Palo (Reglas de Congo)

1. Introduction

Version followed: Palo as described in academic ethnography and Cuban ethnographic reference work (Ochoa 2010, Havana; Kerestetzi 2013; Castro Ramírez 2016, Cali; Joel James, Santiago de Cuba; the Cuban Atlas Etnográfico glossary), set beside the psychotherapist's own culturally responsive work as structured by the DSM-5-TR Cultural Formulation Interview (APA forms) and Kleinman's explanatory-model questions. Palo has no central authority, sacred text or codified doctrine: the ethnographies cited describe autonomous houses and branches whose boundaries practitioners themselves often blur, so there is no single official version of the tradition. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] [synthesis]

What it is. Palo, also called Reglas de Congo, Regla de Palo or Regla Conga, is an Afro-Cuban initiatory religion that took shape in Cuba from Kongo (Bantu-speaking Central African) religious culture brought by enslaved Africans, with Catholic and Spiritist elements. The Cuban ethnographic glossary describes it as venerating the forces of nature gathered in a vessel called the nganga, with a ritual language that mixes Bantu languages and colonial-era Spanish. [source: https://atlasetnografico.cult.cu/en/glosario/P.html] Its main branches (ramas) are usually given as Mayombe, Briyumba (also spelled Vriyumba) and Kimbisa; in the Cali study practitioners often blur these lines ("es simplemente palo monte"), and Mayombe and Briyumba are increasingly merged there. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] West-Durán describes Briyumba as mixing Mayombe, regarded as the "purest" form, with elements of Ocha. [source: https://www.mdpi.com/2077-1444/12/3/172] Practitioners often call themselves paleros/paleras or ngangulero/a; some reclaim the label brujo with pride, in reaction to a long history in which Cuba's Catholic, Euro-Cuban establishment branded Palo as brujería (witchcraft). [source: https://en.wikipedia.org/wiki/Palo_(religion)] [uncertain: secondary, unverified] The vessel is also widely called a prenda [uncertain: not verified].

Who holds authority. Practice is organised in autonomous houses (casa templo), each forming a religious family: godparent (padrino/madrina) and godchild ties create kinship beyond biology, and initiates become "hermanos de religión". [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] A house is led by a tata nganga ("father") or yayi nganga ("mother"), who holds their own nganga and ritual knowledge and initiates others; senior initiates and new initiates (ngueyos) hold lesser roles. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] [source: https://www.mdpi.com/2077-1444/12/3/172] The Kongo name munanso congo for a house, and the custom that when a leader dies a successor is named or members move to another house, come from a tertiary overview. [source: https://en.wikipedia.org/wiki/Palo_(religion)] [uncertain: secondary, unverified] In the Colombian house studied by Castro Ramírez, authority rests on knowledge, seniority, gender and nationality, and teaching passes from godparent to godchild through practice and close observation. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] Joel James, then director of the Casa del Caribe in Santiago de Cuba, wrote that Palo forms religious families "menos sólidas que la santería" (less solid than those of Santería). [source: https://revistas.inah.gob.mx/index.php/cuicuilco/article/download/19779/21173/42291] There is no regulator, licensing body or community council for Palo; legitimacy comes from one's house and lineage. A psychotherapist does not and cannot practise Palo; only a person initiated and recognised within a house does.

Core ideas, as practitioners hold them and scholars describe them. At the centre are the dead. The nfumbe (also spelled nfumbi) is the spirit of a dead person. Practitioners describe a pact or alliance with a dead person, housed in the nganga, which the scholarly sources describe as the spirit's embodiment. [source: https://doaj.org/article/425d92108bd647fd97bafee7925f2410] [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] Kerestetzi reports that daily contact with the nganga produces closeness and affection that practitioners call "love", which she calls "a keystone of Palo Monte"; some practitioners spend much of their time with the dead, sometimes at the expense of relationships with the living. [source: https://doaj.org/article/425d92108bd647fd97bafee7925f2410] James describes the relationship between practitioner and the dead as "un trato entre iguales" (a deal between equals) involving mutual vigilance. [source: https://revistas.inah.gob.mx/index.php/cuicuilco/article/download/19779/21173/42291] Ochoa's publisher calls Palo a Kongo-inspired "society of affliction". [source: https://www.ucpress.edu/flyer/books/society-of-the-dead/paper]

How change happens, in the tradition's terms. Dianteill describes Palo as centred on the relation between an initiate and the spirit of one or more dead people, and notes that paleros also cast spells against enemies. [source: https://www.encyclopedia.com/religion/legal-and-political-magazines/afro-cuban-religions] A tertiary overview adds that people bring problems of health, love, money, property or fear of bewitchment, that many are told their misfortune comes from a poor relationship with the dead, and that some then seek initiation. [source: https://en.wikipedia.org/wiki/Palo_(religion)] [uncertain: secondary, unverified] In the Cali study, entry into Palo is tied to health, prosperity and protection, including protection against harmful "trabajos" (works) believed to be sent by others; some people come only to resolve an immediate problem. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] These are the tradition's own accounts of causation and remedy. This guide states them as practitioners hold them, neither as fact nor as error.

