Culture, Medicine, and Psychiatry

, Volume 36, Issue 3, pp 514–534 | Cite as

Explanatory Models and Mental Health Treatment: Is Vodou an Obstacle to Psychiatric Treatment in Rural Haiti?

  • Nayla M. Khoury
  • Bonnie N. Kaiser
  • Hunter M. Keys
  • Aimee-Rika T. Brewster
  • Brandon A. KohrtEmail author
Original Paper


Vodou as an explanatory framework for illness has been considered an impediment to biomedical psychiatric treatment in rural Haiti by some scholars and Haitian professionals. According to this perspective, attribution of mental illness to supernatural possession drives individuals to seek care from houngan-s (Vodou priests) and other folk practitioners, rather than physicians, psychologists, or psychiatrists. This study investigates whether explanatory models of mental illness invoking supernatural causation result in care-seeking from folk practitioners and resistance to biomedical treatment. The study comprised 31 semi-structured interviews with community leaders, traditional healers, religious leaders, and biomedical providers, 10 focus group discussions with community members, community health workers, health promoters, community leaders, and church members; and four in-depth case studies of individuals exhibiting mental illness symptoms conducted in Haiti’s Central Plateau. Respondents invoked multiple explanatory models for mental illness and expressed willingness to receive treatment from both traditional and biomedical practitioners. Folk practitioners expressed a desire to collaborate with biomedical providers and often referred patients to hospitals. At the same time, respondents perceived the biomedical system as largely ineffective for treating mental health problems. Explanatory models rooted in Vodou ethnopsychology were not primary barriers to pursuing psychiatric treatment. Rather, structural factors including scarcity of treatment resources and lack of psychiatric training among health practitioners created the greatest impediments to biomedical care for mental health concerns in rural Haiti.


Vodou Spirit possession Haiti Explanatory models Treatment-seeking behavior Mental health 



The authors gratefully acknowledge the contributions of field research assistants Jerome Wilkenson, Jean Wilfrid, Lavard Anel, and Vincent Beker. The graduate researchers would like to thank our project mentors Craig Hadley, Kathy Kinlaw, Benjamin Druss, Chad Slieper, and Karen Hochman. The authors would like to thank Jean Cadet, Ralph Chery, Brian Gross, Lovia and Ralph Mondesir, and Lydia Odenat for their help with translations and data preparation. This study was supported by the Emory University’s Global Health Institute Multidisciplinary Team Field Scholars Award and the National Science Foundation Graduate Research Fellowship [grant number 0234618].

Conflict of interest

The authors have no conflicts of interest to declare.


