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Madsen, WilliamSociety and Health in the Tower Rio Grande Valley.Texas Univ., Austin. Hogg Foundation for MentalHealth.6115p.University of Texas Printing Division, Austin, Texas78712 ($0.20)

EDRS Price MF-$0.25 PC-$1.P5Attitudes, Cultural Factors, 'Folk Culture, Health,*Indigenous Personnel, *Medical Services, *MexicanAmericans, Physicians, Public Health, ReligiousFactors, *Social Differences, Values*Texas

ABSTRACTShedding light on problems of mental health and

illness that have Laffled public health workers attempting to improvethe health and welfare of Mexican Americans living in the lower PioGrande Valley, this document reports the folk customs, socialorganization, medical practices, and beliefs of the Mexican Americanof this area. Chapters describe the population, social structure,values, and customs. Particular emphasis is given to the MexicanAmerican concept of illness, the medical referral system, and"curanderiFmoll (the system of disease theory and curing techniquesassociated with the curandero whose healing powers are believed to hea gift from Goi). In conclusion, 14 recommendations are given forimproving the relationship between modern medicine, welfare workers,and the Mexican American in need of assistance. Some of theserecommendations would require a changed relationship betweer doctorand patient, even involving cooperation between physician andcurandero. It is suggested that the United States cui.ture has much tolearn from the Mexican American citizens about family solidarity,child rearing, respect patterns, and religious values. (AN)

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SociLTY6a MALTA:IN THE LOWER RIO GRANDE VALLEY

BASED UPON THE FINDINGS OF THE

Hidalgo Project on Differential

Culture Change and Mental Health

By WILLIAM MADSEN

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introduction

FOR THE PAST four years, Dr, Madsen and his research as-; ciates have been conducting intensive studies of folk cus-toms, social organization, medical practices and beliefs thatcharacterize Mexican-Americans in the lower Rio GrandeValley. These investigations, supported by the Hogg Foun-dation, have shed considerable light upon the problems ofmental health and illness that have baffled public health1-% orkers attempting to improve the health and welfare ofMexican-Americans living in Texas.

The insights and recommendations set forth in this pam-phlet were presented under the auspices of the HidalgoCounty Health Department at a public health conferencein August, H)61. Because of the widespread interest in Dr.Madsen's findings and their significance for public healthand welfare workers, the Foundation has published thisbooklet in advance of the more extensive, technical reportsthat will be forthcoming within two years.

When the study began in 1957, three communities in Hi-dalgo County were selected for intensive investigation by astaff of three full-time anthropologists, WI. Antonieta Es-pejo, Mr. Octavio Romano, and Mr. Arthur Rubel, eachworking in separate communities, but frequently compar-ing field notes. The communities ranged from a border vil-lage, which has managed to preserve its Mexican folkculture, to a middle-sized city with noticeable social stratifi-cation among the Mexican - Americans. In 1959, a fourthr.-search associate, Mr. Albino Fantini, was added to the sta tfto work closely with one of the local public health clinics.

Mrs. Espejo, of Mexico's National Institute of Historyand Anthropology, served as field director, concentratingprimarily upon folk medicine and society in one of the ma-jor agricultural centers of the Valley. By befriending sev-

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eral curanderos, (local folk healers,) she was able to tracein fine detail the referral system used by Mexican-Ameri-cans seeking help with the treatment of illness outside ofregular medical channels. This network ranged all the wayfrom south of Monterrey, Mexico, to San Antonio andserved to dramatize the extent to which Mexican-Ameri-cans travel freely on both sides of the border in conductingtheir daily affairs.

The mental health implications of the findings reportedby Dr. Madsen and his associates are immediately appar-ent, once it is recognized that among lower-class Mexican-Americans most forms of mental illness and abnormal be-havior are attributed to supernatural causz4 that requirespecial kinds of folk medicine such as that dispensed by acurandero, rather than treatment by a psychiatrist or psy-chologist. Many physical ailments are also attributed tosupernatural causes, while others are recognized as havinga natural origin. Although most of the educated Mexican-Americans in the Valley seek modern medical assistance forrecognized illness, reliance upon folk medicine or curande-rismo is by no means limited to the lower social classes.

At the end of this brief report, Dr. Madsen and Mrs. Es-pejo have made a number of recommendations for improv-ing the relationship between modern medical or welfareworkers and the Mexican-American in need of assistance.These suggestions are set forth in ihe hope that they willbe of immediate value in provoking discussion of the issuesinvolved. Several are admittedly controversial in nature,since they would require a changed relationship betweendoctor and patient, even involving cooperation betweenphysician and curandero in some cases. When viewed in thelight of Dr. Madsen's findings, however, all 14 of the recom-mendations deserve serious consideration. The problems ofmental and public health among Mexican-American citi-zens are sufficiently serious to demand that any fresh pointof view be examined thoroughly.

WATNII H. tiotrzmatst

She Population and Me -Apea

A BORDER AREA presents a social situation in which peopleand ideas from two countries mingle to create a sub-culturedifferent from the two national norms. The lower RioGrande Valley in South Texas represents such a situationwhere close contact between Mexico and the United Stateshas produced a distinctive border culture with a dual society based on ethnic differences.

Originally inhabited by migratory Indians, the Valleywas permanently settled from Mexico as an extension ofNew Spain in the middle of the 18th century. Families fromnorthern Mexico who colonized the Valley were given freeland grants by Spanish authorities. U.S. settlers entered thearea at the beginning of the 19th century, but the Mexicansand the Mexican way of life continued to dominate the Val-ley. Most of the original Indian population was wiped outand the survivors lost their racial identity through mixedmarriages.

After Texas won its independence. U.S. cultural influ-ences increased although the population was still primarilyof Mexican descent. The major settlement of Anglo-Ameri-cans in the Valley began in the early part of the 20th cen-turi when real estate syndicates promoted the area as apromising citrus fruit and truck gardening center. Put.chasers IA this undeveloped land came mainly from the

United States Midwest. The period of agricultural develop-ment by United States citizens also witnessed a heavy influxof Mexicans who were political refugees from the Revolu-tion of 1910. Valley land owners hired cheap Mexican laborto clear the underbrush and install irrigation systems.

The two main ethnic groups in the Valley today are theAngles, white residents who came primarily from the Mid-west; and the Mexican-Americans, who are descendants ofearly settlers and recent immigrants from Mexico. A thirdgroup of fluctuating size and significt.nce is composed of"braceros," the transient Mexican laborers imported by in-ternational agreement to pick crops in the U.S.

