Despite having one of the highest suicide rates in Latin America, Cuba denies the existence of mental illness. For relief, citizens turn to the black market and a little white pill.
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August in Havana is a mounting wave of heat—so consuming, the sun so piercing, it can warp your sense of reason. Tempt you to surrender. Make you flirt with insanity. The pained faces around you are covered in grimy sweat, a haze of resignation in the eyes. Here or there a woman fans herself, perhaps with some ladylike, store-bought thing, but more often with a stray scrap of cardboard. Inside, heat radiates from every surface, the temperature rising as the torridity soaks deeper into the concrete walls. Outside is worse. Few dare venture into the scorching light.
And there is nowhere else to go. Havana, for most inhabitants, is an enclosed island within an island. To the north is the water, of course, but it is accessible only by climbing down the Malecón seawall and a ring of perilous cliffs. A trip to the beaches east of the city involves hours of waiting in line, then standing for the long ride on an overstuffed bus with no air-conditioning.
Havana’s neighborhoods explode with the products of sun, water, and the island’s intense fertility: the delicate orange flowers of the outstretched framboyán shade trees, bougainvillea in twists of magenta and purple, squash blossoms peeking from the weeds encircling decrepit mansions, and the red mar pacíficos, or hibiscus, which curl in their blossoms every afternoon.
On a lucky day, this occurs just as the rains come in. The horizon goes from partly cloudy to gray and foreboding, the sky exuding a brilliant, otherworldly yellow. Lightning jags, in white and orange, hover on the horizon, above the imploding buildings. Then the aguacero comes down: angry, gigantic drops beating into the ground in long flashes of light. Few Cubans can afford umbrellas, and they resign themselves to the deluges, like so many daily realities.
As August goes on, the rains become scarce and the temperature rises. As they walk down the street, visit with friends, or ride the bus, people everywhere lament the unrelenting heat. Will September bring relief? Or will the hurricanes start? Even when the sun sets, temperatures never fall more than a few degrees. Across the city, people pray for nights free of blackouts, so their electric fans will not rattle to a stop, so the suffocating heat will be staved off one more night. Then, in the morning, the cycle begins again.
It is in August’s crescendo of waiting and suffering that Cubans often give up on life. But few people in Cuba talk openly about losing one’s mind, much less about suicide. So when, one viscous August afternoon, a woman named Mirta* tells me that her nephew killed himself, she does so without speaking.
Mirta is nearing her 60th birthday and has battled depression and anxiety for years. She is small and stout and wears her gray hair short with a shock of white bangs. “He . . . ,” Mirta begins, her voice dropping off. She stretches her thumb and forefinger across her neck, just below her chin—like a noose. Mirta knows little about what provoked her nephew. He had longed to get off the island for years and was also a heavy drinker, but his parents have told Mirta few other details—only that he suffered from los nervios, the generic Latin American term for mental illness.
Sit down with most medical professionals in Cuba and they will assure you that suicide is rare. However, in most years, a higher percentage of Cubans commit suicide than citizens of any other Latin American country.
Since written histories of Cuba have existed, Cubans have killed themselves in record numbers as a form of social protest. At the dawn of its conquest, according to University of North Carolina historian Louis A. Pérez Jr., as many as one-third of the island’s native inhabitants committed suicide to avoid living under Spanish rule. As the independent nation grew, more and more Cubans turned to suicide: peasants in the time of unemployment after the sugar harvest, wives escaping violent husbands, the working class suffering economic crises, young leftists facing jail under dictator Fulgencio Batista, and thousands disillusioned by Fidel Castro’s transformation of Cuban society after the 1959 revolution.
After the fall of the Soviet Union, the island fell into its own Great Depression, which Castro euphemistically dubbed “the Special Period in Times of Peace,” and suicides spiked to more than double the already-high rate of 1959, becoming the second-leading cause of death for Cubans ages 15 to 49. (Defected Ministry of Public Health workers claim that the official tallies heavily underreport suicides, with the government recategorizing many as accidental deaths.)
The impact of the Special Period on the Cuban psyche is difficult to overstate. Once, on a visit to Havana several years ago, I asked a friend when exactly the Special Period had ended. He laughed, dryly. “Has it?” While the worst of the 1990s is past, Cubans have become accustomed to levels of uncertainty and scarcity inconceivable to outsiders, and, on the whole, they remain subtly traumatized.
