Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 084
Guide XI-084

Kromanti ceremonies (Moore Town Maroons)

Moore Town, Jamaica
A 40 · L 49 · M 1117 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the community heritage of Moore Town (Portland, eastern Jamaica) as UNESCO describes it (proclaimed 2003, inscribed on the Representative List of the Intangible Cultural Heritage of Humanity in 2008), the Moore Town governance reported in the Jamaican press, and the ethnography of Kenneth Bilby (an outsider admitted under conditions of secrecy) as attributed context. The psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI) and its modules.

What it is. Kromanti Play is not a therapy. It is a sacred ceremonial complex of a sovereign Maroon community. UNESCO describes the Moore Town Maroons as descendants of West and Central Africans who escaped enslavement and founded independent settlements in the Blue and John Crow Mountains; a 1739 treaty with the British recognised their autonomy, and the community holds communally owned treaty lands and its own political structure. Their collective religious ceremonies, "Kromanti Play", combine several spiritual traditions and are said to "continue to represent the very foundation of Maroon identity"; UNESCO mentions dance, song, specific drumming styles, the Kromanti language and rare medicinal preparations used to invoke ancestral spirits. [source: https://ich.unesco.org/en/RL/maroon-heritage-of-moore-town-00053] Bilby, writing as an anthropologist, states that Kromanti ceremonies "center around the possession of participants by ancestral spirits", that Kromanti is "highly sacred", and that its primary function today is the attraction and invocation of ancestors, led by a ritual specialist (fete-man). [source: Bilby 1983, New West Indian Guide 57(1/2), pp. 38, 40, 63] Secondary summaries add that the ceremony is still turned to for everyday troubles, including illness attributed to spirits [uncertain: secondary summary of Bilby 1981, not verified from the original].

How change happens, as the tradition holds it. Within the tradition, ancestral spirits are understood to act in the world and to be approachable through ceremony led by recognised specialists; protection and clearing of harm come from the ancestors through that relationship. [source: https://old.jamaica-gleaner.com/gleaner/20070617/arts/arts3.html] This guide neither affirms nor disputes these understandings.

What the therapist does. The therapist does not perform, imitate, observe uninvited or describe Kromanti Play. The therapist's work is culturally responsive psychotherapy alongside it: understanding what the tradition means to this client, assessing distress in the client's own terms, distinguishing culturally normative experience from disorder, supporting collaboration with community authority when the client wishes, integrating meaning, and safeguarding. Change in this work comes from an accurate shared formulation, a relationship the client can trust with something guarded, and care that does not force a choice between the client's tradition and health services. [synthesis]

Authority. Moore Town governs itself under a Colonel and a Council of Elders; the current Colonel is reported to be Wallace Sterling. [source: https://jamaica-gleaner.com/article/art-leisure/20261004/moore-town-where-ancestors-still-speak] Authority over ceremonial knowledge rests with the community's recognised ritual specialists; knowledge is taught only to select people and outsiders are tightly restricted. [source: https://old.jamaica-gleaner.com/gleaner/20070617/arts/arts3.html] [source: Bilby 1983] How the Colonel and Council relate to ceremonial authority is [uncertain: not verified].

Why secrecy matters clinically. Bilby reports that recording during possession was "absolutely forbidden" and that non-Maroons present had to be sworn to a ritual oath of secrecy, strictly held in Moore Town. [source: Bilby 1983, p. 41, p. 64] UNESCO records that decades of missionary opposition drove Kromanti Play partly underground and divided communities, and lists intolerance as a threat. [source: https://ich.unesco.org/en/RL/maroon-heritage-of-moore-town-00053] Jamaica's Obeah Act still makes practising obeah an offence (whipping was removed in 2013), and the 1898 law equated obeah with myalism. [source: https://jamaicaobserver.com/2013/03/08/law-change-was-about-flogging-not-obeah] [source: https://obeahhistories.org/1898-jamaica-law/] Kromanti Play is a distinct Maroon tradition and must not be equated with "obeah"; but this legal and missionary history explains why a client may say little. [synthesis]

2. Framework

The framework below is the therapist's own culturally responsive process. No Maroon or UNESCO source sets out a clinical protocol, so phases, session counts and transition criteria are [synthesis] built on the CFI. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]

