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Effective management strategies when incorporating Curanderismo into a mainstream mental health system

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Title:
Effective management strategies when incorporating Curanderismo into a mainstream mental health system
Creator:
Del Castillo, Ramon
Place of Publication:
Denver, CO
Publisher:
University of Colorado Denver
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Language:
English
Physical Description:
xv, 317 leaves : ; 28 cm

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Subjects / Keywords:
Mental health services -- Management -- United States ( lcsh )
Traditional medicine -- United States ( lcsh )
Women healers -- United States ( lcsh )
Healers -- United States ( lcsh )
Healers ( fast )
Mental health services -- Management ( fast )
Traditional medicine ( fast )
Women healers ( fast )
United States ( fast )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Bibliography:
Includes bibliographical references (leaves 297-317).
Thesis:
Public administration
General Note:
School of Public Affairs
Statement of Responsibility:
by Ramon Del Castillo.

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University of Colorado Denver
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Auraria Library
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All applicable rights reserved by the source institution and holding location.
Resource Identifier:
42618182 ( OCLC )
ocm42618182
Classification:
LD1190.P86 1999d D45 ( lcc )

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Full Text
I
EFFECTIVE MANAGEMENT STRATEGIES
WHEN INCORPORATING CURANDERISMO INTO
A MAINSTREAM MENTAL HEALTH SYSTEM
by
Ramon Del Castillo
B. A., University of Northern Colorado, 1976
M. S. Sc., University of Colorado at Denver, 1983
M. P. A., University of Colorado at Denver, 1994
A thesis submitted to the
University of Colorado at Denver
in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
Public Administration
1999
I
i
t
i
i


1999 by Ramon Del Castillo
All rights reserved.


This thesis for the Doctor of Philosophy
degree by
Ramon Del Castillo
has been approved
Peter Van Arsdale
CLf*J U, Wt
Date


Del Castillo, Ramon (Ph.D., Public Administration)
Effective Management Strategies When Incorporating
Curanderismo into a Mainstream Mental Health System
Thesis directed by Professor Michael Cortes
ABSTRACT
As America approaches the year 2000 and beyond, coupled with the
challenges of a growing and diverse population, public administrators will be asked to
do more with less. The Congress in American government will continue to grapple
with the question of health and mental health care for all of its citizens; therefore, it is
usefult to include all relevant modalities of health and mental health care in the
debate. Additionally, in order to insure effectiveness and prudent expenditure of the
publics dollars, as health and mental health care providers attempt to incorporate
alternative methods of treatment into its health and mental health care systems,
associated management strategies that accompany these innovations should also be
analyzed.
There is a paucity of literature regarding management problems and strategies
associated with incorporating what is considered to be a non-traditional form of
mental health treatment into mainstream systems. This research is exploratory in
nature, utilizing the topical life history approach with both curanderas/os (indigenous


healers) and public administrators and managers. These public servants were
involved in the implementation of curanderismo, defined as the practice of spiritual
folk medicine, generally used in Indian and Mexican-American communities as it was
implemented in a publicly funded mental health system.
This dissertation asks the question what management strategies are effective
when incorporating curanderismo into a publicly funded mental health system. The
actual research demonstrates those strategies used by Southwest Denver Community
Mental Health, a publicly funded mental health center, now consolidated under the
Mental Health Corporation of Denver, as curanderismo was first introduced into the
system, followed by a process of institutionalization. Analyzing the findings of this
research through the eyes of organizational innovation, this research outlines those
management strategies that were effectively implemented that eventually resulted in
the institutionalization of curanderismo into the system, both as a treatment modality
and as educational strategy.
The findings of this research demonstrate that the incorporation of
curanderismo into a mainstream mental health system was successfully accomplished.
Some of the management strategies that were learned include the building of a solid
infrastructure to support alternative mental health programming, the demonstration of
effective leadership, a strong minority voice, the introduction of intermediaries who
play key roles in the process of institutionalization and cultural competency.
v


I
This abstract accurately represents the content of the candidates thesis. I
recommend its publication. Signed Ol(jLLciuBi (siddi 2L Dr. Michael Cortes
vi


DEDICATION
I dedicate this thesis to both my mother Elena Mercedes Del Castillo and my
father Adolpho Constantino Del Castillo. They have both contributed in a lot of
different ways, too many to mention, to my successful journey. Their love for nuestra
cultura was always very evident, but in different ways. I would not be who I am
without them. I promise to transmit that culture to those nearest and dearest to me.
With respect to my mother, never will I forget the many years she toiled at the
Cudahy Packing Company so that my brothers and I could live a better life. Her hard
work ethic has always been an inspiration to me. If she had been bom at a different
time in history, I believe that she would have made an exemplary leader. My fondest
memory of her is still imprinted in my mind as I watched her silhouette slip away into
the darkness of the night, knowing that it would never return again. I know that
somewhere, perhaps in another dimension, she continuously watches over her
children. I did not understand the values that she passed on to me until later on in
life. Now that I have the conocimiento, I want to pass it on to my son and his
children. This thesis completes the manda that I made to her before she died.
To my father who is still alive, never will I forget those nights when you
played your magical saxophone, sharing those deep emotions in the only form that
you knew. I didnt understand you then, but I do now. It was within your disciplined
nature that you passed on to me that I have made this journey possible. I have not


walked in your lifes path, but I know that someday you will find peace and
tranquility. When that day comes, your giving spirit will rejoice.


ACKNOWLEDGEMENT
There are several persons who deserve acknowledgement. First, let me thank
Dr. Michael Cortes for sharing his expertise with me. He did it in such a way that
demonstrated respect for my persona. Gracias, for your excellent mentorship, I
believe that I am a better person for it. I also want to give special thanks to the other
members of my committee Dr. Mark Pogreben, Dr. Lloyd Burton, Dr. Peter Van
Arsdale and Glenn Morris, J.D. for their contributions to this process. In particular, I
want to thank Dr. Mark Pogreben for encouraging me to pursue this type of research.
Your encouragement will not be forgotten.
These types of journeys are filled with wonderful people, some who play
deeper and more significant roles than others. One such person that played a very
supportive role and that I want to deeply thank is Dorothy Ortegon. Her
encouragement during those difficult times was energy that I needed. Of course, my
eldest brother Dr. Steve Del Castillo has always been there for me. Gracias, hermano.
A1 Martinez, my friend and colleague deserves mention. He and I traveled down this
path together. We vowed to make it together. We did it!
I want to give special thanks to La Curandera, Diana Velazquez for her
willingness to take me into the world of curanderismo, both during this research
project but also for many years prior to that. Our manda is also completed.


I think that I would be remiss if I did not mention the many companeros and
companeras who always inquired as to my progress. One in particular was Dr.
Darlene Le Doux. She was an inspiration. Dr. Ed Santos was a friend during this
process. He gave me moral support during a time when I really needed it. Dr. Walter
LeMendola was equally gracious with his time and expertise. He saved me several
times. He rescued my dissertation many times, as well. Thank you for your support.
I hope is that during this arduous process that I have brought more value
to the community in its struggle for social justice.


CONTENTS
CHAPTER
1. INTRODUCTION................................................I
Purpose..................................................1
Statement of the Problem.................................2
Demographic and Historical Information................2
Social Problems of Latinos in the United States......4
Underutilization Patterns of Mental Health Services by
Mexican-Americans.....................................6
General Problems Associated With Access to Services...8
Curanderismo as an Alternative Healing System........10
The Current Health Policies Debate Latino Concerns.12
Purpose of Research..................................16
2. REVIEW OF THE LITERATURE...................................18
A Critical View of Psychiatry........................22
Conceptual Differences Between Traditional and Modem
Systems of Medicine in Psychiatric Diagnosis and
Classification............................................24
Curanderismo: Some Definitions............................26
History of Curanderismo...................................28
Epistemological Foundations of Curanderismo...............31
Mexican-American Beliefs about Illness and Health.........32
ix


Religious Influences......................................34
The Role of the Curandero/a...............................35
Life Histories............................................37
Organizational Innovation and Change: Implementing
Innovation in organizations...............................39
Organizational Cultures...................................46
Centralization vs. Decentralization.......................47
Relations with the Environment............................48
Interpersonal Processes in Implementation.................49
Managing Change Through Innovation........................50
Change Agents.............................................51
The Diffusion of Innovation...............................52
3. METHODOLOGY.....................................................54
Introduction and Research Design..........................54
Research Design...........................................56
Actual Research Conducted.................................61
Sample Selection..........................................62
Data Analysis.............................................69
Validity, Reliability and Limitations of This Study.......70
4. RESEARCH FINDINGS IN GENERAL....................................74
Research Findings on Curanderas/os...........................74
Diana Velazquez: La Curandera Total.......................74
Cultural Diagnostics and Treatment Methods................83
x


Tools of the Trade
.85
Integration into Psychiatric Care.........................90
Gloria Cordova: New Mexican Healer...........................91
Gloria: La Curandera and Her Journey......................93
Techniques in Healing.....................................95
Blending Curanderimso and Western Psychiatry..............99
Rituals..................................................101
Case Study...............................................103
Dr. Ernesto Alvarado........................................105
Introduction to the Philosophy of Curanderismo..............107
Reconciling Western Psychiatry and Curanderismo..........110
Tools and Techniques of the Trade........................113
Research Findings on Public Administrators/Managers.........118
Dr. Paul Polak...........................................118
Organizational Barriers..................................125
Program Innovation.......................................127
The Politics of Community Mental Health..................128
Management Style.........................................131
Dr. Ernesto Alvarado........................................133
Organizational Barriers..................................137
Management Techniques....................................142
Jane Gutierrez..............................................145


I
Mental Health Education: Formal and Informal..............148
Building the Philosophy of a Non-Traditional Clinic.......150
Organizational Barriers...................................155
Managing the Team.........................................156
Working with Western Psychiatrists: Documentation.........158
Personal Challenges.......................................161
Diana Velazquez..............................................162
Management Philosophy.....................................163
Hiring Culturally Sensitive Staff.........................166
Issues in Managing a Non-Traditional Program..............167
Treatment Considerations..................................169
Documentation.............................................171
Clinical Supervision......................................172
Organizational Dynamics...................................173
The Auditing Process......................................176
Dr. Ron Eicher...............................................179
Encountering Curanderismo.................................180
Organizational Barriers...................................182
Role of Psychiatrists.....................................183
Working With the State Division of Mental Health..........185
The Economics of Curanderismo.............................186
Management Philosophy.....................................189
I
XII


Dr. Ollie Wolcott.............................................191
Joining Centro de las Familias: Encountering Diana
Velazquez.................................................194
Reconciling the Differences in the Medical Model of
Mental Health and Curanderismo.............................196
Maintaining a Relationship with the Transcultural Healer...197
Community Mental Health as Non-traditional Approach to
Mental Health..............................................198
5. ANALYSIS OF RESEARCH FINDINGS....................................201
Introduction..................................................201
Tres Curanderas/os: Similarities and Differences...........202
The Influence of Western Education on the Curanderos/as....208
Cultural Diagnostics and Treatment Approaches Utilized in
Curanderismo: Reconciliation of Negotiation................212
Transcultural Healers......................................215
Conclusions of Findings and Analysis.......................217
Research Findings and Analysis with Public Administrators.....218
Introduction...............................................218
Public Policy as a Catalyst for Innovation.................220
Building Positive Relations with the Community: An Open
Systems Approach...........................................223
Defining the Roles of Change Agents and Intermediaries in
Innovation: Building Legitimacy for Traditional Mental
Health Programs............................................225
Building Effective Leadership..............................230


Building and Supporting an Organizational Infrastructure:
Strategic Management.....................................234
Introducing Cultural Competency..........................238
Building Cultural Competency at a Team Level: Centro de
las Familias.............................................241
Institutionalizing Curanderismo.............................247
Management Strategies that Complement Innovation.........247
Building Cultural Competent Personnel Systems............252
Organizational Staff Development.........................260
Complementing Western Psychiatry.........................262
Curanderismo and Economic Sustainability.................266
Monitoring and Documentation of Curanderismo Clients.....268
6. CONCLUSIONS AND RECOMMENDATIONS.................................273
A Comparative Analysis: What works and what doesnt work?...274
Areas of Agreement in the Literature.....................274
Management Strategies that Complement Innovation.........274
Management Strategies that Support Innovation............276
Institutionalizing Curanderismo: Management Strategies
that Integrate Innovation................................278
Areas of Agreement in the Literature: Replication........280
Areas of Disagreement in the Literature..................282
Application of New Knowledge.............................284
Implications for Professional Practice and Management:
Transferring the Lessons Learned to Other Ethnic Groups..286


Implications for Public Policy......................292
Implications for Future Research....................293
APPENDIX
Definition of Constructs..................................295
BIBLIOGRAPHY.................................................297
xv


CHAPTER 1
INTRODUCTION
Purpose
The purpose of this dissertation is to examine a modality of health/mental
health treatment, known as curanderismo and the associated management strategies
that made it successful in a publicly funded mental health organization. The research
question that is being asked is what management strategies are effective when
introducing curanderismo into a mainstream mental health system? Although
practiced throughout the Southwest, mostly underground, that is, hidden from
mainstream mental health practices, mental health practitioners are beginning to
understand its viability as one of many health practices on a continuum of health care
practices.
As the federal government grapples with general health and mental health care
issues and managed care practices in American society, consideration of alternative
types, modalities, and practices of health and mental health care can be advantageous.
In the policy process it is important to consider the most cost-effective options as they
pertain to this critical issue. To bypass consideration for this type of healing would
be omitting an important contribution to the overall debate. In general, curanderismo
1


has been used in Mexican-American and Chicano neighborhoods. However, as this
research explains, there are other ethnic groups who have also accessed services, at
least, within the parameters of this research project.
Statement of the Problem
Demographic and Historical Information
Some researchers predict that as we approach the year 2000, the Latino
population will become the largest minority group in this country. Latinos are the
fastest growing minority population in the U.S. today, and may account for as much
as half of the nation's population growth in the next twenty-five years (Scott, 1990).
The number of Latinos reached 20 million in 1988, a 34 percent increase since 1980
(Valdivieseo & Davis, 1988). A more recent analysis and projection of the
population growth of Hispanics in the United States indicates that between the years
2000-2010, there will be as much as a 31.25% change, in comparison to the 1980 and
1990 census (Homes, 1998).
The rapid growth is due to a combination of factors: a young median age (26
compared to 32 for other Americans); a high fertility rate (the rate for Latinos is 50%
higher than the national average); and continuing migration from Mexico and
elsewhere (Scott, 1990).


