Grisi Siknis : A cultural idiom of gender-based violence and structural inequalities in eastern Nicaragua

Abstract

For the Miskitu of Nicaragua, Grisi Siknis is a contagious illness that predominantly affects women. It is characterized by numerous psychosomatic symptoms, including headache, fear, aggressive behavior, loss of consciousness, and periods of rapid frenzy. Although Grisi Siknis has gained academic and public attention due to its unique cultural elements and perceived sexual aspects, little is known how the contextual and gender dimensions of Grisi Siknis are played out in relation to the socio-political context in the region. Based on 16 months of ethnographic work in the Nicaraguan Miskitu Coast, including semi-structured interviews (n = 20) and participant observation, this article documents a semantic shift in the embodied and symbolic language of a cultural idiom of distress. I show how duhindu (Miskitu spirit associated with illness and misfortune) and witchcraft are symbols that share cultural resonance in the Miskitu community, while gender violence discourse is a new language incorporated into the logic of this cultural idiom of distress. I argue that this semantic shift allows the individuals in this study to communicate local experiences of complex forms of structural inequalities (migration status, unemployment, ethnic identity) and gender-based violence that tend to be normalized as a ubiquitous cultural problem while preserving the broader socio-cultural meaning the Grisi Siknis represents. The ethnographic accounts of Grisi Siknis provide empirical data to unpack the unexplored contextual processes and local discourses that transform the meaning and logic of cultural idioms of distress at the individual level of experience.

Keywords

gender violence idiom of distress illness experience Nicaragua strategic semantic shift

Introduction

Gabriela is a 22-year-old Miskitu female who lives with her parents and five siblings in a barrio of Puerto Cabezas, Nicaragua. She has experienced Grisi Siknis for over two years since 2012, with the most recent episode in September of 2014. Gabriela's first attack of Grisi Siknis happened shortly after cutting wood with her sister. She reports being frightened by an encounter with duhindu, a small, elf-like demon with large eyes, a wide-brimmed hat, gold teeth, and outstretched four-finger hands offering her money. Gabriela attributes her affliction to the fright from this first encounter and explains that she lives in constant fear of encountering the duhindu, who also commonly appears in her dreams. Several of Gabriela's close friends and schoolmates have also experienced Grisi Siknis. Most of Gabriela's attacks of Grisi Siknis have occurred at home and within her neighborhood; some took place at college.

Prior to an episode of Grisi Siknis, Gabriela reports feeling anxious, easily irritated, and unable to focus or control her emotions. During an attack, which can last 20 to 60 min and can spread to others, Gabriela reports a dreamlike state where she remembers very little other than the presence of the duhindu and/or darkness. Gabriela's family members described to her how during an attack of Grisi Siknis, she becomes destructive and aggressive towards others and herself by pulling at her hair and biting her arms. Gabriela also acquires what her mother describes as supernatural strength, requiring up to six men to restrain her. When she wakes up from an attack, she is often tied down to the bed. She describes feeling weak, exhausted, nauseous, and with a bitter taste in her mouth. To counter the affliction, Gabriela's mother prepares a mixture of aromatic herbs and agua florida (water perfumed with flowers) which is thought to dispel the duhindu.

At first, Gabriela's attacks of Grisi Siknis were frequent, sometimes occurring several times a day. However, Gabriela's attacks have decreased in recent months, which she believes is due to the use of traditional remedies and better emotional self-control. Gabriela remarks that if she does not control her fear and anger, the illness will overcome her. She confessed to me that she quit school because of the illness and her inability to focus—but also because she was sexually harassed by a college professor and received unjust treatment for rejecting his advances. In connection with this experience, she recalled that a gym teacher had molested her in high school. She feels that there was no justice and that being quiet was a better option.

Gabriela's vignette is a prototypical Grisi Siknis case among the participants in this study. Gabriela's illness was triggered by duhindu, a Miskitu spirit directly associated with Grisi Siknis and a wide range of other illnesses, malaise, and misfortune. The duhindu is said to lure and tempt its victims (with money or sex) to be taken or ‘carried away’ (Cox-Molina, 2011, pp. 145–146; Dennis, 2004, pp. 211–212; Perez-Chiriboga, 2000). The Miskito expression Grisi Siknis, or ‘crazy sickness,’ is a loan from English Creole, which has been spoken along the Atlantic coast by the descendants of African slaves since the 17th century (Dennis, 1981). It is also known as duhindu blaka, (duhindu is the elf-like spirit and blaka means dizziness) and bakul, the name of another Miskitu spirit (Cox-Molina, 2011). In the last decades, cases of Grisi Siknis have been connected to witchcraft accusations (Davis et al., 2005). Grisi Siknis is characterized by numerous psychosomatic symptoms, such as malaise, fear, aggressive behavior, loss of consciousness, and periods of rapid frenzy (Dennis, 1981). It is commonly reported that, during an attack of Grisi Siknis, victims can pick up machetes, shovels, or sticks and wave them or bang them on houses or other structures, sometimes injuring themselves in the process. Grisi Siknis predominantly affects women, and it is considered a contagious illness that can only be treated by traditional healers. Gabriela's account also reveals her vulnerability and the specific social and personal context of her affliction. Grisi Siknis is a cultural idiom of distress that “often employs socially and culturally resonant means of experiencing distress in local worlds open to elaboration and reinvention” (Nichter, 2010, p. 405). It is highly contextual and its “grammar” (Crandon-Malamud, 1983), or how people talk about it, has changed historically to make sense of the local reality. Grisi Siknis is evocative of current individual experiences intimately connected to migration status, ethnic identity, structural inequalities, and, more recently, to interpersonal violence. In this article, I document a shift in the domain of meaning and the core symbols in individual Grisi Siknis illness experiences. This process of “reinvention” (Nichter, 2010) incorporates “global flows of ideas” (Mendenhall et al., 2019) and social, psychological, and somatic experiences, while preserving the broader socio-cultural meaning that Grisi Siknis represents. Specifically, I show how individuals use discursive and cultural tropes such as duhindu (Miskitu cosmology), witchcraft accusations, and current gender violence discourse to explain Grisi Siknis, with the goal of communicating emotional distress, revealing gender violence abuse, and discharging tensions. Furthermore, I illustrate how Grisi Siknis is experienced and employed in relation to the unique individual experience of illness and cultural milieu.

