This article explores the pragmatic sensibilities that are implicit in idioms of distress among family caregivers for Alzheimer’s disease in Teotitlán del Valle, a rural Zapotec-speaking community in Oaxaca, Mexico. Through analysis of caregivers’ perceptions of progressive memory loss and related etiological understandings, this article emphasizes the pragmatism inherent to local health perspectives. In so doing, the article revisits Nichter’s earliest formulation of idioms of distress as providing an alternative epistemological framework to appreciate how illness is varyingly understood. Such a framework is useful for understanding how idioms of distress are not aimed towards attaining accuracy about what illness is in an objective sense, but rather put into focus how such descriptions are both constitutive of—and themselves pragmatic responses to—broader social circumstances. This article concludes with a consideration of how idioms of distress empower individuals as agents of action.

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This article presents an argument about the advantages of embracing obstacles that arise while conducting research. Through analysis of specific obstacles encountered during research on family caregiving for Alzheimer's disease in Oaxaca, Mexico, this article makes a case for what is termed methodological agility, an approach for how qualitative inquiry invites the use of research instruments to accommodate to the contingencies of a given field site. In Oaxaca, methods inspired by focus group interviewing and constructivist theory were engendered to respond to cultural and linguistic obstacles encountered during the collection of data and an underlying epistemological dilemma. In so doing, this article illustrates how the unique obstacles to conducting research are advantages in themselves, opportunities for researchers to strengthen methodological rigor by directly addressing, embracing, and resolving the broader structures that contextualize the data they seek to acquire.

Researchers have tended to approach cultural competence through two primary models: acquisition of culturally tailored skills and orientation to cultural process. While each model plays an important, complementary role in cultural competence, both can be limited in conceptualizing and responding to cultural variations of distress. This article draws on research in multicultural psychology, psychological anthropology, and pragmatic philosophy to introduce cultural pragmatism, an alternative orientation to cultural competence that reconceptualizes what it means to hold something to be true in the mental health fields. This article first draws on research in multicultural psychology and psychological anthropology to identify an important limitation regarding how truth is understood in contemporary cultural competence models, and how this limitation can impact culturally competent care. Following this, the article considers philosophical pragmatism as an alternative and introduces a preliminary model for practicing cultural pragmatism in clinical settings. As a whole, this article makes two interrelated arguments: first, that a better articulated theory of truth is needed to achieve the goals of cultural competence, and second, that cultural pragmatism can help resolve the limitation that cultural competence approaches currently exhibit.