By Elizabeth Markowitz

“As always, as people, there are problems … perhaps they happen [as depression] but one does not know the form…” 

– Tzununá woman

How does major depressive disorder exist in a society lacking a word for it? I studied this question through the lens of the female experience of tristeza (sadness) in an indigenous Kaqchikel-speaking region above the shores of Lake Atitlán, Guatemala.

My research began with Carmelita (a pseudonym), who weeks after being diagnosed with depression lamented to me: “mi familia sólo piensa que soy una madre mala” (my family just thinks I’m a bad mother). Her words made me realize that suffering can result from a disconnection between native and non-native understandings of illness. I was a volunteer in a medical clinic at the time and could only listen, but I resolved to keep learning.

Four years later, I returned to Guatemala to study local conceptions of tristeza. I participated and observed: conversing with my host mother and her family and joining local activities; interviewed Santa Cruz women in the towns of Tzununá, Pajomel, and Chuitzanchaj; and conducted a “participatory photo-drawing-elicitation” focus group (using photographs the women took and pictures they drew) to visualize local definitions of sadness. I speak Spanish, but not Kaqchikel, so I hired a local translator, María Elena (a pseudonym).

María Elena shows an interviewee and her daughter how to use one of the cameras.

Participants observe their printed photographs before our focus group.

Analyzing my findings, I realized I needed to control for translation and other potentially skewing variables. I did so by discussing Kaqchikel linguistics, María Elena’s background, and my foreign knowledge base. Using this as an analytical lens, I concluded that there is a pathological strain of tristeza. My interviewees called it otra enfermedad (another sickness) in Spanish or ma ki ta ak’ uux (something that bores you) in Kaqchikel. It negatively impacts female emotional, psychological and physical functioning, sharing many characteristics with depression.

Oral responses, annotated by María Elena (in the center), surrounded by focus group participants’ “sadness” drawings. Top: a lifeless tree. Right and bottom: “solitary” and “lonely” faces. Left: “a little animal without a place to share with other animals”. [Descriptions: translated and condensed by author].

However, perhaps due to the poverty of the region, this sadness strain is often somatized – felt as pain in the heart and the stomach – and treated with natural herbs and over-the-counter medicines targeting these physical symptoms. Women encourage other women to drink purified water mixed with ruda (rue), and Sal de Andrews (Andrews Salts) or Alka-Seltzer, sold at local stores for just a few quetzales. Religion and social support are other tools for explaining and treating sadness, available to all women but the most stigmatized.

My findings led me to believe that individuals in most dire need of a boost back to their healthiest physical and psychological functioning should have access to Alka-Seltzer, Sal de Andrews and purified water as well as affordable therapy and anti-depressants. Psychiatric and psychotherapeutic tools can and should mold to local understandings of tristeza. A culturally empathic biomedical model, employing empathic clinicians, would enable this; as would collaborative anthropological, medical and psychological studies develop more effective healing tools.

Carmelita, María Elena and all the women who opened their minds and hearts to me made this research possible. They taught me that labels are only as valuable as the healing tools they unlock, and all work must start with a willingness to understand another’s point of view.

María Elena and I outside her friend’s home after finishing our research.