Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 145
Guide XI-145

Evil-eye removal and lead pouring

Mediterranean and Middle East
A 35 · L 54 · M 1114 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the Turkish nazar belief and kurşun dökme (lead pouring) as documented in Turkish folklore scholarship (Çıblak 2004), set beside Italian malocchio, Greek Orthodox vaskania and Jewish ayin hara as community and religious sources describe them; the psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI). This is not a psychotherapy. It is a family of folk beliefs and remedies held across the Mediterranean, the Middle East and their diasporas. The guide describes it so that a psychotherapist can work alongside it; the therapist does not perform evil-eye diagnosis, removal or lead pouring.

What it is, as sources describe it. In Turkish folk culture, nazar (the evil eye) is held to be harm caused by a look, usually from an envious or covetous person, though excessive admiration or affection, even a parent's, can also cause it. People attribute to it sudden illness, a child's constant crying, loss of appetite, headaches, weakness and marital quarrels, as well as broken objects, vehicle accidents, failed harvests and sick animals [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf]. Protection relies on nazarlık (blue eye beads and many other objects), on saying maşallah, and on amulets written by religious figures. The best-known remedy is kurşun dökme, in which a person said to hold an ocak (a hereditary healing gift, usually passed from an older woman to a younger one in the family) melts lead and pours it into water near the affected person and reads the shapes it forms; the ocak holder is typically paid [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf]. Related remedies the same study records include extinguishing embers in water, fumigation with üzerlik (wild rue) smoke and salt rituals. Belief is reported as widespread, strongest among women, older and rural people and the poor, but also present among educated people who may half-believe and still act on it [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf].

The same belief is called mal'occhio by Italians, mal de ojo by Latinos and ayin hara by Jews [source: https://www.timesofisrael.com/check-yourself-before-you-hex-yourself-an-experts-guide-to-the-evil-eye/]. In Italian and Italian-American families, an older woman in the neighbourhood may be known for the power to remove it [source: https://folklore.usc.edu/?p=31515]; oil dropped in water is a commonly reported diagnostic sign in family practice [source: https://www.timesofisrael.com/check-yourself-before-you-hex-yourself-an-experts-guide-to-the-evil-eye/]. In Jewish tradition the evil eye has roots in Midrash and Talmud and is handled mainly through preventive customs (a protective Yiddish phrase, the hamsa, spitting three times) rather than removal rites [source: https://www.myjewishlearning.com/article/evil-eye-in-judaism/]. In Greek Orthodoxy, vaskania is addressed by the priest's prayers, while the Church forbids resorting to lay "readers" for magical rites [source: https://saintandrewgoc.org/blog/2020/1/29/the-orthodox-tradition-of-exorcising-vaskania-evil-eye]. The Greek lay term xematiasma for folk removal, and lead pouring in Greek, Jewish and other Mediterranean communities, are [uncertain: not verified].

How change is understood. Within the tradition, distress or misfortune has an external, interpersonal cause (another's envious gaze); removing or deflecting that influence restores the person. For the psychotherapist, change comes from understanding the client's explanatory model, separating culturally normative belief from disorder, making sure medical and safety needs are met, and working with the client's concerns (envy, conflict, vulnerability, family obligations) inside a frame the client recognises [synthesis].

2. Framework

No source sets phases for a therapist working with clients who hold evil-eye beliefs; the stages below are a [synthesis] built on the CFI's own structure and intended use.

Phase 1: Engagement and cultural assessment (usually sessions 1–2, can extend). Goal: understand the problem in the client's terms. Use the core CFI's four domains: cultural definition of the problem; perceived cause, context and support; self-coping and past help seeking; current help seeking [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. Add supplementary modules as needed. Move on when you can state, in the client's words, what they call the problem, what they believe caused it, what they have done about it and what they expect from you.

Phase 2: Formulation and safety screen (sessions 2–3). Goal: decide whether the evil-eye attribution sits alongside a mental disorder, a medical problem, both or neither, and check for physical risks from remedies (molten lead, lead exposure, smoke) and for delay of needed medical care. The CFI supports clinical understanding but is not meant to be the only basis for diagnosis [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. Move on once risks are addressed and the client agrees with a shared summary.

