Social Support and Distress among Q'eqchi ... - Wiley Online Library

Faith R. Warner Department of Anthropology Bloomsburg University of Pennsylvania

Social Support and Distress among Q’eqchi’ Refugee Women in Maya Tecun, ´ Mexico This article addresses issues of vulnerability and distress through an analysis of the relationship between social support networks and traumatic stress in a Q’eqchi’ refugee community in southern Mexico. The sociopolitical violence, forced displacement, and encampment of Guatemalan Mayan populations resulted in the breakdown and dispersal of kin and community groups, leaving many Q’eqchi’ women with weakened social support networks. Research involving testimonial interviews and traumatic stress and social support questionnaires revealed that Q’eqchi’ refugee women with weak natal kin social support networks reported greater feelings of distress and symptoms of traumatic stress than did women with strong networks. In particular, a condition identified as muchkej emerged as one of the most significant symptoms reported by women with weak natal kin support networks. I critically consider muchkej as an idiom of distress and argue that aid organizations should consider the relationship between social support and traumatic stress, as expressed through such idioms, when attempting to identify vulnerable members of a refugee population. Keywords: [refugee women; Q’eqchi’; social support; PTSD]

No. It’s different here. People are from other communities and we have no mothers and fathers. It’s like when I had my first son. My mother wasn’t here. Mothers help their daughters, but mine was far away. No one helped me. I was all alone. I had hoped for another daughter, because she didn’t live. If she had lived, I would have had someone to help me. I wouldn’t be alone. Sometimes I sleep well. Other times, a desperation grabs me. A desperation that someone is going to come, something bad is going to happen. I can’t sleep. I want to sleep, but I can’t sleep. . . . This weighs heavily on my mind and I can’t sleep, and my head hurts. My mother isn’t here to talk to. A daughter needs a mother to speak to and a father to protect her. I have nobody. . . . Many children are malnourished.

MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 21, Issue 2, pp. 193–217, ISSN 0745C 2007 by the American Anthropological Association. All 5194, online ISSN 1548-1387. rights reserved. Please direct all requests for permission to photocopy or reproduce article content through the University of California Press’s Rights and Permissions website, http://www.ucpressjournals.com/reprintInfo.asp. DOI: 10.1525/MAQ.2007.21.2.193.

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There is no assistance, no food, no help. We cannot endure. The land here is pure rock. We can’t plant on this land. It gives nothing. What do I want in the future, you asked? I ask God everyday for peace, good land, and a good husband. I ask for food for my children and a home next to my mother so that I can visit her every day. What I had before, before they took it all away. ´ Mexico —“Teresa,” A Q’eqchi’ Refugee Woman in Maya Tecun, Perhaps one of the greatest challenges to refugee camp administrators is the identification of those individuals in the refugee population who are “vulnerable” in terms of being most in need of medical and material assistance. During fieldwork in a Guatemalan refugee community in southern Mexico, I identified Teresa as one of the most vulnerable Q’eqchi’ women in the refugee camp, yet camp administrators did not consider her vulnerable because she was married and her husband was present in the refugee camp. Because Teresa had no natal kin members in the community, her mother had died during the violence in Guatemala, and she suffered numerous physical and psychological ailments on a daily basis, I considered her to be far more vulnerable than many widows who had strong natal kin support, especially in the form of mother–daughter ties. Yet those same widows were targeted for material and medical assistance by camp administrators and health professionals, while Teresa was effectively excluded from the services that she so desperately needed. This article considers Teresa’s situation and the need for refugee assistance to be context driven and culturally sensitive if it is to reach those most in need in refugee communities. Research conducted in refugee communities must consider that “refugee communities are not homogenous; segments within them experience disempowerment unequally” (Krulfeld 1997). Therefore, identifying “vulnerability” in a culture-specific manner is essential to the design and implementation of effective intervention programs, but this not always readily apparent to observers, service providers, and policymakers. As a case in point, through ethnographic research in Campeche, Mexico, in 1995 in a Q’eqchi’ refugee community, I discovered that the medical clinic staff was providing medical and material assistance to those women whom they identified as widows because they assumed that women without husbands were the most vulnerable members of the community. My initial observations and interviews suggested to me that widowhood was not necessarily the best or the only way to identify women most in need of material and medical assistance. I proposed to the clinic staff that the presence of natal kin, and, in particular, the presence of a woman’s mother in the refugee community, was the most significant factor affecting Q’eqchi’ women’s overall health, security, and well-being. To test this proposition and as an extension of a larger ethnographic research project on gender roles, social support, and health, I developed a social support and traumatic stress questionnaire to determine if the absence of natal kin support, and, in particular, the absence of a woman’s mother, was a significant factor affecting women’s physical and psychological well-being. In this article I present and interpret the results of the questionnaire, followed by a discussion of Q’eqchi’ women’s perceptions of social support, gender roles, and the difficulties of camp life in order to reveal patterns of vulnerability, stress, and support in the Q’eqchi’ refugee community.

Social Support and Distress among Q’eqchi’ Refugee Women

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My concern for identifying vulnerable members of a refugee community is just one area of emphasis in the larger specialization of refugee studies that has developed recently in the discipline of anthropology (Harrell-Bond and Voutira 1992). Anthropologists are increasingly concerned with refugee populations and have focused their interests on issues such as health, human rights, safety, acculturation, resettlement, repatriation, empowerment, and identity issues (Camino and Krulfeld 1994; Krulfeld and MacDonald 1998; Morrissey 1983).1 In addition to anthropological inquiry, recent social and medical research focuses on measuring refugee health status and trauma (Hollifield et al. 2002) and calls for greater attention to be paid to culture-specific and intracultural variations in refugee stress, suffering, acculturation, and health outcomes of displacement (Go´zdziak and Tuskan 2000; Pederson 2002; Watters 2001). In terms of intracultural variation, studies demonstrate that men and women refugees experience the stress of social violence, displacement, and encampment differently and that factors such as work, social support, and imbalanced accul´ turation rates influence gender differences in the way stress is manifested (Aron et al. 1991; DeVoe 1992). Despite this observation, and the fact that women are extremely vulnerable during war and in all phases of the refugee experience (Ferris 1987; Kohpahl 1994; Krulfeld 1997; Lykes 2000; Martin 1992), there have been few systematic studies that examine gender differences in the mental health of refugee and war-afflicted populations (Cole et al. 1993; Sideris 2003). Studies that have been conducted point to serious psychological problems among women, including depression, psychosomatic ailments, loneliness, and apathy (Ferris 1987; Iglesias et al. 2003). Based on the literature that discusses the relationship between trauma, stress, and ˜ 1997), I somatization (Castillo 1990; Hinton and Um 2001; Waitzkin and Magana anticipated that Q’eqchi’ women refugees would express war-induced trauma, isolation, lack of social support, and the restrictions of encampment through somatization, idioms of distress, and symptoms associated with traumatic stress in general. Throughout this article, I critically consider these assumptions through an analysis of the ways in which Q’eqchi’ women express feelings of traumatic stress, isolation, ´ Mexico. restrictions on mobility, depression, fear, and poor health in Maya Tecun,

