Mexican-American Folk Medicine: Implications for the Family Physician Alan P. Chesney, PhD, Barbara L. Thompson, MD, Alfredo Guevara, MD, Angela Vela, MD, and Mary Frances Schottstaedt, MD Galveston, Texas, Tucson, Arizona, and Atlanta, Georgia Literature on Mexican-American folk medicine and on Mexican-American utilization of conventional medical serv­ ices suggests that folk medicine and utilization of conventional medical services are related. This study reports on interviews with 40 Mexican-American families randomly selected from the community. The results indicate that choice of conven­ tional medical care and/or folk medicine is dependent upon the symptom, that families often use both folk and conventional medicine, that they are more likely to seek medical help for anxiety than for depression, and that knowledge of folk medi­ cine is best acquired by asking about specific folk diseases. These findings have application in family practice. Social scientists have graphically described an provided ethnographies of health and health care extensive folk medical system within the Mexican- in Mexican-American communities. Currier1' and American culture.1'7 Although they have differed Rubel6 each have focused on one aspect of health in research methods, there is uniformity in their beliefs among Mexican-Americans, the hot-cold descriptions of beliefs and cures among Mexican- syndrome and susto, respectively, and have pro­ American groups. Martinez and Martin, for ex­ vided detailed descriptions. Each of these per­ ample, described the physical symptoms and rec­ spectives is useful in developing a better under­ ommended cures from the perspective of the pa­ standing of folk medicine and identifying its impli­ tients.5 Chavira, on the other hand, traced the his­ cations for practitioners of family medicine. torical evolution of folk medicine and described its present-day character from the viewpoint of one type of folk practitioner (curandero).' Keiv dis­ cussed folk medicine from the standpoint of psy­ chiatry and psychology.7 Kay8 and Clark2 have Background Although it is beyond the scope of this paper to provide a detailed literature review of the Mexican- American culture and social system as regards health, a brief review is necessary. Mexican- From the Departments of Psychiatry and Family Medicine, American folk medicine originated in the humoral The University of Texas Medical Branch at Galveston, Gal­ medicine of Western Europe, which was brought veston, Texas. Requests for reprints should be addressed to Dr. Alan P. Chesney, 415 Texas Avenue, The University to the New World by the conquistadores. Humoral of Texas Medical Branch at Galveston, Galveston, TX medicine was combined with the herbal medicine 77550. 0094-3509/80/100567-08$02.00 ® 1980 Appleton-Century-Crofts 567 THE JOURNAL OF FAMILY PRACTICE, VOL. 11, NO. 4: 567-574, 1980 MEXICAN-AMERICAN FOLK MEDICINE of the Aztecs and has been handed down by suc­ utilization of mental health services by Me cessive generations throughout Latin America. Americans has been well documented,101! k "T Descriptions of folk medicine among Mexican- explanations for these findings vary. jaco,i Americans have identified three aspects which tributes under-utilization to lower rates of m appear to be central. One is the role of the so­ illness, and Karno and Edgerton12 attribute it ■- cial network, particularly kin, in diagnosing and psychological, physical, and social barriers j° treating illness. Another is the relationship be­ eluding language. K eiv7 and Hoppe15 attribute tween religion and illness, which includes the use under-utilization to the widespread use of Curan of religious ritual in many healing processes. deros. These explanations are based more on cor! Yet another is the remarkable consistency of be­ jecture than on data and are not mutually exclu- liefs among Mexican-American communities about sive. This paper focuses on explaining the phe. symptoms, etiology, and regimens of healing. This nomenon by describing the relation between the f consistency, however, does not imply uniformity use of conventional medicine and the belief in and of belief among individuals who are Mexican- use of folk medicine. American. Substantial effort has been given to research The cultural power of folk medicine is described into the patterns of health behavior among I by Kay as follows: Mexican-Americans. Despite these efforts, Wear It seems to me that the underlying principle is the belief er has concluded that the following central ques­ that change is dangerous. This principle is found in most tion has not been answered: are the health atti­ explanations of pathology. It derives from a concept tudes and behavior reported in rural New Mexico of disease that is found