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Susto: Etiology of Mental Disorders in Mothers and Children in Mexico | OMICS International
ISSN: 2376-127X
Journal of Pregnancy and Child Health
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Susto: Etiology of Mental Disorders in Mothers and Children in Mexico

Miriam Castaldo*
National Institute for Health, Migration and Poverty (NIHMP), Via di San Gallicano, Rome, Italy
Corresponding Author : Miriam Castaldo
National Institute for Health
Migration and Poverty (NIHMP)
Via di San Gallicano, Rome, Italy
Tel: +39 0658558201-2
Received: October 13, 2015 Accepted: November 12, 2015 Published: November 19, 2015
Citation: Castaldo M (2015) Susto: Etiology of Mental Disorders in Mothers and Children in Mexico. J Preg Child Health 2:206. doi:10.4172/2376-127X.1000206
Copyright: © 2015 Castaldo M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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This article presents the results of an investigation into the construction and representation of mental disorders that was carried out in the Nahua community of Santa María de la Encarnación Xoyatla and in the Mestizo community of San Cristóbal Tepeojuma, both located in the southwest of the State of Puebla, in Mexico. In such areas, mental disorders are embodied as enfermedades de la cabeza (mental illnesses) and their psychophysical manifestations are locura (madness) and ataques (attacks). Both illnesses are produced by having suffered a susto or an espanto (fright), which in the contexts we consider are synonymous, and can become incurable and even fatal if they develop in children who have been breastfed by women who have suffered a susto.


This article presents the results of an investigation into the construction and representation of mental disorders that was carried out in the Nahua community of Santa María de la Encarnación Xoyatla and in the Mestizo community of San Cristóbal Tepeojuma, both located in the southwest of the State of Puebla, in Mexico. In such areas, mental disorders are embodied as enfermedades de la cabeza (mental illnesses) and their psychophysical manifestations are locura (madness) and ataques (attacks). Both illnesses are produced by having suffered a susto or an espanto (fright), which in the contexts we consider are synonymous, and can become incurable and even fatal if they develop in children who have been breastfed by women who have suffered a susto.

Susto; Mental illnesses; Madness; Attacks
Embodied Memories of a Trauma

The contribution of this article consists of the analysis carried out regarding the role of susto or espanto (fright) in Mexico as an etiological factor in mental disorders, especially those transmitted by mothers to their children. Using a meticulous local taxonomy, both the local etiological-therapeutic system and the symptomology produced from having suffered a susto are examined. To carry out this objective, the embodiment of individual, social historical and colonial [1,2] memory in Mexico is analyzed through the communities in which this work was carried out. It is investigated in the Nahua ethnosemantic codes of mental illness that record the experience of suffering a susto with respect to gender and power relations, in intergenerational relations, in hierarchical and social roles, and in adults' and children's bodies.

It is difficult to exhaust the meaning of susto or espanto, which in Santa María de la Encarnación Xoyatla and San Cristóbal Tepeojuma are synonymous, “espanto or susto are one and the same”, by means of a univocal definition [3-5], due to the fact that its defining characteristic is its sudden, unexpected character, and if it were recognizable it would also be avoidable. The concept of susto is also considered synonymous to espanto by a number of investigators [6-13]. For others, susto and espanto do not have the same meaning and the difference is based on the results they produce and the reasons for their appearance [14-16]. In this sense, espanto is considered more serious than susto since it can involve the loss of the emotional substance or the sombra [17].

Susto is widespread in Central America, South America and Mexico [6,8,9,14,18-22] and in the United States [23], due to the Chicano influence [24]. In literature it has been described as a critical state that arises as a consequence of a striking emotion and a sudden menacing feeling, past or present, natural or supernatural, that can strike and cause illness in people of all ages [8,25], but affects children more than adults [26,27] and women more than men [28]. It often (but not always, and depending on its severity) causes the vital essence, ecahuil [8] or tonalli [29], to leave the body and therefore be lost [5]. In the various literature that pertains to it, susto is an illness [14,22] similar to nervios (nerves) [6,23], hypoglycemia [30] and intestinal parasitosis [21]. There are some who declare it a syndrome [14,27] and some who say it cannot be reduced to this [10,31]; likewise that it constitutes the etiological factor of madness and ataques (attacks) [32], ataques de nervios (attacks of nerves) [33] and other illnesses [9] like diabetes [34-36] and tuberculosis [37].

