The Place of Traditional Hispanic Folk Healing in Modern Medicine
Abstract—For many Americans there is no alternative to alternative healthcare. In this paper I explore curanderismo, a system of Hispanic folk healing. It is one particular alternative healthcare system that is highly unknown, misunderstood, and underutilized by modern medicine. Regardless, many of the rituals, practices, and illnesses associated with curanderismo persist in Hispanic-American populations across the United States. The holistic spiritual and physical healing that defines curanderismo has the ability to improve the services rendered by our modern healthcare providers. Physicians, nurses and pharmacists serve as sources of information, authority, and care, and have the obligation to educate themselves on curanderismo in order to treat patients wholly.
Traditional and conventional medicine share many values and goals in terms of individual patient care, communication and the ultimate goal of wellness. Traditional medicine however, is distinct and valuable in its relationship to the specific communities it serves. Curanderismo, from the Spanish verb “to heal”, is the Hispanic traditional folk healing that continues today in a variety of forms in communities from coast to coast in the United States. Curanderismo as a practice combines both the spiritual and the physical elements of health by utilizing a mixture of prayer, pláticas (conversations), rituals, and herbal remedies. The practitioners of curanderismo are called curanderos (masculine) or curanderas (feminine), and traditionally serve in what the modern medical society usually considers marginalized (rural, low-income, or professionally underserved) populations. Historically curanderos served as the primary healthcare providers in many communities, but with the rise of an exclusive system of modern healthcare the spiritual and herbal healing of the curandero is often dismissed by the strictly scientific and pharmaceutical medicine of the modern physician. As the role of the curandero inevitably diminishes, it is imperative that the healthcare community understand and utilize the positive and widespread influence of these traditional healers within the Hispanic community. At the core of conventional and traditional medicine is the necessity of communication between the “healer” and the patient. The cultural healthcare alternative of curanderismo is the choice for millions of United States residents. This article intends to provide a general introduction to curanderismo, illustrate its relationship to conventional healthcare, and suggest the further education and integration of various elements of the culturally based healing practice in modern healthcare.
Curanderismo exists, on the whole, homogenously throughout Latin-America with only slight differences from country to country. This article focuses on Mexican-American curanderismo in particular, due to its relevance to healthcare in the United States. The foundation of curanderismo as a spiritual and medical practice is built from a five hundred year old mixture of Spanish and indigenous medical customs, Catholic belief and herbal healing. In this practice the healer attempts to treat spiritual or psychological issues as well as physical maladies. “Curanderismo is conceptually holistic in nature; no separation is made between the mind and they body, as in western medicine and psychology” (Perrone, Stockel, and Kruger 1989). Robert T. Trotter and Juan Antonio Chavira’s groundbreaking anthropological study on curanderismo explains, “The religious and spiritual aspects of the healing process capitalize on the patients’ faith and belief systems. The use of herbs, fruits, eggs and oils allows healing to occur though the use of everyday resources, products the patient can easily obtain” (Trotter and Chavira 1997). Curanderos treat a variety of illnesses recognized by modern medicine, but they also treat particular “folk illnesses” unique to the Hispanic population. These illnesses range from the physical (i.e. caída de mollera, the depression of a baby’s cranial soft spot thought to be caused by rough handling) to the spiritual (i.e. susto, where the soul is thought to have left the body due to a shock or a scare), and are treated through the usage of prayer, symbolic cleansing, herbs, drinking of water and even laughter and liquor (Holland 1963) and ( Torres 2006).
The actual term for the practitioner of curanderismo, curandero or curandera, holds a specific meaning for Mexican Americans. They represent “a healer who is part of a historically and culturally important system of health care” (Trotter and Chavira 1997). There are four common types of healers under the designation of curandero: the sobrador (masseuse, treats muscle pain and sprains), the yerbero (herbalist), the partera (midwife), and the curandero total (healer who utilizes both supernatural and physical treatments). All curanderos are given the gift to heal, known as the don, by God (Edgarton 1970). Fundamentally, the power to provide care emanates from a supernatural force, in contrast with the scientific legitimization of modern healthcare. The curandero total can be equated to a general practitioner, and is the most versatile and skilled of the curanderos.
Curanderismo is diminishing with the rise of modern healthcare. Trotter and Chavira state that “the socioeconomic position of many Mexican Americans has improved so that modern medical resources are increasingly available, widely utilized, and appreciated by both curanderos and patients, since modern medicine offers excellent care for a number of medical problems” ( Trotter and Chavira 1997). Our litigious society allows even distant relatives to suggest that the best care wasn’t given to a friend or relative. Though this legal pressure improves the performance of modern physicians there is still a great demand for culturally considerate healthcare. This suggests that a conventional physician’s communication with traditional Mexican Americans should include, at the least, an understanding of the value of curanderismo and acceptance of the help it gives to their patient. Psychiatrist Ari Kiev’s belief that curanderismo “persists in the American Southwest because it works” still holds strong across the country in modern Hispanic communities (Kiev 1968). The values and traditions of the Hispanic population are perpetuated by not only a large community, but also by their proximity to Mexico. Despite this strong connection to the culture, the desire to assimilate causes some reluctance to incorporate traditional beliefs in all aspects of life. Among Hispanic patients there is the possibility of a reluctance to inform the physician of their cultural beliefs for fear of ridicule or misunderstanding. However, the beliefs and practices associated with curanderismo have an evident effect on what a large part of the Hispanic population expect from healthcare. Unfortunately, the majority of physicians and healthcare providers lack education on this traditional healing system.