Grisi Siknis-like behavior has a long history in the Miskitu Coast. Its manifestation appears to reflect particular social and political anxieties in the Miskitu society at large. The earliest accounts of Grisi Siknis come from English explorers at the beginning of the 16th century (see Bell, 1989). In 1881, mass Grisi Siknis-like incidents were reported by Moravian Missionaries in the region. These incidents were interpreted as a “Christian Awakening” in which the “holy spirit” took possession of converts’ bodies (Annual Report of the Province of Nicaragua, 1926; Offen & Rugeley, 2014). Historians have linked the mass conversions and its corresponding Grisi Siknis-like expression to uncertainties related to regional geopolitical and economic changes experienced by the Miskitu in the decades following British relinquishment of the territory in 1860 (Offen & Rugeley, 2014). In contemporary cases of Grisi Siknis, witchcraft accusations have been more commonly cited as the source of this illness (Davis et al., 2005; Dennis, 2004; Wedel, 2012). For example, during the Sandinista-Contra war, cases of Grisi Siknis at the refugee camps in Honduras were directly linked to accusations of witchcraft (sika) and the banishing of accused individuals (Perez-Chiriboga, 2000).

Grisi Siknis has been a focus of study among anthropologists and psychiatrists. Phillip Dennis was the first anthropologist to study Grisi Siknis in the early 1980s, and since then it has been labeled as a Culture-Bound Syndrome (Dennis, 1981, p. 1985). Dennis (1981) argued that Grisi Siknis was related to patterns of stress characteristic of Miskitu culture, with behaviors such as screaming, shrieking, and extreme emotional behavior by women, in particular: “Miskitu children learn that hysterical behavior is a normal way to express frustration and stress, they also learn that supernatural spirits cause Grisi Siknis behavior, thus relieving the individual of responsibility” (Dennis, 1981, p. 479). Dennis (1981) claimed that Grisi Siknis affected more women due to stress associated with psychosexual development in Miskitu culture, tense relations, and social and cultural expectations of women in Miskitu society. Grisi Siknis among women was linked to the desire, typical of teenagers, to experience liberty of movement and freedom to engage in sexual relations (Dennis, 1981, p. 1985). Other psychosexual and anthropological interpretations considered Grisi Siknis a rite of passage for girls to gain social status (Jamieson, 2000, p. 2001). Jamieson (2001) interpreted Grisi Siknis as a liminal phase where sexual intercourse became a device with the potential to turn girls into women. Grisi Siknis was thus interpreted as a performance that allows women to be sexual and to resist parental control, while placing blame onto male demons (Jamieson, 2001). By focusing on the cultural, dramatic, and perceived sexual aspects of the Grisi Siknis experience, past studies failed to further analyze the socioeconomic and historical context of the illness, or how it related to changing discourses on gender and gender-based violence.

The North Caribbean Autonomous Region of Nicaragua (RACCN) has the highest prevalence of physical and sexual violence reported in the country (INEC, 2001). The Women and Children Safety Department in Puerto Cabezas-Bilwi reports that the rate of sexual crime in RACCN has increased between 2006 and 2012 from 78 to 127 per 100,000 inhabitants. Nationally, the RACCN has the highest rate of sexual crimes, with 54 cases per 100, 000 inhabitants in 2018 (National Police, 2018). Nidia White Women's Association in RACCN reports that from 2011 to 2015, the organization provided legal, emotional, and medical assistance to 13,000 indigenous women suffering from instances of gender violence (LatiCe.org). Similarly, in the last two decades, the RACCN has witnessed an increase in local, state, and international initiatives on women's empowerment and gender-based violence awareness. These initiatives have changed local understandings of domestic violence to criminal behavior, which could be responsible for more women reporting this kind of violence. However, the criminalization of gender-based violence is disputed at the communal and state levels. On the one hand, the State retains legal power over serious cases, subordinating indigenous law, while the whista (Miskitu community judge) settles cases that are deemed less serious, such as community-level grievances with a Tala Mana or “payment for blood,” which often does not provide fair restitution for victims (Barbeyto, 2007).

Most residents continue to see Grisi Siknis as an excuse for young women to have sexual relations with men. Due to negative attitudes towards homosexuality in the region, Grisi Siknis among men is commonly seen as a marker for homosexuality (Denis, 1981) and ridicule. Furthermore, the cases of Grisi Siknis among women often overlap with and justify the cultural trope of “Miskitu violent love” (Herlihy, 2012, p. 2013) that regards physical violence as a normal part of Miskitu relationships. These tropes feed into the notion that young Miskitu women perform Grisi Siknis to signal sexual and romantic availability and men as presumed “homosexuals,” while ignoring the possibility of underlying emotional distress and social struggles linked to gender and structural inequalities.

