Reflechi twòp—Thinking Too Much: Description of a Cultural Syndrome in Haiti’s Central Plateau
- 20 July 2014
- journal article
- case report
- Published by Springer Science and Business Media LLC in Culture, Medicine, and Psychiatry
- Vol. 38 (3), 448-472
- https://doi.org/10.1007/s11013-014-9380-0
Abstract
A rich Haitian ethnopsychology has been described, detailing concepts of personhood, explanatory models of illness, and links between mind and body. However, little research has engaged explicitly with mental illness, and that which does focuses on the Kreyòl term fou (madness), a term that psychiatrists associate with schizophrenia and other psychoses. More work is needed to characterize potential forms of mild-to-moderate mental illness. Idioms of distress provide a promising avenue for exploring common mental disorders. Working in Haiti’s Central Plateau, we aimed to identify idioms of distress that represent cultural syndromes. We used ethnographic and epidemiologic methods to explore the idiom of distress reflechi twòp (thinking too much). This syndrome is characterized by troubled rumination at the intersection of sadness, severe mental disorder, suicide, and social and structural hardship. Persons with “thinking too much” have greater scores on the Beck Depression Inventory and Beck Anxiety Inventory. “Thinking too much” is associated with 8 times greater odds of suicidal ideation. Untreated “thinking too much” is sometimes perceived to lead to psychosis. Recognizing and understanding “thinking too much” may allow early clinical recognition and interventions to reduce long-term psychosocial suffering in Haiti’s Central Plateau.Keywords
This publication has 81 references indexed in Scilit:
- Dissemination and Implementation Research Funded by the US National Institutes of Health, 2005–2012Nursing Research and Practice, 2013
- Depression, suicidal ideation, and associated factors: a cross-sectional study in rural HaitiBMC Psychiatry, 2012
- Exploring the expression of depression and distress in aboriginal men in central Australia: a qualitative studyBMC Psychiatry, 2012
- Validation of cross-cultural child mental health and psychosocial research instruments: adapting the Depression Self-Rating Scale and Child PTSD Symptom Scale in NepalBMC Psychiatry, 2011
- Grand challenges in global mental healthNature, 2011
- Understanding locally, culturally, and contextually relevant mental health problems among Rwandan children and adolescents affected by HIV/AIDSAIDS Care, 2011
- Community health workers in health systems strengthening: a qualitative evaluation from rural HaitiAIDS, 2010
- 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes StudyThe Lancet, 2009
- Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trialThe Lancet, 2008
- The Panic Attack–Posttraumatic Stress Disorder Model: Applicability to Orthostatic Panic Among Cambodian RefugeesCognitive Behaviour Therapy, 2008