Phase 0: Preparation (before the client, ongoing). Goal: examine your own assumptions about African-Caribbean religion, possession and "obeah"; learn the basic public history (marronage, 1739 treaty, Nanny of the Maroons as National Heroine, missionary opposition, criminalisation). Move on when you can describe Maroon identity without equating it with general Jamaican culture or with sorcery. [synthesis] [source: https://jamaica-gleaner.com/article/art-leisure/20261004/moore-town-where-ancestors-still-speak]

Phase 1: Engagement and cultural assessment (sessions 1–3; 50–60 minutes each). Goal: safety screen; the core CFI (16 questions, four domains) and relevant supplementary modules; the client's explanatory model; whether, how and with whom the client engages with Kromanti or other help. Format: individual, plus the CFI Informant Version with a relative if the client agrees. Move on when you have the client's own name for the problem, their view of cause, their preferred help, and a shared working statement of the problem. [synthesis] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]

Phase 2: Cultural formulation and differential (sessions 2–4). Goal: decide whether experiences such as possession, ancestral contact or spirit-attributed illness are normative within the client's tradition or part of a disorder; use DSM-5-TR and ICD-11 culture exclusions; consult a cultural broker with consent. Move on when the formulation is written and the client recognises it as theirs. [synthesis]

Phase 3: Shared plan and collaboration (from session 3–5). Goal: agree goals; if the client wishes, coordinate with community-sanctioned help through the client's own channels; coordinate with a prescriber where medicines are involved. Move on when roles are clear and the client has consented to any contact. [synthesis]

Phase 4: Ongoing therapy and integration (typically 8–20 sessions in total, depending on the presenting problem). Goal: treat the presenting problem with the evidence-based method you would otherwise use, adapted to the formulation; help the client integrate ceremonial and ancestral experiences in their own terms; revisit CFI modules as things change (the modules may be repeated during treatment). [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [synthesis for session ranges]

Throughout: safeguarding and medical safety. Screen at every phase for risk, harmful practice, delayed urgent medical care and medicine interactions. [synthesis]

3. Guiding principles

  • The community holds the tradition. Meaning: never describe, perform, adapt or "borrow" Kromanti elements; refer questions about the tradition to the client and, with consent, to community authority. [source: https://ich.unesco.org/en/RL/maroon-heritage-of-moore-town-00053]
  • Secrecy is legitimate, not resistance. Meaning: never ask for ceremony content, language, songs or specialists' identities; ask only what the client chooses to share about effects on their life. [source: Bilby 1983, p. 41] Bilby's later book on the Windward Maroons gives a whole chapter to secrecy, trust and betrayal ("Never to Forget: Secrecy, Trust, and Betrayal"). [source: https://muse.jhu.edu/book/17840]
  • Maroon identity is distinct and sovereign. Meaning: do not fold the client into a generic "Jamaican" or "Afro-Caribbean" category; ask how they identify (Maroon, Moore Town, Windward, diaspora, Christian, several). [source: https://old.jamaica-gleaner.com/gleaner/20070617/arts/arts3.html]
  • Spiritual concepts are recorded as the client holds them. Meaning: write "client understands the illness as spirit-related", never "client believes in superstition" and never "a spirit caused". [synthesis]
  • Neither pathologise nor miss illness. Meaning: a culturally accepted possession or ancestral experience is not in itself a symptom; involuntary, unwanted, impairing states still need assessment. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]
  • Use the CFI as the default lens. Meaning: it is meant for any clinician with any client; it informs, but does not alone decide, diagnosis. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
  • The client decides about collaboration. Meaning: no contact with any community member or healer without explicit, specific, recorded consent. [synthesis]
  • Do not make the client choose. Meaning: present psychotherapy and medical care as compatible with continuing in the tradition; never advise stopping ceremonial participation. [synthesis]
  • Know the history of suppression. Meaning: missionary opposition, criminalisation and stigma may make disclosure risky; earn trust before asking. [source: https://ich.unesco.org/en/RL/maroon-heritage-of-moore-town-00053]
  • Stay in your scope on medicines and preparations. Meaning: ask whether the client takes bush or herbal remedies; never advise on them or on medicines; route to the prescriber. [synthesis]
  • Safeguard without exception. Meaning: cultural respect never overrides duties around abuse, children, risk or urgent medical need. [synthesis]
  • Do not name or expose individuals. Meaning: keep identities of community members and specialists out of notes unless clinically necessary and consented. [synthesis]

4. Intervention inventory

All interventions below are the psychotherapist's own. None reproduces or substitutes for Kromanti practice. Steps are [synthesis] unless a source is tagged.