The population is concentrated in cities and small townswhich line the main highways. A few hamlets are inhabitedonly by Mexican-Americans, but the typical town is popu-lated by both Angles and Mexican-Americans who live inseparated residential districts divided by a highway or rail-road tracks. Anglo isolation from the Mexican-American isnot only spatial but also social. Virtually the only relation-ship between the two ethnic groups is economic. Except fora small elite, most of the Mexican-American populationconsists of wage laborers who work in the fields, canneries,factories, or stores. The predominant relationship betweenthe Anglo and the Mexican-American is that of employerto unskilled employee.

Each imup holds a stereotyped image of the other. Theunflattering nature of these images is reflected in the de-scriptive terms used by one group to designate members ofthe other group.'Mexican-Americans refer to Angles withthe derisive terms "bonitos," "gabachos," and "gringos."Non-derogatory terms for kInglish-speaking people are:"Angles" and "Americanos." Sometimes the Angles aremerely refereed to as "extranjeros" (foreigners) while theMexican-Americans reserve the term "tejalos" (Texans)for themselves Angles customarily refer to the Spanish-speaking population as "Mexicans" but also use the deroga-

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tory term "meskins." More outspoken Anglos use the face-slapping word "greasers."

The Mexican-American resents the economic dominanceof the Anglo and his associated air of superiority. A ma-jority of Mexican-Americans lack the educational back-ground to obtain well-paid work, and even those who arefully qualified for good jobs usually receive lower salariesthan Anglos earn for the same work. The Mexican-Ameri-can also resents the contempt for his customs shown by theAnglo. Some school authorities have punished Mexican-American children and threatened them with expulsion forspeaking Spanish on school premises.

The Anglo regards the Mexican-American as a childlike,undependable creature in need of paternalistic guidance.Many Anglos have expressed the opinion that "we knowbetter than the Meskin what Is good for him." They describethe Mexican-American as "unreliable," "superstitious,""morally lax," "ignorant," and "lazy." Anglo foremenasked to characterize the personality of their Mexican-American field workers typically described them as "lazy"although at the time of the questioning the field crew hadbeen working at exhausting stoop labor for hours without abreak. such misconceptions of the Spanish-speaking popu-lation are due to the Anglo's frequent failure to understandMexican-American customs and values as well as the Anglohope of remaining in control of a servile labor force. TheAnglo white-collar worker sometimes deprecates Mexican-Americans because he regards the educated members oftheir group as a threat to his job which may be taken awayfrom him and given to a lower-paid, darker-skinned em-ployee.

The Anglo stereotype of the Mexican-American is alsoapplied to the Mexican bracero who is looked down upon byboth Ang los and Mexican-Americans. The latter group re-gard both the bracero and the wet-back as economic threatslvcause they work for lower wages than U.S. cititent arewilling to accept. Mexican crop pickers are contemptuously

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called "mariachis" in Mexican-American circles. The Mex-ican-American's feeling of superiority to Mexican laborersis pdrt of a mixed feeling toward Mexico as a whole. He re-gards Mexico as the ultimate source of philosophical truthsand the center of the appreciation of beauty and the arts.But he is proud of his U.S. citizenship and his country'stechnological superiority over Mexico whose manufacturedgoods are automatically condemned as inferior.

The availability of cheap, bracero labor has forod manyMexican-Americans to join migratory labor crews that har-vest crops in the north. The wages of migratory laborers areso low that a man's wife and children must join him in har-vesting crops in order to earn enough money to feed andshelter the family. On returning to South Texas, the migra-tory laborers introduce new ideas from the north, while theold values of Mexican folk culture are simultaneously rein-forced by contact with the braceros.

The social relationship between Anglos and Mexican-Americans is changing with the economic advancement ofeducated Mexican-Americans and their gradual acceptancein Anglo circles. This trend is reflected in the increasingnumber of Mexican-Americans who live on the Anglo sideof the tracks and in marriages between members of the twogroups.

8

otia Rasa

THROUGHOUT THE United States, Mexican-Americans con-sider themselves members of "La Reza" which can be lit-erally translated as "The Race," but carries the bmadermeaning of a group of people united by common values andcustoms. In Mexico, the term "La Raze" carries strong con-notations concerning the spiritual strength of the Mexicanpeople. In the United States, Mexican-Americans use theterm to characterize themselves as a minority group withinthe context of United States 'ulture and to distinguish them-selves from the Anglo members of their particular com-munity.

Despite the common ties that bind "La Reza" together,the ethnic group manifests regional and local differences,which are recognized by the Mexican-Americans who havespecial terms for their fellows from various pal is of thecountry. In South Texas, the Spanish-speaking people fromNew Mexico are called "inanitos" and those from Cali-fornia are known as "pochos." In Mexico the term " pocho"is a derogatory word for a Mexican who emulates gringobehavior patterns. Mexican-Americans often call Mexicannationals "chicanos."

The concept of "La Raze" in South Texas embodies muchof the old value system derived from Mexican folk culture.Religion and group loyalty are focal values in this sys-

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tem. The ideal behavior pattern preg: ribed by the conceptstresses good manners, performance of religious duties, andobservance of high moral standards. Most Mexican-Ameri-cans feel that "La Raza" as a whole fails to live up to itsown standards. Some say that all members of the group aredestined to fail i.t the attempt to live up to their high ideals.Others say that "La Raza" is prevented from achieving itsgoals by a few bad men who become drunkards or "un-clean" individuals. These complaints are expressed in thephrases: "por unos perdemos to -los" (we all lose because ofthe faults of a few); and "la raza siempre tira al mal" (ourpeople always do wrong).

To become a respected member of "La Raza," the indi-vidual must develop certain character traits valued by thegroup. For among the traits essential to male prestigeis the qually of "machismo" or full development of manli-ness. A man display.- this quality by his sexual prowess,dignity, aloofness, and ability '.o stand up for his own rights.I le is the absolute master in his home. In male company heis ready to defend his opinions with force, if necessary, andnewt- retreats from an openly stated opinion. Any ii,sult oroffense must be avenged even though it takes years to repaythe injury. The "true man" pays back his enemy either bya direct. physical attack or by hiring a witch to perform amagical attack. The offense is never forgotten or forgiven.The Anglo custom of patching up a friendship by shakinghands afters row is viewed as lacking all elements of truemanliness. The Mexican-Lmerican man who strives for"machismo" must avoid displaying uncontrolled emotions,getting into ridiculous or humiliating situations, and in-dulging in offensive gossip. If a man must gossip, he does itby oblique analogy without naming or directly identifyingthe person he is talking about.

