The Reports: Objectives and Methods

The first report, Health and Disease in Northern New Mexico, early on makes its goals explicit:

On its surface, the objective here is to improve health outcomes in the Hispano community by convincing members of that “cultural group” to align their “attitudes and activities” with those being promoted by the Anglo public health workers. While the report’s language adopts a positive orientation—“acceptance,” “improved health”—the underlying assumption is that “sharp cultural differences” are keeping rural, Spanish-speaking New Mexicans sick. In effect, Hispano culture was pathologized.Footnote ¹⁶

Implicit in this objective are at least three assumptions. The first is that acculturation is vital for health. As we will see, this assumption relies heavily on perceived religious and racial otherness. Second, it is suggested in the above quote and throughout the reports that “Anglo” and “scientific” are synonymous when it comes to healthcare. A corollary of this assumption is that Anglos either have no culture when it comes to acceptance of scientific medicine or, if they do, it is utterly congruent with science. The third assumption is that sociologists and anthropologists, through their study of the Hispano population, can discover the rhetorical key to convince the Nuevomexicanos at long last to leave behind their religious and unscientific health traditions and adopt rational and modern medicine. In other words, they believe they can understand Hispano culture well enough to be persuasive within its own idioms and cultural symbols. Using those idioms and symbols will finally break through cultural barriers and spark healthy assimilation.

This flurry of public health research came at what researchers considered an opportune time. Anglo migration to the West and Southwest had lessened Mexican American isolation. Changing economic realities, including a Hispano exodus from long-standing village agricultural life to wage labor in towns and cities, was likewise creating more opportunities for increased Mexican American adoption of Anglo customs and labor patterns.Footnote ¹⁷ In other words, by the time of these studies, the integration of New Mexico’s Spanish-speaking population into broader regional and national cultural and economic conventions was well underway. But, the social scientists employed to guide this process realized that challenges remained. Schulman and Smith noted that “the change is seldom complete, and even in highly acculturated persons there are residual health-disease associated habits and ideas stemming directly out of the health-disease complex of the Spanish-speaking village.”Footnote ¹⁸

Two years after Schulman and Smith’s original report was released, another major publication emerged that used and expanded on the first. Entitled Nurse–Patient Communication: A Manual for Public Health Nurses in Northern New Mexico, this second report, as the title suggests, focused the findings of the first into a lengthy series of instructions and advice for nurses. This manual, like the Schulman and Smith report, ultimately aimed at creating long-lasting changes in northern New Mexico’s way of life. The authors, Hanson and Saunders, explain in the manual’s introduction that “Change in one part of a cultural system has consequences for other parts; the nurse who introduces new aspects of health service or health care, whether she intends it or not and wants it or not, is an agent of cultural change.”Footnote ¹⁹ However, the authors show some restraint and insist that wholesale cultural change is not their stated purpose: “Note that it was not the intent of this project directly and deliberately to change the beliefs or practices of patients.” They explain, rather, that the objective was to “try to understand both public health and patient belief systems and to seek ways to change certain aspects of nurse discourse in order to take advantage of what patients already believe or do.”Footnote ²⁰

The approach throughout Hanson and Saunders’s manual stays close to the stated focus on “nurse discourse” and communication. The researchers did a discourse analysis of nurse–patient transcripts (using coding and IBM card punching). The results led to extensive advice for enhanced nurse–patient communication and a lengthy list of rules and guidelines related to language use, establishing rapport, and controlling the discourse and outcomes through careful assessment of the patient’s “variables” and specific “attributes.”Footnote ²¹ The manual concludes with a summary of the “Spanish-American Health Belief System” and reminds the nurse that, due to the considerable cultural gap between the typical public health nurse and her Hispano patient, the nurse must be cognizant and well trained in the proper discourse to bridge this gap.Footnote ²²

Efforts to quantify levels of acculturation relied on survey instruments as well as interviews that gauged types of assimilation and grouped categories of more- and less-acculturated patients. The original Schulman and Smith study focused on two villages where graduate-trained, bilingual “resident workers” collected local history, carried out interviews, and observed cases of healing and disease. The period of observation was approximately two months in length, after which the resident workers returned to share and analyze the data they collected with the directors of the project.Footnote ²³ An anthropologist directed the coding of these data into “some one thousand categories.” The codes were cross-referenced on paper slips in a code file, which allowed a “highly maneuverable . . . means of making textual or content analysis” and of framing the entire report.Footnote ²⁴ After generating various hypotheses from the coded data, the directors of the project convened five panels in “urban centers in the state” to help them test the hypotheses they had formed, based on the resident workers’ interviews and observations in the villages. The panelists, though familiar with northern New Mexican village life, were not villagers and “ranged from an unemployed office worker to a university professor.”Footnote ²⁵ Comparing village field data with presumably acculturated urban Hispanos made it possible for the researchers to draw conclusions about the relationships between acculturation and acceptance of scientific medicine.