Background The Q’eqchi’ Maya and the Trauma of Forced Displacement The Q’eqchi’ are a Mayan people originally from Alta Verapaz, Guatemala. In comparison to many other Mayan groups, the Q’eqchi’ have received comparatively little scholarly attention (Adams 2001; Carter 1969; Schackt 1984; Wilk 1996; Wilson 1995). Historically, the Q’eqchi’ peoples have been displaced numerous times. To escape landlessness and debt peonage enforced through German coffee plantation expansion in Alta Verapaz in the 19th and 20th centuries, numerous Q’eqchi’ fam´ the Petén, and ilies and communities migrated to unpopulated areas in the Ixcan, Belize. ´ Mexico, were involved in a 1960s Some of Q’eqchi’ refugees in Maya Tecun, colonization project established with the aid of various Catholic and Protestant

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´ region in the department of El Quiché, Guatemala (Manz missions in the Ixcan 1988). These colonists joined approximately 30 Q’eqchi’ families already settled in ´ that had migrated from Alta Verapaz in the 1870s to escape German coffee the Ixcan plantation expansion. The colonists formed cooperatives that were beginning to flourish when they were forced to flee the repression that began in their communities in the 1970s with the disappearances and killings of community leaders (Carmack 1988). The sociopolitical violence culminated in the 1981–82 counterinsurgency program that involved military attacks on over 400 villages, the massacre of over 70,000 people, and the displacement of as many as 1,000,000 people (Falla 1993; Manz 1988; Montejo 1999; Smith 1990; Warren 1978). The Guatemalan military made numerous incursions into Chiapas in pursuit of the refugees, inciting the Mexican government and the United Nations High Commissioner for Refugees (UNHCR) to develop a resettlement scheme that would move the Guatemalan population a greater distance from the border (Earle 1988; Manz 1988; Montejo 1999). The Q’eqchi’ refugee community was resettled from Chiapas to the state of Campeche, Mexico, in 1984 with assistance from the UNHCR ´ Mexicana de Ayuda a Refugiados (COMAR), the newly established and Comision Mexican agency to assist refugees (Aguayo et al. 1987; Castillo 1990; Stepputat 1989). In addition to the anthropological research addressing the Guatemalan violence at community, regional, and national levels, ethnographers have examined how the Guatemalan sociopolitical violence affects Guatemalan women’s social roles and gender relations (Billings 1995; Burgos-Debray 1984; Green 1999; Pessar 2001; Smith-Ayala 1991; Wellmeier 1998; Zur 1998).2 Although numerous ethnographic studies in Guatemalan refugee communities have been conducted (Burns 1993; Earle 1994; Loucky and Moors 2000; Manz 1988; Montejo 1999; Stepputat 1989; Taylor 1998), few have addressed the effects of sociopolitical violence on the Q’eqchi’ Maya peoples (Warner 1996, 1998; Wilson 1991, 1993, 1995; Yarrow 2001). The trauma of the displacement experience is still very much ´ Some famipresent in the minds of many Q’eqchi’ inhabitants of Maya Tecun. lies reached Mexico in a few days, and others spent up to 18 months hiding in small groups in the jungle. The refugees arrived in grave health conditions and most were severely malnourished. Epidemic diseases including malaria, cholera, dysentery, and parasitic infections were widespread in the population when they reached Mexico.3 Resettlement in Maya Tecún Once relocated to the state of Campeche, the refugees literally carved their community out of the surrounding rainforest, with local materials used to build their homes, meeting halls, and even their musical instruments. The Q’eqchi’ population ´ represented four villages of origin in Guatemala and was settled into of Maya Tecun a section of the refugee camp with a single K’iche’ village group that had resided ´ region of northern Guatemala. The refugee camp itself was near them in the Ixcan established in a region of Campeche that was sparsely populated. Each village of origin from Guatemala reassembled itself in the refugee camp into distinct spatial units and used their village name to distinguish their subsection of the refugee community


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from others. Furthermore, each village was politically autonomous, with household representatives from all village groups coming together for occasional meetings, especially if mandated by camp administrators. In keeping with tradition, the Q’eqchi’ did not formally recognize village or community leaders and consistently resisted administration attempts to impose formal leadership in their communities. ´ with men and women identifyLife was seen as extremely difficult in Maya Tecun, ing a lack of water, poor land, extreme heat, illness, and insufficient food, household goods, and clothing as major problems that they faced on a daily basis. In addition to the traumatic stressors that the Q’eqchi’ community experienced as a result of the sociopolitical violence in Guatemala and their forced displacement into the refugee community, they continued to experience stressors such as material deprivation, poor health, and feelings of restriction and exploitation on a daily basis. I heard ´ as “the informants, on more than one occasion, refer dolorously to Maya Tecun place of rocks and hunger.” Social Support and Health Although there exists little specific information on the immediate effects of the Guatemalan violence on Q’eqchi’ peoples, scholarly and medical attention was paid to the mental health problems of the Guatemalan refugees shortly after their forced displacement to Mexico (Urrutia 1987), and again when repatriation efforts were underway (Dona 1993). More recent research indicates that, 20 years after the height of the sociopolitical violence in Guatemala, poor mental health is still a central cause of concern for the Guatemalan refugees in Mexico (Sabin et al. 2003). There exists a body of recent research on various populations that indicates that strong social support networks can be associated with positive health outcomes (Adams et al. 2002; Fuhrer and Stansfield 2002; Zunzunegui et al. 2004), and research consistently reports that the negative effects of trauma and stress ´ and Lorion 2003; Jacobson 1987). can be ameliorated by social support (Aron The analysis of social support is often utilized in the study of illness, refugees, and migrant groups (Williams 1993). In particular, social support networks have been argued to be an ameliorating factor of central importance in the study of refugees who experience extreme acculturative stress, resource deprivation, traumatic stress, and depression (DeVoe 1992; Williams 1993; Williams and Berry 1991). Social support networks are considered to be a central factor in determining the well-being of immigrant and refugee women and their families (Kinzie and Fleck 1987; Williams 1993), and crucial to ensuring refugee and immigrant women’s safety and ability to carry out their gender roles in the refugee setting (DeVoe 1992). In numerous studies of women, migration, and acculturative stress, researchers have reported that women with strong social support networks cope more effectively with the changes that migration introduces into their lives and are less prone toward depression (Berry et al. 1987; Vega et al. 1991). Furthermore, studies have demonstrated that, in both refugee and nonrefugee societies, there is a high degree of likelihood that individuals will express traumatic stress and sociopolitical marginalization through somatization (Cancela et al. 1986; Keyes and Ryff 2003; Richters 1991; Westermeyer et al. 1989).

