Nicaragua’s Crazy Sickness

An indigenous community grapples with a mysterious ailment

Illutration by Fiona Smyth

Illustration by Fiona Smyth

Iasked Padre Elvis if he gave credence to the bad spirits that Nicaragua’s Miskitu Indians blame for grisi siknis. “Before, I used to believe a lot,” he told me. “But now only a little bit.” Had my Spanish been better, I’d have accused him of copping out. As it was, I said to him, “Come on Father, either you believe or you don’t believe.”

We were sitting around a highly lacquered kitchen table, carved, no doubt, from some precious and endangered tropical hardwood. The ceramic-tile floor absorbed much of the day’s intense heat. Beads of sweat merged into rivulets on the fridge door. March in the Miskitu town of Waspam marks the end of the six-month-long dry season. But this was late April and the spring rains had yet to arrive, so I was glad to be inside the spacious two-storey cement-block home that housed both of Waspam’s Catholic priests. It provided some relief from the penetrating sun. The padre laughed. “You ask hard questions,” he said. “Put it this way, if I’m deep in the jungle I don’t cut the branch of the ceiba tree.” One of Nicaragua’s largest trees, the barrel-trunked ceiba has, according to Miskitu myth, powerful spirits that are not to be fooled with. I wondered if knowing that a Catholic priest believes in pagan spirits—even a little bit—would help me to understand what was causing indigenous communities up and down the longest river in Central America to suffer from the mass-hysteria-like ailment called grisi siknis.

The Miskitus, a group indigenous to the Atlantic coast of Nicaragua and Honduras, don’t have a word for mental illness. Instead, ailing people are thought to be out of balance with the spirits. Grisi siknis, the Miskitus’ best attempt at a phonetic spelling of “crazy sickness,” causes those afflicted—mostly young Miskitu women—to alternate between a trancelike state of semi-consciousness and periods of frenzied behaviour. During the latter, victims often rip off their clothes, flee into the forest or the murky, fast-flowing river, and appear to develop superhuman strength. In such a crazed state, these women are difficult to stop. With their eyes closed, and armed with machetes or sticks, they think nothing of attacking whoever or whatever stands between them and the mysterious force that beckons.

In this region, there are accounts of entire villages being ransacked during a grisi siknis outbreak, when as many as a quarter of a town’s inhabitants, including women of all ages and a few men, become afflicted and may remain so for months. Patients are tied up with ropes to prevent them from running amok. Dr. Philip Dennis, professor in the department of sociology, anthropology, and social work at Texas Tech University, lived among the Miskitus for more than a year. He described his most vivid memory of a grisi siknis episode as when “a young woman I helped hold down during an attack was obviously having an orgasm brought on, in her mind, by the spirits or devils.” When Dennis asked the woman’s husband if such a sexual experience was commonplace, he grunted an embarrassed yes.

I’d gone to Nicaragua fully expecting to learn that abject poverty, sexual abuse, and post-traumatic stress caused grisi siknis. After all, the Nicaraguan people are long suffering. Following forty-two years of brutal dictatorship under the Somoza family (father Anastasio followed by sons Luis and Anastasio), the country fell into a vicious war that pitted the US-backed Contras against the leftist Sandinistas. During that bloody conflict (1979–1990), the Sandinistas rounded up large numbers of Miskitu Indians and marched them into internment camps in Nicaragua and Honduras where they waited out the war. They returned home to find burned-out villages and fields littered with landmines. Today, Nicaragua remains one of the poorest countries in the hemisphere, massively indebted to foreign lenders. And nowhere in the country is the poverty more acute than along the Río Coco, where most Miskitus live. Add the devastating effects of Hurricane Mitch in 1998 (more than $1 billion in damages countrywide), when torrential rain washed away much of the topsoil in villages throughout northern Nicaragua, reducing crop yields to a third of what they’d been, and my theory of poverty-induced illness made some sense.

Many psychiatrists believe that grisi siknis belongs to a class of disorders commonly known as “culture-bound syndromes.” In the November 2001 issue of Psychiatric Times, Dr. Ronald C. Simons, professor emeritus of psychiatry and anthropology at Michigan State University, wrote, “In theory, culture-bound syndromes are those folk illnesses in which alterations of behaviour and experience figure prominently. In actuality, however, many are not syndromes at all. Instead, they are local ways of explaining any of a wide assortment of misfortunes.” Later he adds, “However, some culture-bound syndromes are indeed syndromes.”