In the view of other writers it is a mental illness with psychogenetic origins and mechanisms and occurs due to a person's inability to meet the expectations of their society concerning their social role [12]. In addition to this, it is caused by stressful factors which influence the bio-psychosocial man [14,19], but there are some who state that the cause cannot be solely attributed to stress [37] and that it is also necessary to consider the socio-economic context; the poverty and social class of the people who suffer it [6,14]. Susto has also been described as a Mexican Folk Illness, a Culture-Bound Syndrome (CBS). In more recent studies it has been called a Culturally Affiliated Syndrome, a Latin American Folk Syndrome, a Latin American Folk Illness, a Traditional Ethnomedical Concept that is broadly recognized by groups of Latin America, an Ethnomedical Syndrome that displays symptoms consistent with post-traumatic stress disorder, anxiety and depression as well as representing Idioms of Distress, often associated with psychiatric disorders, among Hispanic-American migrants (Durá-Vilá et al.) [4,33,38-42].

Far from having any kind of homogeneity, susto manifests its complexity through different shades of aggressiveness-severity [43]. It is dependent on the context, the strength with which it manifests itself, and the agent that causes it (when considered an illness); it is also dependent on the time that passes from contraction to cure, the gender and age of the sufferer, the reason it is produced and which illnesses it causes (when considered an etiological factor).
Fieldwork and Ethnographic Investigation

I carried out the fieldwork from 2000 to 2005, in various stages, in the Nahua community of Santa María de la Encarnación Xoyatla and in the mestizo community of San Cristobal Tepeojuma, both located in the southwest of the State of Puebla, in Mexico.

The village of Santa María de la Encarnación Xoyatla is part of the municipality of Tepeojuma, Puebla which is in turn part of the Izúcar de Matamoros region; it is a rural Nahua community, mostly Catholic; they speak Nahuatl, Spanish and English. The English is due to the large Mexican migratory movement towards the United States, New Jersey [44]. According to the last Population and Housing Census of the National Institute of Statistics and Geography the majority of the population who live in Xoyatla is Spanish-speaking and only 65 people, for the most part women, speak Nahuatl and do not know Spanish [45].

Xoyatla is situated between two small mountains and ravines and morphologically is part of the Valle de Matamoros. Its land area is 3318 square miles, and it is 5118 feet above sea level. As far as its population is concerned, the number varies greatly due to the transnational migration that began in the eighties [44]. The migrants are primarily male, but in the last few decades female migration has also intensified. In 2000, the population was made up of 1320 people, and in 2010 just 839 with the consequent abandonment of agriculture and land [44,45].

The community has electric light and water; however, most people only have access to water outside of their homes. The number of houses that have a land line is also growing. Xoyatla has health care services (a Department of Health and Assistance clinic where medical interns, or pasantes, change every year), and school services (two pre-schools, two primary schools, and one high school), although education is very much affected by early migration to the United States, which leads to a lot of students dropping out of high school.

With a surface area of 75 miles, the village of San Cristobal Tepeojuma is situated in the center-west part of the State of Puebla and to the north borders with Huaquechula and San Diego la Mesa Tochimiltzingo, to the south with Izúcar de Matamoros and Xochiltepec, to the west with Tochimilzingo and to the east with Huaquechula and Tlapanalá.

Morphologically, the southern region is part of the Valle de Matamoros, and the northern region part of the Valle de Atlixco. Tepeojuma is the municipal head of Xoyatla and is connected by a large dirt road approximately 6 miles long. In contrast to what is happening in Xoyatla, the total population of Tepeojuma has slightly increased, from 4346 in 2005 to 4788 in 2010 [45].

