Several Indigenous communities around the globe maintain unique conceptions of mental illness and disorder. The Q’eqchi’ Maya of southern Belize represent one Indigenous community that has maintained, due to highly “traditional” ways of life and the strong presence of many active localized healers or bush doctors, distinct conceptions of mental disorders as compared to Western psychiatric nosology. The purpose of this ethnographic study was to understand and interpret Q’eqchi’ nosological systems of mental disorders involving the factors—spiritual, cultural, social, historical, cosmological, or otherwise—implicated in their articulation and construction. Over a period of 9 months, and with the help of cultural advisors from several Q’eqchi’ communities, 94 interviews with five different traditional Q’eqchi’ healers were conducted. This paper demonstrates that the mental illnesses recognized by the Q’eqchi’ healers involved narrative structures with recognizable variations unfolding over time. What we present in this paper are 17 recognizable illnesses of the mind grouped within one of four broad “narrative genres.” Each genre involves a discernible plot structure, casts of characters, themes, motifs, and a recognizable teleology or “directedness.” In narrative terms, the healer’s diagnostic and therapeutic work can be understood as an ability to discern plot, to understand and interpret a specific case within the board, empirically based structure of Q’eqchi’ medical epistemology.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
The Q’eqchi’ word, aj ilonel, stemming from the verb ilok, “to see,” is often used to describe the work of a traditional healer, translating roughly as “seer” or the “one who sees,” involving the ability to prognosticate disease. The Q’eqchi’ term aj ilonel is singular. The plural aj iloneleb’ is also used when talking about a group of healers. The English word healer and Q’eqchi’ term aj ilonel are used interchangeably throughout.
There were no women healers who took part in the MHA at the time of this research. There are female Q’eqchi’ healers who have been working with researchers from the New York Botanical gardens, and discussions have occurred regarding the integration of these women with the male healers with the same goals and intentions that spurred the formation of the MHA. However, several community members felt this was too premature as women and men are still separated by traditional cultural hierarchies that persist today. There are studies that include women’s health in particular (Ekelman et al. 2003), but research looking into the knowledge of women Maya healers is limited.
We say “only” impact the body lightly here as seemingly physiological conditions, even those that seem as clearly physiological as kaxum xul or snake bite, can invoke a host of mood states and conditions that may be interpretable as “abnormal” by the Q’eqchi’ healers and patients.
This is a reference to two of the 18 months in the Maya calendar which are still in use today among many Maya communities, especially the 260-day tzolk’in or chol q’ij. The 260-day lunar system, sometimes referred to as the tzolk’in (Tedlock 1982), is combined with the macewal q’ij organized in 18 months of 20 days (360 days), with a five-day celebration and gift-giving period called uayeb in K’iche’. Together the 365-day cycle combined with the 260-day lunar system provide a fifty-two-year cycle called the calendar round. The 260-day lunar calendar forms the basis of much Maya religious and ceremonial practice; it is a system of astrology as well as divination. See Hatala (2014) or Molesky-Poz (2006) for more details.
Here during the interview the healer used the term “sachk” which the translator referred to in English as “retarded.”
Although in traditional Maya mythology the snake is a positive figure and worshiped as a powerful deity, contemporary healers, largely through various Catholic and Christian influences, have come to associate the serpent with a general notion of “evil” spirit. In some cases, snakes are even described to be the servants of Satan.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association.
Alarcón, Renato D., Becker, Anne E., Lewis-Fernandez, Roberto, Like, Robert, Desai, Prakash, Foulks, Edward, Gonsales, Junius, Hansen, Helena, Kopelowicz, Alex, Lu, Francis, Oquendo, Maria, and Primm, Annelle (2009) Issues for DSM-5: the Role of Culture in Psychiatric Diagnosis. The Journal of Nervous and Mental Disease 197(8): 559-560.
