Patients' cultural beliefs may affect acceptance of healthcare, compliance and treatment outcomes. Physicians who wish to provide appropriate and acceptable care in a cross-cultural setting should attempt to understand the basis of folk medicine and integrate these beliefs with conventional medicine. Failure to recognize curanderismo's importance for some patients is a commonly encountered obstacle to better treatment.
There is no known reported scientific evidence that curanderismo is effective in the treatment of diseases based on scientific trials. However, there are some individual reports that curanderismo may help to improve symptoms, reduce pain and relieve stress.
There are no well-documented harmful effects. However, some treatment by curanderos may involve taking unregulated herbs and teas. Relying on this type of treatment alone, and avoiding conventional medical care, may have serious health consequences. Also, if the treatment involves acupuncture, this may carry a risk of infection.
While some aspects of curanderismo may be practiced at home, such as using folk remedies for minor illness, many people pursue the specially trained and gifted curanderos (men) or curanderas (women). A curandero usually obtains his or her knowledge of healing passed down from close relatives or learned through apprenticeships with experienced healers. In some cases, their healing powers may be described as a sacred and mystical gift received later in life. Most curanderos claim that their ability to heal involves divine energy being channeled through their bodies.
Practitioners of curanderismo believe good health is achieved by maintaining certain balances, such as a balance of hot and cold, or of the spiritual and physical. In order to treat a person, curanderos often classify the patient's physical activities, food intake, drugs consumed and illnesses as hot or cold and treat the person to restore a balance of both. Supporters also claim folk illnesses such as mal de ojo (the evil eye), susto (fright), and empacho (blockage of the digestive tract) can be treated by curanderismo. To treat these illnesses, the curandero may perform barridas (ritual cleansing) to rebalance the body and soul of the patient.
The curandero's treatment may consist of rituals, herbal antidotes, potions or counter magic, depending upon the ailment. Many curanderos use recetas (prescriptions) that involve drinking water at certain intervals or various other simple treatments. Sometimes the treatment may consist of contacting the brujo, either supernaturally or directly, and demanding that the hex be removed. If the brujo refuses to cooperate, the curandero may hex the original "hexer". Part of the cure might also reside in identifying and locating the hexing agent and eliminating it. If dolls, such as voodoo dolls, were used, the curandero may attempt to find and destroy the doll. The treatment may also involve the eradication of objects magically injected into the victim's body, such as a lizard or a worm.
Love curses, which originally used the victim's photograph, are typically counteracted with rituals involving counter magic. For example, the curandero may press the victim's picture face-to-face with a picture of Christ, or place it on a small altar and perform religious rituals. The curandero's rituals often employ Catholic symbols such as crucifixes, rosaries or holy pictures.
Prayer is a strong foundation of curanderismo. Curanderos generally have strong religious faith and believe that they were given the ability to heal as a gift from God. In the course of a treatment, curanderos may pray to spirits and/or Catholic saints for help in healing their patients.
A traditional healing session may include any combination of spiritual cleansing (limpia), ritual, prayer, massage, and herbal therapy. Curanderas may use herbs and spices, eggs, lemons, flowers, fruits, holy water, pictures of saints, crucifixes, candles, incense, and oils in their healing sessions. Each object has a specific purpose. For example, holy water may be used for protection from negativity or evil spirits. Eggs and lemons patted on the patient's body to absorb negative energies may also be used. Rosemary, basil, and rue branches may be brushed on the body to remove negativity. Candles can be burned to absorb negative energy and create a healing environment. Different colored candles are burned for different reasons: red for strength, blue for harmony, pink for good will. Incense may be used to purify the room, while garlic and oils may be used as protection from negativity and bad spirits.
Treatments may also include balancing the patient. For example, a curandero may bleed for fevers, or blood-let to get rid of excess blood. Herbs, emetics and diuretics may also be used by a curandero to balance the body. Certain foods and medicines are considers "hot" and would be used to correct an excess of "cold", and vice versa. Penicillin, for example, is considered to be a "hot" treatment, and would be avoided if a person were thought to have a hot disease. Cilantro, a cold food, is often recommended in hot diseases, while pork, which is hot, might be avoided. Examples of hot diseases may include diabetes, acid indigestion and hypertension. Examples of cold diseases may include menstrual cramps, pneumonia, and colic.
To relieve the physical and spiritual manifestations of illness, curanderas may use a number of special tools and treatments. Limpias, or spiritual cleansings, are done by "sweeping" the body with a bundle of herbs or an eagle feather to remove negative energies. Often an egg is first rubbed over the body, broken and placed in a glass of water, allowing the practitioner to "read" the person's energy so the treatment can be individualized. Soul retrievals are ritual ceremonies done for patients who are suffering from soul loss, which can be caused by early abandonment, traumas such as rape or unresolved grief for loved ones lost by death or divorce. Soul retrievals allow people to become fully integrated and whole, by reclaiming the part of them that was lost. Healing ceremonies may incorporate holding or burying symbolic articles, fasting, prayer, religious artifacts, chanting, drumming or drinking specially prepared infusions.
