Grisi siknis

Grisi siknis, Miskito for “jungle madness”, also known as “grisi munaia”, “Chipil siknis” and “Nil siknis”, is a contagious, culturally-bound syndrome that occurs exclusively among the Miskito of eastern Central America and affects mainly young women. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] According to Dr. Phil Dennis of Texas Technology University, grisi siknis is typically characterized by longer periods of anxiety, nausea, dizziness, irrational anger and fear, interlaced with short periods of rapid frenzy, in which the victim “lose [s] consciousness, believe [s] that devils beat them and have sexual relations with them” and runs away. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] Often the outbreak of the syndrome is violent in nature, with victims grabbing weapons, attacking unseen enemies and/or hurting themselves. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] The causes of grisi siknis are indefinite, says the American Psychology Association, but the prevailing Western theory calls this syndrome a “psychological disorder due to stress, upheaval and despair”. [American Psychiatric Association. Diagnostic and Statistical Manual (DSM) of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). US: American Psychiatric Pub., Inc., 2000.] Traditional Miskito belief, says Dennis, holds that grisi siknis is the result of evil spirits or black sorcerers. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] While Western medicine typically has no effect on those afflicted with the disease, the remedies of Miskito herbalists or witch doctors are often successful in curing grisi siknis. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.]

The Miskito

Geography and Culture

The Miskito are a large tribal group of linguistically similar people inhabiting eastern Central America between Rio Tinto in Honduras and Pearl Lagoon in Nicaragua. [Jamieson, Mark. “Masks and madness.” Social Anthropology. 9(3) (2001): 257-72. Cambridge Journals. 11 December 2007 .] They are descended from a mix of European, Creole, Chinese, African and Native American peoples, making them racially diverse. [Dennis, Phil. “Grisi Siknis in Miskito Culture.” The Culture-Bound Syndromes. Ed. Ronald C. Simons and Charles C. Hughes. Dordrecht, Holland: D. Reidel Publishing, 1985. 289-306.] The majority of the modern Miskito live in small villages, farming, raising animals or fishing to supply their livelihood. [Jamieson, Mark. “Masks and madness.” Social Anthropology. 9(3) (2001): 257-72. Cambridge Journals. 11 December 2007 .] The Miskito religion is a conglomerate of traditional Indian mysticism and European Christianity, and combines Biblical and mystical spirituality. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] Miskito culture core elements, according to Dennis, include:
#Matrilocal residence pattern
#Strong kinship ethic
#Miskito Chistianity
#Belief in supernatural forces or beings
#Use of the Miskito language [Dennis, Phil. “Grisi Siknis in Miskito Culture.” The Culture-Bound Syndromes. Ed. Ronald C. Simons and Charles C. Hughes. Dordrecht, Holland: D. Reidel Publishing, 1985. 289-306.]

History

Significant European contact with the Miskito people did not occur until the late seventeenth and early eighth centuries. ["Miskito." Encyclopædia Britannica. 2007. Encyclopædia Britannica Online. 1 Dec. 2007 ] When introduced to Europe, however, the Miskito tribes quickly befriended British buccaneers, consequently developing an “Anglo-affinity” [Jamieson, Mark. “Masks and madness.” Social Anthropology. 9(3) (2001): 257-72. Cambridge Journals. 11 December 2007 .] , while nurturing a strong hatred of and engaging in war with Spain and its satellite colonies as England’s ally. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] The introduction of African slaves into Central America mixed the population and changed its racial features, while retaining the common Miskito language. [“Miskito." Encyclopædia Britannica. 2007. Encyclopædia Britannica Online. 1 Dec. 2007 ] Moravian missionaries in the mid-1800s introduced them to Christianity, which they promptly combined with their own traditional cultures to form Miskito Christianity. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] As a result of these genetic and cultural admixtures, the modern Miskito differ greatly from the original Native American tribes. [“Miskito." Encyclopædia Britannica. 2007. Encyclopædia Britannica Online. 1 Dec. 2007 ] The historical introduction of outside influences, Dennis claims, may have helped define grisi siknis as it is today. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.]