A woman cultivates the qt%'.:. quality of womanlinesswhich makes a man feel virile. She waits on her husbandand shows him absolute respect, for to do otherwise wouldbe a reflection on his manhood. She does not resent her sub-

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ordinate role or envy the independence of Anglo women,since her fulfillment lies in helping her husband achieve hispale. Female gossip is tolerated, and the Mexican-Ameri-can women of South Texas are as fond of this pastime astheir Anglo sisters.

The head of the family receives respect not only from hiswife and children but also from any visitor who crosses histhreshold. A visitor must never enter a home, be seated, ortake any other liberty until he is invited to do so. He mustnever question any statement made by his host or expressopinions of his own. So precious is the dignity of the indi-vidual that he is constantly on guard against those whowould lower it. He particularly mistrusts strangers whomight try to take advantage of him, and his fear has beenjustified by the vicious 'kick- back" system that prevails inthe employment of field hands.

Children are taught to defend themselves in a hostileworld in order that they will know how to maintain theirdignity as adults. The education of children takes place pri-marily in the home and stresses the teaching of proper con-duct in dealing with people in any social situation. Everychild must learn a complex system of etiquette which en-ables him to show respect for others while maintaining hisown dignity. He must also learn to be self-reliant in sup-porting himself and solving his own problems. He is taughtto refuse charity. Formal schooling constitutes a small partof the child's education. Among the lower classes, only afew years of schooling are regarded as necessary for a childbefore he goes to work in the fields to help his family earna livable income. The Mexican-American farm hand orfactory worker who feels destined to generations of handlabor sees no advantage in intensive schooling for his chil-dren. However, higher education is a major goal amongthe upper classes and part of the middle classes.

The man or woman who fulfills the ideals of 'La Raze"is rewarded in his later years with the title of "don" or"dofia" as in Don Pedro or Dofia Maria. In 16th century

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Spain, "don" was a title reserved for the nobility. Since fewnobles migrated to the New World, the title "don" came tobe used for Spaniards who achieved high prestige in Mex-ico. The Indians and lower-class mestizos applied the titleto their respected elders, and this usage was introduced inTexas during the era of New Spain. Today the title is earnedsolely on the basis of respected behavior with no referenceto wealth. A "don" may be rich or pour and many wealthyindividuals are not sufficiently respected in the communityto receive the title. Among those honored with donship area few of the older Anglos known for their honesty and theirrespect for Mexican-Americans.

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Social Organization

IN THE SMALL hamlets ("pueblitos") inhabited entirely byMexican-Americans there is no class hierarchy, although aloose distinction is made between the self-employed andthose who work for others. Prestige in these communitiesdepends almost entirely on whether or not the individuallives up to the ideals of "La Raza." Mexican-Americans liv-ing in towns and cities are divided into lower, middle, andupper classes based upon occupation, income, and familybackground. Although an individual may take pride in be-longing to one of the higher classes, his social status is stillevaluated according to the principles of "La Raza."

A. THE CLASS SYSTEM

The lower class consists of field hands, factory or canneryworkers, and servants. Their forefathers came from ruralareas in Mexico, bringing with them various patterns ofMexican folk culture, which persist in South Texas today.This class is the most resistant to new ideas which conflictwith the beliefs they have inherited from their elders. Lowerclass individuals most susceptible to change are the migra-tory workers who have gone to Michigan or other parts ofthe north and the small minority who have received a high

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school education. These individuals may become econom-ically motivated and try to move up into the middle class.

The middle class is in large part the result of immigra-tion from Mexico, but it is also filled by vertical mobilityfrom the lower class. The influx of Mexican fugitives fol-lowing the Revolution of 1910 formed a clearly-recogniz-able middle class, perhaps for the first time. Members ofthis class are referred to as being "de la media" (of the mid-dle) . They mix more with members of the lower class thanwith those of the upper class but attempt to retain their classdistinction through social distance. Close personal contactsbetween members of the lower and middle classes are com-mon only at formal ceremonials such as baptisms, wed-dings, and funerals.

Both an upner and a lower middle class can be distin-guished alibi, 411 this classification is not made by the lo-cal popuktion. The lower middle class is composed prima-rily of skilled workers who often own small repair or retailestablishments. These merchants may double as moneylenders or as migratory peddlers during the harvest seasonwhen they close their stores to follow the crop pickers. Theupper middle class consists of the larger merchants and thesuccessful operators of small farms who have risen from thelower middle category. Most families of the upper middleclass own an automobile and try to give their children ahigh school education. A few of these families see their chil-dren through college and even graduate school. Nearly allgovernment employees of Mexican descent come from theupper or lower middle class, depending on their educationand office position.

The upper class is descended from the original land grantfamilies who came from Mexico during the days of Spanishrule. During the Mexican-French war, a great many daugh-ters from upper class families married French bachelors,while others married Anglos who had moved into the Val-ley. These ladies were highly desired marriage partners be-

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cause they represented wealth and land and also becausethere was a surplus of males.

Loyalty to the traditions of Spanish colonial culture ischaracteristic of the upper class which values formal educa-tion stressing knowledge of the arts and languages. Mem-bers of the aristocratic families speak English, Spanish, andperhaps one or more additional languages with fluency.They send their children to parochial schools in order thattheir education will include religious instruction. Youngpeople of this class receive college degrees and many haveadvanced degrees in law or medicine. Others are successfulranchers, farmers, and businessmen. The upper class gen-erally relies on physicians for medical care.

Wealth is not a criterion for membership or prestige inthe upper class, although the majority of its members arefinancially comfortable. A man earns respect for his gentle-manly behavior and his knowledge rather than the size ofhis bank account. Consequently, the upper-class Mexican-American avoids Jose social ties with the Anglo upper classwhose philosophy of life he finds inadequate. Members ofthe upper middle class frequently try to climb into the up-per class but generally fail. Professional men who holdgraduate degrees may succeed. The upper class is small innumbers and scattered throughout the lower Rio GrandeValley. Their social L. -ions often involve driving to an-other town for visits or parties with other members of theirset. They tend to marry into families of their own class. Fewof them leave South Texas.