The Diagnostic and Statistical Manual IV of the American Psychiatric Association contains a glossary of twenty-five culture-bound syndromes. There’s pibloktoq, a disorder similar to grisi siknis unique to the Inuit, and the suitably named amok, which is particular to Malaysians and involves periods of brooding followed by outbursts of violent, aggressive, or homicidal behaviour. There’s dhat in India, characterized by large losses of semen in men, who feel weak as a result. In Japan, taijin kyofusho causes people to have an intense fear of their own bodies, and in Southeast Asia men and women suffer from koro, which is the fear that one’s sexual appendages are being withdrawn into the body and will be lost. Bulimia and anorexia nervosa are our very own Western culture-bound syndromes. Dr. Wolfgang Jilek, professor emeritus of psychiatry at the University of British Columbia, wrote about culturally related syndromes in the New Oxford Textbook of Psychiatry. He told me that “these phenomena, although mostly not of organic causation, are of course ‘real’ in the sense that they are not ‘made up’ or ‘faked.’ What used to be labelled ‘hysterical’ symptoms are not willfully produced antics but are the outcome of mental dissociation processes, usually in response to stressful, traumatizing experiences.”

Grisi siknis among the Miskitus is not a new phenomenon. An epidemic that began in 1910 lasted for about twenty years, according to local reports. Decades earlier, Charles Napier Bell, an English ethnographer who grew up on the Miskitu coast of Central America, described a case after visiting a Miskitu village during the 1850s. In Tangweera: Life and Adventures among Gentle Savages, he wrote, “I have seen a young girl, who was shrieking hysterically in a dreadful manner, carried in a canoe a long distance to consult a celebrated sookia [medicine man]. All that the sookia did was erect round her painted sticks with charms tied to them, to blow tobacco-smoke over her while muttering strange words, to make a bubbling with a tobacco pipe in a calabash of water, which she was then made to drink, and to tie a knotted string round her neck, on every knot of which was a drop of blood from his tongue. For as many days as there were knots she must not eat the meat of certain animals, must suffer no one to pass to windward of her, and must not see a woman with child.”

The treatment Bell described hasn’t changed much in 150 years. Nicaragua’s best medical science did nothing to curb a grisi siknis outbreak in villages along the Río Coco in 2003. A prestigious team of psychiatrists, doctors, epidemiologists, and government health professionals called in Porcela Sandino, who claims to be the granddaughter of Augusto César Sandino, Nicaragua’s most famous revolutionary and Sandinista namesake. Porcela is a reputed curandera or shaman. Posing for a photo in the treatment room next door to her unassuming, brightly coloured wooden home in Puerto Cabezas, Porcela was surrounded by votive candles adorned with images of Jesus and the Virgen de Guadelupe. Simple wooden crosses hung on the painted white walls. A Catholic, Porcela assured me that grisi siknis “is not a sickness of God; it is a sickness of the bad spirits.” But she wouldn’t say exactly what she’d used to cure it. As is the tradition among Miskitu curanderos, the recipe came to her in a dream. It involved brewing up a stew of medicinal plants and other items, which those afflicted had to wash in, drink, and inhale the fumes of for ten days. Her assistants also spread the concoction in a ring around the village to ward off the bad spirits causing the outbreak. Carlos Salomon Taylor, another curandero who helped out during the 2004 outbreak, said in La Prensa, a Nicaraguan daily, that he needed the tail and horns of a black cow, a seashell, sulphur, needles, methylene, various herbs, and 11,000 cordobas (about $800) to work his magic.

By the time I found myself sitting with Padre Elvis in the sanctity of that cool kitchen, my preconceived ideas about grisi siknis were gone. I’d just returned from a trip to the Miskitu territory. I covered the 560 kilometres between Managua and Waspam in a ten-seater prop airplane. From Waspam I’d travelled along the Río Coco for eight hours in each direction by bató, a ten-metre-long dugout canoe with a twenty-five-horsepower motor. My companions included Ana Rosa Fagoth, a recognized Miskitu anthropologist and author whose brother, the renowned Steadman Fagoth, staunchly opposed the Sandinista government throughout the civil war, and Dud Erminger, a Texan living in a Miskitu community along the Atlantic coast. Dud had first come to Nicaragua as a Peace Corps worker in the 1970s. The civil war had forced him to leave, but he returned two years ago to work on a Canadian forestry project, which turned sour. Dud was at loose ends trying to figure out what to do next so he jumped at the chance to take photos along the river he loved so well.