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Somatization and Idioms of Distress Sickness is not just an isolated event, nor an unfortunate brush with nature. It is a form of communication—the language of the organs— through which nature, society, and culture speak simultaneously. The individual body should be seen as the most immediate, the proximate terrain where social truths and social contradictions are played out, as well as a locus of personal and social resistance, creativity, and struggle. —Nancy Scheper-Hughes and Margaret Lock, 1987

Medical anthropologists often view health, illness, and healing as an emic cultural system that brings together social institutions, symbols, and relations with the physical body and the natural world (Tedlock 1987:1069). They have described somatization as evidence of the fact that “cultural constructions of and about the body are useful in sustaining particular views of society” (Scheper-Hughes and Lock 1987:14). From this perspective, illness in the form of somatization can be interpreted as a form of symbolic communication that links all aspects of an individual’s existence into one discursive realm, thereby connecting “personal illness meanings with larger political and social systems” (Farmer 1988:80). In particular, sickness is considered to be a primary symbolic mode of expression in the realm of human suffering and “in these cases the metacommunication value of the sickness process may be the sole vehicle for acting on and expressing discomfort with physical, social, and psychological realities” (Low 1985:187). Although culture-bound syndromes have long been associated with cultural expressions of depression and anxiety (Nations et al. 1988), there is support for and recently renewed interest in the “idiom of distress hypothesis” in understanding culture-bound somatization (Chung and Singer 1995; Furst 2002; Guarnaccia and Rivera 1996; Keyes and Ryff 2003; Kirmayer and Young 1998; Kleinman 1988; Kohrt et al. 2004). Earlier studies demonstrate that idioms of distress are used to communicate how an individual relates to larger sociocultural groups and processes, including those that link kinship with idioms of distress (Parsons 1984), and gender-specific idioms of distress that primarily affect women (Farmer 1988; Richters 1991). Furthermore, numerous discussions of the idiom of distress nervios argue that it is best understood as means of expressing social marginalization and powerlessness (Cancela et al. 1986; Davis and Guarnaccia 1989; Guarnaccia et al. 2003; Lock 1989; Low 1985). In particular, Peter Guarnaccia and Pablo Farias argue that nervios “expresses the anger at the powerlessness of los de abajo (those at the bottom) who know that they are being exploited, but who cannot resist and need their jobs to survive” (1988:1229). On the basis of previous research on social support, powerlessness, and nervios, I hypothesized that the most vulnerable members of the Q’eqchi’ refugee community ´ would have weak social support networks and would express their of Maya Tecun social position and suffering through an idiom or possibly even multiple idioms of distress. The following methodology was devised to explore this hypothesis and to discover if there existed culture- and gender-specific expressions of distress in the Q’eqchi’ refugee community.


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Methods: Assessing Vulnerability though Traumatic Stress and Social Support ´ in two stages, from August 1993 I conducted ethnographic research in Maya Tecun through July 1994 and from January 1995 through November 1995, in order to investigate the effects of the refugee experience on Q’eqchi’ and K’iche’ gender relations and women’s social status. A central aspect of my larger research agenda emphasized the relationship between gender roles, relations, health, and social support. Most of the survey research and participant-observation data that is presented in this article was conducted during the first phase of fieldwork when I lived in the refugee camp on a daily basis. Many of the life history interviews were conducted during the second phase of research when I resided in the city of Campeche and made excursions into the refugee camp in order to collect the additional data.

Qualitative Research Methods: Interviewing and Participant-Observation My overall research design involved several stages, moving from generalized to individual levels of ethnographic data collection. Testimonial life history, informal interviewing, and participant-observation provided me extensive qualitative and in-depth understandings of the effects of encampment on Q’eqchi’ women’s lives. Heeding the warning that “episodes of suffering and misfortune must be situated not only culturally but also within the context of the individual sufferer’s life experience” (Hollan 1994:75), I collected testimonial life histories so as to qualify generalizations with individual level information. Additionally, I resided with a Q’eqchi’ family and in the medical clinic during my first phase of fieldwork, observing consultations, working with the Q’eqchi’ health promoters, and doing anthropometric research to assess the nutritional health status of the population. My overall discussion of women’s lives, kinship, gender relations, perceptions of social support, and health is based on the data that I collected through qualitative research methods aimed at revealing women’s daily lives. Because displacement occurred prior to my fieldwork experience in Guatemala with the refugee community, I developed an understanding of women’s lives in Guatemala through the memories conveyed to me during testimonial interviews, formal surveys, and opportunistic interviews. My description of women’s traditional activities, status, and gender roles is based on numerous interviews over a nearly two-year period and is grounded in women’s comparisons between their previous lives in Guatemala and their current experiences in Maya ´ Mexico. Tecun,

Quantitative Research Methods: Surveys and Questionnaires I administered several surveys and questionnaires in order to investigate and quantitatively document the relationship between women’s social support networks and traumatic stress. The quantitative data presented in this article is based on information gathered through a survey that was designed through the following process. (1) On the basis of information gathered through preliminary unstructured and opportunistic interviews, I designed an interview questionnaire with closed and openended questions and administered it to an attempted total sample of adult Q’eqchi’ women from one village group and a random sample of women from the K’iche’

