The Puerto Rican Syndrome (Book Review)

Author:  Gherovici, Patricia
Publisher:  Geneva Reynaga-Abiko, PsyD
Reviewed By:  Other Press, 2003, Vol. 26 (2), pp. 36-38

When I first read the title of this work, I assumed the author was promising to expound on conducting psychoanalysis with Puerto Ricans, perhaps including some descriptors of factors that are unique to this population. These projections were shattered the moment I started reading the introduction. I learned that “the Puerto Rican syndrome” is a medical term coined in the 1950s. I learned that Gherovici has worked with poor Puerto Ricans and other Latinos and was looked at with confusion for conducting Lacanian analysis with disadvantaged, poor people of Color. I learned that the purpose of this book is to educate in a way that is rooted in her vast experience and practicality.

Instead of reading about one aspect of clinical work with an ethnic minority group, I found myself enthralled with Gherovici’s eloquence. She captures the experiences of Puerto Ricans, and other Latinos, while arguing for a reconsideration of Lacan’s relevance in North America. I found myself swept away by the level of accuracy in her portrayal of Latinos that I have yet to find in any other analytic text. She never loses her balance as she walked the fine line of clinical work and social critique. This leaves the reader with a contextualized understanding of the Puerto Rican syndrome, deeply rooted in the experience of Puerto Ricans and other disadvantaged Latinos. Gherovici delivers far more than can be expected from one book and I, for one, am grateful for her insight and bravery.

This book may be classified as serving many purposes. It provides a review of a syndrome that continues to plague the Puerto Rican community, a treatise on Lacan’s applicability with disadvantaged and historically oppressed groups, and a lesson in the social reality of Puerto Ricans in the United States. For this reason, it is of use not only to psychoanalysts, but all clinicians working with Puerto Ricans, and anyone interested in gaining insight into North America’s history with Puerto Rico.

In the introduction by the series editor, Dayal explains that Gherovici helps us understand the Puerto Rican syndrome as it relates to and is affected by the social and political forces acting on the individual as a member of the Puerto Rican community. This is different from most analytic works that relate everything back to the unconscious. He makes the point that

Gherovici draws lucid but complex connections between the political and the psychic. She focuses our attention specifically on how, in the case of Puerto Ricans, issues of ‘race,’ mental illness, national origin, or cultural belonging merge with the problematics of political marginalization and social positioning. (p. xvi)

We then embark upon the body of the text. Gherovici begins by giving us a brief overview of how Lacan has been applied in North America. She distinguishes “North” from “South” America because of the distortions Freudian theory has suffered in the United States. Specific facts about the U.S. and its view toward Latinos are interwoven with the way Lacan posits the notion of “subject.” Gherovici helps us understand that, in the U.S., mental health treatment, including psychoanalysis, “…is geared toward the adaptation to ‘reality’…” (p. 4). This ultimately plays out in oppression of ethnic minorities. This chapter is highly political and seemingly oriented within a social justice perspective. What we begin to understand, however, is that Gherovici is unabashedly Lacanian.

In this first chapter, Gherovici explains the Puerto Rican syndrome for the first time. She explains how it was “created” by U.S. Army doctors in the 1950s who witnessed “strange symptoms” in their Puerto Rican soldiers coming back from the Korean War. She considers it a mode of hysteria as described in the Lacanian sense, or a form of neurosis that is “…also a mode of discourse whose ultimate function is to tighten particular social links” (p. 8). The point is clearly made that the Puerto Rican syndrome is simultaneously a clinical as well as a political problem. Clinically, she focuses on hysteria and the power of the clinician who diagnoses and treats the condition. The political side is far more complex and the focus of the majority of the book.

In the next chapter, Gherovici positions herself in North Philadelphia’s Spanish-speaking ghettos, which houses the third largest Puerto Rican population in the U.S. mainland. (The term “U.S. mainland” is used because Puerto Rico is a U.S. territory and, as such, Puerto Ricans can move freely from the island of Puerto Rico to the U.S. mainland.) She also provides an enlightening history of how Latinos have been identified by the U.S. since 1930. She also gives a history of Puerto Ricans, and how many continue to struggle with issues of colonization by the U.S. Just when the reader begins to think that Gherovici has altered the course of the text, she pulls it together by illustrating that the focus on psychopharmacology and behavioral treatment with disadvantaged populations only makes the Puerto Rican syndrome more salient, as it “…makes us aware of our impotence facing issues of gender, class, race, nationality, and language while leading us to challenge them” (p. 20). Lacanian analysis is best able to answer this call, according to Gherovici, because it “…addresses and confronts the subject with some of the most unbearable aspects of reality” (p. 25).

