Mental Health in Guatemala A Comparative Study of Perceptions
and Causes of Mental Illness
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Research Statement What do Guatemalans indentify as the most
prevalent or pressing mental health concerns in their communities?
What do Guatemalans consider to be the causes of these mental
health problems? Do culture-bound syndromes exist and, if so, among
which groups of people? How do ladino and indigenous populations
differ in their articulations of mental health concerns? Context:
How might historical, political, and economic factors influence
mental health and wellbeing? Goal: Assess the mental health status
of different populations to identify unmet needs and to develop
appropriate interventions
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Methods Observation at field sites Conversations with key
informants, including: Spanish teacher, hospital workers,
curandera, leaders in NGO/development organizations Focus Group
Discussion with members of Maya Works in Aguas Calientes de
Comalapa In-Depth Interview with member of Maya Works in Aguas
Calientes de Comalapa
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Ethical Considerations Categorization of mental illness Mental
health as a taboo topic Can diagnosing mental illness enable an
unjust system? Mental illness as coping mechanism
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Literature Review Rubel has written about susto in Latin
America, describing the beliefs about soul and body which underlie
local understandings of this folk illness. He shows that an
epidemiological lens can successfully be applied to folk illnesses.
Rubel, Arthur. 1964. The Epidemiology of a Folk Illness: Susto in
Hispanic America. Ethnology, Vol. 3, No. 3: 268-283.
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Literature Review Green has documented the experience of
chronic fear among Mayan women in the altiplano. She suggests that
people can be socialized to terror, simultaneously habituated to
fear and yet living in a constant state of low-level panic. She
also ties in the idea of social memory to examine the impact of a
history of terror in constructing a culture of fear. As such, she
argues that simply categorizing these womens symptoms as PTSD or a
culture-bound syndrome neglects to account for the socio-historical
context producing these effects. Green, Linda. 1994. Fear as a Way
of Life. Cultural Anthropology, Vol. 9, No. 2. 227-256.
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Literature Review Foxen implicates globalization, gang
violence, and food insecurity (among other factors) as playing a
role in creating an environment of constant stress in present- day
Guatemala along with the inheritance of the Violence. She argues,
however, that investigations into the mental health status of Mayan
communities should keep resiliency in mind rather than solely
construing them as passive victims. Foxen, Patricia. 2010. Local
Narratives of Distress and Resilience: Lessons in Psychosocial
Wellbeing among the Kiche Maya in Postwar Guatemala. The Journal of
Latin American and Caribbean Anthropology, Vol. 15, No. 1.
66-89.
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Results: Susto One of most common ailments treated by curandera
in Comalapa Also identified as a primary mental health problem in
Aguas Calientes de Comalapa Symptoms: loss of color in the face,
difficulty sleeping, loss of appetite Treatment goal = reunite
spirit with body Place roses inside or beside pot containing water,
say sick persons name into the pot
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Susto, continued Susceptibility curandera indicated that
children are especially susceptible to episodes of susto Causes
Frightening incident e.g. earthquake, car accident, unexpected
encounter with snake Discrepancy Curandera psychological, not
physical Informant in Aguas Calientes more prone to get susto after
frightening incident if do not have sangre fuerte, which depends in
turn on nutrition
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Results: Depression and Anxiety Largely not categorized as
depression Hopelessness La Limonada Worried thoughts Aguas
Calientes Treatment No prescription of psycho-pharmaceuticals (with
possible exception of asylum in the capital) Talk therapy External
consult at public hospital (?) Private clinic School counselor
uncommon, only at private schools
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Depression and Anxiety, contd Causes family problems and local
environment Domestic abuse Machismo Womens issues, e.g. education
and reproductive rights Alcoholism Prostitution Gang violence &
narco-trafficking These youth turn to gangs after growing up in an
environment without love maybe their parents are separated, there
was domestic violence, the mother has turned to prostitution. They
join gangs because they know their lives are not worth anything,
and they often take pride in their arrest and imprisonment. (field
notes, conversation with Spanish teacher)
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Depression and Anxiety, contd Causes economic and political
environment Sometimes people have many thoughts and cannot sleep at
night because they are in debt or dont have enough money to buy the
things they need. (IDI, Aguas Calientes de Comalapa) Government
corruption and inefficiency
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Interpretation Comparison: ladino vs. indigenous populations
Susto only articulated by indigenous informants Depression and
anxiety experienced in both populations Is there a link between
economic insecurity and susto among Mayans in the highlands?
Perceived connection between susceptibility to susto and nutrition
could susto be prevented through improved food security? Is susto
an alternative expression of depression and anxiety? Can we justify
separating the two?
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Theoretical Approach: Culture-Bound Syndromes Syndromes from
which members of a particular group claim to suffer and for which
their culture provides an etiology, diagnosis, preventive measures,
and regimens of healing (Rubel 1964: 268)
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Theoretical Approach: Explanatory Models All explanatory models
include: Etiology (cause) Timing and mode of onset Physiological
process Natural trajectory and severity Appropriate response
Problems arise when EMs of patient and healer do not coincide
Kleinman, Arthur. 1978. Concepts and a model for the comparison of
medical systems as cultural systems. Social Science & Medicine.
Part B: Medical Anthropology 12: 87-8.
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Susto as Explanatory Model Etiology: frightening incident +
vitamin deficiency Onset: immediately following incident
Physiological process: body and spirit separate Trajectory: loss of
color in the face, trouble sleeping, loss of appetite Treatment:
bring back color with red roses, call the persons name to reunite
body and spirit
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Hypothesis: Relationship between Explanatory Models and
Resource Availability Are EMs built around/ sustained or tossed
aside according to available resources? In Aguas Calientes de
Comalapa (population ~150), 3-4 women can perform treatment for
susto Limited access to biomedical treatments ambulatory teams,
frequently closed health post, pharmacies (potential cost barrier)
What mental health resources are available? Top-down influence on
subjective experience
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Further Questions Is susto experienced among ladino population,
and what prevalence? Do indigenous people feel that their mental
health needs are being met with the resources currently available
to them? Will the incidence of susto decrease/ incidence of anxiety
increase among indigenous groups with increasing modernization/
spread of alternative EMs?
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Ethics Revisited Claim: both populations experiencing some of
same stressors, expressing in different ways What is the danger of
collapsing the two? Can improving mental health resources actually
increase incidence of mental illness/introduce new illnesses?