Culture, Medicine, and Psychiatry

, Volume 38, Issue 3, pp 448–472 | Cite as

Reflechi twòp—Thinking Too Much: Description of a Cultural Syndrome in Haiti’s Central Plateau

  • Bonnie N. Kaiser
  • Kristen E. McLean
  • Brandon A. Kohrt
  • Ashley K. Hagaman
  • Bradley H. Wagenaar
  • Nayla M. Khoury
  • Hunter M. Keys
Original Paper

Abstract

A rich Haitian ethnopsychology has been described, detailing concepts of personhood, explanatory models of illness, and links between mind and body. However, little research has engaged explicitly with mental illness, and that which does focuses on the Kreyòl term fou (madness), a term that psychiatrists associate with schizophrenia and other psychoses. More work is needed to characterize potential forms of mild-to-moderate mental illness. Idioms of distress provide a promising avenue for exploring common mental disorders. Working in Haiti’s Central Plateau, we aimed to identify idioms of distress that represent cultural syndromes. We used ethnographic and epidemiologic methods to explore the idiom of distress reflechi twòp (thinking too much). This syndrome is characterized by troubled rumination at the intersection of sadness, severe mental disorder, suicide, and social and structural hardship. Persons with “thinking too much” have greater scores on the Beck Depression Inventory and Beck Anxiety Inventory. “Thinking too much” is associated with 8 times greater odds of suicidal ideation. Untreated “thinking too much” is sometimes perceived to lead to psychosis. Recognizing and understanding “thinking too much” may allow early clinical recognition and interventions to reduce long-term psychosocial suffering in Haiti’s Central Plateau.

Keywords

Depression Anxiety Idioms of distress Ethnopsychology Mental health Haiti Suicide 

Notes

Acknowledgments

We gratefully acknowledge the contributions of field research assistants Beker Vincent, Jerome Wilkenson, Desir Fitzner, Wilfrid Jean, Adner Louis, Anel Lavard, and Alexis Ronel. We are grateful to Cate Oswald and her colleagues at Partners in Health/Zanmi Lasante for their collaboration. This work was supported by Emory University’s Global Health Institute Multidisciplinary Team Field Scholars and Global Field Experience Awards. The first author is supported by Graduate Research Fellowship grant 0234618 and Doctoral Dissertation Research Improvement Grant BCS-1260270 from the National Science Foundation. Portions of this paper were presented in the Charles Hughes Memorial Fellowship Lecture of the Society for the Study of Psychiatry and Culture, New York, 2012. We thank Craig Hadley for reviewing an earlier version of this manuscript.

Supplementary material

11013_2014_9380_MOESM1_ESM.doc (64 kb)
Supplementary material 1 (DOC 64 kb)

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Bonnie N. Kaiser
    • 1
  • Kristen E. McLean
    • 2
  • Brandon A. Kohrt
    • 3
  • Ashley K. Hagaman
    • 4
  • Bradley H. Wagenaar
    • 5
  • Nayla M. Khoury
    • 6
  • Hunter M. Keys
    • 7
  1. 1.Department of Anthropology, Department of EpidemiologyEmory UniversityAtlantaUSA
  2. 2.Department of AnthropologyYale UniversityNew HavenUSA
  3. 3.Department of Psychiatry and Behavioral Sciences, Duke Global Health InstituteDuke UniversityDurhamUSA
  4. 4.School of Human Evolution and Social ChangeArizona State UniversityPhoenixUSA
  5. 5.Department of Epidemiology, School of Public HealthUniversity of WashingtonSeattleUSA
  6. 6.Department of PsychiatryCambridge Health AllianceCambridgeUSA
  7. 7.School of Public Health, School of NursingEmory UniversityAtlantaUSA

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