In an analysis of the 1990 census by the Hispanic Link Weekly Report, social
demographers have predicted that the Latino population will reach a level of 15.7% of
the total U.S. population by the year 2020. By the year 2010, Latinos will number a
million or more in eight states. The largest group, the Mexican Americans, is also
expected to grow in numbers. The majority of Latinos are concentrated in the
Southwest, the Northeast, and the state of Florida. According to Scott (1990), most
Mexican-Americans, who comprise 61% of the U.S. Latino population, are
concentrated in the Southwest. He also argues that approximately 75% of the
Mexican-Americans were bom in the United States, many who are indigenous to this
nation before it became U.S. territory (Ibid).
It is predicted that 600,000 legal and illegal immigrants will enter the United
States annually throughout the balance of the century. Most of the newly arrived
immigrants in American society have migrated from Latin America and Asia. This is
contrasted with historical patterns of immigration from other countries. Most of the
new immigrants have settled in the South and West (Ibid, 1990).
The impact of the 1986 Immigration and Reform Control Act is not totally
certain. It is predicted that the amnesty portion of this legislation will legalize the
status of almost three million people, a majority of which has migrated from Mexico
(Valdivieseo & Davis, 1988). If current social needs grow commensurate with the
growth of the population, one can easily predict the need for more types of social
services, including mental health.
3


In tandem with this population growth is the growth of the Mexican-American
population. Currently, this group comprises (62% to 63%) of the total Latino
population in America (Ibid). This places them as the second largest ethnic group
next to African Americans and the largest Latino group in America (Macias, 1977;
Report to the President's Commission on Mental Health, 1978). Mexican-Americans
are concentrated in the Southwest, particularly California and Texas. Only about one-
quarter are foreign-bom, which makes them the oldest Latino groups currently living
in the United States (Ibid, 1988).
A more recent analysis conducted in the State of Colorado indicates that the
Latino community will experience a slight increase in proportion to Colorados
population and will remain the largest ethnic minority group over a thirty-year
period (Pappas, 1997). This analysis also projects that the Latino Population will
double over the next thirty years, reaching almost a million people (Ibid).
Social Problems of Latinos in the United States
From the perspective of the Latino population, there is an increasing fear that
this group will become a permanent underclass. Indicators such as measure of
employment, labor force participation, earnings, and education show that the Latino
population is at a distinct disadvantage in American society (Scott, 1990). Other
indicators that require scrutiny are poor performance in schools, greater dependence
on welfare, a greater incidence of broken families, high rates of children bom to
4


unmarried mothers, and higher rates of criminal arrest. Additionally, Hispanics are
over represented among declining occupations (Johnson, W. & Packer A. H., 1988).
Latinos are often the victims of overt and covert forms of institutionalized
racism and discrimination. At times, this group is blamed for the economic problems
of American society. They have faced discrimination in housing, job acquisition, and
political participation. This has placed a large proportion of this group at a great
disadvantage (Scott, 1990).
Further research demonstrates that Mexican-Americans suffer from a
magnitude of social problems. Over a quarter of a century ago, Mexican-American
and sympathetic Anglo social scientists began the arduous task of informing society
in general that there were significant social problems in the Mexican-American
community that needed to be addressed.
As early as the 1970's, sociologist Armando Morales (1970) described a
variety of social problems that existed in Mexican-American communities. These
included deficient educational achievement due to the lack of educational
opportunities, broken homes and excessive numbers of police in Chicano
communities. The more salient point and that specifically pertains to this research
that Morales makes is the gross lack of mental health treatment facilities in Chicano
communities. Some Mexican-American researchers argue that Mexican-Americans
persevere, living under intense levels of psychologically and environmentally
5


oppressive conditions with a high incidence of stressors that cause problems (Padilla
& Ruiz, 1975).
Although government and public agencies have historically attempted to
ameliorate the aforementioned social problems experienced by Mexican-Americans;
the attempts have been futile.
Underutilization Patterns of Mental Health Services by
Mexican-Americans
The term program utilization is defined as the degree to which clients utilize
services (treatment and intervention) (Santos, 1997, p. 10). The term
underutilization implies that the group in question has not utilized services to the
degree allowable. The predicted growth in the numbers of Latinos, augmented by a
history of underutilization of mental health services presents an interesting dilemma
for the social/human service and mental health arenas. The paucity of research
related to Mexican-American mental health issues prior to the middle 1960's,
following the passage of the Mental Health Act of 1965, has led to the development
of a psychiatric system that has almost totally denied culturally relevant mental health
services to this population.
Morales suggests that the reasons for the lack of appropriate mental health
services is threefold:
l. the brutal discrimination that America practices towards the poor;
6


2. racism; and
3. an institutionalized delivery system of mental health care that
emphasizes quality, individualized, psychiatric treatment for the
affluent, and an almost complete denial of quality mental health care
for those that need the services the mostthe poor (Morales, 1970,
P-6).
Sociologist Ernesto Galarza suggests that Americas institutions suffers from
institutional deviancy or the tendency of an institution to depart from its moral
commitment to its people. He further argues that institutions as systems designed to
deliver specialized services have failed the Mexican-American (de la Garza, 1970).
Theories explaining the underutilization patterns of Mexican-Americans
suggest that because of heavy reliance on the extended family and community
networking, this group chooses not to access service delivery systems. A further
literature review indicates that because Mexican-Americans prefer traditional
methods of healing, they opt not to enter mental health facilities. Others argue that
this is a stereotypical view of the Mexican-American population and that the family
structure of the Mexican-American is experiencing transition just like other groups
(Scott, 1990).
Compared to the majority population, Mexican-Americans have demonstrated
and will probably continue to demonstrate a higher incidence of mental health
problems (e.g., cultural identity conflicts, alienation, low self-esteem, and certain
mental illnesses (Acosta, 1977; Alvarez, et. al., Ruiz, Casas, & Padilla, 1977).
7


Several studies, conducted by mental health professionals, further illustrate
that Mexican-Americans have shown a disproportionately higher incidence of self-
destructive or problem behaviors. This includes, but is not limited to, alcoholism,
drug abuse, incarceration, juvenile delinquency, adult and juvenile court involvement,
and school drop out rates; as well as a steadily increasing rate of suicidal ideation
(Alvarez et.al., 1974; Cuellar, 1978; Carrillo, 1982).
The interesting phenomenon is that while Mexican-Americans live under
stressful conditions, they show a relative lack of utilization patterns with respect to
mental health services. Del Castillo points out the irony of this complex situation.
Through an intensive literature review, she documents an underutilization pattern of
mental health service usage by Mexican-Americans with a simultaneous favorable
attitude toward psychotherapy (Del Castillo, 1986). It would seem that
underutilization patterns would suggest an unfavorable attitude toward
psychotherapy. However, the reverse has been documented (Acosta, 1975; Acosta &
Sheenan, 1976). This suggests that there are other variables that act as barriers
prohibiting the effective utilization of mental health services by Mexican Americans.
General Problems Associated With Access to Services
Del Castillo further outlines the following as significant and/or valid
explanations of barriers to accessing mental health services for the Mexican-
American population:
8


Cultural barriers and insensitivity
Class barriers and insensitivity
Language barriers
Geographic barriers
Limited number of Mexican American mental health professionals
Cultural dissimilarity or insensitivity between therapist and client
Failure to use culturally and linguistically relevant indigenous therapists
Bureaucratic-like barriers to mental health facilities, including adherence
to formal procedures
Institutional racism and discrimination in
service delivery
Adherence to irrelevant traditional forms of psychotherapy
Focus on changing intra psychic individual problems before or without
also changing the environmentally oppressive conditions of society as a
whole
Absence or lack of community input and involvement in organizing and
administering services
Reluctance to develop and implement innovative programs (Del Castillo,
1986, p. 127).
Acosta (1979) and Keefe & Casas (1980) offer some insight into why
Mexican-Americans do not enter mental health treatment. Their research indicates
that Mexican-Americans rely on alternative resources when assistance is needed.
Values such as pride and strong family loyalty prohibit entrance into treatment. They
9


add that the lack of awareness of mental health services is also a barrier for
accessibility.
Other research has demonstrated that some traditional Western
psychotherapeutic approaches are not relevant to the needs of Mexican-American
clients. Others suggest that modification within these approaches must take into
account cultural, psychological, cognitive, and linguistic differences (Abad et. al.,
1974; Burrel & Chavez, 1974; Ramirez, 1972; Torrey, 1972).
Jaco's (1960) findings, from research conducted in Texas indicated a lower
incidence of treated psychoses among Mexican-Americans than Anglos-Americans.
Edgerton and Kamo (1970) reported lower Mexican-American admission rates into
California hospitals compared to Anglo-Americans.
Barrera (1978) argues that Mexican-Americans tend to manifest more severe
disorders or diagnoses upon admission to mental hospitals and clinics. He further
suggests that the severity of diagnosis, coupled with an underutilization pattern of
Mexican-Americans into mental health facilities may be that the most severe
diagnoses receive treatment. His further analysis argues that this may be an artifact
of a culturally biased diagnostic system.
Curanderismo as an Alternative Healing System
Edgerton and Kamo (1970) suggest that the middle class orientation of the
medical health care system may be alienating to Latinos and eventually discourage
10


usage. Warner (1977) suggests that services appearing to be more culturally
sensitive, such as home visits, brief psychotherapy, and family therapy, rather than
the more conventional analytic techniques, be used when working with Latino
populations supports this.
Stanley Sue (1987) has found that utilization rates are not as significant as the
dropout rates of Minority groups versus Whites. This suggests that one of the most
prominent factors contributing to this is the failure of the mental health delivery
system to incorporate culturally relevant systems of healing that would benefit people
of color.
There are some explanations offered by the literature related to this
phenomenon. One explanation offered for the underutilization patterns of health
services is that some Mexican-Americans prefer to be treated by curanderos/as
(Mexican-American indigenous, folk, and/or spiritual healers (Morales, 1970; Torrey,
1972, 1986).
Martinez and Martin's (1966) research indicates that, in this particular sample
taken in Texas, one fifth of the housewives had used a curandero and more than 97
percent of the women had knowledge of folk diseases. Lucero and Rivera's (1981)
more recent research validates curanderismo as an effective alternative healing
system.
11


The Current Health Policies Debate Latino Concerns
The current administration is grappling with health/mental health policy issues
for all Americans (National Council of La Raza, 1992). The formation of a
multicultural policy would have spillover effects on management practices. This
research will add analysis on how to develop effective management strategies that
would complement the incorporation of alternative healing systems, in particular,
curanderismo into in a mainstream system.
There are some disquieting facts that need to be taken into consideration as
the administration debates and discusses this national policy. The facts that I am
making reference to deal with a population that has historically been under-
represented in the area of health coverage, the Mexican-American population. In a
national study conducted by the National Council of La Raza the following results
were outlined.
In particular, the Council demonstrated that Latinos are more likely than
either Whites or Blacks to have no health insurance coverage. It was estimated that
over 6.9 million Hispanics in this country have no health insurance coverage. Lastly,
according to the NCLR, irrespective of state, residency, gender, income or
employment status, Hispanics will do without health insurance coverage unless
Congress takes drastic measures (National Council of La Raza, 1992). This suggests
that Hispanics will either do without health care or access public agencies or
institutions for all facets of care, including mental health treatment.
12


The more critical issue in this research involves effective mental health care
management strategies that would complement the development of an inclusive
national health care policy. It appears that the notion of including mental health
coverage into the overall policy plans has become controversial as the Congress
debates this vital issue. In general, there appears to be resistance to include
"additional increments" of mental health care for Americans in general (Ibid, 1992).
In a public policy report by the National Community Mental Healthcare
Council (April 1994), it outlined a series of points as imperative to the mental health
aspects of a national health care policy. The more salient points suggest that
universal coverage must become a household word. Without universal coverage, the
mentally ill may be left without resources to purchase insurance coverage. Laws
should also include specific services such as case management, crisis care and
rehabilitation. Resources must continue to flow down to community mental health
facilities, which they argue, have been the backbone of effective mental health service
delivery. Lastly, co-payments and deductibles should be eliminated (National
Community Mental Healthcare Council, 1994).
The predicted demographic change will have implications and/or spillover
effects for American society in general. Areas such as business and commerce that
historically have ignored this particular population will be affected. These
aforementioned areas may be forced to contemplate the ramifications of the market
and the subsequent buying power, political clout, and consumerism, that accompany
13


such drastic demographic changes. America will be challenged to incorporate this
group into the overall structures of American society. Associated with these potential
changes will be challenges in the current field of mental health program management.
In turn this presents challenges to public administrators.
In my opinion, health care administrators, should they choose to incorporate
curanderismo as a mental health modality into their current delivery system, will be
facing new management challenges such as cultural competency. Cultural
competency, defined as practicing human relation skills, knowledge and sensitivity in
cross-cultural situations, has become as important as other management practices.
Mental health workers will also face challenges. Assuming they are
accustomed to practicing Western methods of mental health care, culturally
competent health care practices will require training in both understanding and
incorporating curanderismo as another method of mental health care for those who
request it. Other challenges will include the adoption of cross-cultural diagnostics
and culturally specific treatment plans.
For mental health care administrators, some of these challenges may include
how to incorporate a non-traditional system of mental health into a traditional one
while at the same time creating an awareness and acceptance for it. Other challenges
include how to build sensitivity and knowledge for those mental health care givers
who have been trained in Western psychiatry and psychotherapeutic approaches.
14