Arnason John, Cal, Victor, Assinewe, V., Poveda, L., Waldram, James, Cameron, S., Pesek, Todd, Cal, M., Jones, N. 2004 Visioning Our Traditional Health Care: Workshop on Q’eqchi’ Healers Center, Botanical Garden and Medicinal Plant Biodiversity Project in Southern Belize. Final Report to IDRC, Ottawa.
Becker, Gay (1997) Disrupted Lives: How People Create Meaning in a Chaotic World. Los Angeles, CA: University of California Press.
Bonander, Jason, Kohn, Robert, Arana, Belito, and Levav, Itzhak (2000) An Anthropological and Epidemiological Overview of Mental Health in Belize. Transcultural Psychiatry 37(1): 57-72.
Bourbonnais-Spear, Natalie, Awad, Rosalie, Maquin, Pedro, Cal, Victor, Vinda, Pablo, Poveda, Luis, and Arnason, John 2005 Plant use by the Q’eqchi’ Maya of Belize in Ethnopsychiatry and Neurological Pathology. Economic Botany 59(4): 326-336.
Brown, Alex, Ushma Scales, Warwick Beever, Bernadette Rickards, Kevin Rowley, and Kerin O’Dea (2012) Exploring the Expression of Depression and Distress in Aboriginal Men in Central Australia: A Qualitative Study. BMC Psychiatry 12(1): 97.
Bruner, Jerome (1986) Actual Minds, Possible Worlds. Cambridge, MA: Harvard University Press.
Bruner, Jerome (2008) Culture and Mind: Their Fruitful Incommensurability. Ethos 36(1): 29–45.
Charon, Rita (2006) Narrative Medicine: Honouring the Stories of Illness. Oxford: University of Oxford Press.
Craig, Sienna R. (2012) Healing Elements: Efficacy and the Social Ecologies of Tibetan Medicine. Berkeley: University of California Press.
Devitt, Amy J. (2004) A Theory of Genre: Writing Genres. Carbondale, CN: Southern Illinois University Press.
Denzin, Norman, and Lincoln, Yvonna. (2008) Introduction: The Discipline and Practice of Qualitative Research. In Norman Denzin & Yvonna Lincoln (Eds.), Collecting and Interpreting Qualitative Materials (3rd ed., pp. 1–45). London: Sage.
Dickinson, David (2008) Traditional Healers, HIV/AIDS and Company Programmes in South Africa. African Journal of AIDS Research 7(3): 281-291.
Ekelman, Beth, Bazyk, Susan, and Bello-Haas, Vanina (2003) An Occupational Perspective of the Well-Being of Maya Women in Southern Belize. Occupational Therapy Journal of Research 23(4): 130-142.
Erickson, Pamela I. (2008) Ethnomedicine. Long Grove, IL: Waveland Press.
Flemming, M. H., and Mattingly, C. (2008) Action and Narrative: Two Dynamics of Clinical Reasoning. In: J. Higgs, M. Jones, S. Loftus, & N. Christensen (Eds.), Clinical Reasoning in the Health Professions (3rd ed., pp. 110-126). Philadelphia, PA: Elsevier.
Foster, George M., and Barbara G. Anderson (1978) Medical Anthropology. New York: Wiley.
Frank, Arthur (1995) The Wounded Storyteller: Body, Illness, and Ethics. Chicago: The University of Chicago Press.
Garro, Linda (1994) Narrative Representations of Chronic Illness Experience: Cultural Models of Illness, Mind, and Body in Stories Concerning the Temporomandibular Joint (TMJ). Social Science & Medicine 38(6): 775-778.
Garro, Linda (2000) Remembering What One Knows and the Construction of the Past: a Comparison of Cultural Consensus Theory and Cultural Schema Theory. Ethos 28(3): 275-319.
Garro, Linda (2010) By the Will of Others or by One’s Own Actions? In: Jasson Throop and John Murphy, (Eds.), Toward an Anthropology of the Will, pp. 69-101. Stanford: Stanford University Press.