How change happens in the psychotherapist's work. The therapist's job is to understand the client's distress through the client's own explanatory model, to tell apart culturally normative experience from mental disorder without either pathologising or missing illness, to support the client's chosen sources of help (which may include their house), and to keep the client safe. [synthesis] The Cultural Formulation Interview exists to clarify the problem from the perspective of the person and their social network: what it means, possible sources of help, and what they expect from services. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]

Whose accounts these are. Almost everything published about Palo in English and Spanish is scholarly ethnography rather than material issued by houses themselves; the authors work with, and sometimes within, particular houses, and their accounts are local. Ochoa's book is a first-person account built around two Palo teachers on the outskirts of Havana. [source: https://www.ucpress.edu/flyer/books/society-of-the-dead/paper] Lydia Cabrera's Reglas de Congo: Palo Monte Mayombe is a classic Cuban ethnography, translated with commentary in Fhunsu's 2017 dissertation [source: https://cdr.lib.unc.edu/record/uuid:46c300bb-6559-4903-b6b0-bc6d88b8b225]; Britannica dates it to 1986 [source: https://www.britannica.com/biography/Lydia-Cabrera]; its publisher is [uncertain: secondary, unverified]. Initiation and much of the tradition's knowledge are deliberately secret: Dianteill calls Palo more secretive and private than Santería, in Cuba and in the United States [source: https://www.encyclopedia.com/religion/legal-and-political-magazines/afro-cuban-religions], and in the Cali study the tata sets a secret signature (firma) on each new nganga. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] This guide gives no ritual, vessel, initiation, divination, song or prayer content.

2. Framework

Palo is a religion, not a therapy. It has no phases or session structure that a psychotherapist could follow. The framework below is the psychotherapist's own work with a client who practises Palo, consults a palero, comes from a Palo family, or fears that Palo has been used against them. Session counts are [synthesis]; no source sets them.

How the tradition is organised (context, not a protocol). Palo has a strong presence in eastern Cuba but is found across the island. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] After the 1959 Revolution some believers settled in the United States, especially in Florida and around New York, and kept practising [source: https://www.encyclopedia.com/religion/legal-and-political-magazines/afro-cuban-religions]; spread to Venezuela and Mexico is reported in a tertiary overview. [source: https://en.wikipedia.org/wiki/Palo_(religion)] [uncertain: secondary, unverified] It is also practised in Colombia (Cali), where an entry route was often Espiritismo Cruzado. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] Many people practise Palo alongside Santería (Regla de Ocha), Catholicism or Spiritism: Dianteill notes that the Afro-Cuban traditions are not exclusive and that practitioners in Cuba still consider themselves Catholics [source: https://www.encyclopedia.com/religion/legal-and-political-magazines/afro-cuban-religions], and West-Durán describes Palo as combining Kongo beliefs, Regla de Ocha, Spiritism and Catholicism. [source: https://www.mdpi.com/2077-1444/12/3/172] That Abakuá is also combined and that practitioners keep the rites separate comes from a tertiary overview. [source: https://en.wikipedia.org/wiki/Palo_(religion)] [uncertain: secondary, unverified] Within houses, roles run from new initiates (ngueyos) to senior initiates and the house leader (tata or yayi). [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] Clients may therefore be: visitors who consulted a palero once; initiates at various levels; house leaders; relatives of practitioners; or people who fear harm sent through Palo by someone else.

Phase 1: Engagement and cultural assessment (about sessions 1–3).

Goals: a safe, non-judgemental frame in which religious life can be mentioned; the core CFI; a first account of the client's explanatory model; risk screen; physical-health screen where relevant (see mercury, section 4).
Format: individual; with consent, a family member or other informant using the CFI Informant Version.
Time: the APA forms give no administration time. The DSM-5 field trial found later interviews "required less time" after the first, but no figure in minutes is reported there [uncertain: not verified]. [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]
Move on when: the client has described the problem in their own words, said what they think causes it and who they have consulted, and said what they want from you; urgent risk is managed.

Phase 2: Formulation and shared plan (about sessions 2–5).

Goals: a cultural formulation that holds the client's explanatory model and your clinical view side by side; a differential between normative religious experience and disorder; agreement on what you will and will not do; the client's wishes about contact with their house.
Format: individual; supplementary CFI modules as needed; consultation with a cultural broker if the client agrees.
Move on when: the client agrees with (or has corrected) your summary, the goals are in the client's terms, and any need for medical or psychiatric referral has been acted on.

Phase 3: Treatment alongside the tradition (length set by the presenting problem).

Goals: deliver the evidence-based treatment indicated for the presenting problem, adapted to the explanatory model; keep the client's religious help-seeking visible in the room; collaborate with the house only if the client asks and consents.
Format: individual, family or couple sessions; liaison as agreed.
Move on when: symptom and functioning goals in the client's terms are being met, or a re-formulation is needed (repeat the relevant CFI modules, which APA says can be used later in care or repeatedly).

Phase 4: Integration, review and ending.

Goals: help the client make sense of what changed through both their religious path and therapy; plan for relapse or new crises; check that the client knows how to return.
Move on (end) when: goals are met and the client has a plan for future distress that includes the help sources they value.

[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] [synthesis for phase boundaries and session counts]

