Involuntary Mass Spirit Possession Among the Miskitu Johan Wedel a a School of Global Studies, University of Gothenburg, Sweden Published Online: 02 Jul 2012

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Involuntary mass spirit possession among the Miskitu Johan Wedel*

School of Global Studies, University of Gothenburg, Sweden (Received 26 May 2010; final version received 26 April 2012)

This paper seeks to understand the outbreaks and the development of grisi siknis, a form of mass spirit possession among the Miskitu of north-eastern Nicaragua. Earlier documented outbreaks typically involved a few adolescents, however, in recent years, violent large-scale epidemics have taken place, involving many people of all ages. This has coincided with recent developments in Miskitu society marked by conflicts, contradictions and tense social relations. The anthropological field technique of participant- observation was used. The research took place during 11 months from 2005 to 2008 in the port town of Puerto Cabezas. A total of 38 informants were interviewed. Group discussions, narratives and informal and semi- structured interviews were carried out, as well as participation in healing rituals. The paper shows that socio-economic, cultural, personal as well as environmental factors all contribute to outbreaks of grisi siknis. The affliction has previously been considered a ‘culture-bound syndrome’ only occurring among the Miskitu. However, when viewed in a more contem- porary context and cross-cultural perspective, grisi siknis shows similarities with other forms of involuntary mass spirit possession, particularly in the ways it is manifested, experienced and appears to be spreading. The paper argues that the phenomenon should no longer be considered a ‘culture-bound condition’ but in fact a Miskitu version of involuntary mass spirit possession. Further research that seeks to understand other forms of involuntary mass spirit possession should emphasize the social, personal and environmental context as well as cross-cultural comparisons in order to encompass fully the role of culture in relation to illness and suffering. Keywords: Miskitu; mass possession; spirit possession; culture-bound syndromes; cross-cultural comparison; grisi siknis Downloaded by [University of Gothenburg] at 04:15 22 May 2013 Introduction A form of involuntary mass spirit possession known as grisi siknis (crazy sickness) occasionally troubles the population of the Miskitu of north-eastern Nicaragua. The problem, which is locally said to be caused by sorcery, often takes an epidemic form and frequently recurs in schools, especially boarding schools, and poor remote villages or disadvantaged neighbourhoods in the regional capital Puerto Cabezas (also known as Bilwi). The afflicted first experience anxiety, irritation, anger, headaches and dizziness. This is followed by severe convulsions and loss of consciousness. Sufferers may also experience a harsh, localized pain or frightening visions of spirits trying to abduct them, threatening them with blood and knives.

*Email: [email protected]

ISSN 1364–8470 print/ISSN 1469–2910 online ß 2012 Taylor & Francis http://dx.doi.org/10.1080/13648470.2012.692356 http://www.tandfonline.com 304 J. Wedel