Just as we are beginning to understand the convergence of the societal with the psychological, Gherovici pulls us out of that by focusing on the history of the Puerto Rican syndrome in the next eight chapters. She gives a detailed account of the first published account of the Puerto Rican syndrome, which occurred in the U.S. Armed Forces Medical Journal in 1955. What is made clear is that, “the Puerto Rican syndrome varies in characteristics, incidence, prevalence, geographical location of occurrence, prognosis, severity, and risk factors. Each observer seems to have a particular perspective about it” (p. 46). She explains this as the “patient” challenging the “doctor” to tell them who they are:

The initial question starts with an “I” and presents intriguing symptoms addressed to the Others—any Army doctor, priest, anthropologist, social worker, espiritista will do. In fact, while the question appears incarnated in the body of the hysteric, the answer begins in the Other who produces speech. This answer is sent back to the hysteric who then becomes indeed whatever the Other says. Since one always receives one’s own message from the other in an inverted form, when those who are in the position of Other tell the hysteric what he or she (the hysteric) “is,” this answer then comes back to the Other as well. Thus the inverted message returns to say more about the speaker (the Other) than it may say about the addressee (the hysteric). (p. 51)

This is consistent with the idea that hysterical symptoms are “fundamentally culture-specific (p. 52), which means that they are constantly changing. Gherovici explains that

It is because hysteria is permeable to collective formations that certain modalities of hysteria will be produced only in particular cultures and in specific time periods. This articulation of bodies and time, of medical knowledge and cultural mandates, is at the basis of the political and transformative power of hysteria and this is particularly true of the Puerto Rican syndrome. (p. 52)

While it seems clear that the Puerto Rican syndrome is, at its base, a hysterical condition, Gherovici convincingly points out that it does not fit into traditional psychiatric nosology. She explains this as a result of bias on the part of those medical doctors who coined the term. She gives examples of the “contradictory and racially and ethnically charted statements” (p. 56) given in reference to this diagnosis. This begs the question of what is the true purpose of this syndrome? It seems “purely ideological” (p. 70), rather than a “true” psychiatric diagnosis. To illustrate her point, Gherovici gives a history of how psychiatry has consistently failed to recognize its cultural bias, particularly in documents such as the Diagnostic and Statistical Manual of Mental Disorders.

Specific facets seen in the Puerto Rican syndrome are also discussed, including anger, justice, and violence. Gherovici describes its anger as the only way the “patients” could defend themselves in a horribly unjust system. This helps expose to the observer, or the Other, those areas in which they are lacking. That this act occurs in “fits” makes sense, when one considers what are socially acceptable displays of anger in a traditionally peaceful native Puerto Rican society. That they were considered a syndrome by the [North American, culturally biased] doctors makes sense as well:

While violent demonstrations, shootings, and rioting in the name of nationalist resistance cannot be called hysteria but political struggle, when this is perceived from the point of view of the Other—that is, in this case, from the American doxa of law and order—then the subversion of order can only be made sense of by being reduced to a madness seen as stubbornly opposing civilization. (p. 134)

When the Puerto Rican syndrome can be used productively, as Freud used symptoms, it can help guide the cure. Unfortunately, this is now what we see in how these patients have historically been treated, both clinically and socially.

The next two chapters focus on Latinos and what this term has signified in the U.S. Gherovici also discusses the popular belief amongst analysts that psychoanalysis is not suitable for poor minorities:

When the alleged unanalyzability of low-income patients is based on stereotypes that describe poverty as either a psychic problem or a “natural” cultural value, we meet prejudices that encroach on therapeutic models. What is at stake in these assertions of mental disorganization of the poor is the implication of some form of psychic inferiority. We see the strange spectacle of practitioners recommending therapeutic interventions that they themselves call “second class.” The issues revolving around race, class, language, and culture that arise in these settings tend on the whole to exclude a consideration of the effects of the unconscious. Even when Hispanic therapists are committed to their practice and devoted to the population they serve and also represent, they betray the subtle workings of the logic of exclusion by which prejudice accompanies the vindication of difference. The tenacious infiltration of racism and its irrational nature are no news. (p. 190)

She finds this related to America’s pursuit of happiness as a culture and concludes:

I am not advocating that psychoanalysis provide a universal panacea for all evils but cannot help wondering why past efforts to take into account class, culture, and race have produced and added discrimination. The discrimination has been double, first against psychoanalysis as luxury treatment and then against all those who are “different,” not fully included in American mainstream society. (p. 192)

In the remainder of the book, Gherovici focuses on how to treat the Puerto Rican syndrome in a more culturally relevant fashion. This includes an acknowledgement of traditional healing practices, or espiritismo. She also provides case illustrations, though they are a bit curious. The text ends somewhat abruptly, without a conclusion or a summary. Instead, we are presented with a tale about Alaska, Puerto Rico, and the 1993 winner of the Miss Universe contest. Perhaps it is metaphorical for the Puerto Rican syndrome itself?

The reader of this text is taken on a whirlwind ride that may or may not be appreciated. If one desires a simple understanding of the Puerto Rican understanding, they will likely feel distracted by the sociopolitical nature of this work. However, if a complete understanding of the relevance of the Puerto Rican syndrome as a manifestation of a long history of systematic inequities is sought, this text will fully satisfy that craving!

As a Latina psychotherapist interested in psychoanalytic theory, I hold Gherovici’s text as the most in-depth exploration of social justice issues I have found. That she focuses on Latinos is an added bonus! Although the explicit intention of the text is to expound on the Puerto Rican syndrome, Gherovici provides a fully contextual view of the condition that includes social, political, historical, and theoretical factors. The richness of her work cannot be overstated.

 

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