Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 089
Guide XI-089

Winti (Suriname)

1623Suriname
A 39 · L 49 · M 1218 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Winti as Afro-Surinamese community voices and their scholars describe it (Wooding and Stephen as cited in secondary sources; van Wetering's ethnography of Winti healers in the Netherlands, 1991). The psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules. Winti is a living religion, not a psychotherapy. The psychotherapist does not practise it. This guide covers the psychotherapist's culturally responsive work alongside it.

What Winti is. Winti is an Afro-Surinamese religion that formed during Dutch colonial slavery in Suriname (1623–1863). It draws on several West African traditions, including Akan, Fon/Vodun and Kongo sources. Its practitioners today are mainly descendants of enslaved Africans, in Suriname and in the diaspora, especially the Netherlands [source: https://sacredart.caaar.duke.edu/religions/surinamese-and-dutch-winti/] [source: https://en.wikipedia.org/wiki/Winti]. The word means "wind", and the winti are many nature spirits [source: https://fkawdw.nl/en/participants/marian_markelo].

Concepts, as the tradition holds them. The tradition holds that a supreme creator, Anana, stands above a pantheon of winti grouped by realm: earth, water, forest/bush and sky. Some Maroon groups add a realm of the dead. Ancestor veneration is a core principle. A person is held to have a kra (soul) and dyodyo (spiritual parents who protect the person). The yorka is held to absorb life experience and to go to the realm of the dead after death [source: https://en.wikipedia.org/wiki/Winti] (secondary, summarising Wooding and Stephen) [uncertain: Wikipedia only]. Worship includes Winti Prey ("Winti play") dance gatherings, during which winti are held to possess participants [source: https://sacredart.caaar.duke.edu/religions/surinamese-and-dutch-winti/].

Core idea of illness and change, as scholars describe it. Wooding (as cited) describes Winti as centred on personified supernatural beings. These beings can possess a person, reveal past, present and future, and cause or heal illnesses of a supernatural nature. Stephen (as cited) describes Winti as primarily a religion of worship and prayer, with a strong magical side [source: https://en.wikipedia.org/wiki/Winti] [uncertain: Wikipedia only]. Van Wetering reports that Creole Surinamese people distinguish illnesses for the doctor from illnesses with a spiritual cause, which are taken to a bonuman (healer). In her account, some conditions also have a "psychogene" side that is treated ritually. She saw Winti healing as giving emotional relief through catharsis and ritual. She also recorded harm attributed to wisi (harmful magic or bewitchment) [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf]. These are outsider and insider scholarly accounts. Spirit causation is described here as the tradition holds it, neither affirmed nor dismissed.

History that shapes the encounter. Winti was practised in secret during slavery and for a long time after it [source: https://raadvankerken.nl/files/2024/07/Kerken-en-doorwerking-slavernijverleden-Duncan-Wielzen.pdf]. Duke University's Sacred Arts of the Black Atlantic page states that Winti practice was banned by law from 1874 to 1971 [source: https://sacredart.caaar.duke.edu/religions/surinamese-and-dutch-winti/]. The Surinamese news service Starnieuws reports that in 1874 idolatry was made a punishable offence with Winti explicitly named as idolatry, and that the then Minister of Justice, Jnan Adhin, lifted the ban in 1971 [source: https://www.starnieuws.com/index.php/welcome/index/nieuwsitem/27733]. Van Wetering writes that it was prohibited as afkodrey (idolatry) until 1971 [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf]. The theologian Duncan Wielzen dates a colonial ban to 1776, with detention or a fine as penalties, and its removal from the Surinamese criminal code to 1971. He adds that churches contributed to the idolatry label [source: https://raadvankerken.nl/files/2024/07/Kerken-en-doorwerking-slavernijverleden-Duncan-Wielzen.pdf]. The sources agree on 1971 for the lifting. For the start they give 1874 (Duke, Starnieuws: idolatry made punishable) and 1776 (Wielzen); these may refer to different measures, an earlier colonial prohibition and a later penal provision [uncertain: sources differ]. The exact statutes are [uncertain]. With a client, "criminalised until 1971" is accurate on either reading; avoid stating how long the ban lasted. Many clients carry this history as shame, secrecy or family division.

Core idea for the psychotherapist. Change in your own work comes from three things [synthesis, built on the CFI's stated aims]. First, understand the client's own explanatory model and help seeking. Second, separate culturally normative experience from disorder without pathologising or missing illness. Third, coordinate safely with whatever help the client chooses [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].

2. Framework

Winti has no published stage model for psychotherapists. The phases below are a [synthesis] that organises the CFI-based work. Session counts are [synthesis]: no source gives them for this population.

