FWIW, here are a few articles which might shed light on the MB's cultural background, belief system, state of mind, and why traditional medicine was not sought to diagnose/treat previous symptoms (if they occurred):
Culture and Mental Health in Haiti: A Literature Review
2010 World Health Organization
Family and Gender Relations
Craan (2002) underlines the great importance of family in Haitian society, which is heightened in times of stress and difficulties. The family in Haiti is elastic and extended and usually includes a large network of relatives, neighbors, and friends (Dauphin, 2002)...
Middle class families in urban centers are organized around a model combining Haitian and Anglo-American elements. While authority is said to be held by the father, who is often absent, the mother remains the poto mitan, the central pillar of the family. In general, mothers have responsibility for the spiritual and emotional life of the family; fathers are responsible for finances, although mothers take care of the details (Bijoux, 1990, p. 31). Female-headed houses in Haiti are very common, particularly in urban areas (Magloire, 2008). In recent years, the pressures of poverty have disrupted the lakou system, leaving many families without the support and shared parenting afforded by the lakou (Edmond, Randolp & Richard, 2007).
Religion
Religion plays a crucial role in all spheres of Haitian life, including politics, morals and health (Corten, 2000; Hurbon, 2004). Haiti is characterised by religious diversity, including: Roman Catholicism, Vodou (which combines West African traditions and Catholicism), and various Protestant traditions. Catholicism, Vodou and Protestant faiths have evolved in Haiti in interaction with each other and share key symbolic elements
(Brodwin, 1992; 1996). Each religion cannot be understood without taking the others into account (Hurbon, 2001a). Since Catholic and Protestant traditions may be better known to non-Haitian readers, this section will focus on Vodou.
Vodou is widespread in Haiti and is practiced by the majority, including Haitians who identify as Catholics and, to a lesser extent, Protestants (Métraux, 1958). The name Vodou stems from the Fon word meaning spirit. The Code Noir of 1685 by Louis XIV made mandatory the conversion of slaves to Roman Catholicism. In an effort to hide forbidden African religious practices, the slaves identified their African deities with the
saints of the Roman Catholic Church. The slaves could then give the appearance of strict adherence to Roman Catholicism, but were able to retain aspects of their West African
religion, which manifested itself in Vodou (Hurbon, 2008).
Vodou is not a homogenous religious system; there is great diversity in regional belief and practice (Najman, 2008). Most people who practice Vodou or serve spirits do not speak about it openly with strangers, clinicians, or others outside the tradition. Although individual knowledge and attitudes vary with education and religious affiliation, Vodou is part of the cultural background for most Haitians, regardless of their identity.
Psychosis
When people have suffered repeated psychotic episodes and their functioning is impaired, they may be labeled fou (crazy) and viewed as permanently dysfunctional. Their cognitive ability and judgment may never be trusted again, even after a long period of remission. This is a loss for the family especially in first episode psychoses where the person had a promising future (in terms of education and career) (Desrosiers & Feurose, 2002)...
The symptoms that characterize schizophrenia are based on concepts of self and non-self. In Euro-American cultures,
thinking that the some entity other than the self has thoughts, feelings and goals can be seen as pathological, magical thinking or evidence of a psychotic thought disorder. However, in Haitian culture, thoughts, feelings and agency may be ascribed to invisible spirits or to the magical action of others. Diagnostic assessment, therefore, must not look
only at the form, but also at the theme or the content of the behavior exhibited by the person. The same behavior characteristic of schizophrenia in Europe or North America can be representative of normal spiritual and religious beliefs in Haitian culture, for example communication with and appeasement of deceased relatives who live on as ancestral spirits (Miller, 2000).
In the Haitian context, it is particularly important to distinguish spiritual practices from psychological or psychiatric problems. If religion is ignored, misinterpretation of spiritual experiences and explanations can lead to misdiagnosis and mistreatment (Azaunce, 1995). The person who says I see the evil spirit in my house or God came to me and told me to give up my job, so I did may not be delusional or hallucinating
(Gopaul-McNicol, 1997, p. 44).
In religious practices that involve possession, a spirit can enter a member of the congregation to punish, reward, treat or cure another member of the congregation. As such, it is important to distinguish between negative possession experiences (by an evil spirit) which may be best dealt with by spiritual healers, and experiences of possession associated with schizophrenia, which are usually accompanied by a broader range of symptoms including blunted affect, thought disorder, deterioration in functioning, social withdrawal and poverty of speech (Azaunce, 1995).
http://www.who.int/mental_health/emergencies/culture_mental_health_haiti_eng.pdf
Culture-Bound Syndromes
The definition and expression of mental illness varies around the world. According to the DSM-IV, "Although presentations conforming to the major DSM-IV categories can be found throughout the world, the particular symptoms, course, and social response are very often influenced by local cultural factors. In contrast, culture-bound syndromes are generally limited to specific societies or culture area and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations."
Boufée delirante (West Africa, Haiti)
A sudden outburst of agitated and aggressive behavior, marked confusion and psychomotor excitement. It is an acute, nonaffective and non-schizophrenic psychosis, accompanied by visual and auditory hallucinations and/or paranoid ideation. A distinctive feature is a complete remission after an acute episode.
Patients are typically under age 30, and do not have previous diagnoses of psychological or neurological disorders. It strikes "like a thunderbolt." Duration is typically brief, and the patient may never have another episode.
This term was used in French psychology for some time, but is now declining. Although the DSM-IV lists West Africa and Haiti as locations, it appears to be more widespread across the Caribbean and areas that have traditionally been associated with French occupation, and within France itself. Source 1, 2.
http://rjg42.tripod.com/culturebound_syndromes.htm
Bouffée Délirante (Acute Delusional Psychosis) Since it has been recognized that tardive dyskinesia
may develop as a serious complication in a significant minority of patients with schizophrenia on
maintenance therapy with antipsychotic drugs, it has become even more important to make a correct
initial diagnosis. In French psychiatry the condition known as acute delusional psychosis, or bouffée
délirante, is not included in the diagnosis of schizophrenia. Rather, bouffée délirante is considered a
disease entity in its own right, a psychiatric disorder that does not require maintenance pharmacotherapy.
The following are essential criteria for the diagnosis of bouffée délirante, not all of which need to be
present: (1) frequent background of personality disorder; (2) absence of a schizoid premorbid
personality; (3) sudden onset; (4) duration of less than 3 months; (5) spontaneous return to premorbid
level of adjustment, even without specific antipsychotic treatment; (6) polymorphous symptoms, a
disorderly (kaleidoscopic) succession of differing delusional contents; (7) a fascinating intensity of the
delusional experience; (8) oscillations between insight and delusion; (9) mood alterations and
fluctuations; (10) increase in delusions in sleep-related states; and (11) sudden termination after days or
weeks (rarely months).
Accordingly, bouffée délirante episodes belong to the schizophrenic spectrum disorders. In American
clinical practice those episodes are usually diagnosed as schizophreniform disorder.. French psychiatrists
report that about 40 percent of patients with the diagnosis bouffée délirante are later reclassified as
suffering from schizophrenia.
http://www.brown.edu/Courses/BI_278...es/Brain and Behavior/articles/schiz_clin.pdf