3. Guiding principles

You work alongside Palo, never inside it. Practical meaning: do not interpret the dead, the nganga, divination results or ritual instructions; refer those questions back to the client's own house. [synthesis]
Authority sits in the house. Practical meaning: when a religious question arises, ask the client what their tata nganga or yayi nganga, or their godparent, would say, rather than offering your own view. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] [synthesis]
There is no single Palo. Practical meaning: branches, houses and countries differ, and in Cali practitioners blur the branches; ask the client about their own house and branch and do not generalise from reading. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf]
Secrecy is part of the religion. Practical meaning: never ask for initiation details, ritual content or what is in a vessel; a client's "I can't talk about that" is a religious boundary, not resistance. [source: https://www.encyclopedia.com/religion/legal-and-political-magazines/afro-cuban-religions] [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] [synthesis]
Attribute, do not adjudicate. Practical meaning: speak of the dead, sent harm (trabajos, daño) and protection as "what you understand" or "what your padrino told you", neither affirming nor disputing their reality. [synthesis]
Counter the brujería stigma in yourself and the service. Practical meaning: Palo has been branded as witchcraft by Cuban elites [source: https://en.wikipedia.org/wiki/Palo_(religion)] [uncertain: secondary, unverified] and, in Colombia, Afro-inspired practices are still often viewed through that lens [source: https://www.redalyc.org/pdf/1591/159149454007.pdf]; check your reactions and your colleagues' notes for that framing.
Use the CFI to support, not replace, diagnosis. Practical meaning: the CFI informs clinical understanding and decision-making and is not meant as the only basis for a diagnosis. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Neither pathologise nor miss illness. Practical meaning: mediumship, possession or contact with the dead within accepted practice is not in itself a symptom; but possession beliefs can also be a non-specific feature of mental illness, so assess the whole belief system and the person's functioning. [source: https://ps.psychiatryonline.org/doi/abs/10.1176/ps.39.11.1188] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]
The client chooses whether their house is involved. Practical meaning: no contact with a tata, yayi or godparent without explicit, specific, written consent; never seek out a house or practitioner for a client. [synthesis]
Multiple belonging is normal. Practical meaning: expect clients to combine Palo with Santería, Catholicism, Spiritism or other paths, and ask about each. [source: https://www.encyclopedia.com/religion/legal-and-political-magazines/afro-cuban-religions] [source: https://www.mdpi.com/2077-1444/12/3/172]
Physical safety counts. Practical meaning: some practices in Afro-Caribbean religions, including some Palo practitioners, use elemental mercury, which is neurotoxic; screen for exposure without assuming it. [source: https://ldh.la.gov/assets/oph/Center-EH/envepi/Mercury_for_Health_Providers_Hg_Final.pdf]
Medicines go to the prescriber. Practical meaning: never advise starting, stopping or changing medication, or combining it with remedies; route all such questions to the prescriber. [synthesis]
Know your duties. Practical meaning: confidentiality has legal limits (risk to self or others, child protection, and in some places certain criminal matters); explain them at the start. [synthesis]

4. Intervention inventory

All interventions below are the psychotherapist's own. None is a Palo practice. Example language is illustrative wording, not drawn from any manual or house.

4.1 Cultural humility and self-examination

Purpose / when: before and throughout work with any client connected to Palo, because the religion's public image in Cuba, Colombia and diaspora media is shaped by the brujería label [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] and by sensational crime reporting (see 4.18). [source: https://taskandpurpose.com/news/florida-veteran-grave-robbers-rituals/]
Steps: (1) Before the first session, write down what you associate with "Palo", "brujería" and human bones, and where those images came from (films, news, your own religious upbringing). (2) Note which of these come from outsiders' accounts. (3) Read at least one scholarly account written with practitioners (e.g. Ochoa 2010; Kerestetzi 2013) so that your picture includes affection, family and protection as practitioners describe them, not only fear. (4) In supervision, review one set of your notes for words such as "cult", "black magic" or "superstition" and replace them with the client's own terms. (5) Repeat when you notice strong reactions (fear, fascination, disgust). [synthesis]
Example language: (to yourself or a supervisor, illustrative) "Am I curious about this for the client's sake or for mine?"
Watch for: fascination that turns sessions into your education; fear or disgust that leaks into tone; assuming every Afro-Cuban client practises Palo. It is working when your notes use the client's words and the client speaks of their religion without checking your face. [synthesis]

4.2 Opening the door: asking about religion and help seeking without judgement

Purpose / when: at intake, because clients who have been stigmatised often do not mention Palo unless invited, and because many combine it with Catholicism, Santería or Spiritism. [source: https://www.encyclopedia.com/religion/legal-and-political-magazines/afro-cuban-religions] [source: https://www.mdpi.com/2077-1444/12/3/172]
Steps: (1) Ask a broad question about religious, spiritual or family traditions as part of routine history, not as a special topic. (2) Ask whom the client has already turned to for this problem, naming a wide range (doctor, priest, pastor, espiritista, santero, palero, family elder) so none sounds odd. (3) If Palo is mentioned, ask what it means in their life, using their terms. (4) State that you will not judge, will not ask for anything secret and will not contact anyone without permission. (5) Record the client's own words. [synthesis]
Example language: (illustrative) "Many people I see get help from more than one place: a doctor, a church, a santero, a palero, family. Who have you talked to about this so far?" / "You don't have to tell me anything that's private to your religion. I'm interested in how it helps you and what it means to you."
Watch for: guardedness, sudden vagueness, or a family member answering for the client. It is working when the client names their religious sources of help in the first sessions and later brings religious matters up unprompted. [synthesis]

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

Purpose / when: at initial assessment with any client for whom culture, religion or migration shapes the problem; APA describes it as designed for any clinician, any individual, any care setting. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] It has 16 questions in four domains. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Steps: (1) Download the APA form (it may be reproduced by clinicians for use with their patients; changing or translating it needs APA permission). (2) Introduce it as a way to understand the problem from the client's side. (3) Work through the four domains in order: cultural definition of the problem (Q1–3); cultural perceptions of cause, context and support (causes, stressors and supports, role of cultural identity; Q4–10); cultural factors affecting self-coping and past help seeking (Q11–13, including barriers); cultural factors affecting current help seeking (preferences and the clinician–patient relationship, e.g. perceived racism or language barriers; Q14–16). (4) Paraphrase; do not read items mechanically. (5) Where the client mentions the dead, a trabajo, their nganga or their house, note it under the relevant domain without probing ritual details. (6) Note which supplementary module expands each subtopic, as the form indicates. (7) Use the results to inform, not replace, diagnosis. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Example language: (illustrative) "Sometimes people describe their problem in their own way, or the way their family or community would. How would you describe it?" / "Has anything about who you are, your background or your religion made it harder or easier to get help?"
Watch for: answers framed in religious terms (e.g. "my dead are unhappy", "someone put a work on me") are data for the explanatory model, not symptoms by themselves. The Q16 domain is a chance to hear whether earlier services treated the client's religion with contempt. Time per interview is not given in the APA forms [uncertain]. It is working when the client corrects or adds to your summary. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] [synthesis]

