Kumina (Jamaica)

1. Introduction

Version followed: Kumina as the African Caribbean Institute of Jamaica/Jamaica Memory Bank (ACIJ/JMB, a division of the Institute of Jamaica) describes it in its 2022 fact sheet, with scholarship (Maureen Warner-Lewis 2005; Kenneth Bilby and Fu-Kiau kia Bunseki 1983, as cited) as attributed outsider and scholarly context; the therapist's own work follows the APA DSM-5-TR Cultural Formulation Interview (CFI).

What Kumina is. Kumina is not a psychotherapy. It is a living Afro-Jamaican musico-religious tradition that the ACIJ/JMB describes as "based mainly on communication with the ancestors of the Congo people of Africa", brought to Jamaica by indentured Africans who arrived between the 1840s and 1860s. St Thomas parish has the largest number of followers; groups also exist in Portland, St Mary, St Catherine and Kingston. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] Warner-Lewis describes it as a belief system centred on commemorating ancestors, first recorded in the 1950s and probably formed by West Central African indentured labourers brought between 1845 and 1865. [source: https://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and-maps/kumina] The Jamaican government recognised Kumina as intangible cultural heritage in the early 2000s, alongside Rastafari, Maroon practices and Revivalism. [source: https://jamaica-gleaner.com/article/news/20260423/kumina-workshop-explore-african-ancestral-traditions]

How healing is understood within the tradition (attributed). The ACIJ/JMB states that Kumina ceremonies mainly mark deaths in a family (wakes, entombments, memorials), and also births, weddings and thanksgivings. It says they "provide healing" and remove "the wrong kind of spirit" from a person. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] Warner-Lewis writes that ceremonies may seek help with physical and mental healing and with legal matters. [source: https://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and-maps/kumina] In the tradition's own terms, change comes through right relationship with the ancestors, carried out under the authority of a King or Queen. These are the tradition's beliefs. They are not presented here as fact, dismissed, or offered as a treatment for any physical or mental disease.

The psychotherapist's role. The therapist does not perform, lead, imitate or recommend Kumina ceremonies. The therapist's work runs alongside the tradition: understanding what Kumina means to the client, using the CFI and explanatory-model questions, telling culturally normative possession experience apart from disorder, collaborating with community leadership when the client wishes, and safeguarding. In this work, change comes from treatment that fits the client's own understanding of their distress, and from a relationship in which the client does not have to hide their tradition. [synthesis]

2. Framework

Kumina has no therapist-facing manual, phases or session count, and no community-published protocol for clinicians appears in the sources cited here [uncertain: not verified]. The framework below is the therapist's own culturally responsive work, built around the CFI. [synthesis, drawing on APA CFI materials]

Who holds authority in Kumina (attributed).

Kings and Queens. The ACIJ/JMB says each group is led by a King or Queen, a permanent leader with a band of disciples, who must complete "a long apprenticeship". The leader is held to control the spirits, and the leader's position is not questioned. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] Warner-Lewis likewise says a King or Queen presides. [source: https://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and-maps/kumina] One well-known Queen was the late Imogene "Queenie" Kennedy of Dalvey, St Thomas. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf]
Drummers. Drummers also serve long apprenticeships, and only men play the drums. The lead drummer ranks second to the leader. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf]
Nations and Bongo identity. Warner-Lewis describes Kumina ceremonies as presided over by a "king" or "queen" [source: https://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and-maps/kumina], and the Gleaner profiles St Thomas groups led by Kumina Kings, with a Kumina Queen among them and members brought up in Kumina households. [source: https://old.jamaica-gleaner.com/gleaner/20091011/ent/ent9.html] The ACIJ/JMB refers to a "Bongo nation" that originates in Kumina. [source: https://acij-ioj.org.jm/wp-content/uploads/2023/12/Journeying_Revival_Iconography_EXHIBITION_ACIJ_JMB-2.pdf] That Kumina is organised in small family-based "nations", each led by a King and a Queen, that members of Kumina families are called "Bongo", and that women are custodians of Kumina knowledge (Munroe 2024, as cited) come from a tertiary overview. [source: https://en.wikipedia.org/wiki/Kumina] [uncertain: secondary, unverified] Caribbean Beat reports that the community reclaims "Bongo" with pride and that one elder calls the Bongo Nation "scattered". [source: https://www.caribbean-beat.com/?p=49734]
Outsiders. The ACIJ/JMB says guests and the general public are treated as outsiders. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] Caribbean Beat reports that access is difficult and that outsiders generally need a connection to the community. [source: https://www.caribbean-beat.com/?p=49734]
Heritage institution. The ACIJ/JMB (founded 1972; integrated the Jamaica Memory Bank in 1990) documents and preserves Kumina. It is a heritage body, not a religious authority. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] [source: https://www.caribbean-beat.com/?p=49734]