Mexican-American political leaders come primarily fromthe upper-middle and upper classes. They are usually well-to-do leaders in the professions who have political connec-tions throughout the Valley. Their goals are to obtainhigher economic and social standing for the Mexican-Americans through improved job opportunities and educa-tion. Their public relations program reminds the Anglopopulation of the wealth of Mexican tradition that enrichesthe Texas border culture. Mexican-American leaders are

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active in organizations such as the Good Neighbor Commis-sion, the League of United Latin American Citizens (LU-LAC), and the Board of Education. The role of leadershipin a Mexican-American community is never easy to fill be-cause compromise with the Anglo community may lead toa charge that the leader has betrayed the ideals of La Raza.Then the leader is likely to find himself without popularsupport.

The conflict between Anglo and Mexican-Americanvalues has produced a longitudinal split through all of theclasses mentioned above. In each class there is a large con-servative group dedicated to Mexican ideals, a modem ele-ment which eagerly adopts Anglo values and behavior pat-terns, and a few straddlers who try to accept values fr,r-iboth ethnic groups.

The conservative element looks down on the "inglesados"(the anglicized) and "agringados" (the gringoized) whoadopt Anglo values. The "inglesados" find themselves in anextremely uncomfortable social and psychological positionbecause they are seldom accepted by Anglos and they areheld in contempt by their own people. Their new Anglovalues come into direct conflict with the Mexican-Ameri-can values that they have been taught by their parents. Re-action to this situation varies. Some retreat back into thetraditional Mexican-American system and attack the Anglovalues they previously held. Others aggressively pushharder for complete Anglicization and ignore or ridiculethe Mexican-American traditions. This reaction often in-cludes conversion to Protestantism. Another out i3 physicalescape through migration to California, Michigan, or thebigger cities in Texas. A few individuals commit overt actsof rebellion that land them in jail or in mental institutions.

A small group of Mexican-Americans have succeeded intransferring from one way of life to another. They are com-pletely anglicized and. have abandoned the Spanish lan-guage. When they say "we," they are referring to membersof the Anglo-American society.

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4

B. THE FAMILY

The conflict between Anglo and Mexican-Americanvalues is nowhere more pronounced than in the differentconcepts of the family held by the two ethnic groups. TheAnglo democratic family with its concept of female equal-ity violates Mexican-American ideals. No respectable Mex-ican-American male would raise doubts about his masculin-ity by donning an apron and doing the dishes. In home,he alone gives the orders. His philosophy is summed up inthe saying "En mi case yo mando" (In my house I com-mand). As the father rules the family, the mother comfortsand encourages her husband and children. Within the fam-ily is found the strongest feeling of belonging. The Anglopractice of divorce and serial monogamy is regarded as im-moral and disgusting.

Outside the home, the Mexican-American husband en-joys extramarital freedoms that give the Anglo husband asense of guilt or sin. The Anglo concept of sexual fidelity inmarriage is foreign to Mexican-American culture whichbrands infidelity as a vice only when it involves neglect orabandonment of a man's family. A husband may have af-fairs with other women or even maintain a mistress in a sec-ond household known as a "case chica" (little household).Illegitimate children do not threaten the family line, forthey are not their father's heirs and hold no claim to hispurse. But if a man is of "good heart," he will help them fi-nancially when he can and go to their aid in case of trouble.

Parents are responsible for the physical welfare, morality,and education of their chidren. At an early age, the childlearns respect for his elders. IIe is taught good manners, so-cial, and religious obligations, the value system of "LaRaze," and the performance of everyday tasks. Parents stressthe view that proper conduct and intellectual attainmentsare far more important in life than the acquisition ofwealth. Above all, the child is taught to honor and defendthe family.

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Mexican-American parents gain increased respect as theygrow older, since age is venerated. The older a person is, thegreater his knowledge and wisdom, and the closer he is toGod if he has led a good life. Any disrespect shown to oldpeople is regarded as an offense against God which maybring illncss or misfortune on the culprit. Respect for theaged is a strong force for cultural conservatism since theolder generation tends to be the more conservative elementof the population.

Daughters must remain pure and untouched by scandalto protect the family honor and assure a good marriage. Par-ents see to this by pulling girls tightly into the family circleat adolescence when association with boys is largely avoidedexcept ac er the eyes of an elder. Adolescent girls have afew close girl friends with whom they play and gossip, butthey are never far from an older person's observation. Ex-ceptions to this behavior pattern are found among angli-cized families and in the bottom segment of the lower class.

Boys in their early teens begin to take up activities cen-tered outside of the home. They join informal gangs called"palomillas" (a play-group, literally "moths") where theylearn how to behave like men, defend themselves, and ac-quire skill in other elements of male culture. Within the"palomilla" each boy has an intimate friend ("amigo deconfianza") who represents his closest social tie outside thefamily.

Before marriage, children are expected to pay off theirindebtedness to the family. A young man takes a job whilehe is still living at home and turns over his earnings to hisfather, who gives him an allowance for cigarettes, beer, andother small luxuries. A daughter usually helps her motherwith the household tasks.

Marriage is a contract between families as well as be-tween individuals. No proper person would marry withoutthe consent and approval of the elders in his family. Heshould not marry below his family's class and prestige level.The Mexican-American family does not fragment into bio-

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logical units as the Anglo family does after marriage. Whena Mexican-American refers to his family, he inclades notonly his wife and children, but also his parents, grandpar-ents, uncles, aunts, and cousins.

Outside of the family, the closest social relationships arethe ritual kinship ties of the godparenthood system ("com-padrazgo") . Parents choose godparents for their children atthe time of baptism, first communion, and marriage. God-parents become the "compadres" of the godchild's parents."Compadres" are usually chosen from a slightly higherprestige or class level than that of the parents. Godparentsassume serious obligations to their godchild, while anequally important set of mutual obligations is establishedbetween the child's parents and godparents. Parents alwaysconsult their child's godparents before making any majordecisions affecting his welfare. "Compadres" call upon eachother for aid or advice in time of trouble or illness. The so-cial relationship between compadres is very formal. Todaythe mutual obligations of the " compadrazgo" system areweakening due to social and spatial mobility. A godparentwho has moved from South Texas to Michigan or joined aProtestant church cannot fulfill his duties.

C. INSTITUTIONAL AFFILIATIONSThe bonds of the extended family and the "compadrazgo"

system give the Mexican-American a sense of belongingthat makes it unnecessary for him to organize or affiliatewith civic activity groups, lodges, clubs, or secret societiescomparable to those of the Anglo community. The Mexican-American is no joiner. Attempts to organize the Spanish-speaking population on a permanent basis nearly alwaysfail. The main exceptions are church societies and city po-litical organizations, but even these groups are often short-lived. Women's clubs are practically unknown.