I use the definition of cultural idiom of distress as a “semantically and pragmatically effective nonstigmatized way of communicating distress” (Nichter, 2010, p. 407). Drawing from De Jong’s and Reis’ (2010: 302) proposition that idioms of distress go through “a process of elaboration at the level of symbolic language that have powerful cultural resonance,” I show how individuals affected by Grisi Siknis in this study make use of discursive and cultural tropes such as duhindu (Miskitu cosmology); witchcraft accusations (moral and social diagnostic process); and current gender violence discourse as causes of Grisi Siknis. This semantic shift in the meaning and core symbols of Grisi Siknis allows for an embodied and symbolic language to communicate distress and suffering.

Informed by studies of illness expression, I examine how Grisi Siknis narratives are directly linked to the social-cultural context and intimately connected with gender power relations and interpersonal and political violence (Darghouth et al., 2006; Good, 1994; Farmer, 2005; Finkler, 1991; Jenkins & DelVeccchio-Good, 2014; Jenkins & Valiente, 1994; Low, 1981, 1985; Mendenhall et al., 2012; Nichter, 2010; Oths, 1999; Scheper-Hughes & Lock, 1987; Yarris, 2011). The ethnographic accounts of Grisi Siknis provide empirical data to unpack the unexplored contextual processes and local discourses that transform the meaning and logic of idioms of distress at the individual level of experience.

Methods

Ethnographic setting

This article is based on ethnographic field research conducted in the RACCN in the summer of 2008 (Arang Dak, village along the Rio Coco) and in Puerto Cabezas from August 2013 to November 2014. Most of the data was collected in Puerto Cabezas, the RACNN's capital. The RACCN is the larger of two autonomous regions in the northeast of Nicaragua, bordering Honduras to the North and the Atlantic Ocean to the east. RACNN has a population of approximately 177,092 inhabitants (INIDE, 2017), with a large percentage of Mestizo 35.7% (Spanish speaking Nicaraguans), Miskitu (57.3%), Sumu-Mayagnan (3.8%), and Creole (1.0%). Most of the population of the RACCN (54.8%) lives in rural areas.

The British colonization of the Caribbean Coast of Nicaragua has had a lasting cultural and socio-economic impact on the inhabitants. During first contact, the Miskitu formed strategic alliances with the British that led to the extraction of natural resources in the area but also military protection from the Spanish imperial powers. The so-called “anglo-cultural affinity” among the Miskitu (Hale, 1994) was reinforced by the spread of Protestant Christianity and the arrival of Moravian missionaries in 1847. By the end of the 19th century, United States companies established several economic enclaves that exploited the natural resources of the region and shifted the power and ethnic dynamics of the region, giving the Creole (English speaking) greater access to economic and social opportunities (Pineda, 2006). The overthrow of the Somoza dictatorship in 1979 by the Frente Sandinista Liberación Nacional (FSLN) marked the end of the US enclaves, resulting in an influx of landless migrants from the Pacific of Nicaragua, war refugees from rural indigenous communities, and the fight for self-determination in the Miskitu Coast. In 1987, the Nicaraguan National Assembly signed the Autonomy Law recognizing cultural, language, and land rights in the Atlantic Coast. The Autonomous Law became a peace accord to end the civil war between Sandinistas and indigenous movements who were seeking self-determination and secession from Nicaragua. It did not provide law-making powers, and all the regulations are subject to national laws by the Nicaraguan government (Pineda, 2006).

As part of the continuous fight to gain political autonomy, the RACCN developed a Health Model policy in which health and social programs are guided by the principles of integrated health care, social participation, and cultural and ethnic revitalization (Ruiz, 2006). Under this health model, Grisi Siknis was redefined as a cultural and health problem with the goal of providing evidence that would justify the region's ethnic and cultural difference (Venegas, 2016). The RACCN health policy project ultimately seeks to transfer decision-making power to the region and advance the autonomy project (Ruiz, 2006). This health policy process has also contributed to a greater public awareness of Grisi Siknis cases and their reporting via public media, radio and local news channels, as well as in the international press.

Data collection and analysis

I conducted a total of 20 individual interviews with individuals affected by Grisi Siknis. Given the sporadic nature of Grisi Siknis, I identified participants with the help of key informants and through my personal contact with community members who identified individuals affected by the illness. The interviews were voluntary and all individuals in this study have pseudonyms. I conducted most of the interviews in Spanish. I hired a field assistant, who conducted the interviews in Miskitu language under my supervision. Participants in this study were remunerated C$200 (approximately US$10) for each interview. Participants were included based on their interest and willingness to participate in the study. All procedures were conducted in accordance with the ethical standards of the Institutional Review Board at the University of Pittsburgh, USA (IRB # PRO13050381).

Participant observation proved crucial in this study. I learned about episodes of Grisi Siknis through radio and word of mouth and was able to witness Grisi Siknis cases as they were unfolding. This gave me the opportunity to observe the cases and note how other community members reacted to the Grisi Siknis attacks. Many times, during and after an outbreak of Grisi Siknis, I talked to eyewitnesses about their opinions and built up a narrative from their perspective.