Phases of the therapist's work [synthesis]

Phase	Goal	Typical format	Move on when
A. Preparation and self-examination	Check your own assumptions, for example the confusion of Kumina with obeah, or the pejorative label "Pocomania"	Before and between sessions; supervision	You can name your assumptions and how they might show up
B. Engagement and cultural assessment	Core CFI, explanatory model, help-seeking history	Sessions 1–2, individual; family informant if the client agrees	The client's own name for the problem, its cause, and the help they want are written down in their words
C. Differential formulation	Tell normative possession (myal) and spiritual explanations apart from disorder	Sessions 2–4; consult a cultural broker with consent	The formulation states what is culturally normative, what is distress, and what (if anything) meets diagnostic criteria
D. Shared plan	Agree treatment that fits the client's framework; decide on collaboration or referral if the client wishes	Session 3–5 onward	The client has agreed the plan and the consent limits for any contact with community leaders
E. Ongoing work, integration and review	Treatment of the target problem; integrating ceremonial, grief and ancestral experiences; safeguarding checks	Usual course length for the target problem	Goals met, or the client chooses to rely on community care alone, with safety assured

The phase lengths are clinical estimates, not taken from a source. The time the CFI takes is also [uncertain]: the DSM-5 field trial found later interviews "required less time" but gave no figure in minutes. [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]

3. Guiding principles

Alongside, not inside. The therapist works next to the tradition and never conducts or imitates Kumina practice. Practical meaning: never suggest a ceremony, never offer to attend unless the client and the community's leader invite it, and never coach ritual behaviour. [synthesis]
Authority rests with Kings and Queens. Spiritual matters belong to the community's leadership, whose position the ACIJ/JMB says is not questioned. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] Practical meaning: when a spiritual question comes up, ask who in the client's group the client would consult. Do not answer it yourself.
Describe beliefs as held. Ancestral spirits, the dual soul, duppies and myal possession are described as the tradition holds them, neither stated as fact nor dismissed. Practical meaning: use phrasing like "in your tradition…" and the client's own words. [synthesis]
Respect what is not shared with outsiders. Kumina ritual language, songs and procedures are for those inside the tradition. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] Practical meaning: ask what an experience meant to the client, not how a ceremony works. Never record, write up or ask the client to teach ritual content.
Kumina is not obeah. Jamaica's obeah laws historically equated obeah with myalism and were used to prosecute Revivalists and balm healers. Many Jamaicans still see obeah as evil. [source: https://www.historyworkshop.org.uk/the-racist-history-of-jamaicas-obeah-laws] Practical meaning: never use "obeah", "Pocomania" or "witchcraft" for a client's Kumina practice unless the client chooses those words. The ACIJ/JMB calls "Pocomania" a pejorative term that took root in describing Revivalism. [source: https://acij-ioj.org.jm/wp-content/uploads/2023/12/Journeying_Revival_Iconography_EXHIBITION_ACIJ_JMB-2.pdf]
The client's explanation matters clinically. In a Jamaican sample, more than a third of 60 psychiatric patients attributed their illness to supernatural causes. Most felt their understanding did not match their clinician's, and this distressed them. [source: https://journals.athmsi.org/index.php/ajtcam/article/view/1389] Practical meaning: record and work with the client's explanation from the first session.
Normative is not pathological; distress still counts. DSM-5 dissociative criteria exclude experiences that are "a normal part of a broadly accepted cultural or religious practice". [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] Practical meaning: possession within Kumina ceremony is not a symptom. Unwanted, uncontrolled or impairing states outside that context still need assessment.
The CFI supports judgement; it is not a diagnosis. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] Practical meaning: use the answers to shape the formulation, not to replace clinical assessment.
The client controls collaboration. Contact with a King, Queen or other community member happens only if the client wishes, with written consent for exactly what is shared. [synthesis]
Small communities, strict confidentiality. Kumina groups are local and often family-based: the Gleaner profiles small St Thomas groups whose members grew up in Kumina households. [source: https://old.jamaica-gleaner.com/gleaner/20091011/ent/ent9.html] Practical meaning: assume that anyone you consult may know the client or the family. [synthesis]
No health claims, no medicine advice. No ceremony is presented as a treatment for physical or mental disease. Never advise starting, stopping or changing medicines; route those questions to the prescriber. [synthesis]
Safety overrides. Risk to life, urgent medical need and harm to a child or vulnerable adult are handled under ordinary safeguarding duties, whatever explanation of the distress is in play. [synthesis]
Name history and racism. African-derived religions in Jamaica were suppressed by law, and the 1898 Obeah Act's core provisions remain in force. [source: https://www.historyworkshop.org.uk/the-racist-history-of-jamaicas-obeah-laws] Practical meaning: expect wariness of services, and make room to talk about it.