The idea of self-reliance prevents the Mexican-Americanfrom joining unions or mutual-aid societies. Officers of anyorganization are subject to suspicion of embezzlement orself-advancement at the expense of others.

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_Wealth and ilinem

THE ILLNESS of an individual is always a matter of concernfor the extended family. No member of a Mexican-Ameri-can family is regarded as ill unless the head of the familyagrees that he is. No major treatment is ever accepted for asick person unless the head of the family has approved of it.The health worker is not dealing with a single individualbut with an extended family which often includes distantrelatives and compadres.

A. CONCEPT OF ILLNESS

The family usually is reluctant to relinquish its respon-sibility for sick members and frequently resists hospitaliza-tion. The impersonal environment of a hospital or mentalinstitution seems cold and unpleasant to the Mexican-Amer-ican who values the affective interpersonal relations of hisfamily environment. Hospital schedules and unfamiliarfood are distasteful to the Mexican-American patient. Fi-nally, the hospital is feared as "a place where people go todie."

Mexican-American folk medicine diagnoses illness onthe basis of its natural or supernatural causation. Most men-tal illness is believed to be of supernatural origin. Diseasesof supernatural origin fall into three main categories: 1)those sent by God or a saint as punishment for misdeeds;

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2) those caused by witchcraft or the evil eye; and 3) frightsickness caused by seeing ghosts. These theories of diseaseare most prevalent among the lower classes but also per-meate the entire class system. Middle or upper class fami-lies and anglicized individuals often deride supernaturalconcepts of illness, but it is common practice for suchavowed skeptics to cite cases of witchcraft which they havewitnessed.

All local variations of Mexican-American disease theoryand treatment in South Texas cannot be described here, butthe general pattern will be presented. A variety of illnessesis believed to be the result of witchcraft. An individual whowants to harm his enemy may hire a witch who specializesin the magical causation of "darios" (harms). A leadingmotive for bewitchment is "envidia" or envy of the pros-perous individual who indulges in conspicuous consump-tion, to the discomfort of his less fortunate neighbors. Othermotives are sexual jealousy and the desire to avenge an in-sult.

Witch-sent illnesses are called "enfermedades mal pues-tas." The magical techniques for causing illnesses are sup-posed to be professional secrets known only to witches.Some herb stores sell books on black magic and the neces-sary paraphernalia to laymen, but the amateur is never surethat his magic will work, whereas most witches guaranteetheir results. Whether the magic is amateur or professiunal,there is always a method of notifying the victim that he hasbeen hexed, causing him to suffer from shock.

Mental illness is the most common form of disease in-flicted through witchcraft. There is a strong belief that cer-tain individuals are more susceptible than others to mentalillness, bewitchment, and venereal disease. The mental ill-ness called "demencia" (insanity) is said to come from an"aire"an evil element put into the air by a witchdi-rected at the rictim. Symptoms of demencia include am-nesia, hallucinations, and guilt or persecution complexes. Avictim of the most extreme form is called "loco de remate"

21

and is believed to be incurably insane. He is committed toa mental institution only if he becomes violent.

A milder mental disturbance caused by bewitchment iscalled "miedo" (fear). The victim is so frightened that heimagines seeing frightful things that do not exist and can-not be observed by normal people. The ailment known as"visiones" causes the victim to see visions of the menacingwitch and his client who are sometimes reported to leavetheir teeth marks or scratches on the patient's body. TheMexican-American distinction between these two witch-sent illnesses is that the victim of "miedo" just imagines see-ing things while the victim of "visiones" sees real visions ofthose who are harming him.

Evil-eye sickness ("mal de ojo") is caused unintentionallyby certain individuals who are born with a powerful magicforce in their eyes. When such an individual looks with ad-miration or desire at someone, his look releases an evil forcewhich enters the person's body and causes illness. If the in-dividual with the evil eye admires an object such as a vase,it may crack. Today, it is said in the Valley that people withthe evil eye have much "electricity" in them. The victimsof evil-eye sickness are usually children. Young animals arealso susceptible to this disease.

Fright from seeing ghosts is called "espanto" and the vic-tim is described as "espantado." Symptoms of this illnessare restlessness, sadness, nervous tension, dizziness, andweakness. The patient's mind end vision may both beclouded.

Natural illnesses are caused by i.nproper diet. emotionalupsets, night air, drafts, fatigue, and injuries. Any ailmentwhich seems minor at the outset is presumed to !le naturalillness amenable to treatment with home remedies. Butthere is always the passibility that v. stemingly natural ill-ness or injury, such as a broken arm, may have been causedby God as a punishment for immoral behavior. The illnessor injury may also be inflicted on the sinner's child to makehis parents realize that their wrongdoings harm others.

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Common emotional illnesses of natural origin are "susto"and "bilis." Susto is an illness caused by any natural frightsuch as seeing a poisonous snake or witnessing a murder.The symptoms are similar to those of "espanto" but muchless serious and easier to cure. The adult afflicted with"susto" suffers a general malaise and frequently has horri-ble dreams about the fright that made him ill. Symptoms ofthe disease manifested by children are crying, whining, sad-ness, insonn.,d, and nightmares. Tuberculosis is believed tobe a complication of advanced susto ("susto pasado") thathas not been treated. If the susto is cured, the tuberculosiswill respond to simple home treatment according to Mexi-can-American disease theory which does not classify tuber-culosis as a communicable disease. Most Mexican-Ameri-cans do not understand the medis-al insistence on isolatingcases of tuberculosis. This disease is called "tis" by the Span-ish-speaking population.

Strong anger ("co.-aje") causes the illness known as"bilis" which produces an overflowing of yellow stomachbile that results in diarrhea, vomiting, and sometimes a yel-lowish complexion. This concept is a survival of the Hip.pocratic theory that sickness results from an imbalance ofthe four bodily humors: blood, phlegm, choler (the yellowbile that causes anger), and melancholia (the black bilethat produces gloominess). An imbalance of the humors ischaracterized by an overheated or underheated body whichmust be restored to its normal temperature by proper diet.A sick person whose body is too "hot" must consume foodsand herb medicines classified as "cold," while a cold bodyneeds "hot" foods and medicines. The categories cf "hot"and "cold" have no references to the fidget temperature ofthe foods but refer to the supposed effects of the foods onthe human body. Hippocratic medicine was introduced intoMexico Ly the .Spaniards in the 16th century and is still abasic part of Mexican folk medicine but is of little signifi-cance in Mexican-American folk medicine of South Texas.Minor stomach upsets are believed to be caused by eoting

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too many hot or cold foods in most communities, but thehot-cold complex is completely lacking in some localities.

