Ethnomedical and biomedical realities: Is there an epidemiological relationship between stress-related folk illnesses and type 2 diabetes?

Applied medical anthropologists often find themselves working as culture brokers between community and/or patient groups and biomedical providers/public health institutions, where conflicting ethnomedical and biomedical realities can cause tension. In this paper, we examine ethnomedical perceptions of the role of folk illnesses in the etiology of diabetes. We operationalize the biomedical perspective as epidemiological patterns and explore whether ethnomedical perceptions about diabetes etiology can be demonstrated epidemiologically. The motivation for the study was the realization that if an ethnomedical diagnosis of a folk illness such as susto (fright) and/or nervios (nerves) increased the risk for diabetes, there might be important implications for biomedical screening for this disease. Anthropological studies suggesting that folk illnesses and diabetes may be associated have not actually tested for an association; their conclusions rely solely on patients' reports of a causal link. Here, we use a case-control design, similar to Rubel, O'Nell, and Collado-Ardon's (1984) study on susto, to test for an association between having had a folk illness and developing diabetes. This methodological approach, with a comparative study design, may prove useful to other applied medical anthropologists concerned with understanding relationships between ethnomedical and biomedical realities.