According to the last Population and Housing Census [45], all the population who live in Tepeojuma are Spanish-speakers and, like Xoyatla, most of its inhabitants are Catholic; nevertheless, other forms of religion are present, above all those related to non-evangelical biblical religions and to Jehovah's witnesses.

The community has access to electric light, water and land lines. It also has health care services and school services. Just as in Xoyatla, school attendance is affected by early migration to the United States, especially by men, but here one can also notice an internal female migratory movement to the State of Puebla, due to job seeking [44].
Method and Techniques

The results shown here constitute an ethnographic work, for which between May 2001 and May 2004 in Xoyatla, and between September 2002 and May 2004 in Tepeojuma, a total of 48 women, with an average age of 39, and 25 men, with an average age of 45, were interviewed; all bilingual in Nahuatl and Spanish. I interviewed more adult men than young men, due to early migration to the United States.

The favored interviewees were chosen among:

1) men, women and children who were born and lived in Xoyatla and Tepeojuma who had directly or indirectly suffered susto and who had developed ataques (attacks) or locura (madness);

2) families (nuclear and large) made up of men, women and children who were born and lived in Xoyatla and Tepeojuma and who had directly or indirectly suffered susto and who had developed ataques or locura;

3) allopathic and traditional therapeutic specialists;

4) public health workers at the medical clinics in Xoyatla and Tepeojuma.

I used structured, semi-structured and non-structured interviews, and sometimes conducted them more than once on the same person.

I also carried out a type of non-directive interview in which I did not establish the thrust of the conversation, and where the interlocutor was the one who dictated the pace and rhythm of the conversation. In this situation, I would lend my support to the conversations without interrupting. I also carried out a kind of interview for specialists in both allopathic and local medicine, and conducted it on curanderos (traditional healers), hueseros (traditional bone and muscle therapists) and parteras (traditional midwives) in Tepeojuma and a curandera from Puebla who had patients in Xoyatla. I also conducted it on the hospital staff at the clinic in Tepeojuma for data on morbidity and epidemiology; on the staff physician; on doctor pasantes from 2002 to 2004; on staff nurses and nursing pasantes from 2003 to 2004; and on the cleaning personnel and temp workers during the vaccination period. It was also conducted on the doctors and nursing in Xoyatla from 2001 to 2004 and on the Xoyatla Health Committee from 2001 to 2003.

Occasionally I would interview the same person or family groups over 15 times on different subjects or on various aspects of the same subject. This took place in both communities, though in 2004 I worked exclusively in Tepeojuma, which I chose as it was the municipal head of Xoyatla and the place of residence for local and allopathic healers. The people of Xoyatla would mainly go to Tepeojuma as local healers had not lived in Xoyatla for a long time.

I rarely used a voice recorder as the people I interviewed would ask me not to.
Results: Based Around a Taxonomy

“Suffering from susto in Xoyatla is known as suffering mamauhtia” (Don E. February 13, 2002) and represents an unexpected and violent shock for the sufferer. Susto is an adequate metaphor to rethink in the semantic space the vicious conflict of first the Conquest and then the Colony, the unutterable suffering and psychophysical fragmentation produced by the conflicts between hegemonies and subalternities, between men who think they are free and others who feel like slaves, no-men [46,47]. The embodied memory of susto seems to be pedagogical: it teaches and reminds one Mexican generation after another of fear in the face of domination, oppression and violence from the hand of man against man, the hand of the conqueror and, in continuity, the hand of the colonist on Mexico, its territory, its resources, its people and its culture. Susto repeats the trauma of alienation and poverty, the trauma of the migrants' exile in the United States, and more specifically from the State of Puebla in the contexts being analyzed and the fight against the oblivion of fear and the individual's demolition is based on its existence [44,48-50].

