Cult Med Psychiatry (2014) 38:473–498 DOI 10.1007/s11013-014-9381-z ORIGINAL PAPER ‘‘Pensando Mucho’’ (‘‘Thinking Too Much’’): Embodied Distress Among Grandmothers in Nicaraguan Transnational Families Kristin Elizabeth Yarris Published online: 28 June 2014  Springer Science+Business Media New York 2014 Abstract In this paper, I describe an embodied form of emotional distress expressed by Nicaraguan grandmothers caring for children of migrant mothers, ‘‘pensando mucho’’ (‘‘thinking too much’’). I draw on ethnographic fieldwork and semi-structured exploratory interviews about pensando mucho conducted with grandmother heads-of-household to show the cultural significance of this complaint within the context of women’s social roles as caregivers in transnational families. Adopting an interpretive and meaning-centered approach, I analyze the cultural significance of pensando mucho as expressed through women’s narratives about the impacts of mother outmigration on their personal and family lives. I show how women use pensando mucho to express the moral ambivalence of economic remittances and the uncertainty surrounding migration, particularly given cultural values for ‘‘unity’’ and ‘‘solidarity’’ in Nicaraguan family life. I also discuss the relationship between pensando mucho and dolor de cerebro (‘‘brainache’’) as a way of documenting the relationship between body/mind, emotional distress, and somatic suffering. The findings presented here suggest that further research on ‘‘thinking too much’’ is needed to assess whether this idiom is used by women of the grandmother generation in other cultural contexts to express embodied distress in relation to broader social transformations. Resumen en Español En este ensayo, describo una forma de aflicción corporeal e emocional expresada por las abuelas Nicaragüenses quienes cuidan hijo/as de madres migrantes, ‘‘pensando mucho’’. Planteo mi analisis sobre datos etnográficos y entrevistas semi-estructuradas y exploratorias enfocadas en pensando mucho llevado a cabo con abuelas jefas de hogar para mostrar el significado cultural de esta queja de aflicción adentro del contexto de los papeles sociales de estas mujeres como cuidadoras en familias transnacionales. Adoptando un enfoque interpretativo y centrando K. E. Yarris (&) Department of International Studies, University of Oregon, Eugene, OR, USA e-mail: keyarris@uoregon.edu 123 474 Cult Med Psychiatry (2014) 38:473–498 en el significado de las quejas de aflicción expresadas, analizo pensando mucho como es expresado en las historias narrativas de las abuelas-cuidadoras sobre los impactos de la emigración maternal en sus vidas individuales y familares. Demuestro como las abuelas-cuidadoras utilizan pensando mucho para expresar la ambivalencia moral de las remesas económicas y el incertidumbre detrás de la migración, en particular dado los valores culturales para la ‘‘unidad’’ y ‘‘solidaridad’’ en la vida familiar Nicaragüense. Además, describo la relación entre pensando mucho y el dolor de cerebro, como una manera de documentar la relación entre cuerpo/mente, aflicción emocional, y sufrimiento corporal. Los hallazgos aquı́ presentados llaman la atención a la necesidad por más investigación sobre ‘‘pensando mucho’’ para determinar sı́ esta aflicción está expresada por mujeres de la tercera edad en otros contextos culturales para indicar su relación con transformaciones sociales. Keywords Emotional distress
Mental health
Grandmothers
Nicaragua
Migration Palabras Claves Aflicción Emocional
Salud Mental
Abuelas
Nicaragua
Migración Introduction ‘‘Bueno, en si pienso mucho en lo económico, en la salud y en los hijos que no están. De que hacer el dı́a mañana.’’ ‘‘Well, I think too much about the economic situation, about health, and about the children who aren’t here. About what do to tomorrow.’’ *Juana Nicaraguan Migration and Grandmother Caregiving This article explores the emotional experiences of grandmothers in transnational families, women who assume primary caregiving responsibilities for their grandchildren in Nicaragua after the children’s mothers migrate in search of opportunities elsewhere. These grandmother caregivers participate socially, culturally, and emotionally in transnational family life, even though they themselves do not cross national borders. Like other Latin American women of the tercera edad (‘‘third age’’), these are women who experience migration simultaneously as mothers whose daughters leave and as grandmothers who assume care for another generation of children back home. They thus occupy a social location within transnational families that Leinaweaver has referred to as the ‘‘care slot,’’ as they contend with ‘‘the meaningful absence of [their daughters] who are both parents to small children and children of aging parents’’ (Leinaweaver 2010, p. 69). In what follows, I argue that the uncertainties of the social location inhabited by grandmother caregivers shape their subjectivities and find expression through the culturally significant idiom of distress, ‘‘pensando mucho’’ (‘‘thinking too much’’). 123 Cult Med Psychiatry (2014) 38:473–498 475 Feminist scholars have described the globalization of women’s reproductive labor as constituting a ‘‘global care chain’’ (for example, see Parreñas 2001; Ehrenreich et al. 2002; Yeates 2005). While analyses of the feminization of global migration highlight the importance of immigrant women’s caregiving for domestic and national economies in the Global North (Sassen 1998; Parreñas 2002), relatively little attention has been focused on the caregiving that women in the Global South provide for children and families left behind by transnational processes of migration and labor extraction. In contemporary Latin America, for example, women comprise more than 50 % of contemporary migrants (Pessar 2005) and most of these women work in service industries (such as domestic workers) in host countries. The feminization of migration pushes migration scholars to consider the impact of women’s migration on intergenerational transformations in family caregiving in migrant-sending communities. Migration from Nicaragua over the past two decades has been primarily driven by economic ‘‘push’’ factors, including structural under- and un-employment and chronic poverty (Baumeister 2006). Today, the main destination of Nicaraguan migrants is Costa Rica, followed by the United States, other Central American nations (such as Panamá and El Salvador), and Spain. Estimates are that over 40,000 Nicaraguans leave the country each year as external migrants (Andersen et al. 2009). This demographic shift means that one out of every ten Nicaraguans lives outside their country of birth, a relatively high proportion when compared to other Latin American nations (Baumeister 2006). The proportion of male to female migrants from Nicaragua is roughly equal and the majority of migrants (male and female) are between the ages of 20 and 49, meaning that tens of thousands of Nicaraguan children are growing up with one or more parents absent due to migration (Torres and Barahona 2004, p. 37). While discussions of the feminization of migration usually refer to women as migrants themselves, here I want to open the analytical frame to include women of the grandmother generation who assume caregiving after parents migrate as important actors in global care chains. Although when fathers migrate, children are left under the care of their mothers thus providing continuity in caregiving configurations, when mothers migrate, fathers are usually already absent from family life due to the prevalence of paternal irresponsibility and conjugal fragility in Nicaragua. Thus, mother migration implies a shift of caregiving responsibilities to grandmothers or other women in extended kin networks. However, despite the centrality of their caregiving roles, women of the grandmother generation have been largely overlooked in academic accounts of migration. For this reason, attending closely to the ways grandmothers articulate their subjective responses to the transformations and uncertainties that characterize their particular social location in global care chains is a way of legitimizing their experiences, taking seriously their distress, and giving voice to their complaints about the impacts of transnational migration on their individual, family, and cultural lives. Interpreting Pensando Mucho Focusing on this particular expression of distress, I draw attention to the ways Nicaraguan grandmothers’ emotional experiences are both reflective of the social 123 476 Cult Med Psychiatry (2014) 38:473–498 transformations of migration and also generative sites where women render the significance of these changes for their individual and family lives. Das has argued that subjectivity is a ‘‘contested field’’ through which large-scale socio-political processes, changing family relations, and individual emotionality become ‘‘inescapably sutured’’ together (Das 1997, p. 68). Quesada has documented how the disruption of Nicaragua’s war and political violence in the 1980s shaped the subjective emotional experiences of one mother and her ‘‘suffering child’’ (Quesada 1998). In a similar way, I view grandmothers’ subjective experiences as reflective of the broader political and economic processes structuring transnational migration flows, of the cultural values that shape and give meaning to family relationships, and of the uncertain emotional terrain of transnational family life. Adopting a meaning-centered approach to analyze narratives of distress (Kleinman 1988; Garro et al. 2000), I follow the layers of meaning women ascribe to pensando mucho outward into the social and cultural worlds in which this complaint is embedded and out of which its significance is rendered. Rather