During data collection, I moved back and forth between Grisi Siknis victims, their family members, and eyewitnesses. This mode of ethnographic engagement and concurrent data analysis helped me reframe questions and look for relationships between statements and events, allowing for constant comparison and reflection. This ethnographic approach minimized issues related to validity and reliability and helped to capture how the web of meanings connected to the illness plays out in local social worlds (Geertz, 1973; Kirmayer & Ryder, 2016).

In addition, I kept a systematic record of informal observations, interactions, and conversations in the form of field notes. Through methodological and theoretical memos, I kept detailed notes about the context and variations in the phenomena that provided direction for further data collection and analysis. Interviews were recorded digitally, duplicated for safekeeping, and translated and transcribed verbatim, with any identifying information removed.

Individual interview transcripts and field notes were transferred to NVivo qualitative data analysis software (QSR International, 2014). Initial categories derived directly from the interview guide and then from interview data. Qualitative data were summarized, distilled, and condensed into aggregates and codes (Bernard, 2006). I analyzed field notes and memos alongside interviews (DeWalt & DeWalt, 2002). These data provided knowledge on their first and subsequent attacks, memories of suffering associated with the illness, accounts of their treatment, and sources of support.

Of the 20 participants, 17 were Miskitu and three were Mayagna, 16 were female and four were male, and the age range was from 19 to 24 (mode 21). Key and emergent themes included attributions of causes (e.g., witchcraft accusations) and the shifting discourse on sexual and gender violence. See (Table 1)

Attribution of causes

Among the 20 participants in this study, eight cited processes rooted in Miskitu cosmology as the most common cause of Grisi Siknis. Grisi Siknis has been known as a “contagious” illness (see Dennis, 1981, p. 1985). An individual whose name is called by someone afflicted by Grisi Siknis at the time of the unconscious trance-like state soon starts to develop the same agglomeration of physical symptoms and emotional responses. During my fieldwork, I witnessed the name-calling as a way of spreading Grisi Siknis but also found that many affected by the illness share kinship-ties, friendships, or similar life experiences. Another commonly reported way of spreading Grisi Siknis is by writing the names of the future victims on small pieces of paper and leaving them in a public space to be seen. This latter method is related to witchcraft practices.

Grisi Siknis has historically changed its “grammar” (Crandon-Malamud, 1983) to make sense of the local reality. For example, the shift in the social and cultural meaning of duhindu, the Miskitu spirit directly associated with Grisi Siknis, reflects the social and political anxieties in the Miskitu society at large and the individual context of the victims. Images of the duhindu, described as a white man offering money or blood, may reflect memories of foreigners during the Anglo-American occupation and economic boom (Dennis, 1981, p. 449). Likewise, visions of a “black man” reflect the socio-economic inequalities of the “company time” that created competing social categories (Pineda, 2006) and provided social status to Creole black English-speaking workers who held better-paying jobs than Miskitu or other indigenous groups. While duhindu continues to play a role in the Miskitu cosmology and understanding of Grisi Siknis cases, participants and field informants more commonly attributed recent cases of Grisi Siknis to witchcraft or a combination of duhindu and witchcraft.

Symptoms and treatment

In terms of symptoms, participants reported feeling nauseous, dizzy, fatigued, and having headaches prior to a Grisi Siknis attack. Participants also reported experiencing strong emotional states, such as fear or nervios (nerves), and feeling out of control. Among female participants in this study (n = 16), Grisi Siknis cases were understood to be connected to specific experiences, such as lack of family support (n = 6), being afraid of a professor or husband (n = 11), or witchcraft (n = 16). Most participants (18/20) claimed that sukias (traditional healers) are the only ones capable of treating Grisi Siknis, but some also described religion and home treatments as important in the management of Grisi Siknis. Biomedical treatment was only sought if victims were physically injured during an attack.

Communicating structural inequalities

The cases in this section provide the personal and social context in which Grisi Siknis and accompanying narratives are experienced, employed, and resolved by individuals. Through Grisi Siknis, troubling aspects of social life are communicated, negotiated, and transformed by both men and women in this study.

Isabel, a 19-year-old Miskitu woman from Puerto Lempira, Honduras, was among the students affected by Grisi Siknis in a dormitory at a local college in Puerto Cabezas. At least six female students reported Grisi Siknis symptoms and two of them, including Isabel, experienced “attacks” of Grisi Siknis. Isabel came to Bilwi with her two cousins who shared the same room in the dormitory. It was the first time Isabel was living away from her family, and she described difficulty adapting to life in Bilwi, particularly related to the tense political relations among ethnic groups in the area. During our interview, Isabel was afraid to talk about the details of her illness because she thought it would make her succumb to the illness again. The first time she witnessed a case of Grisi Siknis was in Honduras during Mass when two girls were afflicted. Isabel reports that Grisi Siknis is related to witchcraft and the Miskitu spirit duhindu.