It took us the better part of a day to reach Krin Krin, a village of some 400 inhabitants, all of them Miskitu, where grisi siknis outbreaks were legendary. In 2000, almost a quarter of the townspeople had come down with the illness, and in 2003, Krin Krin was part of the epidemic that spread through eight communities along the river. Sensational accounts appeared in Managua’s newspapers describing the crazed antics of those afflicted and referring to the ailment as both grisi siknis and histeria colectiva. The stories quoted doctors whose efforts to treat the symptoms failed. And though some suspected grisi siknis might be related to mercury or other poisons, the consensus was that treatment was best left up to traditional healers such as Porcela, who were in tune with the Miskitus’ rich spirit world. Dr. Florence Levy, who studied medicine in Managua and at the London School for Hygiene and Tropical Medicine, told me, “No, I don’t think I’m the one to treat it.” Levy was convinced that Porcela had done the job.

After stopping in a small community called Wiwinak—where we arranged to interview Wilton Muller, a doctor with Christian Medical Action, on the return journey—we climbed back aboard our bató and headed off to Krin Krin. Twenty-five minutes into the trip, as we swept around a long curve in the Río Coco, the bright blue sky gave way to an eerie muted light. I shivered. Movement high to my right caught my attention and I looked up to see a pair of huge black vultures hovering above our small craft. With the ragged edges of their outstretched wings fully extended, these harbingers of evil soared across the darkening sky in a broad circle. The buzzards seemed to draw us toward Krin Krin as we glided over the Río Coco’s smooth surface. Large fragments of charred ash floated down from the sky. Like huge black snowflakes, they landed on our faces and clothing. A handful of old wooden buildings appeared beneath a few anemic trees above us on the river’s badly eroded southern bank. Lines of laundry hung limply in the subdued air. As we pulled up to shore, several children, their bellies distended by parasite infestations, scampered down the riverbank to meet us. Following Ana Rosa’s and Dud’s lead, I climbed ashore, only to be greeted by a small growling dog who snapped at my ankles. The ash, we soon learned, came from fires burning agricultural debris.

Our arrival, though unanticipated, was soon conveyed to the town’s elders, and a crowd assembled to meet us. In Miskitu, Ana Rosa explained that we’d come to Krin Krin to learn more about grisi siknis. She asked the townspeople if anyone would tell us their story. Seemingly unperturbed by our request, they summoned Aida Gomez, a woman who had been afflicted a year earlier and claimed she wasn’t completely cured yet. As the people set out old primary school desks at one end of a huge covered hall, we observed the town.

Krin Krin had no defined village centre. Instead, small unpainted wooden homes were scattered across the choppy terrain. The houses sat on stilts in anticipation of the rainy season’s flash floods, and had screenless windows and wooden shutters. Barbed-wire fencing separated many of these simple structures. Most had a small tree or two in the backyard, but the land had otherwise been stripped bare by cows, pigs, and goats that roamed freely. The corners of some yards contained the whitewashed above-ground tombs of relatives. Krin Krin had a cement well, but apparently it didn’t provide water.

When the moment arrived, we crammed into our desks. Ana Rosa sat to my right, Dud on my left. Teobaldo, Raili, Jesús, Patricio, Eduardo, Niéves, and Aida formed a loose semicircle before us, waiting expectantly for our questions. The light was dim in the fading evening, and a growing number of villagers looked in through open windows. Several came inside and leaned against the wall to better hear what was going on. Our appearance, I realized, was high entertainment.

Sporting a Fu Manchu moustache and long sideburns, Patricio wore a blue baseball cap and black trousers. His sinewy body and deeply etched face told a story of hard work and inadequate food. He allowed a young child to sit on his lap during the proceedings. The youngster, clothed only in a black net shirt, seemed comfortable not wearing any pants. When he squirmed his way to the floor, it exposed the sinister image of Dracula adorning Patricio’s black T-shirt. It was painted in white, yellow, and bloody red. I shivered again as the gloom enveloped us and evening caught hold.

“The outbreak,” Jesús said, “began in my house.” His daughter Licha, who was only eight years old at the time, was the first to be infected. Initially she simply had a headache and felt dizzy, a condition referred to as bla in Miskitu, but as the young girl fell into a trance, her mouth began to move uncontrollably. As is characteristic of the condition, her eyes turned red and it was necessary to tie her up or risk having her flee. Licha also suffered from another symptom typical of grisi siknis. It began with a bulging, churning movement in her abdomen and ended, according to several eye witnesses, when the young girl vomited a live spider. This would not be the last I heard of victims regurgitating strange objects. Though no one outside these communities ever corroborated such stories, many Miskitus spoke about vomiting pieces of glass, hair, nails, and coins, in addition to live spiders, cockroaches, and, in one case, a grasshopper. I recalled the odd list of ingredients used by curandero Carlos Salomon Taylor.