than a bounded illness experience or the local manifestation of a global diagnostic category, I approach the complaint of pensando mucho as a syndrome or an idiom of distress. Nichter has described idioms of distress as ‘‘symbolic and affective associations, which take on contextual meaning in relation to particular stressors’’ (Nichter 1981, p. 379). Of particular importance to this analysis, idioms of distress contain significance in relation to interpersonal relations, social relations, and political and economic contexts (Nichter 2010). Idioms of distress may be particularly salient for women who are socially and economically marginalized, as they find themselves with few alternate outlets for their complaints (Parsons 1984; Briggs 1992; Das 1997). In Latin America, there is a long history of anthropological research on idioms of distress expressed by women. One syndrome that has received a good deal of attention is nervios, a distress response related to chronic worrying or acute stressors (for example, see Low 1985; Guarnaccia and Farias 1988; Jenkins et al. 1994). More recently, Darghouth et al. documented how headache (dolor de cabeza) is a somatic mode through which women express present distress, memories of past suffering, and concerns about the future (Darghouth et al. 2006, p. 281). My research with Nicaraguan women has shown that nervios is not a widely shared experience; in fact, it is rarely mentioned in the conversations I have with the grandmother caregivers in my study. Furthermore, as I show below, Nicaraguan women make a clear distinction between the chronicity of ‘‘pensando mucho’’ and its associated pain, ‘‘dolor de cerebro’’ (‘‘brainache’’), and the more acute worrying (‘‘preocupaciones’’) that might lead to what is locally understood to be ‘‘headache.’’ Notably, unlike other studies of women’s distress in Latin America that have relied on clinical samples, mine is a community-based ethnography. Although women may take complaints of pensando mucho to biomedical practitioners, more often these complaints circulate and find significance in local networks of families and communities, and, in this case, in conversations with the interested anthropologist. As Kleinman has argued, pain and suffering is best understood in relation to the local moral worlds in which it is experienced (Kleinman 2006, 1992). I propose that the meanings of pensando mucho are intricately related to ‘‘wider context of experience’’ (Kleinman 1992, p. 173) that surrounds women’s roles as grandmother caregivers and mediators of the uncertainties of transnational family life. Pensando 123 Cult Med Psychiatry (2014) 38:473–498 477 mucho is an expression of emotional distress that marks grandmothers’ social locations as intergenerational caregivers in transnational families and articulates a moral critique of the transformations and discontinuities implied by mother migration. While grandmother caregiving in Nicaraguan families is not unique to situations of parental migration, mother migration in particular implies a disruption in the expected roles that women will play across the generations and thus ‘‘pensando mucho’’ has a particular set of meanings tied to these transformations in kinship and caregiving. Anthropologists studying the emotional dimensions of global migration have emphasized either an increased sense of interconnectedness emerging across contemporary transnational spaces (Svašek and Skrbiš 2007), or instead focused on the disconnection and emotional, social, and cultural distance between children and transnational parents (Parreñas 2005; Horton 2009). I will show that Nicaraguan grandmother caregivers experience transnational migration simultaneously as increasing the physical and emotional distance within families while also as an opportunity for strengthening shared emotional ties with the children in their care. In other words, transnational migration is morally ambivalent social and cultural terrain, as grandmothers balance the economic and emotional tensions surrounding remittances, and face the prospect of children’s potential future reunification with mothers abroad. Pensando mucho provides grandmothers a way of making (affective, emotional, and embodied) sense of these complex social and cultural experiences within transnational family life. Taking seriously grandmothers’ complaints of pensando mucho requires sorting out the complex associations between thoughts and emotions, minds (heads) and bodies. While I do not pretend to provide an exhaustive account of these issues here, I do intend to complicate simplistic dichotomies between mind and body, thoughts and emotions. Scheper-Hughes and Lock’s framework of the mindful body (1987) is foundational for understanding the body as simultaneously the site of individual/phenomenological experience and of social/political relations. Csordas has argued that attending to bodily sensations is not ‘‘attending to the body as an isolated object, but to the body’s situation in the world…the intersubjective milieu that gave rise to that sensation’’ (Csordas 1993, p. 138). These frameworks clearly situate the mind–body in a complex relationship to culture and society, where the mind–body can be both a site upon which social relations are inscribed and a generative source of cultural meaning. Yet, there is a tendency in the anthropological literature on embodiment to view the body as ‘‘pre-reflective,’’ as somehow outside or prior to the elaborations of culture and language (see MerleauPonty 1962, cited in Csordas 1990). The present discussion of pensando mucho suggests something different about the relationship between body, mind, emotions, and pain. In particular, what emerges from this analysis is that the somatic pain (felt in the head/ brain) associated with pensando mucho is post-reflective, constituted through thought rather than prior to thought, and with thoughts the generative substance of its meaning. Not only does this analysis complicate mind–body dichotomies, it also suggests that thoughts and emotions are overlapping cultural processes through which subjects make meaning of their social worlds and the disruption in those worlds. I frame pensando mucho both as a reflection of wider social disruptions in family continuity implied by transnational migration and as a means of expressing locally salient cultural ideals of solidarity in family life. I show how family solidarity— 123 478 Cult Med Psychiatry (2014) 38:473–498 understood as unity and togetherness within family life—has local and specific meanings for grandmothers caring for children in transnational families, and how in turn these ideals are threatened by global migration. In making this argument, it is important to situate ‘‘solidarity’’ within the particular political and cultural history of Nicaragua. During the 1980s, ‘‘solidarity’’ was a central feature of the revolutionary project, as Sandinistas and their international supporters would join together in ‘‘solidarity circles’’ to discuss gender, class, and national forms of oppression and brainstorm ways to transform social inequalities (Babb 2001, p. 11). While the historical context has shifted, solidarity remains a central feature of contemporary social and political life in Nicaragua. Since 2006, President Daniel Ortega has made ‘‘solidarity’’ one of the three defining features of his rebranded FSLN (Frente Sandinista de Liberación Nacional) party, whose bright pink Party posters dot the Managua landscape with the slogan ‘‘Cristiana, Socialista, Solidaria’’ [‘‘Christian, Socialist, and Solidarity (sic)’’]. Historically and in the present, discourse of solidarity recalls an external threat (in the 1980s, the U.S.-funded counter-revolutionary Contras; today, the economic threat of contemporary global capitalism), against which Nicaraguans must stand united. Such political discourse has resonance not just in terms of consolidating national identity, but also in shaping social and affective relationships. Jenkins has made a similar argument in her research on ‘‘el calor’’ among Salvadoran women refugees in the U.S. in the 1980s, whose embodied distress indexed the very real ‘‘heat’’ of the civil war (‘‘la situación’’) they were fleeing (Jenkins 1991, p. 141). In other words, I am arguing here that pensando mucho is a claim of embodied distress that indexes a political ethos of solidarity in Nicaraguan cultural life. While my focus here is on ‘‘thinking too much’’ expressed by grandmothers raising children in transnational families, as I mention in the concluding section, this idiom of distress may have significance in other cultural locations where broad social transformations are reconfiguring family relations, particularly for women who have central responsibility for maintaining continuity in family life in the face of such changes. Thus, for Nicaraguan grandmothers to say ‘‘pienso mucho’’ (‘‘I think too much’’) or ‘‘me pongo a pensar’’ (‘‘I get to thinking’’) is not merely a statement about a cognitive process or a mental disposition; instead, I show that it is a visceral, embodied way for grandmothers to express their experiences of absence, separation, and moral uncertainty as caregivers in transnational families. In other words, through the idiom of pensando mucho, ‘‘thinking’’ and ‘‘feeling’’ are best understood as overlapping and entangled emotional experiences whose object is the ways transnational migration upends expectations for solidarity and unity in family life. To say ‘‘estoy pensando mucho’’ in the interpersonal domain of family life is to make a recognizable claim of distress, which draws the attention of immediate and extended family members (and this anthropologist) to grandmothers’ roles in transnational families and the moral significance