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Grisi siknis, also called Histeria colectiva, Grisi munaia, Chipil siknis, Nil siknis, and in English termed Crazy Sickness. Primarily affecting females of the tribal Miskito people of Central America, grisi siknis is a culture-bound syndrome believed by Miskito natives to be contagious. Miskito people are a group of Indian tribes native to Honduras and Nicaragua; however, the illness has also been documented in the Caribbean.

Historical & Cultural Background
According to affected cultural groups, Grisi siknis is centered amongst the spiritual and physical world. In Nicaragua, there is a belief in a spirit realm that constantly interacts with the environment of the physical realm. Many Miskitu believe there is a plethora of spirits holding domain over the forest (aubia), wind (prahaku), hunting and wild game (duende), water (liwa mairin or sirena), and spirits of the deceased (muertos or isingni). These spirits protect and guard the balance of nature within their domains; in the case of an imbalance, the spirits act out amongst the people present in their environment. Individuals that are affected by these spirits and experience illness seek out the only culturally acceptable and successful treatment, of which is provided by herbal/spiritual healers (curanderos), shamans (sukias), or prophets (profetas).

Symptoms
Dr. Phil Dennis, a Texas Tech University professor, describes grisi siknis as "typically characterized by longer periods of anxiety, nausea, dizziness, irrational anger and fear, interlaced with short periods of rapid frenzy, in which the victim 'lose[s] consciousness, believe[s] that devils beat them and have sexual relations with them' and runs away." Symptoms appear to contrast depending upon whether the syndrome occurs within an industrialized country or an underdeveloped (third-world) country. People affected by Grisi siknis within underdeveloped countries, such as Nicaragua, tend to exhibit dissociative symptoms, or a tendency to feel physically disconnected from the body. Research has found that affected individuals in industrialized nations commonly experience "pure anxiety" as Linda Geddes stated in the News Scientist. Geddes believes "the crucial point is that symptoms appear to be contagious," and "[u]sually, the sufferers have had a high level of communal stress." According to Johan Wedel's research, individuals succumbing to the sickness "will go into a state of possession trance, and will not be contactable, or able to recognise people in their surroundings. This is followed by a period of severe convulsions and a hysterical reaction, when they may rip their clothes and hair, try to bite or hurt others, and finally grab a knife or machete and begin to run around with other afflicted people." Occasionally, in some outbreaks, even more bizarre are symptoms that Nicaraguan natives have reported. Nicknamed histeria colectiva by locals, Grisi siknis was reported in a Nicaraguan newspaper with this description of a typical symptom: "many Miskitus spoke about vomiting pieces of glass, hair, nails, and coins, in addition to live spiders, cockroaches, and, in one case, a grasshopper."

Treatment
According to a detailed and lengthy article by Johan Wedel, treatment for Grisi siknis is risky, with the only cure being traditional medicine. The length of time it takes for this culture-bound disorder to be identified is what determines the outcome of the sickened individual. As Nicaragua becomes a more developed country, more people sickened by this illness will seek bio-medical treatment within a hospital setting. For example, digestive symptoms such as nausea, if combined with diarrhea, can be mistaken for cholera. In fact, most curanderos send their patients to hospitals to be seen by a physician as well as by the curandero to determine if spiritual forces or sorcery are the root cause. Traditionally, depending upon the strength of the spirit causing the distress, the affected individual is placed in isolation to prevent the spread of the illness. Next the individual is bombarded with "spiritual exorcism, herbal cleansing, and Christian prayer." Recovery takes roughly one week. Current research has shown that the use of alternative medicinal treatment has improved outcomes as compared with bio-medical based pharmacological treatment with Grisi siknis.

Outbreaks
Recently in early March of 2009, near the river Coco in northern Nicaragua, forty-three people reportedly fell ill to Grisi siknis. At the time, doctors, anthropologists, and sociologists who have studied previous cases of mass hysteria - also known as mass psychogenic illness - have failed to discover a clear explanation for the outbreak. In the years of 2005 and 2006, Grisi siknis outbreaks occurred twice across the campus of Universidad de las Regiones Autónomas de la Costa Caribe de Nicaragua. The outbreak mainly affected students and caused the mass production of pamphlets describing theorized ways to avoid contracting the contagious sickness, which were handed out across many of the country's college campuses. Some people such as many of the Evangelical missions located in Central America believe Grisi siknis outbreaks are occurring more frequently because the world is nearing "the end of times." Whether of not this is valid will require more future research.

Additional Readings/Research
Fell, Nicola, (April 20, 2009)" She ran around like a maniac". BBC News Health. Accessed July 21,2011. 

Jamieson, Mark. (October 26, 2001). Masks and madness. Ritual expressions of the transition to adulthood among Miskitu adolescents. Social Anthropology. Retrieved from http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=88517. SHARROCK, W., & ANDERSON, R. (1985). MAGIC WITCHCRAFT AND THE MATERIALIST MENTALITY. Human Studies: A Journal for Philosophy and the Social Sciences, 8357-375. Retrieved from EBSCOhost.

Widdicombe, Rupert. (December 17, 2003 02.39 GMT). Nicaragua village in grip of madness. "Doctors and traditional healers reach remote jungle community where 60 people are suffering from mysterious collective mania."'"'The Guardian''" Retrieved from: http://www.guardian.co.uk/world/2003/dec/17/1

You Tube - 'Grisi Siknis' illness grips indigenous Nicaraguan communities. TheTicoTimes. Aug 5, 2009. Accessed on July 21, 2011. http://www.youtube.com/watch?v=7i-vbei4D4Q