk Illness: Susto in Hispanic America. Ethnology 3(3):268-283.CrossRefGoogle Scholar
  49. Rubel, Arthur J., Carl W. O’Nell, and Rolando Collado-Ardón 1984 Susto: a Folk Illness. Berkeley: University of California Press.Google Scholar
  50. Salgado de Snyder, Nelly, Ma de Jesus Diaz-Perez, and Victoria D. Ojeda 2000 The Prevalence of Nervios and Associated Symptomatology among Inhabitants of Mexican Rural Communities. Culture, Medicine and Psychiatry 24(2):453–470.CrossRefGoogle Scholar
  51. Scheper‐Hughes, Nancy, and Margaret Lock M. 1987 The Mindful Body: a Prolegomenon to Future Work in Medical Anthropology. Medical Anthropology Quarterly 1(1):6-41.CrossRefGoogle Scholar
  52. Shipley, Tyler 2012 The New Canadian Imperialism and the Military Coup in Honduras. Latin American Perspectives 40(5):44-61.CrossRefGoogle Scholar
  53. Simons, Ronald C., and Charles Hughes C., eds. 1985 The Culture-Bound Syndromes: Folk Illnesses of Psychiatric and Anthropological Interest. Boston, MA: D. Reidel Publishing Company.Google Scholar
  54. Sturrock, Kenneth, and Jorge Rocha 2000 A Multidimensional Scaling Stress Evaluation Table. Field Methods 12(1):49-60.CrossRefGoogle Scholar
  55. Weller, Susan C. 2007 Cultural Consensus Theory: Applications and Frequently Asked Questions. Field Methods 19(4):339-368.CrossRefGoogle Scholar
  56. Weller, Susan C., Roberta D. Baer, Garcia de Alba Garcia, Javier, 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.CrossRefGoogle Scholar
  57. Weller, Susan C., Roberta D. Baer, Garcia de Alba Garcia, Javier, and Ana L. Salcedo Rocha 2008 Susto and Nervios: Expressions for Stress and Depression. Culture, Medicine and Psychiatry 32(3):406-420.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of AnthropologyUniversity of AlabamaTuscaloosaUSA

Personalised recommendations