Hanson and Saunders’s follow-up manual for nurses, with its more specific set of objectives regarding nurse–patient communication, offers several surveys that in-the-field nurses could use to guide their approach to individual patients. For instance, a “Medical Vocabulary Scale” gauged how well patients could understand specific terms such as “respiratory,” “isolate,” and “germs.” Unsurprisingly, results from this scale indicated that patients with higher levels of education as well as English-language usage in the home scored higher than those with less education or who spoke mostly Spanish.Footnote ²⁶ Another survey, entitled the “Health Belief Scale,” tested patients both on their religious orientation to health and their beliefs about disease causation and treatment. For example, one statement in the scale, which referenced a Hispano village health tradition, was “A cord tied around the waist will help some sicknesses.” Another statement asserted “Prayer and faith can cure diseases like cancer.” Data gathered using this scale discovered that high scores (more acculturated) corresponded to younger people and those with more than nine grades of school. In contrast, “low scores were associated with the use of Spanish as the primary language in the home, and living alone or in a broken family.”Footnote ²⁷ This was important, of course, because lower scores indicated more limited access and poorer health outcomes related to the use of scientific medicine. Lack of education and lack of English were symptoms of the larger problem: unhealthy and persistent Hispano cultural and religious norms were related to poor health.

Nuevomexicano Religious Healing

Why were these unhealthy norms and behaviors so persistent? In a word: religion. As far as the researchers were concerned, for centuries the religion of the Hispano villagers had been nearly synonymous with healthcare. An earlier study by Lyle Saunders of Mexican Americans in the Southwest found that “religion was not a thing apart but an omnipresent component” of all daily activities.Footnote ²⁸ This religion was, admittedly, Catholic but different in key ways from the relatively known quantity of white Roman Catholicism. Hanson and Saunders suggest that “Long periods of isolation from the Catholic world produced here a form of folk Catholicism that, while similar to folk Catholicism in other regions, includes traits that are distinctively New Mexican.”Footnote ²⁹ Key within this folk religion was a kind of resignation to God’s will. The Notre Dame sociologist Julian Samora, who was himself a Hispano native of southern Colorado, explained that, in this religious context, God’s omnipotence demanded submission: “the secret of making life endurable is one of submission and acceptance” to God’s will. Any attempts to change one’s fate, including in the area of health, had to navigate what Samora called both a “fatalistic” and a “defeatist” conception of life.Footnote ³⁰

Within these narrow parameters, there was still room for both preventative and diagnostic healthcare as long as God’s will, sometimes mediated through specific saints, remained paramount. Schulman and Smith explain, “It is, perhaps, only in the sphere of the religious that the villager may be said to practice a form of general prevention; it is, however, not relegated to disease or injury, but to all evils which may beset men.”Footnote ³¹ According to the reports, typical forms of religious preventative medicine were prayer to God and the saints and the avoidance of sinful behavior that might incur punishment in the form of sickness. Sickness, whether caused by sin or other factors, was treated by household remedies—or by religious specialists in more serious cases. These specialists, known as médicas or curanderas, treated illness with a variety of modalities including prayer, ritual acts, pilgrimage, herbal remedies, and what we might refer to today as bodywork.Footnote ³² For example, Hanson and Saunders interviewed a village healer who had expertise in concocting herbal remedies for her patients, which she administered with prayer. The healer noted, “If you have faith you can get well, even with a drink of water.”Footnote ³³ In other cases, healers and villagers relied on the power of Catholic saints. “Each family has its protective saint, as does each village; and the intercession of the saints is often requested for special purposes: a good marriage, successful harvests, recovery from illness, a trouble-free birth or a pain-free death.”Footnote ³⁴

By the 1960s, curanderas and curanderos (“healers”) had been treating patients in New Mexico and throughout the Southwest for centuries. While some of their treatments could be biomedically justified, the basis of their care, though certainly empirical, did not result from the scientific method but rather from European and Indigenous religious and medical traditions that predated modern science.Footnote ³⁵ Moreover, as the historian Jennifer Koshatka Seman has shown in her study of two prominent borderlands curanderos, these healers had a wide reach that included “Indigenous peoples, ethnic Mexicans, Tejanos, and even some Anglos with the understanding that they were the conduits through which a larger spiritual force moved.” They healed with “the power of God as well as their own curative knowledge of medicinals and therapies,” and they also addressed a variety of social ills, often ignored by colonial authorities.Footnote ³⁶ In this sense, these local healers had long helped their patients recuperate and cope with suffering, not only as individuals but as communities. Their persistent appeal lay, therefore, both in their efficacious remedies and in the religious and communal legibility of their treatments.