Phase 3: Collaborative plan (one session, revisited). Goal: agree goals that respect the client's beliefs and use their resources (family, faith community, religious leaders) where the client wishes. Move on when goals are written in language the client accepts.

Phase 4: Treatment and integration (length set by the presenting disorder, not by the belief). Goal: deliver the evidence-based treatment indicated for any disorder present, keeping the explanatory model in view and revisiting the CFI modules as needed; modules can be repeated during treatment [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].

Phase 5: Review and ending. Goal: check whether the client's own measures of improvement (as named in the CFI) have been met, and plan for relapse in terms the client uses [synthesis].

Format: individual sessions, with family members by consent (the CFI Informant Version suits a relative's view) [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]. CFI administration time is [uncertain]; the field trial reports later interviews took less time but gives no minutes in its abstract [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/].

3. Guiding principles

  • The belief belongs to the client's world, not to the diagnosis. Holding a belief in the evil eye is common and culturally shared; it is not in itself a delusion or a symptom [synthesis, consistent with DSM-5-TR's cultural concepts of distress: source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf].
  • Attribute, neither affirm nor dismiss. Speak of the evil eye as the client and their tradition hold it ("in your family, nazar is understood as…"), never as established fact or as nonsense [synthesis].
  • Authority sits outside the therapy room. Removal is done by recognised holders (an ocak holder in Turkish practice; a known older woman in Italian families; the priest in Orthodox practice), and religious bodies may object to folk remedies. The therapist neither performs nor prescribes them [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf] [source: https://saintandrewgoc.org/blog/2020/1/29/the-orthodox-tradition-of-exorcising-vaskania-evil-eye].
  • Expect internal disagreement. Within the same faith, folk and official views differ: Islamic sources accept the evil eye but forbid reliance on amulets and beads [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf]; a Turkish newspaper calls lead pouring impermissible (caiz değildir) and superstition [source: https://www.takvim.com.tr/haberler/2022/05/06/diyanete-gore-kursun-dokturmek-gunah-mi-kursun-dokturmek-caiz-mi-kursun-dokme-nedir-nasil-yapilir-ne-ise-yarar]; the official Diyanet position is [uncertain: not verified]. Clients may feel conflicted or ashamed; do not take sides.
  • Physical safety first. Molten lead brings burn and lead-exposure risks; the EU stopped sale of household lead-pouring sets in 2018 because of lead's toxicity [source: https://www.oekotest.de/freizeit-technik/EU-Gesetz-Bleigiessen-ist-jetzt-verboten-_600757_1.html]. Ask, document, route to a physician.
  • Medical care is never delayed. Sudden illness in a child, attributed to nazar, still needs medical assessment [synthesis].
  • Envy and relationships are workable content. The belief often encodes real interpersonal concerns (envy, boasting, rivalry, vulnerability after success); these can be explored without challenging the belief [synthesis, drawing on causes named at source: https://www.timesofisrael.com/check-yourself-before-you-hex-yourself-an-experts-guide-to-the-evil-eye/].
  • Use the client's measures. Ask what would show the problem is resolved and track that [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
  • Consent and confidentiality govern any contact with healers, clergy or family [synthesis].
  • Cultural humility over expertise. Practices vary by region, family and generation; treat the client as the authority on their own version [synthesis].

4. Intervention inventory

All interventions below are the psychotherapist's own culturally responsive work. None of them is evil-eye diagnosis, removal or lead pouring, which belong to the tradition's own holders. Example language is illustrative throughout.

4.1 Cultural humility and self-examination

  • Purpose / when: before and during work with any client who mentions nazar, malocchio, ayin hara, mal de ojo or protective charms; prevents both mockery and over-identification [synthesis].
  • Steps: (1) Note your own reaction to the belief (amusement, discomfort, familiarity from your own family). (2) Check assumptions about class, education or religiosity; the belief is also held by educated, better-off people [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf]. (3) Avoid labels such as "superstition" or pejorative names for healers in speech and notes; use the client's terms. (4) Take any strong reaction to supervision.
  • Example language (illustrative): "I know a little about nazar, but every family understands it differently. Can you teach me how it works in yours?"
  • Watch for: the client testing whether you will laugh; relief when you ask with curiosity. Working: the client volunteers details they had withheld.