4.4 CFI Informant Version (family, partner or other informant)

Purpose / when: when the client agrees that a relative or friend can add their view, for example where the family disagrees about Palo or the client cannot give a full history. It has 17 questions; Q1 covers the informant's relationship to the patient, then the same four domains follow. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
Steps: (1) Get the client's explicit consent, specifying who will be interviewed and what may be shared. (2) Choose the informant with the client. A godparent or house member is an informant only if the client asks for that; otherwise use a family member or friend. (3) Interview the informant, preferably separately. (4) Compare accounts and bring the differences back to the client respectfully. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf] [synthesis]
Example language: (illustrative) "Your sister sees this a bit differently from you. Would it help to talk about where your views are close and where they're not?"
Watch for: an informant using the interview to attack the client's religion, or a religious elder speaking for the client. It is working when the two accounts together make the problem clearer to both of you. [synthesis]

4.5 CFI Supplementary Modules

Purpose / when: add-ons to the core CFI or standalone tools for in-depth assessment, at first evaluation, later in care or repeatedly. There are 12: Explanatory Model; Level of Functioning; Social Network; Psychosocial Stressors; Spirituality, Religion and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Patient–Clinician Relationship; School-Age Children and Adolescents; Older Adults; Immigrants and Refugees; Caregivers. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
Steps: (1) Choose modules from what the core CFI raised. For Palo clients the most often useful are likely to be: Spirituality, Religion and Moral Traditions (role of Palo and other paths, conflicts between them); Social Network (the house as a religious family); Coping and Help-Seeking (consultations with paleros and others); Cultural Identity; Immigrants and Refugees (Cuban, Venezuelan, Colombian or other migration); Patient–Clinician Relationship. [synthesis] (2) Use School-Age Children and Adolescents, Older Adults or Caregivers where relevant. (3) Spread modules across sessions if needed. (4) Revisit modules when the situation changes, e.g. after an initiation, a split from a house, or a leader's death. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [synthesis]
Example language: (illustrative) "You said your religion is a big part of your life. Can we spend some time on what it gives you, and whether it has also brought any tensions?"
Watch for: turning the module into a quiz on the religion. It is working when the formulation includes concrete supports (people, practices, places) the client values. [synthesis]

4.6 Exploring the explanatory model (Kleinman)

Purpose / when: whenever the client attributes the problem to the dead, to a trabajo or daño, to a broken relationship with their nganga, or to something else in Palo's terms; also when client and clinician seem to be talking past each other. The questions derive from Kleinman, Eisenberg and Good (1978). [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]
Steps: Ask, in your own words and over one or more sessions: (1) what the client calls the problem; (2) what caused it; (3) why it began when it did; (4) what it does to them and how it works; (5) how severe it is and whether it will be short or long; (6) what treatment they think they should receive; (7) the chief problems it has caused; (8) what they fear most about it. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] Then (9) summarise the client's model alongside your own clinical understanding, and (10) negotiate a plan both can accept, e.g. the client continues to consult their house while also attending therapy for sleep and panic. [synthesis]
Example language: (illustrative) "What do you call what's happening to you?" / "What do you think started it, and why now?" / "What has your padrino said about it, and what do you make of that?" / "What worries you most about where this is going?"
Watch for: the client testing whether you will mock them; fear of naming who might have sent harm; a model that shifts as trust grows. Do not try to replace the client's model; aim for a shared plan. It is working when the client's model and the treatment plan stop competing. [synthesis]

4.7 Using DSM-5-TR cultural concepts of distress

Purpose / when: when the client's way of talking about distress matches, or resembles, a named cultural concept. DSM-5-TR says cultural concepts of distress "include idioms, explanations or perceived causes, and syndromes", and its examples were revised to avoid stigmatising or generalising language. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] A secondary source lists the DSM-5-TR concepts as ataque de nervios, dhat syndrome, hikikomori, khyâl cap, kufungisisa, maladi dyab, nervios, shenjing shuairuo, susto and taijin kyofusho [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf]; DSM-5 (2013) listed maladi moun ("humanly caused illness") [source: https://revistapsiquiatria.pt/index.php/sppsm/article/download/139/69]; the exact DSM-5-TR list is [uncertain].
Steps: (1) Listen for idioms common among Caribbean and Latin American clients, such as nervios or ataque de nervios. (2) Where the client attributes illness to harm sent by another person, note that DSM includes a Haitian concept of this kind (maladi moun in DSM-5; maladi dyab apparently in DSM-5-TR [uncertain]); do not relabel a Cuban or Colombian client's account with a Haitian term, but use the DSM framing that such attributions are cultural explanations, not diagnoses. [synthesis] (3) Use the concept to guide questions about meaning, social context and severity, then assess for any DSM disorder separately. (4) Document both the idiom and any diagnosis. [synthesis]
Example language: (illustrative) "When you say your nerves are bad, what does that feel like, and what do people around you say about it?"
Watch for: treating an idiom as a diagnosis, or dismissing a real anxiety, depressive or psychotic disorder because it is expressed in cultural terms. It is working when you can name both the client's idiom and your clinical assessment, and they fit together. [synthesis]