There is a great deal of knowledge to be gleaned from the practice of curanderismo for the benefit of modern healthcare. The example of the partera (midwife) is particularly poignant, as within the past ten years she has practically disappeared. An interview published in 1989 illustrates the incredible skill of the New Mexican partera who had delivered more than twenty thousand babies, including twenty-five sets of twins and two sets of triplets (Perrone, Stockel, and Krueger 1989). The parteras not only prayed for expectant mother but were the first to cater to the child by baptizing them and in the case of death counseled the mother in her grief. Modern curandera and psychiatric nurse, Elena Avila R.N. MSN describes the old practices of the partera; she would bury the umbilical cord under a tree so that the child would feel connected both to the earth and to that particular tree. In her book Avila states, “I feel it is important that we discover other rituals that make sense to us that can help children feel as if they belong to a community, and mothers feel comfortable and spiritually and emotionally cared for” (Avila 1999). In the healthcare that the partera provided, this is the care for both the emotional and physical needs of the mother, and although it is no longer widely practiced, it remains an important idea within the Hispanic culture about how birth should be treated.
Curanderismo, even beyond birth,demonstrates the practice of a holistic bedside interaction. The curandero attempts to address the patient from within their social and personal context. Before any healing can begin, most curanderos devote time to a plática, a conversation, with the patient. This individual attention and interest provides more than the clinical family history because, “curanderos usually pass considerable time socializing with their patients as a regular part of the treatment session. Many of these relationships in which sufferers receive solace and reassurance undoubtedly have considerable psychotherapeutic value” (Holland 1963). The plática allows for a personal connection; the healer may touch the patient or pray for them. “The curandero is highly accessible, without the intervening variables of excessive social and spatial distance that sometimes affects the delivery of health care in the United States” (Trotter and Chavira 1997). The curandero integrates the patient’s system of belief into the healing process, and thus includes them in their own curing.
The study of curanderismo continues to provide a particular utility within the Hispanic population in consideration of the culturally specific and otherwise undiagnosed illnesses. A study taken among 250 Mexican families in Tucson, Arizona illustrated that 18% of those interviewed reported having suffered from susto (soul loss), and 56% believed strongly in the illness, clearly demonstrating the prevalence of these beliefs in the United States (Holland 1963). Many of the folk illnesses such as susto or mal ojo (evil eye) present themselves with mental and physical symptoms. In an epidemiology of susto, Arthur J. Rubel, Ph.D. describes the appearance of the syndrome as follows: “(1) during sleep the patient evidences restlessness; (2) during waking hours patients are characterized by listlessness, loss of appetite, disinterest in dress and personal hygiene, loss of strength, depression and introversion” ( Rubel 1964). A modern physician would be inclined to treat the symptoms based on physical evaluation, without regard to what the patient may perceive as the base problem. Although the diagnosis of folk illnesses cannot be generalized for the entire Hispanic population (as not all Hispanics believe in or know about some of these illnesses), understanding susto, mal ojo, bilis, or empacho provides a physician with a cultural framework with which they are able to utilize modern healthcare methods.
The most controversial, but perhaps the most important practice in curanderismo, is the prescription of herbal remedies. Herbs are prescribed in the form of teas, baths, tinctures, and poultices. The curandero can utilize a variety of herbs, many of which are familiar sights in the grocery story (see Curtin and Torres for extensive information on curandero herbal cures). For example, albahaca (sweet basil) “is supposed to have sedative and antispasmodic properties and therefore is often administered to those suffering from susto or shock”. It is also used as a gargle for sores in the mouth or externally for insect stings ( Torres 2006). The consumption of around a hundred pumpkin seeds, peeled and raw, is widely known as a cure for tape worm. There are hundreds more of such cures, and they have the ability to greatly improve the quality of care of an individual. The use of herbal remedies in traditional medicine highlights an area conventional medicine must be attentive to. In the treatment of many illnesses, “herbs are the treatment of choice because they are milder and have fewer side effects than prescription drugs” (Fontaine 2005). Nature seems to provide an unimaginable ingenuity in healing. Gordon Gragg, chief of the National Cancer Institute’s natural-products branch states, “Nature produces chemicals that no chemist would ever dream of at the laboratory bench” (Hallowell 1997). Recently, research of the antibiotic properties of honey is being tested for its ability to fight resistant bacterial infections, particularly in diabetes patients. However, due to a focus on FDA researched and approved drugs, most physicians are not prone to incorporate herbal healing in to their consultations.