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community. This survey included questions on marriage, kinship, reproduction, traditional dress, social support networks, traumatic stress, repatriation, and migration history. Perhaps the most significant aspect of this survey involved questioning on social support networks, because the information obtained in these preliminary interviews revealed to me the importance of natal kin support, which I then targeted in the second and more focused survey. The results of this second survey are presented in this article. Open-ended questioning on health and traumatic stress symptoms during the preliminary interviews also revealed culture-specific health conditions and categories that were more fully investigated through the second survey. Interviewing time for the first survey typically ranged from one to two hours, and the interviews were conducted with a Q’eqchi’ woman field assistant who facilitated translation between Spanish and Q’eqchi’ languages. (2) The next step in the survey process involved modifying the preliminary interviews discussed above in order to address a narrower range of topics and to include as many close-ended questions as possible. At this time, I developed the social support and traumatic stress questionnaires and then integrated them both into the larger survey, which included questions on migration history, repatriation, biographical background, and social support. I attempted to administer this final and more focused questionnaire to the total adult Q’eqchi’ and K’iche’ populations. The length of time for this interview was typically 30 to 45 minutes, and bilingual field assistants helped me to communicate the questions accurately. Interviewing for this survey was done over a four-month period on a nearly daily basis.4 Study Sample The Q’eqchi’ community was comprised of 5 village groups containing 139 families. Four of the Q’eqchi’ village groups were ethnically homogenous, but one village group was an amalgamation of 14 families (7 Q’eqchi’, 5 Ladino, 1 Chuj, and 1 Ixil), who were separated from their villages of origin during forced displacement and relocation. My census information is based on a house-to-house survey of the entire Q’eqchi’ population conducted by the medical clinic staff, although I accompanied the nurse on a daily basis as an equal participant in its administration. The clinic survey has the advantage of being based on people actually residing in the camp and did not include those who were working or residing outside the camp. The Q’eqchi’ population was approximately 712 people, but absolute accuracy was difficult to determine as the number of people actually residing in the community changed regularly.5 I surveyed adult women and men as defined principally by their marital status and estimate that I interviewed 98 percent of the 134 adult Q’eqchi’ women in the 5 village groups.6 My attempted total sample of Q’eqchi’ women totaled 131. The Social Support Questionnaire The social support questionnaire included both closed and open-ended questions that primarily asked each woman who they turned to for affective (advice and emotional support) and instrumental support (food, childcare, illness, clothes, money, and housework), and who, in turn, relied on them for such support. In order to


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examine the various forms of social support that Q’eqchi’ refugee women rely on for the survival of themselves and their families, I devised a section of the longer version of the questionnaire that addressed instrumental, informational, and affective aspects of social support. The portion of the questionnaire that addressed social support networks was ego centered and designed to reveal ego’s support as well as with whom ego reciprocates most often. While Holly Ann Williams (1993) warns that social support is a matter of perception and that one flaw in such a method is that support is self-reported rather than directly observed by the anthropologist, David Jacobsen (1987) argues that perceived support may be the most relevant to understanding the relationship between stress and social support. Furthermore, support and reciprocity are viewed differently in different cultures (Williams 1993:145), and, therefore, the concept of “help” may be laden with cultural assumptions that I could not fully identify. In response to these concerns, I spent a considerable amount of time in direct observation of the social support activities practiced by two families in order to cross-check reports of reciprocity and perceptions of help with actual practice. Traumatic Stress Questionnaire Because there has been significant skepticism toward the application of posttraumatic stress disorder (PTSD) to describe behaviors in non-Western cultures (Bracken et al. 1995), I followed a loosely formulated symptomology checklist for PTSD as a starting point to assess the culture-specific manner in which stress is expressed in the Q’eqchi’ refugee population (see Table 1). Although I did not seek to “diagnose” PTSD, I did loosely translate most of the symptoms from the PTSD checklist of the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (1988). This approach was taken because I agree with Paul Farmer (1988) that in referring to the manual “we need not surrender our relativism nor our attempts at autonomous theorizing” (1988:78). With this in mind, I initiated interviewing with a structured and mostly close-ended checklist but then left the checklist open for any other culture-specific expressions of traumatic stress, thereby accommodating relativism while establishing a basis for comparison with the work of other scholars who utilize the APA manual. I asked women if they had mucho (naxic xbeen) or high intensity of each symptom in order to account for intensity as well as frequency, but I found that the concept of intensity did not seem to translate well during the interview process. Nearly all of the respondents answered yes to experiencing the symptoms with a high level of intensity, leaving me with the impression that distinctions in intensity were not entirely meaningful for most of the informants. Thus, I asked respondents who answered yes to experiencing a symptom in any level of intensity to place its frequency in terms of the following interval scale; 1 = once a week or less; 2 = twice a week or more, but not daily; 3 = daily. The symptom categories were translated into Spanish and Q’eqchi’ depending on the language abilities of the informant, and interviews were always facilitated by a fully bilingual field assistant. Although some of the symptoms shifted somewhat in meaning through the translation process, the same translation was used in each interview so as to maintain consistency in the survey process.

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Table 1 Symptomology Checklist and Translations Used to Assess Traumatic Stress English Lethargy Headaches Digestive Disorder Disorientation Depression Cramps Sleeplessness Nightmares Nervousness Anger

Spanish Falta de energ´ıa Dolor de cabeza ´ Dolor de estomago ´ Desorientacion Tristeza Calambres No duerme Pesadillas Nervioso/Tenso Enojado

Q’eqchi’ Tacwajic Rahooc jolom Rahooc puj Sachbesiin/Lubc Rahilal ch’oolej Muchkej Cwaarc chi Tz’apqui’e Sicsical Josk’

