Working with Haitian Canadian families
SHARON-ANN GOPAUL-MCNICOL, 1DENISE BENJAMIN-DARTIGUE 2 & EMERY FRANCOIS 31
Howard University, 109 Holly Avenue, Hempstead, New York 11550 NY, U.S.A.;2 Multicultural Educational & Psychological Services; 3 Brentwood School District
Abstract. Given the continued increase of Haitian families being referred for mental healthservices, a treatment model on how to intervene therapeutically would prove beneficial for boththerapists and Haitian families alike. This article discusses cultural factors (family, education,language, religion, and the racial demographics of the Haitian people) that impact upon the treat-ment of Haitian families. A model for intervening therapeutically with Haitian families isproposed.
Haiti has met with turbulence and instability from the time of the Frenchrevolution in 1789, to the present. Since Haiti had become the first blackrepublic in the Western hemisphere, the first to gain independence (1804)(Rotberg, 1971), the first colony in Latin America to sever its political tieswith North America, it was perceived as a beacon of freedom for blacks andother oppressed people and a nightmare for the colonial powers. It is thisoppression that so characterized Haitis history, that crystallized the strengthof character of the Haitian people that should earn them the respect of otherAfrican cultures. However, due to the negative propaganda of the colonialpowers (France, North America and Britain), other African groups such asWest Indians residing in France, North America and Britain tend to disasso-ciate themselves from Haitians.
Haitians, like many other migrants coming from politically unsettled coun-tries, leave their native land to escape the repression, persecution, in searchof social justice and economic advancement. The linking of Haitians to AIDSin the late 1980s/early 1990s resulted in many groups including those ofAfrican heritage shunning Haitians. This led to feelings of rejection by theHaitian people, embarrassment and frustration. Even though AIDS was notproven to be endemic to Haitians, to this day, some Haitians still hold resent-ment over this allegation. Many Haitians and their sympathizers have attrib-uted this allegation to their African heritage, since the rumor began when theboat people landed in such large numbers on Pompano beach in Florida,United States. Apparently, seeing so many people of African descent con-
International Journal for the Advancement of Counselling 20: 231242, 1998. 1998 Kluwer Academic Publishers. Printed in the Netherlands.
gregate in an all white community was threatening. Therefore, in order to curbthe preponderance of Haitians entering the United States, the association ofAIDS with Haitians was made, although Haitian AIDS victims made up arelatively small percentage.
There is a powerful class hierarchy (education, language, economics andculture) in Haiti distinguishing the vast majority who are Black peasants andwho represent about 90% of the population. Urban middle class Blacks,Lebanese, Syrians and Europeans represent about 4% of the population. Theelite who are descendants from the original French colonizers and African,now light skinned mulattoes, represent about 5% of the population.
In Haitian culture, as in other African cultures, family is viewed in the broadestsense. The family includes the nuclear family, the extended family and evenclose friends. The extended family system serves as a base of support forfamily members who are migrating from Haiti to Canada. The newly arrivedusually find a home among already established Haitians and a support systemwhile adjusting to this new environment. In Haitian families, authority is oftenbased on the rank or position of members in the family hierarchy. Since Haitiis a patriarchal society (Weil et al., 1985), the father represents the authorityin the home, followed by the mother and then the eldest child. The father isusually the primary financial provider and the mother is usually the primarycaretaker of the home. If grandparents reside in the home, power is redefinedwith the grandparents assuming the authority. However the male spousalposition is not affected, just as the male child is more respected than the femalechild.
Elderly parents are cared for by their children or by relatives. BecauseHaitians have a profound sense of moral obligation and emotional attach-ment to the aged, they avoid placing relatives in nursing homes, since theysee this as a sign of detachment and a lack of concern for their familymembers.
