Mexican curanderismo

1. Introduction

Version followed: Mexican and Mexican American curanderismo as its teachers and scholars describe it. The main sources are the University of New Mexico curanderismo programme led by Eliseo "Cheo" Torres, Trotter and Chavira's insider ethnography (1980 article; 1997 book), and Mexican sources: Gaceta UNAM reporting the medical anthropologist Roberto Campos Navarro, Urióstegui-Flores (2015), and the Secretaría de Salud. The therapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI).

What it is. Curanderismo is a living folk medical system. It is not a psychotherapy. Torres teaches it at UNM as "traditional Mexican healing" with a holistic approach. Trotter and Chavira call it "a systematic body of healing theories rather than a mass cultural phenomenon," and they organise their account into material, spiritual and mental levels of healing. [source: https://dailylobo.com/article/2023/06/curanderismo-course-at-unm-dives-into-the-culture-of-traditional-healing] [source: https://experts.nau.edu/en/publications/curanderismo-an-emic-theoretical-perspective-of-mexican-american-/] [source: https://muse.jhu.edu/book/11414]

Practitioners. Curanderos and curanderas are general healers. The UNM course material covers hueseros (bone-setters), abdominal massage, fire cupping (ventosas), shawl alignments (manteadas) and care of infants and older people. Mexican health authorities recognise parteras tradicionales (traditional midwives). [source: https://www.coursera.org/learn/curanderismo-traditional-healing-body] [source: https://docs.bvsalud.org/multimedia/2025/05/15072/parteras-tradicionales-indigenas.pdf] The fuller set of specialist roles commonly listed comprises yerberos (herbalists), sobadores (masseurs) and oracionistas (prayer healers). [uncertain: not verified]

Illnesses. According to Gaceta UNAM, the main illnesses that traditional healers in Mexico treat are mal de ojo (evil eye), empacho (a digestive blockage), susto or espanto (fright), caída de mollera (fallen fontanelle) and mal de viento or aire. These conditions persist in rural areas and in cities, including Mexico City. [source: https://www.gaceta.unam.mx/el-empacho-y-el-susto-enfermedades-populares-vigentes/] A secondary source (university-hosted DSM-5-TR training slides) lists susto among DSM-5-TR cultural concepts of distress [uncertain: not verified against the APA text]. [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf]

Northern Mexico and the borderlands. Curanderismo norteño honours "Los Tres Grandes": El Niño Fidencio, whose followers make pilgrimages to Espinazo, Nuevo León; Teresita Urrea, "the Saint of Cabora"; and Don Pedrito Jaramillo. Torres reports that after an injury and a vision, Don Pedrito came to believe he had "a don, or a gift from God," to heal. [source: https://www.unm.edu/~cheo/Cheo%27s%20folk%20healing%20page.htm]

How change happens, as the tradition holds it. In this system, illness can come from physical, social and spiritual causes. Susto is held to separate the soul from the body. Aire is held to come mainly from cold wind and sudden changes in temperature. Mal de ojo is held to come from a strong or "hot" gaze. Healing restores balance and the soul, for example through a ritual cleansing (limpia). These are the tradition's explanations, given here without endorsing or dismissing them. [source: https://www.ucpress.edu/books/susto/paper] [source: https://www.redalyc.org/pdf/422/42241778011.pdf] [source: https://www.gaceta.unam.mx/el-empacho-y-el-susto-enfermedades-populares-vigentes/]

Your role. You do not perform limpias, susto cures, bone-setting, massage or temazcal (a traditional steam bath). Your work runs alongside them:

understand the client's explanatory model;
assess with the CFI;
tell a culturally normative experience from a disorder;
check physical safety, including lead-containing remedies and heat exposure;
collaborate with recognised healers when the client wishes;
help the client integrate the healing they choose.

Change in your work comes from a shared understanding of the problem and a plan that respects the client's healing pathway. [synthesis]

2. Framework

The tradition's own structure (attributed). Trotter and Chavira describe curanderismo on three levels, each with its own chapter: the material level, the spiritual level and the mental level. Their account comes from apprenticeships with curanderos and describes how the practice "is learned and passed on." [source: https://muse.jhu.edu/book/11414] The content of each level is not given here. [uncertain: not verified]

Who holds authority.