During grisi siknis attacks, the afflicted often rip their own clothes and hair, hurt themselves and try to bite those who hold them down. Behaviours can be quite violent; victims may grab a machete and run around together, threatening and frightening other people. They may also run into the bush or throw themselves into a river or the sea. On some occasions, metal nails, insects, stones, coins and candles are said to have been magically introduced into the bodies of the sufferers through acts of sorcery. These objects have to be removed as part of the healing process. After each episode, of which there may be several in close succession, the afflicted will usually not remember anything. Involuntary mass spirit possession has been found in a number of countries around the world. Occurrences have been especially prevalent among females, often in remote religious boarding schools in Malaysia. These schools are said to have an oppressive and rigid discipline, a lack of privacy, limited choice and strict gender segregation (Bartholomew 2000, 170). An outbreak of mass spirit possession in a school in Zambia was partly linked to conflicts concerning the implementation of strict disciplinary measures, as well as to the school’s geographical isolation. The afflicted became confused and a teacher described how they were ‘running insane’ (Dhadphale and Shaikh 1983, 85). Similarly, an outburst in a school in Thailand was related both to traumatic incidents and military violence, as well as anxiety and conflicts over the relocation of a spirit house on the school grounds. In a state of altered consciousness, the students saw an old woman, believed to be a spirit, in an old-style dress who tried to abduct them (Trangkasombat et al. 1995). In Madagascar, episodes of mass spirit possession in schools included screaming, running, and aggressive, violent behaviour. These outbreaks were related to contradictions concerning the migration from rural areas, tension between village and town life and the transition from youth to adulthood (Sharp 1990). Mass spirit possession has also been frequent among Malay female workers in Malaysian factories. These outbreaks have been interpreted as a language of alienation and of resistance towards capitalist exploitation (Ong 1988). Native explanations have focused on evil spirits in toilet cisterns and on spirits who were said to punish females for transgressing traditional moral gender codes (Ackerman and Lee 1981; Ong 1988). An outbreak in a Bhutanese refugee camp in Nepal was linked to loss and childhood trauma and locally interpreted as a punishment by spirits (Van Ommeren et al. 2001). When the Embera people in Colombia were struck by mass possession, it was interpreted as psychosocial stress because of Downloaded by [University of Gothenburg] at 04:15 22 May 2013 cultural change and ethnic conflicts. The Embera themselves ascribed the problem to a spell (Pin˜eros, Rosselli, and Calderon 1998). There have also been outbreaks in Papua New Guinea (Frankel 1976) and India (Chandra Shekar 1982). There are also historical records that give accounts of events of mass spirit possession in the more distant past. A well-documented case took place among nuns at a convent in Loudun, France, in 1632 (Bartholomew 2000, 195). The phenomenon is generally considered part of a broader category of ailments known jointly as ‘mass hysteria’, ‘epidemic hysteria’, ‘medically unexplained epidemic illness’, or ‘mass conversion reaction’. However, whatever the name, the disorder is characterized by headaches, dizziness, fainting, nausea and hyperventilation. Between the years 1872 and 1993, 148 outbreaks around the world were reported, mainly in schools, factories and small communities (Boss 1997; Bartholomew 2000). The disorder, which mainly spreads though face-to-face contact, rumours and the mass Anthropology & Medicine 305

media, has been defined as ‘a constellation of symptoms suggestive of organic illness, but without an identifiable cause, that occurs between two or more people who share beliefs related to those symptoms’ (Boss 1997, 233). In Western cultures, outbreaks are often preceded by feelings of stress, and are associated with an infectious illness or an unusual odour believed to be toxic. Epidemics in non-Western settings are also commonly associated with stress and tension although they tend to last over a longer period of time and are frequently related to supernatural agents. The symptoms often involve aggression, convulsions, screaming and crying, visions, possession and an urge to run away. Outbreaks in non-Western settings are commonly said to occur in societies in flux, that are going though rapid social and cultural change (Boss 1997; Bartholomew 2000).

Setting and methods The research took place during 11 months from 2005 to 2008 in the port town of Puerto Cabezas. With a population of about 30,000 inhabitants, it is the most important settlement on the Miskitu Coast. The anthropological field technique of participant-observation was used. A total of 38 informants were interviewed, including 11 victims of grisi siknis, four relatives to the afflicted, seven biomedical health workers, two university employees and 14 Miskitu healers, known as curanderos, sukias and profetas. Group discussions, narratives and informal and semi-structured interviews were carried out, as well as participation in healing rituals where the author of this paper observed healers applying their therapies. Most interviews and informal conversations were carried out in Spanish. The main research questions concerned Miskitu cosmology, illness beliefs, healing therapies and therapeutic cooperation. All interviews were taped and transcribed. An interpreter was used when people only spoke Miskitu.