  1. Augustin, J. 1999 Libérateur. Et si le Vodou était une valeur!. Montreal: Tanboula.Google Scholar
  2. Baer, Hans A., Merrill Singer, and Ida Susser 2003 Medical Anthropology and the World System. Westport, Connecticut: Praeger.Google Scholar
  3. Brodwin, Paul 1996 Medicine and morality in Haiti: The contest for healing power: Cambridge University Press.CrossRefGoogle Scholar
  4. Caron, J. 2010 Quelques reflexions sur la situation actuelle d’Haiti, la prevention des maladies mentales et la promotion de la sante mentale de sa population. In Santé mentale en Haïti: La pensée critique en santé mentale. Y. Lecomte and F. Raphaël, eds. Montreal: Revue Santé Mentale au Québec.Google Scholar
  5. Carrazana, E., J. DeToledo, W. Tatum, R. Rivas-Vasquez, G. Rey, and S. Wheeler 1999 Epilepsy and religious experiences: Voodoo possession. Epilepsia 40(2):239-241.CrossRefGoogle Scholar
  6. Collins, P, and V. Patel 2011 Grand challenges in global mental health. Nature 475:27-30.CrossRefGoogle Scholar
  7. Coreil, J. 1983 Parallel structures in professional and folk health care: A model applied to rural Haiti. Culture, Medicine and Psychiatry 7(2):131-151.CrossRefGoogle Scholar
  8. Deren, M 1983 Divine Horsemen: The Living Gods of Haiti. New Paltz: Documentext, MacPherson.Google Scholar
  9. Desrosiers, A., and S. St. Fleurose 2002 Treating Haitian patients: Key cultural aspects. American Journal of Psychotherapy 56(4):508-521.Google Scholar
  10. Dubois, Laurent 2012 Haiti: the aftershocks of history. New York: Metropolitan Books.Google Scholar
  11. Farmer, P. 1990 Sending sickness: Sorcery, politics, and changing concepts of AIDS in rural Haiti. Medical Anthropology Quarterly 4(1):6-27.CrossRefGoogle Scholar
  12. Farmer, P. 1992 The birth of the Klinik: A cultural history of Haitian professional psychiatry. In Ethnopsychiatry: The cultural construction of professional and folk psychiatries. A.D. Gaines, ed. Pp. 251-272. Albany: SUNY.Google Scholar
  13. Farmer, P. 2011 Haiti After the Earthquake. Jackson, TN: PublicAffairs.Google Scholar
  14. Fernando, Suman 2011 A ‘global’ mental health program or markets for Big Pharma? Open Mind (168).Google Scholar
  15. James, E.C. 2008 Haunting ghosts: Madness, gender, and ensekirite in Haiti in the democratic era. In Postcolonial Disorders. M.-J.D. Good, S.T. Hyde, S. Pinto, and B.J. Good, eds. Pp. 133-155. London: University of California Press.Google Scholar
  16. Kaiser, Bonnie N. 2012 Reflechi Twop (Thinking Too Much): Description of a Novel Cultural Syndrome in Haiti’s Central Plateau [Conference Paper]. Society for the Study of Psychiatry and Culture. New York City: May.Google Scholar
  17. Kaiser, Bonnie N., Brandon A. Kohrt, Hunter M. Keys, Nayla M. Khoury, and Aimee-Rika T. Brewster In press Strategies for Assessing Mental Health in Haiti: Local Instrument Development and Transcultural Translation. Transcultural Psychiatry.Google Scholar
  18. Keys, Hunter M., Bonnie N. Kaiser, Brandon A. Kohrt, Nayla M. Khoury, and Aimee-Rika T. Brewster In press Idioms of Distress, Ethnopsychology, and The Clinical Encounter in Haiti’s Central Plateau. Social Science & Medicine.Google Scholar
  19. Kiev, A. 1961 Folk psychiatry in Haiti. Journal of Nervous Mental Disorders 1322:260-5.CrossRefGoogle Scholar
  20. Kirmayer, L.J. 2007 Psychotherapy and the cultural concepts of the person. Transcultural Psychiatry 44(2):232-257.CrossRefGoogle Scholar
  21. Kleinman, A. 1988 The Illness Narratives: Suffering, healing and the human condition. New York: Basic Books.Google Scholar
  22. Kohrt, Brandon A., and Ian Harper 2008 Navigating Diagnoses: Understanding Mind-body Relations, Mental Health, and Stigma in Nepal. Culture, Medicine & Psychiatry 32(4):462–491.CrossRefGoogle Scholar