of these roles. Research Methods and Participants The analysis that follows responds to the following questions: What do women view as the causes and embodied symptoms associated with pensando mucho? How is 123 Cult Med Psychiatry (2014) 38:473–498 479 pensando mucho related to grandmothers’ experiences as caregivers in transnational families? My intention is that this discussion will establish a basis for future analysis of the association between pensando mucho and other forms of distress (especially depression) and somatic conditions (especially alterations in blood pressure) among Nicaraguan women of the grandmother generation. The data presented here are drawn from a larger ethnographic study of transnational migration, caregiving, and family health and well-being conducted in Nicaragua from July 2009 to July 2010.1 As my primary interest was exploring intergenerational transformations in caregiving following parent migration, all the families in my study were selected because grandmothers were primary caregivers for one or more children of a parent migrant. I included families where children were of primary school age (7–13 years) to provide a common range of family experiences. While my study included a total of 24 families, here I focus my analysis on the fifteen families where grandmothers are caring for children of migrant mothers. I focus on these families of mother migrants because the cultural expectations for women to be physically and emotionally present in family life mean that mother migration has particular impacts on children and their caregivers.2 In all but two of the families discussed here, fathers did not live with children, reflecting widespread paternal irresponsibility and conjugal instability in Nicaragua.3 In assuming caregiving responsibilities, grandmothers are motivated by deeply seated values of women’s sacrifice and solidarity in family life; indeed, grandmothers often told me that they assume care of their grandchildren after mother migration because ‘‘tenemos que hacerlo’’ (‘‘we have to do it’’), reflecting the ideal that women sacrifice their own interests for the sake of their families.4 Nine of the families live in Managua, Nicaragua’s capital city, and six live in rural communities in neighboring departamentos (states). The destinations of the migrants in this study include Costa Rica, Panamá, Spain, and the United States and the duration of migration ranged from 6 months to more than 10 years.5 1 This research was approved by the UCLA Institutional Review Board, IRB# G09-04-043-01. 2 This does not mean that father migration is insignificant, however, given gender roles in Nicaragua and cultural expectations for mothers, mother migration has particular emotional impacts on children and their caregivers in sending communities. 3 For background on gender roles and conjugal and sexual relationships in Nicaragua, see Lancaster (1992), Babb (2001), and Montoya and Rosario (2002). 4 The cultural ideals of women’s sacrifice for the sake of their families are reflected and reinforced by a general reverence for the Virgin Mary in Nicaragua and witnessed in unique cultural holidays such as ‘‘La Griterı́a,’’ which celebrate Mary’s role as mother of God and of Nicaragua. During this annual December holiday, people go door-to-door in groups to pay homage to the Virgin Mary through the presentation of ceremonial altars and the distribution of small gifts such as sugarcane and candy. After visiting a house, a group commonly shouts ‘‘Marı́a de Nicaragua y Nicaragua de Marı́a’’ (Mary of Nicaragua and Nicaragua of Mary). 5 The modal length of mother migration among families in this study is between 1 and 3 years, with nine migrant mothers having left Nicaragua between 1 and 3 years prior to this research (of course, migration continues past the period of this research and so these figures capture a glimpse of the ongoing duration of migration). Five mothers migrated within 1 year, three mothers had been gone for over 10 years (two for 10 years and one for 12 years), and two mothers had migrated between 5 and 7 years of the study. 123 480 Cult Med Psychiatry (2014) 38:473–498 Quite obviously, the duration of migration influences the experiences of both grandmothers and the children in their care. When migration is still recent (during the first year), families may be adjusting to mother absence and perceiving migration as a temporary feature of life; when the duration of absence exceeds 5 years or more, families may have adapted to mother migration and view it as representing a more permanent reconfiguration in family life. In addition, destination country and duration of migration structure the possibilities mother migrants have to return for visits. For instance, of the fifteen families discussed here, only three mothers had returned to visit Nicaragua at the time of this study, their visits were enabled by legal documentation in host countries that they had obtained over the period of many years living abroad.6 All families can be considered working class or working poor, although their social and economic resources vary somewhat (e.g., depending on whether grandmothers have other adult children in Nicaragua who provide them with social and/or economic support). With each participating family, I conducted a series of informal, semi-structured, and structured interviews with grandmothers and separately with children across at least three visits to the family home. I also interviewed other family members in Nicaragua (e.g., coresident aunts) and with five migrant mothers.7 Additionally, I conducted extensive participant observation in family life, visiting, sharing meals, hanging out, helping children with homework, going on outings with the families to church, to the movies, or to the mall. Finally, I engaged in participant observation with two Nicaraguan non-governmental organizations advocating for migrant rights, work that provides an important contextual framing for the analysis presented here. In this paper, I draw specifically on data from a semi-structured interview I conducted with each of ten women who had referred to pensando mucho and/or dolor de cerebro in earlier interviews; all were grandmothers in migrant mother families. The interview was designed specifically to explore the meanings of pensando mucho and to ascertain whether a shared explanatory model of this syndrome existed. The interview questions were open-ended and probed women to expand on their experiences as caregivers in transnational families and the connections they made between these social experiences and pensando mucho. I also probed the associations between pensando mucho and other complaints, such as insomnia, dolor de cerebro, depresión (depression), and presión (alterations in blood pressure). While the following analysis focuses on pensando mucho and dolor de cerebro, future analysis will systematically explore the relationship between these complaints, depresión and presión. All interviews were conducted in Spanish by the author in women’s homes and lasted between 45 minutes and three hours. Interview transcripts were analyzed using narrative content analysis to search for significance within and across interviews. Despite particularities, these women’s narratives of 6 For a fuller discussion of the ways children perceive the duration of their mothers’ migration and experience return visits, see Yarris (2014). 7 Three of the five interviews with migrant mothers were conducted on occasion of their return visits to Nicaragua. I also interviewed two migrant mothers outside of Nicaragua: one interview was conducted via Skype with a mother living in Miami, Florida, and another interview was conducted with a mother migrant who I visited in Panama City, Panamá. 123 Cult Med Psychiatry (2014) 38:473–498 481 pensando mucho reflect themes shared by other grandmothers who have assumed primary caregiving responsibilities in Nicaraguan transnational families. Pensando Mucho: The Moral Economies of Migration In discussing pensando mucho, grandmothers often referred to economic tensions and constraints as a source for and focus of their ‘‘pensamientos’’ (thoughts). These grandmothers receive and manage remittances sent by migrant mothers and assume primary responsibility for household economies. Despite the undeniable economic benefits of migration (enabling families to send children to private school and make needed home improvements),8 grandmothers refer to remittances as both materially inadequate to cover household expenses and as morally insufficient to make up for mothers’ absences. The moral ambivalences surrounding the economies of migration permeate women’s discussions of pensando mucho. For example, Marbeya—a 52-year-old grandmother raising two children (aged 8 and 14) of mother migrant Azucena who had lived in Costa Rica for over 11 years—explicitly associates pensando mucho with her responsibility to oversee her household’s economic circumstances, which in the excerpt below she glosses with the phrase ‘‘lo de la casa’’ (‘‘things at home’’). Marbeya heads a crowded household of 21 members (five of her six children, four of her children’s spouses, eleven grandchildren, and her husband) in an economically poor Managua barrio and is primarily responsible for accomplishing household tasks (cooking, cleaning, fetching water, and washing) and supporting family needs with the limited economic resources she receives from remittances. Her household responsibilities and economic constraints are evident in the following exchange: K What are you thinking about when you think too much? M When I get desperate (desesperada) is when I see that school tuition is coming due, or when the kids ask me for something at exam time, that ask me for things up and down and… it’s exasperating to see that the kids ask me for things and the money hasn’t arrived. K So when you get to thinking (cuando se pone a pensar), it’s usually for economic reasons? M Yeah, right. If I’m fine with things around the house (con lo de la casa), I don’t think too much (yo no pienso mucho). K Yeah= 8 That all the families of migrant mothers in this study send their children to private school is significant, for it reflects the principal aim of mother migration; in the words of migrant mother Azucena, to ‘‘give my children opportunities that I myself did not have.’’ Private grade schools in Nicaragua are often run by church-affiliated groups and are located throughout the poor and working class neighborhoods where families in this study live. Tuition in these schools is reasonable—averaging around $20 (USD) per month per child; however, even this small fee is out of reach for most Nicaraguan families. 123 482 Cult Med Psychiatry (2014) 38:473–498 M =You see, when I sleep well, I wake up fine. But when I have that insomnia and can’t sleep, I wake up depressed.9 In this exchange, Marbeya describes how economic strains can lead her to think too much, and how she struggles to manage remittances in a way that meets all the various needs of the grandchildren in her care. She also links pensando mucho implicitly to several related syndromes or symptoms: feelings of desperation (‘‘desperación’’), insomnia (‘‘insomnia’’), and depression (‘‘depresión’’). Emerging from Marbeya’s description of pensando mucho is a nascent explanatory model wherein the economic responsibilities and constraints she faces as a primary caregiver in a transnational family provoke ‘‘pensando mucho’’, contribute to feelings of desperation, and cause sleeplessness, all of which contribute to Marbeya’s feelings of depression. On the other hand, Marbeya tells me that when everything is in order at home, she feels well and does not think too much. In Marbeya’s words, ‘‘I’m well when everything at home is good, when everything’s good, I feel calm about everything…If I’m good, in other words, with things at home, I don’t think too much (yo no pienso mucho).’’ This reflection hints at the ways that caregiving may also provide grandmothers such as Marbeya a way of coping with the emotional distress associated with mother migration. Beatriz also associated pensando mucho with her family’s economic circumstances and her responsibilities to manage household finances. Beatriz is 63 and raising her 9-year-old granddaughter Alejandra after Beatriz’ daughter Jimena migrated to the U.S. about six months prior to our encounters. Like Marbeya, Beatriz heads a crowded intergenerational household of children, children-in-law, and grandchildren and depends on remittances to support household expenses. While Beatriz was an animated and energetic woman, she often became pensive and quiet during our interviews and thus invited her daughter Juana (J) to participate and help elaborate on the family’s experiences of migration. During one such interview, Beatriz became teary-eyed, affirming she was ‘‘pensando mucho’’ about ‘‘everything,’’ particularly about her economic problems. Here, I excerpt an exchange from this interview: K B J B K So tell me, when you get to thinking too much, what are you thinking about (>en qué se pone a pensar?) Well you see, it depends on the occasion, because there are times that you have thoughts (hay veces uno tiene pensamientos) about how to take care of everything at home. You know, sometimes for the-for the= =Because of the economic part. The economic part and everything because, what can you do? I’m the one who thinks about everything (soy la que piensa en todo). I mean, I’m the one who iswho is responsible. Responsible= 9 In the interview exchanges excerpted here, the symbol = indicates overlapping speech. I have also left certain key phrases in Spanish so as to allow access to their original meaning and make transparent my translations into English. 123 Cult Med Psychiatry (2014) 38:473–498 B 483 =Yes, and if I weren’t attending to money- if I weren’t- this makes me think too much. [Begins to cry] Contributing to Beatriz’ pensando mucho about her responsibilities to oversee her household’s economy is the recent migration of her daughter, Jimena. Jimena had migrated within a few months of this interview, and had not yet found a job in the U.S., so Beatriz had not yet received remittances. Before she migrated, Jimena held a professional job at a Nicaraguan company, and provided Beatriz with a good deal of economic support. Beatriz’ thoughts following Jimena’s migration were focused on how she could support her household without Jimena’s help, and specifically how to continue to send granddaughter Alejandra to private school. For this reason, Beatriz’ ‘‘pensamientos’’ were focused on the economic impacts of Jimena’s migration. She explained Because she was the one who helped me a lot, with everything. What can I sayif she left, I thought about how I was going to make it by, make everything work out. Because when she was here, if we ran out of gas [cooking fuel], I would tell her and she would say, ‘Mom, here you go, take this, buy it.’ So you can see that we can do it but, for everything to be in place, she’s missing. So those were my thoughts (esos eran mis pensamientos). You see? I didn’t sleep, think (no dormı́a pensando). I said to myself, ‘How am I going to do it?’ Beatriz went on to explain that after Jimena left, she thought she would have to take Alejandra out of the private school that she attended because she did not have the money to pay the tuition. Beatriz was able to solve this problem with the help of a co-resident son who stepped up and helped pay for household expenses. However, even more than Jimena’s physical absence, Beatriz is thinking about what her migration means for her goal of having her family ‘‘unido’’ (united). As Beatriz told me, she and her husband have always wanted a life where her family would ‘‘vivir unidos todos’’ (live united altogether), articulating the cultural value for family unity and solidarity that migration disrupts. Juana, a 47-year-old grandmother, also told me she ‘‘thought too much’’ about the economic necessity that pushed her children to migrate and how their absence negatively impacted the family unity and togetherness she desired. Juana (with the help of her husband) is raising two young children of two daughters who had migrated to Costa Rica within the past 5 years and were still living undocumented in the neighboring country. Juana has personal migration experience, as she was the first in her family to cross the border to Costa Rica where she worked as a doméstica (domestic worker) when her children were in their teens. After a few years, Juana and her family decided that her health could not sustain the demands of migrant life and that her children would have better economic prospects as migrants than she would. Of the necessity of migration for Nicaraguan families, Juana says Thinking that (pensando que)… if there were a source of work here nearby there wouldn’t be a necessity to go migrate to another country that isn’t ours. To be in family (para estar en familia), together here, where they would just go out in the day to work and we’d know that in the afternoon or the evening, they’d be here. And we would be able to mutually help one another here united together (aquı́ todos unidos). 123 484 Cult Med Psychiatry (2014) 38:473–498 In their discussions of pensando mucho, Marbeya, Beatriz, and Juana all refer to their responsibilities as household economic managers, and the anxieties of making economic ends meet given limited resources. Contrary to popularly held views of remittances as pushing migrant-sending families into the middle/consumptive class, financial anxieties are often compounded following migration, and grandmothers who assume roles as primary caregivers also assume new burdens as household economic managers.10 However, grandmothers’ discussions of pensando mucho are not limited to the economic impacts of migration, but focus on the ways migration reshapes their desires to have their families united and living together in Nicaragua. Pensando Mucho: The Uncertainties of Transnational Family Life Grandmothers associate pensando mucho with the ambivalences of the moral economies of migration, their experiences of the care slot, and their sense of the uncertain future of their families’ lives. These uncertainties are compounded by restrictive immigration policy regimes and risky border crossings between Nicaragua and destination countries. While space limits me from going into detail about these migration dynamics, most Nicaraguans in Costa Rica are undocumented and face racist exclusion, social discrimination, and police harassment (including deportation).11 These risks and dangers of illicit migration are part of the content of grandmother caregivers’ pensamientos (thoughts). For example, Juana described her experience of the migration of her two daughters to Costa Rica this way: Sometimes during the daytime you can pretend [you don’t feel it] because there’s so much to do, but when nighttime arrives even sleep escapes us (hasta el sueño se nos quita) as they say, because we get to thinking a lot (nos ponemos a pensar mucho) about the fact that they’re not here, about how they’re doing, about what’s happening, about when they may call us… We get to thinking because, well, all this happens. Then you can’t sleep calmly. It’s something that you’re already thinking (que ya estás pensando), maybe you can’t even eat right, because you’re eating and you’re thinking (estás pensando): How is she doing over there? What is she doing now? How is my daughter? So, it just isn’t the same. Interesting in this passage is the way Juana uses the third person singular and plural, as if to emphasize that any woman in her situation (mother of adult daughter migrants) would have a similar experience of loss, absence, and distress. Juana clearly associates pensando mucho with her daughters’ absence; however, it is not only a physical sense of absence that Juana is expressing here, for she is also referring to an emotional separation, a feeling of detachment from her migrant daughters associated with the physical distance of transnational space, which 10 This negative economic impact is exacerbated in cases when mothers worked and provided significant support to household economies pre-migration; as is the case of Jimena (Olga’s daughter) and other migrant mothers in this study. 