The Miskitu The Miskitu people of north-eastern Nicaragua consist of about 100,000 people (Dennis 2004, 23). Most of them live in villages along the Atlantic coast and along the Rio Coco on the border with Honduras. Matrilocality has been the preferred form of residence although today many also live patrilocal. Fishing and farming

Downloaded by [University of Gothenburg] at 04:15 22 May 2013 are common forms of livelihood and the men occasionally work as wage labourers. The Miskitu have a long history of relations with Europeans. In the seventeenth century, they established trade relations with British buccaneers. Escaped African slaves and freed slaves from Belize and the Caribbean islands also arrived on the Miskitu Coast during the seventeenth, eighteenth and nineteenth centuries and integrated into Miskitu society. Moravian missionaries established themselves on the coast during the second half of the nineteenth century and the Moravian Church is still the most prominent one today (Dennis 2004). Many Miskitu also adhere to various Evangelical churches and to the Roman Catholic Church. Today, Miskitu cosmology is a mixture of Indigenous, Afro-Caribbean and Christian beliefs. The Miskitu have a strong belief in the spirit world. A common spirit in their cosmology is the duende, a kind of gnome who lives in forests and mountains and who protects the wild animals. The duende, which can be either male or female, is a musician and an expert in herbal healing. Other spirits include the sirena, a male or 306 J. Wedel

female mermaid who protects everything related to water. There is also prahaku, a dangerous and powerful spirit related to wind and space, aubia who is a forest spirit and the muertos who are the spirits of deceased persons. From an early age, Miskitu children hear stories about how these spirits protect and guard the environment but also how they may cause problems, punish humans in various ways and carry them away into other dimensions. Illness and afflictions are often said to have been caused by these spirits, either directly or through a sorcerer who is said to have ‘worked’ with one or more of the spirits to provoke grisi siknis and other ailments. Grisi siknis is treated by three different categories of healers. The most common one is the curandero (female: curandera) who is an expert in herbal healing. Curanderos occupy an important position in society as they treat many different health problems and are often consulted before the sufferer visits a biomedical health facility. Some curanderos are specialists in managing spiritually caused afflictions such as grisi siknis. However, outbreaks that involve many people are generally dealt with by either a sukia (shaman) or profeta (prophet), who both have an extraordinarily close contact with the spiritual world. While anyone can become a curandero, it is only possible to become a sukia or profeta by being ‘called’ by the spirits. This process usually involves a person becoming ill and lying unconscious for about a week. During recovery, the individual will receive messages from certain spirits who will tell how to divine and heal through dreams, songs, prayers, herbs, liquids and certain objects. Profetas are said to receive their healing abilities by being struck by lightning. They are concerned with the wellbeing of the community and some are said to be able to predict the future and bring down rain. Sukias, who are also known for their divinatory and healing skills, have been oppressed by the Moravian Church as they are said to work with both good and bad spirits when healing.

Outbreaks and treatments of grisi siknis In the beginning of the 1880s, during what the Moravian Church missionaries called the ‘Great Awakening,’ a large number of people in villages along the Miskitu Coast displayed symptoms similar to what later was described as grisi siknis. People suffered severe convulsions, became speechless and lost consciousness. The outbreaks coincided with a sharp drop in the price of rubber, which happened in

Downloaded by [University of Gothenburg] at 04:15 22 May 2013 1879. Many Miskitu, who were employed as wage labourers in the rubber industry, lost their income and the whole economy of the coast was paralysed (Cox Molina 2003, 78–81). Since the 1950s, there have been frequent reports of grisi siknis in Miskitu communities. For example, recurrent outbreaks, mainly among adolescent girls, have taken place in the village of Awastara (Dennis 1985). The village of Krukira was hit in 1956 (12 young women were affected) and Andres Tara was affected in 1975 (30 persons of both sexes were affected) (Rupilius 1998, 5). Sandy Bay was affected in 1976 and the epidemic eventually spread to the villages of Tuapi, Awastara, Dakra and Krukira. In 1979, the poorest neighbourhoods of Puerto Cabezas were also struck by grisi siknis (Cox Molina 2003, 85). Krukira was once again affected in 1979 (20 persons, mainly young women), Wasla in 1981 (12 young men in a military camp), Andres in 1992 (over 60 persons, mainly young men) and Lidaukura in 1993 (19 persons of both sexes). Sandy Bay was again affected in 1993 Anthropology & Medicine 307