Since the handover of power from Fidel to his brother Raúl, much has been made in the international press of reforms on the island, but there has been no change in the basic, untenable chemistry of the nation. Cubans still cannot express themselves without fear of punishment or leave their country freely; there is still no free press, and the government remains rabid in cracking down on dissidents. Owning DVD players and cell phones is now allowed, yet precious few can afford such luxuries.
In an attempt to revive the economy during the Special Period, the government legalized the use of dollars and then set up a network of stores to sell Cubans everyday goods—at U.S. prices. This has created a reality that for ordinary citizens simply does not compute: Cubans—doctors, teachers, and custodians alike—earn an average of 250 to 300 Cuban pesos, or $10 to $12, a month. But once their monthly rations run out, usually after two weeks, they must buy almost everything with a dollar-like currency, the CUC, or Cuban convertible peso. On a $10 monthly salary, a $200 cell phone looks like reform only from the outside.
Real life is an elaborate game of personal economics: always calculating spending and earning, hustling to accrue capital, parceling out cash on carefully selected purchases, and then calculating all over again. If Cubans chance upon some windfall, they splurge—on toilet paper, shampoo, tomato sauce—because who knows what tomorrow will bring? “Tú no sabes,” Mirta tells me. “You don’t know.” She pauses, her gaze on me, forceful, pleading. “You don’t want to know.”
When I leave Mirta’s apartment, she insists on walking with me a few blocks. As she navigates the narrow commercial street, she stops in front of every store, every street peddler. She may not have money, but in a country where you never know if you’ll find an item from one day to the next, everyone has developed the habit of memorizing store inventories.
We pass a crowd peering into the show windows of a state-run department store. On display are pale-skinned mannequins in bikinis, household appliances from China, and a tower of individually wrapped bars of soap. Everything is sold in CUCs, all profits going to the government. Most people linger outside staring, with dejection and longing, at all the things they’d buy if only they had the cash.
As we cross the street, I look back and see that the government has named the store after Yumurí, a valley in a jungle east of Havana where a band of natives escaping slavehunters threw themselves over the edge of a cliff—its very name a permutation of the Spanish for “I died.” Mirta, however, has not found her escape through death. Like countless others across the island, she has found respite in a little white pill. Tonight, just before bed, she will slip one into her mouth and wait for the sweet oblivion of sleep.
Mirta’s sedative of choice is an addictive substance called meprobamate, which was invented in the United States in 1955 as Miltown, the first mass-market psychiatric drug and a precursor to Valium and Prozac. It’s the single most popular drug on the Cuban black market. Yet, because so many Cubans drug themselves to escape, there is simply no stigma attached to this mass sedation. The government publishes no statistics on meprobamate consumption, but nearly every household seems to have a stash. Official numbers do show that, in a country of 11 million people, annual consumption of only three sedatives—including the generic of Valium, which Mirta also takes, but not meprobamate—is 127 million tablets.
Mirta buys the pills, at 25 times the real cost, from a crooked pharmacist. (Most pharmacists, including Mirta’s dealer, refused to talk to me, as jail terms for drug dealing are long.)
Cubans are well informed about health and keep small dispensaries at home, often of black-market meds. After all, among other scarcities, pharmacies commonly lack the most basic medications. Aspirin, for example, is impossible to find. And with their days full of one bureaucratic errand after another, Cubans prefer to avoid missing work, and losing pay, to wait in another long line for an overworked doctor to write a prescription for a medication that is likely to be out of stock. One emergency-room doctor who has seen addicted patients fake convulsions to get sedatives told me point-blank, “In this country, everyone who works in a pharmacy sells medicines.”
To reach Centro Habana, where Mirta lives, you must head east from the middle-class neighborhood of Vedado, away from its quiet tree-lined streets graced with ocean breezes and decaying villas, or west from photogenic Old Havana, where the benefits of government attention and tourist dollars shine in its restored colonial facades and in the gold teeth of its residents. Centro Habana, once the site of one of the island’s first sugarcane fields, is a stifling maze of narrow streets. The ribbons of sidewalk are so thin that residents must walk single file past the jumble of decomposing neoclassical treasures, high-ceilinged colonial homes, art deco apartment complexes, and Soviet-style block constructions. Some walk in the middle of the street, sidestepping fetid puddles, rotting piles of beans and fruit, and dog feces.
