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heavy foods are eaten in the daytime to provide energy for physical labor and light foods are eaten in the evening (Miller, 2000; Nicolas et al., 2006). Moderate and chronic illnesses are often treated within the family or the naturally occurring social support system. However, infectious diseases such as AIDS and tuberculosis, as well as traumatic injuries and wounds, are considered to be best treated by Western biomedicine.

Mental health problems are often attributed to supernatural forces. Mental illness, problems in daily functioning and academic underachievement may all be seen as the consequences of a spell, a hex, or a curse transmitted by a jealous person. In such cases, people generally do not blame themselves for their illness or see themselves as defective. Indeed, the sense of self may even be enhanced as a curse is often aimed at a person deemed to be attractive, intelligent, and successful. Mental illness is also sometimes attributed to failure to please spirits (lwa-s, zanj-s, etc.), including those of deceased family members. Desrosiers and Fleurose (2002) point out that this external attribution may help recovery, in that people can call upon the lwa-s to intervene on their behalf to assist healing. People often rely on their inner spiritual and religious strength to deal with their problems. Mentally ill people may be seen as victims of powerful forces beyond their control and thus receive the support of the community. However, shame may be associated with the decline in functioning in severe mental illness and the family may be reluctant to acknowledge that a member is ill (Gopaul-McNicol, Benjamin-Dartigue, & Francois, 1998).

Haitian Concepts of the Person

Cultural concepts of the person can have a significant influence on help seeking behavior and models of health and illness (Kirmayer 2007). Haitian models emphasize the social and cultural embedding of the person (Farmer, 1992; Raphaël, in press). Sterlin (2006) contrasts the “anthropocentric” view of health, disease and care in the West, where the person is seen as the centre of the universe, to the “comsocentric” view in Haiti, where the person is only part of a much larger universe of spirits, ancestors and the natural world all of which must be in harmony for good health (Appendix A, Table 1). The Haitian concept of the person extends beyond Western individualistic notions of the self, encompass spiritual dimensions. Dayan cites a 1950s study by Haitian ethnographer Lorimer Denis, to give a typical description of personhood:

“The pitit bon anj or ti bon anj (little good angel), the gwo bon anj (big good angel), and the kò kadav (body cadaver) constitute the three parts of individual identity in Haitian thought. […] The ti bon anj, a “guardian” and the source of consciousness, affect, and dreams, depends on the lwa for protection, for keeping the little good angel steady and bound to the person. The gwo bon anj, also called lonb-kadav (shadow-corpse), is the double of the material body […], but is understood as the shadow cast by

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