Cultural Diversity – Mexican Beliefs Towards Medicine and Mental Illness.
Historically speaking, Mexican culture is based on that of the Aztecs. It is a system that was divided into three classes: the aristocrats, the middle class, and the lower class. This system still prevails today and is important to remember when considering all aspects of Mexican culture. Among the middle class, the head of the household be it widowed woman, single man, or married man, is honored and respected in all decision making for the household. As colonists began to conquer Mexico, all blood relatives worked together to meet their needs. This created strong familial ties but also created pressures on family members to maintain loyalties for their new nuclear families but also their adult parents, and adult siblings. Strong familial ties within Mexican families still exist today and are at the roots of their beliefs toward caring for those within the family that are ill.
The Aztec religion that was practiced before colonization is gone today. However, the medical beliefs of the Aztecs combined with Greek beliefs brought over by the Spaniards can still be seen today in some of the traditional Mexican practices. These beliefs are based on balance and supernatural powers. A balance in what they refer to as the four humors: blood, phlegm, black bile, and yellow bile, is what is required for good health. The four humors were combined with the already existing Aztec beliefs and formed a new belief based on the balance of hot and cold. Each individual might have further beliefs based on the region they are from. This is important when they are treated because without this “balance” treatment might be refused. It is best to ask the patient what would be acceptable based on their beliefs.
Hot and cold balance does not have anything to do with the temperature of substances. Medicines, natural remedies, and diseases all have a classification of hot or cold. A “hot” medicine or remedy must be used to treat a “cold” disease and a “cold” medicine or remedy must be used to treat a “hot” disease. “Cold” diseases are ones that typically have invisible symptoms and are things such as earaches, arthritis, chest colds, and stomach cramps. An example of an acceptable treatment of a “cold” disease such as an upper respiratory infection would be penicillin, a “hot” medicine. Interestingly, vitamin C, a “cold” substance, would not be acceptable to treat an upper respiratory infection. On the other hand “hot” diseases are those that present with more visible symptoms. Examples of these are stomach ulcers, nausea, vomiting, indigestion, headache, fever, and sore throat.
Those in the lower class of Mexican society and less fortunate Mexican- Americans will often turn to the above traditional remedies for treatment as they cannot afford medical treatment. Even among those that can afford Western medicine, traditions of the family are so strong that they will often combine Western and traditional medicine. It is reported that within the United States, 17% of Mexican-Americans sought health care initially from what is termed a folk healer, and as many as 72% do not tell their physician that they have initially seen a folk healer for their disease. This neglect is important to note because medical practitioners need to know what is being ingested and practiced when considering their own medical plan for the patient.
As mentioned above, there is a strong belief in supernatural powers that exists in traditional Mexican medical practices. It is believed that supernatural powers can cause disease. With diseases that are caused by supernatural forces, cures must also be provided by supernatural means; thus, the existence of what is known as the traditional healer, “curanderas”, in Mexico. She is believed to get her powers from God. Treatment of disease by anyone other than a curanderas would not be acceptable thus it would be important to explain natural causes of a given disease in order for it to be approved.
Traditionally, disabilities are thought to be of a supernatural etiology. Thought disorders, such as hallucinations, delusions, and those displaying other psychiatric symptoms are thought to be a result of witchcraft and evil spirits. From these beliefs come terms such as mal de ojo or the evil eye, real puesto or a hex, susto or magical fright. Some villagers of Mexico do not relate feelings of anger or upset to individuals but rather to a community. The term coraje describes a phenomenon that spreads through a community after a person experiences negative interactions with another. Illness in the form of stomach upset, headaches, heart attack, etc. fall upon the people that contract coraje. Only a curandera can rid the individual of these symptoms. However, as she relieves the inflicted person, the coraje travels upward and finds another victim.
Today, unfortunately, there still exists a strong division of the classes in Mexico. The private health care sector, for the upper class is developing significantly. However, public sector of health care is lacking. When it comes to psychiatric care there is even less resources. Because most psychiatric disorders are not considered to be a direct cause of death, the government tends to overlook the need to provide funding for it. Thus, many families caring for their mentally disabled family members may actually be turning to traditional remedies or leaving them for the government to care for due to the poor economic crisis that the country has been going through for the past 30-40 years. It is often the case that mentally ill patients are also rejected by hospitals because the attitude of nonpsychiatrists is still very poor despite Mexican law requiring mandatory care for psychiatric patients. On one particular website I was disturbed to see some undercover photos of some locked down facilities which exhibited absolutely horrid conditions. Of those abandoned and locked up in these facilities it was said that more than half did not have disorders that required them to be under 24 hour care.
In treating all patients, my role as an Occupational Therapy Assistant is to always consider who my patient is. What is their culture? What are the belief systems established within their family? Understanding all these contributing factors will assist me in providing the most comprehensive care for the patient. More specifically speaking with Mexican-American families of patients with mental disorders, it will be more beneficial to help the patient and the entire family understand the physiological causes of their disorder. This may perhaps help ease their mind of feeling at blame for their condition as well as assist them in understanding and accepting therapies that I, as well as physicians/psychiatrists, may provide. I may also find that if traditional remedies of their culture are not deemed harmful to the patient, there may be some justification in letting them do it. If it will help them feel better, it could help with the overall attitudes of the patient.