THREE CASES OF FOLK DISORDER AMONG MEXICAN-AMERICANS:
IMPLICATIONS FOR THE STUDY OF CULTURE CHANGE
Margaret Clark
In this paper I will discuss three cases of emotional illness among people of Mexican origin in the Bay Area.
Together they illustrate the persistence of some aspects of the folk-medical system known as curanderismo, and
the modification of other aspects. The first field work I conducted in this community began twenty-five years ago
in a Bay Area district known to the residents as Sal si Puedes (get out if you can); I have had sporadic contact with
Mexican-American people in medical contexts during most of the intervening years, and my most recent research
includes work among urban Spanish-speaking families in the San Francisco Bay Area.
The three cases of illness under discussion were observed respectively in the 1950s, 1960s and 1970s. The
first episode was the illness of Marta, then a woman of 34 years, living with her husband and six children-the
latter ranging in age from 1 to 6 years; she also had an 18-year-old married daughter with one child living in a
neighborhood nearby. This case was first described in Clark, 1959:200-201. The onset of Marta's illness was fairly
sudden. She began to have episodes of nausea and vomiting, accompanied by insomnia. She thought for a while
that she might be pregnant, but when there was no cessation of menses, she gave up that idea. Shortly thereafter,
her insomnia became more severe, and, although the nausea abated, other symptoms appeared. She began to
suffer from shortness of breath, sweating, and rapid pulse. At first these were nocturnal symptoms, but they soon
began to trouble her around the clock. She had to sit up in bed at night in order to breathe, and often she had
dreams of some unknown object pressing down on her face and cutting off her breathing. She became so fearful of
suffocation that she refused to go to bed, sitting up in a chair or pacing the floor. She lost her appetite, fearing that
she would strangle on the food if she attempted to eat. Finally her husband and her married daughter became so
concerned about her that they called in her sister and two of her comadres to discuss what should be done.
In reviewing the case, the family situation was carefully assessed. It was this: the family of Marta found
themselves faced with acute financial problems as a result of a prolonged visit by the husband's brother, his
wife, and their five children. The visiting brother had come to California from another state to seek work, but
had not found a job after several weeks. Both families-fifteen persons in all-were living in a three-room house
and trying to subsist on the wages of one common laborer. Their debt at the grocery store grew larger and
larger, and finally the grocer would no longer extend them credit.
Marta felt obliged to provide food and shelter for her needy relatives but at the same time she feared
that as a result of her hospitality her own children would have to go hungry. She also worried lest the landlord
discover how crowded the house was and decide to evict the family. This was the social background of Marta's
symptom development. She was ashamed to complain about her situation, and had been trying to have faith in
God and pray that everything would turn out for the best. In discussing her symptoms with her sister and two
of her comadres, she was enabled to escape from the dilemma she was in. They assured her that she was
suffering from susto or magical fright. A neighborhood curandera was called in to diagnose and treat her for
this disorder. When it was established that Marta was asustada, relatives and comadres insisted that she was ill,
and should not have the responsibility of cooking for her brother-in-law's family. The visitors were encouraged
to move on to another area where jobs were more plentiful.1
Illness in this case served to excuse the patient from social responsibility. She could not openly refuse to
sacrifice the comfort of her own children in order to provide for even more destitute relatives. She would have
been condemned as a selfish and unfeeling woman who cared nothing about her husband's family. However,
when financial worries became acute, she began to have symptoms of acute anxiety. The symptoms were
attributed to susto, a folk disease. Her illness was recognized, and her intimates insisted on a change to relieve
her of extra responsibility. When the change was made, her anxiety was relieved, and the symptoms were
Acknowledgment: This material was completed while the writer was a Fellow at the Center for Advanced Study in the
Behavioral Sciences. I am grateful for financial support provided by the National Institute of Mental Health, Grant No. 5 T 32
MH14581-03; the Rockefeller Foundation, and the Spencer Foundation.
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CLARK
lessened. Her rapid improvement was attributed to the excellence of the cure performed by the local
curandera.
