Part III: Nervios in rural Costa Rica

Beyond anxious predisposition: do padecer de nervios and ataque de nervios add incremental validity to predictions of current distress among Mexican mothers?

BACKGROUND

Nervios (PNRV) and ataque de nervios (ATQ) are culture-bound syndromes with overlapping symptoms of anxiety, depression, and dissociation, shown to have inconsistent associations to psychiatric disorder. Few studies test the basic assumption that PNRV and ATQ are uniformly linked to distress outcomes across Latina/o immigrant groups. This study examined: (a) the extent to which acculturative stress, Latino/US American acculturation, and anxious predisposition were associated with lifetime history of ATQ and PNRV, and (b) the extent to which ATQ and PNRV add incremental validity in explaining acculturative stress and psychological distress beyond measures of anxious predisposition.

METHOD

Participants (n = 82) included Mexican mothers who completed surveys on acculturation, trait anxiety, anxiety sensitivity, lifetime ATQ/PNRV, psychological distress, and acculturative stress.

RESULTS

Lifetime PNRV, but not lifetime ATQ, was significantly predictive of psychological distress. PNRV was also linked to trait anxiety. Psychometric measures of anxious predisposition (trait anxiety and anxiety sensitivity) were more robust predictors of distress outcomes than lifetime history of ATQ/PNRV.

CONCLUSION

Inquiry into lifetime history of nervios may be a useful point of entry in talking to Mexican immigrant mothers about stress and distress. However, standard tools for assessing anxiety sensitivity and trait anxiety appear most useful in identifying and explaining the presence of psychological distress. Further research is needed to determine the cross-cultural relevance of trait anxiety and anxiety sensitivity, and its implications for the development of anxiety treatments that are effective across cultures.

Bridging Psychiatric and Anthropological Approaches: The Case of "Nerves" in the United States

Psychiatrists and anthropologists have taken distinct analytic approaches when confronted with differences between emic and etic models for distress: psychiatrists have translated folk models into diagnostic categories whereas anthropologists have emphasized culture-specific meanings of illness. The rift between psychiatric and anthropological research keeps "individual disease" and "culture" disconnected and thus hinders the study of interrelationships between mental health and culture. In this article we bridge psychiatric and anthropological approaches by using cultural models to explore the experience of nerves among 27 older primary care patients from Baltimore, Maryland. We suggest that cultural models of distress arise in response to personal experiences, and in turn, shape those experiences. Shifting research from a focus on comparing content of emic and etic concepts, to examining how these social realities and concepts are coconstructed, may resolve epistemological and ontological debates surrounding differences between emic and etic concepts, and improve understanding of the interrelationships between culture and health.

Debilidad: a biocultural assessment of an embodied Andean illness

Northern Peruvian highlanders complain of debilidad to express an embodied exhaustion resulting from a lifelong accumulation of productive and reproductive stresses. This study uses a combination of qualitative and quantitative methods and a political-economic and materialist-informed biocultural approach to explore this "women's illness" and why it is also experienced by men and children. Eighty-two percent of cases of debilidad occur in the households of postreproductive women with debilidad. For women, household sex ratio, number of pregnancies, and death of offspring are associated with the incidence of debilidad, while for men, household wealth is the most salient correlate. The young required to undertake full adult responsibilities are also vulnerable. Findings are strengthened when the household is used as the unit of analysis.

Ataques de nervios in Puerto Rico: culture-bound syndrome or popular illness?

Ataque de nervious is a popular illness category among Puerto Ricans and other Latinos written about in anthropological and psychiatric literature for over thirty years. This paper discusses the issue of categorizing ataque de nervios as a "culture-bound syndrome" using data from the first community-based study of this phenomena using epidemiological methods. The paper summarizes the social and psychological correlates of ataques de nervios and provides a preliminary overview of the situations which provoke ataques and the symptoms people experience. The paper critically examines the use of the "culture-bound syndrome" framework analyzing ataques de nervios and suggests that the term "popular illness" is a more effective label for categorizing this syndrome.

Notes on nervios: a disorder of menopause

The condition of nerves among women in the small Peruvian town of Puente Piedre is described. Both nervios (a symptom) and Nervios (a disorder) describe a woman's difficulty with nerves. In Puente Piedre, the identification of an anxiety condition among women depends only on the women's age. Younger women with anxiety symptoms are diagnosed as nervios, a temporary condition ascribed to a single episode of high blood pressure. Menopausal women with similar symptoms, on the other hand, are thought to have a specific disorder, Nervios. In Puente Piedre, Nervios clearly is a folk illness limited to women of menopausal age.

Nerves, worriation, and Black women: a community study in the American south

The experience of nerves among women in a low-income Black neighborhood was examined. Research conducted in the neighborhood revealed nerves as a formal classification of folk illness linked with life stress, yet in-depth interviews with a purposeful sample of 24 residents showed that a greater manifestation of nerves among women contributes to tendencies among family members to ignore the severity of its symptoms and to equate experiences of nerves with life conditions deemed inevitable for women. Lack of support for nerves among female sufferers was also evident among friends and physicians. These findings are analyzed against a background of gender-specific concepts of nerves and "worriation" operating in the neighborhood. Residents aver that women's "naturally" weaker constitutions and a moral imperative to worry places them at greater risk for nerves. Implications for clinical care of low-income Black women with nerves are discussed, and specific recommendations for culturally appropriate interventions are outlined.

Conceptions of schizophrenia as a problem of nerves: a cross-cultural comparison of Mexican-Americans and Anglo-Americans

This paper explores indigenous conceptions of psychosis within family settings. The cultural categories nervios and 'nerves', as applied by Mexican-American and Anglo-American relatives to family members diagnosed with schizophrenia, are examined. While Mexican-Americans tended to consider nervios an appropriate interpretation of the problem, Anglo-Americans explicitly dismissed the parallel English term 'nerves'. Anglo-American relatives were likely to consider the problem as 'mental' in nature, often with specific reference to psychiatric diagnostic labels such as 'schizophrenia'. Although variations in conceptions appear related to both ethnicity and socioeconomic status, significant cultural differences were observed independent of socioeconomic status. These results raise questions concerning contemporary anthropological views that psychosis is conceptualized in substantially similar ways cross-culturally, and underscore the need for more contextualized understanding of the meaning and application of indigenous concepts of mental disorder. The paper concludes with a discussion of psychocultural meanings associated with ethnopsychiatric labels for schizophrenia and their importance for the social and moral status of patients and their kin.

Culturally interpreted symptoms or culture-bound syndromes: a cross-cultural review of nerves

This paper explores a new approach to culture-specific mental disorders through cross-cultural examination of nerves. A number of case studies are presented from contrasting cultures. It is proposed that nerves be considered a culturally interpreted symptom rather than being culture-bound.