Mal de ojo (Mal: Illness - de ojo: Of eye. "To be made ill by an eye's gaze") often occurs without the dimension of envy, but insofar as envy is a part of ojo, it is a variant of this underlying sense of insecurity and relative vulnerability to powerful, hostile forces in the environment. In her study of medical attitudes in the Santa Clara Valley of California, Margaret Clark arrives at essentially the same conclusion: "Among the Spanish-speaking folk of Sal si Puedes, the patient is regarded as a passive and innocent victim of malevolent forces in his environment. These forces may be witches, evil spirits, the consequences of poverty, or virulent bacteria that invade his body. The scapegoat may be a visiting social worker who unwittingly 'cast the evil eye' ... Mexican folk concepts of disease are based in part on the notion that people can be victimized by the careless or malicious behavior of others".