Respect for elders is highly valued in the Haitian community. When childrenviolate the rules as outlined by their elders, they are harshly disciplined.Corporal punishment such as spanking is an acceptable form of discipline.Children are beaten with a switch or belt merely for being disobedient. Theseactions are not perceived as abusive by the family, and therefore, Haitiansare usually surprised when child abuse charges are brought against them. Inthis situation the role of the therapist should be one of teaching the familiesalternative ways to discipline their children. Both parents should be taught
behavioral principles, whereby children should only be rewarded for compli-ance, and privileges should be withheld when children fail to adhere to rules.Therefore they should be taught to set up behavioral contracts at home,whereby rules, consequences for violating rules, reinforcers (television, socialactivities etc.) should be clearly outlined. While initially parents may seemreluctant to adhere to this manner of disciplining their children, they are morereceptive when they see the positive results.
Haitians view education as a very important vehicle to ones upward socio-economic mobility (Laguerre, 1984). They value education to a great extentand they accord school teachers much respect and expect them to take on greatresponsibility in their childrens education (Foster, 1980; Joseph, 1984). Unlikein their native countries where only the elite and middle class could afford tosecure high school education making the literacy rate 20%, in North America,Haitian immigrants are described as progressive and a high percentage of pro-fessionals have been found to be among them (Joseph, 1984).
The official language of Haiti is French, which is the language used in thegovernment, in business and in the school system. While French is written,spoken and understood by only 20% of the population who are mainly thewell educated elite, and middle class urbanites, everyone speaks Creole anamalgamation of French, some Spanish, a smattering of English, and thesyntax of West African tribal languages. The politics surrounding the use ofFrench and Creole highlights the polarity of Haitian society. Speaking Frenchdoes not enable one to understand Creole and vice versa. Because only 20%of the population are truly bilingual (Weil et al., 1985), the assumption bymany Canadians that all Haitians speak French or anyone who speaks Frenchcan understand Haitian Creole, leads to mis-communication of Haitian immi-grants, mis-diagnosis of Haitian patients and mis-placement of many Haitianstudents.
Roman Catholicism, the official religion in Haiti since 1860, is thought to bepracticed by 80% of the people, while Protestantism is practiced by about 20%of the people (Weil et al., 1985; Ferguson, 1987).
Outside the urban area, one usually encounters religious folk beliefs suchas Voodoo. Voodoo has its origin in Africa and flourished on the sugar and
banana plantations as a way for slaves to maintain their African heritage. Thisoriginal African religion is not limited to the Haitian culture, but is commonlypracticed and termed differently among people of African heritage who haveemerged from colonized systems: In Trinidad, it is called Obeah/Shango; inMartinique, Maldevidan; in Cuba, Santeria.
When Westerners hear the word Voodoo they usually associate it withwitchcraft, animal sacrifices etc. (Wittkower, 1964; Leininger, 1973; Phillippe& Romain, 1979; Weidman, 1979; Davis, 1983; Harris, 1984; Bourguignon,1985). However, like any other religion, Voodoo has its deity, angels, saints,priests and followers. For instance, there is a African Voodoo God Damballa,whom Haitians identify with the Roman Catholic Saint Patrick. In essence,Voodooism is a union of Catholicism and the African beliefs from Nigeria,Congo and other enslaved colonies.
A case sample showing the role of religion and a Haitian male
Following the incarceration of his son, a sixty year old man, Mr. X, had asudden onset of depression. Apparently he suddenly became withdrawn,rarely spoke and seemed listless. According to his family, for the past tenyears he was an active member of the Catholic church, although there wasno mention in his record that he had a strong religious support system. Priorto this incident, he never had a nervous breakdown or any mental problems.Due to his withdrawn behavior, he was diagnosed as having a depressedaffect and was placed on antidepressant medications. The primary author wasasked to serve as a consultant on the case by his family who maintained thathe did not need to be hospitalized, but needed social/spiritual support andpastoral counselling. Immediately a recommendation of spiritual consulta-tion was made to supplement the psychiatric evaluation that had been con-ducted several days prior. The evaluation which was conducted by apsychologist/theologist revealed that the psychiatrist who did the first eval-uation was antipathic to the spiritual issues raised by the client. Accordingto the family, the psychiatrist had denigrated the patients spirituality whichwas his greatest strength.