4.8 Telling normative religious experience from disorder

Purpose / when: when the client reports contact with the dead, spirit mediumship, possession, hearing or seeing the dead, or a strong sense of being watched or acted on by spirits. Dianteill describes Palo as centred on the relation between the initiate and the spirit of one or more dead people installed in the nganga [source: https://www.encyclopedia.com/religion/legal-and-political-magazines/afro-cuban-religions]; in the Cali study the dead (nfumbi) are believed to authorise and carry out the work the tata or yayi asks for. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] That ancestors are also consulted through divination and spirit mediumship, and that the dead are believed able to cause anxiety and sleeplessness, comes from a tertiary overview. [source: https://en.wikipedia.org/wiki/Palo_(religion)] [uncertain: secondary, unverified]
Diagnostic anchors: DSM-5 dissociative identity disorder notes that identity disruption "may be described in some cultures as an experience of possession", and excludes a disturbance that "is not a normal part of a broadly accepted cultural or religious practice" [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]; DSM-5-TR keeps this in substance, exact wording [uncertain] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299]. 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] ICD-11 6B62 Trance disorder and 6B63 Possession trance disorder require that the state is 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 culture note on culturally sanctioned beliefs versus delusions is [uncertain: not verified]. A clinical report on Cuban American Santería practitioners argued that possession belief should not be treated as a culture-bound syndrome, may be a non-specific feature of various mental illnesses, and should be evaluated "in the context of the patient's overall belief system and ability to carry out usual activities". [source: https://ps.psychiatryonline.org/doi/abs/10.1176/ps.39.11.1188]
Steps: (1) Ask where and when the experience happens: within house activities or a consultation, or unbidden at work, at night, alone. (2) Ask whether it is wanted, expected and controllable, and whether it ends. (3) Ask how the client's house and co-religionists view it; ask whether they see it as normal, as a sign, or as something wrong. (4) Assess functioning, distress, sleep, mood, other perceptual changes, thought form and substance use. (5) Look for features outside the religious frame: belief content that the client's own community does not share, decline in self-care, grandiosity, disorganisation, command content urging harm. (6) If uncertain, consult a cultural broker or (with consent) a person the client trusts in the tradition about whether the experience fits their practice. (7) Decide: normative experience, normative experience plus a separate disorder, or disorder expressed in religious terms. Re-assess over time. [synthesis]
Example language: (illustrative) "When this happens, is it something you expect and can manage, like during your religious practice, or does it come when you don't want it?" / "What do people in your house say about what you're experiencing?"
Watch for: both errors: labelling accepted mediumship as psychosis, and missing psychosis, mania or severe depression because content is religious. A client whose own religious community says "this is not from us" is giving strong information. It is working when the client agrees with how you have described the experience and when the plan protects both their religious life and their health. [synthesis]

4.9 Mapping the religious family as social network and support

Purpose / when: when the client belongs to a house. In Palo, each house forms a familia de religión; Castro Ramírez distinguishes blood, religious and spiritual family, describes godparent–godchild ties as kinship beyond biology, and notes that conflicts over money and teaching are common. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] Close relatives may also seek the house's protection. [source: https://en.wikipedia.org/wiki/Palo_(religion)] [uncertain: secondary, unverified]
Steps: (1) Using the CFI Social Network module, draw a network or genogram that includes blood family and religious family (godparent, religious siblings, house leader), using the client's terms. (2) Ask what each relationship gives and costs. (3) Note changes (a house split, a godparent's death, moving country) as possible stressors. (4) Use supportive religious relationships as resources in the plan, at the client's discretion. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [synthesis]
Example language: (illustrative) "Who in your religious family do you turn to when things are hard? Who would you not go to?"
Watch for: loss of a house or godparent can be a bereavement; isolation from living relationships (Kerestetzi notes some practitioners spend much of their time with the dead) may be devotion or may signal depression, so ask what it means to the client. [source: https://doaj.org/article/425d92108bd647fd97bafee7925f2410] [synthesis]

4.10 Respecting secrecy and the limits of disclosure

Purpose / when: throughout. Initiation is secret, and the tata sets a secret signature (firma) on each new nganga [source: https://www.redalyc.org/pdf/1591/159149454007.pdf]; Dianteill calls Palo more secretive and private than Santería. [source: https://www.encyclopedia.com/religion/legal-and-political-magazines/afro-cuban-religions]
Steps: (1) Tell the client early that you will not ask about anything secret. (2) Ask about meaning, feelings and effects on life, not about procedures, contents or words. (3) If the client starts to disclose something they then say is secret, stop and check. (4) Keep religious details out of notes beyond what is clinically needed; record the client's view of what it means. (5) If a clinical risk question touches secret matters (e.g. physical safety), ask only about the risk, not the ritual. [synthesis]
Example language: (illustrative) "You don't need to tell me what happens. Can you tell me how you felt afterwards and what it means for you?"
Watch for: a client who feels they have betrayed their house after disclosing; repair by acknowledging the boundary. It is working when the client can talk about religious life with you without anxiety about disclosure. [synthesis]

4.11 Working with fear of sent harm, sorcery or angry dead

Purpose / when: when the client fears that someone has sent a trabajo or daño, that Palo has been used against them, or that the dead are unhappy. Paleros are consulted about harm sent by others and, in Dianteill's account, also cast spells against enemies [source: https://www.encyclopedia.com/religion/legal-and-political-magazines/afro-cuban-religions]; protection against sent harm is a central reason for entering Palo in the Cali study. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] Stories of accidents, madness or ruin linked to ngangas are reported to circulate. [source: https://en.wikipedia.org/wiki/Palo_(religion)] [uncertain: secondary, unverified]
Steps: (1) Elicit the explanatory model (4.6), including who the client fears and why. (2) Without disputing the belief, identify the distress and impairment: sleep, hypervigilance, panic, avoidance, conflict, low mood. (3) Ask what the client is already doing through religious channels and whether it helps. (4) Agree on targets the client accepts, e.g. sleep, panic, rumination, relationship repair. (5) Use the evidence-based treatment indicated (e.g. CBT for panic or insomnia), framed as helping the body and mind cope while the client's religious path addresses the spiritual side. (6) Assess risk of conflict or violence towards the person believed responsible. (7) Watch for psychotic-level fear (4.8). [synthesis]
Example language: (illustrative) "Whatever is going on spiritually, your body has been on high alert for weeks. Would it be useful to work on the sleep and the panic, while you keep doing what your religion asks?"
Watch for: belief intensifying into fixed persecutory ideas that the client's own community does not share; plans to retaliate; financial exploitation by anyone promising removal of harm (an issue in any religious marketplace [synthesis]). It is working when distress falls and functioning returns, whatever the client's view of the cause. [synthesis]

