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

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Abstract

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.

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Notes

  1. This article utilizes the standard convention of adding—s to indicate plural Kreyòl words.

  2. All case study participant’ names have been changed to protect confidentiality.

  3. There may have been more female FGD participants. However, due to incomplete records from some female FGDs, we are able to ascertain only that the minimum number of women was 23.

  4. The case-study's collateral interviews were excluded from the general semi-structured interview analysis presented in Table 1 to prevent bias in the coding of certain symptoms that were expressed by the case-study participants.

  5. Marie was sent to the community clinic, but it is unclear if she also went to a larger hospital. The term hospital is used by the interviewee, but may be in reference to a community clinic.

  6. ‘Hospital’ is a non-specific terms used locally for biomedical treatment. It typically refers to a local NGO outpatient clinic, but may also refer to a larger hospital with inpatient facilities to which patients occasionally may be referred.

  7. Raphaël writes, “Aujourd’hui encore,il y a une médecine classique occidentale pour une minorité riche, pour les classes moyennes aisées et une médecine créole haïtienne pour la majorité des populations rurales, paysannes et des bidonvilles vivant dans des conditions socio-économiques précaires. De fait, le vaudou haïtien a une présence prépondérante dans des situations concernant la santé mentale d’une grosse partie de la population marquée par la pauvreté, l’analphabétisme et par la violence sous toutes ses formes…Par ailleurs, les services offerts par la médecine classique, celle pratiquée par les médecins, les infirmières, les psychologues, les travailleurs sociaux etc. formés dans des institutions occidentales tant en Haïti qu’à l’étranger sont dispendieux dans les institutions publiques ou privées” (2010, p. 169).

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Acknowledgments

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.

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Authors and Affiliations

  1. Emory University School of Medicine, Atlanta, GA, USA

    Nayla M. Khoury

  2. Department of Anthropology, Emory University, Atlanta, GA, USA

    Bonnie N. Kaiser

  3. Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Hunter M. Keys & Aimee-Rika T. Brewster

  4. Psychiatric Residency Training Program, Department of Psychiatry and Behavioral Sciences, The George Washington University Medical Center, 8th Floor, 2150 Pennsylvania Avenue, NW, Washington, DC, 20037, USA

    Brandon A. Kohrt

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  1. Nayla M. Khoury
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  2. Bonnie N. Kaiser
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  3. Hunter M. Keys
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  4. Aimee-Rika T. Brewster
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Correspondence to Brandon A. Kohrt.

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Khoury, N.M., Kaiser, B.N., Keys, H.M. et al. Explanatory Models and Mental Health Treatment: Is Vodou an Obstacle to Psychiatric Treatment in Rural Haiti?. Cult Med Psychiatry 36, 514–534 (2012). https://doi.org/10.1007/s11013-012-9270-2

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