Ethnopharmacological investigation of plants used to treat susto, a folk illness
Introduction
In the realm of ethnopharmacological research, culture-bound syndromes and folk illnesses are seldom investigated. The issue is complex: the classification and etiology of these ailments is often unclear. Moreover, they are typically linked to local belief systems and treatments often rely predominantly on rituals and sensory perceptions (e.g. aromatic plants) (Frei et al., 1998, Leonti et al., 2001). However, a closer examination of treatments used by traditional practitioners can provide unique and important information on the nature of these complex syndromes.
The case of susto, a traditional ethnomedical concept widely recognized by groups of Latin America, is of great importance since it is associated both with strong cultural beliefs and severe health consequences. Indeed, Collado-Ardon et al. (1983) showed that those suffering from susto generally have a higher disease load and likelihood of death than non-sufferers over a 7-year period. However, its underlying causes are ambiguous, having been linked to ailments ranging from intestinal parasitic infestations (Signorini, 1982) to hypoglycemia (Bolton, 1981), social role stress (Rubel, 1964, O’Nell and Selby, 1968, Uzzell, 1974, O’Nell, 1975), and anxiety-related conditions (Gillin, 1948, Kiev, 1968, Gobeil, 1973, Lopez-Ibor, 2003).
According to local descriptions, susto stems from a frightening event involving startle, which causes the loss of the soul, or vital force. This can then lead to sickness involving various general symptoms such as restlessness during sleep, loss of appetite, irritability, inability to urinate, weakness, depression, introversion, fever, muscular pain, nausea, vomiting, diarrhea, and vertigo (Rubel, 1964, Klein, 1978, Signorini, 1982, Crandon, 1983). It is also widely believed that susto can be fatal if uncured (i.e. if the patient's soul is not returned to its body) (Gillin, 1948, Gobeil, 1973, Crandon, 1983).
Although its etiology is an area of active research, both the American Psychiatric Association (APA) and the World Health Organization (WHO) associate susto with mental disorders, including a number of anxiety and fear related conditions (i.e. post-traumatic stress disorder, anxiety disorder, major depressive disorders, somatoform disorders, and other specified neurotic disorders) (WHO, 1993, APA, 1994). Furthermore, evidence from our previous work on rituals performed by Q’eqchi’ Maya healers and plant treatment associations between ailments suggests that susto might have an underlying neurological/psychological component related to anxiety and/or fear (Bourbonnais-Spear, 2005). In the present study, we investigated the pharmacology of selected herbal remedies used by these healers to treat susto, as complimentary information. To our knowledge, this is the first experimental study of the biological activity of selected plants in the perspective of their use in treating a folk illness. We hypothesized that susto has an underlying neurological or psychological component related to anxiety and/or fear and, therefore, that plants used by traditional healers to treat susto would exhibit anxiolytic and/or fear suppressive properties.
Section snippets
Ethical approval
The project was reviewed and accepted by the University of Ottawa Ethics Committee (Approval # H-06-03-01), and the Ministry of Natural Resources of the Government of Belize issued a permit for plant collection in June 2003 (Ref # CD/6-/9/03 (18)). Close attention was paid to the respect of local customs, which was facilitated by working closely with two Q’eqchi’ research collaborators, Pedro Maquin and Victor Cal, and the healers granted their consent individually for participation. Plants and
Plant use
Fourteen plant species belonging to six plant families are used as remedies for susto (Table 1) (another two species mentioned by the healers could not be collected and were therefore excluded from the analyses). Many of the plants collected grow only in the Maya mountains of southern Belize as epiphytes and understory plants of the semi-evergreen tropical forests of the region. Only two tree species were used, Combretum sp. and Guraea grandifolia. DC. Plant families most represented are a fern
Herbal remedies used for susto
The biological activity of plants used by the healers and identified to species has been understudied, apart from Pityrogramma calomelanos (L.) Link, which has shown cytotoxic and anti-tumoral effects (Sukumaran and Kuttan, 1991), and Scoparia dulcis L. which has anti-diabetic (Latha and Pari, 2004) as well as antiviral properties (Hayashi et al., 1988). Of direct relevance, certain compounds found in Piper species exhibit potent activity on the central nervous system (CNS) (Parmar et al., 1997
Acknowledgements
We are extremely grateful to participating healers and their families, and to the communities of Indian Creek, Jalacte and Big Falls. We are also thankful for the technical and logistic support offered by the Belize Indigenous Training Institute. We are also grateful to Maïa Miguelez, Nathalie Lukenbill, John James, Christine Mountney, Judith Hotte-Bernard and Sylvie Emond for their time and input into this project. As well, we would like to thank Luis Poveda and Pedro Sachez for their
References (47)
- et al.
Triterpenes from Adiantum lunulactum
Fitoterapia
(2002) - et al.
A folk illness (susto) as an indicator of real illness
Lancet
(1983) - et al.
