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

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Presented by Haydee Colon Hernandez, MS. and Theresa Miskimen, MD ... Terminology. Curandera(o) Limpieza (spiritual cleansing) Holy water. Negative energy ... – PowerPoint PPT presentation

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Title: 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

14
(No Transcript)
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
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