Results: Analysis of Stress-Related Symptoms and Social Support Natal Kin Support and Stress Through the initial survey that considered perceived support in combination with my own systematic observations, I was able to identify particular patterns of social support that women reported. I was also able to determine that actual and perceived support did not vary to any significant extent, in that my direct observations confirmed that women did indeed receive the majority of their assistance from individuals who were identified as most supportive in the survey. I recognized that women rarely received support from neighbors, friends, compadres, and affinal kin. The most common source of support that women identified and that I directly observed was from natal kin, especially their mothers. Women consistently identified their mothers as the most important source of social support in their lives at all stages of their lifecycles. My analysis of the data from the two questionnaires involved the creation of a continuum of social support ranging from no kin social support networks to the strongest kin social support networks observed in the community. I then identified two groups of women with weak natal kin support, including women who had no natal kin whatsoever, and those whose mother was not present in the camp. I then compared their responses to the traumatic stress questionnaire with women who had natal kin and mothers present in the refugee camp. I developed a frequency distribution of their responses to identify differences in the frequency of the stress-related symptoms that members of each group reported. Finally, independent samples t tests were administered in order to determine if experience of the symptoms was significantly related to natal kin social support and to identify which symptoms were most significant for women who lacked their mothers and natal kin members in the community. Maternal Kin Support and Traumatic Stress The first step in my analysis of the data from the two questionnaires involved comparing women whose mother was present in the camp, as opposed to those who did


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Table 2 Percentage and Number of Women with No Mother (n1) and Mother Present (n2) Reporting Frequent Experience of Symptoms (two days per week or more) SYMPTOM Lethargy Headaches Disorientation Stomach Ailments Muchkej Depression Nightmares Sleeplessness Nervousness Anger

n1 = 73; % and (# of women)

n2 = 58; % and (# of women)

83.6 (61) 76.7 (56) 74 (54) 68.5 (50) 61.6 (45) 52.1 (38) 49.1 (26) 45.2 (33) 39.7 (29) 26 (19)

81 (47) 55.2 (32) 56.9 (33) 56.9 (33) 50 (29) 44.8 (26) 36.2 (21) 29.3 (17) 19 (11) 19 (11)

not have their mother present in the community. In Table 2, I present their responses to the traumatic stress questionnaire in terms of the percentage and total number of women who reported affirmatively (twice a week to daily occurrences) to each symptom in both groups. The results in Table 2 indicate that the lack of a mother present in the camp increases the likelihood that Q’eqchi’ women will report experiencing all of the stress-related symptoms in greater frequency than those whose mother is present. An independent samples t test comparing the mean scores of all symptoms between the Mother Present Group, and the No Mother Group revealed a significant difference between the means of the two groups (t[129] = 3.30, p < .001). The frequency scores (1 = once a week or less; 2 = twice a week or more but not daily; 3 = daily) for all symptoms by group were added to determine the overall means, and then the same was done for each symptom by group. The significance for each symptom is presented in Table 3. The mean of the No Mother Group (m = 19.92, SD = 4.84) was significantly higher than that of the Mother Present Group (m = 17.03, SD = 5.14). The t test revealed that not having one’s mother present in camp significantly affected the likelihood that women would suffer symptoms in greater frequency overall when compared to women whose mother was present in the camp. Furthermore, it was exclusively muchkej (t[129] = 2.67, p = .008), disorientation (t[129] = 2.89, p < .005), nervousness (t[129] = 2.51, p = .011), headaches (t[129] = 2.51, p = .014), and stomach ailments (t[129] = 2.35, p = .019) that accounted for the significant difference of all symptoms between the two groups. The remaining symptoms (nightmares, lethargy, depression, anger, and sleeplessness), although occurring in high frequencies overall in the Q’eqchi’ women refugee population, were not significantly related to whether or not a woman’s mother was present in the community. Natal Kin Support and Traumatic Stress For the next step of my analysis, I classified women who had at least one natal kin member (parents and siblings) present in the camp in the Natal Kin (n3 = 93) group and then compared them to the No Natal Kin Present (n4 = 22) group. In Table 4,

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Table 3 Independent Samples t-Test Comparing Mean Frequency Scores of Symptoms between Mother Present Group and No Mother Present Groups and Natal Kin and No Natal Kin Groups Significance *(p < .05) Symptom Disorientation Muchkej Nervousness Headaches Stomach Ailments Nightmares Sleeplessness Lethargy Depression Anger Pooled Symptoms

Mother

Natal Kin

p < .005* p < .008* p < .011* p < .014* p < .019* p < .053 p < .119 p < .148 p < .394 p < .543 p < .001

p < .100 p < .000* p < .094 p < .262 p < .562 p < .591 p < .351 p < .714 p < .937 p < .897 p < .073

I grouped women into the two natal kin support categories and provided the total number of women in each group who reported suffering from the symptom on a twice a week to daily basis. Although the descriptive statistics indicate that women without natal kin support experience headaches, disorientation, depression, muchkej, nightmares, nervousness, and anger more frequently than do women with natal kin present in the camp, an independent samples t test (see Table 3), comparing the mean scores of the Natal Kin Support Group and the No Natal Kin Support Group for all symptoms, did not reveal a significant difference between the pooled frequency score means of the two groups (t[129] = 1.68, p = .073). The mean of the group without natal kin was not significantly higher (m = 19.84, SD = 4.46) than that of the group Table 4 Percentage and Number of Women with Natal Kin (n3) and No Natal Kin (n4) Reporting Frequent Experience of Symptoms (two days per week or more) SYMPTOM Lethargy Headaches Digestive Disorder Disorientation Depression Muchkej Sleeplessness Nightmares Nervousness Anger

n3 = 94 % and # of women

n4 = 37 % and # of women

81.9 (77) 63.8 (60) 61.7 (58) 55.3 (52) 47.9 (45) 43.6 (41) 40.4 (38) 36 (34) 25.5 (24) 22.3 (21)

73 (27) 70.3 (26) 59.5 (22) 67.6 (25) 48.7 (18) 78.4 (29) 32.4 (12) 48.7 (18) 40.5 (15) 24.3 (9)


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with natal kin present (m = 18.17, SD = 5.36). Although the effect of no natal kin present in the camp was not significant to women’s overall experience of traumatic stress when all symptoms were totaled, when each symptom was considered independently, only muchkej (t[129] = 4.74, p = .000) was found to have a significant difference between the groups. What is remarkable for both women without their mothers and those without natal kin is the fact that muchkej was the only common significant symptom relating to their lack of natal kin support. When I originally formulated the traumatic stress questionnaire, I did not include muchkej.7 Through preliminary interviewing, openended questioning on the surveys, and participant-observation, I discovered that women were suffering from this condition in high numbers. Women suffering from muchkej usually described it as generalized pain, centered in the chest, but reported that the pain “moves all over the body” and, in extreme cases, extended into the limbs and the head. The pain is always described as mobile, dull, and numbing to the point where one can hardly feel one’s extremities. A person suffering from muchkej receives sympathy and social support. They are given the right to relax, to demand a restful and quiet environment, to be excused from work, and to receive special treatment in terms of food and visitations. Women often identified corn grinding as a major cause of muchkej. Carrying of children or other heavy items, walking long distances, and working in the fields are also considered to be causes of muchkej. Arguably, muchkej is conveyed as a form of very real physical pain for many women, but I also believe that it is an idiom of distress with a multiplicity of physical expressions and social meanings, including the expression of distress over women’s loss of maternal and natal kin support in the refugee community.