4.2 Core Cultural Formulation Interview

  • Purpose / when: first assessment, or whenever the evil eye is named as a cause. The CFI's 16 questions clarify the problem from the perspective of the person and their social network, its meaning, sources of help and expectations of services [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
  • Steps: (1) Introduce it as wanting to understand the problem in the client's own way. (2) Domain 1, cultural definition: what they call the problem and how they would describe it to family. (3) Domain 2, cause, context and support: why they think it happened, what others in their family or community think, stressors and supports, the role of identity (ethnicity, faith, migration). (4) Domain 3, self-coping and past help seeking: what they have done, including protective objects, prayers, consulting an ocak holder, a priest, imam, rabbi or an older relative, and any barriers. (5) Domain 4, current help seeking: what kind of help they want now and any concerns about you (language, discrimination, being judged). (6) Summarise back in their words. The form may be reproduced by clinicians for use with their patients; modifying or translating it needs APA permission [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
  • Example language (illustrative): "Some people I work with understand their troubles as coming from someone's envious look. Others see it differently. How do you and the people close to you make sense of what's been happening?"
  • Watch for: guardedness if the client expects ridicule; disagreement between client and family about cause. Working: you can state the client's model accurately and they confirm it.

4.3 CFI supplementary modules

  • Purpose / when: deeper assessment as add-ons or standalone, at first evaluation or later; modules include Explanatory Model; Spirituality, Religion and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Social Network; Psychosocial Stressors; 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) Use Spirituality, Religion and Moral Traditions when the client is torn between folk remedies and their faith's teaching. (2) Use Explanatory Model when the evil eye is the main cause offered. (3) Use Social Network and Psychosocial Stressors when a named envious person is part of the story. (4) Use School-Age Children and Adolescents and Caregivers when a parent attributes a child's illness to nazar. (5) Use Immigrants and Refugees for diaspora clients for whom protective objects link to home. (6) Use the Informant Version with a relative (17 questions) [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf].
  • Example language (illustrative): "You said your imam doesn't approve of lead pouring, but your grandmother swears by it. How do you hold both of those?"
  • Watch for: shame about practising something one's religious leaders disapprove of. Working: the client can speak about both views without defending either.

4.4 Explanatory-model inquiry (Kleinman)

  • Purpose / when: to map the client's own theory of the problem, especially when it differs from a biomedical one. Kleinman, Eisenberg and Good (1978) set out questions on what the problem is called, its cause, why it started when it did, how it works, how severe it is and how long it will last, what treatment is needed, the chief problems it causes and what is feared most (paraphrased) [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader].
  • Steps: (1) Ask the questions conversationally, not as a checklist. (2) Note who is thought to have cast the eye and whether it was deliberate; sources describe both envious intent and unintended admiration as causes [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf]. (3) Ask what has already been done and what the client expects of each helper (healer, clergy, doctor, you). (4) Write a short two-column summary: client's model / clinical view, with areas of overlap.
  • Example language (illustrative): "What do you fear most about this? … And if the nazar were lifted, what would be different in your life?"
  • Watch for: fixed blame on one person leading to conflict or threats; an explanation that leaves no room for medical care. Working: shared goals emerge from the overlap column.

4.5 Using the cultural-concept-of-distress lens

  • Purpose / when: to read the evil eye as an idiom of distress and a perceived cause rather than as a symptom. DSM-5-TR describes cultural concepts of distress as including idioms, explanations or perceived causes, and syndromes [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]. Mal de ojo appeared in DSM-IV-TR's glossary of culture-bound syndromes and is not among the nine DSM-5 glossary concepts [source: https://thefpr.org/dsm-5-on-culture-a-significant-advance/]; whether DSM-5-TR names it in its text is [uncertain: not verified].
  • Steps: (1) Ask whether nazar is the name for the distress itself (idiom), the cause (explanation), or a cluster of symptoms. (2) Map the symptoms the client links to it onto standard assessment (sleep, mood, anxiety, somatic complaints). (3) Avoid assuming that believing in it explains the symptoms away, or that the symptoms disprove the belief.
  • Example language (illustrative): "When you say you've been 'caught by the eye', what do you notice in your body and in your mood?"
  • Watch for: missing a treatable depression or anxiety disorder because it is framed as nazar. Working: the client accepts symptom treatment as compatible with their belief.