The community. Recognition rests with the community and the healer's clients. Healers often describe their calling as a don (gift). [source: https://www.unm.edu/~cheo/Cheo%27s%20folk%20healing%20page.htm]
University courses do not confer recognition. UNM course instructors state that the class is "not teaching people how to be a curandera." The Coursera course says learners "will not become certified traditional healers." [source: https://dailylobo.com/article/2023/06/curanderismo-course-at-unm-dives-into-the-culture-of-traditional-healing] [source: https://www.coursera.org/learn/curanderismo-traditional-healing-body]
Mexican law.
- Article 2 of the Constitution recognises traditional medicine as a right of Indigenous peoples.
- Article 6 of the Ley General de Salud (General Health Law) makes it an objective of the national health system.
- Articles 102–114 of the Reglamento (the regulations under that law) provide for authorised non-professional personnel, which gives traditional midwives a legal route into obstetric services.
- The Dirección de Medicina Tradicional y Desarrollo Intercultural promotes intercultural care, meaning care that respects body, mind and spirit and regional and ethnic diversity.
[source: https://docs.bvsalud.org/multimedia/2025/05/15072/parteras-tradicionales-indigenas.pdf]
The United States. No state licensing of curanderos was found. [uncertain: not verified]

The therapist's framework. This is not a published protocol. [synthesis]

Phase	Goal	Typical format	Move on when
A. Engagement and cultural assessment	Hear the problem in the client's terms. Give the core CFI, plus the informant version if a family member attends.	Sessions 1–2. APA gives no fixed time for the CFI; the field trial found later interviews "required less time." [uncertain: no minutes given]	You can state the client's name for the problem, its cause, the help they have sought (including curanderos) and what they expect from you.
B. Formulation and safety	Combine the cultural formulation with the DSM-5-TR or ICD-11 diagnosis. Screen physical risks (remedies, bone-setting, heat). Agree a shared plan.	Sessions 2–4	The client agrees with the formulation in their own words. Medical issues are routed to a physician.
C. Concurrent care and collaboration	Continue therapy alongside healing the client chooses. Liaise only with consent.	Ongoing; weekly or as usual for the disorder treated	Symptoms and functioning are tracked. Healing and treatment do not conflict, or a conflict is openly negotiated.
D. Integration and review	Make sense of the healing experiences. Review the explanatory model, relapse plan and help-seeking plan.	Final 2–3 sessions, then review	The client has a plan that names both the biomedical and traditional resources they will use.

You can use the 12 supplementary CFI modules at any point, including repeatedly. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]

3. Guiding principles

Neither endorse nor dismiss. Susto, mal de ojo, aire and empacho are real experiences of illness for the client. Describe them as the tradition holds them. In practice: no "superstition" language, and no claim that a limpia works by the mechanism the tradition gives. [source: https://www.gaceta.unam.mx/el-empacho-y-el-susto-enfermedades-populares-vigentes/]
Do not collapse the categories. Campos Navarro calls equating susto with post-traumatic stress, or empacho with gastroenteritis, "simplificador" (oversimplifying). In practice: assess comorbid disorders separately while keeping the client's name for the illness. [source: https://www.gaceta.unam.mx/el-empacho-y-el-susto-enfermedades-populares-vigentes/]
Expect pluralism. People move between traditional and biomedical care, especially when one fails. In practice: ask about all the help they have sought, each time, without judgement. [source: https://www.gaceta.unam.mx/el-empacho-y-el-susto-enfermedades-populares-vigentes/]
Authority lies with the community. Recognition comes from the community and the healer's don, not from courses. In practice: never refer to self-described healers who are known only through commercial courses or advertising, and never present yourself as a healer. [source: https://dailylobo.com/article/2023/06/curanderismo-course-at-unm-dives-into-the-culture-of-traditional-healing] [synthesis]
No ceremony content from you. In practice: you do not describe, teach or perform limpia steps, prayers or sacred objects. Clients find healers through their own families and communities. [synthesis]
Use the CFI to support decisions, not as the sole basis for a diagnosis. In practice: use it to inform, not to label. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Physical safety first. Lead-containing remedies, bone-setting complications and heat illness are documented harms. In practice: screen for them, and route to a physician without giving any advice on remedies or medicines. [source: https://www.cdc.gov/mmwr/preview/mmwrhtml/00000164.htm] [source: https://journals.sagepub.com/doi/ref/10.1177/00494755221122543]
Consent governs touch and liaison. Bodywork belongs to the healer and the client. In practice: you never touch as part of this work. Discuss consent, the right to stop and limits on intimate touch with the client as part of safety planning. [synthesis]
Take structural context into account. Healers have been "excluido de las políticas públicas" (excluded from public policy) in Mexico. Migration, language and racism shape how people seek help. In practice: ask about these factors, and do not read reluctance as resistance. [source: https://www.redalyc.org/pdf/422/42241778011.pdf] [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Children are seen by families and healers. Mal de ojo, empacho and caída de mollera mainly affect children, and in severe cases they involve dehydration. In practice: ask about the children's health and any urgent symptoms when you work with parents. [source: https://www.redalyc.org/pdf/422/42241778011.pdf]

