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For the few who have access to biomedical psychiatric care, schizophrenia is generally treated with antipsychotic drugs that eliminate the hallucinations and delusions and alleviate symptoms associated with thought disorders. The symptoms that characterize schizophrenia are based on concepts of self and non-self. In Euro-American cultures, thinking that the some entity other than the self has thoughts, feelings and goals can be seen as pathological, magical thinking or evidence of a psychotic thought disorder. However, in Haitian culture, thoughts, feelings and agency may be ascribed to invisible spirits or to the magical action of others. Diagnostic assessment, therefore, must not look only at the form, but also at the theme or the content of the behavior exhibited by the person. The same behavior characteristic of schizophrenia in Europe or North America can be representative of normal spiritual and religious beliefs in Haitian culture, for example communication with and appeasement of deceased relatives who live on as ancestral spirits (Miller, 2000).

In the Haitian context, it is particularly important to distinguish spiritual practices from psychological or psychiatric problems. If religion is ignored, misinterpretation of spiritual experiences and explanations can lead to misdiagnosis and mistreatment (Azaunce, 1995). The person who says “I see the evil spirit in my house” or “God came to me and told me to give up my job, so I did” may not be delusional or hallucinating (Gopaul- McNicol, 1997, p. 44). In religious practices that involve possession, a spirit can enter a member of the congregation to punish, reward, treat or cure another member of the congregation. As such, it is important to distinguish between negative possession experiences (by an evil spirit) which may be best dealt with by spiritual healers, and experiences of possession associated with schizophrenia, which are usually accompanied by a broader range of symptoms including blunted affect, thought disorder, deterioration in functioning, social withdrawal and poverty of speech (Azaunce, 1995).

Depression

There is a distinction between Haitians’ use of the French word ‘dépression’ to mean discouragement, and ‘dépression mentale’ which refers to depression as understood in Western psychiatry, usually expressed in terms of headaches, back pain or other nonspecific bodily pain (Hillel, Desrosier & Turnier, 1994). The Haitian concept of dépression is also usually expressed in terms of somatic symptoms: feeling empty or heavy-headed, insomnia, distractibility (i.e. “my head is not there”), fatigue, low energy and poor appetite. Dépression is not considered a mental illness but a state of general debilitation due to medical conditions such as anemia and malnutrition. It may be seen as due to a Vodou curse, excessive worry, obsessive preoccupation with life problems, or trauma. The extended family provides guidance and support for people experiencing dépression and it is rarely treated by medical professionals (Desrosiers & Fleurose, 2002).

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