The interview with the patient revealed that the psychiatrist would notlisten to the fact that he relied on his inner spiritual strength to deal with hisproblems. The patient was allowed to talk about his experiences without beingsilenced as he had said the psychiatrist had done to him. Mr. X explainedthat whenever he got the cue from the psychiatrist to stay away from spiri-tual matters, he tended to go into a mode of silence and withdrew even further.Mr. X repeatedly said I wish I can speak freely and not have to censor thespiritual things I feel or believe. He was encouraged to engage in his reli-gious activities, such as blessing his home, lighting candles etc. After herecognized that his spiritual belief system was not threatened, he was morereceptive to psychological intervention. Rational emotive therapy where the
focus was on disputing his irrational beliefs regarding the perception ofhimself as a bad father who failed my son that led to his incarceration. Wewere able to work through the depression with Beck cognitive therapy andbehavioral interventions which involved visiting his son, volunteering his timein prison etc. Healthy religious activities were encouraged. After 12 weeksof treatment, Mr. X was engaging his family more, and clearly did not fit thediagnosis of depression.
In our conversation with our colleagues, we have heard a significant numberof cases about clients who use God to avoid confronting their problems. Wehave come to recognize that many of our psychology colleagues are unableto differentiate between healthy versus unhealthy reliance on spirituality. Wehave seen in our practice clients who cope with their psychosis by movingfrom being a skeptic to having profound faith in their religion. Interestingly,according to their pastors, many of these clients are not bizarre with respectto their theology. While we do not ourselves engage in ministrations, weencourage our clients spiritual growth, and their involvement in theirchurches. Even with clients who show little gains in their psychosis, muchimprovement in their soul was noted. We find it amazing that we as psy-chologists tend to overlook these gains and even denigrate them. By ignoringthe spiritual development of their clients, and even that of their own, psy-chologists are limiting their own psycho-spiritual development and are limitedin their ability to discern psychological from spiritual problems.
Therapy with Haitian families
The therapist who works with Haitian families must be willing to be flexible.Moore Hines and Boyd-Franklin (1982) and Gopaul-McNicol (1993) haveemphasized the importance of therapists exploring the impact of socio-polit-ical and broader environmental conditions on the families they treat. Treatmentissues can range from assisting families with basic concrete needs, such asthe need for food and clothing to providing translation for those who areunable to communicate in French or English. A more recent focus in treat-ment has been addressing the traumatic experiences that the Haitianpeasant/urban families endured en route to the metropolitian countries.
Firstly, it is important to note that Haitians generally do not readily acceptpsychotherapy. This is because their approach to solving problems is a familyaffair. The only outsiders that are permitted to interfere are priests, Voodooists,and elders in the community. The churchs role is basically one of reaffirmingthe familys belief that God will solve the problem. Thus, a Haitian familymay seek treatment from mental health workers only after all internal familymeasures have failed.
A therapeutic model for working with Haitian families The multicultural/multimodal/multisystems approach (Multi-CMS)(Gopaul-McNicol, 1993)
The MULTI-CMS approach was developed by Gopaul-McNicol (1993). Thistechnique incorporated the works of Sue (1981) (emphasis on culture mul-ticultural); Lazarus (1976), Bowen (1978), Minuchin (1974) different modesof therapy multimodal, educational, structural; and Boyd-Franklin (multi-systems).
Sues (1981) major point is the importance of the therapist being knowl-edgeable about the clients cultural lifestyle. Lazaruss (1976) multimodalapproach, which emphasizes therapeutic pluralism, utilizes a multilayeredapproach to address human discomfort. The goal is to assess the individualthrough several modalities behavior, affect, sensations, images, cognitions,interpersonal and drugs (BASIC-ID), and then examine the salient interac-tions among them. Via this approach, a therapist is able to achieve a thoroughunderstanding of the individual and his or her social environment. In Bowens(1978) approach, the therapist is portrayed as a teacher who utilizes aneducational approach to therapy. This approach recognizes the value ofeducation in self-change. Minuchins (1974) structural approach helps inrestructuring the family that may be too enmeshed or disengaged. Thisapproach is helpful with immigrant families who find themselves losing manyof their traditional role expectations during the process of acculturation. Boyd-Franklins (1989) multisystems approach is useful with immigrant familieswhose experiences traditionally extend to support systems...