Cultures vary in the techniques customarily used in dealing with personal or social disturbances, and
these techniques are based on shared existential propositions about disease and its causality which the patient
and his associates espouse. In Mexican-American folk medicine, one of the existential propositions pertinent to
the case of Marta's illness has to do with the conception of natural balance and order. In brief, it is the
proposition that normality is a balance of elements. As long as a proper relationship among beings and things is
maintained, everything is well. Disease, social conflict, and misfortune in general are due to planned or
accidental contradictions of the natural balance. A prime example is the hot-an-d-cold concept of health and
disease. In summary, this theory, derived from the humoral medicine of medieval Spain, holds that health is a
temperate state of being, and an imbalance in the direction of either heat or cold can cause disease. Some
illnesses, then, are due to an excess of heat in the body, and must be treated with cold substances whether
drugs, topicals, or diets. These classifications often have no relationship to actual physical temperature (Foster,
1953; Foster and Rowe, 1951).
Furthermore, just as there must be a balance of heat and cold in the individual organism to assure a
healthy state, so the emotions must be kept in balance in order to avoid serious disease. Strong or prolonged
emotional states-such as fear, shock, anger, and envy-can create an imbalance within the individual and result
in folk-defined disorders such as susto, espinto, bilis, and envidia. Even sibling rivalry, if prolonged and
intense, has its sequela: a condition known as chipil.
In cases like Marta's, folk disease provides a means for retreat, in the face of the stresses of urbanization
or culture change, to the traditional and comfortable roles of Latino society. It has been emphasized that "the
utilization of this mechanism is probably rarely conscious. The anxieties and threats of cultural transfer
combined with the desire for relief may provide the psychosomatic genesis of disease symptoms. Successful
reinstatement in society and resulting relief from physical complaint reinforce the cultural acceptance of folk
illnesses. Belief in the reality of these diseases frequently result in the diagnosis of completely physical
ailments as susto, mal ojo, or one of the other afflictions in the folk system" (Madsen, 1964:436).
It should be noted that in this case, as in the one to follow, the curandera is a member of the local
community, whose diagnostic acumen is surely informed by her access to local gossip and her knowledge of
what is transpiring in the patient's social network. As in many parts of the world, her function is nonetheless
important, in that she confers ritual legitimacy on a commonsensical solution.
At the time I recorded this first case in 1954, I was reasonably sure that the Mexican-American medical
folk-belief system was in its last throes in Northern California. Although I was impressed with the tenacity of
that system in the preceding half-century, I attributed this in large part to the absence of other forms of
medical care. I somehow expected that great inroads would soon be made by modern, so-called "rational
scientific" medicine. Yet, within the intervening years, repeated new cases of mal ojo (evil eye), aire (bad air),
and brujerfa (witchcraft) have come to medical attention among the Mexican-American population of San
Francisco-some of them among second, third, and even fourth-generation residents of the United States.
The second case I want to summarize here was referred to me in 1966 by a staff psychiatrist at one of
the Bay Area medical centers. A seventeen-year-old girl of Mexican-American parentage was admitted to a
psychiatric service, suffering from visual and auditory hallucinations, in the absence of any evidence of drug
use. She had been brought to the hospital by her mother, as a consequence of a suicide threat, following some
strange behavior and incoherent speech. The patient, after three weeks in psychotropic drug therapy, was able
to converse with the staff about her situation. She reported that she was in danger of being killed by agents or
persons unknown to her and that her mind was being controlled by some unseen force. She was still agitated,
but was no longer contemplating suicide. She was discharged from the inpatient service, and continued to be
seen on outpatient status. During the ensuing weeks the following information was obtained:
Angie, as I will call her, is a third-generation resident of California. She was the last-born child of her
parents, who were separated when she was six years old. At that time, because of her mother's financial
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FOLK DISORDER AMONG MEXICAN AMERICANS
problems and because her grandmother had recently been widowed and was living alone, Angie was sent to live
with her paternal grandmother; the grandmother was given Angie as her own, to rear to adulthood. This
pattern of grandparental adoption used to be fairly common among Mexican-American families, and there was
no conflict about it in Angie's family-at first. However, when Angie was 15 years old, her mother decided to
take her back; the mother was now remarried, had smaller children with her new husband, and needed Angie's
help in the house and as a baby-sitter. The grandmother, however, had no intention of giving up Angie. She
felt the mother was selfish and exploitative, and there ensued a fierce competition between the two women for
Angie's loyalty. Mother and grandmother did not fight with each other openly, but each tried to persuade
Angie that if she lived with the other, she would be proving herself a wicked, disloyal, and ungrateful girl. Both
threatened never to see her again unless she became more obedient to their respective wishes. Angie was in a
painful conflict-she loved and felt obligated to both her mother and to her grandmother who had reared her.