(30 persons of both sexes) (Rupilius 1998, 5f; Espinoza Blanco n.d.). In 1996, 20 men became affected whilst constructing a canal in Lamlaya (Rupilius 1998) and 10 female students suffered from grisi siknis at a boarding school outside Puerto Cabezas in 2000 (Carrasco et al. 2000). This school was once again struck by grisi siknis in 2009 (La Prensa 2009). There have also been recurrent outbreaks among Miskitu people in Honduras (Pe´ rez Chiriboga 2002). During the last decade, grisi siknis outbreaks have changed considerably. From being a problem that only affected the Miskitu and typically affecting small groups of adolescents, the affliction is now considered a major problem by the Nicaraguan health authorities. Today, outbreaks may involve a large group of people of both sexes and of all ages. The disorder also affects the indigenous group Mayangna and a few mestizos (Espinoza Blanco n.d; Tru¨ bswasser, Davis, and Marley 2005; Wedel 2009a). A curandero in Puerto Cabezas who had treated several grisi siknis victims was himself overwhelmed and described the current situation as a ‘pandemic’ (Wedel 2009a, 57). Some outbreaks of grisi siknis have been exceptionally violent. When the remote village of Krin-Krin was struck in 2000–2001, a total of 55 persons were affected, making it an epidemic. The most severely affected suffered convulsions and attacked people in a state of possession trance. Some were said to vomit objects such as metal nails and coins. Similarly, when the Mayangna village of Santo To´ mas de Umbra was struck in 2003–2004, a total of 19 people, mainly young men, were affected. This outbreak was extraordinarily violent and many of the houses in the village were destroyed by the afflicted. In 2004, a total of 32 people of Miskitu, Mayangna and mestizo origin were affected in San Juan Bodega. The same year, there were large-scale outbreaks in Wawa bar and Namashka (Espinoza Blanco n.d; Patterson, Zamora, and Gutie´ rrez 2004; Tru¨ bswasser, Davis, and Marley 2005). One of the largest outbreaks so far took place in the remote village of Raiti in 2003. Of the 1600 inhabitants, 139 were affected, including roughly equal numbers of both men and women. The youngest person to be struck by the malady was six years old and the oldest was 60 (Espinoza Blanco n.d.). The scale of this outbreak had never been seen before and the epidemic spread along the Rio Coco to other villages. The Nicaraguan ‘Commission of Health for Regional Advice’ declared that grisi siknis had turned into an epidemic and pleaded for economic support in the state of crisis (La Prensa 2004a). The authorities of the community Waspam even expressed a fear that soldiers in the armed forces would become possessed and begin Downloaded by [University of Gothenburg] at 04:15 22 May 2013 shooting at the local population (La Prensa 2004b). When the outbreak began, a brigade of medical personnel was sent to Raiti. Biomedical examinations were carried out on the afflicted and samples of drinking water were tested. The health brigade could not find any abnormalities and were unable to control the outbreak. A curandero and his team were then called in, although they also failed to heal the afflicted and put an end to the epidemic. Subsequently, the Nicaraguan health authorities asked the Institute of Traditional Medicine (IMTRADEC) at the Universidad de las Regiones Auto´nomas de la Costa Caribe de Nicaragua (URACCAN), outside Puerto Cabezas for assistance. IMTRADEC sent a team to Raiti headed by a well-known profeta. After about a week all the villagers were healed and normality was restored (Espinoza Blanco n.d.). The epidemic was closely followed by and reported in the national news media. 308 J. Wedel