4.12 Collaboration and referral with the client's house (only when the client wishes)

Purpose / when: when the client asks you to coordinate with their tata nganga, yayi nganga or godparent, or says that religious and clinical advice conflict. There is no formal programme for collaboration with Palo houses documented [uncertain: not verified]. Elsewhere, controlled trials show that collaboration with religious and traditional healers can help: in Nigeria and Ghana, the COSIMPO cluster-randomised trial (Gureje et al., The Lancet, 2020) of collaborative shared care between traditional or faith healers and primary health workers for psychosis gave a greater fall in PANSS symptoms and fewer harmful practices than usual care [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839]; in a Ghanaian prayer camp, adding psychiatric medication to usual care (Ofori-Atta et al., Br J Psychiatry 212(1)) lowered 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; transferring them to Palo is [synthesis].
Steps: (1) Ask the client what they want: no contact, a letter, a call, a joint meeting. (2) Obtain written consent naming the person, purpose and what may and may not be shared. (3) Approach the religious leader as the authority in their domain; state your role and limits. (4) Share only what is needed (e.g. the client's safety plan, the importance of continuing prescribed medication as the prescriber advises). (5) Ask how the house understands the problem and what it advises, without asking for ritual details. (6) Look for common ground (sleep, safety, support). (7) Report back to the client. (8) Never refer a client to a Palo practitioner yourself or recommend a house; if a client wants religious help, it is theirs to seek through their own community. [synthesis]
Example language: (illustrative, to the client) "Would it help if I spoke with your madrina? You decide what I share." (illustrative, to a religious leader) "I'm here as her therapist, not to judge your religion. She asked me to talk with you about how to keep her safe this month."
Watch for: advice to stop medication or avoid medical care (route to the prescriber and discuss with the client; do not argue religion); pressure on the client; confidentiality leaks within a small community. It is working when the client experiences their helpers as on the same side. [synthesis]

4.13 Interpreters and cultural brokers

Purpose / when: when the client's preferred language is Spanish (Cuban, Venezuelan, Colombian, Mexican or other) or when religious vocabulary is unfamiliar. Palo's ritual language mixes Bantu languages and colonial-era Spanish. [source: https://atlasetnografico.cult.cu/en/glosario/P.html]
Steps: (1) Offer a professional interpreter; avoid family members for clinical content. (2) Check with the client whether the interpreter knows the community, and whether that is a privacy risk. (3) Brief the interpreter not to translate religious terms into pejoratives (e.g. not rendering palero as "witch"). (4) A cultural broker can explain general context, never secret content; use one only with the client's consent. (5) Keep a glossary of the client's terms from the client's own explanations. [synthesis]
Example language: (illustrative) "When you say muerto, tell me what it means to you, so I use the word the way you do."
Watch for: interpreter reactions (laughter, fear, crossing themselves); breaches of confidentiality in tight-knit diaspora communities. It is working when the client's meaning reaches you without loss or judgement. [synthesis]

4.14 Multiple religious belonging, conversion and family conflict

Purpose / when: when the client combines Palo with Santería, Catholicism or Spiritism, or when family members of another faith (e.g. evangelical Christians) reject Palo. Many practitioners combine paths [source: https://www.encyclopedia.com/religion/legal-and-political-magazines/afro-cuban-religions] [source: https://www.mdpi.com/2077-1444/12/3/172]; within the religious field Palo is sometimes ranked below Santería or Ifá as "más atrasado" (more backward). [source: https://www.redalyc.org/pdf/1591/159149454007.pdf]
Steps: (1) Map the client's paths and how they fit together for them. (2) Map family members' religious positions. (3) Identify specific conflicts (e.g. a parent calling Palo devil worship, a partner who wants the client to leave a house). (4) Offer individual or family sessions focused on respect and the relationship, not on which religion is right. (5) Support the client's own choice, including choosing to leave a house, and address any fear about leaving. [synthesis]
Example language: (illustrative) "It sounds like your mother is frightened for you and you feel judged. Can we look at what each of you needs from the other, without deciding who's right about religion?"
Watch for: the therapist taking sides; a client's fear of spiritual consequences for leaving a house, which needs to be heard in their terms. It is working when family talk shifts from the religion to the relationship. [synthesis]

4.15 Integrating religious experiences and decisions

Purpose / when: when the client is weighing initiation, has recently been initiated, has had a powerful consultation, or is processing an experience with the dead. Initiates keep a working relationship with their nganga, whose spirit is expected to follow its owner's wishes but may revolt [source: https://www.mdpi.com/2077-1444/12/3/172]; Kerestetzi describes initiation as transforming the person's identity. [source: https://doaj.org/article/425d92108bd647fd97bafee7925f2410]
Steps: (1) Invite the client to describe what the experience or decision means for them, without ritual detail. (2) Explore hopes, fears, and effects on relationships, work and money. (3) For decisions, help the client think through their own values and the advice they have received, without steering. (4) Notice whether the experience brought relief, meaning, fear or confusion, and work with whichever is present. (5) If the client is distressed after an experience, check for dissociation, trauma symptoms or sleep loss and treat them as such. [synthesis]
Example language: (illustrative) "What changed for you after that? What's been easier, and what's been harder?"
Watch for: feeling pressured into a commitment; financial strain; new or worsening symptoms; or, equally, growth and belonging that the client values. It is working when the client experiences the religious and therapeutic sides of their life as fitting together. [synthesis]

