A Hermeneutic Study of the Curanderismo Experience Among

A HERMENEUTIC STUDY OF THE CURANDERISMO EXPERIENCE AMONG

LATINOS

A Project

Presented to the faculty of the Division of Social Work

California State University, Sacramento

Submitted in partial satisfaction of the requirements for the degree of

MASTER OF SOCIAL WORK

Norma E. Zuñiga

SPRING 2014

A HERMENEUTIC STUDY OF THE CURANDERISMO EXPERIENCE AMONG

LATINOS

A Project

Norma E. Zuñiga

Approved by:

______, Committee Chair Maria Dinis, Ph.D., MSW

Date

Student: Norma E. Zuñiga

I certify that this student has met the requirements for format contained in the University

Format Manual, and that this project is suitable for shelving in the Library, and credit is to be awarded for the project.

______, Graduate Coordinator Date ______Dale Russell, Ed.D., LCSW

Division of Social Work

iii

Abstract

A HERMENEUTIC STUDY OF THE CURANDERISMO EXPERIENCE AMONG

LATINOS

Norma E. Zuñiga

This study explores the Curanderismo experience among Latinos. This qualitative study was conducted through face-to face interviews. This study used a hermeneutic phenomenological approach and content analysis. Eleven participants were selected for this study using a snowball sampling method. All participants provide personal accounts of their experience with Curanderismo. The four themes that emerged from the interviews are as follows: 1) Spirituality 2) Use of Plant/Herbs 3) Sweat Lodge/Temescal; and 4) Cleansing/Limpia. Implications and recommendations for social work policy and practice are also discussed in this project.

______, Committee Chair Maria Dinis, Ph.D., MSW

______Date

ACKNOWLEDGEMENTS

I would like to thank all of the participants who took time out of their day and busy schedules to participate in this study. Without my participants this project would not have come to light. I gained a lot of knowledge about the Latino and Native American community through their stories. This experience has been extremely humbling and a true blessing.

I would also like to thank my family and friends. To Eduardo Zuñiga, my husband, for his support and for always being by my side and encouraging me to pursue my dreams. To Edward and Crystal Zuñiga, my children, for being patient and understanding during this process and for being my guiding light. To my parents and siblings for being supportive during my time in graduate school and reminding me how proud they are of my accomplishments. To Martha Gonzales, thanks for putting up with my rants and motherly ways and for being a part of my thesis writing journey. To Fantoya Hill for her words of encouragement and friendship.

Last but not least, I would like to thank all of the professors who shared their knowledge and guidance during my time in graduate school, especially to Dr. Dinis.

Professor Dinis, thank you for her guidance, positive words, great energy, and good conversation.

TABLE OF CONTENTS Page

Acknowledgements ...... v

List of Tables ...... x

Chapter

1. THE PROBLEM ...... 1

Introduction ...... 1

Background of the Problem ...... 2

Statement of the Research Problem ...... 4

Study Purpose ...... 5

Research Question ...... 5

Theoretical Framework ...... 6

Systems Theory ...... 6

Application of Systems Theory ...... 7

Spirituality...... 9

Application of Spirituality ...... 10

Definition of Terms...... 10

Assumptions ...... 12

Justification ...... 12

Delimitations ...... 13

Summary ...... 13

2. REVIEW OF THE LITERATURE ...... 15

Introduction ...... 15

History of Curanderismo...... 15

Folk Illnesses ...... 18

Healing Practices ...... 27

Hot and Cold Theory ...... 27

Sweat Lodge Ceremony ...... 29

Sweat Lodge Structure and Symbolism ...... 30

Risks of Sweat Lodge ...... 31

Benefits of Sweat Lodge ...... 32

Plants/Herbs ...... 34

Limpias (Cleansing) ...... 35

Spirituality...... 36

Sweat Ceremony and Spirituality ...... 37

Gaps in Literature ...... 37

Summary ...... 39

3. METHODS ...... 40

Introduction ...... 40

Research Question ...... 40

Study Design ...... 40

Study Population ...... 42

Sampling Population ...... 43

vii

Instrumentation ...... 44

Validity and Reliability ...... 45

Data Collection Procedures ...... 47

Data Analysis ...... 46

Protection of Human Subjects ...... 48

Summary ...... 49

4. DATA ANALYSIS ...... 50

Introduction ...... 50

Demographic Data of the Participants ...... 50

Specific Findings and Interpretation of the Findings ...... 51

Spirituality...... 52

Use of Plants and Herbs ...... 56

Sweat Lodge/Temescal ...... 59

Cleansing/Limpia ...... 63

Summary ...... 65

5. CONCLUSIONS AND RECOMMENDATIONS ...... 66

Introduction ...... 66

Conclusions ...... 66

Recommendations ...... 68

Future Research ...... 68

Helping Professionals ...... 69

viii

Agencies ...... 70

Limitations ...... 71

Implications for Social Work Policy and Practice ...... 71

Conclusion ...... 73

References ...... 75

LIST OF TABLES Page

Tables

1. Table 1: Demographic Information ...... 51

x 1

Chapter 1

THE PROBLEM

Introduction

The purpose of this exploratory study is to examine the traditional healing methods used by curanderos to help alleviate physical, spiritual, and psychological ailments among Latinos. The researcher is interested in exploring this topic because of personal experiences in working with the Latino population at Sutter Yuba Mental

Health. The researcher found that Latinos are the second highest population in

Sutter/Yuba County, but less than 5 percent of the Latino population access county mental health services. This information raised curiosity about cultural factors that may influence Latinos to seek mental health services elsewhere. Counties are required to comply with regulations, which include providing, and improving access to service for at risk, underserved, and vulnerable populations. This researcher intends to provide information on Latinos experience with Curanderismo to provide information about this traditional practice.

This researcher will collect data through qualitative interview of participants who received traditional healing services from curanderos. The goal in administering these interviews is to gain insight to the practice of Curanderismo and bring awareness to this practice. The information from this project contributes to existing research on cultural competence. Providing insight on the practice of Curanderismo will hopefully help increase the quality of service provided by practitioners when working with the Latino population.

In this chapter, the researcher will briefly discuss the background of the Latino population and provide information of Curanderismo. The research problem, the purpose for conducting this study, and the theoretical framework used in understanding then phenomenon of Curanderismo will be discussed. Lastly, the definitions for terms used in this study, the assumptions, justifications, and delimitations of this study will be presented. Finally, the conclusion will summarize the chapter and introduce the chapters that follow.

Background of the Problem

According to the 2010 Census, between 2000 and 2010, the Hispanic population increased by 43 percent in the United States. People of Mexican origin represent 63 percent of the Hispanic population, Puerto Ricans make up the second largest population at 9 percent, and Cubans make up 4 percent. These three populations account for three quarters of the Hispanic population in the United States.

Hispanics make up 38 percent of the California population and continues to increase representing one of the largest populations in California. “Latino” is a catch all term for people of various places from Latin America: Mexico, Puerto Rico, Central

America, South America, Cuba, Dominican Republic, etc. Although Latinos are the fastest growing population, Latinos under utilize mental health services. Cabassa, Zayas, and Hansen (2006) conducted a literature review analysis of 16 articles and found that

Latinos compared to non-Latino Whites in the United States under utilize mental health services. Latinos tend to access health care facilities less often than Non-Hispanic Whites and other minority populations (Tafur, Crowe, & Torres, 2009).

Some of the common reasons Latinos under utilize mental health services are fear of being judged by their peers and service care providers, lack of service provided in their primary language, social stigma for receiving mental health services, fear of being labeled as “loco/a” (crazy), fear of deportation for individuals who are undocumented, lack of mental health knowledge, and lack of health care coverage and/or understanding of the sliding scale used by county mental health facilities. In addition, not all Latinos are accustomed to western medicine and may prefer to seek physical, spiritual, and/or mental health services through traditional folk medicine, Curanderismo, well respected elder in their family, or counseling through religious entities.

Western health medicine neglects to recognize the use of traditional folk medicine among diverse populations including Latinos. Some of the traditional folk medicine and practices used by Latinos include use of yerbas (herbs), temescal (sweat lodge), sobadores (massage therapist), and partera (midwife). This hermeneutic study seeks to explore a deeper understanding of the Curanderismo experience among Latinos. The purpose of this study is to provide cultural information regarding Curanderismo and assist mental health and service care providers to be culturally sensitive and competent with this phenomenon when working with their Latino population.

According to the American Psychological Association (APA) (2013), the immigration process can cause a variety of psychological problems as a result of loss of country of origin, family, customs, and traditions. The need to navigate in an unfamiliar culture and exposure to new environment, increase the risks to mental health problems.

APA identifies some of the common mental health problems among immigrants as stress,

anxiety, depression, posttraumatic stress disorder (PTSD), substance abuse, and suicidal thoughts. In addition, APA describes that some of the stressors and reasons for under utilizing services are limited networks and social support, policies that restrict access to health care, and lack of mental health knowledge.

Loss of customs and traditions are among the stressors listed by APA. This study focuses on providing a better understanding of one of the Latino traditions,

Curandersimo. Traditional healers have offered holistic treatments through herbal medicine, home remedies, massage, and spiritual healing before western biomedicine was discovered. Biomedically trained health professionals consider traditional healers as quacks (Huber & Sandstrom, 2001). Because of this misconception and stigma, many people who use alternative medicine or traditional medicine fail to share important information with their practitioners because they fear being judged. Due the risk of drug interactions, it is important for practitioners to openly talk to clients and be non judgmental about traditional and alternative practices. As such, it is important to understand the old systems of health care and incorporate them into current medical care practices or at least be sensitive and have a better understanding of such practices.

Statement of the Research Problem

Since the Latino population continues to increase in the United States, there should be attempts to reduce the disparities and understand the barriers that exist, which prevent them from accessing mental health services. Lack of culturally competent services is among the barriers Latinos have reported they encounter in the medical and mental health systems. This study will provide information about Curanderismo, a

traditional practice of healing to help practitioners better understand this social or cultural phenomenon. The researcher will identify themes to provide insight about the common practices in Curanderismo.

Study Purpose

The purpose of this research study is to gain a deeper understanding of the

Curanderismo experience among Latinos who have received services from Curanderos.

This research will focus on the participant’s narrative of their experience of this cultural folk practice in traditional healing in hopes to gain a meaningful understanding of this social issue and how this practice of using Curanderos either assists or hinders medical and/or mental health healing. This study aims to increase cultural competence for practitioners who work with the Latino population. According to the National

Association of Social Work (NASW) the growing number of immigrants in the United

States is a cause for need of cultural competence in the professional field of Social Work.

Immigrants bring unique cultural, religious, language, and political practices to communities. This researcher hopes to provide insight of the practice of Curanderismo to bring awareness to practitioners working with the Latino population.

Research Question

The research question for this study is: What traditional healing practices do

Curanaderos use to help alleviate physical, spiritual, and psychological symptoms among

Latinos?

Theoretical Framework

The theoretical frameworks used to guide this project are systems theory and spirituality. The researcher will explain each theory followed by a description of how each theory can be applied to this research.

Systems Theory

Systems theory originates from the biological theory, which suggests that all organisms are systems, made of subsystems, which are all a part of a super system

(Payne, 2005). Society also has a set of systems and subsystems, which interrelate.

Systems in social work, applies to the various social systems such as individuals, groups, family, communities, and societies. Individuals are understood in terms of where they fit into the various systems (Thompson, 1992). Thompson describes that the function of each system contributes to the maintenance of equilibrium of the overall system and is regulated by a set of norms, rules, and shared values. Acting out on these values gives individuals a sense of well-being and deviance can threaten the stability of the system.

There are several concepts on how systems work. One concept is that it is “a system with boundaries within which physical and mental energy are exchanged internally more than they are across boundaries” (Payne, 2005, p. 144). In this concept, there is the closed system and the open system. With the closed system, there is no interchange across boundaries, whereas with the open system, energy crosses its boundaries.