Qualitative Analysis of Women’s Lives and Social Support Traditional Q’eqchi’ Gender Roles Traditional Q’eqchi’ gender roles can best be described as complementary, with men and women performing different yet mutually supportive roles within the family. This complementarity has been observed by numerous Maya scholars (Black 1988; Bossen 1984; Wilson 1995). Before displacement, Q’eqchi’ women had primary responsibility for gardening, animal husbandry, food preparation, childcare, and family healing, whereas men were primarily responsible for tending the larger horticultural fields. Women helped men harvest the large fields but never contributed during the planting periods. The dispersed spatial organization of traditional Q’eqchi’ communities allowed women to have extensive land around their homes for gardening and animal husbandry, resulting in their significant contribution to household subsistence. Q’eqchi’ families traditionally arranged or encouraged marriages between lineages that were located near one another. Regional endogamy was widely practiced by Q’eqchi’ peoples before displacement. This is important because, despite an initial period of virilocality, the natal family remains a vital source of social support to a daughter throughout her lifetime. In particular, a woman’s mother would take an increasingly active role in her daughter’s life once she established her own neolocal residence, separate from and, yet, near her husband’s family.

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A Q’eqchi’ family that had recently established a neolocal residence would typically live near both the bride and groom’s families. The groom would visit his natal family on a regular basis, visiting and working in cooperative labor groups with his natal kin. The daughter-in-law would rarely visit her in-laws after neolocal residence was established, although she would regularly visit and be visited by her mother and other natal kin. It was unusual for women to visit women who were not related to them, in that a woman’s social relations were traditionally very much limited to her kinship group. Typically, there was significant support extended to women from their natal families in the form of food, information, assistance in daily tasks, and emotional support. The Mother–Daughter Tie Previous research supports my observations that the mother–daughter tie is one of the most mutually supportive of social relations in Mayan cultures (Bachrach Ehlers 1990; Black 1988). The tie is so crucial to Mayan women that, if a woman does not have a daughter, she will often seek to adopt or borrow a daughter from a relative or friend (Bachrach Ehlers 1990:68). Traditionally, the mother–daughter tie is the strongest social relation for Q’eqchi’ women. It provides mutual social support in that a daughter assists her mother in all gender-specific tasks, especially the care of younger siblings and food preparation, until her marriage. As a woman moves through her life cycle, her elder daughters increasingly assist her in her domestic responsibilities, often taking over childcare responsibilities entirely. Mothers and daughters have the most supportive of social relationships, and once a daughter is established in her own home she receives advice, visitations, food, help in childcare, and support during pregnancy and illness from her mother. After marriage, the mother provides instrumental support to the daughter in the form of food, money, and clothing. In her testimonial interview, Paula explained the importance of the mother–daughter tie across three generations in Guatemala through her childhood memories. We had good land and so many animals! We were never hungry and we had peace. I helped my mother take care of my brothers and sisters. We were very happy. We had a garden with melons, chilies, tomatoes, and many avocado, lime, mango, and banana trees. I helped my mother in the garden. We would go to the center every Sunday. There were no problems. We were happy. Very happy and content. We visited my grandmother every day when I was little. She was a widow and lived near us. My mother would go visit her a lot. She came to visit us. It was not far. She was old, but it was close enough to walk. My grandmother brought us tortillas and crops from her garden. Sometimes she would make tamales and bring them to the family. Sometimes she would kill a pig or turkey and we would all eat meat. She would help grind corn and make tortillas. She would stay with my mother after a birth and take care of her. My grandmother taught us to embroider and weave. The mother plays the very important role of providing emotional support and visiting the newly married couple to ensure that her daughter is well treated. If the daughter is being abused, the mother will often initiate a demand for her return to


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her natal family. The daughter is traditionally permitted to visit her mother on a frequent basis. This right of visitation provides an ameliorating effect on the traditional restrictions on Q’eqchi’ women’s mobility and limits her isolation in her affinal or neolocal residence. The positive effects of natal kin visitations and support on women’s status and security in their marital homes has been documented by other researchers (Fricke et al. 1993), and the Q’eqchi’ are no exception to this trend. The Negative Effects of Encampment on Q’eqchi’ Women’s Lives: Roles, Restrictions, and Domestic Violence One of the most negative effects on Q’eqchi’ women’s lives as a result of encampment was that the refugee camp administrators did not take into consideration women’s traditional subsistence activities when designing the refugee camp. Houses were spaced closely together, thereby preventing women from engaging in traditional gardening and raising of animals that formed the basis for gender-role complementarity. For example, Rosa described her life before in an idealized fashion, saying that her marital relations were far better when she and her husband had to work together. The increased sexual division of labor in the camp made her feel confined, and her limited gender role made her feel less useful. I do not go with my husband to the fields as I did in Guatemala because he can do all the work. He has so little land that he can finish all the work before mealtime. In Guatemala I would go with him and cut brush, and weed, and harvest the corn and beans. He says that I am not worth anything because I sit all day in the house and only eat. This makes me sad. I want to help him like I did before. What can I do? I have no space to grow a garden and all of the animals die here. The chickens do not lay eggs and neighbors get angry if they wander into their homes and gardens. He scolds me and shouts at me when the animals die and I am too ashamed to answer back. My life is not worth anything here. In addition to encampment having a negative effect on women’s traditional roles and gender-role complementarity in general, it also intensified the expectation that women restrict their mobility and interaction with individuals beyond their kin groups. Traditionally, a Q’eqchi’ woman would be expected to avoid all outsiders or unknown people because they would be seen as dangerous to her health and that of her children. For Q’eqchi’ women, encampment placed people in close proximity to one another, thereby increasing the likelihood of contact with non-kin men and ´ each time a woman persons considered q’ix (hot) or dangerous. In Maya Tecun, leaves her home, she takes the risk of coming into contact with a person or object that will affect her balance of hot (q’ix) and cold (ke), thereby endangering her fertility and the health of her children. A complex system of social control through fear of retribution by the Tzuultaq’a (mountain spirits) traditionally provides the ideological basis for restricting women’s movements and contact with non-kin members of the community. The Q’eqchi’ taboos on mobility restricted Q’eqchi’ women’s access to the possible benefits of modernization, wage-labor opportunities, health care, development