ymptoms

Grisi siknis

Symptoms of grisi siknis vary, but a distinct set of central characteristics. Most of the victims are young girls from 15 to 18 years old. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] The attacks are prefaced by headaches, dizziness, anxiety, nausea, irrational anger and/or fear. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] During the attack, the “victim loses consciousness” and falls to the ground, subsequently running away, which running Dennis calls “perhaps the most distinctive defining characteristic of grisi siknis behavior”. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] The victim may view other people as devils, feel no pain for bodily injuries and have absolute amnesia regarding their physical circumstances. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] Some grab machetes or broken bottles to wave off unseen assailants. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] Other victims are reported to have performed superhuman feats [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] , vomited strange objects such as spiders, hair and coins [Ross, Nicola. “Nicaragua’s Crazy Sickness.” The Walrus Jun. 2006.] and spoken in tongues. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] In some cases the semi-conscious victim will speak the names of the next to be infected, although it is not always accurate [Ross, Nicola. “Nicaragua’s Crazy Sickness.” The Walrus Jun. 2006.] . It is still highly contagious. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] During attacks, victims report mental visions in which devils or evil spirits come for them, and have sex with them. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] These visions also include anything from horrifying nightmares to pleasant experiences, but all are sexually influenced. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] Attacks occur anywhere from multiple times a day to rarely when one is infected with grisi siknis. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] A person typically remains with the disease for several months to a year without medical attention, although some cases have been documented to recur for much longer. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.]