A draft called "un aire" or "un goipe de aire" can causea common cold or the flu which are both regarded as nat-ural diseases. Night air ("sereno") is dangerous to anybodyalthough it is especially dangerous to children. Particularcare is taken to see that no windows are open in the roomwhere a baby sleeps. A child's head must be covered if he istaken out at night.

Children are subject to a number of other ailments. Evenin his mother's womb, the unborn child must be protectedfrom dangers unknown to Anglos. An expectant motherfears that the full moon may injure her fetus causing it tobe born with a harelip or some other defect. To protect herchild, she may wear a string around her waist holding apiece of metal over her abdomen. A nursing mother whoagain becomes pregnant gives contaminated milk whichcauses the child to have digestive disturbance and anger.The mother is then called "chipilesa" and the child"chipil." Any emotional extreme experienced by a childmay endbner his health. Heart disease is believed to bepossibly a complication of anger or fright.

Any fall or bump suffered by an infant can cause the ill-ness known as "caida de in mollera" which occurs when thefontanelle "collapses" inward toward the brain. The fon-tanelle is regarded as a loose and movable thing becauseone can feel it throb. A baby's head is always carefullycushioned and protected to prevent fallen fontanelle. Thiscondition produces sadness and lack of appetite.

When a child becomes extremely thin and has a protrud-ing belly, he is called a "panz6n." The actual cause of thiscondition is usually intestinal parasites, but Mexican-Americans believe it comes from overeating.

13. TUE MEDICAL REFERRAL SYSTEM

When a minor illness presumed to be of natural origindoes not respond to home treatment with herb remedies,

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patent medicines, and prayers, outside help is sought. Loweror middle class families may solicit the aid of a neighboror compadre who has had some experience with curing ifthe patient does not seem too sick.

In the event that the patient still fails to improve, hisfamily may consult a diviner ("adivino") to determine thenature and cause of the disease. Diviners also sell their serv-ices to help locate lost objects or foretell the future. Afterdiagnosing the case, the diviner often recommends a specific"curandero" (folk curer) or undertakes treatment himselfif he happens to be a curer as well as a diviner. Upper classanglicized Mexican-Americans consult physicians, naturo-paths, or chiropractors instead of diviners or curanderos.

Professional physicians are viewed with suspicion andhostility by conservative members of the lower class whogenerally regard the germ theory of disease as a fraudulentscheme to help Anglo doctors and nurses extract exorbitantfees from the gullible. The Mexican-American skeptic inthis case reasons that genns which cannot be seen cannotexist. He often refers to germs as "animalitos" (little ani-mals). Furthermore, he knows that physicians lack theknowledge needed to treat illnesses of supernatural origin.He may even doubt the physicians's knowledge of naturaldiseases. He points out that a curandero "knows" how totreat a patient, but a physic:an has to consult books, col-leagues, or rely on x-rays to discover the cause of an ailment.A curandero petitions God and the saints for aid in the curebut a physician generally ignores the possibility of divinehelp. As one Mexican-American put it: "Doctors act asthough they know more than God who created them."

The typical physician and nurse fail b achieve the closeaffective relationship with Mexican-American patientswhich is so characteristic of curandero-client relations. Themost obvious reason for this failure is the language barrierbetween the Anglo physician or nurse and the Mexican-American patient who speaks little English. A second rea-son is the authoritarian relationship which the physician

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and nurse assume with the Mexican-American patients. Thepatient feels that the doctor and nurse are unconcerned withhis welfare, his feelings, and the obligation of his family.As a final insult, the physician may ridicule the patient'sself-diagnosis made in terms of folk disease theory.

The curandero maintains close relations with both theclient and his family. He patiently explains the cause andnature of the affliction and the reasons behind each stepof the treatment. These explanations are meaningful in thecontext of the Mexican-American world view and great in-terest is taken in them. The curandero often uses great skillin manipulating interpersonal relations within the familyso as to relieve pressures that produce stress and anxiety inthe patient. In several documented cases, curanderos havecured mental illness after psychiatric treatment has failed.

re conservative Mexican-American consults a physi-cian only as a last resort when all other curing techniqueshave failed. His attitude is comparable to that of an edu-cated Anglo who places his life in the hands of a faith healerwhen his physician has told him his disease is fatal and in-curable. Even as a last resort, the Mexican-American makeslittle or no attempt to understand the physician's diagnosisand treatment because he is used to carrying out orderswithout question in this type of role relationship with anAnglo.

The fact that many Mexican-American patients comeunder a physician's care only when the disease is far ad-vanced lowers the chances of a successful cure. Every failureto restore the health of a Mexican-American patient iswidely cited as evidence of the inefficiency of scientific med-icine. While the patient is under the physician's care, hisfamily continues to appeal for divine aid and administersfolk remedies to him at home if his case does not requirehospitaliPation. When the pt tient does not improve quickly,his family may transfer him to the care of another doctoror back to a curandero.

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C. CURANDERISMO

The term "curanderismo" refers to the entire system ofdisease theory and curing techniques associated with thecurandero whose healing powers are believed to be a divinegift from God. The curandero or curandera is a highly re-spected individual who often receives the honorific title of"don" or "dofia." Most curanderos Ieans some of their tech-niques from older folk curers.

Patients are received in the parlor of the curandero'shome which is furnished with an altar containing imagesand pictures of Christ and the saints. All cures involve of-ferings of flowers and vigil lights. Similar offerings accom-panied by prayers are made by the patient's family at hishome altar. By the altar, there is a container of holy water,frequently prepared merely by the blessing of thd curan-dero, who uses it in many of his treatments. While somecuranderos charge a standard fee for each treatment, othersmake no request for payment but expect the patient to leavea monetary offering on the altar before leaving. The amountleft is usually one dollar.

The general curandero handles a wide variety of casesbut specializes in diseases of supernatural origin, with theexception of bewitchment illnesses which are treated onlyby witches, spiritists ("espiritistas"), and spiritualists ("es-piritualistas"). Cases of critical illness usually are refusedby the general curandero who refers them to a physican ora hospital in order to avoid the legal embarrassment of hav-ing a patient die under his care.

