Cultural Aspects of Religious Beliefs and Alternative Healing Systems in Psychiatric Care

1. Cultural Aspects of Religious Beliefs and Alternative Healing Systems in Psychiatric Care Presented by Haydee Colon Hernandez, MS and Theresa Miskimen, MD at the Clinical Latina Cultural Rounds November 13th, 2006 Newark, New Jersey

2. Case Presentation Identifying information carefully removed to protect the confidentiality of this person. The facts are real.

3. Identifying Data • 24 y/o Spanish speaking Latino male residing in a shelter • Grew up in Puerto Rico, at the age of 23 y/o moved to NJ • Family in PR bought airplane ticket and sent him to NJ-to “look for his brother in the Bronx” • Was homeless for some time

4. Biological mother diagnosed with schizophrenia, unable to raise client. Eventually father remarried and client was raised by stepmother • Father died of alcohol overdose, client discovered body “on the stairs of a nearby house” • During middle adolescence he develop a good relationship with a “santero” and was indoctrinated over a period of time to santeria “I learned how to work under the protection of the santos (saints), I learned how to read caracoles (sea shells) and I learned how to do brujos (witchcraft).”

5. Presenting Symptoms • Poor sleep, loss of appetite, poor concentration, mood swings, social isolation, distrust of others, auditory and visual hallucinations, delusional thoughts • In addition: alcohol, cocaine and heroin abuse, active during initial presentation • Poor insight about mental illness and addiction • Gastrointestinal complaints

6. 1st episode • Premorbid condition: gang/drug related activity, poor adult supervision, psychiatric hospitalization PR-unknown circumstances, no follow up • NJ: living in a shelter, Spanish-speaking only, no social support • Sxs: visual hallucination, auditory hallucinations, paranoia, concentration • Explanatory model of illness: a ritual or “brujo” was made against him by various male figures in his life

7. He reported: “I know someone is doing something against me because I was eating and the food turned into worms.”

8. 2nd episode - UBHC • Almost four years after first recorded episode pt had a relapse of symptoms. He was no longer homeless but staying at a boarding home. • Sxs: depressed mood, episodic suicidal ideations, paranoia (former landlord sending people to follow and kill him), auditory hallucinations

9. Working diagnosis: Psychotic disorder NOS • R/O: Schizophrenia Subs induced psychotic disorder Major depression with psychotic features Schizoaffective Bipolar disorder

10. Treatment • 1st episode: partial hospital for 2 years. Relapse prevention groups, psychotropic medication management and supportive individual sessions. “Clean” during this period • Group and individual treatment offered in Spanish, addressing the mental illness and the chemical abuse at the same time • The counselor-client relationship was created by focusing support, and counsel

11. Non judgmental exploration of religious beliefs • Religious beliefs were used as a strength to help client in his recovery • Explanatory model aiding recovery: client believed the “santos” did not agree with his drug abuse. This information related to his religious beliefs was highlighted to encourage abstinence

12. Continued to utilize education about mental illness, medication and negative consequences of drug use • When symptoms were not acute, thoughts about irrational distrust of others were explored to increase insight

13. 2nd episode: Acculturation • Delusions changed over time. From believing that illness was related to rituals directed against him to believing that landlord had contracted a person to follow and kill him • Waning of his religious connection to santeria-could be related to not have close proximity to his spiritual leader

15. Espiritismo, Santeria, and Curanderismo • Group setting with individualized attention • Social support • Explanatory model of illness

16. Espiritismo/Spiritism • Philosophical doctrine France 19th century • Allan Kardec, The book of Spirits and The Gospel according to Spiritism • Evolved into current religious practice which is described as a social movement • Covert but widespread belief

17. Terminology • Mediums • Reincarnation • Fluids or spiritual forces • Spiritual evolution

18. Explanatory model of illness karma religious negligence inexperienced mediums obsession by spirits evil eye

19. Santeria • Associated mostly to Cuban population • La Regla de Orisha (Ocha) • La Regla Lucumi (the way of the Saints) • Originated in West Africa-traditional religion of the Yoruba, slave trade dissemination • Combined elements of worship from Roman Catholicism • Santeria has healing powers and harming qualities as well

20. Explanatory model of illness natural illness occult illness spiritual illness

21. Terminology • Aborisha worship of the Orisha, and individual worshiper • Macumba/Candomble/Quimbanda used incorrectly as a synonym for Santeria • Babalz Ayi/St. Lazarus patron of the sick • Shango/St. Barbara controls thunder, lightning, etc • Eleggua/St. Anthony controls roads, gates, etc • Obatala /Lady of Las Mercedes, and Resurrected Christ father of creation • Oggzn/St. Peter patron of war • Oshzn/Our Lady of Charity controls money

22. Controversy • Ritual Sacrifices: Ritual abuse and murder no connection with Santeria. The practice of animal sacrifice can be a seen in some rituals where animal blood is collected and offered to the head saint. Chickens are the most common animal used. Their sacrifice is believed to please the Saints, and to bring good luck, purification and forgiveness of sins. • Possession: of the individual by the particular Orisha being invoked. The individual then speaks and acts as the Orisha.

23. Curanderismo • Folk healing not to be confused with witchcraft • Related to Spanish colonization-Mexico. • Combines Catholicism and traditional folk medicine • Includes prayer, healing/spiritual rituals, psychic healing, prayer, herbal remedies

24. Explanatory model of illness evil spirits punishment curse

25. Terminology • Curandera(o) • Limpieza (spiritual cleansing) • Holy water • Negative energy