'Nerves': folk idiom for anxiety and depression?

This study suggests that 'nerves' as presented in a primary care clinic is a lay idiom for emotional distress and documents a relationship between the folk ailment 'nerves' and anxiety and depression. One hundred and forty-nine patients at a Virginia clinic were studied, 47 with 'nerves', and 102 controls. Testing with the General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) showed 'nerves' patients to be more anxious and depressed than controls. 'Nerves' patients had a mean GHQ score of 13.0 compared to 5.8 for controls (P less than 0.0001) and a BDI score of 7.6 compared to 2.5 for controls (P less than 0.0001). Testing with the Holmes-Rahe Social Readjustment Rating Scale showed 'nerves' patients to suffer more recent life stresses than controls: 'nerves' patients had a mean score of 187.1 compared to 119.3 for controls (P less than 0.05). 'Nerves' patients had somatic symptoms including gastrointestinal disturbances, headaches and shaking. 'Nerves' is most common among women and housewives, and is often attributed to misfortune and tragedy. The ethnomedical illness 'nerves' encompasses a rich array of cultural meanings reflecting the lifestyle and worldview of its sufferers. Despite its chronic debilitating nature, it is rarely recognized by physicians; it is, however, treated by alternative healers. Clinical implications are discussed and recommendations advanced, among them that physicians work with such healers in the recognition and treatment of 'nerves'.

Nerves, worriation, and Black women: a community study in the American south.

The experience of nerves among women in a low-income Black neighborhood was examined. Research conducted in the neighborhood revealed nerves as a formal classification of folk illness linked with life stress, yet in-depth interviews with a purposeful sample of 24 residents showed that a greater manifestation of nerves among women contributes to tendencies among family members to ignore the severity of its symptoms and to equate experiences of nerves with life conditions deemed inevitable for women. Lack of support for nerves among female sufferers was also evident among friends and physicians. These findings are analyzed against a background of gender-specific concepts of nerves and "worriation" operating in the neighborhood. Residents aver that women's "naturally" weaker constitutions and a moral imperative to worry places them at greater risk for nerves. Implications for clinical care of low-income Black women with nerves are discussed, and specific recommendations for culturally appropriate interventions are outlined.

"Hidden" popular illnesses in primary care: residents' recognition and clinical implications.

This study documents that ethnomedical beliefs and practices play an important role in primary care in a southern community. Thirty-three of 73 patients from a rural Appalachian area coming to a university primary care internal medicine practice presented 54 ethnomedical complaints such as "high blood" (24.1%), "Weak 'n dizzy" (22.2%), "nerves" (16.7%), "sugar" (5.6%) and "fallin' out" (3.7%). Thirty-three patients had both biomedical and ethnomedical complaints, 40 patients had biomedical complaints without ethnomedical complaints and no patients presented with ethnomedical complaints alone. Over two-thirds of all patients consulted non-medical personnel for their complaints, mostly family and friends, and 70 percent self-treated prior to clinic consultation. Patients presenting with ethnomedical complaints when compared with those presenting with biomedical complaints sought advice of non-physicians significantly more often (p less than 0.02); no statistical difference, however, was found in their self-treatment practices. Ninety-two of 130 biomedical complaints were recorded by the patient's physician but none of the 54 ethnomedical complaints were formally recorded (p less than 0.001). The high incidence of ethnomedical complaints in this population and the failure of physicians to recognize these complaints demand that primary care medicine residents be taught improved history-taking skills and the essentials of ethnomedical illnesses if they are to provide culturally-sensitive patient care.