In my opinion, America is in crisis with respect to health/mental health care.
With the soaring costs of medical practices and the struggle over managed care, it
would behoove the current administration and Congress to incorporate all aspects of
health/mental care practice in its debate. The incorporation of alternative systems of
health/mental health care can assist in meeting the needs of the Mexican-American
population that has been under served by the health/mental health professions.
In general, alternative systems of health/mental health care such as
curanderismo may prove to be more effective with a given population or with those
who request it. While this public policy debate continues, many Americans will do
without health/mental health care. In the final analysis, the importance of this public
policy is critical. With well-founded research, alternative systems of health/mental
health care can add analysis to the debate as it pertains to all Americans, including
Mexican Americans.
It is hoped that this research will add depth, understanding, critical values, and
analysis to the current debate in Congress with respect to health/mental health care
policy. Mental health administrators will also be facing management changes with
respect to managed care.
This research has investigated curanderismo as one culture specific approach
in the delivery of health/mental health care. It is hoped that this research can add to
the overall all debate of the policy question at hand. Additionally, this research
15


addresses the changes in management strategies that must accompany the adoption of
curanderismo as a mental health care practice.
Purpose of Research
This research proceeds from the position that curanderismo is a viable form of
treatment that can play a significant healing role in community mental health for
Mexican-Americans or whomever chooses to be treated by it. Associated with this
specialized type of programming are significant management strategies that can assist
in the implementation and management of such an innovation.
Mexican-Americans should have available healing systems that are culturally
relevant. As the federal government debates health care and managed care issues in
American society, it might behoove public servants to investigate curanderismo.
Insight into the development, implementation and management strategies of this
specific mental health treatment modality can provide equity and culturally relevant
mental health services into a system that has been dominated by western approaches
to healing.
Specifically, I will focus on the use of curanderismo as a non-traditional
approach; that is non-traditional as viewed by western systems healers, in increasing
the choices available to Mexican-Americans in mental health settings. Western
systems approaches to mental health services have not, until very recently, included
the cultural components necessary for effective Mexican-American treatment. The
16


result has been minimally relevant services for Mexican-Americans and the
underutilization of these services by such clients, implying an inequitable service
delivery system. This research is designed to uncover and address specific
management strategies that were used when incorporating a non-traditional system
into a traditional mental health system. There are management issues and concerns
that need to be addressed as America attempts to provide health/mental health care
for its diversity of constituents.
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CHAPTER 2
REVIEW OF THE LITERATURE
Western Systems Approaches to Psychiatric Classification
Classifications are ways of standardizing and seeing the world. They are
based on an accepted standard of theory and knowledge, or an ideological position in
a society (Sartorius, et. al., 1990). At best, classifications provide human beings
with categorizations, security, and certainty in explaining the world in which they
live. From a health/mental health care economic perspective, classifications can
assist in the process of providing the basis for public policy debates, coverage for
these classifications, and cost containment.
Classifications in psychiatry have existed throughout history and have been
studied by psychiatrists, lawyers, philosophers, and taxonomists. The basis for
psychiatric classifications arose due to the lack of overt physical signs that a client
might be manifesting. They are generally related to an imbalance in mood or affect,
with behavioral manifestations. Classifications are based on the consensus of what
self appointed professional groups in a society define as normal, abnormal, and
asocial. At best, they provide a theoretical framework, based on a societys
expectations of normal behavior.
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In part, also, the interest in psychiatric classification springs from the
intermingling of understandable and incomprehensible behavior, from
the frequency of psychiatric symptoms in the normal population and
from the absence of specific treatments that would allow a classification
ex juvantibus. Many of the conditions that could be the subjects of
psychiatric classification are of unknown origins, have a variable course
and an uncertain outcome; epistemologically, they have a low rank and
present formidable difficulties for placement into a classification of
diseases (Sartorius, el. al., 1990 p. 1).
Psychiatric research in the 1960's failed to adequately establish or create
culturally relevant disease concepts and disease entities. In general, Western
concepts lacked cultural competency. For example:
Syndromessuch as schizophrenia or depressionare widely used, and
most attempts to create coherent links between clinical symptoms,
specific causal factors, pathogenic models and prognostic types have
failed. In order fully to understand the functioning of the mind and body,
"other ways of thinking about health and disease, mind and body, are
needed if we are to formulate hypotheses and design investigations likely
to result in breakthroughs in our knowledge about mental illness"
(Sartorius, el. ai., 1990, p. 2).
Recently, there has been an increase in the recognition of the cultural
constraints associated with diagnostics. This is due to disagreements on diagnostic
and classificatory systems in psychiatry. Communications with Third World
psychiatrists and a simultaneous building of respect for what other countries have to
offer to the field of psychiatry has brought about the "unresolved issues in psychiatric
classifications in the industrialized countries (Sartorius, et. al., 1990).
The Diagnostic and Statistical Manual of Mental Disorders III (DSM HI) in
1980 reflected a major overhaul, specifically related to issues of psychopathology,
diagnosis, and nosology classification. The DSM HI:
19


incorporated a number of features derived from recent and clinical
experience, the most significant of which was the development of
operational criteria for individual disorderscriteria based mainly on
directly observable manifestations of psychopathology. More refined
definitions of psychiatric syndromes and delineation of subgroups within
the syndromes has also been incorporated (DSM EEL, 1980, p. 94).
This renaissance of diagnostic and nosological activity in the United States
was accompanied by an extreme division over the balance of scientific and
humanistic aspects. This generally exists for all medicine. Sometime the unit of
scientific interest is the disorder, (or illness). At other times, the unit of clinical
practice is the individual patient. In other words, medicine studies diseases, but in the
final analysis treats patients (Klerman, 1977; Illich, 1976.).
There are several schools of thought in the treatment of psychiatric disorders
including the biological organism, mental processes (conscious and unconscious), the
societal and institutional setting for care, and the socially adaptive behavioral
perspective. The American psychiatric profession draws from multiple scientific
sources that range from psychoanalysis to psychobiology. It also draws from other
related disciplines such as neurobiology, psychology, and epidemiology (Sartorius, et.
al., 1990).
Psychiatric schools, at times, become movements. Throughout the history of
psychiatry, movements such as the psychoanalytic or the community mental health
movement have emerged and grown in popularity and strength. These schools of
thought differ strongly as they pertain to the concepts of mental illness. In particular,
20


specific aspects such as diagnostic categories, reliability, validity, and appropriateness
vary (Sartorius, et. al., 1990). The differences include the social and ethical issues of
the time. These movements, in turn, assist in the reclassification of particular
disorders. Therefore, the scheme of classification lacks consistency in relation to
diagnostic categorizations.
Third World psychiatry has not always had the respect in the field of
psychiatry. There is no standard definition of a developing nation (Sartorius, et. al.,
1990). It is generally referred to as the countries of Asia, Africa, and Latin America.
These are generally contrasted to the modem industrial nations. Third World
countries have many common features including generally low per capita income,
low life expectancy, high population growth, and a poorly established system of
modem health services (Sartorius, et. al., 1990).
Although there has been an attempt to understand Third World psychiatry, the
paucity of findings has resulted in little respect for or understanding of the
perspective by Western psychiatrists. Until culture is treated as a core aspect of the
mental health treatment process, it is my opinion that on going debate about what
constitutes effective mental health treatment will continue while patients get caught
up in the middle of this political process.
21


A Critical View of Psychiatry
Thomas Szasz, a contemporary radical psychiatrist, in the Myth of Mental
Illness the founder of a movement considered Anti-psychiatry, argued that psychiatric
pioneers invent new diseases in order to justify the calling of certain pre-existing
social interventions as forms of treatment. For example, he uses Kraepelins
invention of dementia praecox and Bleulers invention of schizophrenia as
justifications for psychiatric imprisonment and eventually regarding it as needing a
form of medical treatment (Szasz, 1976).
Other antipsychiatry writers, referred to as labeling theorists, maintained
that psychiatric diagnoses of mental illness was a labeling process
whereby patients are stigmatized and thereby confirmed in a situation
reifying the conditions such labeling was intended to diminish. Further,
they held that the stigma separating the mentally ill from the larger
population was a form of social control, and that mental health
professionals were in danger of becoming agents of social control rather
than advocates of patients needs (Lemert, 1972, Scheff, 1966,1975, In
Sartorius, p. 106)
E. Fuller Torrey, in Witchdoctors and Psychiatrists, argues that psychiatric
imperialism exists in the United States. Psychotherapy is big business. Torrey cites
research that there are 150,000 psychotherapists in the United States, utilizing more
than 250 brands of psychotherapy (Torrey, 1986). This seems to suggest that
economics becomes a critical variable as psychiatrists diagnosis and treat mentally ill
patients. Is there an unconscious motivation to keep a person in treatment in order to
maximize profit margins?
!
t
i
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Some of the literature suggests that culture plays a significant role in the
classification, diagnosis, and treatment of mental disorders. However, due to the
tension between Western science and a more holistic approach, cultural relevancy in
the aforementioned areas, has not yet reached a level where complete cultural
understanding has been incorporated into the field of psychiatry.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has
begun the process of incorporating specific cultural maladies into its diagnostics.
Under the rubric of culture-bound syndromes, the manual is working on developing
appropriate cultural concepts. This will include an outline for cultural formulation
meant to supplement the multicultural diagnostic assessment and to address
difficulties that may be encountered in applying DSM-IV axes (DSM-IV, p. 843). It
is anticipated that this type of inclusion will assist clinicians and healers in the
process of describing systematically the individual cultural and social reference
group...relevant to clinical care (Ibid, p. 843). This is a great starting point, but much
work has yet to be accomplished.
The literature also suggests that other modes of healing need to be researched
in order to leam more about the mind. However, with states placing barriers to
access, how can the incorporation of culturally specific treatments be accomplished?
This is one of the principal questions investigated in this research.
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Conceptual Differences Between Traditional and
Modem Systems of Medicine in Psychiatric Diagnosis
and Classification
The exact etiology of many mental disorders remains a mystery in many
societies. The concept of insanity has at its base the social norms, morals, behaviors,
and a host of other characteristics germane to the culture. For example, the notion of
the unconscious coined by Sigmund Freud is relatively alien to Third World
countries. Does this make it irrelevant to the treatment processes utilized in another
society? Does it make a better treatment concept? These are questions that may take
centuries to discover. For the purpose of this dissertation, it is sufficient to say that
the lack of culturally appropriate understanding can lead to misdiagnosis.
Because of linguistic differences between and among societies, it would be
rather difficult to establish worldwide diagnostics, simply because language in its
precise translation is difficult to attain. In Fantasies of the Master Race, Churchill
argues:
Translation usually involves the encountering of certain words for which
there are no translatable equivalents, particularly when one is dealing
with esoteric or highly technical concepts (such as sorcery, for example).
In practical terms, this generally results in the retention of the original
specialized term or terms (with accompanying definition upon initial
usage), or at least a citation of the original, peculiar, term within a
translated text (Churchill, 1986, p. 52).
Therefore, to import or export diagnostic classifications may not be a good
method to use when dealing with cultural differences. What seems to be an issue here
is whether culturally specific mental health diagnostic are important in working with
24


diverse groups. The incorporation of culturally specific methods of treatment in the
mental health field is critical to the mental health of that particular person. What may
exist in one culture's view of the world may not exist in another's.
The European philosophical tradition has duality or polarity of contrasting
opposites (Wig, 1985; Mora, 1980). Mora (1980) argues that this has led to undue
preoccupation with controversies like nature and nurture, body and mind, conscious
and unconscious, organic and functional, and so on. Other cultures view the world
differently, which might invalidate the imposition of another worldview onto that
culture. Unlike modem medicine, there are traditional forms of medical practice that
do not maintain a strict division between body and mind.
The imbalance between body humors can affect both the physical and
mental functions. As a result, the practitioners of traditional medical
systems tend to have a more holistic approach toward their patients. A
traditional practitioner does not use the modem medical approach of
excluding the organic illness before thinking of psychological causes.
Furthermore, a neurotic patient feels more comfortable with a traditional
healer because there in no tendency to be labeled as having no "physical"
illness and hence to be considered psychologically "inferior," as is
common in predominantly biologically oriented practitioners of modem
medicine (Wig, 1990, p. 195).
In traditional medical systems there is not a unified concept of neurosis.
Modem psychiatry, in the last 100 years, has created such a concept. In terms of
personality types, and personality disorders, traditional systems of medicine reflect
the particular culture. Modem psychiatry uses the concept of the average norm;
25


traditional psychiatry uses the ideal norm. In other words, whatever is less than
ideal is inadequate and thus, in a sense, abnormal (Wig, 1990, p. 196).
With respect to the research proposed in this paper, there are two important
and interrelated variables that need to be addressed. While the literature supports the
efficacy of non-traditional forms of healing such as curanderismo, it does not speak of
the management strategies that would complement these changes, particularly when
introduced to a system that has a mainstream perspective. Therefore, it begs the
question of how to best introduce and manage the differences and innovation in
health care practices that this research addresses.
Curanderismo: Some Definitions
The specific definitions, characteristics and techniques comprising
curanderismo vary geographically and have different labels attached to them. These
include Mexican-American healing practices and rural folkloric medicine. Bobette
Perrone and others define curanderismo;
as consisting of a set of folk medical beliefs, rituals, and practices that
seem to address the psychological, spiritual, and social needs of
additional... people. It is a complex system of folk medicine with its own
theoretical, diagnostic, and therapeutic aspects. Curanderismo is
conceptually holistic in nature, no separation is made between the mind
and the body, as in western medicine and psychology. Curanderismo,
simply is the art of Hispanic healing (Peronne, et. al., 1988, p. 86).
Other scholars define, "a curandero as an individual who is recognized in his
community as having the ability to heal, and who has knowledge of and utilizes the
26