How the systems work and how they can be changed is through input, throughput, output, feedback loop, and entropy. During input, energy passes into the system across

the boundary. Then the energy is used within the systems, which is known as the throughput. The effect this energy has on the environment once it passes the boundary is known as the output. Then, the results of the output go through a feedback loop. Finally, in entropy, systems use their own energy to continue functioning, but need to receive input from outside its boundaries to continue or they die out (Payne, 2005). An example of this process is the transaction that occurs between two individuals. During a conversation, input, throughput, output, feedback, and entropy occur. These transactions and interactions can occur between and among the various systems levels: individual, family, small groups, organizations, communities, and societies or larger social structures

(Robbins, Chatterjee, & Canda, 1998). Change is the goal of systems theory.

Another important value of systems theory is that “it deals with the ‘wholes’ rather than with the parts of human and social behavior” (Payne, 2005, p. 144). Robbins,

Chatterjee, & Canda (1998), explain that people and their environment are involved in a process of continual adaptation to one another and must be viewed as holistic.

Application of Systems Theory

In applying the systems theory to Latinos, first it is important to understand the concepts of the closed and open systems theory. Maduro (1983) explains that the closed systems theory is not a productive model when working with Latinos. He explains that

Latinos expect therapists not only to observe during a therapeutic session, but to also participate in the therapeutic process, thus the open systems theory works best when working with Latinos. He further explains that having an open system with Latino clients does not require self-disclosure, but may require creativity with countertransference for

problem solving, which may lead to a more profound involvement in the relationship. In addition, therapeutic results are best when there is reciprocity, interaction between the therapist and client, and when communication is personal.

By applying the open systems concepts, input, throughput, output, and feedback take place. The process during each interaction and the feedback provided to individuals will help lead to change in behavior. The same concept and process takes place with

Curanderismo. Individuals share their stories with the curanderos/a, the information is processed, and feedback is provided. In practice, this transaction between curanderos/a and client should help alleviate distress and help the individual live a more meaningful life. Systems theory is cyclical and the constant interaction among the various systems helps lead to change.

Lastly, the systems theory deals with the whole, rather than its parts. This holistic approach is a value in Curanderismo as well because curanderos understands that family, community, and the creator or God are all important systems in the individual’s life.

Therefore, all of these factors are taken into consideration during treatment and at times incorporated during a treatment session (i.e. family members may participate in the sweat). In addition, their treatment approach deals with the whole individual: mind, body, and soul. The ceremonies or rituals help treat the emotional, physical, and spiritual states of the individual. This holistic approach helps restore the individual’s energy and brings it back to harmony and balance.

Spirituality

Spirituality means something different to different people. Payne (2005) defines it as “a search for meaning and purpose in life” (p. 190). Payne (2005) describes four concepts of spirituality. First is the idea of common good and the protection human rights. Second is sustainability, which Payne refers to as respect and work for social systems that do not impose demands on resources for poor countries. Third is wisdom, which he describes as the incorporation of carefully thought out values in practice. Last is holistic spirituality, which is finding, developing, and understanding integrity in our lives

(Payne, 2005). Many people use spirituality to connect with their own identity and internal understanding of the outside world and affects how they behave and react

(Payne, 2011).

Crisp (2010) describes that “spirituality involves an awareness of the other, which may be God or other human or Devine beings or something else, which provides the basis for us to establish our needs and desires for, understand our experience of, and ask questions about, meaning, identity, connectedness, transformation, and transcendence”

(p. 7). Crisp also describes that for others these may be integral to their religious beliefs in finding meaning, connectedness, transformation, and transcendence.

In social work and relationship-based practices, religion cannot be ignored since religion is an expression of spirituality. Some people may see little difference between religion and spirituality whereas others may make a clear distinction between the two.

Religion is a social construct and publicly available: churches, mosques, Bibles, prayer books, religious officials, weddings, and funerals; whereas Spirituality is seen as warmer,

associated with love, inspiration, wholeness, depth, mystery, prayer, and meditation

(Crisp, 2010).

Application of Spirituality

“Social work writing seeks to interpret religious or spiritual beliefs in particular cultures and ethnic groups to increase understanding by others, while others seek to extract useful ideas for practice from particular ethnic and cultural beliefs” (Payne, 2005, p. 190). Spirituality is an important factor of Curanderismo and the Latino culture.

Spirituality in Curanderismo practice may include prayer to God the creator, mother earth, saints, or a higher power. Believing and having faith that one will overcome their current ailments, stressors, or situation are important parts of healing. Healing powers are thought to derive from God. Therefore, some curanderos rely on religious icons such as crosses and/or pictures or figurines of saints (Kiev, 1968).

In order to be effective practitioners, it is important to have an open system and be willing to discuss and/or understand the importance of spirituality among Latinos and all clients. Connectedness, identity, meaning, transcendence, and transformation are important in the field of social work and are important factors during interventions. As practitioners, it is important to identify and develop the various worldviews, value the differences, and be culturally competent and sensitive to other ethnic and cultural beliefs.

Spirituality and religion may be important practices in the clients’ system, which helps lead them to better health and wellness.

Definition of Terms

The following is a list of terms and definitions used throughout this study.

Culture: The customary beliefs, social forms, and material traits of a racial, religious, or

social group; also, the characteristic features of everyday existence (as diversions

or a way of life) shared by people in a place or time (Merriam-Webster

Dictionary, 2013)

Curanderismo: A set of folk medical beliefs, rituals, and practices that seem to address

the psychological, spiritual, and social needs of people (Perrone, Stockel,

Krueger, 1989)

Curandero (male) / Curandera (female): Traditional Hispanic folk healer (Perrone,

Stockel, Krueger, 1989)

El Don: spiritual calling, a gift (Tafur et al., 2009)

Herbalism: Herbal medicine (Merriam-Webster Dictionary, 2013)

Latino/a: A person of Latin-American origin living in the United States (Merriam-

Webster Dictionary, 2013).

Partera: Midwife (Perrone, Stockel, Krueger, 1989)

Sobador/a: specialist in massage therapy, especially as it applies to the stomach and

digestive tract; sobadores heal with their hands and supplement their effort with

herbal medications when appropriate (Perrone, Stockel, Krueger, 1989)

Western medicine: Health practices used in the United States for physical and mental

health treatment approved by the medical board of board of behavioral science.

Heirbas: Plants and herbs (Meriam-Webster Dictionary, 2013)

Assumptions

Several assumptions can be made as a result of this study. First, having culturally competent practitioners allows for a better understanding of Latinos traditional practices.

Second, Latinos will be less hesitant to share information regarding traditional healing or alternative medicine used if there are culturally competent practitioners. Third, practitioners could be sensitive to traditional healing practices and be non judgmental with Latinos being served.

Justification

Some may argue that the practice of Curanderismo is slowly being lost as families assimilate to the American culture and as younger generations lose interest in learning about traditional healing from the elderly; however, there are many Latinos who still practice traditional healing and intend on preserving traditional practices and pass them on to younger generations. Cultural beliefs and attitudes about folk medicine play an important role in elderly Mexican Americans approach to their own health care and use of resources, yet little knowledge is available about folk healing in this population

(Applewhite, 1995).

Comprehending the cultural factors of Latinos is vital to properly provide quality service to this population. Social workers need to be aware of the Latino history and traditions as well as the barriers that prevent them from accessing services. Social workers need to be sensitive to these issues to be better prepared to provide culturally competent services. It is important to respond to the need of ethnic and cultural minorities in western society (Payne, 2005). The researcher intends to provide information about

Curanderismo so social workers are open to this traditional practice. This researcher intends to provide insight on Curanderismo and hopes social workers are open with clients who believe and incorporate Curanderismo as an alternative form of healing in their personal lives.

Delimitations

The information received for this study is limited in several ways. First, the information provided is subjective based on the participants’ experiences, recollection of events, and their perception. Second, not all Latinos practice Curanderismo. As such the information provided cannot be generalized. Third, this study does not have a large sample and is qualitative only. Findings of the literature identify various barriers Latinos encounter that contribute to the disparities in seeking mental health services. However, this research only focuses on providing information on one factor, Curanderismo as an alternative form of treatment.

Summary

In this chapter, the introduction of the study was discussed as well as the background of the problem and the purpose for this study. The researcher also listed definitions of terms used in this study, discussed the assumptions, justifications, and delimitations of this study. The chapter concludes with a summary of the chapter. The following chapter, chapter 2, will include a review of literature, which includes background information on Curanderismo and brief history of Latinos. In chapter 3, the methodology used for this study will be discussed. Chapter 4 includes the examination and analysis of the data collected. Finally, this study concludes with chapter 5, which

includes a summary and discussion of the findings of this study, recommendations for future research, and implication for the social work profession.

Chapter 2

REVIEW OF THE LITERATURE

Introduction

In this literature review chapter, a variety of themes will be explored that provide information on common practices of Curanderismo and relevant information for this research study. The first section will include information regarding the history of

Curanderismo. The second section is a discussion on common folk illnesses. The third section will examine the healing practices used to treat folk illnesses, which include an examination of hot and cold theory, sweat lodge ceremony, use of plants and herbs, limpias, and spirituality. The fourth section of the literature review will include the gaps in literature and then conclude with a summary of the chapter.

History of Curanderismo

Curanderismo stems from the Spanish word Curar, which means “to heal” and is the practice of traditional Latin American folk medicine used for healing (Tafur et al.,

2009). Curanderismo uses a holistic approach that focuses on the individual’s soul and spiritual connection with the Creator or God. Lopez (2005) describes, “Ancient Mexico, for centuries, was governed by the holistic perspective that an imbalance in the ‘opposing forces of cosmos’ could lead to illnesses” (p. 24). Curanderismo evolved from indigenous practices used many centuries ago. The Mesoamerican curanderos first appeared during the sixteenth century and is a product of the Conquest (Huber & Sandstrom, 2001).

Trotter, Chavira, & Leon (1997) describes six historical influences that shaped

Curanderismo: Judeo-Christian religious beliefs, early Arabic medicine and practices,

medieval and European witchcraft, Native American herbal lore and practices, modern spiritualism and psychic phenomenon, and scientific medicine. Each of these practices influenced Curanderismo or influenced the current beliefs and practices used by curanderos. Judeo-Christian beliefs and Bible teachings combined with folk wisdom provide the basic framework for Curanderismo, as it does for most western cultures. The

Bible references specific healing properties of animal parts, oils, plants, and wine and also references usage of medicine created from earth for healing (Trotter et al.).

Curanderos are known to have a gift from the creator known as el Don. A healer who has el Don is known to have a special gift for healing others or a spiritual calling

(Tafur et al., 2009). Hoogasian and Lijtmaer (2010) describes el Don as a gift for healing and the ability to wield the metaphysical. In the practice of Curanderismo, spirituality is a strong foundation that is essential in the healing process. Latino American spirituality factors were affected by colonialism, which forced indigenous people to take on

Catholicism by their conquerors and traditional places of worship, spiritual beliefs, texts, and practices were destroyed, repressed or blended with Catholic practices (Hutchinson,

2008). Hutchinson further describes that many Latinos practice Catholicism or Christian faith and have personal relationships with God and Jesus Christ and also celebrate special religious events such as Holy Week, Christmas Eve, feasts of Virgin Mary, and life sacraments (i.e., baptism, first Holy Communion, confirmation, Quiceñeras (coming of age ceremonies), wedding ceremonies, and funerals). In addition to these religious practices, some continue to practice African and indigenous spiritual traditional practices, which include Curaderismo, santiguano espiritismo (form of spiritualism), Santeria

(Afro-Cuban religion), and vodou (voodoo) (Hutchinson, 2008). Zacharias (2006) describes, “Curanderismo is not unique to Mexico but can be found in very similar forms in Middle and South American countries due to common historical background and powerful influence of Indian cultures in those regions” (p. 382). The practices of

Curanderismo have been passed on orally through generations and learned through apprenticeship of elder curanderos. Hoogasian & Lijtimaer (2010) indicate that researchers on Curanderismo found that healers of Latin American and Afro-Carribean traditional healing work at the spiritual level in ceremonies and a form of intervention to treat psychological and physiological problems and that Mexican folk medicine reflects

Native American Indian naturalist religion and Roman Catholic notion as God’s will.