Isabel's cousin Lucia was one of the first ones to become afflicted with Grisi Siknis in the dormitory. Lucia was also given the role of interlocutor or “leader” among the afflicted by the illness. Isabel recalls that Lucia started by claiming to have visions of the guilty party and premonitions of bad omens. One night, Lucia called out the names of several flatmates including Isabel, and the same night Isabel along with eight more female students were stricken by Grisi Siknis. “When we arrived at the dorm, Lucia said something unintelligible, her face turned pale, and she started moving her hands uncontrollably with closed fists like fighting with someone only she could see.” Most of the male students at the dormitory volunteered to help restrain the afflicted since they had acquired supernatural force and needed to be controlled. Isabel claims that Lucia accused the male students of practicing witchcraft and afflicting the females with Grisi Siknis. The university hired two traditional healers (Miskitu and Mayangna) and a Moravian Pastor to control the outbreaks at the dorm. The Mayangna traditional healer, a male in his 30s, prepared a mixture of aromatic herbs to dispel the duhindu and steam-bathed the afflicted with the herbs.

Nonetheless, the treatment failed and the Miskitu healer took over. The young Miskitu healer identified the “evil-doers”—four young Mayangna male students living in the dormitory downstairs—as practicing witchcraft on the female students. Isabel claims that after the Miskitu healer asked the students to stop inflicting pain on the female students and the university threatened to suspend the students indefinitely, the Grisi Siknis attacks stopped. Isabel confided to me that after the healing ritual and the talk with the young Mayangna men, their relations with the male students seem to improve. She also claims to be treated now as taya nani—a Miskitu fictive kinship term to refer to family and non-family members who live in their village, neighborhood, or dorm (Dennis, 2004).

The participants’ illness experiences draw attention to social and structural inequalities of gender and ethnicity. In the following cases, Grisi Siknis communicates structural inequalities but is also a strategic tool to negotiate status. The case of Genaro, a 19-year-old man from a small Rio Coco village, was particularly exemplary of Grisi Siknis experience as a strategic cultural idiom of distress. Genaro was considered by his neighbors as an awkward person and not a good hunter, a skill valued in the village. Genaro's father, Oscar, is a Miskitu man from Honduras who met Genaro's mother during the war in the refugee camp. Genaro's father had not been quite assimilated to the community because of his “assumed” Honduran connection to witchcraft. Genaro and three of his siblings were afflicted with Grisi Siknis. Genaro reported the duhindu spirit as the source of his illness. He also reported physical symptoms along with visions of blood and violence, followed by aggressive behavior and the urge to run towards the river. One night, Genaro and his younger brother were both affected by Grisi Siknis. Because of their strength and destructive behavior, many men tried to restrain the brothers but the lack of electricity in the village made it difficult. Genaro's father went after his sons and was severely injured by a metal barbed wire fence that slashed his face. After that incident, the village residents were more sympathetic towards Genaro's family.

Genaro was also given the job of village police officer; he was responsible for looking after the women and elders while men were absent working in the fields or during hunting expeditions. Coincidentally, Genaro's illness resumed after he was given an important role, thus Grisi Siknis provided Genaro with an opportunity to improve his social standing in the community. Of key importance is how Genaro's family, because of their experience with Grisi Siknis, transitioned from outsiders to accepted community members. Genaro's illness experience provided the means for outsiders like his family to become integrated into the community, and it helped Genaro to gain a more acceptable social role in the community.

Jose, a Miskitu young man in his early 20s from a village north of Puerto Cabezas, was stricken by Grisi Siknis for the first time after migrating to Puerto Cabezas in search of better employment opportunities. Jose started working as a waiter at a local restaurant in Bilwi. He speaks some Spanish but feels more comfortable speaking his native language. One hot afternoon, he was sent to deliver chairs to another locale. I witnessed Jose pulling a horse cart with the chairs in, with which he had to make several trips. After the last trip, he was extremely upset and protested that he was not an animal, a beast, to be pulling a horse cart. The next day, Jose did not come to work. I was informed that he was stricken by Grisi Siknis and stopped working. Jose went back to his family, to his native community, to be treated and cared for by his family. A week later, he came back to work and shared details about his illness with me. “Grisi Siknis is a bad evil thing that even when I am cured now, I need to control myself, I need to avoid getting stressed out or angry because that's when I see it [duhindu] coming.” He explained that his Grisi Siknis episode was caused by witchcraft, “something someone sends you for evil reasons.” Jose had witnessed cases of Grisi Siknis in his native community but had never been affected before.

Although women are overrepresented in most cases, Grisi Siknis among men is often associated with hard labor or forced duties, such as military draft (see Dennis, 1981; Martin & Nahel, 1987; Perez-Chiriboga, 2000). It is my contention that Jose's discernment of being overworked and underappreciated triggered his Grisi Siknis experience, which in turn provided him with temporary relief from obligations and a social space for him to protest his working conditions. After recovering from Grisi Siknis, Jose was welcomed back to his former job as a waiter. He informed me that his work conditions had improved, as he was not asked to perform hard labor outside of his duties as a waiter.

Indigenous migrants to Puerto Cabezas, as in the cases of Jose and Isabel, are treated differently for their “apparent” status as being “real Indians”—they are viewed as less modern and less educated for their lack of Spanish- or English-speaking skills. It is also common in Puerto Cabezas to blame rural indigenous people (Mayangna and Honduran Miskitu in particular) as practitioners of witchcraft. The narratives of Genaro and Isabel allow the space to negotiate and transform their identity as Honduran Miskitu to become taya nani, or insiders. Grisi Siknis helped Genaro and Isabel to forge social alliances and turn their suffering into a form of social empowerment and acceptance. Although witchcraft as a causal model was cited by Isabel and Jose, only in Isabel's case were the “evil-doers” identified and reprimanded. In these three cases, the experience of Grisi Siknis was employed and framed in a way that legitimized the victims’ complaints and suffering, allowing them to break from social expectations and negotiate their identity and status.