Continuous release of low levels of diazepam produces tolerance to its depressant and anxiolytic effects on the startle reflex
European Journal of Pharmacology
(1988) Animal models of anxiety based on classical conditioning: the conditioned emotional response (CER) and the fear-potentiated startle effect
Pharmacology & Therapeutics
(1990)- et al.
Medical ethnobotany of the Zapotecs of the Isthmus-Sierra (Oaxaca, Mexico), documentation and assessment of indigenous uses
Journal of Ethnopharmacology
(1998) - et al.
In vitro and in vivo antiviral activity of scopadulcic acid B from Scoparia dulcis, Scrophulariaceae, against herpes simplex virus type 1
Antiviral Research
(1988) - et al.
Malaria remedies of the Kenyah of the Apo Kayan, East Kalimatan, Indonesian Borneo: a quantitative assessment of local consensus as an indicator of biological efficacy
Journal of Ethnopharmacology
(1995) - et al.
Validation of an auditory startle response system using chemicals or parametric modulation as positive controls
Neurotoxicology and Teratology
(2004) - et al.
Validation of a simple, ethologically relevant paradigm for assessing anxiety in mice
Biological Psychiatry
(2003) - et al.
Phytochemistry of the genus Piper
Phytochemistry
(1997)
Validation of open: closed arm entries in an elevated plus-maze as a measure of anxiety in the rat
Journal of Neuroscience Methods
Spasmolytic activity of some plants used by the Otomi Indians of Querétaro (México) for the treatment of gastrointestinal disorders
Phytomedicine
Screening of 11 ferns for cytotoxic and antitumor potential with special reference to Pityrogramma calomelanos
Journal of Ethnopharmacology
Animal models for the study of anti-anxiety agents: a review
Neuroscience & Biobehavioral Reviews
Triterpenoids from Adiantum caudatum
Phytochemistry
Diagnostic and Statistical Manual (DSM-IV)
Susto, hostility, and hypoglycemia
Ethnology
Pharmacological and phytochemical evaluation of Adiantum cuneatum growing in Brazil
Verlag der Zeitschrift für Naturforschung
Isolation of amentoflavone from Selaginella rupestris and its pharmacological activity on central nervous system, smooth muscles and isolated frog heart preparations
Planta Medica
Why susto
Ethnology
Magical fright
Psychiatry
Cited by (37)
Medicinal plants used in traditional Mayan medicine for the treatment of central nervous system disorders: An overview
2022, Journal of EthnopharmacologyCitation Excerpt :Mirroring its outstanding cultural heritage, Mesoamerica is also one of the world's most biodiverse regions, is among the most eminent centers of plant domestication (Pickersgill, 2016), and has been named a Vavilov center of biodiversity (Hummer and Hancock, 2015). In Mayan medical ethnobotany, there are several herbs used traditionally for treating conditions with an important psychological or spiritual component (Awad et al., 2009; Bourbonnais-Spear et al., 2005, 2007; Castillo-Bautista et al., 2019; Hitziger, 2016; Kufer et al., 2010). Some of these syndromes are recognized universally as central nervous system (CNS) disorders, whereas other ethnopsychiatric interpretations are explained in culture-specific terms.
Ethnomedicine and neuropsychopharmacology in Mesoamerica
2021, Journal of EthnopharmacologyCitation Excerpt :among the most frequently used taxa to treat susto. Ethanolic extracts of A. tetraphyllum (50–300 mg/kg p.o.) showed significant anxiolytic and fear suppression activities in rats in the EPM and CER tests, whereas A. latifolium showed only moderate activity (Bourbonnais-Spear et al., 2007). A methanolic extract of A. latifolium (1–100 mg/kg i.p.) did, however, significantly reduce the nociceptive response of mice in the formalin and writhing tests (Nonato et al., 2011).
Ethnopharmacological uses, phytochemistry and pharmacology of genus Adiantum: A comprehensive review
2018, Journal of EthnopharmacologyFeverfew (Tanacetum parthenium (L.) Sch.Bip.)
2018, Nonvitamin and Nonmineral Nutritional SupplementsAnxiolytic- and antidepressant-like effects of an aqueous extract of Tanacetum parthenium L. Schultz-Bip (Asteraceae) in mice
2017, Journal of EthnopharmacologyCitation Excerpt :In Mexican traditional medicine, T. parthenium is used to relieve ailments, such as fevers, migraine, headache, rheumatoid arthritis, stomachache, toothache, and as an analgesic, anti-inflammatory, and antispasmodic agent. This species is also employed to treat culture-bound syndromes such as susto (roughly translated as fear), espanto (nervousness), or quemados (burns) (Diccionario enciclopédico de la Medicina Tradicional Mexicana, 2009; Bourbonnais-Spear et al., 2007; Estrada-Reyes et al., 2014). Within this cross-cultural construction of illness, there is an association between beliefs of susto and depression.