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emotions-anger born of interpersonal strife, shock, grief, chronic worry, and other affects perceived as potentially harmful” (1988, 63). The move san syndrome is also believed to be capable of progressing to AIDS (Farmer, 1988, Miller, 2000).

Death. Haitians usually approach death as a natural part of cycle of life. Haitians hold their deceased family members in high regard and perform elaborate, costly and extended funeral rituals to assure the goodwill of the deceased. Deceased family members are still considered to be part of the family; they advise and help their descendents through dreams (Miller, 2000). Dayan (1995) writes, “If the disposal of dead slaves was a careless deed that marked irrevocable inhumanity, funeral rites in independent Haiti became central to both the living and the dead. The deceased do not worry about their future life but fear that they might not be properly served by the living” (p. 264). The issue of proper death rites and burial is particularly important in the wake of the earthquake. Many people have not had the opportunity to find and bury their lost loved ones or had to abandon them, or see them buried in a mass grave with no ceremonies. As a result, there may be an increase in ambiguity and uncertainty over the fate of the dead, with the risk of nightmares, worries and moral concerns when thinking about the dead.

Help-seeking and Service Utilization

Regardless of the type of illness, family members are usually the first to be consulted regarding treatment and advice. Haitians may not accept psychotherapy because solving personal problems is viewed as a family or religious matter (Gopaul-McNicol, Benjamin- Dartigue, & Francois, 1998). Instead, they readily consult elders and religious leaders in the community. Churches tend to confirm the belief that God will solve the problem. Many Haitians believe that God is more powerful than any other force, including as Vodou lwa-s or medical treatment (Desrosiers & Fleurose, 2002; Miller, 2000).

Haitians from the lower class will generally seek help for a mental problem from an oungan (a male Vodou priest). They may visit a mental health professional if a visit to an oungan has been unsuccessful. Some may simultaneously use both an oungan and a mental health professional. Upper and middle class Haitians are more likely to seek psychiatric care before consulting an oungan as they adhere to the biomedical model of mental illness and biopsychosocial forms of treatment. While Orthodox Roman Catholics and fundamentalist Protestants will generally not consult oungan, they will visit a doktè fey (herbalist) and will often go to church and pray. This gives them a sense of control over a situation where they may feel powerless. Many patients are averse to hospitals because patients often arrive in advanced states of illness and subsequently die in hospital. This contributes to a commonly held belief that “those who go to the hospital die” (Deren, 1983, 168).

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