theoretical structure of curanderismo" (Trotter and Chavira, 1980 p. 429). Still others
describe the curandero/a as having a gift (don) that has been mentioned by other
researcher findings (Romano, 1960, 1965). It is also consistent with the belief that
curanderos/as have this special gift because it has been bestowed upon them by God.
Hockmeyer (1990) defines curanderismo as a comprehensive system for
classification of illness with highly developed notions of disease causation. Etiology
is generally described with respect to natural and a supernatural cause brought on by
forces, especially at a supernatural level, that no one has control over. Illness is seen
as a symptom or a set of symptoms, of social, psychological, and/or spiritual
imbalance and must be treated according to whether the source of an imbalance
diagnostically is naturally or supematurally caused. Curanderismo utilizes prayers,
rituals, symbolic and magical acts, herbs and massage for healing purposes.
Noted research E. Fuller Torrey separates curanderismo into a set of specific
role categories. The advina is classified as a diagnostician but does not treat any
diseases. The albolaria is a herbalist, utilizing natural medicine as a form of healing.
The medica relies on magica (magic) for treatment, combining herbs and ritualistic
spiritualism in treatment techniques (Torrey, 1986, p. 135).
In Medicine Women, Curanderas, and Women Doctors, James Jaramillo,
(1988) defines curanderas/os in a variety of topologies, "all of whom take their names
from curandera, a generic designation akin to a physician, who can also be a
specialist, e.g., surgeon, psychiatrist, or ophthalmologist." According to Jaramillo:
27


a 'curandera total,' holds the highest position on the hierarchical ladder
of healing (Perrone, 1988, p. 89-90).
This concept includes various sub specialties: herbs, midwifery, massage, and
spiritual techniques. Researcher Margaret Clark states that folk curers are not
professionals from a contemporary perspective in that they do not have formal
training in the art of medicine or make a living by this particular practice. They are,
however, persons in the community who are "regarded as specialists because they
have learned more of the popular medical lore of their culture than have other barrio
people (Clark, 1973, p. 207).
Dr. Aileen Lucero defines this phenomenon as a "holistic approach to
physical, psychosocial, and spiritual conditions used... by contemporary Chicanos
despite the predominance of'modem' medical science." From a pragmatic approach,
Lucero argues that as long as curanderismo works, it will continue to be used
(Lucero, 1981, p. 1).
History of Curanderismo
Curanderismo has been described as a reconciliation between Aztec medicinal
beliefs and European medical theories of the 16th and 17th centuries (Montellano,
1986). It has been argued that the Aztec system of beliefs influenced the European
model of medicine. Comas (1954) introduces the concept of reverse acculturation,
28


wherein New World physicians trained in the classical European theory began to
adopt the New World remedies into their pharmacopoeia.
Ari Kiev argues that curanderismo is a folk medicine with a combination of
New and Old World beliefs (Kiev, 1968 p. 148). Described as the interactive
historical processes and blending of healing practices used by the Spanish and Indian,
it is now imbedded with some Western scientific knowledge. Historically, the
philosophy of curanderismo is taken from classical Greek and Roman theories and
practices, mingled with indigenous Indian scientific concepts and rituals of
Indian/Mexican people. It is surrounded by many Catholic beliefs that have
influenced this population for centuries.
Forms of curanderismo existed in Indian civilizations and were blended when
the Spanish and Mexican pioneers arrived. It was transported and later synthesized
by conquistadors, Franciscan friars, and women healers, referred to as curanderas,
who traveled with the vast caravans who had come to settle the New World, on behalf
of the benevolent dictators of Europe (Perrone, et. al 1989).
These women healers were "the repository of ancient folk-healing knowledge
and seemed to know exactly how to treat complicated afflictions by using a variety of
herbs and healing plants that they possessed (Perrone, et. al., 1989, p. 88). It is
written that with adjunctive leaming/teaching from the indigenous healers, the
curanderas enhanced their knowledge related to the different plants that they
29


encountered in the new world and subsequently combined them with what they knew
to form a branch of medicine and healing that has persisted over time (Ibid, 1989).
From a more contemporary perspective, Trotter and Chavira (1981) have
identified at least six major influences on the use of curanderismo. These include
early Arabic medicine and health practices, Judeo-Christian religious beliefs,
symbols, and rituals. During later developmental processes medieval and later
European witchcraft were added. Native American herbal lore and health practices
modem beliefs about spiritualism and psychic phenomena and scientific medicine are
also considered part of the influences (Trotter & Chavira, 1981).
The practice of curanderismo is sanctioned by the work the curandero/a
performs in the community contrasted with western medical practitioners who get
permission to practice medicine via formal institutions. Trotter and Chavira (1981)
present a tri level structure in curanderismo including the material, the spiritual, and
the mental. However, not all curanderos/as practice at all three levels. The material
level is the most commonly used, work at the mental level, argue the authors, is
highly unusual.
According to some research projects, there is a growing level of spiritualism
among Mexican-Americans in South Texas via los mediums, who heal through
contact with the spirit world achieved through dreams or trance. Training and
development, or desarollo enhances the gift, in order to leam to achieve and control
trance states. Finkler (1984, 1985) has extensively documented work accomplished
30


by trance mediums and the temple life in Mexico, which in turn, seems to have
influenced the Rio Grande Valley. Finkler further presents evidence that many of the
south Texas mediums were actually trained in temples in Mexico.
Epistemological Foundations of Curanderismo
One theory of cultural illness that has been researched (Kiev, 1968; Madsen,
1964a; Toney, 1986; Trotter & Chavira, 1981) sees illness as a result of an
imbalance. Many curanderos/as believe that in order for health to be maintained,
there must be a balance between hot and cold qualities. An example of this metaphor
would be the intake of hot and cold food simultaneously. Additionally, excessive
emotional turmoil imbalances the humors in the body and causes illness (Madsen,
1964).
The hot and cold theory of disease is derived from the Hippocratic theory of
pathology, which postulated,
that the human body in a state of health contained balanced quantities of
the four "humors" (phlegm, blood, black bile, and yellow bile). A
disproportion of hot and cold essences was reflected in illness (Clark,
1973, p. 164).
This knowledge base of medicine was brought to the New World by sixteenth
century Spanish explorers and colonists and shared with the natives of the time
(Clark, 1973). It now exists as a current theoretical framework of many
curanderos/as.
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In utilizing curanderismo as a mental health healing perspective, spirituality
plays an integral role in the healing process of a curandera's client. In her research
with Diana Velazquez, Lucero quotes la curandera as stating that:
A frail spirituality paves the way to further breakdown, emotionally, and
physically. A healthy spirituality, in essence, can cultivate a more
balanced well being which creates a greater resilience to every day
stresses and changes in life. On the other hand, a break in harmony,
particularly in spirituality, fosters an inability to cope with problems of
life changes; therefore, an imbalance and susceptibility to illness occurs
(Lucero 1981, p. 19).
Mexican-American Beliefs about Illness and Health
It is important to note that imbedded in the notion of culture is a set of beliefs
that provide security, structure, balance, harmony, and certainty for individuals who
exist within that particular cultural framework. Therefore, it is important to
understand Mexican-American perspectives on illness and health. Frank (1961, p.
49) argued that traditional illness and its healing process lie within the culturistic
assumptive world, emphatically states that disease and illness are matters of
cultural prescriptions. Saunders (1959, p. 142).
Lucero (1981) contends that curanderismo is a culturally based phenomenon.
In her estimation it possesses its own set of beliefs and curative practices that reflects
the social and psychological conditions and problems unique to Chicanos. She
further argues that as long as curanderismo offers an alternative to modem
medical/psychiatric practices, it will remain in tact.
32


Clark (1959), in early ethnographies of Mexican-Americans, found that
generally members of this group engage in self treatment and/or are treated by
families and friends. Generally, curanderas/os are called in as protagonists only after
interventions have failed and the illness is seen as needing a specialist.
Madsen (1964a, 1964b) and Rubel (1966) used qualitative research methods
of participant observation and biographical studies of selected informants in the Rio
Grande Valle of Hidalgo County, Texas. Rubel views the stratification system of the
Mexican-American family as an important variable in understanding the family
structure and mental imbalance. According to Rubel, authority flows from the top of
the hierarchy to the bottom, with increasingly amounts of responsibility placed on
each individual depending on their particular place in the hierarchy. This, in turn, can
lead to mental frustration and problems.
Madsen (1964a) views the family in a similar fashion. The importance of the
family is central to the existence of the Mexican-American. Family allegiance,
loyalty, and obligation are primary values adhered to in this system. To step outside
of these prescribed boundaries is considered disloyalty. Madsen further argues that
Mexican-Americans are not overly materialistic, placing spiritual values over material
ones. Mexican-American youth are susceptible to the notion of cultural conflict
because of these often conflicting value expectations. Curanderismo is seen as
"providing a mechanism to avoid or relieve situations involving a conflict between
Mexican and American values" (Ibid, p. 433).
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Religious Influences
In Curanderismo: Mexican-American Folk Psychiatry Kiev (1968) places
emphasis on issues of disease and illness into a religious context. He argues that the
Roman Catholic Church has taught Mexican-Americans that suffering is an inevitable
part of life. Suffering is viewed as an integral part of life and is seen as a universal;
therefore,
another's suffering becomes symbolically ones own: thus, it is the
concern of the family and the entire community when an individual is
sick. Illness is not a 'castigo de dios,' (punishment from God), but a
blessing (Kiev, 1968, p. 34)
Kiev's view is that,
Culture determines the specific ways in which individuals perceive and
conceive of the environment and strongly influences the forms of
conflicts, behavior, and psychopathology that occur in members of the
culture. Social and cultural phenomena influences disorders which in
turn have a significant effect on the social system (Ibid, 1972, p. 4).
Trotter and Chavira (1980), make reference to a list of cultural illnesses that
require a curandera/os attention: susto (magical fright), empacho (stomachaches),
mal de ojo (evil eye), caida de mollera (fallen fontel), bilis (excessive bile), and
espanto (excessive fright). Both researchers argue that curanderismo has been treated
as a mass cultural phenomenon; therefore, making any discussion atheoretical.
Within the context of this same article, the authors argue that classification of these
illnesses is essential in order to begin a process of classifying these phenomena by
treating the phenomena as a system, and emphasizing the linkages between the
34


treatments and diagnoses made by specialists or curanderos (Trotter & Chavira,
1980).
The supernatural forces that are recognized are only treatable by a
curandero/a. According to Trotter and Chavira (1980), curanderos/as realize that the
scientific medical system do not recognize the existence of magic or of supernatural
causation when dealing with psychological issues. A person can feel embrujado
(hexed, bewitched) but this spiritual psychological malady goes untreated by
mainstream traditional American psychiatry. Curanderos/as acknowledge these folk
illnesses and treat them accordingly.
The Role of the Curandero/a
Lucero translates the Spanish term curandera into a healer or curer, which
stems from the Spanish verb curar, to cure. As a general practitioner, who has the gift
(don or dona), (this should not be confused with the Spanish title given to nobility),
the role of the curandera/o is to assist the patients in the healing processes who suffer
from a variety of physical and psychological maladies (Lucero, 1981).
There are a variety of specialists of healers that include: sobador (massager
and people who treat sprains and strained muscles), yerbero (herbalist), medica (a
medical healer), partera (midwife), and bruja (witch). Senoras are known for their
abilities to intervene in mild ailments. As well, curanderas/os are known for their
work in manipulating the supernatural and physical world.
35


Romano (1965) presents evidence that there is hierarchy within the structure
of healers. Trotter and Chavira's (1975) research indicates that there are overlaps and
specialization as well as regional differences, which essentially translate into respect
for healing abilities within specific communities. In either case, stratification
according to healing abilities exists. This lays the foundation for respect among
healers who possess varying degrees and knowledge of culturally relevant healing
methods.
Studies have shown that the majority of curanderas/os are highly religious
people (Alegria et. al, 1977; Clark, 1970; Kiev, 1968; Madsen, 1964a; Torrey, 1972).
The aforementioned authors present evidence that the majority of healers come from
a strict Catholic background.
Curanderas/os usually practice a culturally specific form of family therapy.
They are always in consultation with family members in order to establish diagnosis
and healing techniques that will be used. At times, the rituals asked of the patients
include various members of the nuclear and extended family as participants,
depending on the malady being treated (Clark, 1970; Kiev, 1972; Madsen, 1964b;
Saunders, 1954; Torrey, 1972).
Curanderas/os believe they have acquired a "divine power from God," that
allows them to be used as instruments of healing. Others believe that "this divine
power comes from a vision, a calling, or a dream" (Lucero, 1987, p. 6).
36