Garro, Linda, and Mattingly, Cheryl (2000) Narrative as Construct and Construction. In: Cheryl Mattingly and Linda Garro (Eds.), Narrative and the Cultural Construction of Illness and Healing, pp. 1-49. Berkeley, CA: University of California Press.
Government of Belize (2010) Belize National Mental Health Policy: 2010-2015. Belmopan, Belize: Ministry of Health.
Good, Byron (1994) Medicine, Rationality, and Experience: An Anthropological Perspective. Cambridge: Cambridge University Press.
Groark, Kevin (2008) Social Opacity and the Dynamics of Empathic In-Sight Among the Tzotzil Maya of Chiapas, Mexico. Ethos 36(4): 427-448.
Hallowell, Irving (1960) Ojibwa Ontology, Behavior and World View. In: S. Diamond (eds.), Culture and History: Essays in Honor of Paul Radin, pp. 19-48. New York, NY: Columbia University Press.
Hatala, Andrew R. (2011) Resilience and Healing Amidst Depressive Experiences: an Emerging Four-Factor Model from Emic/Etic Perspectives. Journal of Spirituality in Mental Health 13(1): 27-51.
Hatala, Andrew R. (2013) Being and Becoming Maya in Chan Kom: Towards Heideggerian Interpretations of Cultural Transformation. Advances in Anthropology 3(1): 16-22.
Hatala, Andrew R. 2014 Narrative Structures of Maya Mental Disorders: an Ethnography of Q’eqchi’ Healing. Published dissertation. University of Saskatchewan, Saskatoon, Canada.
Hatala, Andrew R., Waldram, James B., and Crossley, Margaret. (2013) Doing Resilience with “Half a Brain”: Navigating Moral Sensibilities 35 Years After Hemispherectomy. Culture, Medicine & Psychiatry 37: 148-178. DOI:10.1007/s11013-012-9294-7.
Hawkins, John P. and Adams, Walter R. (2005) Good Medicine: Steps toward a Maya-accessible health care system. In W. R. Adams & J. P. Hawkins (Eds.), Health Care in Maya Guatemala: Confronting Medical Pluralism in a Developing Country (pp. 215–235). Oklahoma: University of Oklahoma Press.
Hinton, Devon, Alexander Hinton, Kok-Thay Eng, and Sophearith Choung (2012) PTSD and Key Somatic Complaints and Cultural Syndromes Among Rural Cambodians: the Results of a Needs Assessment Survey. Medical Anthropology Quarterly 26(3): 383–407.
Hunter, Kathryn M. 1991 Doctor’s Stories: the Narrative Structure of Medical Knowledge. Princeton, NJ: Princeton University Press.
Hurwitz, Brian 2000 Narrative and the Practice of Medicine. Lancet 356: 2086–2089.
Kahn, Hilary E. 2006 Seeing and Being Seen: The Q’eqchi’ Maya of Livingston, Guatemala and Beyond. Austin: University of Texas Press.
Kaiser, B., McLean, K., Kohrt, B., Hagaman, A., Wagenaar, B., Khoury, N., Keys, H. 2014. Reflechi two`p—Thinking Too Much: Description of a Cultural Syndrome in Haiti’s Central Plateau. Culture, Medicine and Psychiatry 38: 448-472.
Killion, Cheryl, and Cayetano, Claudina. 2009 Making Mental Health a Priority in Belize. Archives of Psychiatric Nursing 23(2) 157-165.
Kirmayer, L. 1996 Landscapes of Memory: Trauma, Narrative and Dissociation. In Dissociation: Culture, Mind and Body. D. Spiegel, ed., pp. 91–122. Washington, D.C.: American Psychiatric Press.
Kirmayer, Laurence J. 2000. Broken Narratives: Clinical Encounters and the Poetics of Illness Experience. In: Cheryl Mattingly and Linda Garro (Eds.), Narrative and the Cultural Construction of Illness and Healing, pp. 153-181. Berkeley, CA: University of California Press.