For physical illnesses, herbal mixtures, poultices, or teas are often recommended. A poultice is a soft moist mass of bread, meal, clay or other adhesive substance, which is usually heated, spread on cloth and applied to heal an aching or inflamed part of the body. One cure for a headache is to place a slice of raw potato over each temple. Dandruff is treated by rinsing hair with juice from the olivera plant, a type of cactus.
To reduce the size of an overly large "energy field," the curandero may beat the air around the patient's head with a large feather, then roll an egg around the patient's face before cracking it open into a glass.
The treatments given by curanderos can vary widely depending upon the nature of the illness or complaint.
Curanderismo is based on many philosophical theories, however, eight key philosophical premises underlie a comprehensible curing world view of Latino patients:
Disease or illness may follow strong emotional states (such as rage, fear, envy or mourning of painful loss).
Being out of balance or harmony with one's environment can also cause disease or illness.
A patient is often the innocent victim of malicious forces.
The soul may become separated from the body (loss of soul).
Cure requires the participation of the entire family.
The natural world is not always distinguishable from the supernatural.
Sickness often serves as a social function, through increased attention and rallying of the family around a patient, thus reestablishing a sense of belonging, referred to as resocialization.
Patients respond better to an open interaction with their healer.
In the Latino worldview, the mind and body are inseparable; there is no perceived dichotomy between emotional and somatic, or bodily illnesses. The idea of psychosomatic illness is a very ordinary thing for most Latinos. One of the main causative factors behind any physical-emotional illness in the Latino culture is the belief that illness is the result of having experienced some strong emotional state. Because of rage (rabia), one suffers physically from destructive rage (bilis). Three other common folk syndromes linked in Spanish to emotional experience are awesome fright (susto), which can scare the soul out of the body, "envidia," the distressing effect of strong envy, and "tristeza" which is unresolved natural mourning or sense of abandonment. This identifies, within the cultural construct, that strong upsetting emotions and reckless impulses can cause interpersonal and intrapsychic distress. Along with susto, envidia, and tristeza, bilis is a folk syndrome caused by an emotional upset leading to the imbalance of bile.
"Bilis" is considered a natural disease caused by furious anger combined with fantasies of revenge. It occurs when a person is badly frustrated or not treated well by others. It is believed that in this condition, bile pours out of the blood stream and the person "boils over" causing vomiting, diarrhea, headaches, dizziness, nightmares and inability to urinate.
Other factors besides strong emotional states that are theorized to cause sickness are: lack of balance or harmony inside and outside a person, dislocation of either real or imaginary parts of the body and diseases of magical or supernatural causation, such as punishment by a saint. It is believed that the human body is healthy when it maintains an exact balance of opposed qualities, such as hot and cold, or moisture and dryness. An excessive amount or deficiency of one of these qualities will cause illness. Curanderismo focuses on balancing the body.
Because curanderismo is focused on an underlying theory that body and soul are inseparable, the role of religion is important because a person in curanderismo is conceptualized as a soul that happens to have a body, while in more modern ideas of medicine and curing a person is first and foremost a body, which may or may not have soul. The practical thought is that a curandero can treat the soul, and then later, or not at all, treat the body. Based on this theory, a curandero may start treatment by having tea with a patient and talking about the cure, therefore treating the psyche, or the soul, first.
Studies show that curanderismo is currently still practiced in San Antonio, Texas, though its practitioners tend to be older, making its future unclear. Several significant characteristics of the practitioners were clarified such as the process of becoming a healer, referral practices, types of disorders treated and treatment of the traditional folk illnesses. It has been confirmed that most of the practitioners and their patients concurrently utilize the folk medical system and the scientific medical system.
In Mexican American communities, curanderismo folk healing traditionally has played an important role in meeting important healthcare needs of residents. However, researchers who study healthcare do not often consider the role of folk healing among elderly Mexican Americans, resulting in little knowledge available about its use by this group. In a recent study, 25 Mexican American elderly people participated in extensive ethnographic interviews about folk healing (curanderismo) and its influence on health care behaviors. The participants generally relied on modern medicine to treat serious injuries and major health problems, but still considered traditional folk healing a practical substitute in situations in which modern health care was unsatisfactory or ineffective.
Two case reports exist that describe psychotic Mexican American patients who were successfully treated with an approach that integrated curanderismo. This suggests that cultural considerations may be successfully incorporated into a treatment plan of optimal benefit for an individual patient.
Bilingual nurse-curanderas are an emerging group of health care providers. This group provides culturally appropriate and proficient care to many Hispanics, a large minority group in the United States. Nurse-curanderas incorporate curanderismo (Hispanic folk healing) with allopathic health care, evaluate safety and efficacy, and implement appropriate interventions. The balance implemented by this health group reduces cultural conflict increases patient compliance with the treatment regimen, thus improving outcomes.
There is no well-documented scientific evidence available showing that curanderismo cures any disease. However, some people report it helps to reduce pain, relieve stress and promote spiritual peace. A study in 1977, which looked at the relationship between Mexican American populations and folk medicine, suggested that curanderismo should be looked at more closely by conventional medicine. Researchers proposed that a better understanding of folk medicine, such as curanderismo, might help physicians treat their patients more effectively by helping them understand patient fears and beliefs.