One afternoon, Mirta tells me about a girl who was killed down the street a few days before. Out of the sky, a rickety cement balcony fell to the ground, crushing the girl. This was not the first such death Mirta has heard of in the neighborhood, and she tells me to check out the balcony two doors down: Even with a wooden splint it is barely held aloft. “You go around the city and it looks like a war zone,” she scowls. “Everything falling down, everything crumbling.”
Fueling Mirta’s melancholy are memories of her other reality: childhood in a small city in the middle of the island, one of those provincial outposts with rows of one-story colonial houses spreading out from a central plaza. There were plenty of activities for young people then—social clubs, concerts on the plaza, parties at friends’ houses—not like today, when a can of soda is a luxury and few Cubans can offer visitors more than a cup of coffee.
In the late 1950s Mirta’s parents were comfortably middle class. They owned a store and sent Mirta to Catholic school. Then, when she was 10, her school was taken over by the new revolutionary government. This greatly displeased her father, who, having emigrated from Spain as a child, was opposed to his only daughter mixing with boys. After an initial burst of enthusiasm, he grew distrustful of the new government.
By the late 1970s and the 1980s, both Cuba and Mirta’s own young family were in a golden age: Stores overflowed with affordable Eastern European goods, Cuban salaries were worth something, and Mirta and her husband, Gilberto, could take their two girls on beach vacations every summer.
Mirta’s success came, in part, from her father’s trepidation and immigrant intuition for planning. “He had a vision of how things were going to go down,” Mirta says, proud but regretful. “All of this”—Cuban code for the system—“he saw it coming,” and he urged his children to participate in the new system as little as possible. Later, as Mirta and Gilberto’s two daughters grew, they taught them the same lesson: Stay on the good side of your teachers and peers, so they can’t say you are antirevolutionary, but don’t sell yourself out and join the Communist Youth. “We don’t speak badly about the revolution,” Mirta says pointedly. “But we do not speak well of the revolution.”
When she tires of talking, Mirta heads to the kitchen for the day’s umpteenth pot of coffee. She stops first in her bedroom, returning with two albums of old snapshots: her husband considerably less tired, Mirta many pounds lighter, and the girls still carefree and smiling. The scratch of metal sounds from the kitchen, where Mirta adds spoonfuls of coarse Cuban sugar to the coffee on the stove, and I flip through sun-bleached images of her two little girls: glamour portraits of her youngest before her friends all fled Cuba, shots of the days at the beach, and baby pictures of Mirta’s only grandson, who was born just as the country—and Mirta’s life—came crashing down in the Special Period. When there was no money for family photos or new clothes, or anything, really. When Mirta realized, with a force from which she is still recovering, that all of her father’s efforts still were not enough.
Now Mirta has the pill, to forget the frustration, the impotence, and the memories. It is magic, this Mirta knows; it is a way to take control for once. Just before bed, at the exact moment when she can no longer stand the stress and is almost exhausted enough to sleep, she pops the pill out of its blister pack and begins to relax. There is no grogginess, no feelings of being drugged or hungover, just a perfect blip in her life, every single night. In the morning she wakes, somehow refreshed enough to face it all again.
At 11 o’clock on a particularly blistering morning, I sip a demitasse of coffee in the Vedado apartment of 35-year-old independent filmmaker Esteban Insausti, who is obsessed with insanity in Cuba—a subject almost as taboo as suicide. I have just watched his polemic documentary on mental illness, They Exist, a film, Insausti says, determined to be “acidic” and “too harsh” by his art school, which attempted to stop him from filming.
“It was to try to explain the Cuban reality through the chaos that is insanity,” he says, “the insanity that we’ve also lived, politically, socially.”
Eventually the film was released in Havana’s annual film festival, where it won a prestigious award from an international panel. Several police officers were stationed in the theater to prevent a popular uprising at the premiere. Now digital copies circulate widely on the underground market.