4.1 Cultural self-examination and humility

  • Purpose: reduce the risk that your assumptions (about possession, "obeah", Maroon people or Jamaican religion) distort assessment. Use before the first session and whenever you notice strong reactions.
  • Steps: (1) Write down what you believe about spirit possession and ancestral communication, and where those views came from. (2) Note any reflex to equate Kromanti with obeah or with "superstition"; the two are different, and the obeah label carries a criminal history in Jamaica. [source: https://obeahhistories.org/1898-jamaica-law/] (3) Learn the public history from community and heritage sources (treaty of 1739, treaty lands, Nanny as National Heroine, missionary opposition). [source: https://ich.unesco.org/en/RL/maroon-heritage-of-moore-town-00053] [source: https://jamaica-gleaner.com/article/art-leisure/20261004/moore-town-where-ancestors-still-speak] (4) Take these reactions to supervision or consultation.
  • Example language (illustrative, to yourself or a supervisor): "I notice I want to explain this away. What would I miss if I did?"
  • Watch for: curiosity that turns into wanting to know secret details; romanticising the tradition; dismissiveness. It is working when you can hold the client's account without needing to judge its truth.

4.2 Opening the cultural conversation safely

  • Purpose: make it safe to mention the tradition at all, given secrecy obligations, missionary opposition and legal stigma.
  • Steps: (1) Explain confidentiality and its limits plainly. (2) Say that you ask everyone about culture, faith and other help, so the client is not singled out. (3) State explicitly that you will not ask about ceremonies or anything the client is not free to share. (4) Let the client set the depth; return later rather than push.
  • Example language (illustrative): "Many people I see draw on their faith, their family's ways or their community's own healing. You never have to tell me about anything that is private to your community. I'm interested in what helps you and what you'd like me to know."
  • Watch for: quick denials, glances to relatives, joking deflection. Do not probe; note it. It is working when the client volunteers how their tradition fits into their life, even briefly.

4.3 Core Cultural Formulation Interview (DSM-5-TR)

  • Purpose: clarify the problem from the client's and their network's perspective: meaning, sources of help, expectations of services. Use at intake with every client; it is designed for any clinician, any client, any setting. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
  • Steps: Work through the four domains in your own words, using the official form (it may be reproduced by clinicians for use with their patients; modifying or translating it needs APA permission). [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] (1) Cultural definition of the problem: the client's own words and how family or community would describe it. (2) Perceived cause, context and support: causes, stressors, supports, and how cultural identity shapes these; for a Maroon client this includes Maroon identity, Christianity, migration and family. (3) Self-coping and past help-seeking: what they have done, including community, church, bush remedies, ceremony, doctors; and barriers. (4) Current help-seeking: preferences, and the clinician–client relationship, including whether they expect you to dismiss their tradition. The time needed is [uncertain]; later interviews were reported to take less time once clinicians were familiar with it. [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]
  • Example language (illustrative): "If people back home in your community knew about this, what would they call it?" "Is there anything about who you are, as a Maroon or otherwise, that you think shapes this problem?" "Sometimes people worry a counsellor won't understand their background. Is that a concern for you with me?"
  • Watch for: the client answering only in biomedical terms to please you; a gap between their words and their family's. It is working when the client corrects or adds to your summary in their own terms.

