During my time volunteering as a guide for the Estibrawpa project in the Bribri village of Yorkin, Costa Rica, the women explained that they started the project to address illness in the community. The first type of illnesses they mentioned came about as a result of the men working with pesticides and fertilizers on plantain and banana plantations. In particular they noted skin and respiratory ailments. The second form of illness they described as “depresión.” As a medical anthropologist I am acutely aware that this term may mean something totally different in this context than how it is understood in the Western medical model. The DSM-IV TR describes a major depressive episode as a period of at least two weeks in duration in which occurs a depressed mood or the loss of interest or pleasure in activities. The individual must also experience at least four additional symptoms that include changes in appetite or weight, sleep, or psychomotor activity, along with decreased energy, feelings of worthlessness or guilt, difficulty thinking or concentrating, or recurrent thoughts of death or suicidal ideation. However, much research in Latin America has shown that there are other cultural terms used to signify similar illness and distress among those populations.
One such research project conducted by Susan Weller and colleagues (2008) found links between the cultural terms susto and nervios and the Western medical formulation of depression. Susto and nervios can both be considered culture bound syndromes, which the DSM defines as “locality specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category.” Weller found that among her study sample of Mexicans, those who had reported experiencing nervios or susto also reported higher levels of perceived stress and depression. In fact, they suggest that those reporting a period of nervios in the past were 20 times more likely to experience depression.
So, what exactly are the experiences of nervios and susto? Nervios has been described as a chronic situation involving persistent emotional distress with symptoms that include crying, difficulty sleeping, sadness, hopelessness, and being quick to anger. It is more common among women and marginalized members of a population. Susto is often also described as “soul loss.” It is often understood to be caused by sudden fright in which the soul leaves the body. Symptoms include listlessness, restless sleep, debilitation, depression, and indifference related to personal hygiene and dress.
So where does this leave me in determining what is meant by the people in Yorkin by the term “depresión?” To determine this, I can begin by asking which symptoms are related to this term. I can then also ask if there are other terms used within their culture to describe this distress. In this manner, I can determine the specific explanatory model which the women are referring to when they use this term to describe the distress they were feeling. I will also ask if they have heard of the terms nervios and susto and whether or not they use them to describe specific experiences with distress. To determine whether or not the distress they were experiencing can be compared to the Western model of depression, I can use an established instrument, for example the CES-D, to determine if the items in the scale accurately describe their experience of distress. To also add validity to the measuring instrument, correlations can be examined between those reporting “depresión” and their resulting score on the established depression scale.
Ultimately, what is most important to me is the cluster of symptoms which they consider when describing their distress as “depresión.” Also, I would like to determine whether or not they use other terms to describe this distress and why or how they have decided to use the term “depresión” when describing this distress to myself and other visitors. Stay tuned for more on methods concerning how to develop locally derived mental health scales as I review a new article by Weaver and Kaiser.