5th Annual Conference on Haitian Mental Health
Still We Rise: Religion, Spirituality & Well-Being in the Haitian Community
Church as a Protective Factor to Suicide and Potential Barrier to Prevention
Tony Dellovo, MPH, and Emily Bhargava, M.A.
The mission of the Massachusetts Coalition for Suicide Prevention (MCSP) is to prevent suicide through statewide collaboration and advocacy. The Greater Boston Regional Suicide Prevention Coalition (GBRSPC) is a subgroup of the MCSP that serves the Greater Boston area. In 2014, the GBRPSC was awarded a grant to conduct a series of focus groups with a variety of cultural groups in order to 1) better understand the prevention needs of particular communities 2) establish and strengthen connections with diverse organizations, 3) expand and diversify membership in the coalition, and 4) learn how to better serve diverse communities. For each cultural community, two separate focus groups were convened. One group brought together individual community members, some of whom had personal experience with mental illness and/or suicide. A second group convened service providers who work with members of the community of interest. The Haitian community was one of three cultural communities that were identified to participate in the focus groups.
Through our focus groups with the Haitian community, we identified key themes related to religion, spirituality, mental illness, and suicide prevention. Our findings indicated that religion and spirituality are both a protective factor and a potential barrier to suicide prevention. The church community was mentioned most frequently by Haitian community members and providers as a source of significant support. Individuals reported that pastors have an opportunity to discuss mental illness and to create openings for people to share their own experiences. Some participants mentioned that pastors/ministers are highly influential in encouraging individuals to seek help and treatment for mental illness. Conversely, individuals reported the church community may be a place where people might not want to share issues related to mental illness. Due to church teachings against suicide and stigma related to mental illness, participants mentioned that people try to hide their challenges and hesitate to approach their pastor. Some people shared that they fear the church will share their challenges with the community they are connected to. Additionally, some participating pastors reported that individuals and families experiencing mental illness sometimes feel that are not welcomed by the church because of their stance on suicide. One community participant explained that mental illness should not happen to someone who is devout.
While limited in scope, the findings from the focus groups underscore the need for a public health approach to education and awareness of mental illness and suicide. Based on these findings, as a vital first step towards improving suicide prevention efforts and increasing capacity for mental health supports within the Haitian community, community-based organizations must engage key stakeholders from the Haitian religious community as well as the general community in suicide prevention education and training provided in schools, churches, healthcare facilities, and other areas where civic engagement occurs. Through our collection of suggestions, the GBRSPC will be sharing a variety of ways for churches and other service providers to improve the accessibility and appropriateness of their services to better meet the needs of the Haitian community.
Cultural Concepts of Health and Illness, with an Emphasis on the Integration of Mind, Body and Spirit
Edna Laurent-Tellus, LICSW; Elizabeth Conward, LICSW; and Maggie Pierre, LICSW, Awake IntuMind
The panel will engage the audience in a conversation about the cultural concepts of health and illness in the Haitian community and how a holistic approach with an emphasis on the integration of the “mind-body-spirit” is more compatible to the Haitians’ African background than the current traditional approach to health care. The presenters will take a brief historical journey from Africa to slavery and beyond to examine the psychological effects of colonization on the Haitian psyche and how that may have resulted in an implicit bias toward alternative methods like yoga and meditation. They will discuss why alternative methods such as meditation, reiki, and yoga are not accepted in the church. They will debunk the myths and show how these methods are not at odds with the Christian faith. On the contrary, the panelists will show how they can strengthen an individual’s faith and create inner peace. The philosophy behind these practices is also in harmony with the Christian teaching and lifestyle. The panelists will review scientific studies that demonstrate the health benefits of various techniques such as meditation, dance, mindfulness, reiki, yoga and exercise. They will also discuss how using these alternative methods in conjunction with traditional mental health can contribute to the recovery of traumatized Haitians. The
presenters will engage the audience in an exercise to de-mystify these alternative methods and brainstorm solutions that can lead to increasing awareness in the Haitian community so they can take advantage of the health benefits of these methods.