Although not an author or contributor to these studies, William Madsen was an anthropologist working at the same time and in similar contexts. He wrote extensively about the religious bases of Mexican American healing traditions in the area of McAllen, Texas, and his interpretations echo and reinforce those of his peers in New Mexico. For instance, in 1964 he wrote the following:

Madsen found that Texan Mexican Americans, like their New Mexican counterparts, often made little sense of the evident Anglo desire to divorce religion from medicine. “While the physician claims to cure merely through acquired knowledge, the curandero operates through the grace of God.”Footnote ³⁸ Not only was it more rational to rely on an all-powerful God, in contrast to meager “acquired knowledge,” but this reliance on God or healing also served as an ongoing ethnic marker of Mexican Americans contra Anglos.

Throughout the New Mexican research reports, there is frequent slippage between assignations of “religion” and “ignorance.” Despite the ostensible stance of objective and scholarly agnosticism—and even at times a kind of appreciation for Hispanos’ rich cultural traditions—the sociologists and anthropologists leading these studies often indicate in their rhetoric that folk traditions and cultural preferences are quaint but will be superseded by information and education. This assumption is underscored by the oft-used phrase “cultural barriers,” a phrase which suggests that the purpose of the villagers’ culture is to withstand necessary change and movement. In one long section of Hanson and Saunders’s nursing manual, transcripts are presented of interviews between local informants and the researchers. Their stated purpose is to share the outlooks of the informants, but it becomes clear that their questions are designed to bait the informants into saying things that highlight their lack of scientific background. For example, in a conversation that was attempting to explore informants’ conception of germ theory, the following exchange unfolded:

It is unclear whether the informant is trying to tell the researchers what they want to hear or to establish that she—the informant—does, in fact, believe in germs, or if she is perhaps supplying an accurate description of her understanding of illness in the body. The lesson that the researchers take away from such exchanges is that the Nuevomexicanos evince “exposure to the public health belief system” but their pre-existing belief systems stymie them in a morass of “considerable confusion.”Footnote ⁴⁰

In another case, the researchers conclude that Hispanos’ faith is inscrutable to the point of being practically useless. Hanson and Saunders submit that the people’s God is “authoritarian,” and therefore must be obeyed. But they lament that “God’s will is never clearly revealed,” which means that “there is no certain way that an individual can draw upon [God’s power] to retain or regain health.”Footnote ⁴¹ Such a conclusion reinforces the ultimate objective of these research projects: to move the Hispano villagers away from their uncertain and unproven religious healing beliefs and acculturate them fully into modern, scientific, and clinical healthcare.

While the religious barriers to medical assimilation were significant, it was also the case that assimilation itself could often hold its own dangers. The influential mid-century historian of ethnomedicine Erwin Acknerknecht reminded researchers like Hanson and Saunders that “primitive mentality looks at first glance strange enough to those who are brought up only with the (incomplete) knowledge of the ‘white, adult and civilized’ man.” He added, “The natural is supernatural and the supernatural is quite natural [for the ‘primitive’]. Perception may not be different, but values are just the reverse of those of our culture.”Footnote ⁴² This meant that efforts at assimilation had a two-part danger. First, they could backfire and create new forms of sickness, as well as novel “magico-religious” responses to these new forms of suffering. Ackerknecht found that unhealthy states of mind in acculturating groups were “typical acculturation phenomena” that emerged logically in a “disturbed culture.” In turn, this produced “new religion,” or new supernatural explanations and remedies for illness.Footnote ⁴³

The second danger, related to the first, was a dissolution of the religious glue of social cohesion. Ackerknecht surmised that “medical ideologies” could be read as “religious symbolizations of society,” which, in turn, guarantee “social cohesion.” According to him, this social cohesion, “perhaps more than therapeutic successes, explains the survival of primitive medicine, even when faced by more successful western competitors.”Footnote ⁴⁴ If acculturation altered the core medico-religious ideologies of a group, the group’s social cohesion would suffer. Margaret Clark, an anthropologist who carried out a health-related study in the late 1950s in a Mexican American neighborhood of San Jose, California, echoed Acknerknecht’s analysis. She found that illness was often “a means of dramatizing to others the evil consequences of cultural change and defending the ‘old ways’—Mexican customs and traditions which are under constant attack in the United States.” As Clark explains, in these cases diseases were attributed to “the demands of Anglo society or the ways of American life which are uncongenial to the patient.”Footnote ⁴⁵ The ironic upshot is that promoting assimilation to improve health outcomes could itself cause new or additional malaise.