  23. Kohrt, Brandon A., and Daniel J. Hruschka 2010 Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress, Ethnopsychology and Ethnophysiology in Alleviating Suffering and Preventing Stigma. Culture, Medicine & Psychiatry 34(2):322–352.CrossRefGoogle Scholar
  24. Kohrt, Brandon A., Daniel J. Hruschka, Holbrook E. Kohrt, Nova L. Panebianco, and G. Tsagaankhuu 2004 Distribution of Distress in Post-Socialist Mongolia: A Cultural Epidemiology of Yadargaa. Social Science & Medicine 58(3):471–485.CrossRefGoogle Scholar
  25. Lecomte, Y., and F. Raphaël, eds. 2010 Santè mentale en Haïti: La pensèe critique en santè mentale. Montreal: Revue Santè Mentale au Quèbec.Google Scholar
  26. Métraux, A. 1959 Voodoo. New York: Oxford Univ. Press.Google Scholar
  27. Nader, Laura 1972 Up the anthropologist: perspectives gained from studying up. In Reinventing Anthropology. D. Hymes, ed. New York: Pantheon Press.Google Scholar
  28. PAHO 2003 Haiti: Profile of the Health Services System.Google Scholar
  29. Patel, V., and M. Prince 2010 Global Mental Health : A New Global Health Field Comes of Age. JAMA 303(19):1976-1977.CrossRefGoogle Scholar
  30. Pedersen, D., and V. Baruffati 1985 Health and traditional medicine cultures in Latin America and the Caribbean. Social Science & Medicine 21(1):5-12.CrossRefGoogle Scholar
  31. Raphaël, F 2010 L’ethnopsychiatrie haïtienne: entre le vaudou haïtien et la médicine classique occidentale. In Santé mentale en Haïti: La pensée critique en santé mentale. Y. Lecomte and F. Raphaël, eds. Montreal: Revue Santé Mentale au Québec.Google Scholar
  32. Richman, Karen 2007 Peasants, Migrants and the Discovery of African Traditions: Ritual and Social Change in Lowland Haiti.. Journal of Religion in Africa 37:371-397.CrossRefGoogle Scholar
  33. Safran, Marc A., Terence Chorba, Merritt Schreiber, W. Roodly Archer, and Susan T. Cookson 2011 Evaluating Mental Health After the 2010 Haitian Earthquake. Disaster Medicine & Public Health Preparedness 5(2):154-157.CrossRefGoogle Scholar
  34. Saxena, S., G. Thornicroft, M. Knapp, and H. Whiteford 2007 Resources for mental health: Scarcity, inequity, and ineffeciency. The Lancet 370:878-89.CrossRefGoogle Scholar
  35. Sterlin, C. 2006 Pour une approche interculturelle du concept de santé.. In, Ruptures, revue transdisciplinaire en santé 11(1):112-121.Google Scholar
  36. UNDP 2010 Human Development Report. United Nations Development Program.Google Scholar
  37. VERBI 1989–2010 MAXQDA: Software for Qualitative Data Analysis. Berlin-Marburg-Amöneburg, Germany: Sozialforschung GmbH.Google Scholar
  38. Vonarx, Nicolas 2005 Vodou et production des savoirs: la place du terrain anthropologique.. Anthroplogie et sociétés 29(3):207-221.CrossRefGoogle Scholar
  39. Vonarx, Nicolas 2007 Vodou, Illness and Models in Haiti: From Local Meanings to Broader Relations of Domination.. Anthropology in Action 14(3):18-29.CrossRefGoogle Scholar
  40. V. Nicolas (2008) In: V.J. Hainard, P. Mathez, O. Schinz (eds) Le Vodou Haïtien Comme Système de Soins, nouvelle lecture. Geneva: Infolio.Google Scholar
  41. Watters, Ethan 2010 Crazy like us: the globalization of the western mind. London: Free Press.Google Scholar
  42. WHO 2005 Mental Health Atlas.Google Scholar
  43. WHO 2010 Mental Health in Haiti: A Literature Review.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Nayla M. Khoury
    • 1
  • Bonnie N. Kaiser
    • 2
  • Hunter M. Keys
    • 3
  • Aimee-Rika T. Brewster
    • 3
  • Brandon A. Kohrt
    • 4
    Email author
  1. 1.Emory University School of MedicineAtlantaUSA
  2. 2.Department of AnthropologyEmory UniversityAtlantaUSA
  3. 3.Rollins School of Public HealthEmory UniversityAtlantaUSA
  4. 4.Psychiatric Residency Training Program, Department of Psychiatry and Behavioral SciencesThe George Washington University Medical CenterWashingtonUSA

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