In 2005 and 2006, undergraduate students living in a compound at the university URACCAN were struck by grisi siknis. During the last one of these outbreaks, 27 male and female students of Miskitu and Mayangna origin were affected. Many of them came from remote villages along the Rio Coco. During these outbreaks, their classmates, who lived in Puerto Cabezas, were unaffected (Espinoza Blanco and McDavis 2006; Wedel 2009a, 2009b). A 17 year old student described his experience of the outbreak: One of my companions had a headache and was shivering. This came back for some days. He also had nightmares about a duende coming and trying to take him away. He was like sleeping, but he saw the duende coming with a machete, blood and bones. First he wanted to escape, then he screamed and demanded that we let him go with the duende. He wanted to run and we had to hold him down and bind him. Other male companions were later affected. Then female students were also affected. The first one affected mentioned [in a state of altered consciousness] the names of the others that would become affected. My name was also mentioned. Later on, when I was sitting in the class-room studying, I suddenly felt a headache and I told my companions. Then I became affected and I screamed. ‘In the eye’ [in a state of altered consciousness] I saw the duende with machete, knives and blood trying to take me away. It’s similar to a dream. We were 7 men and 17 women who were affected. We all lived in the same compound. Then a reverend came and cured everybody with herbs. (Wedel 2009b, 57) In 2007, many Miskitu villages were devastated by hurricane Felix and a number of people were killed. Shortly after this event, minor outbreaks of grisi siknis began to occur. In the village of Krukira, which was almost completely destroyed, people began to see spirits and became sick. According to one curandero, several minor outbreaks occurred in various neighbourhoods in Puerto Cabezas and a whole family became affected in the village of Awastara. In 2009, La Prensa (2009) reported how students in a school in the city of Siuna and at the Moravian church college in Puerto Cabezas were suffering from the malady. Grisi siknis is similar to other forms of spirit possession in non-Western settings in the sense that it is characterized by a temporary absence of a conscious agency. However, some sufferers may only have headaches and dizziness while others lose consciousness, have visions and become completely possessed. When grisi siknis struck in the village of Raiti for example, 45 people out of 139 were heavily affected, whilst the others experienced only minor problems (Espinoza Blanco n.d.). Anxiety and fear are said to increase the risk of being severely affected. A curandero, who Downloaded by [University of Gothenburg] at 04:15 22 May 2013 had treated several outbreaks of grisi siknis, said that if those who held and helped the afflicted were afraid, they would easily become affected themselves. Another curandero told of sorcerers who combined several different spirits to provoke grisi siknis and consequently these cases were very difficult to deal with. By interpreting the movements and behaviour of the afflicted, skilled healers can figure out which one of the spirits had been used. For example, if the afflicted hid their thumb, it indicated that they had been bewitched by a sorcerer who had used the duende, as this spirit is said to have only four fingers. If the sirena was involved, the afflicted would run towards the river or the sea. Similarly, if the afflicted ran towards the cemetery, it indicated that a ‘work’ had been done by the spirits of the dead. A 15-year-old girl told how she experienced possession by the duende: ‘I saw, a chaparro, [‘‘a little guy’’], with a cap. He wanted to take me away to be his mistress. Then I lost consciousness’ (Wedel 2009b, 56). Anthropology & Medicine 309

Nicaraguan Health employees have had difficulties understanding and classifying grisi siknis from a Western medical point of view, although some are beginning to accept Miskitu healing therapies. A medical doctor said: ‘I have to accept the working methods of the curandero even though my theory is not the same. Otherwise we can’t work together’ (Wedel 2009a, 60). Healing is generally carried out by a few highly skilled curanderos, sukias or profetas, who use herbal therapies, prayer, cleansings and exorcism. This involves a divinatory practice where a ‘spiritually activated’ plant is placed on the forehead of the first afflicted who, in a state of trance, responds to all kinds of questions, such as about the identity of the sorcerer. Consequently, the healers establish that a sorcerer is involved but they will seldom accuse him/her in public as this may lead to physical violence. The presumed evildoer is instead warned in public and told to stop his ‘criminal acts.’ This will commonly reduce the widespread anxiety among the afflicted and their relatives and neighbours. The afflicted are then brought together and treated day and night for about a week with cleansings, prayers, herbal baths, steam and massages. Gradually, the attacks will become less severe and less frequent and their visions will transform from frightening to pleasant. All the afflicted are usually healed after a week.