Who holds authority in Winti. Winti has no written scripture and no central authority [source: https://en.wikipedia.org/wiki/Winti] [uncertain: Wikipedia only]. In van Wetering's account, a bonuman's legitimacy traditionally came from kin and village, and was confirmed publicly through an installation (sreka). Recognition also rests on ondrofeni, knowledge validated by lived experience [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf]. In Dutch usage the lukuman is a seer and the bonuman a healer [source: https://www.tijdschriftvoorpsychiatrie.nl/media/5/articles_669pdf.pdf]. Suriname has begun to recognise Winti formally:

  • 2006: a Winti foundation was entered in the government register of religious organisations.
  • 2011: the first two Winti marriage officials were appointed.
  • 2014: the Surinamese government recognised and appointed the first Winti cleric; Starnieuws reports her ceremonial installation as okomfo fu kondre in February 2015 and notes that earlier Winti priests had not been appointed by law [source: https://www.starnieuws.com/index.php/welcome/index/nieuwsitem/27733] [source: https://sacredart.caaar.duke.edu/religions/surinamese-and-dutch-winti/].

In the Netherlands, publicly known Winti priestesses such as Marian Markelo teach and lecture about Winti. In 2002 she consecrated the national Slavery monument in Amsterdam [source: https://fkawdw.nl/en/participants/marian_markelo]. A Winti Renaissance project started there in 2011 [source: https://sacredart.caaar.duke.edu/religions/surinamese-and-dutch-winti/]. For any individual client, authority rests with the practitioner and family network the client recognises, not with the therapist.

Phase 0: Preparation (before and between sessions).

  • Goals: examine your own assumptions; learn the history of suppression and Dutch colonial responsibility; identify Surinamese colleagues or cultural brokers you can consult.
  • Moving on: you can name your own likely biases. You have a consultation route for when you are unsure whether you are seeing winti or illness.

Phase 1: Engagement and cultural assessment (sessions 1–3) [synthesis].

  • Goals: deliver the core CFI (16 questions, four domains). Add supplementary modules as needed: Explanatory Model; Spirituality, Religion, and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Immigrants and Refugees; Social Network. With consent, use the Informant Version with a relative [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf].
  • Format: individual sessions, family members joining by consent. The CFI time is [uncertain]: the DSM-5 field trial found later interviews took less time but gave no minutes [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/].
  • Moving on: you can state the client's name for the problem, their attributed cause, the help already sought (including Winti healers, churches, the GP), and their expectations of you.

Phase 2: Diagnostic clarification (overlapping Phase 1).

  • Goals: decide whether the experience is part of broadly accepted cultural or religious practice, or meets criteria for a disorder. Relevant categories include possession-form DID, dissociative trance (OSDD) and ICD-11 6B62/6B63, as well as psychosis, depression and trauma disorders. Assess risk.
  • Moving on: the differential has been discussed, ideally with a cultural consultant, and urgent medical and psychiatric needs are covered.

Phase 3: Shared formulation and plan (about 1 session) [synthesis].

  • Goals: offer a formulation in the client's terms, alongside the clinical one. Agree on parallel or coordinated help, with consent covering any contact with a healer, pastor or family.
  • Moving on: the client agrees the plan describes their situation, even if they reject a diagnostic label.

Phase 4: Treatment alongside the tradition (typically 8–20 sessions, as the indicated evidence-based treatment requires) [synthesis].

  • Goals: deliver the indicated psychotherapy, integrating meanings from any ritual or possession experience. Liaise with the prescriber. Work with family conflicts, stigma and historical trauma. Keep safeguarding under review.
  • Moving on: functioning improves, there is no harm from any part of the care, and the client feels their worldview is respected.

Phase 5: Review and ending.

  • Goals: repeat CFI elements, which the APA says may be re-administered during care [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]. Plan for relapse, including whom the client will turn to first.