In the final analysis, the curandero/a performs the functional role as "balancer
or restorer to homeostasis" (Scrimshaw and Burleigh, 1978, p. 36). Through various
maladies causing an imbalance, the curandera/o performs rituals, prayers,
incantations, and an assortment of culturally specific remedies that assists the client in
becoming whole and balanced again.
Life Histories
There are qualitative researchers who have used topical life histories and in
depth interviewing, as primary methods of obtaining information that are well
documented and whose central theme was curanderismo. The following is a brief
account of this method of research and the findings.
Estrada, in Maria Sabina: Her Life and Chants more specifically writes about
Maria Sabina's childhood, as she encounters, the saint children (the sacred
mushrooms) and documents the passages of revelations in her account of this
curandera. Trotter and Chavira believe that Maria Sabina, who makes contact with
the spirit world through the ingestion of magic mushrooms (psilocybin), was
impacted by curanderismo (Estrada, 1981).
Bliss, in La Partera: Story of a Midwife, describes Jesusita Aragon as a
woman and one of the last traditional midwives practicing this in the area around Las
Vegas, New Mexico. The book offers an interesting story on the perceived
37


encroachment of Anglos by New Mexicans as they strive to hang onto their cultural
practices (Bliss, 1980).
Another interesting life history is that of Jewel Babbs. P. Taylor, in Border
Healing Woman: The Story of Jewel Babbs, describes an Anglo woman who grew
up on the Texas-Mexico border and was greatly influenced by Latino culture and
beliefs. Her activities include herbal remedies learned from Latino neighbors and it is
also documented that she practiced a form of psychic healing that bears resemblance
to the mental healing that Trotter and Chavira (1980, 1981) describe.
B. Jordan (1980) in, Birth of Four Cultures, a cross-cultural study of childbirth
in Yucatan, Holland, Sweden, and the United States, the author discusses the travels
of Dona Juana, a Yucatan partera. The experiences documented indicate that forms
of curanderismo are certainly widely used in Latin American countries.
Lucero, in a research project funded by the National Institute of Mental
Health, writes about Diana Velazquez, a curandera who practices both psychotherapy
and curanderismo in Denver, Colorado. This ethnography describes the blending of
western psychiatric practices and curanderismo (Lucero, 1981).
Hockmeyer, in The Social Construction of a Curandera: A Model Bicultural
Adaptation, a research project also investigating the life of Diana Velazquez,
emphasized two areas of inquiry in her research. She investigated the personal and
institutional factors that characterized Velazquez's ability to function effectively as a
healer in a mental health setting. She also investigated the cultural changes and
38


adaptations that have occurred in the practice of curanderismo as a result of shifting
from a traditional setting to a modem clinical setting. Lastly, this author investigated
the current role of females healers in Mexican-American culture and has worked with
Diana Velazquez (Hockmeyer, 1990).
Organizational Innovation and Change: Implementing
Innovation in organizations.
The following literature review on organizational innovation is intended to
introduce the reader to the theoretical lenses that will be used to analyze the data in
this research project. Evans defines innovation as "deliberate efforts at modifying the
organization" (Evans, 1993, p. 113). Becker and Whisler, (1967) define innovation as
use of an idea by an organization. A more used definition offered by Aiken and Hage
(1979/) states that innovation is "the first use of an idea within an organization,
whether or not the idea has been adopted by other organizations already" (Aiken and
Hage, 1979, p. 6).
Rogers (1983) states that,
an innovation is an idea, practice, or object that is perceived as new by an
individual or unit of adoption. It matters little, so far as human behavior
is concerned, whether or not an idea is 'objectively' new as measured by
the lapse of time since its first use or discovery. The perceived newness
of the idea for the individual determines his or her reaction to it If the
idea seems new to the individual, it is an innovation (Rogers, 1983, p.
11).
39


Smale (1995) draws a distinction between innovation and change. In his
view, both require a level of management. "Managing innovations applies to
introducing specific new practices, methods of work or pieces of technology" (Smale,
1995, p. 28). Further, he argues that managing change appears to be a wider concept.
It implies that there may be a restructuring process within an organization due to a
change in policy, climate, or changes in the goals or mission of an organization. At
times, it is a change in personnel, for example the Executive Director.
There are general macro and micro views of change and innovation in the
world that we live in. Ogbum (1922) in general characterizes one of the effects of
innovation and change within a society as cultural lag. This theory asserts that
"technology (material culture) advances at a more rapid rate than other social
institutions (nonmaterial culture)" (Ogbum, 1922, p. 200). However, its utility has
been criticized because of the difficulty of measuring the rate of organizational
technological change to the rate of a non-technological change.
Another theory termed organizational lag, introduced by (Evan, 1993), argues
that the concept of organizational lag does not have to have the same fate as cultural
lag because the unit of analysis is smaller, namely an organization. When
organizations are faced with change or innovation disorganization can ensue. This
can have adverse effects on the performance of the organization. Smale (1990)
argues that the real challenge is finding ways to manage the innovation. In his view,
40


the effects of innovation and change are often blamed on personalities, organizational
dynamics or some other phenomena.
Daft (1978) states that there are at least two types of innovations that occur
within an organization, technical and administrative. Daft (1978) postulates that;
A technical innovation tends to originate in the technical core and
include ideas for a new product, process, or service. Administrative
innovations, on the other hand, originate in the organization's
administration and pertain to specific policies of recruitment, resource
allocation, and the structuring of tasks, authority and rewards,
innovations in the technical core are apt to be enhanced by low
formalization, by decentralization and by a distribution of power that
allow the professional employees to handle the innovation.
Consequently, they are handled by loose coupling of the technical and
administrative cores. On the other hand, administrative innovations are
best served by high formalization, centralization and rather tight
structures. Of course, administrative innovations often affect the
technical core as well; therefore, coupling of the two is required (Daft,
1978, p.,12).
When organizational changes are not planned with respect to the effect on
other elements in an organization, an imbalance occurs. This imbalance can result in
production, morale or general organizational chaos. Employees of an organization
may adapt or respond to organizational innovation in a variety of ways. Evan (1967)
argues that employees may become apathetic in an attempt to sabotage the innovation
in order to maintain the status quo.
Innovation presents itself with a set of problems brought about by both
organizational and psychological responses to the change within the organization.
The real issue is not the person who works in the organization but how the manager
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chooses to manage change and innovation as it is taking place. Smale (1992)
describes a series of common fallacies that provide insight into organizational
dynamics.
Smale (1995) describes the cascade fallacy, one method of how transferring
new ideas and policies to organizations take place. Top managers are introduced to
new ideas. Through a process referred to as the trickle-down effect, the process of
diffusing the new ideas begins from the top. According to this well known English
organizational analyst;
The cascade model is an orthodox view of the diffusion of a new policy,
research findings or new methods of practice to organizations. It is
consistent with a pyramidal organization and the assumption that
innovation and change does, or should, emanate from the apex. Like the
research and development model, it relies on passive recipients (Smale,
1995, p. 5)
Evan (1995) discusses the trickie-up theory, wherein the diffusion of change
and/or information can be spread throughout an organization, beginning from the
bottom up. He argues that in order to minimize organizational lag, "the trickle effect
with respect to both administrative and technical innovation would probably have to
operate in both directions" (Evan, 1995, p. 117).
Another fallacy cited by Smale (1992) is the anthropomorphic fallacy.
According to Smales description of this phenomenon, peoples actions/s make things
happen in organizations. The changes do not occur by themselves.
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The natural selection fallacy, refers to the notion that the best innovations
survive the onslaught of organizational politics while those that are less successful,
fall by the wayside. Smale (1995) suggests that:
It is clear that it is not the change itself the innovation, that is resisted but
the way that it is being introduced. When the action researchers work
with the managers to change their behavior when introducing new ways
of working, the resistance largely disappears. Of course the innovation
in management behavior has to be the right one (Smale, 1995, p. 9).
Smale (1992) defines the Trojan Horse fallacy, as the belief that innovations
are best introduced into agency structures through pilot projects. Further analysis of
this fallacy is that good elements of the project's experience will somehow be
sustained, perhaps naturally and eventually adopted. The bad ones will fall by the
wayside and become unuseful. He argues that special projects can cause considerable
resentment from others within the organization. In his estimation, the main cause of
the resentment emanates from either the allocation of extra resources or a release
from statutory duties (Smale, 1995).
During the time period that the pilot projects are introduced, a degree of
sabotage can occur as other employees, opposed to the innovation, can begin the
process of building counter arguments; therefore, setting it up for failure.
Smale (1995) has also conceptualized the charismatic individual's fallacy,
which argues that credit for heroines or heroes cause innovation. He quotes Sigmund
Freud (1970) in describing Civilization and its Discontents. Freud (1970) suggested
that charisma is not a personal attribute of a subject but rather a shared characteristic
43


of the beholders. The reverse corollary of this fallacy is that there are villains, driven
by self-interest, which will obstruct the implementation of this idea. Smale believes
that:
managers should distinguish between those who are resistant to the
actual innovation that is being introduced, those whose persistent actions
make the new way of working impossible, and those people who are
resisting the way that changes are being introduced (Smale, 1995, p. 14).
The implementation of innovation presents an array of problems that can
affect performance factors within an organization. Once the idea has been presented,
preliminarily approved and ready to be put into action, managers must be able to
strategically implement the idea. Organizations, in turn, respond to its
implementation in a variety of ways. There are other considerations that a manager
should take into account when implementing innovation. According to Nord and
Tucker (1987);
Organizations can vary in so many ways that a myriad of organizational
characteristics could potentially affect implementation...a number of
aspects of the organization as a whole were critical. Structure, history,
strategy, size, culture, the ability of the organization to learn, and the
nature of a firm's relationships with its environment were especially
important (Nord and Tucker, 1987, p. 13).
The structure of the organization is one of the critical variables that needs to
be understood when the time for implementation occurs. Bums and Stalker (1961), in
their treatment of innovation, draw a distinction between organic and mechanistic
structures. These two researchers;
view mechanistic organizations as classic bureaucracies. In these
organizations work tends to be divided into many subtasks, individuals
44


who perform the subtasks are unlikely to see the relevance of their work
for the whole task...the duties and powers of each person's role are
defined in precise terms. Hierarchical relationships are stressed
communication lines are vertical and people's work is controlled by
decisions and directives of their superiors. Organic systems are different
on every one of these dimensions. Although organic structures are
hierarchical, hierarchy plays a less important role in direction and
control..Moreover, top-level managers are not assumed to be
omniscient; and formal definitions of approaches, duties and power are
less important in defining what people do than are ongoing interactions
among individuals working on ask (Bums and Stalker, 1961, p. 14).
The literature regarding which structure accepts and/or responds the best
during organizational change presents opposing views. Those organizational analysts
who operate out of the organizational change tradition,
assume that organic structures, including participative processes and
free-flowing communication, are the most conducive to implementation.
Those working out of the innovation tradition assume that mechanistic
structures are the best for effective implementation (Nord and Tucker,
1987, p. 17).
Those who subscribe to innovation through organic processes seem to be
interested in how to motivate individuals to accept change. They argue that reducing
resistance to change is important. This ultimately leads to buy-in and ownership of
the change. Participation seems to be a useful tool in accomplishing this task (Nadler,
1983).
Those who favor the organizational change tradition, favor the mechanistic
processes. Duncan (1976), argues that mechanistic structures will be implemented
best when change centers on issues rather than motivation. In further analysis, this
author argues that low complexity reduces the chances of conflict. Formalization
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procedures reduce ambiguity while at the same time provide clear guidance for
administrators.
Organizational Cultures
Another contributing factor in implementing innovation into an organization
is organizational culture. Nord and Tucker (1987), offer insight into the role that
organizational cultures play in change and innovation. They believe that there are
certain elements in an organization's culture that may contribute positively to change.
It is through culture that individuals gain a sense of "shared meanings, goals and
commitments, making it possible for focused efforts to occur at times when novelty
and uncertainty involved in innovation precludes formal procedures or even
moderately firm guidelines (Nord and Tucker, 1987, p. 31).
The ability of an organization to learn is also important. Members of an
organization, at this point in the process, begin to understand more concrete
relationships between their actions and their outcomes (Duncan and Weiss, 1979).
This factor needs to be analyzed when innovation and change occur within an
organization. Although there is a dearth of literature in this area, the organization's
members ability to develop social and technical competence seems to be a vital part
of organizational change.
46


Centralization vs. Decentralization
The concept of centralization has become a part of organizational life. It is
defined "as the degree of concentration of power and decision-making, regardless of
where in the hierarchy the concentration occurs (Mintzberg, 1979, p. 19). Other
organizational theorists point out two important dimensions of centralization, the
locus of authority and the process of making decisions in an organisation There are
two general principles that coincide with this viewpoint. First, the higher in the
hierarchy the decisions are made, the greater propensity for centralization will be.
Second, the less the participation in decision making, the greater propensity of
centralization will be (Zaltman, Duncan, Holbeck 1973).
Studies conducted looking at the relationship between the degree of
centralization and the actual implementation of innovation are sparse. Corwin (1969)
and Gamson (1966) report that participation by organizational members could
increase the expression of conflict. They also argue that participation could facilitate
change under some conditions. Two additional studies reported evidence that there is
particular elements that aid implementation. In another research project, Greenwood,
Mann and McLaughlin (1975) present some successes relative to implementation of
decentralization wherein there was change in behavior.
47


