An anthropological investigation of mental health in Haiti: Language, measurement, and the socio-spiritual world Open Access

Kaiser, Bonnie N. (2015)

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This dissertation examines issues of language, measurement, meaning, vulnerability, and resilience as they relate to the study of mental distress. I draw on interpretive and political economy theoretical orientations to argue that investigations of mental distress must combine attention to systems of meaning-making and structural violence. In the first chapter, I consider how bridging anthropology and epidemiology can advance measurement in global mental health, balancing the sometimes competing goals of ethnographic validity and cross-cultural comparison. In chapter 2, I examine the idiom of distress reflechi twòp ("thinking too much"), a cultural syndrome that indexes intense rumination and social isolation, often linked to perceived failure and lack of agency due to economic conditions. I argue that this idiom of distress serves as an indirect critique of the structural violence at its root. In chapter 3, I provide an overview of my community-based epidemiologic survey testing hypothesized predictors of mental distress, and in chapter 4 I present the results. Many of the epidemiologic findings are consistent with literature from other settings. For example, linear regression models found that female sex and increasing age are associated with more mental distress. Traumatic events and daily stressors were independently associated with increased burden of mental distress, while socioeconomic status and social support were associated with less mental distress. Other findings were less in line with anthropological literature. For example, non-material stressors and systems of meaning-making, like locus of control, were not significantly associated with mental distress in final regression models. In the final chapter, I explore my counter-intuitive finding that perceived threat of supernatural harm is associated with better mental health outcomes. In particular, I analyze narratives of "sent spirits." I argue that such stories are fundamentally social narratives, reflecting links among structural forces, socioeconomic status, and restricted social mobility. I consider how these narratives potentially function to displace blame from impoverished, disempowered individuals, yet at the same time draw attention away from the social inequalities and forms of structural violence that are the root causes. I consider the implications of these cultural models for understanding the interconnectedness of social relationships, structural violence, and solidarity.

Table of Contents


Chapter 1: Strategies for assessing mental health in Haiti: Local instrument development and transcultural translation...27

Chapter 2: Reflechi twòp - Thinking too much: Description of a cultural syndrome in Haiti's Central Plateau...63

Chapter 3: Anthropological and epidemiological approaches to understanding mental distress: Methods of data collection and scale development...107

Chapter 4: Predictors of mental distress: Epidemiologic survey results...130

Chapter 5: Sent spirits, locus of control, and the socio-spiritual world in Haiti...156


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