Developing Partnerships with Haitian Vodou Priests/Priestesses to Provide More Appropriate Care to the Mentally Ill Haitian Client
Marie Maude Evans, M.A., Mental Health Clinician and Vodou Priestess
As a consequence of the slave trade, many Africans from various tribes disembarked on the shores of Haiti in the 16th century deprived of their identity, their culture, their language, and their traditional way of life. After centuries of mistreatments, deprivation, increasing violence in the form of degradation, rapes, lynching, and mental abuse, to name a few, Haitian slaves from various African tribes collectively formed the Vodou religion, united as a monolithic group, and uprooted slavery. Their resilience and determination to eradicate this macabre era in their history as a people gave way to Haitians’ strong sense of self that was, in some respect, founded in their resistance. The contribution of Vodou, in particular the Ceremony of the Bwa Kayiman on the eve of the revolutionary war in 1791, has had a lasting, remarkable effect on the lives of Haitians. To this day, Haitian pride is explained in these terms: We are the First Black Independent Republic in the world and the first country in the Western Hemisphere to stage a successful slave revolt and win our independence. Historically, Vodou has been the essence of the Haitian people; that is, it constitutes our identity, our “self”. It is through the lens of Vodou that most Haitians view and understand the world around them. It is in this frame that socio-political, environmental, spiritual, economic, and health constructs are assigned meanings. Therefore, one cannot overlook Vodou in consideration of Haitian wellbeing. With the rise of mental healthcare needs in the Haitian community, especially after the devastating earthquake in 2010 when about 300,000 Haitians lost their lives, coupled with socio-economic disparities, many Haitians find themselves in a state of imbalance. Some attribute this imbalance to the presence of evil spirits and develop a new form of resistance by rejecting the very culture which once constituted their identity. Others become fixated on Vodou to the point that they reject any viable alternative to Vodou. While still others fall somewhere between these two extremes, all Haitians are aware of our cultural belief in magic and the spirits. Therefore, it is essential that mental health providers and Vodou priests/priestesses work in partnership to develop a holistic understanding of the root causes of their Haitian clients’ mental illnesses; thereby developing a treatment plan that encompasses both a spiritual and psychosocial approach. This presentation will provide a culturally competent framework for mental health practitioners to explore in service of Haitian clients. Attention will be given to the Haitian beliefs system that is rooted in spirituality, in particular, in the practices of Vodou that may hinder clients’ ability to accept mental health care solely from a Western perspective. Culturally sensitive practices in the treatment of Haitian clients that avoid negative stigmatization of Vodou’s healing traditions will also be discussed. Particular emphasis will be placed on the influence of Vodou on Haitian cultural practices and the dichotomy that these practices can create among Haitian mental health clients. When treating mental health clients, it is recommended that providers conduct a thorough intake, taking into consideration clients’ beliefs system and using that system as the cornerstone in providing mental health support and giving voice to their clients so they become active participants in their wellbeing.
Haiti Service Learning 2015: Spirituality & Community Identity and Connections in Vallue, Petit-Goâve
John Meigs, Alison Armour, Ashley White, Brittany Murphy, Catherine Barba, and Alessandra Frissora, William James College
This presentation will focus on the service learning experience of William James College (WJC) students during the summer of 2015 in the mountainous rural community of Vallue, Petit-Goâve. It will provide an overview of service learning goals, evolution of the service learning program, and implementation of workshops with community participants. The presentation will also address the role that spirituality and community identity played in discussions with local teachers, parents, adolescents, and youths. More specifically, how spirituality is integrated throughout daily life, as exhibited by interactions between WJC students and community participants. The presentation will contain observations of practiced daily spirituality and the importance of being attuned to unique aspects of spirituality and community identity in Vallue. The panelists will put forth the “big S” and “little s” versions of spirituality. Spirituality (“big S”) is the more overt, explicitly expressed notion of spirituality, as observed in organized religion (Catholicism) or other spiritual practices (Vodou). The “little s” spirituality are the more covert, implicit daily acts that connect one spiritually to the community, environment, and shared history. One of the major lessons taken from the immersion experience regarding spirituality is the importance of being open to these ideas when working cross culturally. By being more attuned to daily practices of spirituality, clinicians (and those in training) may be able to connect in a deeper way with their clients. Discussions of spirituality can help define the role of spirituality in identity creation and in establishing a sense of self and community. Presenters will share observations of spirituality witnessed during the immersion experience. These observations have led the presenters to understand that members of the Vallue community appear to integrate spirituality more fluidly into daily practices. These observations are in contrast to the compartmentalization of United States culture where spirituality, religion, community, social connections, physical health, and understanding and appreciation of nature as separate pieces of an individual’s self. The panelists will examine the role of spirituality in practitioners’ current understanding of clients from cultures other than their own as well as explore the role of spirituality in psychological healing.