3. Guiding principles

  • You work alongside, never inside, the tradition. Do not diagnose spirits, interpret possession as a Winti specialist would, or recommend rituals. Leave those to practitioners the client recognises [synthesis].
  • Use the client's words. Van Wetering notes that "winti" has acquired negative associations and that "kulturu" is often preferred. Ask which term the client uses [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf].
  • Attribute, do not adjudicate. Record "the client attributes this to a winti", not "a winti caused this" and not "the client believes in superstition" [synthesis].
  • Expect secrecy for historical reasons. Long legal prohibition (until 1971) and church condemnation means disclosure may be slow, and clients may test you. Wielzen records a taboo on speaking about Winti, including keeping children away from it so they would not mention it at school [source: https://raadvankerken.nl/files/2024/07/Kerken-en-doorwerking-slavernijverleden-Duncan-Wielzen.pdf]. In practice, ask more than once and in a normalising way.
  • Expect pluralism and conflict within families. Many Afro-Surinamese Christians reject Winti as idolatry, and Pentecostal groups reject it entirely. Others combine church and Winti elements [source: https://raadvankerken.nl/files/2024/07/Kerken-en-doorwerking-slavernijverleden-Duncan-Wielzen.pdf] [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf]. Never assume a Surinamese client practises Winti.
  • Normative is not pathological; distress is not automatically normative. DSM-5-TR excludes trance or possession that is a normal part of broadly accepted cultural or religious practice. Possession experiences that are involuntary, unwanted and impairing can still be a disorder [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299].
  • The CFI informs, it does not decide. It supports understanding and is not meant to be the only basis for a diagnosis [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
  • Respect the client's choice about parallel care. In one Dutch case report, the clinician respected the patient's attribution to sorcery (Curaçaoan brua), explained treatment in his terms and supported faith healing alongside it. The patient's functioning recovered without him accepting the psychosis label [source: https://www.tijdschriftvoorpsychiatrie.nl/media/3/articles_1434pdf.pdf]. In practice, aim for agreement on the plan, not on the label.
  • Matching and brokerage matter. In a Dutch outpatient study, nearly 70% of Surinamese respondents wanted an ethnically matched clinician [source: https://www.tijdschriftvoorpsychiatrie.nl/media/3/articles_1427pdf.pdf]. A review of Giel's book highlighted Surinamese professionals as interpreters for, and trainers of, Dutch clinicians [source: https://www.dbnl.org/tekst/_vri013boek05_01/_vri013boek05_01_0067.php]. In practice, offer the choice, and consult when you are unsure.
  • Consent governs every contact. Speak to a healer, pastor or relative only with explicit, specific consent from the client [synthesis].
  • Safeguarding overrides cultural deference. Fraud and exorbitant fees by some healers have been reported [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf]. Coercion, restraint, abuse or delay of urgent care trigger your usual duties whatever their framing [synthesis].
  • Never advise on herbs, baths or medicines. Note what the client uses and route any question to the prescriber [synthesis].
  • Do not seek out ceremonies. Do not attend or recommend Winti gatherings yourself, and do not reproduce their contents. Participation is for the community to offer through its own channels [synthesis].

4. Intervention inventory

All interventions below are the psychotherapist's own. None is a Winti practice. Instruments are described, not reproduced. The core CFI may be reproduced by clinicians for use with their patients, but changing or translating it needs APA permission [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].

4.1 Cultural humility and self-examination

  • Purpose: to reduce the risk that your assumptions, or the colonial and church framing of Winti as idolatry, shape assessment. Use before the first session and whenever you feel certainty, discomfort or fascination [synthesis].
  • Steps:
    1. Write down what you think Winti is and where the idea came from (media, church, training).
    2. Learn the documented history: secrecy under slavery, legal prohibition until 1971, church contribution to the idolatry label [source: https://raadvankerken.nl/files/2024/07/Kerken-en-doorwerking-slavernijverleden-Duncan-Wielzen.pdf].
    3. Note your institution's position. Dutch services have long been unsure whether to read behaviour as winti or illness [source: https://www.dbnl.org/tekst/_vri013boek05_01/_vri013boek05_01_0067.php].
    4. Identify a consultation route: a Surinamese colleague, a transcultural psychiatry service, or a cultural broker.
    5. Revisit your assumptions in supervision after each formulation [synthesis].
  • Example language (illustrative, to yourself or in supervision): "Am I hearing this as religion, as symptom, or as exotic? What would a Surinamese colleague notice that I am missing?"
  • Watch for: fascination that turns the client into a teaching case; reflexive pathologising; the reverse, over-deference that ignores risk. It is working when your notes record the client's terms and your formulation names more than one possible reading.

4.2 Opening the topic and naming

  • Purpose: to make it safe to mention Winti, kulturu or spiritual explanations, given historical secrecy and stigma. Use in the first session and again later [synthesis].
  • Steps:
    1. Normalise: say that many people use several kinds of help and have their own explanations.
    2. Ask open questions about the client's own words for the problem and its cause, without offering "Winti" yourself unless the client has.
    3. If the client raises it, ask which word they prefer (winti, kulturu, or another) [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf].
    4. State plainly that you will not judge or ridicule, and that you are not a Winti practitioner.
    5. Record the client's term verbatim.
  • Example language (illustrative): "Some people I see explain what is happening through their faith, their family's traditions, or spiritual causes, as well as or instead of medical ones. Is there an explanation like that in your family?" / "You used the word kulturu. Can you tell me what it means for you? I will use your word if that is all right."
  • Watch for: sudden silence or a glance at a relative may signal family disagreement or fear. Do not press; return to it later. Signs it is working: the client corrects you, adds detail, or mentions help they had not disclosed.