4. Intervention inventory

Every item below is your own psychotherapeutic work, not a curanderismo procedure. Healing practices such as limpia, susto cures, bone-setting, massage, temazcal and herbal remedies are described only as context. Their steps belong to recognised healers. [synthesis]

4.1 Cultural humility and self-examination

Purpose: Notice your own assumptions about folk illness before they shape your assessment. These include "superstition", seeing the client as a "risk" for using a healer, and romanticising tradition. Use this before the first session and whenever you feel dismissive or fascinated. [synthesis]
Steps:
1. Write down what you believe causes susto, mal de ojo and aire, and where those beliefs come from.
2. Note any experience you have with Mexican and Mexican American communities, and the gaps in it.
3. Identify the language you will use. Ask the client which terms they prefer, such as susto or espanto, and curandera or señora.
4. Plan supervision or consultation for cultural blind spots.
[synthesis]
Example language (illustrative): "I am not an expert in your family's ways of healing. I would like to understand them as you do."
Watch for: Curiosity that turns into fascination with ritual detail, and questions about ceremonies the client has not raised. It is working when the client corrects you freely. [synthesis]

4.2 Core Cultural Formulation Interview (DSM-5-TR)

Purpose: Clarify the problem from the client's perspective and that of their social network: what it means, sources of help, and expectations. Use it at intake, especially when the client mentions susto, nervios, mal de ojo, envidia (envy) or a healer. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Steps: The 16 questions follow four APA domains. Ask them in your own conversational wording. Clinicians may reproduce the form for use with their own patients, but modifying or translating it needs APA permission.
1. Cultural definition of the problem (Q1–3): the client's name for the problem, how they would describe it to family, and what troubles them most.
2. Cultural perceptions of cause, context and support (Q4–10): causes, which may include susto, envidia, a strong gaze or a spiritual cause; stressors and supports; and the role of cultural identity.
3. Self-coping and past help-seeking (Q11–13): what they have done themselves, including home remedies, prayer, church and curanderos; and barriers, including cost, documentation status and language.
4. Current help-seeking (Q14–16): preferences, and the clinician–patient relationship, for example perceived racism or language barriers.
Record the client's terms verbatim. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Example language (illustrative): "Some people call what they feel susto or nervios. What do you call what is happening to you?" / "¿Qué cree usted que lo causó?" ("What do you think caused it?")
Watch for: Hesitation before mentioning a curandera. Probe gently, because people often under-report traditional care. The CFI is working when the client volunteers both the folk and the biomedical vocabulary. No minute estimate for the CFI was verified. [uncertain: not verified] [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]

4.3 CFI Informant Version with family

Purpose: Families often name the illness and choose the healer, especially for children. The informant version (17 questions) starts with the informant's relationship to the patient and then follows the same four domains. Use it when a parent, partner or grandparent is central to decisions. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
Steps:
1. Get the client's consent to involve the informant.
2. Interview the informant separately or jointly, as the client prefers.
3. Compare the explanatory models.
4. Note who decides on healer visits.
[synthesis]
Example language (illustrative): "Abuela, when you saw her like this, what did you think was happening, and what did the family do?"
Watch for: Disagreement between generations, for example a young adult who rejects a limpia that the family insists on. Treat this as a family process, not as "non-compliance". [synthesis]