Some curanderos also are believed to possess powers ofwitchcraft or black magic which are L.elieved to come fromthe Devil rather than from God. The witch-doctor is calleda "bnijo" or "bruja." lie is said to have the power to changehimself into an owl which can fly. Witches are feared anddisliked to the point of being physically attacked on occa-sions. It is believed that a witch who bleeds profusely froma wound will lose his evil powers.

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In addition to witches, there are a number of other spe-cialists including the midwife ("partera"), the herbalist("yerbero"), and the bone setter ("huesero"). Spiritist andspiritualist curers will treat almost any kind of illness buttheir services are sought maihry in eases of bewitchment.They must undergo an extensive period of training at cen-ters in Mexico or by taking correspondence courses in orderto become proficient in their curing techniques which aredifferent from those of the general curandero. They divineand cure with the aid of spirits of the dead. Their fees aremuch higher than those of the general curandero.

Any curandero must demonstrate his abilities by a seriesof successful cures in order to enjoy a large clientele. A nov-ice just starting in the business is suspected of being a frauduntil he proves that he is not. Unless his first cases are cured,he receives no more business and may be forcibly drivenfrom the community.

The most common tech Agues of curing practiced by thegeneral curandero are: "cleaning" the patient's body witha handful of medicinal herbs and an unbroken egg to drawout the contamination which is causing the illness; admin-istering herb teas; reciting prayers; and making offeringsof flowers and candies to God or the saints. The cleansing("limp+a") ritual is used to treat espanto, susto, evil eye,and some kinds of bewitchment.

The curandero's procedure may be illustrated by a typi-cal treatment for espanto. The patient suffering from thisdisease must be taken immediately ton curandero or witch-doctor who is skilled in treating espanto. The diagnosis isbased on the patient's pulse beat. The patient lies on a dirtfloor while the curandero outlines his figure in the earthwith a knife. After the sick person rises, the curanderoscoops up the dirt from the marks of the outline., mixes itwith water, and gives the mixture to his patient to drink.Next the patient drinks an herb tea made with a few sprigsof pennyroyal ("poleo") boiled in water. Finally, the cu-randero cleans his patient with a handful of herbs including

2b

1pennyroyal and rosemary ( "romero "). Throughout thetreatment the curandero recites the Lord's prayer andchants Hail Marys. This treatment must be performed dailyfor nine days or repeated three times a day for three days.During this period, it is the duty of the patient's family tourge the offending ghost to return to purgatory and seekeventual rest. God is asked to reclaim the ghost from thisworld. Prayers are accompanied by offerings and vigil lightsplaced on the home altar. The family tries to obtain a photo-graph of the man whose ghost is causing the illness. If theysucceed, the picture is sprinkled with fresh flowers dippedin holy water every day during the period of treatment Amuch simpler cure for fright from natural causes involvescleaning the ptitient with an unbroken egg and giving himherb teas.

Recovery from any serious illness may be effected througha patient's vow to make a pilgrimage to aholy shrine in re-turn for divine help. The most important shrine in Texasis that of Don Pedro Jaramillo, in Fulfurrias. The spirit ofthis dead curandero is now revered as a saint by thousandsof Mexican-Americans. Two popular pilgrimage centers inMexico are the shrine of the Virgin of San Juan de los Lagosin Jalisco and the shrine of El Chorrito in Nuevo Leon. Themost sacred shrine in Mexico is the Basilica of Our Lady ofGuadalupe.

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Recommenciaflorid

IMPROVEMENT OP health facilities and practices in SouthTexas presents the two-fold problem of gaining Mexican-American acceptance of scientific medicine without dis-rupting the social organization and creating unnecessarytensions.

New practices can be introduced in any society by: 1) at-tempting to make the new form compatible with the estab-lished value system of the receiving culture; or 2) attempt-ing to change that value system in order to replace it in partwith both the form and associated meaning of a complexconcept. Trying to "sell" people on both the form and mean-ing of an innovation is a difficult and time-consumingproc-ess which is likely to arouse hostility. In dealing with healthand welfare problems, the best approach is to begin withthe first method by adapting scientific medical services toMexican-American culture patterns. In due time, it may bepossible to increase the acceptance of modern medical the-cry without arousing widespread antagonism between theadvocates of scientific medicine and the advocates of Mexi-can-American folk medicine.

Specific suggestions for en integrated program of healthservice improvement among the Mexican-American popu-lation are presented below:

1. Improve communication between health workers and

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Mexican-American patients by making a concerted effort toovercome the language barrier.

Although the ultimate goal should be for all doctors andnurses who deal extensively with Mexican-American pa-tients to learn Spanish, the immediate goal can be limitedto: a) placing a few Spanish-speaking personnel in key po-sitions in every clinic and hospital; b) assigning house-callsto Spanish-speaking health and welfare workers; c) hiring ahealth or welfare department translator who would be oncall to accompany Mexican-American patients to the doc-tor's office; and d) improving the teaching of English in thepublic schools.

2. Increase knowledge and understanding of Mexican-American folk culture among health and welfare workers.

This immediate goal could be achieved by means of shortbut intense co-arses given periodically by an anthropologistwho has worked in South Texas. The course should includethe basic concepts of: culture, cultural relativity, cultureconflict, culture change, and culture integration. In apply-ing these concepts to Mexican-American culture, stressshould be placed on tho importance of observing the Latinrules of etiquette that govern the conduct of interpersonalrelations. Health and welfare workers must know how todeal with Mexican-Americans as individuals and as mem-bers of a family group without offending them. Referencebooks on Mexican-American culture should be available forthe professional staff.

3. Improve the physical appearance of the clinics, mak-ing them mor 4 attractive to Mexican-Americans so that theywill associate modern health services with pleasant sur-roundings.

The typically drab walls of the clinics could be paintedin pastel colors and decorated with simple religious sym-bols. Flower pots placed around the waiting rooms wouldappeal to the Mexican-American fondness for flowers.Where feasible, low background music featuring Mexicansongs would be appreciated. A comfortable reading room

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with pictorial magazines and literature on health problemsshould be provided for patients and the relatives who accom-pany them to the clinic.

4. Treat illness in addition to the practice of preven-tive medicine at those clinics where it is feasible.

The idea that one can prevent illness by certain healthprecautions is difficult to communicate to the many Mexi-can-Americans who still believe that any illness may have adirect supernatural origin. Such a fatalistic theory of diseasemakes no provision for preventive medicine, and indeed,may occasionally serve as a deterrent to modern publichealth practice since human attempts to thwart divine willare reguarded as sinful. This common belief that illnesses ofa supernatural origin cannot be prevented by any kind ofmedicine severely hampers the effectiveness of a publichealth clinic which is restricted to public education and pre-ventive measures. Despite the belief in supernatural causa-tion, once an illness is recognized it is the duty of the familyto seek treatment. To the extent that modern medicine candemonstrate curative effectiveness, the Mexican-Americanwill turn to it for help.