In light of this, I have attempted a taxonomic order of the appearance of susto and of its ability to select and harm people based on age and gender; differenciating between the following kinds of susto:

Caused susto

women have caused their children

beings and entities from the invisible world have caused both men and women of all ages

Summoned susto

Normal or everyday susto

Susto suffered indirectly during the day or night

All the above types of susto, apart from caused, can be suffered directly or indirectly.

1. Caused susto refers to harm caused by both forces and beings from the invisible world and one person to another, causing specific disorders that may or not be curable.

1.1 Susto women have caused their children

Someone who is affected by this type of susto is liable to transmit it to third parties who develop an illness constructed locally as enfermedades de la cabeza (mental illnesses): ataques and locura. In Xoyatla and Tepeojuma, suffering from locura and ataques means that you are enfermo de la cabeza. You can tell someone is loco (crazy) because of their unusual conduct, which is far from the behavioral codes of the community; within the sociocultural fabric they walk, talk and move differently to the rest, making them easily identifiable. A person who has ataques, even more than a loco, is categorized by the convulsions affecting them over periods of time of varying lengths.

This is the key element of the only kind of susto it is impossible to cure; firstly because it is not suffered directly and this increases its severity, and secondly because there is a very special, and intimate relationship between the provider and the sufferer. It is categorized in accordance with the female gender's manner of transmission, which acts as mediator in the passing from one body to another, and as it is not directly endured its potency increases, leading to suffering. The mother figure is the one who, suffering susto for natural and supernatural reasons, becomes a vehicle for the susto-trauma that transforms itself into enfermedades de la cabeza. The mother can only transmit susto to her children, and does so in three ways: 1) during pregnancy she can get susto and pass it on to the embryo; 2) when she is breast-feeding she can give the susto to her child through her milk; during childhood she can transmit susto through physical contact [4,51-53]. It can also cause harm by aggressively ranting and raving, insulting and acting with physical and psychological violence against a person. Men's feelings of anger and aggressive behavior, expressed through the concepts of enojo (annoyance), muina (strong anger), coraje (anger) and nervios (nerves) and which act on their wives by means of psychophysical violence, can asustar (cause susto). This kind of susto can be directly transmitted from the mother to her children who are also likely to develop enfermedades de la cabeza. Enfermedades de la cabeza do not necessarily all appear at the same time. It is possible that the same person can suffer from both ataques and locura, or from one or the other separately. In Xoyatla and Tepeojuma, however, susto is the causal factor of locura and ataques and is relegated when they appear. It is only named to remind oneself, and to remind the sociocultural environment, of how it came about: the genealogical path of the illness.

1.2 Susto that beings and entities from the invisible world have caused both men and women of all ages

This kind of susto affects women, men and children, independent of gender and age. Although the impact it has is dramatic, due to the supernatural and horrifying attack by the agent that embodies it, it can be less serious for the health of the sufferer than other types of susto. In the invisible world, the figure of the nahual, among others, emerges: “(Susto) can be caused. The worst is from cats or a viper, but it's really strong from cats. There's something called nahualismo, basically they themselves can turn into animals; they're black evildoers, the black witches I mean”.

Nahualismo is manifested and found in colonial sources and in many contexts of present-day indigenous Mexico. It refers to the metamorphosis of Man into animal in order to act illictly and its zoomorphic appearance causes espanto [54-60].

2. Summoned susto happens for various reasons, and changes the adult individual from victim to the arquitect of first the suffering from the susto, and later of the progression of the consequences of having suffered it. There seem to be ways to avoid being the victim of an espanto: “thinking positively, not being afraid, not feeling weak, not calling on the names of spirits”.

This attributes a responsibility to someone who does not do this and becomes the arquitect of their own suffering and of the suffering it can cause in other people. Women are also responsible for this kind of susto since they can neglect its etiological power and are therefore liable to pass it on to their children.

3. Normal or everyday susto refers to everyday events (seeing animals, domestic and public accidents of various types and degrees of severity) that can sometimes cause a strong, sudden shock. This kind of susto is not severe or aggressive, and although the curanderos interviewed said that it could also cause enfermedades de la cabeza, there is a chance of a cure in contrast to the type passed on by a mother. A woman highlight this: “You get fear when you see something, a snake, your parents hitting each other, seeing someone get killed; that's fear. Normal susto, like I was telling you about, sometimes goes away with time”.