4. Intervention inventory

These are the psychotherapist's own interventions. None of them is a Kumina practice, and none involves Kumina ceremony, songs, ritual language or sacred objects. Example language is illustrative throughout.

4.1 Cultural humility and self-examination

Purpose / when: Before the first session with a client who names Kumina, Bongo identity, Revival or Afro-Jamaican spirituality, and whenever you notice a strong reaction to spiritual material. [synthesis]
Steps: (1) Write down what you associate with Kumina, "Pocomania", obeah, spirit possession and Jamaican folk religion. (2) Check each association against attributed sources: for example, the ACIJ/JMB describes Kumina as ancestor-centred, and legal history shows that African-derived practices were criminalised as "obeah" and "myalism". [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] [source: https://www.historyworkshop.org.uk/the-racist-history-of-jamaicas-obeah-laws] (3) Name in supervision where your own faith, secularism, or training in pathology could bias you. (4) Decide in advance that you will learn from the client and the community, not from stereotypes. [synthesis]
Example language (illustrative): To yourself or in supervision: "Am I hearing 'possession' and thinking 'psychosis' before I've heard what it means to them?"
Watch for: Curiosity that turns into voyeurism (wanting ceremonial detail). Over-correction, where real symptoms go unassessed because they were framed spiritually. It is working when you can hold both possibilities in your formulation. [synthesis]

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

Purpose / when: Early assessment (session 1 or 2) with any client, and especially when the presenting problem is framed in ancestral or spiritual terms. APA says the CFI is "designed to be used by any clinician providing services to any individual in any care setting". [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
Steps: (1) Use the official APA form. Clinicians may reproduce it for use with their patients, but modifying or translating it needs APA permission. (2) Work through its four domains in order: the cultural definition of the problem; cultural perceptions of cause, context and support (including the role of cultural identity); cultural factors affecting self-coping and past help seeking (including barriers); and cultural factors affecting current help seeking (preferences and the clinician-patient relationship, for example perceived racism or language barriers). The core CFI has 16 questions. (3) Record the client's own words, for example "the wrong kind of spirit" or "my ancestors are vexed", rather than translating them into clinical terms. (4) Use the answers 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): "People describe problems like this in different ways. How would you describe what's been happening, in your own words?" / "Is there anything about your background, your family or your faith that I should understand to help you properly?" / "Has anything about how services treat Jamaican people, or people of your faith, made it hard to come here?"
Watch for: Guarded or minimal answers about spirituality, which may reflect the history of criminalisation or fear of being judged "mad". [source: https://www.historyworkshop.org.uk/the-racist-history-of-jamaicas-obeah-laws] [synthesis] It is working when the client offers their own explanation without prompting, or corrects your summary.

4.3 CFI Informant Version (family or community member)

Purpose / when: When a family member or a member of the client's nation comes with the client, or the client wants a relative's view (for example, during an acute episode or when assessing an older adult). [synthesis] The Informant Version is used with a family member or friend. It has 17 questions: the first covers the informant's relationship with the patient, and the same four domains follow. It is labelled DSM-5 (2013). [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
Steps: (1) Get the client's consent for who is interviewed and what you may say. (2) Interview the informant separately or jointly, as the client prefers. (3) Note where the family's explanation differs from the client's (for example, the family sees an ancestral call while the client sees depression). (4) Bring the differences into the formulation without taking sides. [synthesis]
Example language (illustrative): "Your daughter has agreed I can ask you a few questions. In your family's understanding, what is happening to her?"
Watch for: An informant who speaks for the client, family pressure towards one explanation, and confidentiality in small family-based communities. It is working when the client feels the family's view has been heard but is not imposed. [synthesis]

4.4 CFI supplementary modules

Purpose / when: For in-depth assessment, as add-ons to the core CFI or standalone, at the first evaluation, later in care, or repeatedly. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] Modules most relevant here [synthesis]: Spirituality, Religion, and Moral Traditions (the place of Kumina, Revival or church in the client's life); Explanatory Model; Cultural Identity (Bongo identity, parish, Jamaican or diaspora identity); Social Network (nation and family); Coping and Help-Seeking; Patient-Clinician Relationship; Immigrants and Refugees (for diaspora clients); Older Adults; School-Age Children and Adolescents; Caregivers (completed by the caregiver).
Steps: (1) Note which core-CFI subtopic opened up; the core form shows which module expands it. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] (2) Choose one or two modules per session rather than all of them. (3) Paraphrase, do not read out, questions where the client prefers conversation. Do not change the instrument itself. [synthesis]
Example language (illustrative): "You mentioned your grandmother's people and the ancestors. Would it be all right to spend some time on what your faith means for you and how it helps you cope?"
Watch for: Questions that drift into ceremony detail. Keep the focus on the client's experience and the support it gives. It is working when the formulation names specific supports (people, practices, obligations) the client draws on. [synthesis]