There was no one to tell her definitively what she should do. Her older brothers and sisters were divided in
their opinions, and both they and her friends simply told her she should do what she herself thought to be
right and best for everybody.
After several months of this discord, Angie ran away from her grandmother's house, and moved in with
her mother's family. However, she began to have trouble sleeping, lost her appetite, and began to miss school
fairly often. She began to envision her grandmother dying alone and abandoned. Six months later, she was
evidencing the psychiatric symptoms for which she was admitted to the clinic.
I have indicated above that Angie had a rather rapid recovery from the acute phase of her illness. There
is no doubt that the medication helped her, as did the temporary residence in the inpatient ward, where she
was removed from all of her family members. After a relatively short time as an outpatient, however, she
reported to her therapist that she was cured completely, and would not be coming to the clinic anymore. The
psychiatrist elicited the information, tendered somewhat reluctantly by Angie, that she did not attribute her
"cure" to the clinic or the therapist, but to the fact that her case had been properly diagnosed by a curandera
who had prescribed treatment that had miraculously healed her mind. The curandera had been hired by
Angie's older sister; after a semi-magical, semi-religious divining ceremony, this practitioner had diagnosed
Angie's illness as brujeria (witchcraft) worked, she was shocked to learn, by the grandmother. The curandera
went on to say that, in Angie's unsettled condition, she should not have any unnecessary responsibilities such
as caring for young children or doing heavy housework. For this reason, the curandera ordered that Angie
should move out of her mother's house, live for awhile with her older sister, and begin a regimen of prayers
and ceremonies to counteract the black magic.
What an ideal solution to Angie's conflict! The folk explanation relieved the patient of responsibility for
her grandmother's loneliness, her mother's fatigue and overwork, and even her own madness. She reported to
the psychiatrist that the moment she had lit the first candle in her healing ceremony, she felt the evil leave her
body: "I could feel it let go of my shoulders, then my neck, and finally fly out of the top of my head." Angie
never Tetumed to the clinic again.
These two cases, occurring twelve years apart, are almost identical in terms of the way the folk medical
belief system was utilized to resolve a thomy problem in human relationships. There was one principal
difference, however: the hierarchy of resort, that is, the relative primacy of choice from among a set of
possible therapies. In Marta's case, the Anglo-American or cosmopolitan system, based on medical doctors and
clinical facilities, did not enter into the case at all. The first and only resort was to the system of curanderismo.
In the case of Angie's illness, regular hospital-based clinical services were called upon first; only later was the
curandera consulted. Consider, however, the fact that in both cases the "cure" was attributed to the folk-
healer.
The third case, that of Victoria (known to her friends as Vicki), reached crisis proportions in the 1970s.
iIhis case is of a slightly different order. The folk belief system is still important, but it is combined with
elements from another American belief system, which I will call contemporary eclectic mysticism. A psychia-
trist at a private San Francisco hospital brought the case to my attention. Vicki came into the psychiatric
walk-in clinic with her three fellow commune members, two young men and another young woman. They
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were concerned about Vicki because she had been making a number of seemingly suicidal gestures-darting
towards traffic-laden intersections, or running at windows of the upstairs rooms as though to throw herself
out, for example. Her history was taken in part from Vicki herself and in part from her roommate, Ben.
Vicki's mother had died when she was an early adolescent, and her Mexican-American father reared her.
Her only sibling had died in infancy. Vicki was lonely at home, and frustrated by her father's attempts to see
that she did not go out too much without supervision, that she remain at home in the evenings, and that she
not get involved in premarital sexual relationships. She did manage, however, to get acquainted with Ben and
his friends, some of whom were Anglos and others who were of Mexican-American backgounds. Finally, she
broke with her father, who was vociferous in his disapproval of these friendships, and moved into the
commune. These young people did some experimentation with "soft" drugs, but did not take heroin or other
opiates, according to Vicki's report.
