Sheila Panez
University of California, Irvine College of Medicine
Susto, preocupación, estres -- these are common phrases used in place of ansiedad among Spanish-speakers. Many pieces of historical literature have captured the large-scale adversity and corresponding emotional trauma that afflict the Latino community. The health of this patient population ensued by plight has been examined through the lens of diverse Latin American societies. I hypothesize that these differences in interpretations and labeling of the emotional affect following structural violence cause the conception of mental health concern in the community to go ill-defined. As a heterogeneous population, we have learned to define our own mental health schema into a unique cultural entity that contrasts that of American biomedicine. This dissonance is misperceived as a stigma against mental health. As the future caretakers for this vulnerable population, it is imperative that we recognize this public health issue that has been marginalized by the medical community’s discourse. We must understand the complexity of this concept and address it in our practice to be able to heal the whole patient.
For decades, Latinos who immigrate to this country have been met with overwhelming hardship. As seen under the 1893 National Quarantine Act, “in El Paso, and along the [Mexico] border in general, forced nudity and totalizing disinfections continued into the late 1920s, long after the typhus panic had subsided” (Stern, 49). Although this law was enacted with the pretext of safety from the typhoid epidemic, it is evident that this was an act of intentional discrimination for “Mexicans, as well as all other immigrants seeking entry through El Paso, found themselves subjected to elaborate medical inspection that differed in significant ways from procedures that were also in effect as Ellis and Angel Islands” (Stern, 45). After reading this, one cannot help but wonder how these blatant acts of prejudice were supported by law and funded by the federal government.
Unfortunately this account of institutional racism, discrimination, and injustice is only one documented instance. Since the current rhetoric in American society criminalizes immigration across the Mexican border, the recounts of inconceivable burden are kept silent, left at the border, or discreetly passed on to the next generation to shoulder. I remember as a child how my mother’s undocumented status plagued her mind with constant fear. She was consumed with susto – as they would call it – that one day she would be reported, met with heinous acts from the U.S. Customs and Border Protection and ripped away from her one and only family. This is a pervasive norm for our people as “this fear of being deportable can be just as devastating as deportation itself, leading to self-monitoring behavior such as avoiding medical appointments, not seeking help from police, or staying at home and avoiding ‘dangerous’ public spaces, even going to the grocery store” (Chavez, 72). So then, one must ask how the needs of this community are met if the very society that is supposed to provide it coerces them into self-deprivation of basic rights. Furthermore, how would living in this constant state of tension and fear affect one’s health and that of their family?
This is where the issue becomes further compounded. Mainstream media has rewritten our narrative and led us to believe that there is a mental health stigma within our community. This could not be further from the truth. Mental health has always been in our discourse but expressed in its very own unique way. As a teenager I remember rolling my eyes as my mother would take out a bottle that read ‘Valeriana’. This was always followed by “vas a tomar una tasa de Valeriana con tu Aguita de Azahar para los nervios” the night before a big exam. At the time, I believed this to be a nonsense remedy passed down by my abuelita. Little did I know that this was a product of cultural belief rooted in the “enormous role that curandero(a)s [played] in the area of treatment of psychosomatic and nervous system problems” (Bussmann, 12). This traditional use of medicinal plants dates back to 2,000 years as a common practice in Northern Peru. It goes on to say that my mother never neglected mental health given some sort of cultural stigma, but rather she did not label my test-related anxiety as such. In medical school we are taught that anxiety is a product of chemical imbalance of neurotransmitters and must be corrected in accordance with that (i.e SSRIs). For our community though, mental health is not a biomedical concept but rather one intertwined with spirituality. Given this, there are many synonyms for anxiety in our dialect as it is considered a strong emotion linked to the state of our soul rather than a medical condition with a definitive diagnosis.