4.6 Asking about remedies and healers without judgement

  • Purpose / when: at assessment and whenever symptoms change; clients often do not volunteer that they have consulted an ocak holder, a neighbourhood healer or clergy, especially if their faith disapproves [synthesis; disapproval documented at source: https://saintandrewgoc.org/blog/2020/1/29/the-orthodox-tradition-of-exorcising-vaskania-evil-eye].
  • Steps: (1) Normalise: many families use protective objects and remedies. (2) Ask what was done, by whom (relationship, not name), how often, at what cost, and how the client felt afterwards; sources note the ocak holder is usually paid [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf]. (3) Ask whether any remedy involved heat, molten metal, smoke or substances taken by mouth (feeds 4.8). (4) Do not ask for the method, words or prayers used; they are not needed and may be private. (5) Record in neutral terms.
  • Example language (illustrative): "Lots of families have their own ways of dealing with nazar. Has anyone done anything for you, like lead pouring or prayers? I'm asking so I understand the whole picture, not to judge it."
  • Watch for: fear that disclosure will be mocked or reported; financial strain from repeated paid sessions. Working: the client mentions remedies spontaneously in later sessions.

4.7 Distinguishing normative belief from disorder

  • Purpose / when: whenever the belief is intense, new, idiosyncratic or impairing. The aim is to avoid both pathologising shared belief and missing illness [synthesis].
  • Steps: (1) Shared vs idiosyncratic: is the belief held in the same form by family and community? Ask a relative or cultural broker if unsure (4.13). (2) Form: a culturally shared attribution of misfortune to envy differs from fixed, elaborated beliefs that specific people are watching or harming the client, with other psychotic features; consider persecutory delusion only on the usual clinical criteria. (3) Rituals: protective habits (a bead, saying maşallah) are normative; repetitive, time-consuming, distressing checking or neutralising that the client cannot stop and that goes beyond family norms raises the question of OCD or health anxiety. (4) Somatic symptoms: weakness, headache or loss of appetite attributed to the eye still need medical and psychiatric assessment. (5) Trance and possession codes (DSM-5-TR dissociative presentations; ICD-11 6B62 trance disorder and 6B63 possession trance disorder, both requiring the state to be involuntary, unwanted and outside accepted cultural or religious practice) rarely apply to evil-eye belief and should be considered only if such states occur [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]. (6) Document reasoning.
  • Example language (illustrative): "How do your mother and aunts see this? Do they think about it the way you do, or do you see it differently from them?"
  • Watch for: your own unfamiliarity making ordinary belief look bizarre; equally, cultural explanation masking psychosis, severe depression or OCD. Working: a formulation the client, family and colleagues can all follow.

4.8 Physical-safety and lead-exposure screen

  • Purpose / when: whenever lead pouring or other heat- or smoke-based remedies are used, especially with children, pregnant clients or repeated sessions.
  • Facts to hold: lead-pouring metal is mostly lead; lead is toxic even in small amounts, can reach the mouth via the fingers and is toxic as inhaled fumes; in children it can harm the nervous system, liver and kidneys; household lead-pouring sets have not been sold in the EU since 2018 under its chemicals rules [source: https://www.oekotest.de/freizeit-technik/EU-Gesetz-Bleigiessen-ist-jetzt-verboten-_600757_1.html]. Chronic low-level lead exposure is linked to anaemia, high blood pressure, kidney problems and lower IQ, and lead dust can be carried home; lead has also been applied to children as evil-eye protection [source: https://www.mcgill.ca/oss/article/pseudoscience/evil-eye]. Pouring molten metal near a person carries an obvious risk of splash burns [source: https://www.mcgill.ca/oss/article/pseudoscience/evil-eye]; documented burn case series specific to this practice are [uncertain: not verified].
  • Steps: (1) Ask how often lead pouring has happened, whether it was done at home, whether children handled lead or were nearby, and whether anyone was burned. (2) Ask about lead-containing amulets or substances. (3) If exposure is plausible, recommend the client discuss it with their physician or paediatrician, who decides on testing; do not interpret symptoms yourself. (4) Burns: advise prompt medical care. (5) Frame advice as safety, not as an attack on the practice. (6) Never advise on medicines.
  • Example language (illustrative): "I'm not going to tell you what to believe about lead pouring. I do need to mention that lead can be harmful, especially for children. Would you be willing to mention it to your doctor next time?"
  • Watch for: defensiveness; families switching to non-heat or non-lead remedies themselves. Working: the client reports the medical check or a safer family choice.