4.3 Core Cultural Formulation Interview

  • Purpose: to understand the problem from the client's and their network's perspective, including meaning, sources of help and expectations. The APA intends it for any clinician in any setting [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]. Use it at intake, and again when diagnosis is unclear or care is stalled.
  • Steps: work through the four APA domains in your own words, following the official form [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
    1. Cultural definition of the problem: what the client calls it, and how family or community describe it.
    2. Cultural perceptions of cause, context and support: causes the client and others hold (e.g. a winti, wisi, family conflict, stress, illness), stressors and supports, and the role of cultural identity, including Surinamese, Creole, Maroon, Dutch, Christian and Winti identities.
    3. Self-coping and past help seeking: what the client has done, whom they consulted (GP, pastor, bonuman or lukuman, family elders), and barriers such as cost, shame or fear of judgement.
    4. Current help seeking: what help they want now, and concerns about the relationship with you, including experiences of racism or language barriers.
  • Example language (illustrative): "What do the people closest to you think is going on?" / "Have you seen anyone outside the health service about this, such as a pastor, a healer or an elder? Whatever you tell me will help me fit my part in alongside it." / "Is there anything about me, or about this service, that makes it harder to talk?"
  • Watch for: answers given "for the doctor", which are biomedical answers that hide a parallel spiritual account. Van Wetering describes a split between illnesses taken to the doctor and those taken to a bonuman [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf]. Signs it is working: you can write the client's explanatory model in a paragraph they would recognise. The field trial found the CFI feasible, acceptable and useful [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/].

4.4 CFI Informant Version with a relative

  • Purpose: to gather the family's view. Explanations and decisions about help are often family-based in this population [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf]. Use it when the client consents and a relative is involved, or when the client cannot give a history.
  • Steps:
    1. Get the client's consent: who, what may be shared, what must not.
    2. Give the Informant Version. It starts with the informant's relationship to the client, then covers the same four domains [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf].
    3. Note where the family's explanation differs from the client's (e.g. a Christian parent calling it idolatry, or a relative who has already arranged a healer).
    4. Feed the differences back to the client privately.
  • Example language (illustrative): "Your daughter has agreed I can ask you some questions. I would like to understand how you see what is happening to her, and what your family has tried."
  • Watch for: a relative speaking for the client; pressure towards a particular healer or church. These are signals to see the client alone.

4.5 Explanatory model (Explanatory Model module; Kleinman's questions)

  • Purpose: to map in detail what the client thinks the problem is, its cause, its course and the treatment they expect. Use it when the client attributes the problem to a winti, wisi, ancestors or a disturbed relation with dyodyo, or when adherence is poor.
  • Steps:
    1. Use the CFI Explanatory Model supplementary module [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf], or Kleinman's eight areas in your own words: name, cause, why now, how it works, severity and course, what treatment, chief problems caused, and what is most feared [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].
    2. Ask what help the client expects from each source (doctor, therapist, church, bonuman).
    3. Summarise the model back to the client and check it.
    4. Write it into the formulation as attributed.
  • Example language (illustrative): "What do you fear most about this?" / "If this is, as you say, something spiritual, what kind of help do you think it needs, and what part could talking with me play?"
  • Watch for: fear of being labelled "crazy" if they disclose spirit causation. Fears about wisi from relatives can signal real family conflict, which is also a therapy target [synthesis]. Signs it is working: the client links their model to concrete goals you can share.

4.6 Spirituality, Religion and Moral Traditions module

  • Purpose: to explore religious identity, practice and conflicts. This includes the documented tension between Christian denominations and Winti, and people who combine both [source: https://raadvankerken.nl/files/2024/07/Kerken-en-doorwerking-slavernijverleden-Duncan-Wielzen.pdf]. Use it when religion appears in the explanatory model or in family conflict.
  • Steps:
    1. Use the APA module [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
    2. Ask about every affiliation (church, Winti, both, none) and how they fit together.
    3. Ask about religious supports and religious stress, such as guilt, condemnation or fear of spiritual consequences.
    4. Ask what the client's faith says about seeking mental-health care.
  • Example language (illustrative): "Some people I work with go to church and also keep Winti or ancestor practices from their family. Others see these as in conflict. How is it for you?"
  • Watch for: guilt or shame about Winti involvement, or condemnation from a congregation, as stressors in their own right [synthesis]. Signs it is working: the client can talk about both sides without defending either to you.

4.7 Cultural identity, migration and historical context (Cultural Identity; Immigrants and Refugees modules)

  • Purpose: to place the client's experience in migration between Suriname and the Netherlands, colonial history and racism. Use it with migrants and with second and later generations.
  • Steps:
    1. Use the relevant APA modules [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
    2. Ask about language: Dutch, Sranan Tongo or a Maroon language. Speaking Sranan Tongo was historically suppressed in favour of Dutch [source: https://en.wikipedia.org/wiki/Winti] [uncertain: Wikipedia only].
    3. Ask about experiences of discrimination in services.
    4. Ask whether the family history of slavery and suppression is talked about.
  • Example language (illustrative): "Which language do you think and feel in when this happens?" / "Some people tell me that what happened to their ancestors, and the way Winti was banned, still affects their family. Is that true for you?"
  • Watch for: reluctance to criticise Dutch services to a Dutch clinician. Van Wetering reports that Winti healers filled gaps such as bereavement support and help for people who felt failed by migration [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf]. Ask whether those gaps exist for your client.