4.4 CFI supplementary modules

Purpose: Explore in depth. There are 12 modules: Explanatory Model; Level of Functioning; Social Network; Psychosocial Stressors; Spirituality, Religion and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Patient–Clinician Relationship; School-Age Children and Adolescents; Older Adults; Immigrants and Refugees; Caregivers. They can be added to the core CFI or used standalone, at any point in care. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
Steps:
1. Use Spirituality, Religion and Moral Traditions when the client's understanding is Catholic, Fidencista (followers of El Niño Fidencio) or otherwise spiritual.
2. Use Coping and Help-Seeking to map healers and remedies.
3. Use Immigrants and Refugees for migration history and access to care.
4. Use Caregivers with a parent of a child treated for mal de ojo or empacho.
5. Use Older Adults with elders who hold the family's healing knowledge.
[synthesis]
Example language (illustrative): "Your faith seems important in how you understand this. Can you tell me how it helps, and whether it ever makes things harder?"
Watch for: Overloading early sessions. Choose one or two modules per session. [synthesis]

4.5 Kleinman explanatory-model questions applied to susto, mal de ojo, aire and empacho

Purpose: Elicit the client's model of the illness, so that you can negotiate a plan that makes sense to them. Kleinman, Eisenberg and Good (1978) set out these questions. [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]
Steps: In your own words, cover eight points [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf]:
1. what the client calls the problem;
2. what caused it;
3. why it started when it did;
4. what it does and how it works;
5. how severe it is and how long it will last;
6. what treatment they think they should receive;
7. the chief problems it has caused;
8. what they fear most.
Then summarise the model back to the client, and note where it overlaps with your formulation. For example, a frightening event, poor sleep and loss of appetite fit both susto and depression or trauma. [synthesis]
Example language (illustrative): "When the susto started after the accident, what did it do to your body and your sleep? What worries you most if it is not cured?"
Watch for: The client's model of severity. In Taxco, healers described severe susto and mal de ojo as potentially fatal, so fear may be high. The questions are working when the client's priorities show up in your treatment goals. [source: https://www.redalyc.org/pdf/422/42241778011.pdf]

4.6 Recognising cultural concepts of distress and comorbid disorder

Purpose: DSM-5-TR uses "cultural concepts of distress" for idioms, explanations or perceived causes, and syndromes. A secondary source lists susto, nervios and ataque de nervios among its examples [uncertain: DSM-5-TR list not verified against the APA text]. Use this when a client presents with one of these, so you neither pathologise the idiom nor miss a disorder. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf]
Steps:
1. Record the cultural concept as the client's idiom of distress or perceived cause.
2. Assess separately for depression, PTSD, anxiety and somatic symptoms, using your usual measures.
3. In the formulation, state both the cultural concept and any diagnosis, without equating them.
4. Explain the diagnosis in terms that leave room for the client's model.
This guide does not paraphrase the DSM-5-TR text on susto; consult the manual. [uncertain: not verified] [synthesis]
Example language (illustrative): "Many people who have susto also have trouble with sleep, nightmares or low mood that we can help with here. Your curandera may help with the susto in her own way."
Watch for: Treating susto as PTSD under another name. Campos Navarro calls that oversimplifying. Also watch for the opposite: missing suicidality or psychosis because "it is just susto". [source: https://www.gaceta.unam.mx/el-empacho-y-el-susto-enfermedades-populares-vigentes/] [synthesis]

4.7 Asking about healer consultation without judgement

Purpose: Learn which curanderos, hueseros, parteras, priests or pilgrimages (for example, to Espinazo) the client uses, so that care can be coordinated and risks seen. Ask at intake and at reviews. [source: https://www.unm.edu/~cheo/Cheo%27s%20folk%20healing%20page.htm] [synthesis]
Steps:
1. Normalise the question before you ask it.
2. Ask what the healer does, without asking the client to reveal prayers or ritual detail.
3. Ask what the client got from the visit and whether anything felt unsafe.
4. Ask whether they want you and the healer to know about each other.
[synthesis]
Example language (illustrative): "Many families I work with also see a curandera, a huesero or a priest. Has anyone like that helped you with this? You don't need to tell me anything private about what they did."
Watch for: The client expecting disapproval. Anthropologists report that people switch between traditional and biomedical care when one fails. Openness keeps both visible. [source: https://www.gaceta.unam.mx/el-empacho-y-el-susto-enfermedades-populares-vigentes/]