Kirmayer, Laurence J. 2006 Beyond the “New Cross-Cultural Psychiatry”: Cultural Biology, Discursive Psychology and the Ironies of Globalization. Transcultural Psychiatry 43(1): 126-144.
Kirmayer, Laurence J. 2007 Psychotherapy and the Cultural Concept of the Person. Transcultural Psychiatry 44(2): 232–257.
Kirmayer, Laurence, and Minas, H. 2000 The Future of Cultural Psychiatry: An International Perspective. Canadian Journal of Psychiatry 45(5): 438 − 446.
Kleinman, Arthur 1988 Rethinking Psychiatry: from Cultural Category to Personal Experience. New York: Free.
Klein, Janice 1978. Susto: The Anthropological Study of Diseases of Adaptation. Social Science and Medicine 12: 23-28.
Lock, Margaret, Nichter Mark 2002. From Documenting Medical Pluralism to Critical Interpretations of Globalized Health Knowledge, Policies, and Practices. In: M. Nichter and M. Lock (Eds.), New Horizons in Medical Anthropology: Essays in Honour of Charles Leslie (pp. 1-35). New York, NY: Routledge.
Manson, Spero, Shore, James and Bloom, Joseph 1985. The Depressive Experience in American Indian Communities: A Challenge for Psychiatric Theory and Diagnosis. In: Arthur Kleinman and Byron Good (Eds.), Culture and Depression, pp 331-368. Berkeley, CA: University of California Press.
Mattingly, Cheryl 1994 The Concept of Therapeutic ‘Emplotment.’ Social Science and Medicine 38(6): 811-822.
Mattingly, Cheryl 1998 Healing Dramas and Clinical Plots: The Narrative Structure of Experience. Cambridge, MA: Cambridge University Press.
Mattingly, Cheryl 2000 Emergent Narratives. In: Cheryl Mattingly and Linda Garro (Eds.) Narrative and the Cultural Construction of Illness and Healing, pp. 181-212. Berkeley, CA: University of California Press.
Mattingly, Cheryl 2010 The Paradox of Hope: Journeys Through a Clinical Borderland. Los Angeles, CA: University of California Press.
Molesky-Poz, Jean 2006 Contemporary Maya spirituality: The Ancient Ways are not Lost. Austin: University of Texas Press.
Montgomery, Kathryn 2006 How Doctors Think: Clinical Judgement and the Practice of Medicine. Oxford: Oxford University Press.
Mogensen, Hanne O. 1997. The Narrative of AIDS among the Tonga of Zambia. Social Science and Medicine 44(4): 431-439.
Nash, June 1967 The Logic of Behavior: Curing in a Maya Indian Town. Human Organization 26: 132-140.
O’Nell, Theresa D. 1996 Disciplined Hearts: History, Identity and Depression in an American Indian Community. Berkeley: University of California Press.
Pan American Health Organization (2007) Health in the Americas: Belize Situational Analyses (Vol 2, pp. 88–101). Washington DC: Pan American Health Organization.
Pesek, Todd., Abramiuk, M., Fini, N., Rojas, M., Collins, S., Cal, Victor, Sanchez, P., Poveda, L., Arnason, John (2010) Q’eqchi’ Maya Healers’ Traditional Knowledge in Prioritizing Conservation of Medicinal Plants: Culturally Relative Conservation in Sustaining Traditional Holistic Health Promotion. Biodiversity Conservation 19: 1-20.
Ricoeur, Paul 1981 Hermeneutics and the Human Sciences. Edited and translated by John B. Thompson. Cambridge, MA: Cambridge University Press.
Rothe, John P. 2000 Undertaking Qualitative Research: Concepts and Cases in Injury, Health and Social Life. Edmonton, AB: University of Alberta Press.
Rubel, A., O’Nell, C. W., and Collado-Ardón, R. 1984 Susto: A Folk Illness. Berkeley: University of California Press.