Grisi siknis in relation to culturally-bound syndromes

Joseph Westermeyer, Head of Psychiatry at Oklahoma University, states that a culturally-bound syndrome is defined as “certain trance-like disturbances occur with unusual frequencies in certain societies”. [Westermeyer, Joseph. “Psychiatric Diagnosis Across Cultural Boundaries.” The American Journal of Psychiatry. 142(7) (July 1985): 798-804.] These syndromes, he says, actually occur in a wide variety of cultures separated by great distance that have similar symptoms including “fear, anxiety, amnesia, aimless escape, psychophysiological symptoms, social withdrawal, behavioral deviance and nondirected violence”. [Westermeyer, Joseph. “Psychiatric Diagnosis Across Cultural Boundaries.” The American Journal of Psychiatry. 142(7) (July 1985): 798-804.] However, these symptoms are not confined to culturally-bound syndromes, as others, such as “personality disorder, neurasthenia, crisis/judgment disorders, organic brain syndromes, drug-induced delirium, major depression, mania, schizophreniform and schizophrenia” might constitute the true psychiatric diagnosis. [Westermeyer, Joseph. “Psychiatric Diagnosis Across Cultural Boundaries.” The American Journal of Psychiatry. 142(7) (July 1985): 798-804.] Because of these cross-cultural symptoms, it is argued that these syndromes are not necessarily unique [Westermeyer, Joseph. “Psychiatric Diagnosis Across Cultural Boundaries.” The American Journal of Psychiatry. 142(7) (July 1985): 798-804.] and that applying the term ‘culturally-bound’ to them hampers science’s ability to explore them on the same level as other psychological problems. [Edgardo Ruiz. “Cultural Politics and Health: The Development of Intercultural Health Policies in the Atlantic Coast of Nicaragua.” Puerto Rico: Universidad de Puerto Rico, 1999. ] Outbreaks of these symptoms are sporadic and epidemic. [Westermeyer, Joseph. “Psychiatric Diagnosis Across Cultural Boundaries.” The American Journal of Psychiatry. 142(7) (July 1985): 798-804.] Some culturally-bound syndromes, in addition to grisi siknis, include:
*Amok (among Malay, Indonesian or Pacific Islander males) [(Westermeyer, Joseph. “Psychiatric Diagnosis Across Cultural Boundaries.” The American Journal of Psychiatry. 142(7) (July 1985): 798-804.]
*Anthropophobia (in Japan) [Westermeyer, Joseph. “Psychiatric Diagnosis Across Cultural Boundaries.” The American Journal of Psychiatry. 142(7) (July 1985): 798-804.]
*“Bulimia nervosa” or “anorexia nervosa” (among Western Euroamericans) [(Westermeyer, Joseph. “Psychiatric Diagnosis Across Cultural Boundaries.” The American Journal of Psychiatry. 142(7) (July 1985): 798-804.]
*Cathard (in Polynesia) [Mental Disorders. Ed. Daniele Focosi. 2005. 11 Dec. 2007. ]
*Chakore (among Ngawbere of Panama) [Mezzich, Juan E. Culture & Psychiatric Diagnosis: A DSM-IV Perspective. US: American Psychiatric Pub., Inc., 1996.]
*“Falling out” (among African-Americans or in the Bahamas) [(Westermeyer, Joseph. “Psychiatric Diagnosis Across Cultural Boundaries.” The American Journal of Psychiatry. 142(7) (July 1985): 798-804.]
*“Fits” (in India) [Boeree, C. George. Dissociative Disorders. 29 January 2007. 29 October 2007. .]
*“Frenzy” witchcraft (among the Navajo) [Mental Disorders. Ed. Daniele Focosi. 2005. 11 Dec. 2007. ]
*“Indisposition” (in Haiti) [Boeree, C. George. Dissociative Disorders. 29 January 2007. 29 October 2007. .]
*Koro (among Asian males) [Westermeyer, Joseph. “Psychiatric Diagnosis Across Cultural Boundaries.” The American Journal of Psychiatry. 142(7) (July 1985): 798-804.]
*Latah (among Southeast Asian females) [Westermeyer, Joseph. “Psychiatric Diagnosis Across Cultural Boundaries.” The American Journal of Psychiatry. 142(7) (July 1985): 798-804.]
*Mal de pelea (in Puerto Rico) [Mental Disorders. Ed. Daniele Focosi. 2005. 11 Dec. 2007. ]
*Pibloktoq or arctic hysteria (among Inuit) [Dennis, Phil. “Grisi Siknis in Miskito Culture.” The Culture-Bound Syndromes. Ed. Ronald C. Simons and Charles C. Hughes. Dordrecht, Holland: D. Reidel Publishing, 1985. 289-306.]
*Wild-man behavior (in New Guinea) [Dennis, Phil. “Grisi Siknis in Miskito Culture.” The Culture-Bound Syndromes. Ed. Ronald C. Simons and Charles C. Hughes. Dordrecht, Holland: D. Reidel Publishing, 1985. 289-306.]

According to the American Psychiatry Association, pibloktoq, “frenzy” witchcraft, chakore and amok, are all, like grisi siknis, classified as “running” syndromes, in that they contain “sudden high-level activity, [a] trance-like state, potentially dangerous behavior in the form of running [and] exhaustion, sleep [and/or] amnesia”. [American Psychiatric Association. Diagnostic and Statistical Manual (DSM) of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). US: American Psychiatric Pub., Inc., 2000.] It is generally applied to purposeless roving. [Mezzich, Juan E. Culture & Psychiatric Diagnosis: A DSM-IV Perspective. US: American Psychiatric Pub., Inc., 1996.]

In addition, Dr. Richard Castillo, as quoted by Dr. C. George Boeree, believes that amok (with very similar symptoms to grisi siknis), pibloktoq, latah, “falling out”, “indisposition”, and the “fits” are all related to impulse control disorders, and thus are associated with trichotillomania, compulsive gambling, pyromania, and kleptomania in Western medicine. [Boeree, C. George. Dissociative Disorders. 29 January 2007. 29 October 2007. .]