4.8 Remedy history and the lead-containing remedies greta and azarcón

Purpose: Find exposures that can cause serious harm, especially to children. CDC reports describe the following. [source: https://www.cdc.gov/mmwr/preview/mmwrhtml/00000164.htm] [source: https://www.cdc.gov/mmwr/preview/mmwrhtml/00021165.htm] [source: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5131a3.htm]
- Azarcón (lead tetroxide) and greta (lead oxide) are fine powders containing roughly 70% to over 90% lead.
- They were given mainly to infants and children for gastrointestinal illness, including chronic diarrhoea.
- They were sold by herb shops and folk healers on both sides of the US–Mexico border.
- In 1982 a 3-year-old in California died with seizures after azarcón treatment; lead encephalopathy was suspected.
- In California in 1991–1992, 40 children aged 8 months to 5 years had blood lead levels of 20–86 µg/dL after traditional remedies; 36 of those cases involved greta or azarcón.
- In 1999–2000, a greta sample from one home contained 770,000 ppm of lead, and two siblings needed chelation.
Gastrointestinal illness of this kind matches what families may call empacho. [synthesis]
Steps:
1. Ask about remedies by their common names, since families may not think of them as "medicines" and may deny using them at first. Also ask about imported candies and pottery, which CDC also lists as lead sources.
2. If the client or family reports any use, or you are uncertain, route them to the child's physician or a public-health lead programme for blood lead testing, with consent.
3. Do not advise starting, stopping or substituting any remedy or medicine. Route those decisions to the prescriber or physician.
4. Record the conversation.
[source: https://www.cdc.gov/mmwr/preview/mmwrhtml/00021165.htm] [source: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5131a3.htm]
Example language (illustrative): "When children have empacho or stomach trouble, some families use powders like greta or azarcón. Has anyone in the family used these? Some of them contain a lot of lead, so I'd like the doctor to check, without any judgement about why they were used."
Watch for:
- CDC notes that many children with high lead levels had no symptoms, so the absence of symptoms is not reassuring.
- Shame or fear of authorities: explain why you are asking.
- It is working when the family accepts testing and keeps their relationship with you.
[source: https://www.cdc.gov/mmwr/preview/mmwrhtml/00021165.htm]

4.9 Physical-practice safety screening: hueseros, abdominal massage, ventosas and temazcal

Purpose: Bodywork and heat practices are the healer's work, carried out with the client's consent. Your role is to support safety and informed choice. Use this when a client reports an injury treated by a huesero, abdominal massage, cupping or temazcal use, or plans to have any of these. [source: https://www.coursera.org/learn/curanderismo-traditional-healing-body] [synthesis]
Steps:
1. Bone-setting. A 2023 systematic review in Tropical Doctor covered 12 studies with 833 participants, mainly from low- and middle-income countries, and reported "limb and life-threatening complications including mortality" after fracture treatment by traditional bone-setters. Encourage medical assessment, including an X-ray, of any suspected fracture or dislocation, without disparaging the huesero. That review was not specific to Mexico. [source: https://journals.sagepub.com/doi/ref/10.1177/00494755221122543]
2. Heat. Temazcal is a steam or sweat bath, and heat is a documented hazard of sweat lodges. At a 2009 commercial self-help retreat near Sedona, Arizona (not an Indigenous-led ceremony), three participants died: two of heat stroke and one of organ failure from hyperthermia. Dozens more fell ill or collapsed after participants were reportedly urged to push past their limits. Ask about cardiac, respiratory and kidney conditions, pregnancy, medications that affect heat tolerance, and alcohol use. Route medical clearance to the client's physician. Do not give temperatures or durations. [source: https://www.cbsnews.com/news/sweat-lodge-autopsies-two-died-from-heat-stroke-one-from-organ-failure-at-tragic-arizona-retreat] [synthesis]
3. Cupping. Complications of ventosas are not documented in the cited sources; burns are a plausible risk with fire cupping. [uncertain: not verified]
4. Touch and consent. Review the client's rights with any bodywork: explicit consent before and during, the right to stop at any time, and no sexual or genital touch. Abdominal or pelvic work, including by parteras, should be explained and agreed in advance. You do not touch the client as part of this work. [synthesis]
Example language (illustrative): "It is your choice to go to the temazcal. Because of your heart condition, would you be willing to ask your doctor first? And remember you can always leave if you feel dizzy or unwell. A good leader will respect that."
Watch for:
- Leaders who discourage leaving, shame participants or pressure endurance. These were features of the Sedona deaths.
- Untreated deformity or worsening pain after bone-setting.
- Any touch the client describes as sexual. That is a safeguarding matter (see 4.15).
[source: https://www.cbsnews.com/news/sweat-lodge-autopsies-two-died-from-heat-stroke-one-from-organ-failure-at-tragic-arizona-retreat] [synthesis]