4. Susto suffered indirectly during the day or night refers to the concept that a person's consciousness lies in the vital organs, like for example the heart. Because of this, the organs, independently of the person's will, can sometimes leave the bodily sheath during the day or night, suffer a susto and go back to their place. When they go back, they reunite with the person and give them their susto.
Body: Water, Blood and Susto

When susto comes into contact with body it traumatizes it and causes a series of reactions exemplified in the testimony reported below:

In the body a susto causes a series of events. The blood that está alimentando el cuerpo (is feeding the body) firstly se calienta (heats up), then da vuelta (turns around) and se detiene (stops) [and with it all the liquids], then se cuaja (curdles) and when it coagulates the functions of the organism also stop. When it stops se despierta la sangre (the blood stirs), then stops circulating and can even cause paralysis. Furthermore: susto can stir up both the blood and the diseases that were lying dormant. A curandera refers to it like this: for susto, the virus might have been awoken. Sometimes the evil is asleep.

The blood that gets stirred up creates a series of changes in the blocked organism: it changes its temperature, making it hot; it changes its position. It no longer goes around the whole body as it usually does, but moves around from the waist to the head, warming the higher areas and freezing the lower ones, until it damages two organs in particular: the brain and the heart, the consequences of which are represented by enfermedades de la cabeza.

When susto comes into contact with the “liquid blood” it paralyzes it, immobilizes it and stops it; it takes control of the properties of the blood, turning it into water, stripping it of its qualities: “that is why if you cut yourself with a machete and only water comes out, you are not worth anything” [14].

It is a liquid without force, and therefore watery; indeed, when a person gets espanto it can take on a white, and then yellowish, color, as a young women said: “(children suffer and) just cry; some go purple and some go yellow and that's the susto”.

When the blood and the water of the body are immobile, dry or curdled, the addition of other liquids taken orally, like water or soft drinks, creates even further damage because it makes the fluids which had stopped coagulate completely, increasing the effects of the espanto after its initial impact. As reported by a woman in Xoyatla: “You get espanto and you can't drink water, it causes you harm. The water collides with the espanto. The blood gets stirred; the blood stops and then you drink the water; it curdles because the blood is feeding the body”.
The Symptoms: Between Loss and Introduction

The symptoms do not differ greatly between children and adults. According to Uzzel, in the case of children with susto the parents are the ones who categorize the illness and who consult the therapeutic specialists [20].

The symptoms are not exclusive to certain sustos in particular, that is to say, they do not differ depending on the type, severity and the manner in which it was suffered. The only symptomological difference arises when enfermedades de la cabeza have already appeared. In this case the symptomology corresponds to the illness and no longer to the espanto that caused them; nevertheless, the treatment is not for the symptoms of the suffering, but for the susto as an etiology.

On the one hand, I consider the “internal” symptoms that do not yet constitute “visible” signs and can only be determined by the curanderos; that is to say, the stopping of the blood. On the other hand, there are “external” symptoms which become visible at a bodily level and which the sufferer themselves, as well as their sociocultural environment, can observe and refer to:“(Children) just cry; some go purple and others go yellow. It's as if their bones hurt, orsometimes babies are born writhing and this is because of the coraje”; “When susto strikes you tremble, change, fall like in an ataque; I just fall”.

One of the symptoms that can arise from having suffered a susto is the loss of animic substance, or sombra: it is believed that when separated from the body in any form, the beings that lust after its energy, the same beings that intentionally cause people susto, imprison or devour it [29]. The susto can be related to the concept of loss as well as addition. It is as though the “shell of the soul” opens up due to trauma and lets the person's essence out, their soul, or allows a foreign essence in; both the loss and the introduction-invasion harm the sufferer in their own way and whether they return to health or not depends on the aggressiveness of the intrusion-extraction.