Hendrickson (2013) discusses the work of Elena Avila, a curandera who practiced in Alburquerque, New Mexico and published Women Who Glows in the Dark: A

Curandera Reveals Secrets of Physical and Spiritual Health. According to Hendrickson,

Avila suggests that Mexican American Curanderismo continues to evolve and explains that curanderos in the United States communicate with indigenous and alternative healers in Mexico and other parts of Latin America to the extent that Curanderismo has evolved in new ways that will last for decades.

The National Center for Complementary and Alternative Medicine (NCCAM) describes that traditional healers are a form of complementary and alternative medicine whom use methods based on indigenous theories, beliefs, and experiences that are passed down from generation to generation (NCCAM, 2012). NCCAM describes that these traditions in the United States are common among the Native American healers or

medicine man. However, it is important to note that Western cultures reject some of the traditional healing methods and ideas of communicating with ancestors for healing, looking to plants and animals for guidance, and the power of the spirit in healing and wellness (McCabe, 2008). McCabe describes that this has caused traditional healing practices to go underground

Folk Illnesses

Lopez (2005) sought out to increase knowledge about indigenous health care resources among the Latino population and describes the aspects of folk medicine among

Hispanics as the role of diagnosing and treating illness, connection between religion and illness, and universality of many health beliefs, symptoms, and regimens for healing.

Lopez explains that Hippocratic theories contributed a theoretical framework explaining disease, which Mexican Indians incorporated and also explains that mental illness is the most feared of folk illnesses, which is thought to be composed of supernatural illnesses of evil eye (male de ojo) and supernatural hex (embrujado). Mal de ojo is thought to be caused by jealousy or someone desiring things the other person possesses and embrujo is a hex that causes an imbalance of evil spirits and positive energy. Lopez also describes susto (soul loss) and espanto (fright, fear) as other interpersonal maladies, which are described as soul loss or spirit attack as a result of a traumatic event and describes the symptoms of susto as physical weakness, depression, introversion, and apathy; whereas the symptoms for espanto include susto symptoms and anorexia, insomnia, and hallucination.

Lopez (2005) administered a questionnaire to 70 women ages 20 – 47 years of age

(mean age of 28.8) from a southern California social work program. Seventy seven percent of her participants were born in the United States and twenty-three percent were born in Mexico. Lopez found that participants who have heard of the eight Indigenous illnesses reported knowledge of the following: mal ojo or ojo (evil eye) (90.0%), male de aire (negative air) (65.7%), envidia coraje (envy, jealousy out of anger) (78.6%), embrujo (hex, curse) (88.6%), susto (soul loss) (92.9%), espanto (fright, fear) (70.0%), and empacho (indigestion) (81.4%).

Mexican Curanderos understand health and illness as a process between three dimensions: religious/spiritual (spirit “espiritu”), affective-emotional dimension (soul

“alma”), somatic (body “cuerpo) (Zacharias, 2006). Zacharias describes that Curanderos understand the dream state, altered state, consciousness, and recognize having a sense of identity to manifest a properly functioning “espiritu” and people whose mental health is affected by trauma and psychotic confusion are viewed as having severe spiritual dysfunction and if the “espiritu” is not in balance, the “alma” is affected. Healers report the most frequent dysfunction of the soul as having excess of emotions: envy, rage, overwhelming sadness. Curanderos diagnosis of mental illness include “susto (magical fright), mal aire (negative air), mal de ojo (evil eye), envidia (envy of others), sentimientos fuertes (vehement feelings), brujeria (illness caused by witchcraft), and falta de fe (lack of faith)” (Zacharias, p. 388).

Zacharias (2006) further explains the symptoms described by curanderos are similar to those of western psychotherapy: depressive symptoms, pain syndromes,

psychosomatic symptoms, anxiety and agitation, schizophrenic/psychotic states, pathologic affective reactions, dissociative symptoms, and sleep disorders. During

Zacharias’ six-month follow-up, the researcher found the treatment of all different kinds of degree of mental illness led to a complete recovery of six cases and partial improvement of two cases. The two cases that showed partial improvement, displayed symptoms that were moderate to severe; whereas the six cases with complete recovery displayed symptoms that were mild to moderate. Zacharias concludes that her study provides evidence that Mexican Curanderismo provides clinically significant health care service in diagnosis and treatment of mental illness.

Maduro (1983) describes Curanderismo as a holistic system in which people seek help for physiological, psychological, and social maladjustment. He identifies eight philosophical premises of Latino curing: the mind and body are inseparable, balance and harmony are important, the patient is an innocent victim, the body and soul are separable, cure requires family participation, the interpenetration of the natural and supernatural worlds, a sick person needs to be re-socialized, and a healer is expected to interact openly. In the first premise, Maduro describes that Latinos view the mind and body as inseparable. There is no separation between emotional and somatic illness. Maduro provides several examples of physical-emotional illness due to the experience of strong emotional state: los nervios (the nerves, anxiety), la bilis (destructive rage), susto (fright), envidia (feeling strong envy), tristeza (separation and loss, unresolved natural mourning, sense of abandonment). Maduro describes, “the most common physical symptoms of bilis are vomiting, diarrhea, headaches, dizziness, migraines, nightmares, loss of appetite, and

inability to urinate”(p. 870). The second premise, Maduro describes that in Curanderismo balance and harmony between the emotional, physical, and social states are important for the health and well-being of individuals. Maduro describes the body and human relations can have an imbalance between hot and cold bodily substances. He also references

Hippocratic theory and notion of qualities and indicates it is compatible with the Aztec concepts of balance of universal opposites: hot/cold, night/day, and good/evil. Maduro explains the notion of qualities is based on Graeco-Roman theories of humoral pathology, which came from the Spanish in the 16th century. Maduro describes, “the human body contains four humors, or liquids: blood, phlegm, black bile, and yellow bile and each humor is characterized by qualities of heat and cold and moisture or dryness” (p. 870).

Maduro describes the third premise, as the patient is an innocent victim. He describes that

Latinos believe they are innocent victims of malevolent forces, which can be internal or external forces in the environment. Maduro further describes that internal stability can be disrupted by witches, bacteria, sorcery, poverty, evil spirits, and/or an angry saint, which result is person’s transgression and can be treated with unconditional love, care, and support from family, friends, and curanderos. In the fourth premise, Maduro explains that the body and soul are separable. This premise is about the relationship one has with the spirit world, which stems from the belief of soul loss. In terms of psychoanalysis, Maduro describes it as depersonalization, or loss of self. He explains that Curanderos treat people by having tea with them and have a conversation about a cure, thus dealing with the psyche (soul). In the fifth premise, Maduro explains that cure requires family participation indicates that Curanderos believe that the family aids in the healing process

because they help provide social, emotional, and physical support. Although family involvement can pose problem in treatment, curanderos know when to separate family members when needed during any given session as do psychotherapists during a therapy session. The sixth premise is the interpenetration of the natural and supernatural worlds.

Maduro indicates that this premise is similar to the fourth premise and curanderos activities include “propitiation, prayer, sacrifice, penance, miracles, vows, and attempts to coerce the gods and saints into granting requests” (p. 872). Maduro further explains that sympathetic magic is used as interpenetration of the natural and supernatural worlds. In the seventh premise, Maduro explains that the sick person needs to be re-socialized and describes that Curanderos may identify a sick person as being ‘deviant’. It is believed that this disorder is due to acculturation. Treatment may include reintegration into the broader culture and provide a sense of belonging to one’s culture. Maduro states, “when traditional values are weakening and need to be reclarified, the interpretation of illness is given in a way that resists cultural change, acculturation, and socially structured stresses”

(p. 872). In the final premise, Maduro describes that the healer is expected to interact openly. Maduro explains that Latinos require an open personal approach in order to be treated successfully. He explains that personal approach includes an initial handshake, friendly rapport, communication, interaction, and active participation. Personalismo is an important concept among Latinos and Maduro defines it as “to relate to and trust people, rather than institutions, and their dislike of impersonal structures and organizations” (p.

873). Maduro concludes, given these eight premises, Latinos expect personal interaction

and reciprocity from their practitioners and the concept of respect and building rapport is the foundation of the Latino culture.

In another study, Applewhite (1995) interviewed 25 Mexican American elderly people from two senior citizen centers in the metropolitan area of Arizona. The interviews were regarding Curanderismo and its influence on health care behaviors.

Applewhite reports the participants used or heard of home remedies, herbs, bone and muscle manipulation, midwifery, faith healing, spiritualism, tarot card reading, witchcraft, praying, and the use of religious icons for spiritual purposes. Participants report they learned about folk medicine in early childhood, adolescence, and early adolescence and 84 percent of the participants reported folk treatment from family members, neighbors, or local curanderos. Applewhite describes that the participants also report that they sought folk healers to treat their children. Some of the most common health ailments for which the sought treatment were colic (colico), locked bowels

(empacho), fright (susto), evil eye (real de ojo), and fallen fontanel (caida de la mollera).

12 percent of the participants recall rituals or ceremonies involving candle lighting, praying, laying of hands, and spiritual cleansing through barridas or limpias

(Applewhite).

Applewhite (1995) also found that skepticism about the efficacy of folk healing appeared in late adulthood for the participants whom then turned to more conventional health care providers, self-medication, home-remedies, or God’s will. Applewhite found that 92 percent of the participants believed folk healing involved malevolent of benevolent practices and did not deny the supernatural forces of good and evil.

Applewhite also found that 64 percent of the participants were knowledgeable in herbalism and were able to make a distinction between home remedies (remedios caseros) from over the counter medication (remedios botanicos). Many expressed preference of home remedies due to the high cost of prescriptions and over the counter medication. In addition, 76 percent of the participants believed herbs were effective in treating mild illnesses (i.e. headaches, insomnia) to more serious problems (i.e. hypertension, nervous tension). For more serious problems, 12 percent did not consult with an herbalist and chose to treat themselves with their own herbs, teas, ointments, home remedies, or seek modern medical treatment. It was also common for participants to place faith in God or divine intervention. As many as 68 percent discussed the best health care as a combination of, folk healing, modern medicine, and the power of God.

Of the 25 participants, 80 percent moved from traditional healing to modern health care, depending on the seriousness of their illness. Applewhite further reports that all of the participants acknowledged that not even modern medicine could eliminate chronic problems or declining health problems related to their old age. Participants in

Applewhite’s study also believed that in old age, major health problems and diseases cannot be treated by folk healers. However, 16 percent indicated the lack of faith in modern medicine and lack of money resulted in their choice to seek treatment with a folk healer. In addition, 48 percent reported they would consult a curanderos/a if their physician could not help them. Two participants reported that they did not seek treatment from either modern medicine or curanderos and chose to treat themselves with over the counter medication or home remedies. Of the participants, 22 percent reported negative

views of folk healing due to fear of the supernatural, overcharging among curanderos, frauds, or primarily believe in modern medicine. Finally, 32 percent reported they personally knew of a folk healer in their community, 66 percent knew of a sobador

(massage specialist) or yerbero (herbalist), 12 percent used services of curanderos, sobadores, yerberos, or other folk healer, and 76 percent chose to treat themselves with herbal remedies, common folk treatments, or self-medicated.

Applewhite (1995) concludes that the degree in which Mexican Americans use folk healing may depend on their ethnic culture, access to modern medicine, and health problems and it is not uncommon for Mexican Americans to adopt both practices of the

Anglo culture and Mexican culture. Traditional folk healing and indigenous beliefs represents an alternative to modern medicine that help people who are tied to their ancestral culture maintain a healthy lifestyle (Applewhite).

In a study by Dobkins de Rios (2002), the researcher describes that she spent one year living in Iquitos, a Peruvian Amazon city. Dobkins de Rios studied the hallucinogen plant ‘ayahuasa’ and how curanderos incorporate the plant into treatment of psychological and emotional disorders. Dobkins de Rios draws her data from 700 Latino immigrants whom she worked with in over a seventeen-year period. Dobkins de Rios provides three parallels between traditional folk healing and psychotherapy practices: hypnosis, behavioral modification and cognitive restructuring.