4.10 Distinguishing normative spiritual experience from disorder

Purpose: Avoid two errors: pathologising experiences that are normative in the client's tradition, such as feeling a deceased relative's presence, spiritual explanations of susto, devotional practices around El Niño Fidencio, or a healer's sense of a don; and missing psychosis, mania or dissociative disorder. [synthesis]
Steps:
1. Ask whether the client's family and community regard the experience as normal or as a problem.
2. Use the diagnostic exclusions:
  - DSM dissociative identity disorder: identity disruption "may be described in some cultures as an experience of possession," but the disturbance must not be a normal part of a broadly accepted cultural or religious practice.
  - Dissociative trance: excluded when it is a normal part of accepted collective cultural or religious practice.
  - ICD-11 6B62 trance disorder and 6B63 possession trance disorder: require the state to be involuntary and unwanted, and not part of accepted cultural or religious practice.
  [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]
3. Look for distress, impairment, involuntariness, symptoms that persist outside religious or healing contexts, and features that the community itself considers abnormal.
4. Consult a cultural broker or community member, with the client's consent.
DSM-5-TR's exact wording on these points, and its note on culturally sanctioned beliefs versus delusions, is [uncertain: not verified].
Example language (illustrative): "In your family, when someone feels a loved one's presence like this, is that seen as normal, or as something that needs help?"
Watch for:
- The client's own sense that "this is different", and family concern.
- Experiences that are worsening, intrusive or command-like.
- It is working when the client feels believed and you have enough information to decide on a diagnosis.
[synthesis]

4.11 Collaboration and referral with community-recognised healers

Purpose: Coordinate care when the client wants their curandera, partera or other healer involved. Use this only at the client's request. [synthesis]
Evidence on collaboration: Trials of collaboration with traditional and faith healers come from other regions. [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839] [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]
- COSIMPO (Gureje et al., The Lancet, 2020) was a trial in Nigeria and Ghana. Shared care between healers and primary care for psychosis reduced symptoms more than usual care (adjusted PANSS difference −15.0). Harmful practices also fell.
- The Ghana prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)) added psychiatric medication to prayer-camp care. Symptoms fell, but days in chains were not significantly reduced.
- Neither trial was done with curanderos. That collaboration would work the same way in this tradition is [synthesis].
Steps:
1. Ask whether the client wants contact, and in what form: none, a letter, a call or a joint meeting.
2. Get written consent that states what may be shared. Share the minimum: the goals and the safety concerns.
3. Ask the client how the healer is known in their community, for example through family and reputation. Do not use advertising or course certificates as recognition. In Mexico, traditional midwives can be authorised through the state health system, and health services there are asked to integrate parteras under an intercultural model. [source: https://docs.bvsalud.org/multimedia/2025/05/15072/parteras-tradicionales-indigenas.pdf]
4. Agree with the client on roles: the healer's spiritual and traditional care, and your psychological care and risk monitoring.
5. Agree in advance what happens if safety concerns arise.
[synthesis]
Example language (illustrative): "If you'd like, I could write a short note to Doña ___ saying we are working on your sleep and your fears, and asking her to let us know if she is worried about you. Only with your permission."
Watch for:
- Healers who advise stopping prescribed medicine or medical care. Discuss this with the client and route it to the prescriber.
- Payment pressure.
- It is working when the client experiences one coherent plan.
[synthesis]

4.12 Interpreters and cultural brokers

Purpose: Language barriers are a named part of the clinician–patient relationship domain of the CFI. Many clients prefer Spanish or an Indigenous language. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Steps:
1. Use trained interpreters, not children.
2. Brief the interpreter beforehand that terms such as susto, espanto, aire, mal de ojo, empacho and limpia should be kept, not translated as "fright" or "cleaning".
3. Ask the client whether they know the interpreter, given the confidentiality risks in small communities.
4. Consult a cultural broker, with consent, when the meaning is unclear.
[synthesis]
Example language (illustrative): "Please keep the client's own words like espanto. I'd rather ask what they mean than lose them in translation."
Watch for: An interpreter who minimises or ridicules folk terms, and a client who goes quiet. [synthesis]