4.5 Kleinman's explanatory-model questions

Purpose / when: To elicit the client's model of the illness when the CFI's cause domain opens up, or as a briefer alternative. Source: Kleinman, Eisenberg and Good (1978), Annals of Internal Medicine. [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]
Steps: Ask, in your own wording, the eight areas: what the client calls the problem; what caused it; why it started when it did; what it does to them and how it works; how severe it is and whether it will last a short or long time; what treatment they should receive; the main problems it has caused; and what they fear most about it. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] Then (1) summarise the client's model back to them; (2) set your clinical model beside theirs and look for overlap; (3) negotiate a plan that both models can accept. [synthesis]
Example language (illustrative): "What do you call this trouble?" / "Why do you think it came now, and not some other time?" / "What kind of help do you think would set it right: from your people, from a doctor, from me, or a mix?"
Watch for: Mixed models are common, for example "it's spiritual, and also stress". Do not force one. Within the tradition, a duppy is described as the shadow of an improperly buried person. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] A client who links distress to a funeral that was not completed may be expressing both grief and a spiritual obligation. It is working when the agreed plan uses the client's own terms. [synthesis]

4.6 Asking about healers and community help without judgement

Purpose / when: In every assessment and at review. This covers Kumina Kings and Queens, Revival leaders, balm yards, churches and other help the client uses. [synthesis] Jamaican practitioners in one study acknowledged that traditional medicine plays a major role in treating mental illness, and the authors called for collaborative models. [source: https://journals.athmsi.org/index.php/ajtcam/article/view/1389]
Steps: (1) Normalise seeking help from several sources. (2) Ask what help was sought, from whom (role, not name, unless the client offers it), and what was helpful or unhelpful. (3) Ask whether anything that was advised conflicts with treatment, for example stopping medicine or delaying medical care. (4) Record it neutrally. [synthesis]
Example language (illustrative): "Lots of people I see get help from their church or their community as well as from services. Is there anyone like that you've gone to, or would like to go to?" / "Did anyone suggest anything that would mean changing your medicine? If so, let's bring your doctor in on that."
Watch for: Fear of the "obeah" label leading to concealment. [source: https://www.historyworkshop.org.uk/the-racist-history-of-jamaicas-obeah-laws] It is working when the client keeps you informed about community help as treatment goes on. [synthesis]

4.7 Working with cultural concepts of distress and idioms

Purpose / when: When the client describes distress in Kumina or wider Jamaican spiritual terms. DSM-5-TR says cultural concepts of distress "include idioms, explanations or perceived causes, and syndromes". [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
Steps: (1) Treat Kumina-related terms (the tradition's own concepts: ancestral spirits, the personal spirit and the shadow, the duppy, being troubled by "the wrong kind of spirit" [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf]) as idioms and explanations, not as symptoms. (2) Do not map them onto a DSM glossary entry. None of the listed DSM concepts is a Kumina concept; maladi moun or maladi dyab, for example, is Haitian, not Jamaican. [source: https://revistapsiquiatria.pt/index.php/sppsm/article/download/139/69] [synthesis] (The exact DSM-5-TR glossary list is [uncertain].) (3) Ask what the idiom implies for action, help and prognosis. (4) Assess the underlying distress (mood, anxiety, trauma, psychosis, substance use) in the usual way. [synthesis]
Example language (illustrative): "When you say a spirit is troubling you, what does that feel like day to day? What would need to happen for it to settle?"
Watch for: Two errors: treating the idiom itself as a delusion, or accepting the idiom and missing treatable illness. It is working when the client can describe both the spiritual meaning and the concrete symptoms. [synthesis]