For hypnosis, Dobkins de Rios describes that the shaman’s key role is to enter an altered state of consciousness with their client, induced by drumming and in some cases plant hallucinogens are introduced into the ceremony. During altered states, the shaman

“predicts the future, to experience metaphorically a change in his shape, and contact spiritual entities” and these entities are called upon to “conquer evil, negate hexes, neutralize witchcraft, and restore the client to good health” (p. 1577). Dobkins de Rios describes a parallel with psychotherapy and explains that her patients arrive with symptoms of pain, anxiety, agitation, or other symptoms of distress. Dobkins de Rios uses relaxation therapy, which can often be a gloss of hypnosis that helps alleviate the patient’s symptoms. Dobkins de Rios also explains that gift giving enhances therapy and helps build alliance with Latino clients, which help ensure future visits. The researcher explains that empowerment is an important concept of hypnosis and gives an example of metaphorically calling on the power of an eagle and describes that her client takes on its power. Dobkins de Rios further explains that at the University of the Burn Center studies have shown efficacy in altered states in pain management, treatment for depression, and treatment for posttraumatic stress disorder.

For behavior modification, Dobkins de Rios (2002) draws from the ways shaman describe and analyze of magic and theatrics when working with clients. Dobkins de Rios builds on the theatrical concepts to explain behavioral modification through the use of photographs. Dobkins de Rios uses photographs to motivate clients (i.e. parents) to learn techniques such as positive reinforcement and ignoring negative behavior.

Dobkins de Rios (2002) describes a third parallel with cognitive restructuring which focuses on the shaman’s rationality. The researcher describes that the shamanic healer strengths are both empirical and rational and explains that psychotherapist assist client’s in thinking rationally and assist them in restructuring irrational thoughts. While

the shaman uses spiritual entities, psychotherapist can use metaphors or proverbs with clinical issues. Dobkins de Rios indicates that Latinos seek quick relief of symptoms and not long-term therapy and explains that those likely to benefit from the techniques described are recent Latino immigrants whose culture of origin is closest to shamanism.

The literature documents common folk illnesses among various studies. The literature also provides information and insight on cultural beliefs among Latinos and their perspective on illnesses and practices used for self-care and wellness. The following discussion includes information of common healing practices used in Curanderismo.

Healing Practices

The healing practices used by healers to treat symptoms include healing rituals of altered states of conscious, sweat lodge ritual, psychospiritual healing rituals (ritual of cleansing, ritual of reintegration, rituals of protection and strengthening), therapeutic talk, and supportive physiological treatment procedures (Zacharias, 2006). Interventions used by curanderos vary significantly. There are various specialties of Curanderismo: herbalist

(yerberos/as) specialize in botanical remedies; midwife (partera); massage therapist

(sobadores); psychic mediums (espiritualisto/as) (Tafur et al., 2009). The following practices are only a few of the many practices used by curanderos. The following subsections include a discussion of the hot and cold theory, the sweat lodge ceremony, use of plants and herbs, a discussion on limpias (cleansing), and spirituality.

Hot and Cold Theory

Tafur et al. (2009) describes that curanderos encourage people to eat hot and cold foods (not in temperature, but in context of hot and cold properties) to maintain

equilibrium and balance. As such, curanderos often use special diets as a form of intervention to help restore balance. Tafur et al. explain that concepts considered cause a shift in temperature in cooling activity are walking barefoot, walking outside with wet hair, menstruation, childbirth, surgery, and exposure to cold air or cold substance. The heating activities include pregnancy, digestion, and exposure to heat. Tafur et al. describe that eating foods opposite to either cooling or heating activities help neutralize the body and helps restore balance (as cited in Maduro, 1983; Torres & Sawyer, 2005).

Lopez (2005) describes that physical health is viewed as the proper balance from the “hot fluids of the blood and yellow bile, and the cold fluids of the phlegm and black bile” (p. 25). The body’s imbalance is restored with the opposing qualities. Cold ailments such as headaches, cold, or tuberculosis are restored through “hot” foods or teas. “Hot” illnesses, like digestive problems, kidney ailments, rashes, and soar throat are restored through “cold” foods.

As stated earlier, Maduro (1983) describes concepts of the hot and cold theory by describing that in Curanderismo balance and harmony between the emotional, physical, and social states are important for the health and well being of individuals. Maduro describes the body and human relations can have an imbalance between hot and cold bodily substances. Maduro describes, “the human body contains four humors, or liquids: blood, phlegm, black bile, and yellow bile and each humor is characterized by qualities of heat and cold and moisture or dryness” (p. 870). If the hot and cold and wet and dry qualities are in balance, the body is healthy. Some of the treatments used to restore balance are herbs, cupping, emetics, diuretics, cold or hot foods.

Amerson (2008), a nurse educator, Master of Science in Nursing, and Registered

Nurse interviewed a curandera in Oaxaca, Mexico. Amerson reports the curandera, Doña

Queta, defined “health” as components including spiritual, physical, mental, and nutrition. Doña Queta reported that some of the treatments used for pregnancy are massage with a warm shower, which helps reposition the fetus and cider or mint teas are used to relax and calm the mother to be. She also reports that after delivery, the mother is given chicken broth, cooked with onion or garlic. Doña Queta describes what is known as cold-hot theory, which has also been reported in other research on Curanderismo. She reports that onion, oregano, garlic, and thyme are known as ‘hot’ ingredients and jicama root, avocado, watermelon, and cactus are known as ‘cold’ ingredients.

Sweat Lodge Ceremony

The sweat lodge provides a space that is both public and a private opportunity for emotional openness for participants. Sweat lodges are also known as hothouses, sweat house, sweat baths, and temescal in Spanish. Sweat lodge ceremonies have been used across various cultures since before recorded time (Garrett et al., 2011). Garrett et al. explore the purpose and nature of Native American and indigenous sweat lodge practices and ceremony and describe the sweat lodge ceremony is a ritualized cleansing of the mind, body, and spirit. Bucko (1998) describes each sweat as unique in its experiential and structural aspects, which he believes makes each sweat compelling. “The sweat represents a transformation of the past as understood by participants in the present, which they designate as tradition” (Bucko, p. 12). Within Native nations, sweat lodge ceremonies serve various purposes: bathing, warmth, socialization, schooling for the

young, heritage, language, myths, religion, celebration, ceremonial cleansing, physical doctoring, spiritual training; preparation for war, hunting, marriage, vision quest, and various rites of passage, cleansing, and healing (Garrett et al.). Currently, Native

American sweat lodges are being used for various types of services: medical, mental, correctional, and substance abuse treatment programs (Garrett et al.).

Sweat Lodge Structure and Symbolism

The sweat lodge is most often used by First Nations peoples in the Americas and was most likely present when the Europeans arrived in the Americas (Livingston, 2008).

The sweat lodge structure is round or oval in shape. The materials used for sweat lodge structures vary from region to region. The most common sweat lodge is a dome like structure made of willow branches set up to create four quadrants, which symbolize the four cardinal directions (west, north, east, and south) and four elements (fire, earth, water, and wind) (Garrett et al., 2011). This willow frame structure is then covered with heavy tarps or blankets to keep the heat from escaping the lodge. The opening of the lodge door faces the west and a few yards from the door lay a fire pit with river rocks inside the fire

(Bucko, 1998). Usually the opening of the door is low, so participants need to get on their hands and knees to enter the sweat lodge, which is “symbolic of entering the womb of

Mother Earth in a humble manner, being immersed in the total darkness once inside”

(Garrett et al., p. 89).

The water used during a ceremony symbolizing the life-giving power of the

Creator and the steam created once it is poured upon the hot rocks symbolizing the visible prayers of the people rising to the creator and the stones or river rock used in the

ceremony symbolizing the healing power of the earth (Garrett et al. 2011; Mehl-

Medrona, 2010). Herbs and tobacco used in the ceremony are used in a respectful manner through prayer and symbolize the energy of all living things (Garrett et al.). The tobacco smoke symbolizes ones prayer rising to the heavens (Mehl-Medrona).

During a sweat ceremony, there are four rounds. Each round is from the closing of the door to the opening of the door (Mehl-Medrona, 2010). Participants are not allowed to exit the lodge during the round, but may step out or skip a round when the door opens.

The first round honors the Guardian of the West, the second round honors the Creator and/or spirits, during the third round participants listen for positive guidance from the spirits, and the fourth round each person has the opportunity to pray for someone and/or can share a story, joke, or just tell a story (Mehl-Medrona).

Risks of Sweat Lodge

Livingston (2010) reports findings of at least four deaths, all whites, related to sweat lodge or sauna use. Livingston describes one death was an Iowa man who died in a makeshift sauna in 1998, another was an Austrian man who died of dehydration and heat prostration in 2004; and in 2002, a 34 year old woman and 36 year old man died in the

United states in a lodge of airtight plastic. Livingston also reports several recorded deaths in Finnish saunas due to heatstroke, Hashimoto thyroiditis, alcohol use, heart disease, cocaine use, and epilepsy. He points out that sauna use is usually unsupervised whereas sweat lodge use is carried out in a careful manner by an experienced leader and indicates that “no Native American deaths are documented from a sweat lodge” (Livingston, p.

617).

Greater caution is needed for sweat lodge use in substance abuse treatment programs due to withdrawal risks, which include seizures, transient dehydration, heat prostration, dysrhythmias, or alcohol consumption (Livingston, 2010). In addition, individuals in alcohol treatment programs may be taking medication that can increase dehydration or cause drug toxicity during a sweat ceremony. As such, it is important to discuss these risks, hydrate, and educate participants as part of their medical care

(Livingston). Livingston further explains other medications that may increase heat related problems are lithium used to treat bipolar symptoms, and antipsychotic medications.

Furthermore, individuals with unstable angina, of recent myocardial infarction, should avoid sweat lodges.

Colmant (2005) reports sweat lodge causes low-level stress, increased heart rate, fatigue, and pregnant women should not participate or should take caution. Livingston

(2010) also reports that pregnant women should take caution or seek medical advice before participating in a sweat ceremony.

Benefits of Sweat Lodge

Some of the benefits of participating in a sweat ceremony are that bodily toxins are released from the skin, increased body temperature create a hostile environment for bacterial and viral infections, the sweat creates removal of excess salt, toxic metals are flushed out (i.e. copper, lead, and mercury), capillaries are dilated which helps blood flow, and tension and soreness is relieved (Garrett et al., 2011). Furthermore, sweat ceremonies are used for group therapy counseling in prisons, substance abuse treatment

programs, and medical settings (Garrett et al.). Sweat ceremonies do not require movement, which provides an ideal setting for group counseling and psychotherapy.

In a study by Colmant (2005), 85 college students participated in the investigation of the effects of sweat therapy on group therapeutic factors. Participants were randomly assigned to a sweat group (counseling in a sauna) and another group to a non-sweat group

(counseling in an office setting). Twelve groups were conducted in the study: six sweat groups and six non-sweat groups. The therapeutic factors measured in Colmant’s study are Catharsis, Self-Disclosure, Interpersonal Action, Universality, Acceptance, Altruism,

Guidance, Self-Understanding, Vicarious Learning, Instillation of Hope, and

Experiential. Colmant’s results indicate that sweat participants perceived a greater availability of therapeutic factors than the non-sweat group in all areas, especially in the area of Acceptance and Interpersonal Action. Colmant also found that absenteeism was

12% greater in the non-sweat group than the sweat group over the six-session period. In addition, the number of dropouts in the sweat group was one participant in comparison to the nine participants who dropout from the non-sweat group. Colmant used the

Subjective Exercise Experiment Scale (SEES), which measures positive wellbeing, psychological distress, and fatigue. The Exercise Induced Feeling Scale (EIFI) measures positive engagement, revitalization, physical exhaustion, and tranquility. Colmant’s hypothesis that sweat therapy group participants would report higher scores in positive feeling state subscales on the SEES and EIFI than the non-sweat group was not supported in his findings. More revitalization, less fatigue, and less physical exhaustion at the two hour post session were the only positive feeling states that the sweat therapy group

reported higher scores on than the non-sweat group. Overall, sweat therapy groups reported greater therapeutic quality in comparison to the non-sweat group and less absenteeism (Colmant).

Livingston (2010) explains that people with rheumatic disease report improved joint mobility and reduced paid after participating in a sweat ceremony. Livingston also reports that blood pressure is reduced by 10%-20% and repeated participation improves overall cardiac function. Sweat lodge participation can be beneficial for some people who have attention-hyperactivity disorder (Livingston). Livingston recommends that people who participate in sweat lodge ceremonies should talk to the sweat lodge leader if there are any health concerns and those who have moderate to severe health problems should consult with their physician before participating in a sweat lodge ceremony.