11 For further background on Nicaraguan–Costa Rican migration, see Rocha (2006) and Goldade (2009). 123 Cult Med Psychiatry (2014) 38:473–498 485 renders Juana unable to know exactly what or how they are doing. Juana also refers to her awareness of the ways transnational communication is altered so as not to reveal the more troublesome side of migrants’ experiences. All of these dimensions of transnational family life cause Juana to feel a growing sense of emotional distance with her daughters, and, while she can distract herself during the day, at night her thoughts enter her consciousness and prevent her from sleeping, as she finds herself ‘‘thinking too much’’ about her migrant daughters. Also, in Juana’s excerpt is a sense of the in-betweenness of transnational migration. Even though they themselves do not migrate, grandmothers like Juana feel a sense of dislocation when their daughters migrate, as their emotional lives become suspended across national borders. In other words, grandmother caregivers feel themselves occupying the ambivalent affective space between ‘‘here’’ (Nicaragua) and ‘‘there’’ (destination country) (Hondagneu-Sotelo and Avila 1997). This physical and intergenerational separation between women is significant, as it represents a disruption of Nicaraguan cultural values for unidad (unity) and solidaridad (solidarity) in family life. In their discussions of pensando mucho, grandmothers highlight the intergenerational dimensions of family separation of transnational migration, for as grandmothers, they find themselves caring for another generation of children and as mothers they are separated from their migrant daughters. Pensando mucho thus indexes the moral ambivalence of transnational family life for grandmothers who work to maintain emotional ties between children and their mother migrants abroad as they simultaneously negotiate the changes that transnational migration implies for their own lived experiences and hopes for the future. For grandmothers like Juana, pensando mucho also indexes the emotional and instrumental support that is missing from their experiences within the ‘‘care slot.’’ Juana talks about the dangers her daughters are exposed to as undocumented migrants in Costa Rica and her own inability as a mother to protect them. Juana wants to be present for her daughters and she wants them to be present for her in ways that become impossible due to the distance and separation of transnational life. This is clear when I ask Juana directly, ‘‘What are you thinking about when you get to thinking too much?’’, and Juana replies I think about the economic part, about the health of my family, and about my children who aren’t here- you can feel the loneliness. You feel alone. After being full of people, you find yourself alone. And sometimes you need someone- even if it’s just for them to bring you a glass of water when you’re sick. Here, Juana refers with nostalgia to having her house ‘‘full of people’’ before her three adult children (two daughters and one son) migrated to Costa Rica. Even though she lives with her husband and grandchildren, and has a daughter and son-inlaw who live nearby, Juana still feels lonely. This sentiment runs counter to her expectation that at this stage in her life, she would be surrounded by supportive adult children, who would provide her with emotional and instrumental support, even in tasks as small as bringing her a glass of water. Bringing a glass of water in grandmothers’ narratives of transnational family life has symbolic meaning as a 123 486 Cult Med Psychiatry (2014) 38:473–498 concrete example of the kinds of instrumental and emotional support that grandmothers miss when their adult daughters migrate. Nostalgia, or longing for a time before migration when ‘‘toda la familia era unida’’ (all the family was united), was a recurrent theme in women’s narratives of pensando mucho. When I ask Marbeya to describe her pensamientos, she talks of a longing for a life prior to her daughter’s migration, before taking on the (grand)parenting responsibilities she has assumed: There are times, right, when a longing (una nostalgia) takes hold of me and I say to myself, ‘Ay, if my daughter were here with me I might feel in good health (bien de salud)’, or I would feel calm because I would be relieved of a burden that I have now, I would pass it off onto her. It’s like an obligation I have right now with her children. And if she were here, I wouldn’t have this obligation, I would pass it off to her hands. So it would be fewer thoughts for my brain (serı́a menos pensamientos para mi cerebro). In Marbeya’s account, her ‘‘nostalgia’’ is a way of rendering her memories of a past (prior to mother migration), when the order of reproductive and caregiving responsibilities within her household would not have been disrupted and when she would have been ‘‘bien de salud’’ (‘‘in good health’’), or well—in other words, when mothers cared for children, and adult children cared for aging mothers. While I do not know whether this memory matches pre-migration realities in Marbeya’s family, her account of pensando mucho connects a remembered past with a longed-for (post-migration) future, when she will be relieved of her responsibilities as what we might call a mother-in-the-meantime, able to pass on care of her grandchildren to their (hopefully returned) migrant mother, and to set straight the culturally valued order of caregiving within her family life. While pensando mucho contains feelings of nostalgia for longed-for pasts, women’s thoughts also are focused on highly uncertain futures. An illustrative example here is Angela, 53 years old and raising granddaughter Laleska, aged 11 at the time of the study, whose mother Karla had migrated to the U.S. over 10 years before. Also living with Angela are two other granddaughters who Angela has raised since they were young, despite the fact that their mothers are not migrants, but live elsewhere in Managua. Laleska views these maternal cousins as sisters and Angela treats all three girls as ‘‘mis hijas’’ (my daughters). Angela maintains an orderly household and has her ‘‘girls’’ help with regular chores, cooking, cleaning, washing, and organizing the weekly meetings of her church Bible study that Angela hosts. Angela describes her experience of ‘‘thinking too much’’ in relation to the possibility that Laleska will eventually ‘‘reunify’’ with Karla in the U.S., leaving Angela alone and without the company she has grown to love. The possibility of Laleska’s migration was highly uncertain at the time of this study, reflecting the complexities of the U.S. immigration bureaucracy and the opaqueness of the family reunification visa process. While in early interviews Angela talked about reunification as an immanent possibility, over time it became much less clear whether Karla had even initiated the necessary paperwork for her daughter’s and her mother’s residency visas or whether either would be traveling to the U.S. anytime 123 Cult Med Psychiatry (2014) 38:473–498 487 soon. When I ask Angela to describe her pensando mucho, she tells me that what she most thinks about is this uncertain future of her family life. On a personal level, Angela worries that if Karla were to obtain a residency visa for her, Angela would not want to leave Nicaragua because of her family ties, responsibilities, and sense of community. Angela has two children who live not far from her in Managua and she is involved in their lives as they are in hers. Angela also helps care for grandchildren other than Karla’s daughter and worries about leaving them behind were she to go to Miami with Laleska. Angela also has very strong ties and a leadership role within her church, and while she knows there are Christian churches in Miami that she could attend, she does not want to leave her ‘‘hermanos y hermanas’’ (brothers and sisters of the church). Angela knows life in the U.S. is different from Nicaragua, more individualistic and less family oriented; she worries about the possibility that she would end up being ‘‘encerrada’’ (closed up in) her daughter’s house, with few friends and little of the social support she enjoys in Managua. But even more than ‘‘thinking too much’’ about herself, Angela is thinking about the uncertainty surrounding Laleska. For Angela, the decision about whether or not Laleska migrates is not hers to make, but something that Karla will decide. Still, Angela worries about Laleska’s future if she were to leave Nicaragua for the U.S. after living for more than 10 years in her care. Angela is concerned that Laleska will not adjust well to living with her mother and she contemplates the possibility that Karla’s new husband will expect Laleska to babysit her younger siblings. She wonders if Laleska might end up dropping out of school, just like her mother Karla did after she migrated to the U.S. years earlier. As she describes these uncertainties to me, Angela connects one concern to another in a litany of worry and fret; saying, ‘‘You see, I get to thinking too much about all of these things’’ (‘‘Ya ves, en todas esas cosas yo me pongo a pensar mucho’’). Angela’s emotional distress partially reflects the fact that she feels decisions about the future of her family life are largely outside her control. First, there is the complex and costly U.S. immigration bureaucracy, which makes possible ‘‘reunification’’ a long and expensive process for Karla and the family. Second, decisions about ‘‘reunification’’ are largely in Karla’s hands since, as a U.S. resident and Laleska’s mother, she has to submit residency petitions for her daughter and mother. Thus, Angela feels marginalized from the very actions that will determine her personal and family future. As Angela explains, this uncertainty provokes her pensando mucho: It’s this that has me- at any moment- it’s something that she’s already thought about, it’s a situation that’s presenting itself and that I think about- in any moment- How am I going to do it? How can I leave here? So, I get to thinking (me pongo a pensar). In this excerpt, Angela frames future migration-related decisions as something that her daughter Karla ‘‘has already thought about’’ (past tense) but that she herself experiences as a situation that is ‘‘presenting itself’’ (in the troublesome present perfect) and that she continues to ‘‘think about.’’ In other words, Angela portrays Karla as the mother migrant and agent making decisions about the future; whereas 123 488 Cult Med Psychiatry (2014) 38:473–498 she, as grandmother, is coping with the consequences of ‘‘reunification’’ on herself and her family in the present. Like Angela, Olga (62 years old and raising granddaughter Juliana, aged 9) associates pensando mucho with the ways immigration politics impinge on her family’s future. Olga’s daughter Manuela had lived undocumented in Panama City for 2 years prior to my fieldwork. Olga knows of other residents of her lower-class Managua neighborhood who have migrated to Panama and who have been deported, and Olga considers this a real risk facing Manuela. Olga tells me that her pensando mucho was precipitated by Manuela’s initial departure; however, her ongoing thoughts are focused on the insecurity her daughter faces and the uncertain future her family confronts. Olga says, ‘‘Ay! I think about the fact that migration [Panamanian immigration enforcement] can grab her at any time (que la agarra la migración) and they can send her back. Like they say, they’ll send her back without anything, they say that everything [Manuela’s belongings] will stay where she lived. Migration- Yes, I get to thinking (me pongo a pensar).’’ Olga’s fear of Manuela’s possible deportation (‘‘que la agarra la migración’’) reflects a very real threat. I had occasion to visit Manuela in Panama City in the small, two-room house she shares with another Nicaraguan migrant in an immigrant neighborhood. At some point during our two-hour conversation, Manuela received a phone call from a friend who resided nearby, telling her that ‘‘la migra’’ (migration authorities) were conducting a sweep of the barrio, asking people to show their immigration papers, and taking them into custody if they did not have documents. Manuela seemed accustomed to such immigration raids and told me they happen all the time (the ways Manuela and her friends use social networks and cell phones to protect each other is revealing of the frequency of these raids and immigrants’ resourcefulness in responding to them). While her daughter has grown used to the risks of her own undocumented status, back home in Nicaragua, Olga fears the worst, thinking Manuela may be detained and deported at any time. When Olga does not receive her bi-monthly phone call from Manuela, anxiety sets in and she gets to thinking, ‘‘Could it be that immigration detained her? I get upset (Yo me quedo afligida.)’’ For Olga, then, the vulnerabilities and uncertainties of transnational family life provoke deeply felt anxieties (or aflicción), and contribute to her pensando mucho. This discussion shows how ‘‘illegality’’ (see Willen 2007) structures the subjective experiences not just of migrants themselves, but also of family members of migrants in sending countries, who experience the vulnerabilities of undocumented status as a significant source of distress. Somatic Symptoms of Pensando Mucho The two most common somatic symptoms mentioned by women in conversations about pensando mucho were ‘‘dolor de cerebro’’ (lit. ‘‘brainache’’) and ‘‘insomnia’’ (‘‘insomnia’’). Dolor de cerebro is described as a pulsing pain felt at the back of the head or base of the skull/top of the neck; distinct from, but possibly co-occurring with, both ‘‘dolor de cabeza’’ (headache) and ‘‘migraña’’ (migraine) (for a discussion of dolor de cerebro among rural Nicaraguan women, see Yarris 2011). 123 Cult Med Psychiatry (2014) 38:473–498 489 While ‘‘cerebro’’ can be translated literally as ‘‘brain,’’ women use ‘‘cerebro’’ almost interchangeably with ‘‘mente,’’ which would be translated as ‘‘mind.’’ Thus, ‘‘dolor de cerebro’’ could be translated as ‘‘brainache,’’ but could also be glossed by the phrase ‘‘mindache.’’ Beatriz explains the association between pensando mucho and dolor de cerebro in the following exchange: K B Do your thoughts (pensamientos) hurt you? Is there any place in your body that= =In the brain/mind (en el cerebro), yes, in the brain/mind. Because that wears you out (desgastarse), the brain/mind- Well it’s the circumstances that we live in. If you had the means, ahh- you’d live well! But you tell me, being poor, you have to think (tiene que pensar) about how you’re going to get by. In Beatriz’ explanation, she ‘‘thinks too much’’ about the circumstances of her life, specifically her economic poverty. Thinking about how she is ‘‘going to get by,’’ she feels a physical sensation of pain in her brain/mind, described as a ‘‘wearing oneself out’’ (desgastarse). Similar to Beatriz, Marbeya describes dolor de cerebro as a somatic reflection of pensando mucho. According to Marbeya, I’m thinking (estoy pensando), how is money going to last me? What am I going to spend it on? If the boy [her grandson Selso] gets sick today, tomorrow I can’t buy the pair of shoes, because I have to take him to the doctor. So there is the brain/mind (cerebro) going, it’s the mind (mente) and the brain (cerebro), and everything is working. It’s like being super worried (super preocupada). In this excerpt, Marbeya portrays the experience of pensando mucho as a sensation that her brain/mind is working, processing thoughts and worries related to her responsibilities for her two grandchildren, and her economic constraints as their primary caregiver. In her description, pensando mucho is ‘‘like being super worried’’; in other words, pensar (to think) is different from, and more intense than, preocupar (to worry). (The distinction between ‘‘thinking’’ and ‘‘worrying’’ will be discussed further below.) In addition to associating pensando mucho with dolor de cerebro, Marbeya also connects pensando mucho with symptoms of sleeplessness: If I don’t think too much, I sleep well (Sı́ yo no pienso mucho, yo me duermo tranquila). But if I lie down and I start to close up in thoughts, like going ‘riqui, riqui’ [makes machine-like sounds and points to her head], the cassette going around, that tape is going round and round… but if I don’t think too much, my brain is calm. Like dolor de cerebro, Marbeya describes sleeplessness as caused by ‘‘thinking too much.’’ When Marbeya is thinking too much, she ‘‘closes up in thoughts,’’ with her brain/mind processing thoughts repeatedly and incessantly and thus making it difficult for her to rest. On the other hand, when she is not distracted by thinking too much, Marbeya’s ‘‘brain is calm’’ and she can sleep well. In her descriptions of ‘‘pensando mucho,’’ Marbeya describes how her ‘‘cerebro’’ (brain/mind) works, 123 490 Cult Med Psychiatry (2014) 38:473–498 machine-like, to process her thoughts. In this view, the brain/mind is experienced as a distinct object, organ, or site within the body that is an agent of thinking (pensando) and of thoughts (pensamientos). The brain/mind ‘‘working too much’’ causes dolor de cerebro and insomnia, and in Marbeya’s portrayal, it seems there is little she can do to intervene and control her thoughts so that her ‘‘brain is calm.’’ Marbeya talked about the experience of pensando mucho in a separate conversation this way: ‘‘It’s when you are wearing yourself out (‘‘se está desgastando’’), you put yourself- I feel like my brain (‘‘cerebro’’) is tired (‘‘cansado’’).’’ Beatriz and Marbeya make explicit the sensation of a ‘‘wearing out’’ or a tiredness (‘‘cansancio’’) in the brain due to thinking too much. These findings recall an earlier study of Puerto Rican mental health patients in the U.S., where dolor de cerebro was cited as a specific pain associated with ‘‘un desgaste cerebral’’ (‘‘a wearing out of the brain’’) (Abad and Boyce 1979). I have also documented this embodied pain as experienced among a separate sample of rural Nicaraguan women (Yarris 2011). While there is a need for more scholarly attention to dolor de cerebro and pensando mucho in different cultural settings, these preliminary findings reveal the possibility of an emergent explanatory model whereby the social location of women of the grandmother generation and their experiences of cultural change and uncertainty produce the embodied distress of pensando mucho. In these descriptions of dolor de cerebro, the brain/mind is a generative source for the broader social and cultural significance of pensando mucho. The descriptions presented here also contain interesting insights into the meanings of ‘‘cerebro’’ (brain) and ‘‘mente’’ (mind). Although I did not explicitly ask women about the distinctions between these three bodily sites, across women’s discussions of pensando mucho emerges a sense that the cerebro is a generative site of pensamientos (thoughts), which, when experienced in excess, can in turn cause pain in the brain/mind. Studies of chronic pain in the U.S. have shown how the idea of pain being ‘‘in the head’’ can delegitimize sufferer’s experiences by contributing to a sense that pain has no biological basis but is instead imagined (for example, see Garro 1992, p. 131). Interestingly, in the narratives of pensando mucho analyzed here, women seem to use the assertion that this syndrome is somatically sensed as pain in a particular physiological location (the brain/mind) as a way of emphasizing their experiences of emotional distress. In other words, assigning pain a physical location may be a way for women to legitimate their experiences of troubling social realities (here, their roles as caregivers in transnational families). Thus, rather than physical pain as the ‘‘ontological assault’’ unsettling the integrity of personhood (Garro 1992, p. 130), in these descriptions of pensando mucho, the physical pain of dolor de cerebro indexes the social assaults of transnational migration that are upending grandmothers’ cultural expectations for family life. Thinking, Worrying, and the (Im)Possibilities of Resolution One way to understand the syndrome of pensando mucho is to consider how it differs from other forms of distress. The women in my study were very clear in 123 Cult Med Psychiatry (2014) 38:473–498 491 articulating the difference between pensando mucho and ‘‘preocupandose’’ (‘‘worrying oneself’’). In fact, while not a focus of my initial interview questions, women would raise the difference between pensando mucho and preocupacı́on as a way of explaining the significance of pensando mucho. This is a distinction of severity and temporality: whereas preocupación is framed as a common sort of worrying about everyday problems that have relatively straightforward solutions, pensando mucho is situated as a chronic and intense form of distress associated with thoughts that have neither an apparent nor a facile resolution and so extend into uncertain futures. Angela explained this distinction: Yes I think they’re different [pensando mucho and preocupación], because worrying (la preocupación) you have it all the time, right. For example, you worry about ‘what am I going to cook?’ Or if you have money, let’s see, ‘What am I going to do?’ It’s a worry, but it’s already over. On the other hand, thinking too much is about a problem that you maybe don’t know how to resolve. It’s different. In Angela’s description, preocupación is related to everyday concerns of running a household, such as preparing meals on a limited budget. Pensando mucho, on the other hand, is a more profound form of thinking about problems without solutions, problems that are in essence moral contradictions. For Angela, then, pensando mucho is derived from ‘‘el problema de ser madre en esta situación’’ (‘‘the problem of being a mother in this situation’’), a ‘‘problem’’ that is inherent to her condition as a grandmother occupying the care slot in a transnational family. As discussed earlier, Angela thinks too much about whether or not she and granddaughter Laleska should leave for the U.S. and about the fragility of Laleska’s ongoing relationship with her migrant mother. Angela says, ‘‘You’re always going to have these thoughts, I feel like these are the things that sometimes drive you to- well, it’s that you’d like to find a solution but you can’t, so you don’t stop having this problem in your mind (no deja de tener ese problema en la mente).’’ While Angela would like to find a resolution to her situation, she cannot change the fact that her daughter has migrated and that she has assumed care for her granddaughter; thus, in her words, ‘‘you can’t stop because it’s hard to stop thinking about them.’’ In this way, pensamientos are framed as chronic, persistent thinking that accompanies women’s roles as grandmothers in transnational families responsible for caring across distance and generation. Juana similarly made a temporal distinction between pensando mucho and preocupación, associating the former with a long-term problem and the latter with a more immediate or short-term worry. Using the example of how she responds to her granddaughter’s illness episodes (the 3 year old is asthmatic and has recurrent flareups), Juana says ‘‘me preocupo’’ (‘‘I worry’’) about finding money to cover the cost of the medicines needed to treat her granddaughter’s asthma. However, Juana says, ‘‘me pongo a pensar’’ (‘‘I get to thinking’’) if she spends money on medical treatment for the girl one day she will be unable to cover the costs of food to feed her family over the following few weeks. For Juana, ‘‘Thoughts are more long term (son más allá). If I spend on medicine for her today, what are we going to eat tomorrow? It’s a problem without a solution. We’re—as we Nicaraguans say— 123 492 Cult Med Psychiatry (2014) 38:473–498 between a rock and a hard place.’’12 Thus, not only are the thoughts of pensando mucho situated within uncertain futures, they are also thoughts without easy resolution. In a separate interview, Juana provides another clear description of the way pensando mucho is a reflection of the lack of a simple solution: Because to think too much, I think that brings us … depression. Because I feel depressed because I don’t feel there’s an exit or a solution to my problem. I don’t have an answer or a way out of my problem, so this makes me tense, I get… In other words, it’s like a continuous desperation because I can’t resolve my problem. Or if the problem is too much for me…. For that reason I said that with several people it’s more possible- my daughter told me when she was here [on a recent visit], ‘Don’t worry mom, we are going to make a store, or we’ll find a way to do something’. There you see there are two heads thinking, not just one. We can do this or that other thing and there we go. But when there’s only one person, then I’m like, ‘What am I going to do tomorrow?’ I don’t know, I feel I don’t have a way out, I can’t figure out which way to go. For Juana, depression is a reflection of the chronicity and gravity of the thoughts at the basis of pensando mucho. Juana relates a very visceral sense of ‘‘continuous desperation’’ associated with her perception of having no answer to her problems. Juana also contrasts this emotional state of desperation—thinking too much about problems without solutions—with an example of a recent conversation she had with her daughter. During a visit home, her daughter offered promises of solutions to the economic problems facing the family (solutions that imply her daughter’s return and setting up a small store to generate income for the family). Juana uses this example to illustrate how pensando mucho results from a sense of solitude since, if her daughter were at her side, Juana would feel accompanied and able to address her problems in a more proactive way. Alone, Juana finds herself back in the cycle of pensamientos without an apparent solution; she ‘‘can’t figure out which way to go.’’ For her part, Beatriz explained that preocupación is about ‘‘something light’’ (‘‘algo leve’’), such as her son coming home late on a weekend night. Her son’s drinking and partying is something Beatriz worries about, but it is also something that has ‘‘una solución’’ (‘‘a solution’’), for once she hears him come in the front door, she feels better and stops worrying. (Beatriz also believes this is just a phase of early adulthood that her son, like all men, will pass through). On the other hand, pensando mucho is distinct and for Beatriz related to her role as head of an economically poor household. As she explains, ‘‘You tell me, when I’m thinking about something like that [her economic concerns], it’s something that doesn’t have a resolution. Because you see- it’s when I can’t make ends meet that I get to thinking, how am I going to do it?’’ For Beatriz, financial constraints are irresolvable, she thinks about them repeatedly and chronically, thus they are the substance around which her pensando mucho has significance. 12 Here, Juana uses the phrase, ‘‘Entre la espada y la pared’’, which literally translates as ‘‘Between the sword and the wall’’ but can be idiomatically translated as ‘‘Between a rock and a hard place’’. 123 Cult Med Psychiatry (2014) 38:473–498 493 Embedded in these discussions of pensando mucho are women’s feelings of limited control over the problems that they ‘‘think too much’’ about. In fact, grandmother caregivers are often sidelined from their daughters’ migration-related decisions, and respond by assuming care for children out of a sense of moral obligation to support family life. In some ways, then, pensando mucho is a reflection of the limited agency women feel in relation to the economic circumstances causing their daughters to migrate and their sense of limited control over the ongoing challenges of caregiving in transnational families. On the other hand, women do express an ability to intervene and overcome their ‘‘preocupaciones.’’ Since worries are related to the everyday concerns that women face as heads-of-households, they must face and overcome these immediate challenges as part of their social roles. As another grandmother, Teresa, said of preocupaciones, ‘‘And being worried- we’re always going to be worried- worries are always going to be a part of our lives. So it’s up to us how we are going to respond to them.’’ While women cannot resolve the concerns that cause pensando mucho, they find some relief for their chronic thoughts through the very acts of caring for grandchildren that result from their troublesome social location in transnational families. This is the dialectic complexity of caregiving in transnational families: the very absences that lead grandmothers to concern also produce opportunities to provide care that grandmothers experience as life affirming. In other words, while daily routines of cooking, washing, cleaning, accompanying children to school, and overseeing homework are partially burdensome, they also provide grandmothers the chance to ‘‘mother again’’ for another generation of children. These caregiving relationships also are uncertain; however, for grandmothers know they will forfeit their emotional ties to grandchildren should mothers decide to reunify with their children. Such uncertainties and moral ambivalences are at the core of the sentient experience of pensando mucho for these Nicaraguan grandmothers. In sum, the substance of pensando mucho involves the irresolvable concerns and contradictions in family life provoked by mother migration. Through pensando mucho, grandmothers contend with the moral limitations of remittances, the reconfigurations in their roles as intergenerational caregivers, and the upending of cultural expectations to have ‘‘toda la familia unida.’’ Concluding Thoughts As these examples demonstrate, grandmothers’ discussions of pensando mucho highlight the ambivalence of transnational family life, where mother migration has ruptured expectations of having ‘‘toda la familia unida’’ and resulted in a profound sense of uncertainty about the future. Narratives allow participants to situate present troubles ‘‘within a larger temporal surround’’ (Garro 2005, p. 62) that includes nostalgic renderings of the past, problematic portrayals of the present, and ambivalent accounts of possible futures. Through their narratives of pensando mucho, grandmothers articulate broader concerns about the impact of mother migration on their lived experiences of the ‘‘care slot,’’ as mothers of migrant daughters and grandmothers of children of migrants. These women’s lives become 123 494 Cult Med Psychiatry (2014) 38:473–498 suspended across national borders through an emotional in-betweenness that characterizes the affective domain of transnational family life. Through the idiom of pensando mucho, grandmother caregivers subtly critique the ways transnational migration upends cultural ideals for solidarity and togetherness in Nicaraguan family life. ‘‘Thinking too much’’ becomes a chronic worry about whether migration is temporary or permanent, whether grandchildren will stay in Nicaragua or rejoin migrant mothers in host countries, whether their migrant daughters will be deported or return voluntarily, and how migration will impact family relationships in the future. These are the tensions and uncertainties of transnational family life that give significance to grandmothers’ emotional distress and are communicated through the idiom of pensando mucho. Pensando mucho indexes a rupture in cultural expectations for family life, which hold that women of the ‘‘tercera edad’’ or grandmother generation would expect to receive social, emotional, and instrumental support from their adult daughters as they age into later adulthood. As indicated by the examples presented here, mother migration undermines women’s desires to have ‘‘toda la familia unida’’ (‘‘all the family united’’) in physical copresence and emotional support. It is in this cultural context that we can understand grandmothers’ emotional experiences of mother migration and the ongoing ambivalence and uncertainty associated with transnational life. Mother migration results from economic circumstances and provokes troubling consequences for family life that grandmothers cannot resolve. Because their thoughts lack a simple solution, women experience thinking too much as a chronic source of embodied distress. The interpretation of pensando mucho I am advancing here is that the prevalence of ‘‘pensamientos’’ among grandmother caregivers indexes their social location in the care slot in transnational families, the persistence of their migrant daughters’ absences, and the uncertainty of their families’ futures. In other words, where migrant mothers were once physically present in everyday family life, now grandmothers are left ‘‘thinking too much’’ about their ongoing absence; thoughts remain like emotional traces of the migrant mothers now far removed in transnational space. As discussed above, pensando mucho is distinct from other forms of emotional distress because of its severity and chronicity. It may be precisely because women see these as thoughts related to social situations of transnational migration that are immutable that they are unlikely to see clinical or biomedical practitioners as offering resolution for their distress. Furthermore, according to Marbeya, ‘‘We say ‘My brain/mind hurts’ (Me duele el cerebro). The doctor says, ‘The brain/mind doesn’t hurt.’ (El cerebro no duele.) For us, we feel ‘my brain hurts’; but for doctors, the brain can’t hurt. So I say to them, in other words, ‘Ok, fine, I feel exhausted.’’’ Here, Marbeya indicates that medical practitioners do not take women’s claims of pensando mucho seriously, but rather disregard them as illegitimate claims of suffering or possibly attempts at malingering. Given such disregard, it is unlikely that women will present the pain of pensando mucho in clinical settings. It may also be that precisely because I took such serious interest in pensando mucho that women were willing and open to talk with me about their distress. I also argue that for the grandmothers with whom I work, pensando mucho functions as an idiom of distress, meaning that they use this complaint to draw attention (from this anthropologist and 123 Cult Med Psychiatry (2014) 38:473–498 495 other concerned observers) to the importance of their intergenerational caregiving for the maintenance of transnational families. I have also documented the embodied dimensions of pensando mucho through a discussion of dolor de cerebro. Here it is apparent that culture shapes not only ways of talking about the body, but also, importantly, ways of feeling, sensing, and being in the body; or, in the case of pensando mucho and the associated pain of dolor de cerebro, of being in the brain/mind (which my interlocutors view as part of, not separate from, the body). Thus, the thoughts associated with ‘‘thinking too much’’ are evidence not only of a cognitive process, but also of a social, emotional, sentient, and embodied experience. Rather than situating pensando mucho in relation to a pre-reflective—ontologically primary—body, these examples of dolor de cerebro show how the body can be a sited upon which thoughts inscribe pain. In other words, the argument about pensando mucho advanced here runs somewhat counter to philosophical notions that the body is a pre-reflective generative force (see Merleau-Ponty 1962). In the idiom of pensando mucho, thoughts and emotions are productive, generative sources of cultural meaning, just as cultural meanings shape emotional experiences and cognitive content. Based on this discussion of pensando mucho, the relationship between body, mind, and culture appears inextricably intertwined such that culture shapes mental, physiological, and emotional experiences, which reciprocally are productive sources of cultural meanings and actions. It is hoped that additional research will determine whether ‘‘thinking too much’’ is an idiom of distress salient in other cultural contexts. From the present analysis, I hypothesized that ‘‘thinking too much’’ may be revealed to be a significant form of distress for women of the grandmother generation in social settings beyond Nicaragua, particularly for women who find themselves assuming primary caregiving responsibilities for (grand)children following parental migration or other forms of parent absence. I propose that ‘‘thinking too much’’ indexes the emotional distress of grandmothers who find themselves engaging in caregiving as a way to foster family togetherness and broader cultural continuity in the face of contemporary social upheaval such as that following transnational migration. While it is possible to leave an analysis of pensando mucho at the level of embodied distress or social suffering, doing so would represent an incomplete interpretation of the experiences of the grandmothers discussed here. For, despite the hardships and challenges of their caregiving roles, these are women of the tercera edad who actively and affirmatively participate in the recreation of individual, family, and cultural life despite their limited economic resources and in the face of the challenges of transnational migration. As I suggested above, it is through caregiving itself that grandmothers are able to find an internal source of resilience they draw upon to counter their sense of loss and uncertainty surrounding mother migration. In other words, while child caregiving is a significant social responsibility and may at times be experienced as a burden, grandmothers also gain a sense of purpose and motivation through extending care as a means of supporting their migrant daughters and grandchildren. Thus, where pensando mucho evidences the troubling emotional uncertainty and cultural disruption embodied in 123 496 Cult Med Psychiatry (2014) 38:473–498 transnational migration, grandmothers may draw upon caregiving as a resource for their own and their families’ emotional well-being. Acknowledgments The author would like to thank the organizers and participants of the 2013 Cascadia Seminar in Medical Anthropology for the opportunity to workshop an earlier version of this article in that venue. 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