By Nadiyah Fisher
Mental health is defined as our psychological well-being and it is prevalent in our everyday behaviors (U.S Department of Health & Human Services, 2020). Even with the extreme prevalence of mental health in our lives, there is still a stigma surrounding it. Stigma is defined as a negative connotation applied to someone with a disadvantage or “distinguishing characteristic” (Mayo Clinic, 2017). Due to the recent traumatic natural disasters in Haiti, Haitians face a variety of mental health illnesses but are hesitant to seek out treatment (Desrosiers et al., 2002). Could aspects of Haitian society such as culture, religion, and the healthcare system enforce stigma around mental health care?
Due to the strong presence of the French in Haiti during colonialism, many Haitians today practice Christianity. More than 70% of the Haitian population is Catholic (Guynup, 2004). Even in 2021, there is a stigma around mental health in Christian communities. Many Christians are under the belief that mental illness is a result of sin (Peteet, 2019). In a 2017 interview with Vox, a Christian with a mental health diagnosis explained his experience with mental health in a church setting. “If he couldn’t shake off the feelings of depression he had, it meant he wasn’t praying hard enough…Anytime I’d ever seen someone confess a personal struggle with mental illness, a team of people prepared to cast out a demon” (Burton, 2017). Peteet (2019) explains how religion reinforces mental health stigma through biblical counseling movements. These movements are used to reject psychiatry and point believers toward the scripture for all of their worries. Prayer is often seen as an intervention for various mental health disorders or as a tool to “give your worries'' to God and confess your sins. Mental illness is seen as abnormal and unnatural, like demons (Peteet, 2019).
Along with the strong presence of Christianity in Haiti due to colonialism, Vodou is also extremely prevalent. Vodou is derived from the languages of West Africa: Fon and Ewe. Vodou translates to the word “spirit” or “god” (Harvard, 2020). Haitians call on the Vodou spirits by offering a sacrifice of food and drinks. After Haiti gained its independence in 1804, many of the enslaved Africans looked up to Vodou spirits and attributed their victory to them. The Vodou spirits are seen to have divine interventions in the lives of the Haitian people (Desrosiers et al., 2002). Vodou was seen as a way for enslaved Africans to maintain their heritage and despite their conversion to Catholicism. Similar to priests, Vodou practitioners perform ceremonies and rituals. They are seen as the point of contact for guidance and prayer (Harvard, 2020).
In 2002, Desrosiers et al. found that a vast majority of Haitians believed that specific mental health diagnoses like psychotic breaks and major depression were viewed as a result of a curse. It was assumed that Vodou practitioners could make “peace with the spirits'' that imposed this curse. Oftentimes, depression is viewed as “discouragement” due to a person’s inability to function properly when depressed (Desrosiers et al., 2002). In a study on whether Vodou was an obstacle for mental health care, Khoury et al., (2012) found that when many Haitian patients showed clear signs of mental illness, their families would take them to a Vodou practitioner rather than a physician. The families believed that mental illness was caused directly by the spirits. Many Haitians used their religion to gain knowledge about questions with no clear answer (Khoury et al., 2012). During their case study with a Haitian family, they found that “God, prayer and clergy” were seen as primary interventions in close to half of the participants because mental illness was seen as a “supernatural possession” (Khoury et al., 2012). Why are physicians seen as the “last resort” for many Haitians?
Along with the stigmas placed on mental health by their faith, Haitian Catholics face another intersectionality, their culture. Haitian culture is built upon values of hard work and determination (Desrosiers et al., 2002). When a person is unable to function “normally,” they cannot work well and are considered as , or crazy. This can cause great shame to their family and make them worry about the future of their loved one (Desrosiers et al., 2002). This is seen as extremely scary for a family who cannot afford mental healthcare.
Haitian healthcare is classified as a private for-profit sector. This commercialization of healthcare often leads to higher costs, long wait and travel times, and the possibility of being denied care (Miami Herald, 2017). Compared to nearby countries; the “annual per capita public health spending is around $13” (World Bank, 2017). A 2003 Pan American Health Organization reported a total of 10 psychiatrists and 9 psychiatric nurses working in the public sector of healthcare. Public sectors of healthcare are “owned, administered, or financially dependent in great part on public-sector support, especially for vulnerable populations” (Andrulis, 1997). Many of these clinicians work far from rural areas (PAH, 2003). There are fewer clinics and preventative care options as opposed to hospitals (Miami Herald, 2017). With the alarming poverty rate due to the lack of government funding and natural disasters, Haitians turn to their spiritual leaders in times of turmoil. These circumstances breed the emergence of mental health illness in the community.
About 200,000 Haitian civilians were killed in the 2010 earthquake (Faustin, 2015). Many Haitians faced near-death experiences and as a result, developed Post Traumatic Stress Disorder. Post-Traumatic Stress Disorder, or PTSD, is triggered by witnessing or experiencing an event that is perceived as negative or terrifying (Mayo Clinic, 2018). Eddy et al. (2018) surveyed Haitian youth and found a strong prevalence of Post-Traumatic Stress Disorder. Participants were between the ages of 18-22 and were called to perform a series of psychological assessments. Overall, 36.7% of participants showed signs of PTSD. Of those with signs of PTSD, 88.6% had no access to mental health care and 36.4% had no access to healthcare at all (Eddy et al., 2018). Along with the overwhelming statistic of Haitian youth dealing with mental illness, 75% of the participants reported having at least one day without food in a three-month span (Eddy et al., 2018).
Due to the lack of psychologists and psychiatrists in Haiti, Doctor Guerda Nicolas from the University of Miami developed the Teachers Mental Health Training (TMHT) to treat the alarming rate of mental illness surrounding Haitian youth (Louis, 2014). The program took place over a six-month period. It aimed to teach educators about the impact of mental illness on a child’s performance and livelihood and how to support students in need. The teachers underwent over 70 hours of training. They were evaluated after their completion of the program and were encouraged to train others in their field. The teachers helped provide culturally competent mental healthcare to their students. However, they are not substitutes for psychiatrists and other mental health professionals (Louis, 2014).
The strong pride surrounding Haitian culture and religion makes Haitians reluctant to get professional mental healthcare. However, other factors exacerbate this issue as well. Haitian mistrust in the healthcare system was bred from their lack of access due to the decrease of providers who work in the public sector of healthcare as opposed to the private for-profit sector Haitians were forced to lean on their religion for survival. Their Vodou practitioners provided answers and comfort for free. Dr. Nicolas’ Training program is a step in the right direction, but until the government assesses the poverty felt by their citizens, Haitian mental health will continue to suffer.
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