The healthcare provider has an ethical obligation to respect the cultural differences and uniqueness of their patients and be able to discuss treatment specifically applicable to the variety of belief systems. For the Hispanic population in the United States this means having a basic knowledge of curanderismo and a working understanding of herbal remedies. “If we dismiss a patient’s interest in an alternative therapy, the patient may choose to use it without the physician’s knowledge. If instead we discuss the efficacy of an alternative therapy in a balanced manner, we are more likely to gain the patient’s trust and respect” (Udani 1998). It is worthy to note that not all aspects of curanderismo should necessarily be considered for modern healthcare.“The spectrum of possible responses to alternative medicine is quite broad, ranging from an obligation to stifle harmful practices to mere acceptance of nonharmful modalities, to encouraging the use of beneficial interventions” (Sugarman and Burk 1998). The spirituality and sense of community that curanderismo promotes, as well as the impetus it gives the patient to pursue their own health, make the practice worth emulating. Because patients utilize alternative healthcare methods (approximately 42% of the U.S. population in 1997 used alternative therapies), healthcare providers must educate themselves (Eisenberg, et al. 1998). Physicians, nurses and pharmacists serve as sources of information, authority, and care, and have the obligation to obtain the knowledge to treat patients wholly. “In the best of all worlds, consumers would have an educated professional – a nurse, a pharmacist, or a doctor – to help guide them” (Fontaine 2005). More ideally, professional health care providers would also have an understanding and consideration of the healing value or traditional medicine as provided through curanderismo.
For an accessible description of curanderismo written by a curandera who is also a psychiatric nurse, see Elena Avila’s R.N., MSN, Woman Who Glows in the Dark (1999). Also, for a more ethnographic study see Robert T. Trotter II and Juan Antonio Chavira’s Curanderismo: Mexican American Folk Healing (1997). For information on herbal remedies, including usages and interactions with prescription medications, see Angella Bascom’s Incorporating Herbal Medicine into Clinical Practice (2002) and Karen Lee Fontaine’s Complementary & Alternative Therapies for Nursing Practice ( 2005).
- Avila, Elena and Joy Parker. Woman Who Glows in the Dark: A Curandera Reveals Traditional Aztec Secrets of Physical and Spiritual Health. New York: J.P. Tarcher/Putnam, 1999.
- Edgerton, R. B., M. Karno, and I. Fernandez. "Curanderismo in the Metropolis. the Diminished Role of Folk Psychiatry among Los Angeles Mexican-Americans." American Journal of Psychotherapy 24, no. 1 (1970): 124-134.
- Eisenberg, D. M., R. B. Davis, S. L. Ettner, S. Appel, S. Wilkey, M. Van Rompay, and R. C. Kessler. "Trends in Alternative Medicine use in the United States, 1990-1997: Results of a Follow-Up National Survey." JAMA : the journal of the American Medical Association 280, no. 18 (1998): 1569-1575.
- Fontaine, Karen Lee, and Karen Lee Fontaine. Complementary & Alternative Therapies for Nursing Practice. 2nd ed. Upper Saddle River, NJ: Pearson Prentice Hall, 2005.
- Hallowell, Christopher. The plant hunter. Time, October 1, (1997) 17-22.
- Holland, W. R. "Mexican-American Medical Beliefs: Science Or Magic?" Arizona Medicine 20, (1963): 89-102.
- Kiev, Ari. Curanderismo; Mexican-American Folk Psychiatry. New York: Free Press, 1968.
- Perrone, Bobette, H. Henrietta Stockel, and Victoria Krueger. Medicine Women, Curanderas, and Women Doctors. Norman: University of Oklahoma Press, 1989.
- Rubel, Authur J. "The Epidemiology of a Folk Illness: Susto in Hispanic America." Ethnology 3, no. 3 (1964): 268-283.
- Sugarman, Jeremy, and Larry Burk. "Physicians' Ethical Obligations regarding Alternative Medicine." JAMA: The Journal of the American Medical Association 280, no. 18 (1998): 1623-1625.
- Torres, Eliseo, Eliseo Torres, Eliseo Torres, and Timothy L. Sawyer. Healing with Herbs and Rituals : A Mexican Tradition. Albuquerque: University of New Mexico Press, 2006.
- Trotter, Robert T., and Juan Antonio Chavira. Curanderismo, Mexican American Folk Healing. 2nd , University of Georgia Press pbk. ed. Athens: University of Georgia Press, 1997.
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Allied health practitioners, or doctor's assistants, are being increasingly utilised in modern Anglo medicine. It has been suggested that such practitioners could play an especially important role in minority communities. To investigate this possibility a study of curanderos (Mexican folk practitioners) was undertaken. A survey of the literature unearthed no references to personal interviews with curanderos. In this study, the first method for locating curanderos, questioning Mexican-American clinic patients about their health practices and practitioners, failed to provide successful leads to curanderos. A second approach, in which the author established a social relationship with the least Anglicised Mexican-Americans, identified 17 curanderos, of whom 14 were successfully interviewed. Demographic information, the curanderos' conception of illness and their role led to the develop ment of a composite profile, as well as to individual profiles. The findings suggest that at least some curanderos might be incorporated as allied health professionals in Anglo medical care. Possible ways to accomplish this and the benefits to be derived are discussed.