Grisi siknis in relation to Western medicine

According to the American Psychiatric Association, a Western medical condition similar in many aspects to culturally-bound syndromes, particularly the “running” syndromes, of which grisi siknis is part, is dissociative (or psychogenic) fugue. [American Psychiatric Association. Diagnostic and Statistical Manual (DSM) of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). US: American Psychiatric Pub., Inc., 2000.] In any fugal state, a person appears normal, but has amnesia or identity forgetfulness. [American Psychiatric Association. Diagnostic and Statistical Manual (DSM) of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). US: American Psychiatric Pub., Inc., 2000.] Dissociative fugue is distinguished by impulsive travel and amnesia, identity uncertainty, stress, and impediment to normal social function, all of which must not be influenced by substance intake. [American Psychiatric Association. Diagnostic and Statistical Manual (DSM) of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). US: American Psychiatric Pub., Inc., 2000.] It is most often related to intense emotional stress and occurs randomly. [American Psychiatric Association. Diagnostic and Statistical Manual (DSM) of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). US: American Psychiatric Pub., Inc., 2000.] However, some argue that “running” syndromes are really not dissociative fugue, and have no proper Western medical classification. [Mezzich, Juan E. Culture & Psychiatric Diagnosis: A DSM-IV Perspective. US: American Psychiatric Pub., Inc., 1996.] Others contend that associating culturally-bound symptoms with known ailments severely limits the discovery of new psychiatric disorders in folk culture. [Guarnaccia, Peter J. and Rogler Lloyd H.. “Research on Culture-Bound Syndromes: New Directions.” American Journal of Psychiatry. 156(9) (Sep. 1999): 1322-27.] Edgardo Ruiz, PhD, the University of Pittsburgh, argues that grisi siknis does not correlate with Western scientific cultural perspectives, and the cross-cultural translation of symptoms is an inaccurate device wherewith to understand the disease. [Edgardo Ruiz. “Cultural Politics and Health: The Development of Intercultural Health Policies in the Atlantic Coast of Nicaragua.” Puerto Rico: Universidad de Puerto Rico, 1999. ]

