Haitian Voodoo Curse: A Systematic Review and Case Report

Background: Cultural context is imperative to consider when making psychiatric diagnoses as it provides a foundation to determine how cultural idioms and concepts of distress interfere or coexist with psychiatric disorders. The DSM-V establishes a framework for culture-centric interviewing to be utilized when there is uncertainty between culturally distinctive symptoms and diagnostic criteria. There is limited research on psychiatric illnesses present in Haitian culture or religious influence on somatization. This is the case report of a 17-year-old Haitian woman whose psychiatric diagnosis was complicated by the cultural explanation of a Voodoo curse. We performed a systematic review of the literature to better understand the correspondence between DSM-V disorders and Haitian cultural concepts of distress with respect to Voodoo practice. Objectives: 1) Provide a case report in which psychiatric diagnosis was complicated due to a Haitian concept of distress. 2) Conduct a systematic review to understand the correspondence between DSM-V disorders and Haitian cultural concepts of distress with respect to Voodoo. 3) Propose a direction for future research. 4) Provide direction for cultural competency training. Case Description: We present a 17-year-old Haitian female with no prior psychiatric history, who was evaluated in an inpatient facility after symptoms of panic disorder with atypical features resulted in two emergency department (ED) admissions. On both occasions, the patient presented with altered mental status (AMS), moaning, crying, and thrashing. The patient was noted displaying bizarre affect and occasionally responding to internal stimuli. When evaluated in the inpatient facility, the patient disclosed her symptoms were a result of a Voodoo curse. Methods: A systematic review of the literature was performed using four online databases: PubMed, Google Scholar, EBSCO CINAHL, and APA PsychArticles. Key terms: “maladi dyab,” “indisposition,” “voodoo,” and “Haiti” yielded 55 articles. 4 articles were identified that met stringent inclusion criteria. Somatic symptoms that corresponded with sent sickness were extracted and categorized to determine any similarities with current psychiatric diagnoses. Results: Currently, no work exists which identifies psychological disorders in the context of Haitian idioms of distress, and fewer studies that characterize disorders of psychosis and somatic manifestation of anxiety. Most studies are not current, and virtually all recent literature is merely a review of previous work detailing Haitian culture and religious influence. Discussion/Conclusion: This case highlights the importance of culture-centric interviewing as physicians were unable to initially identify the appropriate diagnosis and treatment for this patient without the proper cultural context. The patient presented with typical symptoms of generalized anxiety disorder but also with atypical somatic symptoms of panic attacks that may be explained by a cultural response to stress similar to “indisposition” described in Haiti.Due to the paucity of literature, there is a need for further research on somatic manifestation of non-physical illness, or “sent sickness,” Voodoo, and its connection to mental illness. This is especially relevant due to the growing Haitian population in America that establishes the need for culturally competent care.