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projects, job-skills training, and the educational opportunities that were provided in the camp, thereby increasing the likelihood that they would suffer more from acculturative stress, depression, and feelings of powerlessness. I observed that an uneven rate of acculturation between men and women had already emerged after ten years in Mexico, with most women having little opportunity to positively adapt to the new sociocultural milieu. Perhaps the most serious impact of not having one’s mother present in the refugee community is that many Q’eqchi’ women lacked access to gender-specific knowledge, such as healing rituals, childcare, and food preparation, which was traditionally passed from mother to daughter. Not only do many lack knowledge and skills, but lacking the emotional support and security that comes from a mother’s guidance and instrumental support has caused many women intense loneliness and suffering, such as described by Carmen in her testimonial life history. In Guatemala, my mother or my sister would visit two or three times a week. They would always bring food or candles and we would be together until the men came back from the fields. My mother would help me to prepare food or work in the garden. When I was pregnant, she would massage me and take care of the animals and other children. When my mother died, I was left alone. She died when we arrived here. She had fevers and was very thin. She died here. She was sick for months and we had to help her walk when we came here. I cry a lot when I think of her. When my children are sick and I do not know what to do, I think of her. She would help me before. I am afraid sometimes because I do not know what to do. There is no one to help me. I feel very alone.

Conclusion: Muchkej as Idiom of Distress over Lack of Social Support Manifested as very real physical pain, I believe that muchkej also metacommunicates the anguish of isolation, loneliness, restrictions on mobility, and lack of emotional and instrumental support that women traditionally gained from their mothers and natal kin. Although women without natal kin arguably have fewer people to assist them with labor-intensive household tasks and are therefore much more likely to experience physical pain from overexertion, the way that many women identified their pain as muchkej once they heard that it was allowing other women rest and attention convinced me that it was also used as an idiom of distress. But what perhaps is most relevant about muchkej is that the idiom was often well understood by members of the community, as seen through the positive and supportive response that sufferers received from affinal kin, their children, friends, and the medical clinic staff. For example, a specific community response to muchkej involved numerous women who wanted access to the motorized corn mill in the camp, but whose affinal kin members insisted that they maintain tradition and continue the laborious task of hand-grinding corn. These women were allowed access to the mill from their affinal kin once the doctor in the medical clinic diagnosed them as suffering from muchkej. For most women, the process was a lengthy one with a long period of suffering and appeals for medical attention made to their affinal kin, followed by a consultation, and, then, once a diagnosis was made and the


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recommendation of rest was ordered, affinal family members would relieve the woman of work.8 When word spread that the doctor was recommending that women with muchkej be relieved of work that required extreme physical exertion, I noticed a dramatic increase in the number of sufferers who arrived at the medical clinic in search of the same diagnosis and recommendation. As a participant-observer and occasional translator during many consultations, it appeared to me that muchkej was increasingly used to express a wide range of complaints, including various expressions of both physical and emotional pain. It was not unusual for a woman to be brought to the clinic for muchkej and then find that she wanted to use the consultation to address other social and emotional problems, including depression, domestic abuse, and restrictions on mobility. Through observations made during consultations and interviews, I came to see muchkej as having a multiplicity of meanings, expressions, and causes. Depending on the individual, it could be an expression of very real pain, a somatization associated with traumatic stress, an idiom of distress that communicated a lack of social support or other problems, or even a conscious act of manipulation aimed at accomplishing a specific end. Muchkej rapidly developed into a generalized illness that women used to express a variety of individual complaints. As time went on, however, and word of muchkej spread throughout the community, it was clear that the number of women coming to the clinic specifically to gain access to the corn mill increased. Refugee camps are ideally places of refuge and security, but for some individuals and social groups they are places of continuing violence, isolation, and disempowerment. For many Q’eqchi’ women, the unfavorable conditions of encampment added further stress to the trauma that they experienced during the violence in and flight from Guatemala. While Q’eqchi’ women traditionally depend on their natal family for social support (and, in particular, on their mothers), the violence, forced migration, and dispersal of families separated many women from their natal families. Lack of natal kin isolates and silences Q’eqchi’ women in that they are restricted to their homes and have no means of communication with other women. Most importantly, they will have no natal kin to intervene in their marriage households if they experience abuse and exploitation, and, in particular, if they are overworked. Furthermore, women with weak natal kin support networks are more likely to have experienced ruptures in the transmission of gendered knowledge and are more likely to lack basic skills associated with their traditional gender roles, thus intensifying the breakdown of gender-role complementarity. The research presented supports the hypothesis that women with weak natal kin networks, and particularly those whose mother is not present in the refugee community, are more likely to express distress through various somatizations associated with traumatic stress. Women in such situations may experience very real physical pain caused by overexertion in combination with emotional distress, making it nearly impossible to differentiate between the two forms of suffering. I discovered that Q’eqchi’ women without natal family present in the refugee community suffered most significantly from the illness muchkej, and that it could be used to express a wide range of emotional, social, and physical complaints. Furthermore, I believe that the Q’eqchi’ women suffering from muchkej were arguably the most vulnerable members of the community and, therefore, most in need of social support

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and assistance. The research that I conducted led me to believe that widowhood was not the best way to identify Q’eqchi’ women most at risk in the refugee community. To accomplish that, a close examination of women’s natal kin support and associated traumatic stress symptoms is recommended. I believe that my approach to ´ can be utilized in other identifying the most “vulnerable” women in Maya Tecun refugee communities in that an analysis of social support networks and traumatic stress targets the idea of vulnerability at social, familial, individual, psychological, and physical levels. Ultimately, such research can be used to develop an understanding of the overall patterns of “stress” and social support in particular populations that experience forced displacement and thereby assist in intervention programs and policy making for those individuals who are actually the most vulnerable in refugee communities.