Causes

Western theories

There is no definitively known cause of grisi siknis, although there are some theories which attempt to explain its origin. Although it has no discovered organic cause, says Dennis, grisi siknis still “follow [s] the classic model for contagious disease”. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] Dennis claims that grisi siknis is the source of the emotionally volatile Miskito culture, saying “it is clear that grisi siknis is related to emotional upset, worry, fear and general anxiety”, while microorganisms, if involved, are intermediate. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] Dr. Ronald C. Simons, professor emeritus of psychiatry and anthropology at Michigan State University, as quoted by Nicola Ross in The Walrus magazine, upholds this argument, proposing that grisi siknis is caused by poverty and stress among the Miskito. [Ross, Nicola. “Nicaragua’s Crazy Sickness.” The Walrus Jun. 2006.] Culturally-bound syndromes, Simons says, are often strongly influenced by behavior and experience and have become a local way of expressing misfortune. [Ross, Nicola. “Nicaragua’s Crazy Sickness.” The Walrus Jun. 2006.] Dr. Wolfgang Jilek, of the University of Columbia’s psychiatry department, also quoted by Ross in The Walrus, calls culturally-bound syndromes “real” despite a general lack of evidence for organic causes. [Ross, Nicola. “Nicaragua’s Crazy Sickness.” The Walrus Jun. 2006.] They are primarily the result of trauma and stress, Jilek claims, that end in mental dissociation problems. [Ross, Nicola. “Nicaragua’s Crazy Sickness.” The Walrus Jun. 2006.] Susan Kellogg, Associate Professor and Chair of the History Department at the University of Houston, says that grisi siknis is the result of the cultural “physical and emotional stresses” that Miskito women endure. [Kellogg, Susan. Weaving the Past: A History of Latin America’s Indigenous Women from the Prehispanic Period to the Present. US: Oxford University Press, 2005.] Ariel Shlomo, Co-Director of the Integrative Psychotherapy Center in Ramat Gan, Israel, says that such disorders are the product of the culture, delineates acceptable coping mechanisms for dealing with external or internal changes. [Ariel, Shlomo. Culturally Competent Family Therapy. US: Greenwood Press, 1999.] In a typical homeostatic function, Shlomo says, “ emotional or behavioral disorders in the individual are defined as such by the culture”, which culture subsequently imposes treatment in order to restore equilibrium. [Ariel, Shlomo. Culturally Competent Family Therapy. US: Greenwood Press, 1999.] Grisi siknis can be considered a ritualized behavior associated with the adolescent to adult transition among the Miskito, says Mark Jamieson, professor of social anthropology at the University of Manchester. [Jamieson, Mark. “Masks and madness.” Social Anthropology. 9(3) (2001): 257-72. Cambridge Journals. 11 December 2007 .] Girls in Miskito culture, claims Jamieson, are faced with the culturally inconsistent task of attracting a husband sexually while remaining safe and pure to maintain societal status quo. [Jamieson, Mark. “Masks and madness.” Social Anthropology. 9(3) (2001): 257-72. Cambridge Journals. 11 December 2007 .] The contradictory familial pressures to both protect and marry off the daughter adds to this. [Jamieson, Mark. “Masks and madness.” Social Anthropology. 9(3) (2001): 257-72. Cambridge Journals. 11 December 2007 .] Thus, says Shlomo, “the syndrome may be viewed as a safety valve” to maintain equilibrium between these conflicting pressures. [Ariel, Shlomo. Culturally Competent Family Therapy. US: Greenwood Press, 1999.] Miskito girls express transitional sexuality through the syndrome while maintaining social purity, with the culture holding the victims blameless for their actions while attacked by the disease. [Ariel, Shlomo. Culturally Competent Family Therapy. US: Greenwood Press, 1999.]

Miskito theories

Miskito tradition, according to Dennis, holds that grisi siknis is caused by possession by evil spirits. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] This belief stems from the combination of traditional Native American animism [Mental Disorders. Ed. Daniele Focosi. 2005. 11 Dec. 2007. ] and Miskito Christian idea of the devil. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] When epidemic outbreaks of the disease occur, the Miskito hold that it is the result of an imbalance with spirits, says Nicola Ross, a reporter for The Walrus magazine [Ross, Nicola. “Nicaragua’s Crazy Sickness.” The Walrus Jun. 2006.] , which predicament they believe to be caused by a dilman or evil sorcerer. [Mental Disorders. Ed. Daniele Focosi. 2005. 11 Dec. 2007. ]

Cures

Grisi siknis is generally only cured by traditional Miskito healing methods, according to The Journal of the American Botanical Council. [“Herbs and Healing on Nicaragua's Atlantic Coast.” The Journal of the American Botanical Council. 41 (1997): 35.] In treating the ailment, the Miskito typically follow a hierarchy of remedies, turning first to home-based remedies, second to modern health facilities and finally to curandero or witch doctors, the latter particularly, if evil spirits are believed to be involved. [“Herbs and Healing on Nicaragua's Atlantic Coast.” The Journal of the American Botanical Council. 41 (1997): 35.] These healers use an assortment of vapor baths, anointing, teas and potions, all of which are organically derived. [“Herbs and Healing on Nicaragua's Atlantic Coast.” The Journal of the American Botanical Council. 41 (1997): 35.] According to Dennis, the Miskito healers use a variety of undisclosed steamed herbal remedies that are generally more successful than any Western medicine. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.] However, the cures can be counteracted, Dennis says, by exposure to dead people, pregnant women and various meats. [Dennis, Phil. “Grisi Siknis Among the Miskito.” Medical Anthropology 5(4) (1981): 445-505.]

References