Plants/Herbs

The National Center for Complementary and Alternative Medicine (NCCAM) describes that the use of herbal medicine were the first attempts in improving the human condition (NCCAM, 2012). And by the middle ages, thousands of herbs or plants were documented for their medicinal effects. Curanderos use herbs and plants in various ways.

Amerson (2008) describes culture bound syndromes such as susto (fright), caida de la mollera (fallen fontanel), empacho (digestive condition), and mal de ojo (evil eye) are treated with herbs, teas, or massage. Amerson describes that the smoke of herbs, leaves, and bark from various plants are used to cleanse the body of unhealthy emotions.

Herbs and tobacco used in the sweat lodge ceremonies symbolize the energy of all living things (Garrett et al., 2011). Burning tobacco is used as “an agreement based on the

giver of the tobacco asking something of the receiver, which often relates to teaching, help with a particular problem and/or emotional support” (McCabe, 2008, p. 145).

McCabe describes that based on medicine wheel teachings burning tobacco helps unite the body with ones own emotions, and thoughts with spiritual voices. McCabe also describes that tobacco burning is a symbol of “personal integrity and respect for all other creations” (p. 146).

Tafur et al. (2009) describes that plants and herbs are used to treat various ailments. Teas are prepared by boiling leaves, stems, and flowers in water. Ointments are made by infusing herbs into solid oils. Plants are diluted into oils that are used for massage. Capsules are filled with powdered herbs and taken as supplements or to treat ailments (Tafur). Herbal remedies can be prepared at home or purchased at a local herbal market, known as botanicas.

Limpias (Cleansing)

Limpias are rituals performed to restore an individual’s energy or soul retrieval a result of a susto or mal de ojo (Hendrickson 2013). Amerson (2008) describes limpias are used when ailments are a result of unhealthy relationships. The common ritual of a limpia is “the act of sweeping eggs or branches of herbs over the body to cleanse ones of illness, and use of herbal teas, especially an infusion of basil” (Hendrickson, p. 631).

During the sweeping of the egg and plants, the curanderos prays over the individual. The purpose of the egg is to drain off the disturbing power (Baer & Bustillo, 1993).

Curnaderos report that they are not the ones healing, but it is God’s will and God who cures the individual (Hendrickson).

Spirituality

Religion and spirituality play a key role in the practice of Curanderismo. Lopez

(2005) describes that curanderos serve as links with spirits to direct positive and negative forces when helping clients. In a qualitative study by Zapata and Shippee-Rice (1999), female participants reported that faith and prayer had an influence on their folk medicine treatment outcome. Female participants spoke of the role spirituality plays in healing

(Zapata & Shippee-Rice).

Heathcote, West, Hall, and Trinidad (2011) tested the association between religiosity and utilization of complementary and alternative therapy and found that in several conventional and alternative medicine (CAM) Hispanic-specific studies, a variety of traditional healing and folk CAM therapies were reported. The mainstream CAM includes massage therapy, chiropractic therapy, energy healing, megavitamins, homeopathy, and acupuncture. The traditional mainstream CAM includes herbal therapies, home remedies, traditional and folk massage therapies, and use of psychics and traditional healers (Heathcote et al.). Heathcote et al. report that Hispanic-specific studies often fall short in discussing prayer as a CAM practice; however, when studies include prayer in their surveys, prayer was found to inflate estimates of CAM utilization.

Heathcote et al. also describes that prayer was found as the second most common type of alternative medicine utilized by Mexican Americans in Texas and Los Angeles urban

Hispanic participants (as cited in Keegan, 2000; Mikhail et al., 2004).

Sweat Ceremony and Spirituality

Sweat lodge ceremony is designed to benefit people and is a spiritually powerful ceremony. Ceremony begins in silence, which is thought to be the true voice of the

Creator followed by a prayer or chant to the Great Spirit, Mother Earth, the four directions, the spirits, and all relations in nature (Garrett et al., 2011). Moving clockwise from east around to the west during each round, each participant prays for their family, friends, each other, and themselves. The direction of east to west imitates the path of the sun. Participants ask for strength, healing, blessing, protection, forgiveness, or any issues or struggles each person is encountering (Garrett et al.). Each participant prays in the way they were taught and name the Creator they are most comfortable with (Mehl-Madrona,

2010). Songs of prayer, drumming, and rituals are also performed during a sweat ceremony and may slightly vary from region to region. Spirituality involved in the sweat lodge ceremony assists participants to seek harmony and balance with one’s relationships, the universe, and natural environment or mother earth (Garrett et al.).

Gaps in the Literature

The researcher is interested in learning about Curanderismo and the practices used to help Latinos alleviate physical, spiritual, and psychological symptoms. An examination of relevant literature on Curanderismo was presented in this chapter. The literature includes documented information regarding common folk illnesses and common practices used to treat these illnesses. The researcher hopes to provide insight on this cultural practice and contribute more knowledge to practitioners in the medical and mental health field.

People from indigenous populations around the world, including the United

States, are revisiting their ancestral beliefs and practices as a form of maintaining health and wellness (McCabe, 2008). The personal stories shared during the interviews for this study supports the idea that some people are revisiting their ancestral traditions. In this investigation, the researcher found that current literature on Curanderismo is limited. The researcher hopes this study’s findings lessen the gap in the literature, provide beneficial information, and increase cultural awareness and competence among practitioners when working with the Latino population. “Lack of knowledge or understanding of actions by curanderos has contributed to a negative image by many mental health professions”

(Amerson, 2008, p. 386).

A variation of healing practices used among Latinos was discussed in the literature. Some of these practices were traditional methods, western medicine practices, and home remedies. However, the researchers in the literature fail to address whether or not participants communicate their health practices with their practitioners, which may potentially lead to more harm than good.

The study of this researcher is intended to build on the body of knowledge available and help decrease the gap in literature by reporting current and present perspectives of Latinos and their experiences with Curanderismo. The researcher also intends to fill the gap on the lack of communication with practitioners by identifying reasons Latinos fail to communicate traditional practices with their western health practitioners. If practitioners recognize conflicting values, beliefs, and expectations he or she may be able to provide better care for clients of diverse backgrounds. Knowledge

about cultural beliefs and practices will help practitioners build rapport and should be beneficial in establishing a culturally appropriate treatment plan and supportive services.

Effective health care depends on practitioners being knowledgeable and culturally sensitive and knowing folk traditions may provide valuable information for the reform of modern medical practices and health care service delivery (Applewhite, 1995).

Summary

The literature reviewed for this chapter provided information relevant to this research study. The topics discussed include the history of Curandersimo, common folk illnesses, an examination of healing practices used to treat folk illnesses, which include hot and cold theory, sweat lodge ceremony, use of plants and herbs, limpias, and spirituality. This literature review concluded with the gaps in literature and summary of the chapter. In the following chapter, chapter 3, the methods used to conduct this research study are discussed.

Chapter 3

METHODS

Introduction

This chapter includes a discussion of hermeneutic phenomenology followed by a description of the research design. A description of the subjects used for this study is discussed followed by a description of the instrumentation used. Then, the data collection procedures are discussed and followed by the statistical analysis. Finally, a discussion of the protection of human subjects is included and the chapter concludes this with a summary of the methods for this study.

Research Question

What traditional healing practices do Curanaderos use to help alleviate physical, spiritual, and psychological symptoms among Latinos?

Study Design

The qualitative research design used for this project is hermeneutics. In this study, the researcher will work independently and initiate the plan for the study, facilitate the interviews, and oversee the entire project. The researcher is the primary instrument of qualitative research design (Saldana, 2011). In general, qualitative research attempts to explore the quality of something or individuals experience in the attempt to discover new meaning (Dudley, 2010). In qualitative studies, the primary focus is to fully understand the participants experience through their narrative; as such: standard data collection is not important in qualitative research (Dudley, 2010). An advantage of using qualitative study

instead of a quantitative study in this research is that social concepts can be better- explained and understood through language or words vs. numeric measures.

Through this qualitative research, this researcher’s goal is to relate the experience of participants for a better understanding of this cultural practice of Curanderismo within the

Latino community. However, it is important to note that not all Latinos believe in

Curanderismo and some may not have any knowledge of this traditional healing practice.

Hermeneutics Phenomenology research attempts to gain a deeper understanding of individual’s life experience. Laverty (2003) describes hermeneutics phenomenology and specifies that it is “concerned with the life world or human experience it is lived”. In this hermeneutic study, this researcher explores the experiential narrative of the participants for a deeper understanding of Curanderismo and this human phenomenon.

The purpose of this hermeneutic study is not to examine the specific lives of the participants, but rather to find the commonalities of their collective experience and their perceptions (Saldana, 2011). Their experiences and perceptions will be documented thematically based on their statements and commonalities.

The primary data collection method for this study is a one on one face-to-face interview with each participant. This researcher explores a deeper understanding by starting each interview with one interview question and uses a probing strategy throughout the interview to search for deeper meaning and understanding of the participant’s experience. The results of this study will provide useful information about

Curanderismo traditional healing practices in the Latino community and provide cultural insight to medical and mental health professionals.

One of the strengths of qualitative research design is that it allows for more flexibility than quantitative research. The approach in this study is holistic and the topics of the research are not identified prior to the study, which allow an exploration of topics brought forth by participants. During the interview process, the researcher elicits data using a naturalistic approach through conversation. Qualitative research is beneficial in this study because it will provide information about a particular group of people and provide a better understanding of some cultural practices among Latinos.

Qualitative design also has weaknesses to consider. One of the main weaknesses is that there is no such thing as being neutral, bias free, or objective in any study

(Saldana, 2011). As such, the researcher may have biases and beliefs that may influence the interpretation of the data. Since qualitative studies are subjective, it is important for the researcher to practice mindfulness and not allow her thoughts to influence the interpretation of the participant’s narrative and should avoid making any assumptions during the research process.

Study Population

The study population will be Latinos who have personal experiences with curanderos or have sought out curanderos for healing purposes. Practices may include ceremonies, massage, spiritual cleansing, counseling, and/or herbal treatments. The study is conducted in Northern California region, primarily in Sacramento County and Yuba

County. The participants interviewed for this study reside in Sacramento and Yuba

County.

Sampling Population

A snowball sampling design technique was used in this study. The researcher contacted individuals who have received services from Curanderos and scheduled interviews. After each interview, this researcher asked the participants for recommendation of other individuals whom they know that have sought out services from

Curanderos and who may me willing to participate in this study. For the purpose of this study, ten case studies will be used for the statistical data analysis. By having at least ten participants in this study, the findings may insure more credibility and saturation of the data (Saldana, 2011).

As with any study, there are strengths and weakness to using a sample population.

The strengths of this population are that they will provide a first person account of their own experiences and perceptions of Curanderismo. Their narratives will provide themes and topics of their own accounts and not topics selected by the researcher. Some of the weaknesses of working with a small sample population are that some experiences are not current experiences with Curanderismo. Some of the narratives are stories of childhood experiences or experiences over ten years ago; as such, their recollection may exclude important details of Curanderismo.

In qualitative studies, a large sample size is not required since it focuses more on the richness or content of the data. As such, one of the strengths is that a small sample size can be used to generalize the findings to a larger population.

One of the weaknesses about this sampling population is that the group of people needed for the interview is difficult to identify. Once identified, the researcher has to earn

their trust and respect in order to be accepted in their community and be allowed to interview participants.

Instrumentation

The researcher is the primary instrument in this research study. Through phone contact, the researcher spoke with each participant and scheduled one on one face-to-face appointment. Upon meeting each participant, the researcher spent time building rapport with each participant prior to starting the investigation.

During each interview, an audio recording device was used to record the interview. Each recording was assigned a number prior to the beginning of each interview to protect the participant’s identification. If a participant was not comfortable with being recorded, permission was asked to take notes in lieu of the recording. Recording devices are ideal to ensure accurate records and are more reliable than note taking; however, it was provided as an option if the participant appeared uncomfortable with being recorded.

The researcher was prepared with note pad and pen in case the participant opted out of the recording.