4.13 Integrating healing experiences

Purpose: Help the client make meaning of a limpia, a susto cure, a pilgrimage or a temazcal in relation to their therapy goals. Use it after a healing experience the client brings up. [synthesis]
Steps:
1. Invite the client to describe what they want to share, but do not ask about prayers, objects or ritual steps.
2. Ask what changed in their feelings, body, sleep and relationships.
3. Link the changes to goals, for example the sense of having "recovered" after a susto cure and their re-engagement with work.
4. Note any distress the experience raised, and plan for it.
[synthesis]
Example language (illustrative): "You said you felt lighter after the limpia. What has that lightness made possible this week?"
Watch for:
- Using the healing experience to avoid trauma-focused work that the client has agreed to.
- Disappointment when the healing "didn't work". Normalise switching between kinds of care, a pattern Mexican researchers describe.
[source: https://www.gaceta.unam.mx/el-empacho-y-el-susto-enfermedades-populares-vigentes/] [synthesis]

4.14 Working with parents and families of children

Purpose: Mal de ojo, empacho and caída de mollera mainly affect infants and young children in the tradition's account. Reported signs include crying, diarrhoea, vomiting and, in mal de ojo, fever and dehydration. Use this when parents describe these illnesses. [source: https://www.gaceta.unam.mx/el-empacho-y-el-susto-enfermedades-populares-vigentes/] [source: https://www.redalyc.org/pdf/422/42241778011.pdf]
Steps:
1. Respect the parents' framework.
2. Ask about warning signs: persistent vomiting or diarrhoea, poor feeding, lethargy, a sunken fontanelle or fever. Advise same-day medical review for any of these.
3. Screen for lead-containing remedies (4.8).
4. Use the CFI Caregivers module for the parent's own stress.
5. Do not name or identify children in collaboration notes beyond what consent allows.
[synthesis] Campos Navarro describes a traditional check for empacho that is followed by biomedical care if it is negative. This shows that families themselves combine the two systems. [source: https://www.gaceta.unam.mx/el-empacho-y-el-susto-enfermedades-populares-vigentes/]
Example language (illustrative): "You know your baby best. Alongside what the señora is doing for the ojo, if she isn't drinking or is very sleepy, please take her to the clinic today. Both can happen."
Watch for:
- Delayed medical care for dehydration in infants. Healers in Taxco described severe cases as potentially fatal.
- Fear that the clinic will dismiss the family.
[source: https://www.redalyc.org/pdf/422/42241778011.pdf] [synthesis]

4.15 Safeguarding

Purpose: Respond when any practice harms the client or a child. Examples include lead poisoning, sexual misconduct during bodywork, coercion in heat ceremonies, financial exploitation and delay of urgent medical care. [synthesis]
Steps:
1. Separate the tradition from the harm. Most traditional care is not abusive, and abuse can hide behind tradition.
2. Assess the client's immediate safety.
3. Follow your jurisdiction's duties to report child abuse or neglect. CDC asks health professionals to report azarcón- and greta-associated lead poisoning.
4. Support adult clients in reporting sexual misconduct.
5. Document carefully.
[source: https://www.cdc.gov/mmwr/preview/mmwrhtml/00000164.htm] [synthesis]
Example language (illustrative): "What you describe isn't part of any healing you agreed to. You have the right to say no, and I'd like to help you decide what to do next."
Watch for:
- Secrecy demanded by a healer.
- Fees that escalate with fear ("the curse will return unless...").
- Touch to intimate areas presented as treatment.
[synthesis]