Licha, now thirteen years old, took a seat at one of the desks. The sun had dropped well below the horizon, and I couldn’t make out her face. But eerie as it was for me to be interviewing these Miskitus in the soupy darkness, I can only imagine how it felt to this young woman. She’d likely seen Dud, Ana Rosa, and me arrive. Dud, tall and lumbering, huge by Nicaraguan standards; me, with my blond hair and white skin, also an aberration. We snapped photos, flashes blazing. We carried notebooks and I used a penlight to illuminate its pages. Asking questions from behind my glowing torch, I hoped I didn’t sound like an interrogator.

Licha’s most vivid memory was of the visions that accompanied her illness. She described small, black men riding red horses. They came down from the mountains to lure her away from the village. They offered her a cup filled with blood. She was afraid of the duende, as the Miskitu refer to the spirits from the forest, but felt compelled to follow these powerful strangers anyway. Licha was also disturbed by her ability to predict who the next grisi siknis victim would be and was at a loss to explain how this knowledge came to her.

Licha’s description of men on horses was often repeated, both by those who’d been affected by grisi siknis and by researchers I met who’d studied the disease. Sandra Davis, an instructor in the humanities department at uraccan, a small Miskitu university with a campus in Puerto Cabezas, is skeptical about supernatural explanations and is convinced that sexual abuse has a lot to do with it. She explained that grisi siknis is a way for young women to escape, if only for a time, from a hard life that offers few prospects. “Many Miskitu men at the end of the war knew nothing but how to point a gun, drink beer, and take drugs. That’s another form of grisi siknis,” she told me, suggesting that the disease is indeed rooted in conflict and poverty.

Aida Gomez, now thirty-four years old, had also been stricken. In fact, she claimed she still suffered the effects. “I can’t eat, my stomach is extended, and I’m nauseous,” she told me. At one time, she explained, “My family had to tie me up or I’d run away and hurt myself.” They didn’t always succeed in restraining her; she pointed out several old wounds on her legs suffered from kicking her house. Obviously fed up with her illness, Aida said that she’d actually been successfully treated by a curandero. “But I couldn’t afford to pay him his 1,000-cordoba fee so the symptoms returned.” Aida also talked about her visions. She described two or three old men who would come to take her away. “What causes your grisi siknis?” I asked her. “Only God knows what causes it,” she replied, then added, “We believe someone is causing it.”

This was another recurring theme. Bad things done by bad people invited the bad spirits that caused the illness. The collective wisdom in Krin Krin was that three men who practised black magic had instigated the most recent outbreak. Two of them had been banished, but the third remained in town and, according to Jesús, was stirring up problems once again.

Although Porcela Sandino assured me she’d rid Krin Krin of grisi siknis, the illness seemed to linger. Our hosts claimed that when people visited their community, those causing the problem eased up so the village appeared normal. The villagers hoped that I could help them rid their community of evil spirits. Patricio told me he was convinced Krin Krin needed the assistance of “Parson Taylor” in Honduras. He explained plans to head north across the border in search of him. I had thought that Parson Taylor was a church minister—and he was. But I discovered that to the villagers Parson Taylor was actually parsin tailar, which, when said quickly, becomes “fortune teller.” According to the Miskitu, the most powerful fortune tellers—the ones who could cure grisi siknis once and for all—were in Honduras.

Almost four hours after we’d arrived in Krin Krin, we’d exhausted our list of questions so our hosts offered us accommodations for the night. They assured us that the small cabin next door to the Catholic church would serve us well. We made our way across the cropped grassy fields, and although a full moon loomed low in the hazy night sky, it cast little light. We entered the church compound through a locked gate and then climbed up a ladder to the entrance of a simple wooden cabin. It was perched on high stilts. Our home for the night had a front veranda and two rooms empty but for some bat guano and the remains of an old engine, which sat in a pool of grease.

After our hosts left, Ana Rosa, Dud, and I moved out onto the veranda for air. I sat on a roughly hewn bench and leaned back against the outer wall of the cabin, while my companions stretched out on the wooden floor. We could only just make out the cross that capped the long, low church next door. We watched the reddish moon climb in the night sky and realized we had neither the energy nor the will to eat a simple dinner.

I leaned forward to retrieve a bottle of water and, as I did, the floor seemed to shift beneath me. I glanced over at Ana Rosa and Dud, but they continued their quiet conversation. I leaned back; the sensation persisted, and I felt shaky and slightly nauseous. I rubbed my eyes and tried resting my forehead on my knees, but this made it worse so I sat up straight. Soon, my head cleared. But as I contemplated spending the night under a full moon in the lee of the Catholic church among the grisi siknis–prone Miskitu of Krin Krin, I couldn’t help wondering if my dizziness had been brought on by the duende spirits—if I too believed, just a little bit.

Nicola Ross
Fiona Smyth