Susto as a Culture-Bound Illness


Susto is a culturally defined mental health disorder that occurs among the Hispanic population in Central and South America, as well as among Hispanic settlers in the United States. The word «susto» means as a fear that poses a sudden threat (Black, 2018).

When this disease takes on a more severe and potentially lethal form, it is called «espanto», which is translated from Spanish as a terror or intense fear. It is also sometimes called «perdida del alma» or «chibih» (Black, 2018). Susto is considered a culture-bound disease which has a strong psychological connotation and social background.

This disease can be experienced by all genders and age groups. However, most often, adults suffer from it, especially young women. It is considered the social disorder since adults most often have this alignment, although there have been cases of illness in children (Black, 2018). The onset of the disease is generally the same: a sudden fear.

Cultural Context of Illness

Susto occurs in some cultures in Latin America, mainly among the Quechua people in the highlands of the Andes (Black, 2018).

The peoples of Central and Latin America believe that a person becomes ill when the soul leaves his or her body as a result of some terrible life episode (Moreira et al., 2018).

Although susto happens in individuals of different genders and age groups, it is most often found in young women of Latin America.This illness is attributed to a magical event, for example, a contact with supernatural forces, such as a witch or a devil, which frightens a person (Moreira et al., 2018).

The role of cultural factors in the etiology, manifestation, course, and outcome of this psychological disorder has been established (Moreira et al., 2018). It is therefore not surprising that certain cultural settings and traditions are associated with this illness.

Possible Causes of Susto

A sudden dog’s barking.

Falling from a horse.

Staying at a hospital room where a patient died.

Meeting with a ghost in a dream.

Social or community violence.

A situation that causes fear or anger.

Researchers have found that susto symptoms do not always begin immediately after a traumatic episode (Yahalom, 2019). The event that has caused the disease may occur several years before its onset.

There is a widespread belief that susto cannot disappear by itself and, if untreated, can lead to death (Yahalom, 2019). The illness can last from several months to several years. Although people are slowly fading away, doctors or healers do not find physical signs of illness or injury.

The Symptoms of Susto

Depression, Apathy, Loss of appetite, Loss of weight, Weakness, Fatigue, Lethargy, Sleep disorders.

Susto is characterized by depression and apathy which are believed to indicate the loss of the soul. Its symptoms include loss of appetite, weakness, fatigue, sleep disorders, loss of weight, apathy, and lethargy. The person does not pay attention to personal hygiene and is unable to perform normal daily duties.

The local understanding of these usual symptoms has an interesting and unusual cultural background. The Quechua Indians believe that during the fall, the soul leaves the body and becomes captive to the ground (Pérez-Nicolás et al., 2017).

What do Researchers Think

Many doctors and researchers liken susto to PTSD, with which it has many similarities. It is a culturally significant syndrome of anxious hysteria, which allows the patient to gain recognition (Yahalom, 2019).

Arthur Rubel describes this syndrome, it begins with an intense feeling of fear. It is followed by a loss of appetite and weight, pallor of the skin, fatigue, lethargy, untidiness, and intense thirst (Yahalom, 2019).

Ari Kiev suggests that susto is an anxiety disorder caused by unacceptable impulses that make the individual dependent on defense mechanisms such as projection, isolation, and displacement (Yahalom, 2019).

The scholars also argue that susto makes it possible to play the role of a sick person, which brings significant secondary benefits in the form of manifestations of attention and love (Yahalom, 2019). The development of susto in children can occur due to a sense of insecurity and fears associated with abandonment.

Relationship between Social Context and Illness

Some scholars argue that modern Western classification schemes cannot be used to understand culture-bound disorders since they are perceived from a qualitatively different point of view.

Wolfgang Pfeiffer states that the cultural interpretation of exceptional behavior is linked to culture-specific treatment interventions. For example, interventions to treat the loss of soul associated with susto involve the local healer making sacrifices to pacify the earth and force it to reclaim the soul (Moreira et al., 2018).

Local systems of healing can be more effective because they operate within the framework of a particular culture’s worldview. For example, a spiritual ritual performed by a local healer may prove to be a more successful treatment for culture-bound susto syndrome than the cognitive behavioral approach commonly used in the United States (Moreira et al., 2018).

Local Healing Ceremonies

Susto is mainly treated by curandero, the healers of Latin America. It is believed that curandero heals people with the help of supernatural powers (Pérez-Nicolás et al., 2017).

The most effective treatments are thought to be ceremonies known as limpieza or barrida (Pérez-Nicolás et al., 2017).

Local healers called curandero must receive the appropriate training and initiation to be able to cure psychological and physical diseases (Pérez-Nicolás et al., 2017). The ceremonies of healing are best done immediately after the traumatic event by a good curandero (Pérez-Nicolás et al., 2017). During these ceremonies, the patient tells all the details of the event lying down on a crucifix located on the ground. Curandero dresses up the crucifix with aluminum foil or other shiny materials. Then the body of the patient is rubbed with bouquets of fresh herbs such as basil, purple sage and rosemary, while the curandero and other participants begin to read prayers (Pérez-Nicolás et al., 2017). Depending on local customs, the curandero can also jump over the patient’s body. This is done in order to call the frightened soul back into the body. After the ceremony, the patient has to drink mint tea. Usually, the procedure is carried out for three days, at the end of which the soul must return to the body.


Susto is seen as a unique cultural manifestation of universal primary fear responses. In Latin America, where this kind of mental health disease occurs, there is a tendency to combine culturally specific methods and concepts to create unique systems of healing.

Society shapes the perception of mental disorder both in determining the manifestation of symptoms and their treatment. Thus, recognizing the role of social context in the formation of pathological behavior requires that the methodology for assessing and treating individuals with mental disorders be revised.


Black, J. K. (2018). Latin America: Its problems and its promise: A multidisciplinary introduction. London, England: Routledge.

Moreira, T., Hernandez, D. C., Scott, C. W., Murillo, R., Vaughan, E. M., & Johnston, C. A. (2018). Susto, coraje, y fatalismo: Cultural-bound beliefs and the treatment of diabetes among socioeconomically disadvantaged Hispanics. American Journal of Lifestyle Medicine, 12(1), 30- 33. Web.

Pérez-Nicolás, M., Vibrans, H., Romero-Manzanares, A., Saynes-Vásquez, A., Luna-Cavazos, M., Flores-Cruz, M., & Lira-Saade, R. (2017). Patterns of knowledge anduse of medicinal plants in Santiago Camotlán, Oaxaca, Mexico. Economic Botany, 71(3), 209-223. Web.

Yahalom, J. (2019). Pragmatic truths about illness experience: Idioms of distress around Alzheimer’s disease in Oaxaca, Mexico. Transcultural Psychiatry, 56(4), 599-619. Web.