Grisi Siknis, witchcraft accusations, and gender violence

Grisi Siknis continues to be portrayed in popular culture as a performance by women to express sexual desire. During episodes of Grisi Siknis, it is common to hear men explaining that the girls affected by the illness “quieren hombre” (have a desire for men) as the cause for their illness, often giving males permission to disrespect or assault the victims (see Dennis, 1981 for reported cases of rape related to Grisi Siknis). There is also the widespread notion that Miskitu expect pain and violence in their romantic relationships (Herlihy, 2012, p. 2013). These notions of

Grisi Siknis as a sexual desire indicator or performance, along with local discourse of “violent love” as accepted Miskitu behavior, contribute to the lack of seriousness given to cases of Grisi Siknis and to reports of domestic and sexual violence by Miskitu women. It is noteworthy that discourse on violent love among the Miskitu are increasingly being rejected due to state laws and the presence of international human rights and women's rights discourse in the region (Herlihy, 2013).

Miskitu women face systemic and cultural barriers when seeking justice for gender-based violence offenses. In many cases, the perpetrator is a close family member (Dixon & Torres, 2008, p. 11), and the case fails to go to trial because the judge imposes a mediation procedure wherein the victim forgoes filing for criminal justice (Figueroa-Romero & Barbeyto, 2014). At the community level, when families try to seek justice for domestic or sexual violence, the Whistas (community judges) mediate through Tala Mana or “payment for blood,” which often does not provide fair restitution for victims of domestic and sexual violence (Barbeyto, 2007). In this section, I show the ways Miskitu women reframed, communicated, and positioned their experiences of gender-based violence through the cultural idiom of Grisi Siknis. Specifically, I demonstrate how witchcraft accusations and the discourse of gender violence reflect the semantic shift in Grisi Siknis among women to expose and negotiate gender-based abuses.

Recent outbreaks of Grisi Siknis cases have been linked to witchcraft practices (Davis et al., 2005). During a mass outbreak of Grisi Siknis at a public school in Puerto Cabezas (42 cases in total), affecting mostly the female school population, I spoke to one of the students affected. She claimed that a male teacher planted “cochinada” (dirty witchcraft) in the girls’ bathrooms and this triggered the Grisi Siknis cases at the school. A teacher at the school confirmed this accusation and assured that the male teacher (who had a history of sexually accosting female students) was transferred to another institution. In a group interview with Gabriela and two of her friends, all suffering from Grisi Siknis at the time of the interview, each reported an uncomfortable and stressful experience with a male. For example, Lupe, a young Miskitu woman in her 20s, stated that her episodes of Grisi Siknis were related to her anxiety and fear when the father of her child would call or visit her. Lupe claimed that her ex-partner forced her to fall in love with him with the help of witchcraft. Miskitu love magic or involuntary love is a practice that makes use of potions that are understood to cause involuntary romantic love. Generally, men use the potions to cause feelings of love and to manipulate a woman into fulfilling traditional roles and submit to them sexually (Herlihy, 2013, p. 5).

In the Miskitu Coast, witchcraft accusations are linked to recent socio-cultural and socioeconomic developments, to civil unrest, and to misfortune and illness (Dennis, 2004; see also Wedel, 2010). Normally, witchcraft accusations are considered real threats to community harmony and evil doers are dealt with by Miskitu customary law which is supported by Miskitu elders, voluntary police, and a judicial facilitator (Wedel, 2019). Female participants in this study linked cases of Grisi Siknis (their own and that of others) to the action of witches who force people to pay for expensive cures, and to the action of men who have learned the “trick” to dominate duhindu, with the purpose of causing pain and suffering to women. In the context of competing, and at times contradictory, discourses on gender and domestic and sexual violence, men have occupied the symbolic role of “evil-doer,” controlling the Miskitu spiritual world and women's emotional worlds. Hence, witchcraft accusations in the context of Grisi Siknis represent a shift in the semantics of suffering “in which the moral order may be negotiated” (Comaroff & Comaroff, 1999, p. 309) at the communal level of justice and as the shared symbolic language for the expression of suffering among the women in this study.

Local and international gender equality initiatives in the RACCN, such as Nidia White Women's Association, the University of the Autonomous Caribbean of Nicaragua's Multicultural Women Studies (CEIMM), and Services to Victims of Intra-Family and Sexual Violence in Puerto Cabezas (CAIMA), have worked to empower women in navigating the different levels of justice regardless of systemic barriers (Figueroa-Romero & Barbeyto, 2014; Gomez-Barrio & Dixon-Carlos, 2018; Herlihy, 2013). The cases of Grisi Siknis related to witchcraft accusations reveal that not all women choose or are able to navigate the new world of gender activism and women's rights. However, the participants’ framing of cultural elements employed and shared by the community legitimizes their suffering while pointing towards specific sources for their afflictions. In the next narrative, the participant connected Grisi Siknis directly to her experience of domestic and sexual violence.

Yerlita, age 20, is a Miskitu woman who first experienced Grisi Siknis at the age of 16. Yerlita described herself as an active member of the Moravian church and a part-time student at one of the local universities in the region. When she was 16, after witnessing her best friend's experience with Grisi Siknis, Yerlita reported experiencing nightmares and visions of a man in black with a knife. The next day, she went to school but the images of the man in black kept her feeling anxious and frightened. “After school I ran to church and started crying uncontrollably, then I lost consciousness.” In terms of treatment, Yerlita visited different traditional healers.