Crisis and sorcery in Miskitu society Grisi siknis epidemics have created ‘major social problems that disrupt family and community life’ (Dennis 2004, 216). Outbreaks happening within the last few years coincide with a more general crisis in Miskitu society, which is currently taking place on various levels. During a revisit to Awastara in 1999–2000, Dennis described how things seemed ‘out of control’ (Dennis 2004, 268) as drug addiction, violence and crime had noticeably increased. As in Awastara, elsewhere on the Miskitu Coast, alcoholism, the cocaine drug trade and a competitive economic system, based on market exchange instead of traditional forms of reciprocity and gift exchange, were creating alienation and delinquency among the young, and conflicts between generations; all of which resulted in a ‘social breakdown’ (Dennis 2004, 268). In the comparatively poor and isolated villages along the Rio Coco, which to a large extent lack basic health services, schools and general economic development, Tru¨ bswasser, Davis, and Marley (2005) also depicted a crisis between generations where the older generation argued that the youth did not want to follow old cultural

Downloaded by [University of Gothenburg] at 04:15 22 May 2013 values. The younger generation, on the other hand, did not have much hope and saw no alternatives to their current situation. The crisis is commonly expressed in terms of hechicerı´a (sorcery), and there are many stories of people having been killed (Tru¨ bswasser, Davis, and Marley 2005, 87). Young people were accused of not wanting to work and also of practising sorcery. Jamieson (2008) compared two Miskitu villages in relation to accusations of sorcery. In the first village, subsistence farming and fishing and a sense of shared purpose and transparency prevailed. Misfortune was usually ascribed to the spirits themselves and accusations of sorcery were uncommon. In the second village, people were more involved in a cash economy. This meant that as they competed for work they sometimes became involved in illegal activities; selling drugs and sex. A sense of solidarity was replaced by envy and suspicion. Perceptions of peoples’ engagement with each other were often mystified and related to acts of sorcery, said to be provoked by fellow villagers. 310 J. Wedel

During the fieldwork for this paper, a healer who had been present during several grisi siknis epidemics claimed that sorcery only took place in the poorest neighbourhoods of Puerto Cabezas. When discussing the poor villages along the Rio Coco, he said that the situation was ‘rock bottom’ and that people felt they had to save themselves as best as they could. He had been working with a team of healers during a very violent grisi siknis outbreak in the area and was astonished: ‘There were men who had three partners. There were pastors who offered religious services but it was normal for them to drink and dance.’ When discussing sorcery with Miskitu healers, they claimed that minor outbreaks of grisi siknis involving few people were caused by a spirit, who, for example, had been offended for some reason. Larger outbreaks however, were always ascribed to sorcery as a sorcerer was said to have ‘worked’ with various spirits, frequently because of envy or jealousy. These cases were considered extremely difficult to deal with. They were also dangerous as the sorcerer, who could strike back, had to be identified and forced to leave the area before the afflicted could be healed. Sometimes, outbreaks were said to have been carried out by four young sorcery- apprentices who had performed sorcery out of curiosity and because they did not understand the social consequences of it. A curandero explained: ‘They are always four. They say their prayers to the east, west, south and north and always sit or stand in the form of a cross. One needs to be wise to observe these movements and to know who they are.’ Another healer said that a sorcerer who had learned his skill had to try it on someone, otherwise he would become affected himself. There are frequent stories about how sorcerers have ‘worked’ with spirits and sent illness and misfortune to an unsuspecting victim. A curandero said: ‘Sometimes, when someone is about to die, he begins to mention names and say that ‘‘this person is killing me.’’ The family members go to a especialista [healer] who may say that this person is the killer.’