4.16 Structural, migration and historical context

Purpose: Address the conditions that shape how clients seek help. These include healers' exclusion from Mexican public policy, migration stress, documentation status, racism in services, and the inherited knowledge of grandparents. Use this throughout, guided by the cultural identity and clinician–patient relationship parts of the CFI. [source: https://www.redalyc.org/pdf/422/42241778011.pdf] [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Steps:
1. Ask about past experiences of being dismissed by health services.
2. Ask about the client's identity and generation, for example whether they are recent migrants or Mexican American.
3. Ask about what was lost or kept in the family's healing knowledge. The UNM course frames curanderismo as helping students understand "why their ancestors" acted as they did.
4. Name racism openly when the client raises it.
[source: https://dailylobo.com/article/2023/06/curanderismo-course-at-unm-dives-into-the-culture-of-traditional-healing] [synthesis]
Example language (illustrative): "Sometimes people have been made to feel foolish by doctors for mentioning susto. Has that happened to you? I'd like this to be a different experience."
Watch for: Reluctance that reflects past dismissal rather than lack of motivation. It is working when disclosure deepens over the sessions. [synthesis]

5. Handling problems

The sources do not address these problems directly. Unless a source is cited, the guidance is [synthesis].

Client won't mention the curandera, or denies using remedies. CDC reports that families may first deny using greta or azarcón and may not consider them medicines. Response: ask by common names, normalise the question, explain your safety reason, and return to it later rather than pressing. [source: https://www.cdc.gov/mmwr/preview/mmwrhtml/00021165.htm]
Client expects you to cure the susto or perform a limpia. Response: say plainly that you are not a healer in that tradition. Describe what you can offer, such as help with sleep, fear and grief, and support the client's choice of a recognised healer.
Stuck: "the limpia didn't work and therapy isn't working." Response:
1. Revisit the explanatory model (4.5).
2. Reassess for a missed disorder, such as depression, PTSD or a medical cause.
3. Check adherence to both forms of care.
4. Ask the client what their family would try next. Switching between systems is common.
[source: https://www.gaceta.unam.mx/el-empacho-y-el-susto-enfermedades-populares-vigentes/]
Resistance as protection of the tradition. A client may defend curanderismo against perceived criticism. Response: acknowledge any dismissal they have experienced from you or from services, and repair it explicitly (4.16).
Rupture after you raise a safety concern about lead, a fracture or temazcal. Response: name the tension, affirm respect for the tradition, and separate the specific risk from the practice as a whole. Offer the client the choice of how to proceed, keeping in mind any mandatory duties.
Overwhelm or retraumatisation. For example, intense memories surface after a susto cure or a pilgrimage. Response: use grounding and stabilisation, slow the pace of trauma work, and consider whether the client wants their healer's support as well.
Non-adherence to prescribed medicine because a healer advised stopping. Response: do not adjudicate. Explore the client's reasons, and route the medication discussion to the prescriber. Offer to share information with the healer, with consent (4.11).
Heat-ceremony or bodywork pressure. Response: rehearse the client's right to leave or stop. Arrange medical clearance through their physician. Treat coercion or sexual touch as a safeguarding matter (4.15). [source: https://www.cbsnews.com/news/sweat-lodge-autopsies-two-died-from-heat-stroke-one-from-organ-failure-at-tragic-arizona-retreat]
Commercial or self-styled "curanderos" with large fees, online-only credentials or demands for secrecy. Response: help the client check the healer's standing through their own family and community. University courses state that they do not certify healers. [source: https://www.coursera.org/learn/curanderismo-traditional-healing-body]
Family disagreement, for example parents insisting on remedies for a child or an adult child rejecting tradition. Response: use the CFI Informant Version and family sessions (4.3) to make the competing models explicit. Keep children's medical safety non-negotiable (4.14).
Diagnostic uncertainty about spiritual experiences. Response: apply the cultural exclusions in DSM and ICD-11 (4.10), consult a cultural broker, and review over time instead of deciding in one session. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]
Your own discomfort, whether scepticism or fascination. Response: take it to supervision, and revisit 4.1.

Sources

Web sources

Books and articles cited

Trotter RT, Chavira JA (1997). Curanderismo: Mexican American Folk Healing. University of Georgia Press.
Trotter RT, Chavira JA (1980). Curanderismo: an emic theoretical perspective of Mexican-American folk medicine. Medical Anthropology 4(4):423–487.
Rubel AJ, O'Nell CW, Collado-Ardón R. Susto: A Folk Illness. University of California Press (paperback edition 1991; original publication year [uncertain: not verified]).
Kleinman A, Eisenberg L, Good B (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88:251–258.
Gureje O et al. (2020). COSIMPO cluster randomised trial. The Lancet.
Ofori-Atta A et al. Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial. British Journal of Psychiatry 212(1). The publication year is given variously as 2018 or 2019. [uncertain]

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