Just prior to Vicki's move into the commune, Trini, a young Chicano friend of Ben's, had committed
suicide by taking an overdose of barbiturates. Ben felt greatly responsible for not having prevented Trini's
death. He talked about this to Vicki at length. He introduced Vicki to Trini's grieving mother, and the two
women became extremely close friends. Vicki began calling Trini's mother "Mama," and spent several hours a
day visiting with the older woman. Trini's mother gave Vicki some pictures of Trini, and Vicki asked if she
might have some of his clothes-a jacket and a couple of shirts. After two or three months of this growing
relationship, Vicki began to wear Trini's jacket, and to have periods when she would speak with Trini's voice,
and assume his identity. She eventually developed a full-blown case of spirit possession, when she believed
herself to be the dead boy. When she was free of her possessional state, she was terribly frightened, and tried
to re-establish contact with her father. Her father, however, would have nothing to do with her. He called her a
bruja (a witch) and forbade her to come into his house again. At this time Vicki began to make suicidal
gestures; the episodes of possession increased in frequency and duration.
Vicki's friends decided they would try to help her by taking her to a psychic healer, an Anglo spiritualist
medium in San Francisco, for exorcism. Her friends had become convinced that the spirit of the deceased
Trini, jealous of Vicki's invasion of his former precincts, had indeed possessed her, and would destroy her
unless she could be exorcised. The medium did try several times to help Vicki, but to no avail. Vicki called and
begged her father to take her to a curandero, but he refused. At last Vicki's frightened friends brought her to
the psychiatric ward for help.
I cannot tell you how this case was resolved, because Vicki left the clinic and didn't retum. The
psychiatrist had planned to try to enlist the father's help, and obtain some supplementary aid from the
Latin-American folk-belief system. It is clear that Vicki herself had attempted to rally the Mexican-American
folk medical system as a bridge back to her father and to her ethnic identity. Her well-meaning Anglo friend,
Ben, tried in vain to help her through his own folk-psychiatry-a visit to a spiritualist medium. Further work
with cases of this sort will surely enlarge our understanding of ethnic interactions and conflicts, and the role of
various medical systems in their resolution.
I have used these three cases of emotional disturbance to illustrate the remarkable tenacity of traditional
health beliefs and practices. As we see the descendents of Mexican immigrants in a struggle for adaptation in
the urban American environment, we are aware of the physical and psychological toll taken by the stresses of
migrancy, acculturation, and culture change. There are continuing disturbances in family and community
organization which upset traditional systems of security for the individual, rapid social change with resulting
conflict between generations holding different values and fundamental attitudes, geographic mobility and its
accompanying problems in adjustment, and population pressures and deprivations associated with poverty. It
is my position that, in dealing with such personal and social disturbances, some of the premises and procedures
of traditional medical systems have proved empirically useful as an adjunct to standard medical practices.
Similar findings have been reported by Janzen (1978) in Africa and by many other investigators.
Anthropologists have previously written about some of the significant differences between standard
psychiatric practice and folk-medical practice. For instance, Fabrega and Silver (1973) list thirty-three major
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FOLK DISORDER AMONG MEXICAN AMERICANS
contrasts between Zinacantan shamanistic curing and the Western psychiatric system. Among those distinct-
ions, the following seemed most important to my respondents:
1. The therapist in Western medicine is thought, by virtue of his training in "objectivity," to be
impersonal and lack real concern for the patient. He is also a stranger, and therefore unlikely to share the
existential propositions about disease and its causality which the patient or the patient's relatives espouse.
2. Folk medicine is functionally related to the rest of the culture; standard medicine is not-it is isolated
in spatial, temporal, social, and symbolic context. Kiev had written of the functional nature of folk medicine:
"To Western man, illness is an impersonal event brought about by neutral, nonemotional, natural
agents, such as germs, while for the Mexican-American, illness relates to an individual's life, his
community, his interpersonal relationships and, above all, to his God. In such a culture, illness is a
social as well as a biological fact. Because of its central significance illness is clearly related to other
beliefs and patterns in this culture. Disease is defined not only in naturalistic, empirical, sympto-
matic terms, but also in magical and religious terms. In the same way, diagnosis and treatment
occur in the larger, more meaningful context of major institutions and belief systems, not isolated
from them.. ." (1978:177).
