How culture influences the experience of illness
Is a headache the same experience across cultures? According to Kristin Yarris (below), the way we describe—and even feel—physical distress and symptoms of illness can depend on cultural context. A “stress headache,” for instance, may be an everyday phenomenon in the U.S. but not in rural Nicaragua, where a stress headache is unheard of. However, something called a “brain ache” is described by Nicaraguan women who are missing a loved one.
Yarris, a new assistant professor of international studies and women’s and gender studies, has a long list of credentials that have led her to explore cross-cultural health concerns from many intersecting angles. With a PhD in sociocultural anthropology as well as three master’s degrees (Latin American studies, anthropology and public health), her regional focus has been Latin America, with a special interest in mental health and the influence that migration has on health outcomes.
Yarris was hired to help develop a professional concentration in global health in the Department of International Studies, with a shared appointment in the Department of Women’s and Gender Studies. She taught the first core class in this concentration last winter, called Global Health and Development.
Interview by Lisa Raleigh
Q: One of your areas of expertise is medical anthropology. How do you define this field?
Yarris: At its roots, medical anthropology looks at different cultural expressions of illness and sickness—the ways different cultural groups experience suffering—with an attempt to push back against the tendency to import diagnostic categories from the “West” to other cultures. The goal is to understand lived experience of illness from the point of view of those who suffer.
Q: How did you get interested in this field?
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.
Among the women I interviewed, they said, “The onset of this pain happened when our adult daughters out-migrated”—meaning when they left Nicaragua in search of work and economic opportunities. In that region of Nicaragua, most migrants leave for Costa Rica for agricultural work or domestic service. They make money and send it home. So the women say, “They’re not abandoning us.” But there’s tension around loss, definitely.
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.
So there were multiple layers of stories of suffering and loss, and out-migration is the most recent layer of that experience. That’s really what was provoking this pain.
Q: So we don’t have an analogy for that in our culture?
A: That’s right. Studying pain cross-culturally is really interesting. Why, in the United States, do we get stress headaches? When we say, “I’m so stressed out,” or “I have a stress headache,” we know what that means—culturally, we share this set of signs and significations. But stress doesn’t translate to other places. The women in rural Nicaragua that I worked with didn’t use the term estrés or estresada to describe what they were feeling.
Consider also irritable bowel syndrome. This tends to strike a certain demographic in the U.S.—professional, highly educated, stressed out women. But why do they feel this in their intestines and not somewhere else? I think this is related to U.S. culture, but in ways I don’t fully understand. I’m not an expert on that—but this is where we as anthropologists insert ourselves in these discussions. These are the kinds of questions we ask.
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.
I asked the grandmothers how this reconfiguration of their family life had impacted their bodily experience, and heard again about dolor de cerebro—even though most of these women were not in rural communities (as in my earlier research), but around the capital of Managua. They also described other specific pains associated with the chronic worry and anxiety that comes from this family transformation.
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.
For me, this is connected to an important issue that is broadly related to global health: caregiving, specifically the role of what the health literature calls informal caregivers (often implicitly understood as women). The unpaid family caregivers.
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.
—Photo, Matt Cooper
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