Chapter 11 Cultural aspects of stress and suffering CASE STUDIES Case study: nervios in San José, Costa Rica Low53, in her 1981 study in San José, Costa Rica, found that both men and women, of all ages and from all social classes, could be afflicted by ‘nerves’ (nervios). In a culture where family links and the tranquilidad (tranquillity) of family life are very important, it is often a symptom of family discord or disruption of the family structure. For example, a crisis of nervios may be precipitated when a son marries an undesirable woman, when a child is born illegitimately, or when a sudden bereavement occurs. People also blame their own nervios on a poverty-stricken childhood, an alcoholic father or a mother who was unwed when she gave birth to them. It can manifest in a variety of vague physical and emotional symptoms, including headache, insomnia, vomiting, lack of appetite, fatigue, anger, fear and disorientation. All of these indicate that the individual feels out of control, or separated from body or self. It is thus a culturally sanctioned way of signalling to others that something has gone wrong with family relationships, and that they need sympathy and attention. Overall, the belief in nervios is a way of ‘encouraging culturally appropriate behaviour and an adherence to cultural norms’, especially those that reinforce family relationships and thereby enhance family cohesion. Case study: nevra among Greek immigrants in Montreal, Canada Dunk54 in 1989 described ‘nerves’ (nevra) among Greek immigrants in Montreal, a form of somatization found mainly among women. An attack of nevra manifests as a feeling of loss of control, of ‘being grabbed by your nerves’, which then ‘burst’ or ‘break out’. At the same time there is often screaming, shouting, throwing things and hitting one’s children. Often there are vague physical symptoms, such as headaches, neck pain, shoulder pain and dizziness. Sufferers from the condition commonly use the expression ‘my nerves are broken!’. Its cause can be related to the specific conditions of the immigrants’ lives, including: economic pressures, crowded living conditions, the effects of migration upon the family, gender-role conflicts and the women’s double burden of running a home and going out to work. It is thus a culturally constituted metaphor for distress, and a cry for help; it can be viewed as a realistic way of coping when responded to positively by family members and others.