Experience of Nervousness and Anxiety Disorders in Puerto Rican Women: Psychiatric and Ethnopsychological Perspectives
In a recent review of studies in culture and anxiety, Good and Kleinman (1985) observed that there are relatively few able to inform us about the full range of variations in the phenomenology of anxiety or the type of emotional distress classified as "anxiety disorders" by psychiatry. Among the questions these authors raise for future research the most interesting for clinicians are, "What is the relationship of different anxiety disorders to different styles of illness behavior and idioms of dis-
tress?" "Are there cross-cultural differences in the cognitive, affective, and communicative processes that contribute to the development and expression of anxiety disorders?" (Good & Kleinman, 1985, p. 323). My goal in writing this article is to contribute to the literature on cultural variations in the expression, course, and treatment of anxiety disorders, with a special focus on women. I record and analyze their and their clinicians' descriptions of experiences of suffering, identified by mental health professionals as due to "anxiety disorders" and by Spiritist healers as variations on spirit-caused distress that include the popular illness complaint (sometimes referred to as a syndrome) of nervios or "nervousness" (see Garrison, 1977; Koss, 1975, 1977). By comparing cases seen by mental health professionals and Spiritist healers (a widespread traditional healing system in Puerto Rico), I have the advantage of teasing out both popular and professional variations on the cultural construction of a Western medical nosologic category of emotional disorder. I also describe some of the ways in which Puerto Rican culture structures situations and stresses for women that render them vulnerable to both severe "nervousness" and "anxiety."