4.4 CFI supplementary modules relevant here

  • Purpose: go deeper where the core CFI points. The modules may be used as add-ons or standalone, at first evaluation, later, or repeatedly. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
  • Steps: Choose by need. Spirituality, Religion and Moral Traditions: how faith and ancestral tradition support or burden the client; any conflict between church and Kromanti that UNESCO notes has divided communities. [source: https://ich.unesco.org/en/RL/maroon-heritage-of-moore-town-00053] Cultural Identity: Maroon, Moore Town, Jamaican, diaspora, and how the client holds these. Explanatory Model: see 4.5. Coping and Help-Seeking: sequence and combination of helpers. Social Network: who in the community the client trusts. Immigrants and Refugees: for clients who migrated within Jamaica or abroad, which UNESCO notes is common. Caregivers / Informant Version: with a family member, if the client agrees. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
  • Example language (illustrative): "You mentioned church and also your elders' ways. How do those sit together for you? Is there any tension between them in your family?"
  • Watch for: fatigue from too many questions; spread modules over sessions. It is working when the formulation explains why the problem started and what help the client trusts.

4.5 Explanatory-model inquiry (Kleinman)

  • Purpose: elicit the client's model of the illness so the plan fits it. Use alongside the CFI, especially when the client links distress to spirits, ancestors or being "worked on".
  • Steps: Ask, in your own words, the eight areas from Kleinman, Eisenberg and Good (1978): what the client calls it; its cause; why it started when it did; what it does and how it works; how severe and how long; what treatment they think they should receive; the main problems it causes; what they fear most. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader] Then (1) summarise back; (2) name points of overlap with your view; (3) negotiate a plan that respects both.
  • Context: a Jamaican ethnographic study (rural St Thomas, not a Maroon community) found people sorting illnesses into "natural", treated with pharmaceuticals or bush remedies, and "unnatural", attributed to spirits ("duppy") and treated by traditional practitioners. [source: https://pesquisa.bvsalud.org/portal/resource/pt/med-17202] A national survey found 28.3% named devil possession as a cause of mental illness. [source: https://www.mona.uwi.edu/fms/wimj/system/files/article_pdfs/wimj-iss5-2017_553_561.pdf] Do not assume these categories apply to a given Maroon client; ask. [synthesis]
  • Example language (illustrative): "Some people see an illness as natural, some see it as coming from somewhere else, and some see both. How do you see this one?" "What do you fear most could happen if this goes on?"
  • Watch for: a model the client believes you will mock; offer both-and framings. It is working when the client can say which part of the plan fits their view and which part they doubt.

4.6 Asking about Kromanti participation and other healers, without judgement

  • Purpose: know what help the client is using, its timing and any risks, without breaching community secrecy.
  • Steps: (1) Ask generally: "any other help"—church, elders, ceremony, bush remedies. (2) If Kromanti is mentioned, ask only about effects and timing: did it help, is more planned, did anything worrying happen. (3) Never ask what happened in the ceremony, which specialist led it, the language used or any song. (4) Record only what is clinically needed, in neutral terms. [source: Bilby 1983, p. 41 on secrecy] [synthesis]
  • Example language (illustrative): "I don't need to know anything about what happens there. I'm only asking how you've been since, and whether it's something you'd like to keep alongside our work."
  • Watch for: the client becoming guarded or anxious about having said too much; reassure and move on. It is working when the client tells you about other help before you ask.

4.7 Distinguishing culturally normative possession and ancestral experience from disorder

  • Purpose: avoid diagnosing ceremonial possession or ancestral contact as illness, while not missing dissociative, psychotic, mood or trauma disorders. Use whenever possession, spirit contact or ancestral voices come up.
  • Criteria to apply: DSM-5 dissociative identity disorder allows that identity disruption "may be described in some cultures as an experience of possession" but requires that it is "not a normal part of a broadly accepted cultural or religious practice"; dissociative trance (other specified dissociative disorder) does not apply when the trance is "a normal part of a broadly accepted collective cultural or religious practice". [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] DSM-5-TR keeps these points in substance; exact wording [uncertain]. [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299] ICD-11 6B62 trance disorder and 6B63 possession trance disorder require the state to be involuntary and unwanted and not part of accepted cultural or religious practice, with significant distress or impairment. [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] A DSM-5-TR note that culturally sanctioned beliefs or experiences are not counted as psychotic symptoms is [uncertain: not verified].
  • Steps: (1) Establish context: did the experience occur within community ceremony, in ordinary life, or both? Bilby reports possession within Kromanti as the centre of the ceremony and possession by the oldest ancestors as rare and dangerous to the medium, so within-tradition concern about possession exists too. [source: Bilby 1983] (2) Ask whether it was wanted, expected, bounded in time and recognised by others in the community as fitting. (3) Ask about distress, impairment, sleep, mood, substance use, trauma, and other symptoms outside these episodes. (4) With consent, ask a cultural broker or family member whether the experience is typical within the tradition (CFI Informant Version). (5) Formulate: normative experience; normative experience plus a separate disorder; or disorder expressed through cultural idiom.
  • Example language (illustrative): "When this happens, is it something you expect and that others around you understand? Or does it come when you don't want it?" "Outside of those times, how have your sleep, mood and thinking been?"
  • Watch for: command hallucinations, persistent unwanted states, functional decline, suicidality, mania, trauma triggers. It is working when the client and, if consulted, family agree with your distinction.