Previous theories of grisi siknis Grisi siknis has been studied by the anthropologist Philip Dennis (1985) who carried out fieldwork in the late 1970s in the village of Awastara. Dennis found that the large majority of the victims were adolescent women. When the afflicted recounted their experiences, these included both positive experiences of being carried away and having sex with human-like figures and negative experiences of being threatened and

Downloaded by [University of Gothenburg] at 04:15 22 May 2013 sexually possessed by devils and spirits. Dennis argues that the Miskitu generally express strong emotional behaviour in reaction to grief or when experiencing drunkenness. Both physical punishment and loud scolding are common when raising children and Miskitu children are exposed to ‘hysterical behaviour’ in various contexts. Accordingly, ‘they learn that such behavior is the normal way to express frustration and stress’ (Dennis 1985, 303). In addition, Miskitu adolescent girls are exposed to conflicting problems and stress. Whilst being sexually controlled and restricted by their parents, they must find a man who can support them. This is a precarious position, as men are believed to be unreliable and may leave them, especially if they become pregnant. The grisi siknis attacks thus become a form of attention seeking and a reaction against subordina- tion. For Dennis, grisi siknis is a ‘culture-bound syndrome’ (Dennis 2004, 216), a form of ‘extreme emotional expressiveness’ and a stress-related ‘culture-bound condition occurring only among the Miskito’ (Dennis 1985, 305). Anthropology & Medicine 311

Anthropologist Mark Jamieson, who also carried out fieldwork among the Miskitu, mainly based his findings on interviews relating to grisi siknis epidemics taking place in the village of Raitipura in 1992 and 1993 (Jamieson 2001, 267). Jamieson takes Dennis’ analysis further and argues that grisi siknis represents a ritualized form of behaviour associated with the transition from childhood to adulthood. In Jamieson’s view, adolescent girls are kept under surveillance by their parents and controlled through discourses about ‘shame’ in relation to illicit sex. However, the girls also know that they must use their charms to attract their future spouses as it is through sexual intercourse that the transition to adulthood takes place. This situation, which causes stress and anxiety, is subsequently expressed as grisi siknis attacks. Although well founded in the Miskitu socio-cultural context, Dennis’ and Jamieson’s mainly psycho-sexual theories do not fully account for the grisi siknis phenomenon. They build their theories on the assumption that the large majority of the affected are young women. However, many former outbreaks have in fact involved men. Indeed, during some of the outbreaks, all the afflicted have been men. In addition, during some of the massive outbreaks in the last decade, people of all ages, from the young to the very old, have been struck by the malady. Moreover, the author of this paper never heard anyone relating large-scale grisi siknis outbreaks to sexuality or any other pleasant experience. On the contrary, it was always very frightening and tormenting. A healer said: ‘It’s a criminal person who is doing this with the intention of torturing. It’s not a love relationship.’ Psychologist Gerhild Tru¨ bswasser, Davis, and Marley (2005), who carried out interviews in three villages along the Rio Coco, very briefly mentions machismo, conflicts between generations concerning old and new values, sexual abuse and the consequences of the Contra war as the most important factors for the outbreaks of grisi siknis. It is, however, unclear how these theories are related to the interviewees’ statements. In a similar vein, Isabel Pe´ rez Chiriboga (2002), who did anthropological fieldwork among Miskitu refugees in Honduras, briefly ascribed grisi siknis outbreaks to various forms of stress and tension also caused by the Contra War, and as a culturally acceptable way for Miskitu men to escape military service (during the Sandinista government’s effort to nationalize indigenous land in the 1980s, many Miskitu fled to Honduras where they joined rebel groups known as the Contras). On the whole, none of these authors give much weight to indigenous understandings and treatments of grisi siknis or to the role and fear of sorcery Downloaded by [University of Gothenburg] at 04:15 22 May 2013 in relation to outbreaks. By mainly presenting single cause explanations, they only partially account for a problem that is multifaceted in its nature. A more comprehensive understanding of grisi siknis should strive to include socio-cultural as well as economical, environmental and personal factors. In addition, the theories are mainly in relation to Miskitu culture itself and do not seek to provide a cross- cultural perspective. By not questioning the accepted view of grisi siknis as a culture- bound affliction they do not seek for a full understanding of the phenomenon.