In the case of loss it is necessary to go into detail about what happens inside someone. The sombra can exit the body or rise up to the shoulder. Some people state that this substance can abandon the body, others say it cannot leave because “the person would die afterwards”, others say it can leave “but only for a few moments” and others state that “the only thing the sombra does is rise up to the shoulder”, moving away from the pulses in which is normally situated.

It is possible to diagnose the loss of sombra through the pulse. If the vein beats with the pulse it means it is in the right place, but if the beating is weak it indicates that it has left the body or at best risen up to the shoulder. A specialist, from the beats, knows when it is one or the other. When the sombra has moved up to the shoulder, through the “sucked up water” in the veins it can be convinced to return to the pulse, to “go down”. When it leaves the body the sombra urgently needs to go back to its “container” before the container gets weak and dies. When the sombra is lost another sombra often catches it, although it may also be lost; the difficulty it has in returning to the body is based on these two factors. The system of cure consists of helping the sombra in its journey back to its origin, the person's original sheath, its reinsertion into the body closing the fissure, at least until the next espanto.
The Etiological-Therapeutic System

Both the people from Xoyatla and Tepeojuma alternate between biomedical cures and the local medical system. The diagnosis of the curandero pinpoints the cause of the diseases seen in the body when a susto is suffered. By searching through the memory of the person who has suffered the susto, one or more traumatic events are always recalled; if the person hesitates when doing this then family members are the ones who are given the responsibility of reconstructing the events of the espanto. It should be specified that although it is the curandero who gives the final diagnosis, and determines the type of espanto, its severity and the consequent treatment, self-diagnosis can also be carried out in the immediacy of the trauma. The curandero acts on the susto and examines it based on the signs of intensity it acquires with respect to the incubation period and the capacity it has to move from one body to another. Allopathic doctors, on the other hand, can partly intervene in the healing of enfermedades de la cabeza, especially with the ataques that they diagnose and treat as epilepsy. They do not look at the ataque as an illness, or as the local idiom for suffering, but as an expression of epilepsy. Nevertheless, the local population state that the results of allopathic therapies are not completely efficient because in the semantic map of Xoyatla and Tepeojuma, ataques do not just affect the central nervous system but also the heart, and therefore allopathic therapy that uses psychotropics does not give a complete cure.

There are treatments that relate to all kinds of susto interchangeably and others that try to intervene directly in enfermedades de la cabeza, especially when the enfermedades are temporary.

The following interviews show examples of medicines and therapeutic rituals: “(Susto is cured with) white witchcraft, limpias with herbs, but in Xoyatla there's nobody, you've got to go to Atlixco or Tepeojuma. I think it's a herb called ruda. My mom says that if you go out in the night you can get susto, she used to put it in my clothes”.

(With enfermedades de la cabeza) you're like nervous, prickly. Kids get little pot-bellies and at night they want water. They're given rosa de castilla with the water. It gets cooked in a griddle, toasted and ground, then mixed with egg white. You put it on the crown of the head and the joints. You do this three times, take a bath, and the day after you apply the cure; it's three cures and three baths [61-69].

This study contributes to the knowledge and discussion of the construction and embodiment of susto as an etiological agent of mental disorders (locura and ataques) and as an illness itself, the illness of susto in the communities of Santa María de la Encarnación Xoyatla and San Cristobal Tepeojuma, in Mexico. In this article, a sociocultural and political analysis of the female gender in Mexico is developed, describing the body of the woman-mother as the vehicle and the field of action of susto, as the dispenser of the “Evil” their children suffer; in brief, as the carrier of this guilt before her society.

In addition, the study presented here constitutes an ethnographic contribution to the local etiological-therapeutic system in the south-west of the State of Puebla, related to susto and mental disorders. In particular, I believe that the results of the investigation have shown the complexity and the heterogeneity of the characteristics (of colonial and post-colonial genealogies) of susto, going beyond categorical characterizations (is it a disease or not) and biomedical translations with respect to the local ethnosemantic codes of health and disease.


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