4.8 Consulting cultural brokers and respecting community authority

  • Purpose: gain cultural context without breaching secrecy or bypassing community authority.
  • Steps: (1) Ask the client whom they trust to explain their community's view (a relative, a church or community member). (2) Get specific, written consent naming the person and what may be discussed. (3) Ask only about what is typical and acceptable, not about ceremony. (4) Where wider questions arise (e.g. a service wishing to engage the community), recognise that Moore Town governs itself under a Colonel and a Council of Elders and approach through them, not through individuals. [source: https://jamaica-gleaner.com/article/art-leisure/20261004/moore-town-where-ancestors-still-speak] (5) Never seek out a ritual specialist yourself.
  • Example language (illustrative, to a broker): "I'm not asking about anything private to the community. I'd like to understand whether what [the client] described is something people there would see as usual."
  • Watch for: the broker revealing more than the client agreed; dual relationships in small communities. It is working when the client feels represented, not exposed.

4.9 Collaboration and referral with community-sanctioned help, when the client wishes

  • Purpose: support care that combines community healing and health services, safely.
  • Steps: (1) Ask whether the client wants their community help and therapy to be coordinated, kept separate, or neither. (2) If coordinated, the client makes the contact through their own community pathway; you offer information about your role only with consent. (3) Agree what each party will do and what you will do if risk rises. (4) Coordinate with any prescriber. (5) Never refer someone who is not of the community to Kromanti, and never encourage seeking ceremony outside community pathways.
  • Evidence context: a formal Jamaican programme linking mental health services with Maroon specialists is [uncertain: not verified]. In West Africa, the COSIMPO cluster trial (Gureje et al., The Lancet 2020) found collaborative shared care between traditional and faith healers and primary care reduced psychotic symptoms more than control and reduced harmful practices. [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839] In a Ghanaian prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)), adding psychiatric care reduced symptoms but did not significantly reduce days in chains. [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial] These are different traditions and settings.
  • Example language (illustrative): "Some people like their community help and our work to know about each other; some prefer to keep them apart. Either is fine. What would suit you?"
  • Watch for: pressure from family either way; any practice causing harm (see 4.16). It is working when the client uses both without feeling split.

4.10 Integrating ceremonial and ancestral experience into therapy

  • Purpose: help the client make use, in their own terms, of meaning drawn from ancestral relationship, identity and community, after ceremony or in daily life.
  • Steps: (1) Invite the client to say, only if they wish, what the experience meant for them (not what happened). (2) Link it to therapy goals: relief, protection, belonging, obligations. (3) Use the client's own words in the formulation and plan. (4) Revisit the Spirituality module as meanings shift.
  • Example language (illustrative): "Without telling me anything private, what did you take away from it? How would you like that to shape what we do next?"
  • Watch for: distress or confusion after an experience, conflict with church members, disappointment that a problem persists. It is working when the client describes a coherent link between their tradition and their goals.