Non-religious barriers to assimilation to Anglo medicine also existed. For instance, Lyle Saunders, one of the authors of the nursing manual, found in an earlier study that Mexican Americans often avoided Anglo medical treatments and considered them a last resort. Consequently, by the time patients went to the biomedical clinic, they were often quite sick and therefore were less likely to find a cure. This led to “the development of the belief, which could be supported by reference to known cases, that Anglo medical institutions were places where people went to die.”Footnote ⁴⁶ Moreover, many Mexican Americans viewed Anglo medicine as impersonal, unfamiliar, passive for family members, and costly. In contrast, traditional medicine was personal, familiar, inclusive of family participation, and inexpensive.Footnote ⁴⁷

Certainty about the positives of biomedical healthcare pervades the New Mexican reports, but, given all the problems related to assimilation, there is far less certainty when it comes to the project of assimilation. To begin with, the researchers were professional social scientists with good intentions. Decades later, we can and should recognize and critique the implicit colonial and racial overtones of their work. At the time, however, they believed they were studying Hispano culture to understand it, contextualize it, and even appreciate and preserve parts of it. The normative impetus of the project—to change healthcare beliefs and practices—lived within an overall project of trying to find the best, most culturally legible ways to communicate the positives of adopting scientific medicine. The desire to communicate in the cultural and religious idioms of the villagers, though sometimes paternalistic and superior, nonetheless recognized the internal importance and durability of Hispano cultural norms.Footnote ⁴⁸

A danger, then and now, of this assumption is a determinism that is enmeshed in spoken and unspoken conceptions of racial difference. Although the researchers show a degree of sensitivity to the villagers’ internal diversity, particularly between different generations, they cannot completely avoid generalizations and stark dichotomies between Anglos and Hispanos. The Nuevomexicano villager, even one who has “progressed” by assimilating many Anglo cultural norms, remains essentially anchored to a clannish and benighted folk Catholicism marked by a persistent commitment to the irrational and to fatalism. The anthropologist Ozzie Simmons, in a 1961 study of Mexican American and Anglos’ mutual expectations near McAllen, Texas, wrote that, even when Anglos profess that they want Mexican Americans to adopt Anglo norms, Mexican Americans “do not find that acculturation is rewarded in any clear and regular way by progressive acceptance” into mainstream Anglo society.Footnote ⁴⁹ This effectively meant that the gap between whites and Mexican Americans could never be completely bridged.

Religious and Scientific Racialization

The primary discursive category used in the public health reports for maintaining this one-way bridge to nowhere is “science.” It is an ideal category in this context in that it is, on the one hand, ostensibly universal and universalizable, and, on the other, racialized and, therefore, ultimately unattainable for some and natural for others. The researchers in New Mexico acknowledge and were motivated by science’s universal nature. In fact, it was their overriding concern and was the ultimate limitation on how far they would extend their commitment to understanding, appreciating, or tolerating Mexican American religious and folk healing traditions. If their dedication to scientific objectivity was clear to the researchers, the racialization of science (and religion) was, however, opaque to them. Khyati Joshi writes, “The racialization of religion is a process by which particular religions are associated with certain physical appearances[,] and human differences come to be treated as absolute, fundamental, heritable, like race.”Footnote ⁵⁰ Racialization of science is analogous: the process by which adherence to and respect for scientific truth becomes associated with particular racial groups, over and against other groups that, in contrast, are essentially unable to apprehend reality based on scientific evidence. Finally, racialization and medicalization of a particular population often go hand in hand. When scientific experts bring new healing modalities to racialized groups, “racial difference acquires the weight of truth through the production of biomedical knowledge and its deployment in therapeutic practice and the public health policy.”Footnote ⁵¹

Evidence of racialization of science and medicine is embedded in the language of the research reports. Two central dichotomies that recur throughout are “Hispanic/Anglo” and “traditional/scientific.” To reiterate, the impetus of the research in New Mexico was the conviction that, if Anglo healthcare providers better understood “Hispanic traditions,” they would be more successful at encouraging Hispano acculturation from their ancestral religious and cultural traditions to Anglo scientific norms. This, in turn, would lead to better health outcomes. For instance, fieldworkers noticed that the failure of traditional village medicine opened the door for Hispano experimentation with “Anglo medicine” such as antibiotic injections and surgeries. Some Nuevomexicanos came to trust Anglo medicine even more than their traditional practices, but this is not necessarily evidence of acculturation since “they usually have little or no understanding of why it is superior.”Footnote ⁵² The nursing study echoes this viewpoint: “Anglo-American medicine is likely to be imperfectly understood by the villager.” In the surrounding sentences to this assertion, other adjectives used for “Anglo-American” medicine are “scientific” and “professional” medicine.Footnote ⁵³