4.16 Addressing stigma, racism and historical suppression

Purpose / when: when the client has met contempt for their religion from services, police, employers, churches or family, or carries Cuban, Colombian or diaspora histories of racialised stigma. Palo has been marginalised by Cuba's Catholic, Euro-Cuban establishment as brujería [source: https://en.wikipedia.org/wiki/Palo_(religion)] [uncertain: secondary, unverified]; in Colombia Afro-inspired practices are still often seen through that lens despite legal religious freedom. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf]
Steps: (1) Ask directly (CFI Q16 and the Patient–Clinician Relationship module) whether the client has experienced judgement or racism in care. (2) Acknowledge it without defensiveness. (3) Explore how stigma affects help seeking and self-image. (4) Where a colleague's notes or a referral use pejorative terms, correct them. (5) Recognise that crime reporting linking Palo to grave desecration can expose all practitioners to suspicion; do not treat a client as a suspect because of their religion. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] [synthesis]
Example language: (illustrative) "Have people in health services ever made you feel your religion was a problem? I'd like to know, so I don't repeat it."
Watch for: shame, guardedness, or the client using humour to deflect. It is working when the client tells you about prior mistreatment and you can repair it. [synthesis]

4.17 Screening for elemental mercury exposure

Purpose / when: when a client or household member who practises any Afro-Caribbean religion has unexplained tremor, irritability, nervousness, insomnia, memory loss, shyness or loss of confidence, headaches or tingling; these can mimic anxiety or depression. A Louisiana health department guide names Espiritismo, Santería, Voodoo and Palo as traditions in which elemental mercury (azogue) may be used, and notes that not everyone in these religions uses it. Mercury vaporises at room temperature, so exposure can continue after use; the fetus, young children, pregnant and nursing women are most at risk. [source: https://ldh.la.gov/assets/oph/Center-EH/envepi/Mercury_for_Health_Providers_Hg_Final.pdf] The US EPA warned in 2006 that "Mercury vapors resulting from ritual uses can pose a health risk". [source: https://pluralism.org/news/epa-warns-against-use-mercury-afro-caribbean-ritual-practices] Forensic reports also describe ritual assemblages contaminated with mercury. [source: https://ircommons.uwf.edu/esploro/outputs/journalArticle/Afro-Cuban-ritual-use-of-human-remains/99380090343306600]
Steps: (1) Include household exposures in routine physical-health screening, asking about products used at home among other sources, without singling out the religion. (2) If the answer suggests exposure or symptoms fit, refer to the client's physician for medical assessment and testing; public health or poison services may also advise. (3) Do not give any advice on ritual practice; the client's house decides religious matters. (4) Note any risk to children or pregnancy and make sure the medical referral addresses it. [source: https://ldh.la.gov/assets/oph/Center-EH/envepi/Mercury_for_Health_Providers_Hg_Final.pdf] [synthesis]
Example language: (illustrative) "Some of what you're describing, the shaking hands and poor sleep, can have physical causes as well. I ask everyone about things used at home. Is there anything like mercury, sometimes sold as azogue, in your home?"
Watch for: the client feeling accused; symptoms in children. It is working when the client sees a doctor and the question is settled medically. [synthesis]

4.18 Human remains, legal risk and confidentiality

Purpose / when: when a client raises fear of, involvement in, or accusations about human remains, or when the topic arises from news. Dianteill describes the nganga as holding sticks, stones, earth and bones, sometimes human [source: https://www.encyclopedia.com/religion/legal-and-political-magazines/afro-cuban-religions]; in the Cali study the main human remain is the skull (kiyumba), and one yayi preferred a pact with a deceased relative to one with an unknown skull outside Cuba. [source: https://www.redalyc.org/pdf/1591/159149454007.pdf] Reports that some branches accept substitutes and that many practitioners claim to hold remains they do not come from a tertiary overview. [source: https://en.wikipedia.org/wiki/Palo_(religion)] [uncertain: secondary, unverified] James describes the Cuban nganga as including parts of a human skeleton. [source: https://revistas.inah.gob.mx/index.php/cuicuilco/article/download/19779/21173/42291] Forensic anthropologists describe identifying Palo assemblages of human crania and discuss legal and illegal sourcing and safe, ethical handling (Winburn, Martinez and Schoff, 2017). [source: https://ircommons.uwf.edu/esploro/outputs/journalArticle/Afro-Cuban-ritual-use-of-human-remains/99380090343306600] In one reported case, human remains were removed from veterans' graves in Mount Dora, Florida, in December 2020; the men arrested said they practised Palo Mayombe. [source: https://taskandpurpose.com/news/florida-veteran-grave-robbers-rituals/]
Steps: (1) Do not raise the topic unless the client does or there is a clinical reason. (2) If raised, explore the client's feelings and concerns (fear, guilt, legal worry, community stigma). (3) Before any disclosure of possible offences, remind the client of the limits of confidentiality in your jurisdiction. (4) Seek legal and ethics advice on any duty to report; these vary by country and state [uncertain]. (5) Do not investigate or become an agent of law enforcement. [synthesis]
Example language: (illustrative) "Before you go on, I want to remind you of what I can and can't keep confidential, so you can decide what to tell me."
Watch for: your own fear or disgust; assuming all practitioners are involved. It is working when the client can discuss the issue's emotional weight without being treated as a suspect. [synthesis]

4.19 Safeguarding and risk assessment

Purpose / when: whenever there is risk to the client or others, including suicide risk, harm attributed to spiritual causes, pressure or exploitation within any religious relationship, or concern for children in the household.
Steps: (1) Do a standard suicide and self-harm risk assessment, including religious meanings of death and the dead, which may raise or lower risk; use lethal-means counselling (storage and removal) as usual. (2) Assess whether fear of spiritual harm is driving aggression towards a person believed responsible. (3) Ask about financial, sexual or emotional exploitation by anyone in a position of religious power, as you would in any setting. (4) For children, follow local safeguarding procedures; neither ignore harm because it is framed as tradition nor treat religious participation as harm in itself. (5) If a client is advised to delay urgent medical care, discuss with them and liaise with their doctor. (6) Document and consult. [synthesis]
Example language: (illustrative) "Some people feel that the dead are calling them. Have you had any thoughts like that, or thoughts of ending your life?"
Watch for: hopelessness expressed in religious terms; isolation; sudden withdrawal from a house. It is working when the client can talk about risk openly and the safety plan includes people they trust. [synthesis]

4.20 Medication and remedy questions

Purpose / when: when the client asks whether to take, stop or change medication, or whether religious remedies and medication can be combined.
Steps: (1) Do not advise on starting, stopping or changing any medicine or remedy. (2) Tell the client the prescriber is the right person and help them prepare questions. (3) With consent, inform the prescriber of the client's concerns. (4) Explore what the medication means in the client's model (e.g. whether it is seen as interfering with spiritual work). [synthesis]
Example language: (illustrative) "That's an important question, and your doctor is the one who can answer it safely. Shall we write down what you want to ask?"
Watch for: stopping medication silently; conflicting advice. It is working when the client and prescriber are talking. [synthesis]

5. Handling problems

The cited sources do not address therapy problems with Palo clients specifically; this section is [synthesis] except where a source is cited.