5. Show respect for Mexican-American beliefs abouthealth instead of ridiculing them as "superstitions."

Do not discourage or ridicule appeals for divine aid andthe use of herb teas which are certainly harmless and maybe beneficial. Suggest that the patient also try the phy-sician's recommendations in addition to these folk remedies.

6. Combat the notion that clinic patients are acceptingcharity.

This goal can be achieved by: a) charging a token pay-ment (e.g. 25 cents a visit) and giving the patient a receiptto prove that he did not accept charity; or b) hang signs onthe wall saying that this clinic is supported by the peoplethrough the taxes that they pay on income and luxuries.The Mexican-American value system prohibits the directacceptance of charity. Since the clinics are commonly asso-ciated with charity cases, the Mexican-American often feels

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that going to a clinic might make him lose face with hisneighbors.

7. Establish friendly doctor-patient and nurse-patientrelationships in place of the authoritarian relationship thatnow exists between the Anglo doctor or nurse and the Mexi-can-American patient.

The doctor or nurse should greet the Mexican-Americanpatient cordially, shake hands, and chat pleasantly withhim for a few minutes. The doctor should suggest treatment,not gibe orders.

8. Deal with the family as well as the patient.Encourage expectant mothers to bring an older female

relative with them to classes. Before treating illness, requestconsultation with the patient's parents and obtain the per-mission of the male head of the family to try a particulartreatment.

9. Protect the Mexican-American patient's strong senseof modesty.

Avoid physical exposure of the female patient before amale doctor and the male patient before a female nursewhenever possible. The same principles should be followedin instruction courses utilizing illustrations.

10. Pub !kite the advantages of scientific medicine.An occasional open house at the clinic should present

talks on modern medical facilities by respected Mexican-Americans, including patients who have been cured byscientific techniques. The open house should be a festive oc-casion accompanied by refreshments, mariachi or bandmusic, and movies. Conferences with priests and ministersshould suggest their advocacy of modern medical

11. Add a Mexican-American interviewer to the staff ofeach clinic and hospital to act as an intermediary betweenthe doctor and the patient.

The interviewer must be a respected local resident, prefer-ably one who holds the honorific title of "don" or "dofia."He should be the first member of the staff to receive the pa-tient and his family in a private room. The clink interview,

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conducted in Spanish, should obtain the patient's case his-tory including his self-diagnosis, symptoms, and previoustreatments for the present ailment. The interviewer thenaccompanies the patient to the nurse or doctor who merelygreets and examines the patient. The interviewer then de-scribes the symptoms to the doctor who in turn will explainthe recommended treatment to the interviewer. He returnsto the interview room with the patient, calls in the family,and explains each step of the recommended treatment interms that are meaningful to the Mexican-American. Heremains with the patient during the treatment given at theclinic. He would also accompany nurses and doctors onhouse-calls and make follow-up calls by himself to see thatthe treatment is being carried out. The hospital interviewerwould receive the patient and explain hospital proceduresto him on admittance. He would visit the patient daily andmake reports to his family. A curandero (but not a witch-doctor) would be the person most likely to have the pre-requisites for this job.

12. Clinic lectures should be given in Spanish in termsthat are compatible with the concepts of Mexican-Americanfolk medicine.

For example, penicillin can be described as a gift fromGod to man enabling man to help cure himself. Lectures ongerms should not be illustrated with cartoons. The existenceof germs can be most convincingly proved by live demon-strations with microprojection so that the "animalitos" canactually be seen. Displays of biological specimens are alsoeffective in illustrating talks. Lectures on nutrition shouldstay within the bounds of Mexican-American eating cus-toms and avoid recommending diets that the clinic patientcannot afford or finds distasteful. Clinics should not try toteach Anglo child-training practices which are incompat-ible with Mexican-American culture.

13. Atoka the Mexican-American patient more comfort-able in a hospital.

Allow his family to visit him for longer periods of time, if

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possible, and allow the mother of a hospitalized child to staywith him at night. Serve the patient Mexican-Americanfood or allow his family to bring him food. The "tasteless"quality of Anglo cooking in most hospitals is almost nauseat-ing to the Mexican-American. The availability of a hospitalaltar and holy pictures would also make him feel less appre-hensive. Children appreciate any kind of entertainment,such as television cartoons, in the hospital. The adult patientwho adheres to the concepts of folk medicine will have farmore confidence in the successful outcome of his hospitaltreatment if his curandero or the Mexican-American inter-viewer is allowed to visit him under a program of joint treat-ment supervised by the physician.

14. Improve relations between medical personnel andcuranderos.

Direct oral and legal attacks on curanderos should beavoided wherever possible. If curanderismo is driven under-ground it could become much more difficult to manage. Oneexcellent way to establish a working relationship with se-lected curanderos would be to give them brief courses per-mitting them to qualify as practical nurses. They could begiven impressive diplomas, allowed to wear uniforms oremblems, and given simple medicines such as aspirin fortheir patients. They could be taught to work with phy-sicians and to bring their patients to clinics and hospitals.Their cooperation in this way would undoubtedly increasethe : number of cases referred to physicians. Cooperation be-tween physicians and curanderos could be particularly valu-able in those cases of mental illness which would respond totreatment better in a home environment than in an institu-tion. The value conflicts often present in the Mexican-American ex-patient when he returns from the Anglo-oriented mental hospital to his home environment wouldbe minimized by the presence of a properly trained prac-tical nurse or social worker.

It may be impractical to apply all of these recommenda-tions simultaneously in any one area. The most suitable sug-

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gestions can be combined in drawing up workable programsadapted to local situations. If these programs increase Mexi-can-American confidence in modern medical services, thenPublic Health workers will be hi a much more favorableposition to explain the scientific bases of preventive medi-cine, sanitation measures, and disease treatment.

In concluding, it seems appropriate to emphasize the factthat U. S. culture is the product of peoples from many lands.Our Mexican-American heritage deserves understandingand respect. In this era of high divorce rates, mental break-downs, and suicides, we have much to learn from our Mexi-can-American citizens about family solidarity, child rear-ing, respect patterns, and religious values.

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