Each interview took place in a non-structured setting: coffee shop or participant’s home. During each interview, the participant and researcher were the only people involved in the interview conversation.

A questionnaire was used to collect demographic information and coded with a number as an identifier. Each questionnaire coding number coincides with the corresponding number identified in the recording of each participant. The question of inquiry for each participant for the interview was, “What was your Curanderismo

experience like or tell me about your Curanderismo experiences?” Throughout the interview, probing questions were used to seek further exploration of their experience with Curanderos. Each interview ranged from 10 – 15 minutes.

After each interview was completed, the researcher transcribed each audio recording on a WORD document on her computer. Each document was identified with the coded number used in each recording. The transcription was used for the statistical analysis of the study.

Validity and Reliability

Dudley (2011) defines validity as “ a standard that determines whether an instrument measures what it is supposed to measure and whether it measures it accurately” (p. 91). Dudley also defines reliability as “the internal consistency of the measure” (p. 93). For a study to be reliable, the instrument should measure the same concept consistently from time to time and consistently among different people (Dudley,

2011).

To determine how valid and accurate the data is, the researcher should view the data with skepticism. Dudley suggests that one of the final stages of the analysis should include challenging the validity by asking some of the following questions: “Was the data solicited of volunteered?”; “Are the findings direct or indirect data?”; “Who, if anyone, was present may have influenced the views the participant shared?” (p. 265). The narratives are accounts of lived events by the participants and are considered to be valid or true based on their experiences and found to be credible.

Since the researcher is the primary instrument used for this qualitative study, in order to provide valid and reliable information, it is important for the researcher to practice mindfulness throughout the research study, view the data with skepticism, and challenge the validity of the qualitative data. Since common themes were discovered from the narratives shared by the participants, the findings are recognized to be reliable.

Data Collection Procedures

The data collection approach used for this study was unstructured one on one face-to-face interviews with the participants. This researcher contacted potential participants that fit the criteria of the study population and the purpose of the study was explained to them. An appointment was scheduled with each participant at his or her choice of location, preferably in a public location (i.e. park, coffee shop, etc.). Upon meeting with each participant, the interviewer spent a few minutes building rapport with each participant.

During each interview appointment, this researcher gave a consent form to the participants and reviewed the consent for. If the participant agreed to participate in the study, s/he signed the researchers informed consent and a copy of the consent form was given to the participant for his/her records. The consent form explains the participant’s rights to confidentiality, purpose of the study, instrumentation procedure, risks and benefits, and contact information of the researcher. The consent form was written in both

English and Spanish in case participants were monolingual. The researcher conducted the interview in Spanish if the participant was monolingual.

During each interview, one question was asked to the participant, which inquires on “what their Curanderismo experience was like.” Throughout the interview, probing questions were introduced to obtain a deeper understanding of their experience, for clarification, and/or elaboration on their narrative. An audio recording device was used to record the interviews and each recording was assigned a number prior to the beginning of the interview. In addition, a demographic sheet was completed by each participant, and numerically coded with the same number assigned for each recording. The audio recordings were later transcribed and analyzed for a deeper understanding of their

Curanderismo experience. If the participant did not appear comfortable with the recoding, the researcher asked permission to take notes of the interview. One participant opted out of the recording, but agreed to allow the researcher to take notes of the interview.

Data Analysis

For the statistical analysis, each individual’s case was transcribed on to a WORD document. This researcher printed the transcriptions and color-coded the data with colored highlighters. The data highlighted were key words or phrases that had similar themes. A label or theme name was given to each category and organized on a spreadsheet. In qualitative studies, statistical frequency of occurrence becomes an important measure and broken down into themes (Saldana, 2011). Specific themes were explored and the most frequent and relevant themes were identified. These themes were explored and described thoroughly for deeper insight, meaning, and understanding of the

Curanderismo experience and/or how the themes are interrelated with each other. The description of each individual’s interview, allow for a more meaningful understanding of

this phenomenon and provide insight of the Latino culture and their experiences with traditional healing.

Dudley (2011) summarizes the stages for thematic analysis as follows: “1)

Determine the unit analysis; 2) Prepare the narrative; 3) Acquaint yourself with the entire narrative; 4) Identify themes; 5) Assign a code to each theme; 6) Record impressions separately; 7) Group comments together; 8) Articulate label for each theme 9) Identify variations in each theme; 10) and Present results” (p. 258). For the purpose of this study, this researcher used these stages for my thematic analysis. Each transcribed narrative was assigned a code number. Once acquainted with each narrative, themes were highlighted and selected. A label was assigned to common themes and organized on a spreadsheet.

This researcher grouped specific common comments pertaining to each theme, which were analyzed. During the analysis of the content, this researcher identified variations in themes and whether they were presented in different or contrasting ways, or positive versus negative perspectives.

In the results of this study, common themes are listed, which include examples or comments from the narrative. The results also include my impressions of the findings and recommendations supported by the results.

Protection of Human Subjects

This researcher submitted an application for human subjects review and received approval for “exempt risk” level from the California State University, Sacramento

Human Subjects Committee on November 26, 2012.

The participation of the participants was strictly voluntary and the participants were allowed to withdraw from the study at any time. For confidentiality purposes, the audio recordings for this study were identified by numbers, kept in a safe and secure place, and will be destroyed after the study is completed and approved.

Summary

In this chapter, the researcher discussed the study methodology, which included the research design, study population and sample population, instrumentation, data collection procedures, statistical analysis plan, and protection of human subjects.

Chapter 4

DATA ANALYSIS

Introduction

Interviews were conducted with eleven Latino participants in Sacramento County and Yuba County. All eleven participants had personal experiences with Curanderos or traditional healers. The purpose of this study is to gain a deeper understanding of

Curanderismo among Latinos. The participants were asked one question: What was your

Curanderismo experience like or tell me about your Curanderismo experiences? During each interview, the researcher asked probing questions to seek a deeper understanding of

Curanderismo. Four main themes emerged from the interviews: 1) Spirituality 2) Use of

Plant/Herbs 3) Sweat Lodge/Temescal 4) Cleansing/Limpia. This chapter includes a discussion of each theme and quotes from the interviews will be highlighted. To protect the identity of the participants in this study, fictitious names will be used.

This chapter will first include demographic information about the participants who participated in this study. Second, a detailed exploration of the responses given by participants will be discussed, which include common themes.

Demographic Data of the Participants

For the purpose of this qualitative study, the researcher wrote the informed consent forms and demographic forms in Spanish and English. Participants were given the option to choose and complete either the Spanish or English demographic form and consent form. The interviews were administered in either Spanish or English, based on the language preferred by the participant.

The demographic form designed for this qualitative study contains four questions, which help establish demographic information about the participant. Eleven participants participated in this qualitative study. Interviews were conducted in Spanish for the three participants who choose to complete the Spanish demographic and informed consent forms. Three participants identified as male and eight as female. The participant’s age ranged from 28 to 80 years of age (see Table 1). Ethnicity follows with one self-identified as Hispanic; one as Indigenous Otomi; one as Latino; four as Mexican; one as Mexican

Indian; one as Native American Chichimeca; one as Mexican American; and one as

Mexica. Ten of the participants reside in Sacramento county and one in Yuba county.

Table 1 Demographic Information

Demographic Information Gender 3 male; 8 female Age 62, 58, 47, 32, 46, 28, 80, 41, 56, 34, 36 1 Hispanic 1 Indigenous Otomi (peoples of central Mexico) 1 Latino 4 Mexican Ethnicity 1 Mexican Indian 1 Native American (Chichimeca – Nahua peoples of Mexico) 1 Mexican American 1 Mexica – Nahua peoples of Mexico 10 Sacramento County County of Residence 1 Yuba County

Specific Findings and Interpretation of the Findings

The participants from these interviews provide insight to the folk traditions of

Curanderismo through their personal stories with curanderos or traditional healers. After

analyzing the data, four main themes emerged from the interviews: 1) Spirituality 2) Use of Plant/Herbs 3) Sweat Lodge/Temescal 4) Cleansing/Limpia. The following discussion includes direct quotes from participants relevant to each theme. All participants were given a pseudonym.

Spirituality

Spirituality is a dominant theme and a strong foundation in the practice of

Curanderismo and traditional healing. Western psychotherapy is a common practice in the clinical setting, but it is limited in addressing the spiritual needs of people (Comas-

Diaz, 2005). Hoogasian and Lijtmaer (2010) indicate that psychoanalytic practices have struggled with spirituality since the beginning and that the boundary between psychological disorders and spiritual practice is complex (as cited by LaMothe, 2003;

Carr, 2000). “Mexican traditional healing has been used effectively throughout the generations, many Western therapist continue to have hesitancy in drawing from these clients’ spirituality” (Hoogasian & Lijtmaer, 2010, p. 299). For these reasons, Western therapy and practices may increase uneasiness and discomfort in the clinical setting for both the practitioner and client when the discussion of spirituality arises.

Kiev (1968) describes that in the Latino culture reliance on prayer is one of the first methods used to help reduce anxiety and has an effect in comforting patients. Kiev further explains that the engagement of prayer gives the patient a meaningful and complex activity to focus on which lessens the patient’s concentration on his/her ailments and/or problems. The use of religious forces and power of prayer by healers would appear favorable to Latinos (Kiev). Luz’s story is an example of the power of prayer and

her reliance of prayer to comfort her and support her mother during a stressful period in her life. Luz shares “After the limpia (cleansing) say a prayer…while making the sign of the cross with the eggs…I repeated this three different days and prayed Our Father. I had fear, but have a lot of faith in God. I could not believe she got better after that. How?

After that I began to have a lot more faith in God and alternative healing.”

Luz holds a strong belief in her faith and God’s will to heal her mother. It is not uncommon for Mexican Americans to place faith in God’s will. Loved ones help support change by being actively involved and supportive through prayer (Hoogasian & Lijtmaer,

2010), which is the case with Luz and her mother. Trotter et al. (1997) describe two biblical foundations for folk healing. First is healing through divine intervention. Second is the healing power of faith in God and in prayer. Like Luz, all participants in this study expressed faith in God or the creator and/or the power of prayer as an intervention for healing. Joe shares a similar story when he met with curandera Doña Maria:

You are going to take your uncle and pray for those who have caused

harm to him… I prayed about it, I went to sweat and prayed about

it…took care of my doubts, took care of my fears, took care of the past,

and all of that. We finally did three days of limpias (cleansing), praying

over him.

In this example, Doña Maria believes someone wanted to harm Joe’s uncle, which explains his illness. Trotter at al. (1997) describe that curanderos recognize and treat illnesses brought by supernatural forces or malevolent spirits. Trotter describes curanderos believe in the existence of good and evil or God and the Devil, which

influence the destiny of individuals. Doña Maria also displays compassion by asking Joe to not only pray for Joe’s uncle, but also for those causing harm or evil will upon him.

Huber (2001) describes that those who have the power to heal also have the power to harm. Huber indicates that traditional healers also have professional ethics as doctors do.

In Joe’s experience, Doña Maria displays her ethics and will to heal and not cause harm.

Her display of compassion will help her clients develop trust in her and her practice.

Curanderos also know how to manipulate the forces of the good and evil powers by using their knowledge in materials (amulets, plants, herbs, candles, etc.), spiritual, or psychic healing (Trotter et al.). Saul gives an example of how materials were used in manipulating his aura and how prayer was used to dispel negative (bad, evil) energy.

My grandmother and people south of the border use Pirul (American

pepper or Peruvian peppertree) and what they do is take the branches of

pirul and pray over you with the branches to manipulate your aura…the

prayer varies on whether you are trying to dispel negative energy of attract

positive energy or you’re doing both because sometimes you want to

dispel the negative energy, thoughts, or emotions the person is exhibiting

so you want to say prayers …because prayer is one of the most important

aspects of traditional healing and Curanderismo.

Trotter et al. (1997) describes that certain materials can emit or absorb vibrating positive or negative energy: positive energy can cause happiness, good, and good luck whereas the negative energy can cause sadness, evil, or bad. This positive or negative energy can affect the individuals well being. Curanderos use material objects to

manipulate the person’s energy or aura and help restore the individual’s health (Trotter et al.). Saul provides insight on how his energy was manipulated to either dispel negative energy or attract positive energy. Saul also addresses the importance of prayer in this ritual.