Shweder, Richard 2003 Why Do Mean Barbecue? Recipes for Cultural Psychology. Cambridge, MA: Harvard University Press.
Simons, Ronald, and Huges, Charles (1985) The Culture-Bound Syndromes: Folk Illnesses of Psychiatric and Anthropological Interest. Dordrecht, Holland: Reidel Publishing Company.
Staiano, K. V. 1981 Alternative Therapeutic Systems in Belize: A Semiotic Framework. Social Science and Medicine 15: 317–332.
Tedlock, B. 1982 Time and the Highland Maya. Albuquerque: University of New Mexico Press.
Thomas, F. 2008. Indigenous Narratives of HIV-AIDS: Morality and Blame in a Time of Change. Medical Anthropology: Cross-Cultural Studies in Health and Illness 27(3): 227-256.
Waldram, James B. 2004 Revenge of the Windigo Constructing the Mind of Aboriginal Peoples. Toronto, ON: University of Toronto Press.
Waldram, James B. 2010 Moral Agency, Cognitive Distortion, and Narrative Strategy in the Rehabilitation of Sexual Offenders. Ethos 38(3): 251–274. DOI:10.1111/j.1548-1352.2010.01144.x.
Waldram, James B. 2012 Hound Pound Narrative: Sexual Offender Habilitation and the Anthropology of Therapeutic Intervention. Berkeley: University of California Press,
Waldram, James B. 2013 Transformative and Restorative Processes: Revisiting the Question of Efficacy of Indigenous Healing. Medical Anthropology: Cross-Cultural Studies in Health and Illness 32(3): 191-207. DOI:10.1080/01459740.2012.714822.
Waldram, James B., Cal, Victor, and Maquin, Pedro 2009 The Q’eqchi’ Healer’s Association of Belize: An Endogenous Movement in Heritage Preservation and Management. Heritage Management 2(1): 35-54.
Waldram, James B., Hatala, A. R. 2015 Latent and Manifest Empiricism in Q’eqchi’ Maya Healing: A Case Study of HIV/AIDS. Social Science and Medicine 126: 9-16.
Watanabe, John M. 1992 Maya Saints and Souls in a Changing World. Austin: University of Texas Press.
Weller, S., Baer, R., Garcia de Alba, J., Rocha, A. 2008. Susto and Nervios: Expressions for Stress and Depression. Culture, Medicine and Psychiatry 32: 406-420.
Wilson, R. 1993. Anchored Communities: Identity and History of the Maya-Q’eqchi’. Man (NS) 28(1), 121-138.
Wilson, R. 1995. Maya Resurgence in Guatemala: Q’eqchi’ Experiences. Norman: University of Oklahoma Press.
Wood, Mary E. 2004 “I’ve found him!” Diagnostic Narrative in the DSM-IV casebook. Narrative 12(3): 195-220.
World Health Organization, 2009 Who-Aims Report on Mental Health System in Belize: A Report of the Assessment of the Mental Health System in Belize Using the World Health Organization—Assessment Instrument for Mental Health Systems (WHO-AIMS). Geneva: World Health Organization.
Yarris, Kristen. E. 2014. “Pensando Mucho” (“Thinking Too Much”): Embodied Distress Among Grandmothers in Nicaraguan Transnational Families. Culture, Medicine and Psychiatry 38: 473-498.
Zarger, Rebecca 2002. Acquisition and Transmission of Subsistence Knowledge by Q’eqchi’ Maya in Belize. In: J. R. Stepp, F. S. Wyndham, & R. K. Zarger (Eds.), Ethnobiology and Biocultural Diversity (pp. 593–603). Athens: University of Georgia Press.
About this article
Cite this article
Hatala, A.R., Waldram, J.B. & Caal, T. Narrative Structures of Maya Mental Disorders. Cult Med Psychiatry 39, 449–486 (2015). https://doi.org/10.1007/s11013-015-9436-9
- Cultural psychiatry
- Mental illness
- Indigenous knowledge