The flip side to Cuban self-sedation, Insausti reminds me, is the national habit of joking about misfortune. “We add a burlesque, festive tone to almost everything,” he says. “This has been good in some moments of the reality of this country, because it gives us a capacity for surviving, for assimilating the worst of life. But it’s also horrible.”
His film focuses on a mentally ill young man named Manolito, who sings for pesos to adoring city dwellers and who, while he suffers from bouts of paranoia, gives disarmingly cogent sidewalk lectures haranguing Castro and the Party. (Anyone else who spoke this way in public would be arrested.) Manolito is both amusement and cautionary tale: In surreal Havana, almost anyone could end up this way.
Yet few know Manolito’s backstory: that he divorced himself from reality at age 7 or 8, when his parents left in the 1980 Mariel Boatlift. It was a tumultuous year. Cubans who wanted to leave were harassed and beaten in the street, and some committed suicide rather than be called traitors. Manolito’s parents left without telling him, and in the crossing they both drowned. “People waiting for buses that never arrive, they see Manolito and they know they’ll have half an hour of entertainment,” Insausti says. “I laugh, because it’s crazy. Everything is laughter, everything merits being made fun of, and everything is a good excuse for making jokes. This cannot be, you know?
“Who are the crazy ones?”
On the eve of the Special Period, Mirta’s husband was so successful as a mechanic that he and Mirta decided to give their girls the promise of lives in Havana. Her younger daughter went to university, and the older one started working, moved out, and had a baby. Right as Mirta’s grandson arrived, the Soviet Union fell.
Food supplies disappeared. Everyone was stuck with rice and beans for lunch and dinner, and sugar water for breakfast. Mirta was frantic. By the end of 1991 she was losing weight and fainting; when she finally went to the doctor she was hospitalized with polyneuropathy, extensive inflammatory nerve damage caused by an immune system weakened by malnutrition and a lack of vitamin B. She couldn’t walk for two months, Mirta tells me, bending down slightly in her rocking chair to rub her hands along the fleshy insides of her chronically painful knees. The government did give Mirta free treatment and leave from her job, but she wasn’t alone. An epidemic of the disease swept Cuba from 1991 to 1993, afflicting more than 45,000 people.
The illness, coupled with watching the suffering around her, sent Mirta tumbling into depression, for which she saw a psychologist and took antidepressants. Now she has devised her own treatment method. Her doctor prescribes meprobamate ostensibly to lower the high blood pressure she developed after moving to Centro Habana a few years ago. (This is a common usage, although the drug isn’t indicated for hypertension.) She buys it in the pharmacy the rare times it’s in stock, and on the black market the rest of the time.
Mirta stops cooking and sits down at the small kitchen table. She turns her head to look out the window. “You feel static—that you do nothing. Sometimes, I feel despair,” she says. “Especially at noontime.” This is the hour, Mirta says, beginning to cry, when she most thinks of her hometown, where neighbors got together every day for coffee and a card game before lunch. She pretends to call out to her neighbors to come over, as they did then, wiping at her eyes with her palms in large swipes. Most of her old friends have left Cuba, and every time she goes home, Mirta is increasingly distraught by the loss of her world: “Everything depresses me. What I saw, and what I am, and my past.” She does not, however, think of leaving. The government would take her house, the only thing she has.
The last time I see Mirta before leaving Havana, I ask about her future. She rocks in her chair, the friction of wood on tile a metronome of stagnation. “I don’t see any change,” she spits out. “They all talk and talk and nobody does anything at all. I see myself exactly as I am now. Always the same.” She rocks silently, her face contorted in sadness, lips pursed. “I see myself without a future. We are here in the hands of God.”
*Mirta, like most Cubans I spoke with, asked that I not use her real name.
Lygia Navarro is a fellow at the Phillips Foundation. She has written about Latin America for a host of outlets, including the Christian Science Monitor, NPR’s Latino USA, and FRONTLINE/World. Jason Florio is a globe-trotting photographer whose work has appeared in Orion, the New Yorker, Die Zeit, and the Times of London. Excerpted from the Virginia Quarterly Review (Winter 2009), a literary digest designed to spur discussion and a 2009 Utne Independent Press Award nominee for general excellence; www.vqronline.org.