City Lit: Working our Nerves

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Two years ago, a middle-aged friend of mine in Washington Heights suffered a devastating blow. On a quiet, leisurely Sunday afternoon, she walked into her TV room and found her husband slumped on the floor. EMT workers arrived and pronounced him dead. My friend promptly began screaming, lunging, cursing and trying to force herself into the ambulance, which by then was en route to the morgue.

Cops responded by taking her to a hospital, where for three days she was involuntarily committed to a psychiatric ward. As her kin engaged in communal acts of mourning–including planning the funeral–this normally sensitive, stylish woman was locked down in an immodest gown, without even a hairbrush, and left to grieve among sedated strangers.

The funeral took place a day after she was released. There she again acted remarkably: as she entered the chapel, her eyes rolled up and she collapsed. Now, though, no one hustled her to Bellevue. Instead, women friends held her up and pressed juice to her lips. Even the priest looked on matter-of-factly. The Ave Marias were recited and everyone drove to the cemetery, then took my friend back to her apartment. Today, she has no memory of the funeral, but she knows she was there and that is a comfort. On the other hand, she still cries thinking about the hospital.

My friend’s reaction to her husband’s death wouldn’t surprise author Patricia Gherovici. She used to run a mental health clinic in a barrio in Philadelphia, where she did classical psychoanalysis on poor people–something she thinks can help everyone, not just the affluent. In her new book, Gherovici draws on that experience to analyze behavior that her profession used to call the “Puerto Rican syndrome.”

These days the official term is ataque de nervios–Spanish for “nerve attack.” The phrase appears in the bible of emotional illnesses, the Diagnostic and Statistical Manual of Mental Disorders (DSM), which every U.S. hospital and insurance company uses to label, treat and process claims for patients’ psychological troubles. ataque de nervios is one of several disorders the DSM says is specific to ethnic subcultures: among them Malayans, Native Americans, and yes, Latinos.

Malaya men, for instance, frequently suffer from koro, in which they become extremely anxious and convinced that their penises are shrinking into their bodies. Among a number of cultures, including the Navajo, men who have been insulted have violent outbursts of murderous behavior that they don’t later remember–or run, as the DSM calls it, amok.

When the Puerto Rican syndrome was first remarked on, in the 1950s, it was also deemed a male affliction. Stateside military psychiatrists noticed it among Puerto Rican soldiers fighting the Korean War. Under stress, many would scream, fall, flail and foam at the mouth–sometimes for minutes, sometimes for hours, even days.

In subsequent years, therapists treating Puerto Ricans, including in New York City, noted that women also displayed the syndrome. But among Puerto Ricans, it was not traditionally considered a sign of mental illness. Instead, it was said to come from enemies casting bad spells, or from malign, invasive spirits that must be exorcised by espiritistas–folk healers who work at botanicas.

Today, ataque de nervios and other syndromes are understood among mental health practitioners as reactions to stress whose specifics depend on the sufferer’s ethnicity. (If the cops who dealt with my friend had known this, maybe they’d have committed her to the care of family rather than a hospital.)

Could these syndromes be forms of hysteria? That old Freudian category–which was used to describe strange behavior in women–got thrown out ages ago. But lately, psychoanalytically oriented writers like Elaine Showalter have been calling for its revival. Without the venerable concept of hysteria, they say, we’re at a loss to understand all kinds of modern, culture-bound responses to stress: everything from multiple personality disorder to satanic ritual abuse panic and maybe even Gulf War Syndrome.

Not to mention the Puerto Rican one. Gherovici is a big fan of hysteria–for her, the Marias, Consuelos and Socorros who come to her barrio clinic are Latina reincarnations of Freud’s Anna O. and Dora. Middle-class, late-19th-century Viennese hysterics are today seen as having unconsciously rebelled against gender inequality by going mute or spasmodic. Gherovici thinks her screaming, flailing Puerto Rican women are also raging–against wrongs done by the U.S. to the island and its people.

Hmmm. The idea that they harbor rage seems compelling, but her attempt to tie ataque de nervios to a specific type of politics is dicey. As Gherovici notes, Puerto Rico exists in a netherworld of dependency on the U.S. Its residents are citizens of this country, but can’t vote for president if they still live on the island. Since the mid-20th century, they’ve formed a despised but valuable low-wage workforce on the mainland, especially in New York. Even today, their education and income levels fall below those of blacks and other Latinos.

So it’s understandable if they’re angry. Yet ataque de nervios occurs among other Latinos besides Puerto Ricans–Latinos whose countries were not turned into U.S. colonies. In the Southwest, immigrants’ complaints of nervios are so common that health workers talk informally of a “hysterical Mexican syndrome.” And there’s my friend whose husband died–she’s Dominican, not Puerto Rican.

But geopolitics aside, Gherovici makes a more interesting argument: that poor, uneducated minorities can benefit from psychoanalytic techniques as much as affluent whites can. She despises typical U.S. therapy, with its HMOized, 15-sessions-and-you’re-done time-tables and kneejerk Xanax–which she believes is used to mask feelings, not engage them. Gherovici’s clinical tales about her troubled barrio patients–including a homeless woman–suggest that the stress of their hard lives contributes to their ataques. But just as with Upper West Siders, she believes, delving into childhood conflicts and learning how to interpret their dreams helps poor people break out of ruts, live life as more mature individuals–and banish their ataques, even while maintaining a healthy anger towards injustices that should stay on all of our nervios.