Nicaragua’s Crazy Sickness

I asked Padre Elvis if he gave credence to the bad spirits that Nicaragua’s Miskitu Indians blame for grisi siknis.” Before, I used to believe a lot,” he told me. “But now only a little bit.” Had my Spanish been better, I’d have accused him of copping out. As it was, I said to him, “Come on Father, either you believe or you don’t believe.”

We were sitting around a highly lacquered kitchen table, carved, no doubt, from some precious and endangered tropical hardwood. The ceramic-tile floor absorbed much of the days intense heat. Beads of sweat merged into rivulets on the fridge door. March in the Miskitu town of Waspam marks the end of the six-month-long dry season. But this was late April and the spring rains had yet to arrive, so I was glad to be inside the spacious two-storey cement-block home that housed both of Waspam’s Catholic priests. It provided some relief from the penetrating sun. The padre laughed. “You ask hard questions,” he said. “Put it this way, if I’m deep in the jungle I don’t cut the branch of the ceiba tree.” One of Nicaragua’s largest trees, the barrel-trunked ceiba has, according to Miskitu myth, powerful spirits that are not to be fooled with. I wondered if knowing that a Catholic priest believes in pagan spirits—even a little bit—would help me to understand what was causing indigenous communities up and down the longest river in Central America to suffer from the mass-hysteria-like ailment called grisi siknis.

The Miskitus, a group indigenous to the Atlantic coast of Nicaragua and Honduras, don’t have a word for mental illness. Instead, ailing people are thought to be out of balance with the spirits. Grisi siknis, the Miskitus’ best attempt at a phonetic spelling of “crazy sickness,” causes those afflicted—mostly young Miskitu women—to alternate between a trancelike state of semi-consciousness and periods of frenzied behaviour. During the latter, victims often rip off their clothes, flee into the forest or the murky, fast-flowing river, and appear to develop superhuman strength. In such a crazed state, these women are difficult to stop. With their eyes closed, and armed with machetes or sticks, they think nothing of attacking whoever or whatever stands between them and the mysterious force that beckons.

In this region, there are accounts of entire villages being ransacked during a grisi siknis outbreak, when as many as a quarter of a town’s inhabitants, including women of all ages and a few men, become afflicted and may remain so for months. Patients are tied up with ropes to prevent them from running amok. Dr. Philip Dennis, professor in the department of sociology, anthropology, and social work at Texas Tech University, lived among the Miskitus for more than a year. He described his most vivid memory of a grisi siknis episode as when “a young woman I helped hold down during an attack was obviously having an orgasm brought on, in her mind, by the spirits or devils.” When Dennis asked the woman’s husband if such a sexual experience was commonplace, he grunted an embarrassed yes.

I’d gone to Nicaragua fully expecting to learn that abject poverty, sexual abuse, and post-traumatic stress caused grisi siknis. After all, the Nicaraguan people are long suffering. Following forty-two years of brutal dictatorship under the Somoza family (father Anastasio followed by sons Luis and Anastasio), the country fell into a vicious war that pitted the US-backed Contras against the leftist Sandinistas. During that bloody conflict (1979-1990), the Sandinistas rounded up large numbers of Miskitu Indians and marched them into internment camps in Nicaragua and Honduras where they waited out the war. They returned home to find burned-out villages and fields littered with landmines. Today, Nicaragua remains one of the poorest countries in the hemisphere, massively indebted to foreign lenders. And nowhere in the country is the poverty more acute than along the Río Coco, where most Miskitus live. Add the devastating effects of Hurricane Mitch in 1998 (more than $1 billion in damages countrywide), when torrential rain washed away much of the topsoil in villages throughout northern Nicaragua, reducing crop yields to a third of what they’d been, and my theory of poverty-induced illness made some sense.

Many psychiatrists believe that grisi siknis belongs to a class of disorders commonly known as “culture-bound syndromes.” In the November 2001 issue of Psychiatric Times, Dr. Ronald C. Simons, professor emeritus of psychiatry and anthropology at Michigan State University, wrote, “In theory, culture-bound syndromes are those folk illnesses in which alterations of behaviour and experience figure prominently. In actuality, however, many are not syndromes at all. Instead, they are local ways of explaining any of a wide assortment of misfortunes.” Later he adds, “However, some culture-bound syndromes are indeed syndromes.”