4.11 Responding to distress attributed to spirits or harm by others

  • Purpose: respond when the client fears spiritual harm, is troubled by ancestors or by being "worked on", outside a contained community setting.
  • Steps: (1) Take the fear seriously as an experience; do not argue its cause. (2) Assess risk, sleep, safety at home, and medical causes. (3) Ask who in their community or faith they would normally turn to. (4) Offer grounding and anxiety-management skills from your usual practice as an addition, framed as support for the body and mind. (5) If symptoms suggest psychosis, mania or severe depression, arrange urgent medical assessment while respecting the client's model.
  • Example language (illustrative): "I hear that you feel something is against you. Whatever its source, I'd like to help you sleep and feel steadier, and I'd like you to have the support your community offers too."
  • Watch for: paranoia generalising to others, aggression, self-harm. It is working when fear decreases and functioning returns.

4.12 Working with families and community networks

  • Purpose: families often decide help-seeking; include them with the client's consent.
  • Steps: (1) Map the network (Social Network module). (2) Use the CFI Informant Version with a willing relative. (3) Hold a family meeting to agree the shared plan. (4) Respect intergenerational differences: Bilby notes some younger Maroons never attended Kromanti Play. [source: Bilby 1983] UNESCO notes weakening transmission to younger people as a concern. [source: https://ich.unesco.org/en/projects/action-plan-for-safeguarding-the-maroon-heritage-of-moore-town-00058]
  • Example language (illustrative): "Families here often see things differently between generations. How does your family see what's been happening?"
  • Watch for: coercion, family conflict over religion, confidentiality breaches. It is working when family supports the plan.

4.13 Historical, intergenerational and racial trauma

  • Purpose: recognise the impact of enslavement, warfare, colonial and missionary suppression, criminalisation, economic hardship, migration and racism in services.
  • Steps: (1) Name the history when the client brings it; do not lecture. (2) Ask about experiences of racism or dismissal in health care (CFI clinician–client domain). (3) Explore pride and resistance as resources: sovereignty, treaty lands, Nanny of the Maroons. [source: https://jamaica-gleaner.com/article/art-leisure/20261004/moore-town-where-ancestors-still-speak] (4) Acknowledge UNESCO's report that missionary opposition drove the tradition underground and divided communities. [source: https://ich.unesco.org/en/RL/maroon-heritage-of-moore-town-00053]
  • Example language (illustrative): "Your community has a long history of people trying to suppress its ways. Has that shown up in how services have treated you?"
  • Watch for: retraumatisation, anger at services including you; validate. It is working when the client feels the history is understood without being reduced to it.

4.14 Addressing stigma and dismissive messages from services

  • Purpose: repair the effect of messages that dismiss spiritual explanations or brand them as obeah.
  • Steps: (1) Ask what professionals have said before. (2) Acknowledge that some public health messaging has framed spiritual explanations as myths; for example, a Jamaican Ministry of Health director of mental health services said in 2007 that beliefs in obeah or demon possession hindered treatment. [source: https://jamaicaobserver.com/2007/10/05/obeah-beliefs-hurting-mental-health-care] (3) Make clear that you can work with both the client's explanation and medical care. (4) Support mental health literacy without attacking beliefs; the authors of a Jamaican survey call for context-specific, culturally sensitive programmes. [source: https://www.mona.uwi.edu/fms/wimj/system/files/article_pdfs/wimj-iss5-2017_553_561.pdf]
  • Example language (illustrative): "You don't have to give up your understanding to get help here."
  • Watch for: shame, dropout after a dismissive encounter. It is working when the client discloses more over time.

4.15 Medical safety: remedies and medicines

  • Purpose: prevent harm from interactions or delayed care. UNESCO mentions rare medicinal preparations within the ceremonies and gives no detail; a Jamaican survey links herbal use to a wider pattern of using herbs and prescription medicines together. [source: https://ich.unesco.org/en/RL/maroon-heritage-of-moore-town-00053] [source: https://www.mona.uwi.edu/fms/wimj/system/files/article_pdfs/wimj-iss5-2017_553_561.pdf]
  • Steps: (1) Ask whether the client takes any bush, herbal or other remedies, without asking what is in community preparations. (2) Encourage the client to tell their prescriber or GP. (3) Never advise starting, stopping or changing any medicine or remedy. (4) If a physical illness is being treated only by non-medical means and is worsening, encourage prompt medical assessment.
  • Example language (illustrative): "It helps your doctor to know about anything else you're taking, even teas or bush remedies. Would you be willing to mention it to them?"
  • Watch for: new side effects, confusion, sudden medicine discontinuation. It is working when the prescriber has the full picture.