Relations with the Environment
Relations with the environment are of critical importance in analyzing change
and innovation in organizations. Tomatsky et al (1983), argues that innovation is an
interorganizational process, implying that an organization must be familiar with the
external stimuli outside of its boundaries. There are other critical questions about
how organizations transcend their boundaries in order to find information about
innovation. Boundary spanning has been cited as a useful contribution to
understanding innovation in organizations. Adams (1980) states that boundary
spanning encompasses;
those activities of members or agents of an organization that serve to
functionally relate the organization to its environment. These activities
include acquisition of inputs, disposal of outputs, filtering inputs and
outputs, information search and collection, representation off the
organization, and protecting and buffering the organization of the threat
(Adams, 1980, p. 328).
Guided by individual boundary spanners perceptions, the organization relies
on these individuals to screen and interpret information that is relevant to the
functionality of the organization. Boundary spanners also provide linkages to the
organization that can be useful to the organization's successes. The establishment of
relationships with people outside of the organization is important. However, there
needs to be clear cut and established criteria forjudging the value of the information
brought into the organization.
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Interpersonal Processes in Implementation
While the characteristics of an organization can explain many of the issues
involved with implementing innovation, the human element cannot be left out of the
formula. The relationships between and among people internal and external to the
organization plays a functional role in implementing innovation. It has been assumed
that involvement in a process leads to actual buy-in from employees.
The way change is introduced, not just the substance of the change, is
viewed as critical to the success of the change because the process itself
affects motivation, perception, and learning of those involved (Nord and
Tucker, 1987, p. 34).
There are opposing views to this notion. Locke and Schweiger (1979)
concluded that participation can have positive effects on both productivity and
satisfaction. However, they also argue that participation does not always lead to the
best decision being made. Nadler (1983) has divided the requirements for
organizational change into three parts. The three factors that contributed most to
organizational change were how managers motivated change, managed the transition,
and shaped the political dynamics for the change. The innovation literature has made
contributions in this area. Berman and McLaughlin (1978), Yin, Heald, and Vogel
(1977) and Gross et. al (1971) concluded that participation, especially by those who
were closely affected by the change, led to positive and successful implementation.
f
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Managing Change Through Innovation
Smale (1995) has introduced a model of managing change through innovation.
According to Smale, "the management of innovations is a way of approaching the
management of change (Smale, 1995 p. 28). It requires the breaking down of a
change of policy into its component parts. Viewed as an intellectual discourse, Smale
states;
the process of managing change involves differentiating between the
complex, interrelated elements concerned and making connections
between people and the different changes taking place (Smale, 1995,
p. 29).
Change in organizations breeds its resistors, particularly those who may be
reaping the benefits of current organizational arrangements in some form or another.
One should not assume that all change is good. Some changes have proven to be
disastrous in organizations (Smale, 1995, p. 32). One of the functions of the change
through innovation model is to manage these processes. This may reduce the harm
"that unplanned, uncontrolled, or mindless innovation can cause through unintended
consequences such as the unrestricted introduction of new ways of burning fossil
fuels (Smale, 1995, p. 33).
Perhaps one method of dealing with unintended consequences when change is
introduced is to change the way that change is introduced. A level of pain or
discomfort may follow organizational change; therefore, managers need to be able to
respond to the change in an organization. Smale (1995) suggests that organizational
50


innovation and change should be judged by their impact on those who they are
intended to serve. Whether they happen or not seems to be irrelevant. Smale (1995)
also suggests that managers who meet resistance to change might want to think of it
as a challenge to his/her management style.
Change Agents
Those interested in developing and promoting innovations have been referred
to as change agents or transactors. This term has a long history in the literature on
change and innovation and is typically
used as a generic term to apply to those people who consciously seek to
introduce planned change into social situations (Bennis and others,
1985), either through a professional role such as management consultant,
organisation developer, psychotherapist, or because of the particular way
they approach their formal organizational role as a manager (Smale,
1988, p. 37).
Not all personnel within an organization will see the status quo as a problem.
There may be those who see innovation as the problem. Innovative methods can be
useful tools in handling this change. Handy (1981) argues that persons who desire
change should seek change or innovation through awareness. In his estimation, it
should not proceed along the lines of argumentation or rationality but by exposure to
objective fact. Domoney (1992), argues those processes of change and innovation are
unpredictable. As Smale eloquently states;
to introduce "solutions" to people whom do not perceive themselves as
having a problem will not unreasonably be seen as imposing a gratuitous
51


burden, or at least an inconvenient interruption in their work. To
introduce a solution that is not seen as related to the problem as the
people define it themselves, is reasonably seen as an irrelevance. To
introduce a solution without people being able to see how it will solve
the problem is to seek faith in the innovation and/or the innovator
(Smale, 1995, p. 38)
The Diffusion of Innovation
A literature review by (Rogers, 1983, Rogers and Kincaid, 1981) drew the
following conclusions following an examination of3,085 diffusion studies. The five
most significant attributes that affect the speeds of innovation adoption are:
Relative Advantage: the degree to which an innovation is perceived by
the potential adopters as better than the idea it supersedes;
Compatibility: the degree to which an innovation is perceived as
consistent with the existing values, past experiences and needs of the
potential adopters;
Complexity: the degree to which an innovation is perceived as relatively
difficult to understand and use;
Trialability: the degree to which an innovation may be experimented
with on a limited basis;
Observability: the degree to which the results of an innovation are visible
to others (In Smale, 1995, p. 39).
Stocking (1985), in her research concluded that there were important features
that would need to be present when the diffusion of innovation wold occur. The
more salient points included the existence of identifiable enthusiasts and the appeal of
the innovation. She also stated that the innovation should not require major role or
52


attitude changes. Lastly, she indicates that adaptability and the requirements of little
resources are critical (Stocking, 1985).
Some organizational theorists argue that there are orders of change when
introducing innovation into an organization. Nord and Tucker (1987), discuss routine
contrasted to radical change. Beckhard and Pritchard draw a distinction between
incremental and fundamental change. Angle and Van De Ven (1989) use the terms
incremental and radical innovations. This has led some organizational theorists to
classify change either in the First Order or the Second Order.
First Order change is change within a given system, its rules and existing
patterns of relationships. Second Order change is when the nature of the
system changes, through a change in the rules, a change in the
relationships between people (Smale, 1995, p. 44).
In conclusion, the introduction of innovation into an organization should be
approached with a well-thought effort in order to deal with the organizational
dynamics that will follow.
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CHAPTER 3
METHODOLOGY
RESEARCH QUESTION: What management strategies are effective when
introducing curanderismo into a mainstream mental health system?
Introduction and Research Design
This study utilizes a type of qualitative research referred to as life history.
Qualitative research uses methods that can uncover the nature of a persons
experiences.. .and understand what lies behind any phenomenon about which little is
yet known (Strauss and Corbin, 1990, p. 23). The utility of the qualitative approach
is supported by a number of other researchers such as Reissman (1994), Lock,
Spirduso and Silverman (1993) and Strauss and Corbin (1990).
Those authors argue that the qualitative approach lends itself to an in-depth
understanding of the phenomenon under study based on the perceptions and
experiences of the actors involved (Locke, Spirduso and Silverman, 1993, p. 99)
In comparison to the quantitative approach that seeks to analyze aggregated
data, once it is collected, the qualitative approach vigorously attempts to understand,
interpret, and report the variations in responses that unfold as the phenomenon is
being studied (Emerson, 1983; Strauss and Corbin, 1990).
54


Contrasted to a quantitative approach, qualitative research can explore the
intricate details of a phenomenon/a that can be difficult to uncover using the
quantitative methods (Strauss and Corbin, 1990, p. 19). There are a number of
principles that exist within the field of qualitative research that add validity to this
approach. One principle is referred to as the grounded or emergent theory
collaboratively developed by Barney Glaser and Anselm Strauss. Within their
theoretical framework, these authors argue that grounded theorys methods are;
systematic techniques and procedures of analysis that enable the
researcher to develop substantive theory that meets the criteria for doing
good science: significance, theory-observation compatibility,
generalizability, reproducibility, precision, rigor and verification (Strauss
and Corbin, 1990, p. 31).
Grounded theory is further guided by the principle that theory should emerge
from an inductive approach. According to Strauss and Corbin grounded theory is
inductively derived from its study. Additionally, it is developed and provisionally
verified through systematic data collection, followed by an analysis (Strauss and
Corbin, 1990).
Within the design of this study and its subsequent data analysis, grounded
theory will be used. This inductive approach is consistent with a valid method of
theory building. One of the goals of grounded theory is to develop a theory as the
process unfolds. Its focus aims at extrapolating a variety of relevant theoretical
categories that can be further examined at a later time.
I
i
I
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Comparative analysis is a tool that will be used to analyze and explain the
phenomenon under scrutiny. Grounded theory is often referred to in the literature as
the constant comparison method of analysis (Glaser and Strauss, 1967, pp. 101-116).
Comparative analysis uses the logic of comparison to analyze empirical date once it
has been generated. In turn, this generates theoretical categories that guide the study
in discovering meaning gathered from the data. The use of comparisons assists the
researcher in breaking through the assumptions and also to uncover specific
dimensions of the data (Glaser and Strauss, 1967). Strauss and Corbin (1990) argue
that in order for the researcher to make the aforementioned comparisons that he or she
must draw upon personal knowledge, professional knowledge and the technical
literature (Strauss and Corbin, 1990, p. 84).
As previously mentioned, this study will utilize a method referred to as the
topical life history. The research is exploratory in nature; therefore, no hypothesis
testing will be conducted. This is consistent with the grounded theory approach.
Research Design
The major thrust of this research, utilizing the topical life history approach,
will be to uncover form the perspectives of the interviewees those salient
management strategies that led to the success of curanderismo in a publicly funded
mental health center. The topical life histories approach "shares all of the features of
the complete form (life history) except that only one phase is emphasized" (Denzin,
56


1970, p. 222). In particular, the subjects management experiences will be
emphasized. To the extent that other parts of the subjects life has influenced his or
her management style, this researcher will delve further into that area of the subjects
life.
John Dollard, an expert on the life history approach to research, presents
evidence that life histories can be used to define historical personalities and their
subsequent meaning in a society. In order to understand that particular persons point
of view, life histories provide researchers with cultural nuances, experiences, and
traditions that may have been left out by the usage of other research methodologies
(Dollard, 1949).
Dollard further suggests that in order to obtain a successful life history, the
following specific elements must be present.
1. The subject must be viewed as a specimen in a cultural series.
2. The organic motors of action ascribed must be socially relevant.
3. The peculiar role of the family group in transmitting the culture must
be recognized.
4. The specific method of elaboration of organic materials into social
fabric must be shown.
5. The continuous related character of experience from childhood
through adulthood must be stressed.
6. The "social situation," must be carefully and continuously specified
as a factor.
7. The life history material itself must be organized and conceptualized
(Dollard, 1949).
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Mandelbaum, who argues that life histories emphasize the particular behaviors
of an individual as shaped by their individual cultural experiences, further supports
this (Mandelbaum, in Marshall and Rossman, 1989, p. 96). Lieblich and Josselson
(1997) present evidence that, through time, researchers began to see life-story
narrating as an everyday life phenomenon that obviously serves certain functions
(Lieblich and Josselson, 1997, p. 6).
These authors introduce the concept of face, or the expectation that a person
should be self-consistent, when reporting about his or her self to others. If the
consistency principle is applied, this means, that the characteristics by which the
storytellers describe themselves are consistent with the life events told in the story
(Lieblich and Josselson, 1997, p. 10).
The literature on the history research method is appropriate for the research
question posed by this dissertation. Attempting to reconstruct a persons life history
requires an approach that will allow the free flow of thought, supplemented by asking
a person to remember significant events that transformed their lives. In other words,
memory is key to this type of research. With this in mind, Halbwachs collective
memory and Youngs collected memory argue that the past is kept alive in social
groups. Although, the memory is individually based, the collective memory is
equally important (In Lieblich and Josselson, 1997).
Through the eyes of subjects interviewed the topical life history will be
utilized to tell the story as experienced by the subjects themselves. There has been a
58


resurgence of the life history approach. It has been characterized as knowledge that is
ideological. Beck and Micall assert that life histories have always been used.
Through this method, assumptions are examined and individuals seek out other
concepts to understand the complexities of social change (Beck and Micall, 1990, p.
46). This allows for a more thorough critique of the phenomenon under study. This,
in turn, can lead to further research in this area.
Norman Denzin assumes that in researching life histories, that human conduct
will be studied and understood from the perspective of the person/s involved. He
states, "clearly this is a case for taking the role of the acting other and actively sharing
in his/her experiences and perspectives" (Denzin, 1970, p. 220).
Schutz (1967), Blumer (1969), and Denzin (1978) argue that In the course of
daily life, people make sense of the world around them. They give meaning to it.
The function of the researcher is to document life information relating to the
perspectives elicited from the interviewee, with all of its associated meanings that are
integral parts of the individuals social relationships. Denzin argues that life
histories are viable because they allow for the interviewees to define their own
experiences (Denzin, 1970).
It is argued that the subjects definitions and interpretation takes precedence
over the perceived objective analysis. Thompson argues:
There may be, and is, doubt as to the objectivity and veracity of the
record, but even the highly subjective record has a value for behavior
study....Very often it is the wide discrepancy between the situation as it
59


seems to others and the situation as it seems to the individual that brings
about the overt behavior difficulty....If men define situations as real, they
are real in their consequences ( Thompson,1928, pp. 571-622).
There is always a question about the interviewing process. Micall and Wittner
argue that, too often, a common fallacy made by the traditional positivists in their
research is that social scientists have enough knowledge bout the phenomenon in
question to ask the right questions (Denzin, 1982). When this fallacy occurs,
questions of veracity arise.
Life histories allow for the individuals being interviewed, through self-
definition to tell their own stories. Cultural identity in relationship to life histories is
a significant factor within self-definition. With persons of color, it allows for the
cultural perspective to emerge. With respect to this point and the cultural relevance
of this research, particularly since several Latinos/as were interviewed, this became a
critical issue. Rosenthal (1997) in her research with multicultural women argues that
self-definition is important. In further analysis, she states that as social scientists, we
must be able to reconstruct the life histories of others. Without the history of the
individual it would be difficult to understand the meaning of their social acts
(Rosentha, 1997, p. 36).
In the final analysis, Becker (1972) notes that understanding comes from
viewing the world, as much as possible, from the eyes of the actor. Life histories
allow for this to occur. They help us understand the processes at work from the
subjects point of reference.
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Actual Research Conducted
This researcher conducted interviews with two separate but interrelated sets of
subjects. The interviews with the curanderas/os were employed because it was
necessary to lay the foundation for an understanding of curanderismo. As well, with
one of the interviewees who is practicing curandera and also an administrator, it was
important to see the dynamics of curandismo from someone who plays dual roles.
This added depth to the information that was collected.
The interviews with the administrators provided in depth exploration relative
to what types of management strategies were implemented from various levels of the
organization in order to make this program so successful.
Semi-structured interviews, using the topical life history as an approach, were
used with curanderas/os that were interviewed. The objectives were not just to
inform the reader about the relative efficacy of curanderismo as described by the
interviewees. In juxtaposition to this was the need to explain the inter and intra
organizational dynamics that occurred as this innovation was implemented. This
study was also exploring how curanderismo was accepted, both within the
organization where it was practiced and in the community.
Semi-structured interviews with three curanderos/as were conducted. The
interviews covered various aspects of each interviewees lives, particularly those
areas that specifically related to curanderismo. Two of the curanderos/as, who were
interviewed, at some time, were also in management positions within their
61


