3.1 Case 1
Mrs. Z. was 27 years old when we first met her. She has five children ranging in age from six months to twelve years, three girls and two boys. Mrs. Z. lives with her husband (a stove craftsma n in the bazaar) and her five children in one room of her husband's father's house. The other room is occupied by her husband's mother, father, and two sisters. They all maintain a single kitchen. Their simple house is surrounded by a fifteen foot brick wall that encloses a small cou rt yard with a piped water supply. The house has electricity but no water. The family income averages about 100 dollars per month, plus a small income from Mrs. Z.'s sister-in-law who works as a seamstress. The family leads a simple life, their income providing for sufficient food but little in the way of extras.
Mrs. Z. has never attended school, is completely illiterate, and knows no Persian. She
does not know how to count money and has to be accompanied by her husband or sister-in-law on those few occasions when she goes to the market to shop. She goes out to visit her parents, who are poorer than her husband's family, about once per week to clea n their house for them. Other trips into the outside world are limited to rare wedding celebration, a few religious mourning rituals, and an occasional trip to a doctor or a public health clinic. Thus Mrs. Z. passes nearly all of her days within the confines of her walled courtyard and home, surrounded by children and the women of her husband's family.
From the time we knew her Mrs. Z. complained about heart distress. She fretted continuously about her weak condition, her lack of strength and lack of blood, and the lack of meat on her bones. She complained of her heart pounding, her nerves being upset, and the sensation of her heart being squeezed (darux) and depressed. This continued for the 18 months that we knew her, without any significant change in her symptoms. She complained to anyone who would listen - her husband, others in the household, her neighbors, and the visiting anthropologist. On one occasion she told my wife that she always felt like screaming out. She blamed this on the fact that she was 27, already had 5 children, was stifled by narrow living quarters, and lived with her mother-in-law as the head of the household. She said, "I feel like screaming. But if you heard me you would be frightened, I would scream so loudly." Her desire to scream out was released in a series of fights with her mother-in-law which occurred at least weekly, loud fights with shrill screaming and crying which sounded over the walls and into the street. The fact that these fights were heard was a source of great embarrassment, for a woman's voice should not be heard outside of her courtyard just as her face should not be seen beyond the intimacy of her home.
In an attempt to limit her family size, Mrs. Z. took birth control pills for a brief period (less than one month) at the urging of her more educated neighbors. But when she took the pill, she said, she had heart palpitations, shaking hands, and upset nerves, all symptoms that she had experienced before but that she believed were exacerbated by the pill. Previous to taking the plll for contraceptive purposes, Mrs. Z. had once taken a whole month's supply in an effort to abort her last child. (She thus associated the pill with abortion and with prevention of pregnancy.)
Mrs. Z. occasionally used herbal medicines for both her weakness and her heart distress. She also visited the doctor several times to complain of her weakness and heart problems and was given a Vitamin B tonic. She never received any lasting relief. Mrs. Z. blamed her illness on having too many children, her cramped living conditions, the poverty of her parents and the chronic illness of her younger brother (who has a rheumatic heart
condition), her past use of the contraceptive pill, and the conflict she feels over her desire to avoid pregnancy while still satisfying her husband. These conditions continue, and so does her heart distress.