4.8 Asking about consultation with Winti healers and other help (Coping and Help-Seeking module)

  • Purpose: to know all the care the client receives, without judgement, so you can coordinate and spot risks. Use it at intake and at each review. About 10% of migrant outpatients in one Dutch study had consulted a bonuman, lukuman, fqih or imam before mental-health care [source: https://www.tijdschriftvoorpsychiatrie.nl/media/3/articles_1427pdf.pdf].
  • Steps:
    1. Ask about past and current help: GP, psychiatry, church, bonuman or lukuman, family elders, internet [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
    2. Ask what each source said the problem was, and what it recommended in general terms. Do not ask for ritual details.
    3. Ask whether any bath, herbs or remedy is being used, only so you can pass it to the prescriber. Never advise on it.
    4. Ask about costs and whether payment feels fair. Some healers negotiate fees, and fraud and exorbitant fees have been reported [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf].
    5. Ask whether the client wants you to take any of this into account, and how.
  • Example language (illustrative): "I do not need to know the details of what the healer does. That belongs to them and to you. I would like to know roughly what they have advised, so my part does not clash with theirs."
  • Watch for: debt or financial pressure; advice to stop prescribed medication; delay of urgent care. Each of these is a safeguarding or liaison issue. Signs it is working: the client tells you about the next consultation before it happens.

4.9 Differential assessment: culturally normative possession and spirit experience versus disorder

  • Purpose: to avoid two errors. One is treating possession at a Winti gathering, or a spirit-related explanation, as psychosis. The other is missing psychosis, mood disorder, a dissociative disorder or a medical cause because "it is cultural". Use it whenever possession, spirit contact or wisi is reported.
  • Steps:
    1. Establish context. Did the experience happen within a broadly accepted collective practice, such as a Winti Prey, which is a setting where possession is expected [source: https://sacredart.caaar.duke.edu/religions/surinamese-and-dutch-winti/]? Or did it happen spontaneously and outside any such practice?
    2. Apply the published criteria. Under DSM-5-TR, possession-form identity disruption counts towards DID only when it is not a normal part of broadly accepted cultural or religious practice. The same applies to dissociative trance under other specified dissociative disorder [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]. Whether DSM-5-TR keeps the exact DSM-5 wording is [uncertain]. ICD-11 6B63 possession trance disorder requires the state to be involuntary and unwanted, with significant distress or impairment. 6B62 trance disorder covers trance without an alternate identity [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://www.findacode.com/icd-11/code-1807490186.html].
    3. Ask how the client's own community views this episode. Is it seen as expected and meaningful, or as something gone wrong? Van Wetering notes that some healers distinguish begeestering (inspiration) from bezetenheid (possession) [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf]. Ask which the client means.
    4. Screen across the usual range: psychotic symptoms outside the religious frame, mood, trauma, substance use, sleep, and medical and neurological causes. Refer for medical work-up where indicated.
    5. Consult a cultural broker or transcultural psychiatrist before settling a contested diagnosis (see 4.10).
    6. Record both readings and your reasoning.
  • Example language (illustrative): "When this happened, was it during a gathering where this is expected, or did it come on by itself?" / "Do people in your family or community see what happened to you as normal for someone in your position, or as a sign that something is wrong?" / "Apart from these experiences, have you noticed changes in your sleep, your thoughts, or how others see you?"
  • Watch for: spirit explanations offered by a family that hide abuse, conflict or illness; and a clinician's discomfort with the unfamiliar. In a Dutch case report of a Hindustani patient, a schizophrenia diagnosis was revised once a cultural formulation showed that the spirit experiences were culturally normal. This is a different tradition, and the analogy is [synthesis] [source: https://www.tijdschriftvoorpsychiatrie.nl/media/3/articles_1433pdf.pdf]. Whether DSM-5-TR's note on culturally sanctioned beliefs and psychosis applies is [uncertain: not verified]. Signs it is working: the diagnosis holds up after cultural consultation, and the client feels understood rather than judged.

4.10 Consulting cultural brokers, Surinamese colleagues and transcultural psychiatry

  • Purpose: to get informed outside perspective on what is normative and on how to approach the family. Use it when you are uncertain, when there is a diagnostic stalemate, or before contacting a healer.
  • Steps:
    1. With the client's consent, or in anonymised form, describe the situation to a Surinamese mental-health colleague or a transcultural consultation service.
    2. Ask specifically: is this expected within the client's group? What would a community member see as a warning sign? How should you raise it with the family?
    3. Do not treat any one consultant as speaking for all Surinamese people. Views differ widely between Winti practitioners, Christians and secular people [source: https://raadvankerken.nl/files/2024/07/Kerken-en-doorwerking-slavernijverleden-Duncan-Wielzen.pdf].
    4. Write the advice into the formulation as attributed.
  • Example language (illustrative, to the client): "I would like to talk your situation through with a colleague who knows Surinamese culture well, without your name unless you agree. Is that all right?"
  • Watch for: confidentiality in small communities, since the consultant may know the family. Ask the client first. Gokoel recommends consulting a transcultural psychiatrist when a diagnostic deadlock threatens [source: https://www.tijdschriftvoorpsychiatrie.nl/media/3/articles_1433pdf.pdf]. Reviewers of Giel's work stressed Surinamese professionals as interpreters for Dutch clinicians [source: https://www.dbnl.org/tekst/_vri013boek05_01/_vri013boek05_01_0067.php].