organizations. The interviews were based on their relative experience at the
management level of an organization, specifically where he or she had implemented
curanderismo as a mental health program.
The interviews were conducted in a location where the healers felt most
comfortable. This allowed for a free flow of information. I conducted one interview
with a curandero who practices outside of a formal mental health system. The
interviews lasted from 2 to 3 hours in length. Subjects agreed to follow up telephone
calls that were made following the interviews in order to clarify any additional
questions that might arise later.
Sample Selection
In a review of the literature on methodology and with respect to the nature of
this exploratory study, purposive sampling was the best choice for sampling purposes.
According to Strauss and Corbin (1990) since discovery is the aim of grounded
theory, data collection and its associated theoretical sampling must be structured to
allow this (Strauss and Corbin, 1990, p. 180).
The aforementioned researchers argue that purposive sampling is an excellent
method for use in the qualitative approaches to research. Purposive sampling provide
choices to the researcher. It allows the researcher an opportunity that might be absent
if other methods were chosen (Strauss and Corbin, 1990).
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For reasons noted above, purposive sampling was used in selecting the
participants, both curanderas/os and public administrators. The following were the
specific criteria used in selecting the sample group:
1. Individuals who have had either experiences in the practice of
curanderismo or direct management experience over curanderismo
programs in the field of mental health in publicly funded mental
health agencies in the State of Colorado will be selected.
2. Both curanderas and curanderos (male and female healers) will be
sought out for possible interviews.
3. Persons who will provide experiences and/or stories related to the
subject matter under study will be selected.
4. Since there are few potential subjects who have the experience for
this research project and based on the exploratory nature of the
subject area, this researcher may be guided to others who may know
about this phenomenon.
The curanderos/as who were selected for this project were selected because
each participant met one or more of the criteria stated above. Additionally, this
researcher followed university protocol with his human subjects. Each interviewee
was provided with a form, giving permission to be interviewed. Interviewees also
gave permission to use his or her specific name in the project. Interviews were taped
and transcribed. The following is a list of curanderas/os who were interviewed.
Diana VelazquezCurandera and Special Programs Director at Centro
de las Familias.
Mr. Ernesto AlvaradoPh.D Medicine Man/Curandero and past team
manager at Centro de las Familias.
Gloria CordovaCurandera and Private practitioner in the field of
mental health.
1
i
I
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The following questions were used to guide the process. In semi-structured
interviews, the researcher prepares a list of questions. Through this process, the doors
for more in-depth and follow up questioning are opened.
1. Would you please define curanderismo?
2. What important events in your life led you to believe that you were a
curandera/o?
3. Who were the significant persons in your life that guided you in your
journey to becoming a curandera/o?
4. When did you begin the practice of curanderismo?
5. What types of training have you had in the area of curanderismo?
6. What experiences relative to the actual application of curanderismo
can you share with me?
7. Where do you currently practice curanderismo?
8. What kinds of rituals do you practice and what are the spiritual
meanings and significance behind them?
9. What other information relative to curanderismo is important in
understanding this phenomenon?
10. If you have practiced curanderismo in a formal institution/agency
what management practices or methods are most useful in managing
such a program? What management practices are not useful?
The same methods that were described with the first set of interviews were
duplicated with the public administrators and managers that were interviewed. The
following is a list of person who were interviewed because of his or her experience in
the management of curanderismo in a publicly funded mental health setting.
64


Diana VelazquezDirector of Special Services at the Mental Health
Corporation of Denver.
Mr. Ernesto AlvaradoPast team leader of Centro de las Familias.
Jane GuiterrezPast team leader at Centro de las Familias.
Mr. Ron EicherPhD, Past Executive Director of Southwest Denver
Community Mental Health Center.
Mr. Ollie WolcottPsychiatrist at Centro de las Familias.
Mr. Paul PolakPast Executive Director of Southwest Denver
Community Mental Health Center.
The following questions were used as guideposts in the interviews that were
conducted with the mangers and/or administrators who had actual experience in the
implementation or management of curanderismo.
1. Please tell me about yourself and how you ended up in the field of
mental health.
2. What experiences have you had in managing curanderismo in a
publicly funded mental health setting?
3. What are some of the organizational barriers to implementing an
effective curanderismo program in a formal institutional setting?
4. What kinds of attitudes did you encounter, if any, from upper level
administrators, both from the funding body and your own
organization while this program was being implemented or while
you managed it?
5. What kinds of responses did you receive form the community, in
general, while implementing curanderismo/
6. What attitudes did you encounter with clinic team members when
you first introduced curanderismo as a mental health modality that
would be used in the clinic?
65


7. Did those attitudes change, and if so, what types of management
strategies did you implement to change those attitudes?
8. In your opinion, what are some sound management philosophies,
methods, and practices for administering or managing alternative
mental health programs like curanderismo in a traditional
organizational setting?
It is important to note that there are very few curanderos/as who practice this
form of healing openly. The curanderos/as who were selected have also had some
type of contact with community mental health programming. Managers and
administrators who were selected for this research project were chosen because each
one has had some type of contact with a curanderismo program. It appears that very
few have had this experience.
Interviews were conducted with five public and not-for-profit administrators
mentioned above who operated at various levels of organizational structures and
whose organizational mission was to meet the mental health needs of the citizens. I
taped the interviews and had them transcribed.
Interviews with two upper level and two middle-level managers who were/are
responsible for the implementation of programs at all levels of the total system were
conducted. The upper level of management may not have the specific information
relative to the implementation of a non-traditional system of mental health and its
implications with a specific program area or division. At times, upper level
administrators are caught up in the administration of the total system; therefore, they
may not have the experience or information that middle level managers possess as it
66


relates to the phenomena that I am attempting to research. On the other hand, mid-
level managers may not necessarily have the complete picture of organizational
dynamics. They do have information relative to many of the intricacies that may
arise when non-traditional types of programs are implemented, particularly since this
level of mid-level managers may not necessarily have the complete picture of
organizational dynamics. However, they do have information relative to many of the
intricacies that may arise when alternative mental health programs are implemented,
particularly, since this level of administration supervises lower level staffs who apply
any given mental health technique.
In order to gather information about the more intricate details, interviews with
mid-level managers who generally are more fully aware of the daily operations of a
system were conducted. They are generally cognizant of the conflicts, either inner
organizational or client driven, that have arisen. This level of manager has daily
contact with staff and clients. They are also responsible for any and all
documentation that leaves that particular program. As such, when client conflicts
arise, it is their responsibility to resolve those conflicts.
In order to gather information about the more intricate details, interviews with
mid-level managers who generally are more fully aware of the daily operations of a
system were conducted. They are generally cognizant of the conflicts, either inner-
organizational or client driven, that have arisen. This level of manager has daily
contact with staff and clients. They are also responsible for any and all
i


documentation that leaves that particular program. As such, when client conflicts
arise, it is their responsibility to resolve these conflicts.
Mid level managers are responsible for creating a positive image of their
clinics and programs in the community. Any client dissatisfaction will generally
come through their doors. Any negative feedback from the community that can have
negative implications on the program and/or organization usually has to be dealt with
by this person.
Lastly, there are two reasons why an interview with a psychiatrist was
conducted for this study. As previously mentioned, there are very few public
administrators and/or managers who have the experience of managing a curanderismo
program. Finding this type of administrator was difficult. Secondly, due to the
important role the psychiatrist plays in mental health, this researcher felt that it would
be important to interview one who had contact with both a curandera/o and a
curanderismo program.
The psychiatrist who was interviewed has been with Centro de las Familias, a
specialty team under the auspices of the Mental Health Corporation of Denver, for
over 15 years.
More specifically, interviews were conducted with curanderos/as who have
been both practitioners and managers. One of the interviewees has practiced
curanderismo in a mental health setting for over 20 years and is now the manager of
68


Centro de las Familias. The other interviewee was the past manager of the clinic and
is now practicing curanderismo in the community.
These interviews provided first hand information of the practices of
curanderismo and an understanding of the particular management strategies that were
used to manage the clinic. The interviews with the past manager gave me an
opportunity to gamer some history since this person was the initiator of the current
curanderismo program.
Data Analysis
The final step in a research project is data analysis. Marshall and Rossman
(1989) define data analysis as:
the process of bringing order, structure and meaning to the mass of
collected data. It is a messy, ambiguous, time consuming, creative and
fascinating process. It does not proceed in a liner fashion; it is not neat
Qualitative data analysis is a search for general statements about
relationships among categories of data; it builds grounded theory
(Marshall and Rossman, 1989, p. 112).
Qualitative research and grounded theory share a series of common data
analysis techniques that researchers use. One such method is comparative analysis.
Referred to as constant comparative analysis, it is a technique that is used where an
ongoing comparison of the collected data and theoretical constructs and/or categories
is used. Comparative analysis is used constantly during this process. This also
allows for the elimination of those theoretical categories that do not fit while


reinforcing those that do. It enhances and verifies data as it is collected. It is in this
fashion that grounded theory and comparative analysis complement each other.
The following is a description of how this method was utilized in this study.
Once the information was transcribed, it was synthesized. Sound judgement and a
review of the management literature that had been gathered was used to determine if
any significant and consistent management styles and/or practices emerged that were
effective when implementing an alternative mental health program such as
curanderismo.
It is anticipated that the final results will fill a void in the public
administration literature and ultimately provide information for the development of
management strategies that can complement traditional methods of healing in a
mainstream system of mental health administration.
Validity, Reliability and Limitations of This Study
As researchers struggle for certainty and an ability to explain human behavior,
the question of methodology arises. There are issues of validity, reliability and the
limitations of the study. There are also a variety of issues that follow such as the
relevance of the study, acceptance from peers and the studys over all utility. Each
research method has it strengths and limitations.
Validity includes three components, face, construct and content. Babbie
defines validity as the extent to which an empirical measure adequately reflects the
70


real meaning of the concept under consideration (Babbie, 1983, p. 117). Within this
study, the methods that were chosen appear to measure what they were intended to
measure. The value of qualitative theory and grounded theory is that there are no
preconceived notions to guide the study. An emergence process allows for the
information to build from the ground up. Through an inductive approach, what is
validated, are the relationships among the various categories, guided by the questions
posed to the subjects.
Construct validity is defined as the extent to which the constructs are
successfully operationalized in a study. Babbie argues that construct validity is based
on the logical relationships among the variables (Babbie, 1986, p. 28). The research
design must insure that the concepts being studied are guided by sound theoretical
constructs. It is through the gathering of the data and its verification that one can
argue construct validity. Comparative analysis is the key to insuring that this takes
place. This study employed a comparative analytical approach.
In addition to construct validity, content validity must be satisfied in a
research study. Babbie (1994) defines content validity as the degree to which a
measure covers the range of meaning included within a concept (Babbie, 1994, p.
128). According to Babbie (1994), content validity is not an issue when the
combination of qualitative research and grounded theory are used. The rationale is
that grounded theory is geared towards an ongoing process of data gathering and
interpretation simultaneously with seeking out conceptual relevance (Babbie, 1994, p.
71


129). This study utilized grounded theory as a method. Within this study the
requirements for validity have been met.
However, the reliability of this study is a limitation. Babbie refers to
reliability as the likelihood that a given measurement procedure would yield the
same description of a given phenomenon if that measurement were repeated
(Babbie, 1983, p. 119). With respect to quantitative theory, all things being equal,
similar results would be obtained if another researcher administered the research.
It is difficult to ascertain whether the qualitative design used in this study
would yield similar results if it were administered with another sample group. On the
other hand, it remains possible that a similar research project would yield other results
and/or patterns. This uncertainty is inherent in research relying on grounded theory.
Another limitation of this study is generalizability. Because of the limited
number of interviewees, restricted generalizability is usually a problem. Rossman &
Marshall (1989) argue another concern with a small number of interviewees is the
inability to develop any accepted principles or coherent frame of reference. However,
there are other ethnographers who argue that sample size is irrelevant to the reliability
and validity of a study that utilizes the life history method (Facio, 1996, p. 64).
With respect to interviewing as a research method, Marshall and Rossman
(1989) argue that an interview is a useful way to get large amounts of data quickly.
The process allows for immediate follow-up question/s, and, if necessary for
clarification, follow-up interviews can be scheduled. Combined with observation,
72


this allows the researcher to check description against fact. The authors argue that in
depth interviewing and a subsequent description of the phenomenon under scrutiny is
rich with data and therefore valid.
From a critical perspective, the interviewees may not be willing to share all of
their information. If the interviewer is not familiar with the subject area,
inappropriate questions may be asked.
The strengths of the topical life history, a method of the qualitative research
approach are the thoroughness, and richness of the information. The interviewer can
enter into the personal world of the interviewee. Rossmann and Marshall (1989)
argue that this technique provides fertile ground for the development of hypotheses
for further study. Life histories can lead to further research strategies. Life histories
elucidate behavioral processes and personality types that may be analyzed when a
sufficient number of detailed life histories are accumulated for comparative study.
Life histories can provide a mosaic from which to understand those peoples
motivations (Rossman and Marshall, 1989).
This study did not utilize a quantitative approach; therefore, did not concern
itself with hypothesis testing. There were no set of assumptions that needed to be
identified. The theory of quantitative research and in particular the life history
method are more learning methods of research than the traditional model of
hypothesis testing.
I
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CHAPTER 4
RESEARCH FINDINGS IN GENERAL
Research Findings on Curanderas/os
Diana Velazquez: La Curandera Total
Diana Guevara Velazquez was bora in Lockhart, Texas on March 11, 1939.
She is the eldest child in her family and has two stepbrothers from fathers previous
marriage. She was bom into a family of women healers and was destined to fulfill
this role at birth. Her great-grandmother Petra and Grandmother Chona were
considered strong healers in their respective communities. Her grandmother died
while giving a curacion (the healing), fighting off evil spirits. According to Diana,
her grandmother knew,
A young person, about 22 years of age needed to be cured. My
grandmother was about 63 (sic) Which at that time, you were elderly.
She weighed her life against the life of a young person and figured that it
was worth saving because of this young person, and if she was gone that
was fine because then this person had a long life to live. But if the young
person died, well they didn't have any time; they would have been here
in too short a time. So she went into battle and she lost The young
person lived (Velazquez, Interview, 23 July, 1993).
Dona Chona was considered a primary physician within the hierarchy of
healers. She was instrumental in the application of curanderismo, as well as making
referrals to other curanderas, that lived in her barrio (neighborhood). Networking is
74


vital for the curandera because of the large number of clients and the various diseases
she/he must contend within the barrio.
For some curanderas/os the process of becoming a curandera/o begins with a
revelation, a vision or a dream (Foster, 1953; Madsen, 1964; Romano, 1965).
Velazquezs role in life was begun in the womb. The sounds of her voice, crying in
the womb, and witnessed by family and community members was an Indian/Mexican
cultural sign that another healer was coming to life. Dr. James Jaramillo in Medicine
Women, Curanderas, and Women Doctors who writes, Legend has it that if a child
cries in the womb, she will be given the Don/Dona and become a curandera
(Perrone, et. al. 1989, p. 92). Velazquez has a vivid recollection of her grandmother
and first mentor being a mean woman but who was able to use here power to heal.
God gave us freedom of choice and that certainly one option in a
multitude of choices was to be mean. You have the ability to heal; but
that doesn't mean you are pretty, or thin, or young, or conscientious or
even considerate. It really doesn't You know, we assume, that you are
given the gift because you are given the gift and then you decide what
kind of person you are and how you are going to use this gift (Velazquez,
Interview, 23 July, 1993).
Dianas Texas Mexican childhood was not normal as compared to the
socialization processes defined in American society. She began training to enhance
her dona at an early age, accompanying her abuelita (grandmother) throughout the
community, sometimes being carried in an old orange crate; nevertheless, present at
many of the cultural healing rituals that were performed. She recalls:
75