Conclusion All conditions and disorders are more or less influenced by culture. In this perspective, the term ‘culture-bound’ is misleading as it gives the assumption that some conditions are culture-bound while others are culture-free. In addition, it has 312 J. Wedel

been shown that similar forms of ‘culture-bound syndromes’ have been found in many cultures, suggesting that these syndromes are not necessarily ‘bound’ to certain particular cultural settings (Tseng 2006). To consider a phenomenon as ‘culture-bound’ precludes cross-cultural comparison. Grisi siknis should first and foremost be contextualized and understood in relation to Miskitu culture and society. However, this should not exclude comparison. When grisi siknis is subject to cross-cultural analysis, it shows similarities with other cases of involuntary mass spirit possession as it is related to the spirit world and involves aggressive behaviour, convulsions, visions and possession. As with other forms of involuntary mass spirit possession, the problem is most likely to occur at boarding schools and remote villages and the outbreaks are frequently linked to stress, anxiety and social tension. Moreover, grisi siknis is mainly transmitted from person to person. When spreading from village to village, it is also likely to be transmitted through rumours and the mass media, such as newspapers, radio and television. In this perspective, grisi siknis should not be considered a ‘culture-bound condition’ only occurring among the Miskitu, but a Miskitu version of involuntary mass spirit possession. Outbreaks of grisi siknis may vary considerably and the affliction does not lend itself to being ascribed to one single cause. Socio-economic, environmental, cultural as well as personal factors all play their part. When an illness is said to be caused by sorcery, its explanations are related to the social world. The development of grisi siknis, with its increasingly violent manifestations, reflects a development in Miskitu society at large, marked by tense social relations and a competitive economic system. Equally, the transition from childhood to adulthood, strong emotional behaviour learned from childhood, a firm belief in spirits and sorcery, conflicts and contradictions concerning old and new values and environmental disasters may all be important factors that could influence outbreaks of grisi siknis. In addition, people are affected in varying degrees and those who are most afraid are also those most likely to be severely affected. This indicates that feelings of intense fear and anxiety surrounding grisi siknis may be important triggers themselves. From an anthropological perspective, the issue is not to fit grisi siknis into existing diagnostic psychiatric categories but to study culture from both emic (inside) and etic (outside) perspectives. Further research that seeks to understand the many aspects of grisi siknis and other forms of involuntary mass spirit possession should emphasize the social, personal and environmental context as well as cross-cultural

Downloaded by [University of Gothenburg] at 04:15 22 May 2013 comparisons in order to fully encompass the role of culture in relation to illness and suffering.

Acknowledgements The author wishes to thank Dr Manuel Ortega Hegg at Universidad Centroamericana, Managua; Lic. Pablo McDavis, Universidad de las Regiones Auto´ nomas de la Costa Caribe de Nicaragua, Puerto Cabezas, and Julian Morgan, Puerto Cabezas. The study was funded and approved by the Swedish Research Council (427-2005-8695). The places and institutions where the fieldwork was carried out did not have ethic research committees. However, the study was approved by the Centro de Ana´ lisis Socio-Cultural (CASC), Universidad Centroamericana, Managua, and the Institute of Traditional Medicine, Universidad de las Regiones Auto´ nomas de la Costa Caribe de Nicaragua, Puerto Cabezas. The stipulated ethical codes advocated by the American Anthropological Association were followed. No informants were mentioned by their real names. Confidentiality and informed consent was ensured. Anthropology & Medicine 313

All informants were informed about the purpose of the study and granted full freedom to withdraw from participation at any time. No conflicts of interest occurred.

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