4.9 Safeguarding children and vulnerable adults

  • Purpose / when: when a child's illness is attributed to nazar (sources list a child's constant crying and illness among attributed effects [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf]) or a remedy exposes a child to heat, lead or smoke.
  • Steps: (1) Check that the child has seen a doctor for the symptoms. (2) Screen exposure as in 4.8. (3) Recognise that protective beads, prayers and blessings are not abuse; avoid misreading tradition as abuse. (4) Where medical care is being delayed for a serious illness, or a child has been burned or seriously exposed, follow your local safeguarding procedure and consult your safeguarding lead; harm hidden as tradition is still harm [synthesis]. (5) Keep parents informed where safe. (6) Never name minors in shared records beyond what procedure requires.
  • Example language (illustrative): "You've done what your family trusts to protect her. Alongside that, I'd want a doctor to look at her fever today, because some causes need treatment quickly."
  • Watch for: parental fear that doctors will dismiss their beliefs; repeated attendance at paid remedies instead of clinics. Working: medical care and family practice proceed together.

4.10 Working with envy, exposure and relationships

  • Purpose / when: when the evil-eye story centres on a named envious person, recent success, a new baby, marriage or migration success. Sources describe envy, boasting and admiration as core triggers, and marital quarrels among attributed effects [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf] [source: https://www.timesofisrael.com/check-yourself-before-you-hex-yourself-an-experts-guide-to-the-evil-eye/].
  • Steps: [synthesis] (1) Explore the relationship with the suspected person: history, actual conflicts, obligations. (2) Explore the client's own feelings about success and visibility (guilt, fear of standing out). (3) Use standard methods for the presenting problem (e.g. problem-solving, interpersonal work, managing anxiety) within the client's frame. (4) If blame risks hostility or threats toward the suspected person, address it directly and assess risk.
  • Example language (illustrative): "It sounds as if, after the promotion, you felt everyone's eyes on you. What has that been like, apart from the nazar itself?"
  • Watch for: escalation of family feuds; the client feeling you are reinterpreting their belief as 'just psychology'. Working: the client can talk about the relationship and the belief side by side.

4.11 Collaboration with clergy, community figures and healers (client-led)

  • Purpose / when: when the client wants their faith leader, a respected elder or a family healer involved. No formal referral programme for evil-eye practitioners is documented; collaboration is case by case [synthesis]. Trials elsewhere show that structured collaboration between traditional or faith healers and health services can work: in Nigeria and Ghana (COSIMPO; Gureje et al., The Lancet, 2020) collaborative shared care reduced psychosis symptoms and harmful practices more than usual care [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306]; in a Ghanaian prayer-camp trial (Ofori-Atta et al., Br J Psychiatry 212(1)) adding psychiatric care reduced symptoms, though days in chains were not significantly reduced [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]. These concern psychosis and other traditions; transfer to evil-eye practice is [synthesis].
  • Steps: (1) Ask whom the client trusts and what role they want that person to have. (2) Recognise each figure's authority as their community gives it: Orthodox priests hold the Church's prayers against vaskania [source: https://saintandrewgoc.org/blog/2020/1/29/the-orthodox-tradition-of-exorcising-vaskania-evil-eye]; Islamic and Jewish leaders may hold views that differ from family folk practice [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf] [source: https://www.myjewishlearning.com/article/evil-eye-in-judaism/]. (3) Obtain written consent that specifies what may be shared. (4) Share only what supports the client (e.g. that they are in therapy, safety concerns). (5) Do not refer clients to paid healers yourself, and do not encourage remedies involving molten metal [synthesis].
  • Example language (illustrative): "Would it help if your priest and I were both aware of what you're going through? You decide what I can say to him."
  • Watch for: the client feeling pushed toward religion or away from it; confidentiality risk in small communities. Working: consistent messages from therapist and trusted figure.