These facile equations of “Anglo” with “scientific” and “Hispanic” or “villager” with “traditional” reveal a kind of dramatic irony in that the reports’ reader, who is assumed to be Anglo—or, perhaps, a highly acculturated Nuevomexicano—knows something that the objects of the studies do not. Namely, the presumed Anglo reader is tacitly expected to share the conviction that scientific medicine is fact-based and consistently effective, which invites the reader into the scientifically (and racially) superior space from which the studies were carried out.

One of the most prominent examples of this rhetorical device, employed repeatedly throughout the studies, is discussion of disease etiology. Etiology—the attributed cause of some phenomenon—functions in these studies as a bright dividing line between Anglo science and Hispano religion and tradition. Schulman and Smith attribute villagers’ disease etiology to various sources: “From the Hispanic past comes the notion of imbalance in the hot and cold elements in the body; from the Anglo-American present comes the poorly understood idea that some ideas are ‘catching’; from very remote American Indian antiquity is the rare mention of object intrusion as a cause of illness.” But above all these sources, however, is “God’s will.”Footnote ⁵⁴ A similar and contemporaneous anthropological study carried out in the Rio Grande Valley in Texas corroborates the New Mexican studies’ findings and elaborates on the source of mental illnesses. Such maladies result from three principal causes: “1) those sent by God or a saint as punishment for misdeeds; 2) those caused by witchcraft or the evil eye; and 3) fright sickness caused by seeing ghosts.”Footnote ⁵⁵ In short, both physical and mental afflictions were often judged to have a divine or metaphysical source, whether this be punishment for sin or malevolent curses evoked by one’s enemies.

The researchers acknowledge that this conception of health makes room for both prevention and treatment of illness. For example, Hispano disease prevention measures included wearing protective devices such as amulets and taking protective medications such as herbal remedies.Footnote ⁵⁶ Nevertheless, such measures were “alien to the germ-theory oriented medical milieu in which both researchers and sophisticated informants have been socialized.”Footnote ⁵⁷ The study in Texas found that some Mexican Americans in the 1950s and ’60s actively rejected germ theory and its proponents: “Professional physicians are viewed with suspicion and hostility by conservative members of the lower class who generally regard the germ theory of disease as a fraudulent scheme to help Anglo doctors and nurses extract exorbitant fees from the gullible.”Footnote ⁵⁸

Ignorant of “germ theory,” what were the details of villagers’ etiology of disease? Schulman and Smith, based on their teams’ interviewing, conclude that traditional Nuevomexicanos attribute the cause of illness to “six major areas:”

Four of the identified six causes of illness, like “germ theory,” concern forces outside the body entering it or influencing it in a deleterious way: God’s punishment, forces of nature, personal mana, and alien culture. Of these four, two clearly fall in the remit of what researchers considered to be “religious,” i.e., God’s punishment and mana. (It is important to note that “mana,” which here indicates the unique power of certain individuals to bewitch, curse, or enchant others, is certainly not a local term but one imposed by the anthropologists in charge of the study.) But all six, according to the studies, operate in a folk setting that is based on belief and tradition rather than on scientific medical knowledge and evidence. In this sense, an exploration of Nuevomexicano theories of disease etiology serves not as an avenue for finding common ground but rather as a sustained argument for the incommensurability of village healing traditions and Anglo biomedicine. Indeed, one can even get sick from “contact” with Anglos.

This racialization of medical science as Anglo and religion and tradition as Nuevomexicano presents an internal tension in the researchers’ studies (and in the entire enterprise of the public health campaigns related to the studies). On the one hand, the reports’ and the campaigns’ explicit objective is to acculturate Hispano villagers so that they can better access life-saving healthcare. The studies into their culture are meant to open up avenues of understanding. So informed, doctors, nurses, social workers, and other public health professionals are meant to be able to find the right strategies to convince villagers to leave behind the scientifically useless aspects of their healing traditions and to embrace scientifically vetted medicines and practices, including vaccinations, antibiotics, and hospital care when necessary. But, on the other hand, the same studies implicitly insist over and over again that racial differences are essential markers of science and tradition, barriers that, while based on culture and history, are durable. Assimilation in a context of racialization becomes a kind of impossible recursion where every accommodation or adoption of Anglo norms—which in themselves claim to be universal, scientific, and objective—subtly reinforces the essentialist chasm constructed between different racialized groups.