Client will not talk about religion. Do not push. Repeat the offer, name the secrecy boundary (4.10), and work on presenting problems. Some clients test whether you are safe for months. [synthesis]
Client asks what you think of Palo, or whether the dead are real. Answer honestly about your role: you are not a religious authority and respect that their house is. Return to their experience. (illustrative) "I'm not the person to judge that. What matters here is what it means to you and how it's affecting you." [synthesis]
Client wants you to endorse or fight their religious advice. Stay neutral on religious content; address safety and health; offer collaboration if the client wishes (4.12). [synthesis]
Stuck: the client sees the problem as purely spiritual and therapy as irrelevant. Use the explanatory model to find shared targets (sleep, family conflict, panic). Ask what their house thinks of therapy. Accept that therapy may be a smaller part of their help seeking. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] [synthesis]
Overwhelm after religious events. Ground first; check for dissociation and trauma symptoms; delay meaning-making until stable; reassess with 4.8. [synthesis]
Non-adherence. Ask what got in the way in their terms (e.g. religious obligations at night, advice from elders, cost). Adjust timing; do not frame religious obligations as avoidance. [synthesis]
Rupture over perceived judgement. Name it; apologise for specific acts (a remark, a note); ask what repair looks like; use the Patient–Clinician Relationship module. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [synthesis]
Your own fear or fascination. Take it to supervision; read scholarship by authors who worked with practitioners; do not ask the client to educate you. [synthesis]
Conflict between psychiatric diagnosis and religious account. Present both in the formulation; avoid forcing a choice; review over time; involve the house only with consent. [synthesis]
The client fears you or a colleague will report them to police because of their religion. Clarify that religion itself is not reportable; explain the actual limits of confidentiality. [synthesis]
Small-community confidentiality. Check whether the interpreter, cultural broker or other clients know the client's house; arrange accordingly. [synthesis]
Client leaves or is expelled from a house. Treat as a potential loss; explore fears of spiritual consequences in their terms; support new or existing sources of belonging. When a leader dies, members may move to another house, which can also be destabilising. [source: https://en.wikipedia.org/wiki/Palo_(religion)] [uncertain: secondary, unverified] [synthesis]
Physical symptoms that may be exposure-related. Refer to medicine promptly (4.17). [source: https://ldh.la.gov/assets/oph/Center-EH/envepi/Mercury_for_Health_Providers_Hg_Final.pdf]

Sources

Palo: ethnography, reference and reports

Palo (religion), Wikipedia (tertiary overview citing Ochoa 2010, Palmié, Kerestetzi and others; used only for low-stakes points marked [uncertain: secondary, unverified])
Palo Monte, Atlas Etnográfico de Cuba glossary (publisher [uncertain: not verified])
Ochoa, T. R. (2010). Society of the Dead: Quita Manaquita and Palo Praise in Cuba. University of California Press, publisher page
Kerestetzi, K. (2013). Pénétrer le monde des morts. Ateliers d'Anthropologie 38, doi 10.4000/ateliers.9357 (DOAJ record)
Castro Ramírez, L. C. (2016). Reglas de palo, reglas de muerto: reconfiguración de la familia y lo familiar en la práctica palera caleña. Revista Brasileira do Caribe 17(33), 115–134
Dianteill, E. Afro-Cuban Religions. Contemporary American Religion (Gale), Encyclopedia.com
West-Durán, A. (2021). Mpambu Nzila: José Bedia at the Crossroads. Religions 12(3), 172, doi 10.3390/rel12030172
Lydia Cabrera, Encyclopaedia Britannica (dates Reglas de Congo: Palo Monte Mayombe to 1986)
James, J. Sobre dioses y muertos (journal year and issue [uncertain: not verified])
Fhunsu, D. (2017). The Kongo Rule: The Palo Monte Mayombe Wisdom Society. PhD dissertation, University of North Carolina at Chapel Hill (annotated translation of Lydia Cabrera, Reglas de Congo: Palo Monte Mayombe; Cabrera's year and publisher [uncertain: not verified])
Winburn, A. P., Martinez, R., & Schoff, S. K. (2017). Afro-Cuban ritual use of human remains: medicolegal considerations. Journal of Forensic Identification 67, 1–30
Task & Purpose: report on removal of remains from veterans' graves, Mount Dora, Florida (December 2020)
Mental Illness Complicated by the Santeria Belief in Spirit Possession. Psychiatric Services (Hospital & Community Psychiatry) 39(11):1188 (authors [uncertain: not verified])
Pluralism Project: EPA warns against use of mercury in Afro-Caribbean ritual practices (2006)
Louisiana Department of Health and Hospitals (2008). Mercury Exposure and Toxicity: Information for Health Care Professionals

Cultural assessment, diagnosis and collaboration

Books cited

Ochoa, T. R. (2010). Society of the Dead: Quita Manaquita and Palo Praise in Cuba. University of California Press.
Cabrera, L. Reglas de Congo: Palo Monte Mayombe (1986, per Britannica; publisher [uncertain: secondary, unverified]).

← Previous · XI-081Puerto Rican and Cuban espiritismo Next · XI-083 →Obeah and myal