None of the traditional remedies were working and I was extremely sad and frustrated with my illness. I hated that men would restrain me and tie me down to the bed. I know I had extra strength during an attack and it was hard for my parents to take care of me.

She stopped the traditional treatment and decided to “control” herself through prayers and her faith. She reported still suffering from Grisi Siknis at the time of the interview.

Yerlita was 19 when she married her husband, but only lived with him for one year. “We lived with his family. He was an alcoholic. He abused me physically and was unfaithful, always looking for girls to sleep with.” Yerlita told me that the reason she left her husband was because her brother-in-law abused her sexually.

He would harass me continuously and threatened to kill my younger sister, who was six years old at the time. I was terrified. That's why I never told my husband or the police. Instead, I tried to kill myself by ingesting rat poison. I was in the hospital for several days, and when I recovered I left my husband's house. I could not deal with it.

Yerlita left her husband after one year of marriage. She then migrated to several towns and cities searching for work and reported experiencing Grisi Siknis at that time. “I can't control my illness, I am crazy. I think that everything I have been through has made me crazy. [Laughs] I am not normal.” Yerlita self-disclosed her sexual orientation by pointing at her male-like clothing style. Yerlita asserted she was “different” and that she is still vulnerable to Grisi Siknis, both because she is not as religious anymore and because of her parents’ rejection of her sexual and gender identity.

Yerlita's Grisi Siknis experience shares common elements with Gabriela's experience. Yerlita's illness was also triggered by duhindu (a man in black), and she presented the same physical and emotional symptoms and state of agitation. Both narratives also highlight their vulnerable position and the specific social and personal context of their affliction. Unlike the other participants, Yerlita perceives her experience of domestic and sexual abuse, her husband's family mistreatment, and her anxious state due to her sexual preferences as the cause of her Grisi Siknis episodes. Instead of emphasizing the duhindu or witchcraft as the source of her affliction, Yerlita positioned her gender violence experience at the center of her illness, exposing the sources of her affliction in attempts to make sense of her current reality. I theorize that Yerlita's exposure to gender rights workshops at college might have an influence on the way she verbalized and expressed her experience with Grisi Siknis using the discourse of gender and women's rights. It is also probable that my status as foreigner, my affiliation to the local regional university, and an assumption of my having knowledge of gender and sexual identities encouraged Yerlita to discuss her sexual orientation with me, despite the fact that homosexuality is highly stigmatized in the region.

This semantic shift in the cause of Yerlita's Grisi Siknis allows for a simultaneous embodied language to convey individual suffering, while integrating a gender violence discourse that resonates with the current social context and preserves the broader socio-cultural meaning of Grisi Siknis. Yerlita's case is exemplary of how Grisi Siknis is a highly contextual idiom of distress and how the shift in the domain of meaning (e.g., gender violence as directly associated with Grisi Siknis) allows the individual to communicate the sources of affliction in their own semantic and conceptual universe.

Discussion

This article reports qualitative and ethnographic data on Grisi Siknis, a culturally recognized and indigenously diagnosed idiom of distress among the Miskitu of Nicaragua. The cases presented in this article provide evidence of Grisi Siknis as a highly contextual idiom of distress intersecting with individual experiences of migration, ethnic identity, structural inequalities, and, more recently, gender-based violence. I identified a semantic shift in Grisi Siknis that allows for an embodied and symbolic language connected to global flows of ideas and micropolitics of the region (Mendenhall et al., 2019; Nichter, 2010). The identification by Yerlita of gender violence as linked to Grisi Siknis is an example of how global flows of ideas influence how cultural idioms are understood and expressed (Mendenhall et al., 2019).

Grisi Siknis has gone through various changes related to symbolic language and social context and its current use points to specific bodily, psychological, or social events (Kirmayer, 2015). For example, participants in this study made use of the duhindu (Miskitu spirit associated with illness and misfortune) and witchcraft as symbols that derive legitimacy from shared metaphors, meanings, and understandings in the Miskitu society. Grisi Siknis linked to gender violence represents a new language incorporated into the logic of this cultural idiom of distress that allowed the individuals in this study to draw attention to social and structural inequalities of gender and ethnicity, while serving as a bargaining tool to negotiate social status and to protest strained relations and work conditions.

This finding is consistent with studies of cultural idioms of distress and folk illnesses as means to communicate prolonged social struggles or social indignations that are intimately connected to power relations; historical, socio-cultural, and political structures; interpersonal violence; and severe forms of distress (Finkler, 1991, p. 1997; Guarnaccia et al., 2010; Jenkins & Valiente, 1994; Kirmayer, 2015; Low, 1985, p. 1989; Mendenhall et al., 2010, 2012; Oths, 1999; Scheper-Hughes & Lock, 1987; Yarris, 2011). As demonstrated here, Grisi Siknis afflicts women and men in vulnerable social positions.

Although women continue to represent most cases of Grisi Siknis, contemporary cases also include men. The narratives of male participants seemed related to their work experience and status. This finding is consistent with past studies that linked Grisi Siknis among men to hard labor and forced duties, as in the case of military draft (Dennis, 1981; Martin & Nahel, 1987; Perez-Chiriboga, 2000). In addition, this finding extends studies of idioms of distress among men that have found such idioms may reflect: the channeling of social discontent; lack of economic opportunities; lesions in life, such as family losses; strained relations; hunger; and anxiety (Finkler, 1994; Guarnaccia et al., 2003; Low, 1981; Scheper-Hughes, 1988) through idioms of sickness.