transculturally, the concept and in south Texas determined culturally, or are of “ balance.” One of the primary paradigms which sci­ they the result of inaccessibility of scientific med­ entific medicine uses to explain pathology concerns icine compounded by misunderstandings and a change and bodily adjustments to achieve homeostasis. perceived lack of respect at the hands of Anglo Pathology is demonstrated when intracellular fluid shifts providers?16 to extracellular paths, and when the chemistry of the To begin to answer this question, the authors blood is outside the narrow range of balance between studied utilization of both conventional and folk acid and alkaline, due to metabolic or respiratory alter­ medicine among Mexican-American families who ation. The same explanations have been used by sys- tematists throughout millenia. Thus Grecian humors, lived close enough to a source of conventional Chinese yang and yin principles, American color- care that use of it would be relatively convenient directions, and 20th century fluids and electrolytes must This study is an extension of the research of | remain in balance, or there will be illness.8 Creson10 and Martinez and Martin.5 Both o f these studies identified folk practices and b e lie f s among This underlying principle may provide practi­ M exican-Americans who were seeking conven­ tioners of scientific medicine a conceptual frame­ tional medical care, and both were able to demon­ work for discussing their views of diseases and strate that some Mexican-Americans w ho live illnesses with Mexican-American patients. It also relatively close to a medical center will use both appears to be a guiding factor in the work of conventional and folk healing processes. Unfortu­ Mexican-American folk healers. nately, the studies do not describe the circum­ Today, the curandero (one type of folk medical stances under which a patient might use one orthe practitioner) treats a variety of ailments with a other. This study was conducted in an effort to combination of psychosocial interventions, mild clarify these issues. herbs, and religion. Some of the ailments upon which curanderos focus their attention are thought to be equivalent to those that psychiatrists treat. This commonality has led some authors9 to sug­ gest that the curandero and providers of psychiat­ Methods ric services be more closely integrated. The first step in the procedure was to select a The literature on folk medicine is complemented group of Mexican-American families who lived in by the studies on the utilization of conventional med­ close geographic proximity to The University of ical services by Mexican-Americans. The under­ Texas Medical Branch at Galveston (UTMB1. 568 THE JOURNAL OF FAMILY PRACTICE, VOL. 11, NO. 4,1980 MEXICAN-AMERICAN FOLK MEDICINE Table 1. Demographic Characteristics of a Sample of Mexican- American Families Number Percent Years Lived in Galveston Less than 10 years 9 22.5 More than 10 years 31 77.5 100.0 Location of Respondent's Education No formal education 3 7.5 Mexico 10 25.0 United States 27 67.5 100.0 Employment of Principal Breadwinner Employed 26 65.0 Not employed 14 35.0 100.0 Language Preference for Interview Spanish 24 60.0 English 16 40.0 100.0 Number of Persons in Household 1 or 2 10 25.0 3 or 4 15 37.5 5 or more 15 37.5 100.0 Single-Parent Household Yes 19 47.5 No 18 45.0 Unknown 3 7.5 100.0 which offers a complete range of inpatient and Results outpatient medical services at sliding-scale fees. Forty Spanish surnamed families living within an Demographic Data area adjacent to the medical center were selected randomly from the 1976 Directory of Street Ad­ The families included in the sample are all low- dresses. All 40 families eventually participated in income Mexican-American families. Many of complete interviews. The area to be surveyed was these families, 77.5 percent, have lived in Galves­ chosen both because of its proximity to the medi­ ton for more than ten years, and 68 percent re­ cal center and because it contained a housing proj­ ceived all of their formal education in the United ect with a large proportion of Spanish surnamed States (Table 1). These two measures indicate that families. Interviews were conducted in Spanish or the sample is geographically stable. An indicator English, whichever the respondent preferred. of social participation is employment status. In a The interviewers were bilingual fourth year large percentage of families, the breadwinner is medical students who were trained in the use of a not employed (35 percent), although in most cases, structured interview. They collected information this is because of retirement. on actual health care utilization during last illness, In spite of the indications of assimilation into a hypothetical health