Religion, Spirituality and Well-being in the Haitian Community: Toward a Greater Collaboration between Spiritual Leaders and Mental Health Service Providers
J. Abède Alexandre, DMin, PsyD
Traditionally there has been a general hostile relationship between mental health practitioners and religious/spiritual leaders. Such hostility stems from philosophical or metaphysical ideas about religion and spirituality from scientists in the field of psychiatry and psychology, and has caused religious/spiritual leaders to look at the field with suspicion. For instance, Freud’s writings on religion have influenced many mental health practitioners to see the practice of spirituality and religion as a form of psychopathology or more specifically akin to neurosis (Freud, 1907). On the one hand, mental health practitioners who do not share the values of certain religions tend to develop negative attitudes toward religion as a whole. On the other hand, religious leaders who reduce all human functioning to the physical and the spiritual may not see the need for psychological interventions to address issues that should be resolved through prayers, confession of sin, and repentance. As such, serious mental health needs may be overlooked, appropriate referrals may be delayed and appropriate treatment methods, such as the use of medications to deal with certain mental disorders, may be discouraged. Those factors, among others, have resulted in low levels of cooperation between spiritual leaders and mental health service providers. Since religion plays a crucial role in all spheres of Haitian life, including politics, morals and health (Corten, 2000; Hurbon, 2004), mental health practitioners may need to overcome their own religious biases to facilitate greater cooperation with spiritual leaders in addressing various emotional, psychiatric and psychological issues of their clients. This should be accomplished through reviewing the various empirical studies that show how religion and spirituality are helpful in dealing with major life stressors such as natural disasters, illness, loss of loved ones, divorce and serious mental illness. The literature abounds with positive associations between religiosity and mental health. Religion can create a sense of coherence, meaning and stability that can be accessed as a resource in the face of adversity, distress and suffering. In addition, since many Haitians perceive personal and mental problems as a family or religious matter (Gopaul-McNicole, Benjamin-Dartigue, and Francois, 1998), they are likely to turn to their spiritual leaders first before considering a visit to a clinic or a mental health center. In such instances, religious/spiritual leaders may serve as “consultants or co-therapists” since they may be trusted, more readily than conventional mental health professions in medical institutions (Kirmayer, 2010). The legitimate concerns that mental health practitioners might have regarding how certain religious practices or activities may be harmful to the clients would be better addressed via collaboration with religious/spiritual leaders. Such collaboration would facilitate not only more comprehensive and better treatment interventions but it would create greater opportunity for religious leaders to receive more adequate training in assessing mental health needs and greater opportunity for mental health practitioners to develop and demonstrate more religious competence in addressing the needs of their client/patients. Such collaboration can be created via mutual respect, respect of boundaries, referrals and consultations to the benefit of help seekers.
Religious Beliefs, PTSD, Depression and Resilience in Survivors of the 2010 Haiti Earthquake
Judite Blanc, Ph.D., Psychologist and Assistant Professor, Université d’Etat d’Haiti
This study examines associations between religious beliefs regarding the origin of the 2010 earthquake in Haiti and posttraumatic symptomatology as well as depressive symptoms and resilience among its survivors. Method: The researchers used convenient sampling to recruit participants (n = 167) who completed six scales that had been translated into Haitian Creole. These include the Earthquake Experience Exposure (EEE), the Peritraumatic Distress Inventory (PDI), the Peritraumatic Dissociative Experience Questionnaire (PDEQ), the PTSD Checklist (PTSD-CL), the Beck Depression Inventory (BDI) and the Connor-Davidson Resilience Scale (CD- RISC). Results: Among the participants, 51% were male (mean age = 30.5, SD = 11.03), 92% (n = 155) were believers in some sort of supernatural force, and 65% (n = 108) endorsed the earthquake as a natural phenomenon. Perceiving the earthquake as divine punishment was associated with severe PTSD symptoms (χ² = 5.06, df = 2, p < 0.05). There was also an association between low scores on resilience and severity of depressive symptoms (χ² = 7.49, df = 1, p < 0.01); the latter were more prevalent among Vodou adherents than among their peers from other religions (χ² = 9.05, df = 1, p < 0.01). Finally, the belief that the earthquake was divine punishment was predominant among those who scored ≥ 80 on the CD-RISC (χ² = 8.15, df = 1, p < 0.01).