The Diagnostic and Statistical Manual IV of the American Psychiatric Association contains a glossary of twenty-five culture-bound syndromes. There’s pibloktoq, a disorder similar to grisi siknis unique to the Inuit, and the suitably named amok, which is particular to Malaysians and involves periods of brooding followed by outbursts of violent, aggressive, or homicidal behaviour. There’s dhat in India, characterized by large losses of semen in men, who feel weak as a result. In Japan, taijin kyofusho causes people to have an intense fear of their own bodies, and in Southeast Asia men and women suffer from koro, which is the fear that one’s sexual appendages are being withdrawn into the body and will be lost. Bulimia and anorexia nervosa are our very own Western culture-bound syndromes. Dr. Wolfgang Jilek, professor emeritus of psychiatry at the University of British Columbia, wrote about culturally related syndromes in the New Oxford Textbook of Psychiatry. He told me that “these phenomena, although mostly not of organic causation, are of course “real’ in the sense that they are not “made up’ or “faked.’ What used to be labelled “hysterical’ symptoms are not willfully produced antics but are the outcome of mental dissociation processes, usually in response to stressful, traumatizing experiences.”

Grisi siknis among the Miskitus is not a new phenomenon. An epidemic that began in 1910 lasted for about twenty years, according to local reports. Decades earlier, Charles Napier Bell, an English ethnographer who grew up on the Miskitu coast of Central America, described a case after visiting a Miskitu village during the 1850s. In Tangweera: Life and Adventures among Gentle Savages, he wrote, “I have seen a young girl, who was shrieking hysterically in a dreadful manner, carried in a canoe a long distance to consult a celebrated sookia [medicine man]. All that the sookia did was erect round her painted sticks with charms tied to them, to blow tobacco-smoke over her while muttering strange words, to make a bubbling with a tobacco pipe in a calabash of water, which she was then made to drink, and to tie a knotted string round her neck, on every knot of which was a drop of blood from his tongue. For as many days as there were knots she must not eat the meat of certain animals, must suffer no one to pass to windward of her, and must not see a woman with child.”

The treatment Bell described hasn’t changed much in 150 years. Nicaragua’s best medical science did nothing to curb a grisi siknis outbreak in villages along the Río Coco in 2003. A prestigious team of psychiatrists, doctors, epidemiologists, and government health professionals called in Porcela Sandino, who claims to be the granddaughter of Augusto César Sandino, Nicaragua’s most famous revolutionary and Sandinista namesake. Porcela is a reputed curandera or shaman. Posing for a photo in the treatment room next door to her unassuming, brightly coloured wooden home in Puerto Cabezas, Porcela was surrounded by votive candles adorned with images of Jesus and the Virgen de Guadelupe. Simple wooden crosses hung on the painted white walls. A Catholic, Porcela assured me that grisi siknis “is not a sickness of God; it is a sickness of the bad spirits.” But she wouldn’t say exactly what she’d used to cure it. As is the tradition among Miskitu curanderos, the recipe came to her in a dream. It involved brewing up a stew of medicinal plants and other items, which those afflicted had to wash in, drink, and inhale the fumes of for ten days. Her assistants also spread the concoction in a ring around the village to ward off the bad spirits causing the outbreak. Carlos Salomon Taylor, another curandero who helped out during the 2004 outbreak, said in La Prensa, a Nicaraguan daily, that he needed the tail and horns of a black cow, a seashell, sulphur, needles, methylene, various herbs, and 11,000 cordobas (about $800) to work his magic.

By the time I found myself sitting with Padre Elvis in the sanctity of that cool kitchen, my preconceived ideas about grisi siknis were gone. I’d just returned from a trip to the Miskitu territory. I covered the 560 kilometres between Managua and Waspam in a ten-seater prop airplane. From Waspam I’d travelled along the Río Coco for eight hours in each direction by bató, a ten-metre-long dugout canoe with a twenty-five-horsepower motor. My companions included Ana Rosa Fagoth, a recognized Miskitu anthropologist and author whose brother, the renowned Steadman Fagoth, staunchly opposed the Sandinista government throughout the civil war, and Dud Erminger, a Texan living in a Miskitu community along the Atlantic coast. Dud had first come to Nicaragua as a Peace Corps worker in the 1970s. The civil war had forced him to leave, but he returned two years ago to work on a Canadian forestry project, which turned sour. Dud was at loose ends trying to figure out what to do next so he jumped at the chance to take photos along the river he loved so well.