4.11 Shared formulation and explaining care in the client's terms

  • Purpose: to agree a plan the client can accept without giving up their explanation. Use it at the end of assessment and when adherence falters.
  • Steps:
    1. Present the client's explanation first, in their words.
    2. Present the clinical view as an additional lens, not a correction.
    3. Find shared targets, such as sleep, fear, conflict, functioning or grief.
    4. Explain how each part of care (therapy, medication if prescribed, the client's own spiritual help) addresses those targets.
    5. Agree what the client will do if things worsen.
  • Example language (illustrative): "You see this as connected to your winti and your family. I see signs of exhaustion and strong anxiety. We may not see the cause the same way, but we both want you sleeping and back at work. Can we work on that together, alongside the help you get elsewhere?"
  • Watch for: apparent agreement that hides covert non-use of treatment. In the Curaçao-origin case report, medication was explained as protection against the "bad energy" the patient described. Use was sporadic until the patient chose to use it regularly, and he never accepted the label [source: https://www.tijdschriftvoorpsychiatrie.nl/media/3/articles_1434pdf.pdf]. Prescribing decisions sit with the prescriber. Signs it is working: the client names the plan in their own words and returns.

4.12 Collaboration with a Winti practitioner or religious leader the client recognises

  • Purpose: to coordinate when the client wishes it, so that parallel care does not conflict and risks are shared. Use it only at the client's request or with their explicit agreement. It does not apply where the client prefers to keep the two separate.
  • Steps:
    1. Confirm the client wants contact, with whom, and what may be shared. Get written consent where your service requires it.
    2. Let the client say how this practitioner is recognised in their community. In van Wetering's account, legitimacy traditionally came through kin, village and public installation, and healers who seek publicity may lose standing [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf]. Do not verify spiritual credentials yourself.
    3. Propose a narrow agenda: shared safety concerns, timing, medication continuity, and how each side can reach the other.
    4. Agree roles. You do not take part in or advise on ritual, and the practitioner is not asked to change their practice.
    5. Document what was agreed and review it with the client.
  • Example language (illustrative, to the practitioner): "Thank you for speaking with me. [Client] asked me to make contact so that what you do and what we do support each other. My concern is that they keep taking the medication their doctor prescribed and stay safe. Is there anything you would want me to know?"
  • Watch for: pressure to choose sides; any advice to stop medication or delay urgent care; financial exploitation. Evidence for collaboration comes from West Africa, not from Winti. In Nigeria and Ghana, collaborative care between traditional and faith healers and primary-care staff for psychosis (COSIMPO; Gureje et al., The Lancet, 2020) reduced PANSS symptoms more than usual care, and harmful practices fell from 57% to 9% [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839]. In a Ghanaian prayer camp, adding psychiatric care reduced symptoms but did not significantly reduce days in chains (Ofori-Atta et al., Br J Psychiatry 212(1)) [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]. Collaboration does not by itself end harmful practice, so keep monitoring. Historically, some Dutch hospitals and services referred patients to certain healers. Amsterdam's Winti therapy centre Hakwatimba opened in 1984, and its planned evaluation never took place [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf]. Any current formal Dutch referral pathway is [uncertain: not verified].

4.13 Liaison with the prescriber about remedies and medication

  • Purpose: to make sure herbs, baths or other remedies the client uses are known to the prescriber. Use it whenever the client mentions them or is on medication.
  • Steps:
    1. Note in general terms what the client reports (e.g. "herbal baths", "a remedy from a healer").
    2. Encourage the client to tell the prescriber and GP, and offer to pass it on with consent.
    3. Never comment on whether to start, stop or change any medicine or remedy.
  • Example language (illustrative): "I am not the right person to advise on that. Could we let your doctor know you are using it, so they have the whole picture?"
  • Watch for: the client stopping medication in favour of spiritual treatment without telling anyone. In the Curaçaoan case, tactile hallucinations returned when medication stopped [source: https://www.tijdschriftvoorpsychiatrie.nl/media/3/articles_1434pdf.pdf].