I remember being in an orange crate in a pink blanket (to this day pink is
her favorite color). In my hair was a ribbon that had been put on with a
piece of tape, not scotch tape, just regular tape. And I heard what was
going on, and described what was going on.. J remember talking to the
person who had been healed at a later time in life. I know her name
Virginia because that is what I heard them call her and she was married
to a man who worked in a hospital. They found Virginia, maybe 30
years ago. They found her through an aunt who had a mutual friend.
They asked her if she knew Chola Reyes.Oh ya, la curandera, ya did I
know her. I went to her. The curacion was so difficult that it had to be
done outside so we went to the chicken coop in the back, and that is
where we went get the curacion (Velazquez, Interview, 23 July,1993).
Diana Guevara began practicing curanderismo at the age of eight. Within her
abilities and through the counseling, mentoring and guidance of her grandmother, she
began to perform healing rituals with barrio women. She remembers,
I started practicing when I was eight. My grandmother, when I was
eight, would say, "so and so is sick," that is what is wrong with her. Get
what you need and go take care of them. As a child, it did not occur to
me to say, well what if I dont know, what if I fail? I've never done this
before. I went. I picked up what I needed: the herbs, the eggs, the
lemon, the charcoal, and I went and said, "Chona told me to come. They
said, "ok," and I did what I was supposed to do. I went back home,
didn't report to anybody or was never asked how did it go. I assumed
that lady was going to get well. I did everything I was supposed to. And
she did get well (Velazquez, Interview, 23 July, 1993).
Through the concept of a traditional marriage contract, Diana was promised a
hand in marriage to Cecilio Velazquez at the young age of 12. She still defines her
marriage as a "marriage of convenience (Ibid). Cecilio, a Yaqui Indian, had been
sent on a mission by his father, to find another healer to join the family. The
Velazquez clan from Sonora had a family tradition of curanderismo; however, a
generation had passed, and there were no signs that a healer existed among that
76


particular generation. It was Cecilio's cultural duty to find a curandera who would
become part of their family and continue the cycle of curanderismo. Regarding her
Yaqui in-laws, Diana says that,
Well, my father-in-law in Mexico was a real powerful medicine man and
his power had come through the male line, father to son. But for some
reason in this particular generation, he had twelve sons and none of them
had the ability. So then his eldest son had the responsibility to bring in
somebody that would perpetuate the healers in the family (Velazquez,
Interview, 23 July, 1993).
As promised, Diana was married at the age of 15 to Cecilio Velazquez. They
moved to Sonora, Mexico, where she was embraced and mentored by Cecilio's father,
Herman Velazquez (Don Chito), and a well-known healer from the State of Sonora.
While in the Yaqui Indian village, Diana played the role of a partera (midwife) and a
nurse. It is here that she encountered the general practitioner from the community,
who also mentored her while simultaneously allowing her to treat Indian patients
(Ibid).
While living at this Indian village for several years, she delivered 612 babies.
She treated pregnant mothers before and after delivery. At an early age, she practiced
a method of delivery that is consistent with how other curanderas deliver babies; in
particular, the role of the father and relationship between mankind and nature
(Lucero, 1987, p. 15).
The teachings of Don Chito were designed to enhance the development and
enhancement of her power as a healer. Velazquez describes her mentorship as one
77


full of rituals, with significant cultural meaning, common sense and full of the lessons
of life. Diana said that,
Well, at the time, I had asked him for a solution to a problem. He asked
me to bring him seven pieces of wood hat had to be a certain size. And
then, he had me place the logs on the ground and start a fire...so I made
the fire along with a lot of tears....the fire startedhe asked me to go out
and bring in a piece of branch, it was called pirul. It had to be a certain
length and it had to be flexible. I went out and he handed me the branch
and he had left And he asked me to look for the solution to the problem
I had. After sorting through the amber and the ashes, it finally came to
me....So he said what is the solution to the problem? And he said, did
you find the solution in the amber or the fire? No, I said. Was it in the
ashes or in the stick? No, I said. So I pointed to my head and heart and
said that is where the answer is at.' "Ah," he said. That was his highest
compliment...Tie was teaching me that I did not need a crystal ball, I
didnt need anything to find the solutions. That I had to trust what I
already knew, that I had to trust that I had to trust myself (Velazquez,
Interview, 23 July, 1993).
Diana's relationship with Don Chito was filled with learnings of the
philosophy of curanderismo, with its inherent traditions passed down from Yaqui
ancestors who had lived in Mexico for many generations. He became her mentor,
friend and ally, not merely her father-in-law.
Diana grasped the importance of training as an important part of a curandera's
successful practice. Diana's training with Don Chito was a blessing because of his
knowledge, strength, and his ability to understand the concept of power. The use,
versus the abuse, of power was critical to her training and it was something that she
learned quickly. She stated that,
The first thing I learned from Don Chito was how to channel that power
for myself. How to inwardly heal myself spiritually...He taught me
78


how to go off to a mountaintop or to the desert by myselfi sweat out a lot
of things, and concentrate on how anything bad that happened,
something good was going to come out of it (Velazquez, Interview, 23
July, 1993).
Its important for that middle step of your learning how to use your
psychicness, your own power, the cleansing, the purification, the getting
together with that higher spirit And when that is missing you use the
only resources you haveyour own energy and itbums out quick
(Lucero, 1981, p. 14)."It was the responsibility of the healer to leam
aspects of power. This is exemplified in Carlos Castaneda's, The
Teachings of Don Juan (Castaneda, 1968). Casteneda was an
anthropologist who studied with Don Juan, a sorcerer from the State of
Sonora, Mexico and considered a powerful healer by some. In one
exchange, Castaneda wrote that power was both a friend and an enemy.
Don Juan allegedly responded that Power is the strongest of all enemies.
And naturally the easiest thing to do is to give up; after all, the man is
truly invincible. He commands; he begins by taking calculated risks; and
ends in making rules, because he is a master. Power will turn him into
acruel, capricious man (Teachings of Don Juan, 1974 p. 86).
In 1962, the Velazquez family returned to San Antonio, Texas where Diana
continued her practice as a curandera. Until she reached the age of 35, Diana
practiced curanderismo in a very traditional sense. She was enhanced by other
curanderas/os, in an community networking system. This healing art has not been
accepted by the American Medical Association; therefore, its practice was confined to
Mexican barrios where clients entered treatment, being referred by word of mouth.
Velazquez earned her "credentials when the community acclaimed her skilled
effective healing practices. Essentially, the credentials earned by a "Curandera Total"
are earned by her/his reputation in the community and an informal training
curriculum learned in the sociocultural subsystem. A curanderas reputation flourishes
as a result of the actual work accomplished. This is contrasted against modem
79


society where one cannot inherit the right to practice medicine, the person must first
certify theoretical competence (Kurts, Chalfant, 1984, p. 144).
It was in 1972 that the Velazquez family moved to Denver, Colorado. For
Diana, breaking into the field of mental health was either an aberration, or perhaps an
act of God, leading her down a path that was meant for her. She could play multiple
roles in her life, but being a curandera was her greatest calling.
In 1973, things changed for Diana. She was diagnosed as having cancer and
diagnosed clinically with depression. She decided to seek out counseling and
therapy, paradoxically from a modem psychiatric counseling center. This was her
first encounter with Centro de las Familias, a bilingual, bicultural mental health clinic
located in southwest Denver. She was displeased with the lack of compassion and
sterile ambience shown at this clinic. As it turned out, Diana believed that this
frustration was meant to happen. Her belief that out of bad situations goodness
prevails came hue.
At the time of her admission to the clinic, die psychiatric team was looking for
a secretary. Through a bit of persuasion, Velazquez applied for the job and became a
part of the staff. It was during a psychiatric case consultation that the team leader
inquired about her abilities as a healer. According to Diana,
The team was staffing families that had been admitted into the clinic.
This was considered general supervision. In one particular case, feed
back about intervention mental health strategies were given to the
assigned mental health therapist. My role was to take notes. However, I
felt compelled to intervene. When she finished her assessment, the team
80


leader asked herhow she knew what to do. She retorted, 'I am a
curandera. I have been working with our people for a long time.'
(Velazquez, Interview, 23 July, 1993)
She believed that this admission was part of the path to her final destination.
During that time in the mental health field, there were governmental funds available
for creative and innovative mental health programs. The team leader (Ernesto
Alvarado) applied for funds to implement curanderismo as a specialized mental
health treatment modality. Following her introduction into the field of modem
psychiatry, she was able to grasp many of the concepts of community mental health
that were already a part of her Indian/Mexican/Chicano cultural perspective. In the
counseling field of psychiatry it is often referred to as ethnopsychiatry or transcultural
healing.
-After joining Centro de las Familias, Dianas work began to be recognized,
appreciated, and validated by both the institution and the community. She began to
practice curanderismo at Centro de las Familias. One of the functions that she
performed for the total mental health center was as an in service provider/trainer.
Through historical oral tradition, the community came to know her presence. She
describes one of her most vivid experiences in healing a hexed client. Diana said
that,
The staff at the children's ward (sic) And I remember the name of the
person, who called, Dr. X. He asked me if I would be willing to
come...and I said.well sure but I would have to get the appropriate
permission. So I talked to Dr. Paul P., so he madearrangements with the
head of the children's division at the time...(sic) so when I went in, they
81


I
were expecting me, but they didn't know what to expect...they were used
to when a consultant comes in, which is to sit down and go over the case
history withthe consultant So I did that and I listened to it all and all the
different presentations. And then, I finally got to see the child. And I
said hello to her and I asked her if she knew who I was. I thought maybe
they had told her they were bringing a curandera. And she said, 'no, I
dont know who your are. But somehow I feel that you are the one that is
going to help me.' So I figured I'm half way home. And I asked for a
room that I could work with her and right away they wanted to videotape
it and all that stuff. And I said no that I did not approve of that, that this
was something that was sacred and so they said OK (sic) So I went in
there and entered the room.. J had a set of beads, they are round like
sunburst and they have like three different kinds of heads and seeds (sic)
And this is something that my father-in-law made for me; so that when I
worked with a child. It's almost like a condenser, that the right energy
would flow to her as opposed to an adult So I took the beads and swept
her with them, and we prayed the Our Father, which she was familiar
with and 1 prayed the way I do. And then we had finished the prayer, I
said to her, now I want you to move this finger (pointing to the index),
and she very slowly and she did it And I saidnow I want you to move
your other fingers and she did (sic) So now lets move your whole hand,
and she opened both hands and she was able to extend them. And that
took about 25 minutes. So I wheeled her out and the doctors said is
there anythingthat you are going to be able to tell us about her that we
can help her? Is there anything you are going to be able to do to help us?
And I said well, I think so. And I said Lisa would you shake hands with
your doctor. So she extended her hands with Dr. X and then she waved
with the other one (Velazquez, Interview, 23 July, 1993).
Diana stated that this was her "first miracle." The professional staff had
mixed emotions about this experience; some were in awe, others were in doubt and
some were even angry. Nevertheless, the word permeated the local psychiatric
community that a healer had performed a miracle. This set the stage for an influx of
calls from the Denver Chicano community requesting services. The word spread
regionally, then nationally.
I
i
I
82


Cultural Diagnostics and Treatment Methods
Diana utilizes cultural diagnostics in order to determine her clients disorders
and/or needs. This provides the basis for building a/n effective treatment plan suited
for each individuals from which she sees diagnostically.
She defines trisia "as a tristeza (depression) that goes not only from the body
but into your soul." It appears that this particular diagnosis describes categorically
what western psychologists call depression or perhaps melancholia, except that it
manifests itself in the spirit and the soul as well. Beyond the textbook definition,
Diana added,
But tirisia means that down to the very core of your soul there is this
sadness...this deep depression. So I also see people with this. The other
thing that I see is a lot of men who carry a lot ofguilt and are exhibiting it
through bad luck or illness that they cant diagnose. Guilt such as having
killed somebody, having incested their daughter or sister, and even guilt
of having come to the United States from Mexico, promising to support
their mothers and fathers, and not following through whether its because
they can't afford it or its because they have given money to women or
whomever it is...they have that feeling. So they come in exhibiting
symptoms of what you might call a hex (Velazquez, Interview, 23 July,
1993).
Diana treats men with these types of psychological and spiritual problems by
the use of cultural rituals, prayer and empowerment. She believes that she is a vessel,
given power to heal by God, and that is used to transmit energy and healing back into
her clients. Her techniques are culturally specific laden with the values that Chicanos
and Mexicanos cany as part of their cultures.
83


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