4.16 Safeguarding

  • Purpose: meet duties where any practice, in any setting, harms someone. Whether harmful practices occur within Kromanti is [uncertain: not verified]; the steps apply to any help a client receives. [synthesis]
  • Steps: (1) Screen for restraint, beating, deprivation of food or sleep, sexual abuse, coercion, exploitation for money, accusations against children, and delay of urgent medical care. (2) Separate the tradition from the harm: report the harm, not the belief. (3) Follow local child and adult protection procedures and consult your safeguarding lead. (4) Never name minors in notes beyond what procedures require.
  • Example language (illustrative): "I respect the help you get from your community. My job also means I must make sure nobody is being hurt. Has anything happened that frightened or hurt you?"
  • Watch for: disclosures made indirectly, fear of community consequences. It is working when safety is secured and the client's trust in you survives.

4.17 Documentation, confidentiality and legal care

  • Purpose: protect the client and community. Obeah remains a criminal offence in Jamaica. [source: https://jamaicaobserver.com/2013/03/08/law-change-was-about-flogging-not-obeah]
  • Steps: (1) Record spiritual material neutrally and minimally ("client participates in community ceremonies that support them"). (2) Never record ceremony content, language or names of specialists. (3) Never label Kromanti as obeah in records. (4) Explain to the client what goes in their record.
  • Example language (illustrative): "I'll write only that your community support is important to you. Is that all right?"
  • Watch for: requests for records by third parties. It is working when the client knows and agrees with what is written.

5. Handling problems

Published guidance on clinical problems in this context is [uncertain: not verified]; all guidance below is [synthesis] unless tagged.

  • Client will not discuss their tradition. Treat as legitimate (secrecy obligations are real [source: Bilby 1983, p. 41]). Say you will not ask again unless they raise it; work on the presenting problem. Say (illustrative): "That's yours to keep. Let's focus on what you came for."
  • Client fears you will judge or report them. Explain confidentiality limits clearly, that belief and participation are not reportable, and that only harm triggers duties. Name the history of dismissal and criminalisation without lecturing.
  • Stuck: progress stalls because client and therapist models conflict. Return to the explanatory model; find the shared goal (sleep, safety, relationships); offer a trial of your method framed as complementary.
  • Client stops therapy after a ceremony or says it is no longer needed. Respect the choice; leave the door open; check risk before closing. Say (illustrative): "I'm glad it helped. If anything comes back, you're welcome here."
  • Non-adherence to medicines. Explore the client's model of medicine; never advise on it yourself; encourage the client to discuss concerns with the prescriber; liaise with consent.
  • Rupture after a dismissive remark (yours or a past clinician's). Name it, apologise specifically, ask what it meant to them, and repair. Say (illustrative): "I think what I said came across as dismissing your community. I'm sorry. Can you tell me how it landed?"
  • Overwhelm after an intense experience. Grounding, sleep and safety first; assess medical and psychiatric causes; ask who in their community supports them afterwards.
  • Possession-like or dissociative states occurring in session. Stay calm; ensure physical safety; do not try to address or engage the experience as a spirit; wait, then reorient gently; afterwards, explore with the client whether this is expected for them and assess (4.7).
  • Family pressure for or against the tradition. Hold the client's own preference at the centre; meet the family with consent; avoid taking sides between church and tradition.
  • Therapist curiosity or appropriation. Never ask to attend, record or learn ceremonies; never use Maroon terms or practices in your own work. Take the impulse to supervision.
  • Requests from non-Maroon clients to experience Kromanti. Explain that it belongs to the community and is not offered to outsiders as healing; explore what they are seeking and offer appropriate help.
  • Dual relationships in a small community or diaspora network. Clarify boundaries; check who else you see; discuss with the client how to handle chance meetings.
  • Risk of suicide, psychosis or mania. Follow standard risk assessment and crisis procedures regardless of cultural framing; involve community supports the client chooses alongside, never instead of, urgent care.

Sources

Books and articles cited:

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