4.14 Integrating ritual, possession or healing experiences in therapy

  • Purpose: to help the client make personal meaning of what they experienced, for example relief, catharsis, renewed family ties, confusion or fear. Do not interpret the spiritual content. Use it after the client has taken part in Winti healing or a gathering and wants to talk about it.
  • Steps [synthesis]:
    1. Invite the client to describe what it meant to them, in as much or as little detail as they choose. Do not ask for ritual specifics.
    2. Reflect emotions and changes the client names. Van Wetering describes catharsis and emotional relief as part of Winti therapy [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf].
    3. Link the changes the client values to therapy goals, such as reconnecting with family, grief or self-worth.
    4. If the experience was frightening or destabilising, assess for trauma symptoms, dissociation or psychosis (4.9) and offer grounding and stabilisation.
    5. Leave questions about the spiritual meaning to the client and their practitioner.
  • Example language (illustrative): "You do not have to tell me what happened there. What has changed for you since?" / "It sounds as if that brought your family together in a way you had missed. How can we build on that here?"
  • Watch for: feeling pressed to explain or validate a spiritual event. Stay with the personal meaning. Signs it is working: the client integrates the experience into their story with less shame or fear.

4.15 Working with families

  • Purpose: to address family conflict that may be expressed through spiritual idioms, and disagreement within families about Winti and the church. Use it when relatives are involved, when wisi is suspected between relatives, or with children.
  • Steps:
    1. Map family members' positions on the problem and on Winti, the church and services (4.4, 4.6).
    2. Look for interpersonal conflict behind an attribution. Van Wetering records fyo-fyo, a childhood disorder that the tradition links to unspoken conflict between parents [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf]. A Dutch case report linked a sorcery attribution to an inheritance dispute among relatives [source: https://www.tijdschriftvoorpsychiatrie.nl/media/3/articles_1434pdf.pdf].
    3. Name conflicts in everyday terms the family can accept, without contradicting their spiritual reading.
    4. Use standard family or systemic methods for the conflict itself.
  • Example language (illustrative): "Whatever the spiritual side, it sounds as though there is real tension between the two of you that no one has said out loud. Could we talk about that here?"
  • Watch for: blame and scapegoating of one member, especially a child. Escalate to safeguarding if accusations lead to exclusion or harm (4.18).

4.16 Addressing suppression, stigma, racism and intergenerational effects

  • Purpose: to acknowledge the legacy of slavery, prohibition and church condemnation, and of racism in Dutch services, which may shape distress, trust and disclosure. Use it when the client raises history or identity, or when mistrust stalls therapy.
  • Steps:
    1. Acknowledge the history plainly when the client raises it: Winti was criminalised until 1971 and labelled idolatry, with churches contributing [source: https://raadvankerken.nl/files/2024/07/Kerken-en-doorwerking-slavernijverleden-Duncan-Wielzen.pdf].
    2. Explore how it lives in the family: secrecy, shame, divided loyalties. Wielzen writes that the slavery legacy still works through in Dutch churches, and that more systematic research is needed [source: https://raadvankerken.nl/files/2024/07/Kerken-en-doorwerking-slavernijverleden-Duncan-Wielzen.pdf].
    3. Invite feedback on your own and your service's conduct (CFI domain 4).
    4. Support connection with community-led heritage and commemoration if the client wishes, such as public education by Winti priestesses or the Winti Renaissance project [source: https://fkawdw.nl/en/participants/marian_markelo] [source: https://sacredart.caaar.duke.edu/religions/surinamese-and-dutch-winti/].
  • Example language (illustrative): "For a long time, what your grandparents practised was against the law and called idolatry, including by churches. I can see why it would be hard to talk about here, in a Dutch institution. If I get something wrong, I would like you to tell me."
  • Watch for: making history the whole story when the client wants help with something current. Follow the client's lead.

4.17 Language and interpreters

  • Purpose: to make sure the client can express experience in the language closest to it. Use it with clients more fluent in Sranan Tongo or a Maroon language, and with older relatives.
  • Steps:
    1. Ask about language preference (4.7).
    2. Use a professional interpreter, not family, for assessment. Check that the interpreter is comfortable with religious content and will translate without commentary.
    3. Check that key terms (winti, wisi, kra, bonuman) are kept as spoken, not "translated" into psychiatric words.
  • Example language (illustrative): "Please use whatever words come naturally. If there is a word I do not know, I will ask you to explain it."
  • Watch for: interpreters known to the family or community, which raises confidentiality concerns; interpreters' own religious views colouring the translation [synthesis].

4.18 Safeguarding

  • Purpose: to protect the client and others where any practice or arrangement causes harm, whatever its framing. Use it whenever there is restraint, beating, starvation, sexual contact, coercion, child accusations, financial exploitation, or delay of urgent medical or psychiatric care.
  • Steps:
    1. Ask directly and neutrally about safety in every form of care the client receives.
    2. Distinguish harm from practice. The tradition itself is not the concern. Specific acts are.
    3. For financial exploitation, help the client review costs and pressure. Fraud and exorbitant fees by some healers are documented [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf].
    4. For children, or adults at risk, follow your local safeguarding procedure (in the Netherlands, the Meldcode and Veilig Thuis [uncertain: not verified]). Never name or identify minors outside the record.
    5. Document and consult a supervisor. Inform the client unless doing so would increase risk.
  • Example language (illustrative): "I ask everyone this about every kind of help they get: has anyone, in any setting, hurt you, held you down, or pressured you for money or anything else?"
  • Watch for: your own reluctance to act for fear of seeming culturally insensitive. Safety comes first. Also watch for over-reaction that treats ordinary religious practice as abuse.

