Medical anthropology: How culture influences the experience of illness

Yarris studied how rural women in Nicaragua describe physical distress

Kristin Yarris, a new assistant professor of international studies and women’s and gender studies, was interviewed recently by Lisa Raleigh of Cascade magazine, regarding a study of rural women in Nicaragua and how they describe physical distress and symptoms of illness. For the full interview, visit Cascade.

Q: How did you get interested in medical anthropology?

A: When I was at UCLA, I taught medical Spanish at the UCLA School of Medicine to first- and third-year medical students; this led me to participate in volunteer medical brigades in Nicaragua as a translator. I would be translating between the med students and the patients, and sometimes the patient would express things that I could translate in literal terms—like “bone pain” or “kidney pain”—but I often felt the medical student and or doctor would, in their diagnosis, transform what that meant. Bone pain might become rheumatoid arthritis, for example—but I always was uncertain about the jump to a diagnostic conclusion and found myself wondering, “What is this person really trying to say? What does he really mean by bone pain?”

I also heard a certain pain articulated by lots of patients: dolor de cerebro. I literally translated this as “brain ache,” because the term for headache is dolor de cabeza, and that’s not what they said. But I didn’t know how to interpret what they were saying. Was it a migraine? Was it something else? These were two-week medical brigade experiences where I was translating all the time, so I didn’t have the opportunity to explore the meaning.

But later I went back for three months as part of a master’s program summer field experience and did a study of rural women in Nicaragua. I asked them, “Tell me about this pain” (dolor de cerebro). This was a classic medical anthropology approach, using qualitative ethnographic interviews. I asked them to tell me about the onset, what other pains or symptoms or signs were associated with it, what kind of treatment they received.

Q: And what did you learn? What is a “brain ache”?

A: It’s a physical pain at the base of the skull, top of the neck. These women identify it clearly there. I can’t say this is just a headache or just a migraine because the women themselves make a distinction. They have explanatory models: A migraine, they would say, often comes from the sun or being out in the fields too long. A headache was something that you get if you were worrying a little too much or you didn’t sleep well. But a brain ache comes from a more chronic kind of worrying.

This particular pain was also associated with the social suffering many of them had experienced. This was a region of Nicaragua that was heavily impacted during the Contra War, and many of these women had lost sons or husbands or both, or their families had been divided by the war, with one son fighting with the Sandinistas and the other fighting for the Contras.

Q: There’s an interesting intersection between your interests in mental health and migration. How does this all fit together?    

A:  I did not expect at all to become a scholar of migration. But the women I interviewed in Nicaragua brought it to my attention as a factor to consider. These were women largely of middle age, many of them grandmothers—women there give birth at an early age, so they can be grandmothers in their forties—and they were raising the children of their children who had out-migrated. So my dissertation became a study of the impact of out-migration on women who raised their grandchildren as a result—a study of the role of grandmothers in contemporary global migration and how they assume intergenerational caregiving.

Q: What did you find out?

A:  I designed a study with twenty-four families whose sons or daughters had out-migrated. As an anthropologist, we have small samples like this so that we can do much more in-depth work with them. In each of these families, the children who out-migrated (their main destinations were Costa Rica, Panama, Spain and the U.S.) left behind a school-aged child, and it was a grandmother who had assumed primary caregiving responsibility.

In a nutshell, the expectations that these women had for their lives and their families had been completely pulled out from under them. And they were left wondering, “Well, now what do we do?” Paradoxically, they find a lot of continuity by raising children. The daily routines of caregiving sustain them in interesting ways, even though it’s partially experienced as a burden or responsibility—as anyone finds when they raise children; it’s both things. It’s enjoyable and also burdensome.

I’m really interested in how transformations associated with global migration and rapid cultural change are having an impact on well-being, broadly construed—how it affects women’s subjective sense of “this is how I thought my life was going to be.” Medical anthropologists have argued that complaints that are felt in the body or experienced as pain—conditions like irritable bowel syndrome or fibromyalgia or even chronic headaches—can be linked to people feeling that there’s a disconnect between what they hoped for their life and then the reality of their life. So I’m using that framework in understanding these women’s lives.

- by UO Office of Strategic Communications, from an article that originally appeared in Cascade, the alumni magazine of the UO College of Arts and Sciences