4.8 Distinguishing normative possession (myal) from disorder

Purpose / when: When a client, family or referrer reports possession, trance, or hearing or seeing ancestors. Within Kumina, possession is called myal (spelled mayal by Warner-Lewis and Myaal by Caribbean Beat) and is understood as ancestral spirits returning. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] [source: https://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and-maps/kumina] [source: https://www.caribbean-beat.com/?p=49734] The ACIJ/JMB says the leader is held to control the spirits. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf]
Steps: (1) Establish context: did the experience happen within a Kumina ceremony under a leader's authority, or outside it (at home, at work, alone)? (2) Ask whether it was expected, welcomed and ended as the community expects, or was involuntary, unwanted and distressing. (3) Apply the diagnostic exclusions. DSM-5 dissociative identity disorder Criterion A allows identity disruption described "as an experience of possession", and Criterion D excludes what is "a normal part of a broadly accepted cultural or religious practice". Dissociative trance under other specified dissociative disorder carries a similar collective-practice exclusion. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] DSM-5-TR keeps these points in substance; its exact wording is [uncertain]. [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299] ICD-11 6B63 possession trance disorder requires replacement of identity by an external "possessing" identity that is "involuntary and unwanted". [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] ICD-11 6B62 trance disorder covers involuntary, unwanted trance outside accepted cultural or religious practice, with recurrent episodes or a single episode lasting several days, and significant distress or impairment. [source: https://www.findacode.com/icd-11/code-1807490186.html] (4) Screen for other conditions: psychotic symptoms between ceremonies, mania, substance use, neurological causes (refer for medical assessment if indicated), and trauma. A DSM-5-TR note excluding culturally sanctioned beliefs from psychotic symptoms is [uncertain: not verified]. (5) With consent, ask a cultural broker or the client's leader whether the experience is normal in their community (see 4.9). [synthesis]
Example language (illustrative): "In your community, when the spirit comes during a ceremony, how do people know it's right? Has what happened to you been like that, or different?" / "Has this happened at times or places where it wouldn't usually happen?"
Watch for: Referral letters that call ceremonial possession "psychotic". A client who says the experience is unlike ceremonial possession. Possession-like episodes with self-harm, violence or extended loss of function. It is working when the formulation explicitly says which experiences are normative and which are not, and the client agrees with that account. [synthesis]

4.9 Consulting cultural brokers and community members

Purpose / when: When you cannot tell whether an experience or belief is normative, or when the client wants their community involved. [synthesis]
Steps: (1) Ask the client whom they trust: a King or Queen, an elder, a family member, or a Jamaican colleague outside the community. (2) Get written consent that names the person, the purpose, and exactly what may be shared. (3) Ask about community norms, not about ceremony content: for example, "Would this be expected?" rather than "What happens in the ceremony?" (4) Remember that outsiders are treated as outsiders and that access depends on a connection to the community. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] [source: https://www.caribbean-beat.com/?p=49734] Use the client as the bridge. (5) The ACIJ/JMB is a heritage and documentation body. It can give general cultural background but is not a clinical or spiritual authority over any individual case. [synthesis]
Example language (illustrative): To the client: "Would it help if I spoke with someone you respect in your community about whether this is usual? You'd decide who and what I can say." To the broker: "I'm not asking about anything private to your practice, only whether what [client] describes would be expected."
Watch for: Breaches of confidentiality in small, family-based communities. Brokers with their own stake in the family. Not to be done in an emergency without consent, except as safeguarding law allows. It is working when the broker's view clarifies the formulation and the client feels respected. [synthesis]

4.10 Collaboration and referral with Kumina leadership when the client wishes

Purpose / when: When the client wants their spiritual care and their psychological care to work together, for example around a memorial obligation, ancestral distress, or returning to community life after a crisis. [synthesis]
Steps: (1) Confirm the client's wish and the limits of consent. (2) Clarify the roles: the leader holds spiritual authority, and you hold psychological care. Neither directs the other's domain. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] [synthesis] (3) Agree practical points, for example how the client will tell you about community care, and what happens if risk rises. (4) Never refer a client to Kumina, or to a particular leader, who is not already connected to it or seeking it through their own family or community route. [synthesis] (5) No formal Kumina–health-service collaboration programme is documented in the sources cited here [uncertain: not verified]. As evidence that collaboration can work in other settings: in Nigeria and Ghana, collaborative shared care between traditional and faith healers and primary care (COSIMPO; Gureje et al., The Lancet, 2020) reduced psychosis symptoms more than usual care, and reduced harmful practices. [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 reduced symptoms, but days in chains were not significantly reduced (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] These findings are from West Africa and are not about Kumina.
Example language (illustrative): "You've told me your Queen is important in this. Would you like the two kinds of help to know about each other? What would you be comfortable with me sharing, and what not?"
Watch for: Collaboration that pressures the client either way. Advice from any source to stop medicine or delay medical care. The prayer-camp findings show that collaboration alone may not end harmful practices, so keep safeguarding active. It is working when the client reports less conflict between the two kinds of help. [synthesis]