“Social workers need to understand the importance of both religious institutions and folk healing traditions when working with Latino populations” (Hutchison, 2008, p.

213). It is also important to note that indigenous spiritual traditions among First Nations people have persisted and currently are being restored and revitalized (Hutchison). Nora provides an example of the overlap in traditions between religious institutions

(Catholicism and Christianity) and Native American or indigenous spiritual traditions:

…when you go to Doña Queta (Native American healer from Mexico),

she prays ‘Our Father’ and mixes Masateco (indigenous language) with

Catholic, which is a lot of what happens in Mexico. Here, when you go to

the Native American traditions, it’s more about creator and your

relationship with the elements and the spirits…I come from a Yaqui

family in Mexico. It’s interesting in that sense of prayer in Catholicism

and Native traditions is so endowed in ourselves as being Mexicans.

Coming here, the Native Americans have also that mix of Christianity and

Native.

Nora provides an example of the mezcla (blending) between Mexican, European, and Indigenous traditions. Hendrickson (2013) describes, “Mexican Americans have

Native American heritage that predates Spanish colonization (p. 628). The ethnic

demographics of this study support the fact that some Mexican people identify as Native

American or as Indigenous peoples of Mexico. Nora reports her family is Yaqui, but she did not identify as Yaqui on the demographic sheet, she identified as Mexican. Other participants from Mexico identified as indigenous (Otomi, Chichimeca, and Mexica) as their ethnicity. This information is crucial in the field of social work and a good example of why clinicians should not generalize information, but instead should build rapport and understand each client’s background and history. Nora not only provides great insight on the overlap of cultures but she also provides insight on variation of prayer and overlap between Catholicism, Christianity, and Native American Church.

Use of Plant/Herbs

The use of prayer, plants, and herbs is fundamental in the practice of

Curanderismo. Literature and the findings of this study support the importance of prayer, plants, and herbs in the various rituals used in Curanderismo for healing purposes and wellness maintenance. Perrone, Stockel, and Krueger (1989) discuss that when the settlers first came to the Americas, the tradition of healing with herbs was shared freely because it was a natural gift that mother earth had to offer. Curanderos make teas out of leaves, bark, roots, or flowers to alleviate symptoms and will occasionally make ointments by mixing powder forms of herbs with oils (Kiev, 1968). Kiev describes that curative properties are attributed to the herbs; however, it is often believed that it is only effective when associated with prayer when given.

Easom (2006) also discusses that home remedies are often used and are perceived to be less expensive than prescriptions dispensed by medical pharmacies. Easom

describes that Hispanics use folk remedies and folk healers because mainstream health care providers fail to address spiritual aspects and prescribed medication is not natural (as cited by Zapata & Shippee-Rice, 1999). Easom also found that folk remedies include the use of teas and natural herbal substances for treatment of ailments and maintaining wellness along with prayer and spiritual practices.

Curanderos primary use of herbal interventions is to help restore balance. An imbalance can be caused by physical or emotional fatigue, unhealthy or problems in relationships, or a sudden change in temperature, such as going outside with your hair wet in cold weather or stepping on a cold floor (Tafur et al., (2009). Saul states, “I went to my doctor and they said it was stress and they didn’t do anything more.” Saul provides a good example of an imbalance in his health caused by physical and emotional fatigue.

Since Saul did not receive further treatment by his doctor, he decided to go to a local herbalist for treatment. Saul shares this story and draws parallels between western and alternative medicine:

Herbs, we always took as kids, for stomachaches, colds, flus and anything

that ailed us. I started meeting an herbalist who worked on that kind of

healing, it wasn’t foreign to me…Herbalist is the same as going to the

pharmacy. Pharmaceuticals are plant based or plant derived medications

so that’s a parallel there…what I did was go to an herbalist, a Mayan

woman here in Sacramento.

Nora shares a similar story as Saul’s and her experience with an herbalist:

I’ve always dealt with herbs…I try at all time to heal myself with herbs. I

usually go to the doctor to find out what I have and then I search for my

herbs...I get my blood test then I can go with my herbalist…I believe in

the herbs and believe that doctors are good for bones, surgeries, but the

rest I can take care of for health and self-healing.

Herbs are important in Mexican American folk medicine, but should not be confused with the art of Curanderismo and there are curanderos who specialize in herbs and are known as yerbero or yerberas (herbalist) (Trotter et al., 1997). Saul and Nora share their positive experience with the use of home remedies and the use of their herbalist as resource in their community. It is also important to understand that there are plants and herbs that can cause more harm than good and/or can adversely interact with prescribed medication.

When I interviewed Beatriz, it was clear that she had a lot of knowledge in the use of home and herbal remedies. She was very familiar with the use of herbs and plants grown in the region of Mexico where she was raised. She shares her story and knowledge of herbal treatments, but also points out the dangers of certain plants. She states that,

“there are dangerous plants that can kill you. Toloache (a hallucinogen plant) can cause you to go crazy”. Huber (2001) describes that the use of hallucinogenic substances by curanderos was common and kept secretive. The use of peyote, hallucinogenic plant, was condemned for the Chichimec people and people living in the central area of Mexico during the 1620 Spanish Inquisition (Huber). The use of peyote for spiritual ceremonies has since been a controversial issue and peyote laws have passed allowing the use of

peyote for spiritual ceremonies. The American Indian Religious Freedom Act was amended in 1994 to allow the use of peyote by Indians for religious and other purposes

(American Indian Religious Freedom Act Amendments of 1994, 2006). Individuals ingesting substances should use caution and/or consult with their physician about these types of cultural practices.

Use of home remedies is another common use plants and herbs among Latinos.

Home remedies include special diets that take into account properties of the hot and cold theory. Tafur et al. (2009) as cited by Avila describes, “people are encouraged to eat foods that are hot or cold in essence, not in temperature, in order to maintain equilibrium in the body to regulate the amount of heat or cold” (p. 84). Beatriz describes a special diet that was prescribed by her great, great, great grandparent who was a curandero in her village, “I had to drink hot water all afternoon up until the afternoon the following day. I had to drink Chalalate (tree trunk shred) tea for three days…The diet lasted for three days”.

Whether the use of plants an herbs is through an herbalist, spiritual ceremony, or home remedy, it is important to note that some herbal remedies may have serious side effects or may adversely interact with prescription medication. As such, it important for individuals to consult with and their health care provider if natural substances are being consumed (Tafur et al., 2009).

Sweat Lodge/Temescal

The sweat lodge ceremony is a spiritually powerful ceremony. The sweat lodge is a sacred place for physical and spiritual cleansing and “is considered to be one of the

most spiritual elements in traditional healing” (McCabe, 2008, p. 148). The sweat lodge allows an individual to get in touch with oneself; it helps individuals with personal problems, allows individuals to experience deep emotions, allows individuals to have a clearer perception on personal issues, and encourages belief in the community (McCabe).

From a Native perspective, the purpose of sweat lodge ceremonies is to keep oneself in good relations with oneself, friends, family, community, environment, or the spirit world

(Garrett et al., 2011). Joe shares his story about keeping himself in good relations as said,

“I talked to Rob and told him I need to sweat, I need the ceremony. The very next day a lot of my friends came out to support me, even the friend who I chewed out came… My other friends supported me and loved me but they were like you’ll get over this, it will pass…So I had to acknowledge him and tell him ‘thank you’ and apologize…We had other sweats to address my relationship with C, N, my parents, my sister, people who I done bad.” In this example, Joe worked on rebuilding relationships with those he did wrong in the past and also worked on other relations inside the sweat ceremony.

Mehl-Madrona (2010) explains that those who lead a sweat lodge ceremony understand the responsibility of their role as a leader and know not to take a ceremony beyond their capability. Saul shares his story and explains that he has a sweat lodge in his back yard and has lead ceremonies for the past 35 years:

The sweat lodge is some kind of a structure that is covered so it can be

made dark. We heat rocks outside and we have analter. We take the heated

rocks inside and we use herbs on top of the heated red rocks so the herbs

do what I said earlier about limpias, they dispel negative energy, and then

we poor water over the rocks and that produces steam, which is really

cleansing and we pray and sing songs and we do other kinds of work in

there, traditional healing work.

Sweat lodge ceremonies include a combination of extreme heat exposure combined with counseling and group support (Garrett et al.). The sweat lodge ceremonies honor transformation, reflection, and healing. Participants in this study report participating in sweat lodge ceremonies for various personal reasons: maintain wellness, restore balance, prayer, and connection with oneself or others, and seek guidance). Lisa shares that she attends sweat lodge ceremonies for several reasons, “It is for healing and for the connection. It’s almost like going to church in some ways…Usually when I feel like I need to go it is because I’m not feeling good, I’m not doing well, maybe I’m really stressed, or whatever… I think I use it more as a way of taking care of myself”. Lisa’s main purpose for attending sweat lodge ceremonies is for wellness and maintaining balance in her life.

Nora shares a similar story, “I run a sweat lodge and I participate…It’s about self- cleansing and maybe a connection with creator, but not because I need that person, but my own connection, and I think this person (leader, water pourer) is just being the door for my connection.” Nora, who also runs the a sweat lodge, shares that many people who attend sweat lodge ceremonies are in recovery from alcohol or substance use. She said,

“The people that come to the sweat lodges are in alcohol and drug recovery. They do come with the realization that they have to connect with creator so you are only the server, the provider of the songs, and of the space, but that’s a good thing. I feel they

understand I’m just the facilitator.” Application of sweat lodge ceremonies has been used for many Native and non-Native clients as a way of mending a broken circle (neglect of traditional ways) that result in disease, such as alcohol and substance abuse (Garrett et al.). There are reports that sweat lodge ceremonies have proven to be effective among inmates who were enrolled in a substance abuse treatment programs (Garrett et al,

Livingston, 2010). Joe indicates his experience in the sweat lodge is “like making amends, like an Alcoholics Anonymous program. I had to face a lot of things I have done in the past.”

Sweat lodge ceremonies are also used to reconnect with give thanks and reconnect with ancestors. Alma shares that her primary reason for participating in a sweat lodge ceremonies is to reconnect with her ancestors “ceremonies are used to help ourselves, to show gratitude to our ancestors, and remember them. That is a way of healing, to have the nostalgia of our ancestors, to still have their presence, because we believe that they are still with us. We connect with them through prayer or spirituality. This helps us stay in harmony and balance.” Alma’s use of the sweat lodge is primary to reconnect with her ancestors, which is a way for her to keep balance in her life and appears to be a form of self-care and maintenance of wellness.

Henry shares a similar story as Alma, but also points out that he felt some form of guidance through his sweat lodge experience. He shares, “The goal is to bless you and guide you while you figure out what’s going on for you so it’s different for everyone…you feel connected to something…I felt guidance while I was going through

my experience even though I knew it was just me…For me it would only come from a spiritual level…I felt vulnerable.” Henry reports feeling a spiritual connection to something, but couldn’t explain what that something was. It appeared like he was looking for answers and guidance during a stressful point is his life. The sweat is an experience of inner thoughts and feelings (Bucko, 1998).

Bucko (1998) describes that a good sweat is one in which harmonious relations are established and maintained. The sweat lodge is a place where personal work is done through prayer, songs, narratives, and humor (Bucko). Although it can be physically challenging due to the heat, it is a place where healing and self-care takes place.

Although each participant shared different stories and purposes for attending the sweat lodge, their outcome appeared to be positive. Many continue to attend and it is a part of their lives for maintaining wellness.

Cleansing/Limpia

The purpose the limpia ritual is to have the soul return to the body naturally and restore balance. There are various rituals used for cleansing in Curanderismo, such as the sweat lodge, but one common and favorite method curanderos use for limpias is to rub the patient’s body with an egg. The egg is believed to absorb negative energy or intruding pain (Kiev, 1968). Hendrickson (2013) describes a limpia as “the act of sweeping eggs or branches of herbs over the body to ‘cleanse’ one of illness, and the use of herbal teas, especially an infusion of basil” (p. 631). Huber (2001) describes a limpia as cleansing that is aimed to withdraw airs. These airs are known to be an invisible being that invade the body. Hendrickson describes that limpias affect energy in the body around the

chakras (body’s energy centers) and aims to bring a degree of balance back around the chakras. For this reason, it is beneficial to repeat limpias because chakras improve over repeated sessions. This may explain why Luz was instructed to repeat the limpia ritual in three different days. “He instructed me to get two eggs and put copal (hard aromatic resin obtained from tropical trees) on both sides of your mother (participant points to her right and left side) and sweep the egg over her body: hands, arms, chest, thighs, and legs.