“Susto” has been a documented widespread phenomenon across Latin America as early as the 1960s. From “a psychological perspective, susto has been linked to loss/grief reaction, post-traumatic syndrome, or stress and depression” (Herrera et al., 72). This has been further explored in the field of medical anthropology in which mental health is perceived diversely among different Latin American countries. “In Punata, Bolivia…social conditions [are viewed to] produce emotional responses that become embodied in illness” (Herrera et al., 73). “Among the Nahua, [susto] is related to relationships between humans and nature or with other humans, and with situations that escape the control of the person, violence being a key example...Conflict between family members and neighbors, violence and relationship experiences generate life conditions that lead individuals to experience fear in their daily lives.” (Herrera et al., 79). This ambiguity of the collective concept of susto is further emphasized in Paucartambo, Cuaco, Peru. “A prototypical account of susto is recognized (lethargy, disturbed sleep/appetite, diarrhoea, one sunken eye) [but] …has no single, definitive and universally shared set of symptoms in Paucartambo. Many yachaqs do not diagnose based on symptoms, but rather on reading the coca leaves or through spirit or dream revelations; symptomatology therefore holds only secondary importance. These accounts as a whole give insight into “how communities may link conditions such as susto to ‘social suffering’…more often than is sometimes recognized” (Herrera et al., 75). Thus, recognition of these affects and their varying descriptions that reflect the social fabric of the time are difficult to capture and label as just “anxiety” or “depression.”
As the future healers of this community, we must combat the mental health crisis and transgenerational trauma with a two-fold approach. We must utilize our agency in society to bring attention to the structural violence that discriminates against and further marginalizes our community and their voicing of injustice. And furthermore, we must correctly identify and remedy the long-standing trauma within our community with cultural humility and an understanding that Latinos are not a homogenous group. All stages of medical education must adapt to this notion as “many mental health practitioners lack the training to address spirituality with Latina/o clients” (Hoskins and Padrón, 80). If we want to provide the best quality care to this vulnerable community as their healers, we must acknowledge and learn of our history. After all, healers and curanderos are direct translations of one another – why then do “many individuals of Mexican descent who utilize Curandera/os in the U.S do so in private…[and] do not share their use with mainstream mental health practitioners” (Hoskins and Padrón, 80)? As the future caretakers of generations of Latinos, let us heal years of unjustified psychological trauma by working with the cultural beliefs of our ancestors. Our rich Latin American history and health practices do not need to be mutually exclusive but rather combined into a synergistic effort to where we can promote mental wellbeing in our community and uplift from our roots.
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Works Cited:
Stern, Alexandra Minna. “Buildings, Boundaries, and Blood: Medicalization and Nation-Building on the U.S.-Mexico Border, 1910-1930.” Hispanic American Historical Review, vol. 79, no. 1, 1999, pp. 41–81. Crossref, doi:10.1215/00182168-79.1.41.
Chavez, Leo. “Diminished Citizenship.” Anchor Babies and the Challenge of Birthright Citizenship (Stanford Briefs), 1st ed., Stanford Briefs, 2017, pp. 55–79.
Bussmann, Rainer W., and Douglas Sharon. “Traditional Medicinal Plant Use in Northern Peru: Tracking Two Thousand Years of Healing Culture.” Journal of Ethnobiology and Ethnomedicine, vol. 2, no. 1, 2006. Crossref, doi:10.1186/1746-4269-2-47.
Herrera, Frida Jacobo, et al. “Susto, the Anthropology of Fear and Critical Medical Anthropology in Mexico and Peru.” Critical Medical Anthropology: Perspectives in and from Latin America (Embodying Inequalities: Perspectives from Medical Anthropology), New edition, UCL Press, 2020, pp. 69–89.
Hoskins, David, and Elena Padrón. “The Practice of Curanderismo: A Qualitative Study from the Perspectives of Curandera/Os.” Journal of Latina/o Psychology, vol. 6, no. 2, 2018, pp. 79–93. Crossref, doi:10.1037/lat0000081.