4.11 Language, interpreters and ritual language

Purpose / when: With clients most at ease in Jamaican Creole (Patwa), and when Kumina terms of Kongo origin come up. [synthesis] Warner-Lewis says Kumina ritual language mixes Jamaican Creole English with Kongo words. [source: https://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and-maps/kumina] Caribbean Beat reports that Kikongo survives in some communities but is disappearing outside specific ceremonies. [source: https://www.caribbean-beat.com/?p=49734]
Steps: (1) Offer the client the choice of speaking Creole. Use an interpreter or a Creole-speaking colleague if your own comprehension is limited. (2) Ask what everyday terms mean to the client, rather than assuming. (3) Do not ask the client to translate or teach ritual language. The ACIJ/JMB says communication with the spirits must use "the language of the ancestors". [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] [synthesis]
Example language (illustrative): "Talk whichever way feels natural. If I don't catch a word, I'll ask."
Watch for: Mishearing Creole as disordered speech, which is a known risk in assessment. [synthesis] It is working when the client switches freely into their own register.

4.12 Integrating ceremonial and possession experiences

Purpose / when: When a client brings an experience from a Kumina ceremony (for example, being possessed, a message attributed to an ancestor, or a healing ceremony) and wants to make sense of it, or finds it unsettling. [synthesis]
Steps: (1) Let the client decide how much to tell you, and do not ask for ritual detail. (2) Explore what the experience meant, what it asked of them, and how it fits their life now. (3) Distinguish feeling unsettled, which may be expected after an intense communal experience, from new symptoms such as persistent sleeplessness, intrusions, fear or loss of function. (4) Support the client in taking spiritual questions back to their leader. (5) Link any meaning they take from it to concrete goals, such as relationships, duties or rest. [synthesis]
Example language (illustrative): "You don't need to tell me anything private to your practice. What's stayed with you since then?" / "Is that a question for your Queen, or one we can work on here, or both?"
Watch for: Interpreting the experience yourself in spiritual terms (that is outside your role), or explaining it away. It is working when the client describes the experience as integrated rather than intrusive. [synthesis]

4.13 Grief, the ancestors and memorial obligations

Purpose / when: Kumina ceremonies mainly mark deaths in a family: wakes, entombments and memorials. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] Warner-Lewis also lists the cementing of graves among ceremonial "duties". [source: https://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and-maps/kumina] Bereavement may therefore carry spiritual obligations, and a client may relate distress to obligations left undone. In the tradition, an improperly buried shadow can become a wandering duppy. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf]
Steps: (1) Ask about the death, the rites that took place or are still due, and who in the family or nation is responsible for them. (2) Assess grief, including prolonged grief, depression and trauma, in the usual way. (3) Treat obstacles to completing obligations (cost, distance, migration, family conflict) as real stressors, and problem-solve them. (4) Leave the spiritual side to the community's authority. (5) For diaspora clients unable to attend rites in Jamaica, explore the guilt and the alternatives the client and family themselves consider acceptable. [synthesis]
Example language (illustrative): "In your family, what still needs to happen for your father to be properly at rest? What's standing in the way?"
Watch for: Grief that is complicated by a sense of spiritual danger or blame. Family conflict over the rites. It is working when the client can grieve and plan for the obligations without overwhelming fear. [synthesis]

4.14 Addressing historical suppression, racism and stigma

Purpose / when: When mistrust, shame or concealment is affecting care, and as part of the CFI's clinician-patient relationship domain. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Steps: (1) Know the history. Obeah was first outlawed in 1760 after Tacky's Rebellion. The 1854 Obeah Act equated obeah with myalism and made it punishable by flogging and imprisonment. Revivalists and balm healers were prosecuted. The core of the 1898 Act remains in force, though the last conviction found was in 1964. [source: https://www.historyworkshop.org.uk/the-racist-history-of-jamaicas-obeah-laws] Drums were historically disguised to hide them from plantation overseers. [source: https://www.caribbean-beat.com/?p=49734] (2) Invite the client to say whether they have experienced disrespect of their faith from services. (3) Acknowledge it without defending the system. (4) Repair practical barriers, for example by choosing a different language for records or a clinician the client trusts. [synthesis]
Example language (illustrative): "African-Jamaican religions have a long history of being policed and looked down on. If that's ever shown up in how you've been treated, I'd want to know."
Watch for: Lecturing the client about their own history; let them lead. It is working when the client discloses more over time. [synthesis]

4.15 Working with families and nations

Purpose / when: Kumina is often learned in the family: the Gleaner describes group members brought up in Kumina households and taught by their parents, while others join a group by invitation. [source: https://old.jamaica-gleaner.com/gleaner/20091011/ent/ent9.html] Membership through marriage or initiation is reported in a tertiary overview. [source: https://en.wikipedia.org/wiki/Kumina] [uncertain: secondary, unverified] Family decisions and duties are therefore often collective. [synthesis]
Steps: (1) Map the client's family and community network, using the CFI Social Network module. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] (2) Identify both supports and conflicts. (3) Offer family sessions if the client wishes, with clear agreements on confidentiality. (4) Respect hierarchies the client accepts, while keeping the client's own goals central. [synthesis]
Example language (illustrative): "Who in the family would need to be part of this decision? Is there anyone you'd want kept out of it?"
Watch for: Coercion, and pressure about marriage, membership or leaving the tradition. Young people torn between Kumina and other faiths or a secular life. It is working when family involvement increases support without overriding the client. [synthesis]