Then, put a glass of water next to the copal. After the limpia (sweeping of the eggs), say a prayer while making the sign of the cross with the eggs…I repeated this three different days and prayed Our Father.” Not all curanderos will refer to the field of energy as chakras, but their work primary focuses on the manipulation of positive or negative energy (Hendrickson, 2013). Use of a chicken egg is common among the Nahua people of Mexico and people from the central region of Mexico (Huber, 2001).

The limpia rituals range from Native belief to those based on Christian beliefs

(Huber, 2001). The primary act of cleansing is to pass ritual objects, which vary from culture to culture, around the body to attract or absorb the illness (Huber). Linda describes her experience, “she cleansed my spirit, so with that she said some prayers starting from my head then she went to my toes and then she used the herbs, sage. She said her prayers and asked God to give me my soul back and kind of let me be me…then she cracked the egg and put it in the water and there was green stuff coming out and she said it was negative energy…” Herbs and branches are commonly used in limpias and

“symbolize cleaning, since branches of other plants are used daily to sweep the houses and to clean the skin in a sweat bath” (Huber, p. 86).

The limpia purpose and experience is different for every individual. Nora describes her limpia as a spiritual cleansing. She describes, “It was a healing of your spirit, not so much that we were physically ill…She had herbs, she had flowers, and she burned the smoke, and she had the regular egg…she would first clean you with the herbs and then put the egg in the middle and then she would pass them all over your body, from top to bottom and all around and the she would ask you to break the egg, then she would read the egg…She would talk about, you know, you feel like there is sorrow in your heart, or I feel that everything is going good in you life.”

Summary

In this chapter, the researcher provided demographic data of the participants and demographic information. In addition, the specific findings of this study are discussed, which include information on the top four themes: spirituality, use of plants/herbs, sweat lodge/temescal, and cleansing/limpias. In the next chapter, conclusions and recommendations are described, including the limitations of this study, and the implications for social work practice and policy.

Chapter 5

CONCLUSIONS AND RECOMMENDATIONS

Introduction

In this chapter, the researcher will discuss the conclusions found in this study. It includes a discussion of the themes that emerged from this study: spirituality, use of plants/herbs, sweat lodge/temescal, and cleansing/limpias. This chapter will also explore recommendations, the limitations of this study, and the implications for social work practice and policy

Conclusions

The information provided in this study offers information about the Curanderismo experience among Latinos. This information provides valuable information in regards to the Latino and Native American cultures and the importance of traditional practices.

Tafur et al. (2009) discuss that cultural barriers is one of several theories that explains why Hispanics are underrepresented in healthcare. It is important for social workers and professionals to explore and educate themselves on the diverse cultures and be more effective service care providers. The main themes that emerged from this study, as the common practices of Curanderismo are spirituality, use of plants/herbs, sweat lodge/temescal, and cleansing/limpias.

In terms of spirituality, participants identified that prayer and the belief in God or the creator are important factors in the healing process and foundation of Curanderismo.

The participants in this study also identified their involvement in the healing process of a loved one, through prayer, participation of a ritual for a family member, or support during

a sweat lodge ceremony. In Curanderismo, it is believed that God influences healing and that loved ones support change through prayer and by being actively involved

(Hoogansian & Lijtmaer, 2010). It is important for helping professionals to understand the importance spirituality when working with the Latino population and be aware of traditional healing practices.

In terms of use or plants and herbs, participants identified that it is not uncommon to use natural substances to help alleviate symptoms or as part of a ritual or ceremony.

Lopez (2005) cites Trotter and Chavira and describes that the use of medicinal herbs by curanderos is a form of primal chemotherapy. Home remedies and use to teas is prominent and often a part of the Latino’s daily diet for healing or maintenance of wellness. Herbs, plants, and flowers are also an important part of cleansing rituals including sweat lodge ceremonies. It is important for helping professionals to be aware of the use of natural substances during the screening process, especially if individuals are ingesting natural substances as they may cause adverse affects with prescription medication.

In terms of sweat lodge ceremonies, participants report participating in sweat lodge ceremonies for various reasons. The sweat lodge ceremony is spiritually powerful and is designed for the benefit of people (Mehl-Madrona, 2010). The main purpose for sweat lodge ceremonies is to be in good relations with oneself or others (i.e. friends, family, creator, God, spirits). People also attend sweat lodge ceremonies to maintain balance and wellness, for cleansing purposes, seek guidance, ask for thanks and forgiveness, or to reconnect with ancestors. During sweat lodge ceremonies, individuals

in attendance provide support and prayer for themselves and loved ones. The sweat lodge ceremony is known to be curative in its healing techniques and aims to strengthen people

(Mehl-Madrona). Participants in this study report positive experiences regarding their participation in sweat lodge ceremonies.

The last theme to emerge is the ritual of limpias/cleansing. This common cleansing ritual identified by participants is used to help restore balance or to have the soul return to the body. Most limpias include the use of an egg, herbs, oils, candlelight, laying of hands on the client, and prayer (Lopez, 2005). The egg is believed to absorb negative energy thus helping restore balance. As with other practices, prayer is also an important part of limpias. The cleansing rituals vary from region to region; however, the purpose and concept is similar with regards to restoring balance and healing individuals.

The themes extracted from this study are consistent with the findings of other studies and review of literature. This study is intended to help social workers or other helping professionals improve their insight and understanding of Curanderismo or the practice of folk traditional healing. Although the findings of this study cannot be generalized among all Latinos, the information is beneficial in bringing cultural awareness to this topic.

Recommendations

This researcher will discuss three areas of recommendations as a result of this study: future research, helping professionals, and agency policies.

Future Research

The results of this study indicate that further exploration is needed in

Curanderismo, as limited literature resources are available. The results of this study found that there are benefits in Curanderismo based on the discussion by participants; therefore, future research on the risks of benefits of Curanderismo could shed more light on this cultural practice. In addition, based on the findings of this study, future research on therapeutic modalities, practice approaches, or indigenous techniques would benefit the

Latino community. For example, the use of the sweat lodge ceremony has proven to have benefits for individuals in treatment programs for alcohol and other substances (Garrett et al., 20110; Livingston, 2010; Mehl-Madrona, 2010).

Helping Professionals

The findings of this research indicate that individuals sometimes fear to share information with their practitioners or withhold information. One of the recommendations for helping professionals is to develop skills to help build the practitioner-client relationship, which is known to be a factor in the healing process.

As helping professionals, it is impossible to have complete knowledge and fully understand the cultural background of all clients, but skills can be developed to be more effective practitioners. Barrera and Corso (2002) discuss that the key aspect of cultural competence is cross-cultural communication and learning information about others.

Barrera and Corso explain that practitioners can find it overwhelming and unrealistic to learn everything there is to know about all the persons they interact with, especially when families participate in multiple cultures. Barrera and Corso provide information on skilled dialogue in helping practitioners achieve cultural competence. Skilled dialogue is broken up into three qualities respect, reciprocity, and responsiveness: respect is defined as the

awareness and acknowledgment of boundaries between persons (i.e. physical, emotional, cognitive, and spiritual boundaries); reciprocity helps build respect by balancing the power between the practitioner and client by trusting that the interaction and experience of each individual is of equal value; responsiveness allows others to uncover who they are rather than the practitioner shaping them (Barrera & Corso). Being mindful of these three skilled dialogue qualities will help build trust and rapport with individuals of diverse cultural backgrounds; hence, help in the development of practitioner-client relationships.

Agencies

Western mental health service delivery focuses on individual rather taking into consideration the family and community as a whole. A recommendation for agencies is to use a holistic approach when working with the Latino population. Community and collectivism are integral parts of the healing process for Latinos and it is important to learn about the role and meaning of the various systems (church, family, community, group, individual, etc.) that surround the client’s life (Hoogasian & Lijtmaer, 2010).

Mexican Americans value interdependence and rely on the support of their family or community and are comfortable with the institutionally defined dependency role (Kiev,

1968). Developing therapeutic programs using modalities that are traditionally familiar to

Latinos may help increase their motivation to seek assistance and increase their participation in treatment programs. Agencies should engage in collaborative activities, health education, and preventive services with local Latino services agencies.

Limitations

There are several limitations to this study since it is a qualitative study. First, this research is limited because of the small sample size. As a result of the small sample size, the findings cannot be generalized to the greater population at large. In addition, the participants reside in only two counties of Northern California; therefore, their experiences may differ from the experiences of other Latinos who reside in communities where Curanderismo is more prevalent (i.e. border towns of Texas or New Mexico).

Second, biases may emerge from this study because the researcher transcribed and interpreted the data. Third, the study involves subjective information because the study focuses on the experiences, perceptions, and personal knowledge of Curanderismo.

Finally, since some of the interviews were administered in Spanish, transcribed, and translated to English, language meaning may get lost in the translation process.

Implications for Social Work Policy and Practice

The implications of this study will benefit social workers and helping professionals in their practice. The benefits of this study affect professionals at micro, mezzo, and macro levels.

On a micro level, social workers and helping professionals will benefit from the insight provided in this study by increasing their cultural awareness of the traditional practices of Curanderismo. One of the standards of the cultural competence code of ethics in social work practice is self-awareness, which indicates that social workers should develop and understanding of their own cultural values and beliefs to appreciate the importance of the identity of other’s multicultural identity (National Association of

Social Work, 2007). In addition to practicing self-awareness, practitioners must also learn to examine their own biases, values, and beliefs through the practice of self-reflection.

The practice of self-awareness and self-reflection is especially important when discussing spirituality with Latinos.

On a mezzo level, the findings of this study suggests that supporting and strengthening the efforts of community defined programs and empowering community experts in addressing the needs of Latinos mental health will help decrease the disparities of the Latino community. The implications of the cultural differences, suggests that tailoring of treatment approaches may help reduce disparities (Easom, 2006). The findings also suggests that Latinos are seeking treatment elsewhere and not using western medicine practices for treatment; as such, this implication suggests that agencies should evaluate their services and find areas in which they can improve to help decrease these disparities.

On a macro level, the findings of this study and literature provide implications for policy makers and program administrators. Latinos are the fastest growing population in

California and are among the largest population in the United States, which means that professionals need to be prepared in providing culturally competent services. It is important to note that although Latinos are among are among the highest population in the Untied States, they underutilize mental health services. The literature and findings of this study describe the need for the development of culturally competent policies and programs.

The implications of these stories are significant in the field of social work. It is important to develop treatments that help to eliminate disparities. By providing culturally sensitive care to clients of diverse cultural backgrounds, clients will receive the proper treatment; hence, have a greater opportunity for improvement in mental health or physical health.

Conclusion

The purpose of this study was to explore the Curanderismo experience among

Latinos. In particular, this study focused on the cultural aspect of Curanderismo and sought to find a deeper understanding of this traditional practice. The participants provided limited information regarding ailments or folk illness, but identified that spirituality, use of plants/herbs, sweat lodge/temescal, and cleansing/limpias are important components in the practice of Curanderismo. This research identified these top four themes and provided descriptive information about each theme from the findings of the interviews and review of literature. In addition, this research discusses approaches that can be used with the Latino population to build rapport and trust to lessen the gap in disparities and increase their confidence in helping professionals.

This study also provides recommendations at the micro, mezzo, and macro levels, which include recommendations for helping professionals, agencies, and future research.

Some of the implications of this study are that considerable attention should be given to the spirituality component when working with the Latino population and the importance of building rapport and trust when working with the Latino population. In addition, tailoring treatment plans using a culturally sensitive approach to address Latinos needs is

ethical and important in the healing process. Finally, an exploration of effective culturally sensitive methodologies will help strengthen the Latino community and social justice aspects.

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