3. The folk therapist draws no dichotomy between diseases of natural and supernatural origin; the
secularization of standard medicine is felt to be a false and amoral world view in a sacred society such as that
characteristic of most folk cultures, where the power to heal is felt to be a gift from God.
4. The folk therapist places no emphasis on biological determinism, and among some Mexican-
Americans the mind-body dichotomy is not understood. Thus, many diseases are thought to be of magical
origin, and strong emotional states are presumed to be capable of inducing physical disorders.
5. The reliance of Western practitioners on the hospital is in conflict with Mexican-American value on
familial responsibility for the sick; it is felt to be an indication of moral delinquency for a family to surrender
one of its sick members to the care of strangers.
6. Standard medicine is based on hieratic knowledge; folk medicine can be explained in lay terms.
Effective communication encourages belief and confidence in both the patient and his collaterals. In Angie's
case, this was the problem; her symptoms were relieved, but not explained in terms that she and her relatives
could understand.
7. Finally, standard medicine has emphasized the development of diagnostic and therapeutic techniques
for the most acute and deadly of physical ills. Standard medicine is remarkably effective when confronted
with dramatic medical emergencies deriving from physiological disorders, such as episodes of acute febrile
illness that were often fatal in pre-antibiotic days. Organ-system emergencies (cardio-vascular accidents, cardiac
arrest, or renal failure) are handled well by modern hospitals with the use of such intensive care equipment as
electronically monitored respirators, pacemakers, and artificial kidneys. Dozens of medical miracles-organ
transplantation, restoration of sight to the blind through cataract removal or corneal transplants-are per-
formed every day in modern medical centers throughout the world.
However, the vast majority of health problems in a population are not of this genre. They are the
everyday infirmities, ongoing low-grade pain, slowly crippling degenerative diseases, the lethargy of chron-
ically poor nutrition, and the emotional disorders that so often accompany prolonged stress: alcoholism,
addiction, violence, child abuse. Standard institutional medicine does not handle these well. And here is the
fertile field where folk medicine continues to play a vital role as an exotic but functional form of social
psychiatry.
Until we can create physicians and medical treatment facilities in our country that share some of the
characteristics of folk medical systems, these will continue to be successful competitors in the treatment of the
ill among many groups in the United States.
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NOTES
'I am grateful to Abner Cohen who reminded me of Gluckman's description (1958:98-99) of the social use of
witchcraft accusations among the Zulu against the wife of one of a group of brothers sharing the same
household. The linkages of brothers is a pivotal institution in Zulu life, and when it is necessary for practical
reasons that a joint household be split, charges of evil-doing may be brought against one of the women, thus
making it possible for the brothers to continue their vital social and economic cooperation. In this case the
wife was regarded as an innocent victim, but no blame was placed on the brother-in-law; the cause of the
susto remained a mystery.
REFERENCES
Clark, Margaret, 1959. Health in the Mexican-American Culture. Berkeley, Los Angeles: University of
California Press.
Fabrega, Horacio, Jr. and Silver, Daniel B., 1973. Illness and Shamanistic Curing in Zinacantan. Stanford:
Stanford University Press.
Foster, George M., 1953. "Relationships between Spanish and Spanish-American folk medicine." Journal of
American Folklore 66:201-217.
and Rowe, John H., 1951. "Suggestions for field recording of information on the Hippocratic
classification of diseases and remedies." Kroeber Anthropological Society Papers 5:51.
Gluckman, Max, 1955. Custom and Conflict in Africa. Glencoe, IL: Free Press.
Janzen, John M., 1978. The Quest for Therapy in Lower Zaire. Berkeley, Los Angeles: University of California
Press.
Kiev, Ari, 1968. Curanderismo, Mexican-American Folk Psychiatry. New York: Free Press.
Madsen, William, 1964. "Value conflicts and folk psychiatry in South Texas," in A. Kiev (ed.), Magic, Faith
and Healing, pp. 420-440. Glencoe, IL: Free Press.
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