4.16 Spiritual crisis and acute distress

Purpose / when: When spiritual experiences are overwhelming, frightening or out of context (for example, possession-like states outside ceremony, or terror about a duppy or a spirit), or when risk appears. [synthesis]
Steps: (1) Ensure immediate safety and do a standard risk assessment for suicide, self-harm, harm to others and self-neglect. (2) Use grounding and stabilisation in the client's own terms. (3) Arrange medical review for first-episode or atypical presentations, to exclude organic causes, substance effects and medication effects. (4) Offer contact with the client's spiritual leader, with consent, as part of the support around them. (5) Revisit the differential (4.8) once things have settled. [synthesis]
Example language (illustrative): "You're safe here right now. Can you feel your feet on the floor? Who would you want with you tonight: family, your Queen, or both?"
Watch for: Ascribing everything to spiritual crisis while missing mania, psychosis or delirium. Equally, admitting someone to hospital for normative experiences. It is working when arousal drops and the client can describe what happened. [synthesis]

4.17 Safeguarding and urgent medical care

Purpose / when: Whenever any practice by any party, community or otherwise, risks harm: physical restraint, beating, deprivation of food or sleep, sexual abuse, harm to children, or delay of urgent medical care. [synthesis] None of the sources cited here reports such harms as features of Kumina. The duty is general, and is the same for any tradition or service. [uncertain: not verified]
Steps: (1) Ask directly and neutrally about safety in any setting where the client gets help. (2) Follow local safeguarding and reporting law, consulting with your service. (3) Keep the client's spiritual framework separate from any harmful act. (4) Ensure urgent physical symptoms get medical assessment, and never present a ceremony as a treatment for physical or mental disease. [synthesis]
Example language (illustrative): "Wherever people go for help, I always ask: has anything happened that hurt you, frightened you, or that you didn't agree to?"
Watch for: Over-reporting of normal religious practice (for example, drumming, dancing or a night-long ceremony) as abuse, and under-reporting of real harm framed as tradition. It is working when concerns are acted on, and the client's community ties are not harmed unnecessarily. [synthesis]

4.18 Questions about medicines, herbs or substances

Purpose / when: When the client raises herbal remedies, rum or cannabis in a spiritual context, or asks whether to continue medication. The ACIJ/JMB mentions rum in a ceremonial context, and Warner-Lewis describes rum libations at the opening of a ceremony. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf] [source: https://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and-maps/kumina] A link between cannabis and Kumina is reported in a tertiary overview. [source: https://en.wikipedia.org/wiki/Kumina] [uncertain: secondary, unverified]
Steps: (1) Assess substance use and its mental-health effects as you would for anyone, without judging the religious context. (2) Never advise starting, stopping or changing a medicine or a remedy; refer the client to their prescriber or GP. (3) Ask about herbal products so the prescriber can check for interactions. (4) Note psychiatric risks from cannabis, such as psychosis, where they apply. [synthesis]
Example language (illustrative): "I can't advise on medicines or remedies, but your doctor needs to know everything you're taking so it's all safe together. Shall we write a list for them?"
Watch for: Concealment out of fear of judgement. Medication stopped because of competing advice. It is working when the prescriber has a full picture. [synthesis]

4.19 Diaspora clients

Purpose / when: With Jamaican-heritage clients in the UK, North America or elsewhere, who may be far from their nation, their parish and their rites. [synthesis]
Steps: (1) Use the CFI Cultural Identity and Immigrants and Refugees modules where they fit. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] (2) Explore the client's ties to Kumina now: active, ancestral memory, or rediscovered heritage. (3) Explore the losses of migration, including missed funerals and rites. (4) Support the client's own routes back to community where they want them, without directing them to any particular group. [synthesis]
Example language (illustrative): "What does your family's Kumina heritage mean to you living here? Is it something you're connected to now, or something you're looking for?"
Watch for: Heritage-seeking that leads a client to unvetted commercial "ceremonies" outside community pathways. Encourage connection through family and recognised community routes. It is working when the client's sense of identity and belonging strengthens. [synthesis]

5. Handling problems

The sources do not address therapy problems specific to Kumina. All guidance in this section is [synthesis] unless a source is tagged.