5. Handling problems

The published sources address few of these problems directly. Unless a source is cited, the guidance is [synthesis].

  • Client will not discuss spiritual explanations (secrecy, testing the clinician).
    • Why it happens: prohibition and taboo are documented [source: https://raadvankerken.nl/files/2024/07/Kerken-en-doorwerking-slavernijverleden-Duncan-Wielzen.pdf].
    • Response: do not push. Say once that such explanations are welcome and that you are not a Winti practitioner. Revisit at review. Offer an ethnically matched clinician if available [source: https://www.tijdschriftvoorpsychiatrie.nl/media/3/articles_1427pdf.pdf].
    • Illustrative language: "If there is another side to this that you would rather not tell me yet, that is fine. The door stays open."
  • Stuck on the diagnostic label. The client rejects "psychosis" or "depression" as an insult or as denial of the spiritual cause.
    • Response: work on agreed targets rather than labels (4.11). In the case report, recovery of functioning happened without acceptance of the label [source: https://www.tijdschriftvoorpsychiatrie.nl/media/3/articles_1434pdf.pdf].
  • Diagnostic deadlock within the team, for example "it's cultural" against "it's schizophrenia".
    • Response: run a full CFI with informant input, apply the context criteria in 4.9, and request transcultural consultation [source: https://www.tijdschriftvoorpsychiatrie.nl/media/3/articles_1433pdf.pdf].
  • Non-adherence because the client prefers spiritual treatment.
    • Response: explore the explanatory model again (4.5) and reframe care in shared terms. Liaise with the prescriber (4.13) and, if the client wishes, with the practitioner (4.12). Never argue the spiritual point.
  • Rupture after a perceived dismissal (e.g. a colleague called Winti superstition, or a note recorded a "bizarre belief").
    • Response: name the rupture, apologise for the service's part, and invite the client's view of what was hurtful. Correct the record to attributed language with the client.
    • Illustrative language: "I think the way this was written made it sound as though your faith was a symptom. That was wrong, and I am sorry. Can we write it together in your words?"
  • Family pressure to see a particular healer, or to renounce Winti for the church.
    • Response: see the client alone. Clarify what the client wants, and support their autonomy within family loyalties (4.15). Watch for coercion (4.18).
  • Overwhelm or destabilisation after a ritual or a possession experience.
    • Response: stabilise first with grounding, sleep and safety planning. Assess for psychosis, dissociative disorder and trauma (4.9). Integrate meaning later (4.14). Do not attribute the distress to the ritual itself.
  • Fear of wisi from a relative or ex-partner, with hypervigilance and insomnia.
    • Response: treat the fear and sleep problems with standard methods. Explore the real relationship conflict. Assess whether there are concrete threats or abuse, which would raise a safety issue whatever the spiritual framing.
  • Financial exploitation or a healer advising against medical care.
    • Response: follow 4.18. Help the client weigh costs. Inform the prescriber about any advice to stop medication. Fraud and exorbitant fees are documented [source: https://meertenspublicaties.meertens.knaw.nl/pdf/vb/181_VB_1991_17.2.pdf].
  • Asked to attend, endorse or recommend a ceremony or healer.
    • Response: decline politely and explain your role. Recommending or vetting healers falls outside it; the client's own community does that.
    • Illustrative language: "It means a lot that you would invite me. That belongs to you and your community. My part is here, and I will support whatever you decide."
  • Clinician over-identification or exoticising.
    • Response: take it to supervision (4.1). Keep the focus on the client's goals.
  • Distrust of the clinician because of colonial history or racism.
    • Response: acknowledge the history (4.16), invite feedback, offer a choice of clinician, and be consistent and transparent.
  • Children presented as spiritually afflicted, with exclusion, punishment or withheld care.
    • Response: assess the child's safety and follow safeguarding procedure. Work with the parents on the conflict behind the attribution (4.15). Never identify the child outside the record.

Sources

Web sources:

Books and articles cited (details as given in the web sources above):

  • Wooding, Ch.J. (1972). Winti: een Afroamerikaanse godsdienst in Suriname. Meppel: Krips. De Jong (1986) cites it as a 1979 dissertation, so the year is [uncertain].
  • Wooding, Ch.J. (1984). Geesten genezen. Ethnopsychiatrie als nieuwe richting binnen de Nederlandse antropologie. Groningen: Konstapel.
  • Stephen, H.J.M. (1983). Winti, Afro-Surinaamse religie en magische rituelen in Suriname en Nederland. Amsterdam: Karnak.
  • Stephen, H.J.M. (1990). Winti en psychiatrie (cited by Jessurun & Raes 2005; further details [uncertain]).
  • Kleinman, A., Eisenberg, L. & Good, B. (1978). Culture, illness, and care. Annals of Internal Medicine 88:251–258.
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