Notes Acknowledgments. A Claudia DeLys Grant from the Department of Anthropology at Syracuse University allowed me to conduct the first phase of my fieldwork, and a Fulbright Garc´ıa-Robles Grant enabled me to carry out the second phase of fieldwork. The Maxwell School of Citizenship and Public Affairs at Syracuse University awarded me a Roscoe Martin Award, and the Graduate School at Syracuse University provided a Creative Projects Research Grant for predissertation research. My sincere appreciation goes to Dr. Winona Cochran, chairperson of the Department of Psychology at Bloomsburg University for her generosity and expertise in the analysis of the statistical data for the article. I am especially grateful for the guidance provided by members of my dissertation committee, including Hans Buechler, Duncan Earle, Susan Wadley, John Burdick, and Deborah Pellow. My deep ´ especially Dr. Sergio Aguilar Castillo thanks to the staff of the medical clinic in Maya Tecun, ´ and Elizabeth Dzib Ek. I am also appreciative of the Universidad Autonoma de Campeche and Dr. William Folan for accepting me as a visiting scholar and of COMAR for providing permission to conduct fieldwork. Bloomsburg University of Pennsylvania gave me profes´ Salas Elorza, Janet Locke, sional support to produce this article, and my colleagues Jesus Louise Tokarsky, and DeeAnne Wymer provided me invaluable assistance throughout the analysis and write-up of my fieldwork experience. The advice and keen analysis of the anonymous reviewers allowed me to move past some significant hurdles in the earlier drafts of the article, and I am very grateful to them. Most of all, I would like to thank the people ´ who shared their lives and homes with me. Their graciousness, generosity, of Maya Tecun, and courage impressed me beyond all measure. Bantiox. This article is based on a poster entitled “The Ameliorating Effects of Natal Kin Support Networks on Manifestations of Traumatic Stress Among Q’eqchi’ Refugee Women,” presented at the 2001 American Anthropological Association 100th Annual Meeting in Washington, DC. 1. For more information on anthropology and the study of refugees, the Committee on Refugees and Immigrants (CORI) of the American Anthropological Association has published nine edited volumes on refugees, encompassing a broad range of issues and cultures. 2. For information on Q’eqchi’ men, migration, and health in Canada, see Dunn 2000. 3. The death toll in the Q’eqchi’ communities can only be estimated. In the four Q’eqchi’ communities I surveyed, 216 people died of direct violence and disease during the periods of flight and first asylum. On the basis of interview data on the total Q’eqchi’ adult population ´ I determined that over 23 percent of the original population died as a result of Maya Tecun, of the genocidal campaign and forced displacement.


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4. When I started fieldwork, I was fluent in Spanish. The majority of the Q’eqchi’ community did not speak Spanish before their displacement from Guatemala. After 12 to 14 years of contact with Spanish speakers, the majority of the younger generation was effectively bilingual. A Q’eqchi’ woman research assistant accompanied me at all times and translated when interviewing most women over the age of 30. As my Q’eqchi’ language abilities improved, I was able to participate more fully, but never with complete fluency with monolingual speakers of Q’eqchi’. 5. The refugee community was extremely unstable, and most of the census information collected by various agencies was unreliable. Individuals would leave the camp for extended visits with family members in other camps to seek wage labor opportunities and to reenter Guatemala for various reasons. At any time there would be far fewer individuals residing in the camp than reported in most census reports. Because individuals were prohibited from leaving the camp for an extended period of time, it was nearly impossible to collect accurate demographic data. 6. I did not attempt to define adulthood by age but, instead, used marital status as an indicator of adult status in order to accurately reflect emic understandings of when adulthood is reached in Q’eqchi’ culture. Given this, I had women as young as 14 years of age in the adult category if they were married. Pseudonyms are used for all informants in the study, and no data was collected with identifying information unless informants explicitly requested that they be identified. 7. The origin and etiology of muchkej is not entirely clear. One of the Guatemalan Ladino herbalists who translated for the Q’eqchi’ in medical consultations translated the condition as calambre (cramps) and associated it with rheumatism. When I asked the healer if the Q’eqchi’ sufferers had actually used the term muchkej, he could not confirm this. He did agree that he was the first one who translated their condition as having calambres to the medical staff. The illness was then apparently translated back from calambre into muchkej in the Q’eqchi’ community. When I conducted my fieldwork, no Q’eqchi’ informant associated the condition with rheumatism or any other illness, always identifying the condition as a distinct illness and used either the term muchkej or the expression “tengo mucho calambre” (I have a lot of or severe calambre) in Spanish. When I asked if there was a predisplacement origin of the illness, I was often told that a person “could” suffer from the illness in Guatemala, although no individual admitted to having suffered from it previously. I was also informed that, in more severe cases, muchkej could be treated through bloodletting. I observed that the doctor in the camp originally used the diagnosis of rheumatism, then started writing calambre, followed by somatization, and finally the use of muchkej in patients’ medical records. I grew convinced that calambre was mistranslated by the non-Q’eqchi’ healer but was then accepted as a diagnosis by the Q’eqchi’ community and then was translated back into Q’eqchi’ as muchkej. I do not believe, based on numerous interviews, that the condition first originated as muchkej. I believe that the exact origin cannot be precisely determined, and that it was inaccurately translated between Spanish and Q’eqchi’. The medical doctor in the camp shared my belief. We both concluded, after nearly a year of experience with muchkej, that the healer ascribed a purely physiological condition to a much more complex situation involving both very real physical pain and somatization. 8. It was rare to see adult women at the mill. Most families sent preadolescent girls to have the corn ground at the mills. Recently married daughters-in-law rarely left their homes, and when they did they were almost always accompanied by elder women or men associated with the household. Young girls were sent to run almost all errands outside the home and were the primary means of communication between women in different households. Young girls were permitted to move about quite freely and would regularly bring back community news and information to the women in their households.

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