The client won't talk about their faith. This may be self-protection, given the history of criminalisation and stigma. [source: https://www.historyworkshop.org.uk/the-racist-history-of-jamaicas-obeah-laws] Response: say plainly that you will not judge or label their faith, that you won't ask for anything private to their practice, and that they choose what to share. Return to it later through the CFI's help-seeking questions rather than pressing now.
The client asks you to take part, or to say whether the spirits are real. Response: decline warmly and name your role: "That's for you and your Queen; my part is how you're coping." Do not attend ceremonies unless the client and the community's leader invite you, and even then go only as a guest, not in any role. [source: https://acij-ioj.org.jm/wp-content/uploads/2022/03/FACT-SHEET-1-KUMINA.pdf]
The client and their family hold competing explanations (for example, spiritual versus mental illness). Response: use the CFI and the Informant Version to set out both views (4.3). Look for a plan that both can accept, for example medical review plus community support. Do not side with the family against the client.
The client is stuck: no change despite a plan that fits culturally. Response: revisit the differential (4.8). Check for unrecognised depression, trauma, psychosis, substance use or medical illness. Ask whether unfinished obligations (4.13) or family conflict are maintaining the problem. Consult a cultural broker with consent.
Non-adherence to medication or therapy because of competing advice. Response: explore the client's model (4.5) without blame. Involve the prescriber, and never advise on the medicine yourself. Offer, with consent, to share information with the community leader so that the advice is not experienced as contradictory.
Rupture after you used a clinical label (for example "psychosis" or "delusion") for a spiritual experience. Response: acknowledge that the word landed badly, explain what you meant in plain terms, separate the experience from the diagnosis, and invite the client to correct you. Check whether records need wording that is accurate and also respectful.
A referrer, team or record has labelled possession as illness. Response: put the cultural formulation in writing, with the CFI findings and the DSM and ICD exclusions (4.8). Ask for a second opinion where diagnosis or detention is being considered on cultural material alone.
The opposite error: the team accepts "it's spiritual" and misses illness. Response: document the symptoms that fall outside community norms (4.8, step 2), and ensure medical and psychiatric review.
Overwhelm during sessions when discussing spirits, death or the ancestors. Response: slow down, use grounding (4.16), titrate, and agree a stop signal. Offer the client contact with their community supports between sessions.
Confidentiality worries in a small community. Response: agree specifically who may be told what. Avoid consulting a broker who knows the family unless the client chooses them. Store records with neutral wording.
Safeguarding concern arising in any healing setting. Response: follow 4.17. Act on the harm while respecting the tradition. Note that in the Ghanaian prayer-camp trial, adding psychiatric care reduced symptoms but did not significantly reduce days in chains, so collaboration alone may not remove harmful practice. [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]
The therapist feels pulled towards fascination, or towards discomfort. Response: take it to supervision. Watch for questions that serve your curiosity rather than the client's goals (4.1).
The client seeks commercial or online "Kumina" or "African ceremonies" outside their family or community. Response: explore what they hope for. Encourage connection through family and recognised community routes. Do not recommend any provider.

Sources

Web sources:

Books and papers cited:

Bilby, K. & Fu-Kiau kia Bunseki (1983). Kumina: A Kongo-Based Tradition in the New World. Brussels: Centre d'étude et de documentation africaines. (As cited by Warner-Lewis.) [uncertain: not verified]
Warner-Lewis, M. (1977). The Nkuyu: Spirit Messengers of the Kumina. Mona: Savacou. (As cited by Warner-Lewis.) [uncertain: not verified]
Ryman, C. (1984). "Kumina: Stability and Change." ACIJ Research Review 1: 81–128. (As cited by Warner-Lewis.) [uncertain: not verified]
Munroe, T. (2024). "Kumina: Kumina! Afro-Jamaican Religion, Education, and Practice…" In N. N. Wane (ed.), Education, Colonial Sickness. Palgrave Macmillan. (As cited in a secondary source.) [uncertain: secondary, unverified]
Kleinman, A., Eisenberg, L. & Good, B. (1978). "Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research." Annals of Internal Medicine 88: 251–258.
Lewis-Fernández, R., Aggarwal, N. K., Lam, P. C., et al. (2017). "Feasibility, acceptability and clinical utility of the Cultural Formulation Interview." British Journal of Psychiatry 210(4): 290–297.
Gureje, O., Appiah-Poku, J., et al. (2020). Collaborative shared care for psychosis in Nigeria and Ghana (COSIMPO). The Lancet.
Ofori-Atta, A., Attafuah, J., Jack, H., Baning, F., Rosenheck, R., et al. "Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial." British Journal of Psychiatry 212(1). Year listed as 2019 by the repository; volume 212 is the 2018 volume. [uncertain]

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