4.12 Working with families and intergenerational practice

  • Purpose / when: when relatives (often grandmothers or mothers, in whom the healing gift is passed [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf]) arrange remedies, or generations disagree.
  • Steps: (1) Use the CFI Informant Version with a relative, with the client's consent [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]. (2) Acknowledge protective intent. (3) Help the family agree on what each person does: family remedies, faith practice, medical care, therapy. (4) Where a younger client rejects the practice, support their choice without shaming the older generation [synthesis].
  • Example language (illustrative): "Your grandmother clearly cares a great deal. Can we find a way for her care and the doctor's care to work together?"
  • Watch for: the client being caught between loyalties; family members feeling accused. Working: less conflict about help-seeking.

4.13 Interpreters and cultural brokers

  • Purpose / when: when language or community knowledge limits understanding, or when you cannot judge whether a belief is normative [synthesis].
  • Steps: (1) Use a trained interpreter, not a family member, for assessment. (2) Brief the interpreter that terms such as nazar, ocak or malocchio should be rendered as said, not explained away. (3) With consent, ask a cultural broker (a community worker or colleague from the same background) whether the client's account fits common practice. (4) Check confidentiality in small communities.
  • Example language (illustrative): to the interpreter: "Please keep the client's own words for the evil eye and tell me if a term has no English equivalent."
  • Watch for: interpreters softening or editorialising. Working: clearer, richer accounts.

4.14 Integrating remedy experiences and protective objects

  • Purpose / when: after the client has had a remedy, or when a protective object matters to them [synthesis].
  • Steps: (1) Ask what the experience meant: relief, fear, renewed blame, feeling cared for. (2) Allow protective objects in sessions and plans (e.g. a bead the client keeps on them), as long as safety is not affected. (3) Link any relief to the client's own goals and coping. (4) If a remedy 'failed', note that sources record people usually attribute failure to the strength of the evil eye rather than to the method [source: https://turkoloji.cu.edu.tr/HALKBILIM/nilgun_ciblak_nazarlik.pdf], which can lead to repeated or escalating remedies; review risks then.
  • Example language (illustrative): "After the lead pouring you said you felt lighter for a few days. What helped most about it? Can we keep some of that going?"
  • Watch for: dependence on repeated paid remedies; despair when relief fades. Working: the client uses a mix of family, faith and therapy supports.

5. Handling problems

  • Client expects ridicule and stays guarded. Name that many people fear being judged for this; ask with curiosity (4.1, 4.6); do not argue the belief [synthesis].
  • Client asks whether you believe in the evil eye. Answer honestly and briefly, then return to their experience ("I don't hold that belief myself, but I take seriously that it matters to you and your family") [synthesis].
  • Client wants you to recommend a healer or remedy. Explain that this is outside your role; suggest they ask their own family or faith community; mention safety concerns about molten lead (4.8) [synthesis].
  • Belief blocks medical or psychiatric treatment. Work within the model: "The nazar may need your family's care, and the symptoms also need the doctor's care"; involve trusted figures (4.11); never advise on medicines, refer questions to the prescriber [synthesis].
  • Stuck: repeated remedies, no change. Revisit the explanatory model, screen for depression, anxiety, OCD or a medical cause, and ask what the client would count as improvement [synthesis].
  • Escalating blame of a named person. Assess risk of conflict or harm; work on the relationship (4.10); safety plan if threats emerge [synthesis].
  • Religious conflict and shame (client uses a remedy their faith forbids). Use the Spirituality, Religion and Moral Traditions module; help them clarify their own position; offer contact with their faith leader if wanted [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
  • Overwhelm or panic after a remedy reading (e.g. fear about who cast the eye). Ground, contain, and treat as acute anxiety; follow up on interpersonal fears [synthesis].
  • Rupture: client feels you reduced their belief to psychology. Acknowledge, apologise, re-state their model accurately and ask how to proceed (4.4) [synthesis].
  • Non-adherence to medical advice on lead exposure. Repeat once, respectfully, with the reason; respect adult choice; act under safeguarding procedure if a child is at risk (4.9) [synthesis].
  • Psychosis, mania or severe OCD presenting through evil-eye content. Treat the disorder by standard care; keep the cultural content in the formulation; involve the family carefully (4.7, 4.12) [synthesis].
  • Therapist from the same culture. Watch for assuming shared meanings; still use the CFI; take over-identification to supervision [synthesis].

Sources

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