The findings reported here are also consistent with anthropological studies of witchcraft and sorcery that illustrate the ways witchcraft can be employed to account for experiences and conditions that might not otherwise be explained but also to undermine inequalities of power (Geschiere, 1998; Herlihy, 2013; James, 2012; Kleinman et al., 1997; Wedel, 2019). I show that by linking instances of gender-based violence to the culturally accepted trope of witchcraft and direct witchcraft accusations, Miskitu women are able to express their suffering and negotiate justice, given the exclusionary and often ineffective judicial and communal institutions that fail to process domestic and sexual violence in the region.

This qualitative study employed multiple methods (ethnographic observations and interviews) at multiple sites over 12 months, which improved validity and reliability, captured the meanings people used to navigate their illness experience, and showed how these meanings played out in their local social worlds (Geertz, 1973; Kirmayer & Ryder, 2016). However, this study was limited by a small sample of male participants and a lack of further documentation on witchcraft accusations related to Grisi Siknis and its communal resolution. Further data on the witchcraft accusations associated with Grisi Siknis could identify specific markers of risk and provide a framework for recognizing physical and emotional vulnerabilities among those affected.

Conclusion

In the past decade, global mental health research has been marked by a growing recognition of the broader social and environmental contexts in which individuals are embedded and how these contexts shape individual risks, health, and emotional distress (Aronwitz et al., 2015; Carpenter-Song & Snell-rood, 2017; James, 2016; Karpati et al., 2002; Kidron & Kirmayer, 2019; Kirmayer & Minas, 2000). The Grisi Siknis cases in this study represent local experiences of complex forms of violence (domestic and structural) that tend to be overseen and normalized as ubiquitous cultural problems.

Regarding the experience of men afflicted by Grisi Siknis as “homosexuals” and viewing women as “performing” Grisi Siknis to sexually attract sex partners diverts attention away from the forms of violence that make individuals vulnerable to this illness and the emotional and physical consequences of violence. These findings have implications for efforts to develop more comprehensive models of care.

Widespread poverty, lack of economic and educational opportunities, rurality, and a corrupt, exclusionary and inefficient judicial process to criminalize domestic and sexual violence are factors that make Miskitu women vulnerable to domestic and sexual violence. As gender violence becomes widely recognized in the RACCN and as local notions of violence and sexuality among Miskitu are challenged, it is imperative to draw attention to the ways that women and men communicate their suffering and how this is translated into real and legitimate sources of distress.

Mental health programs and interventions in the region must be comprehensive, accounting for local understandings of personhood, embodiment, and violence-related suffering (Duncan, 2016; James, 2016), and paying attention to social factors such as ethnicity, migration, and socio-economic status. The discursive and causal models of Grisi Siknis experiences can reveal the specific stressors and sources of suffering among the individuals affected by the illness. In terms of treatment and management of Grisi Siknis, the role of the traditional healers cannot be underestimated. Traditional medicine among indigenous peoples in Nicaragua has been a prime source of health care and plays cultural, symbolic, social, and therapeutic roles in Miskitu communities. Integrating knowledge and therapeutic skills of traditional healers into mental health programs can help to create and design effective intercultural programs that respond to the emergent problems in the region. Finally, future work and efforts to address and redress psychosocial distress in the region must target the current structural and socio-economic challenges in the region.

Table 1.

Grisi Siknis signs, causes, and treatments described by interview participants (N = 20).

	Emic Responses	n	%
Physical symptoms and signs	Headache Body aches Weakness Vomiting Dizziness Tremors Loss of consciousness	18 18 11 3 20 6 15	90 90 55 15 100 30 75
Psychosomatic symptoms and signs	Loss of control Visions of the spirit (duhindu) Fear Nervous Anger	16 11 12 4 7	80 55 60 20 35
Attribution of causes	Dihundu (Miskitu spirit) Ouija Board Evil spirits Witchcraft Fear of male violence Lack of family support Jealousy	8 4 4 16 16 4 5	40 20 20 80 80 20 25
Treatments	Sukia (Miskitu traditional healer) Agua florida (perfumed water) Hospital (Biomedicine) Church/pastor Witch doctor	18 9 3 6 6	90 45 15 30 30

Footnotes

Maria D. Venegas, MPH, PhD, is medical anthropologist at the New England Geriatric Research, Education, and Clinical Center (GRECC) ENRM Veterans Hospital. Dr. Venegas completed a postdoctoral fellowship at the Centers for Health and Aging, Department of Psychiatry, Dartmouth Hitchcock Medical Center. Her primary research interests focus on ethnographic-informed studies of mental health, m-health, and telehealth for the management of complex chronic conditions, medication adherence, and care utilization among economically disadvantaged, minority, and older populations.

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Grisi Siknis : A cultural idiom of gender-based violence and structural inequalities in eastern Nicaragua

Abstract

Keywords

Introduction

Methods

Ethnographic setting

Data collection and analysis

Attribution of causes

Symptoms and treatment

Communicating structural inequalities

Grisi Siknis, witchcraft accusations, and gender violence

Discussion

Conclusion

Footnotes

Acknowledgements

Declaration of Conflicting Interests

Funding

ORCID iD

References