Beyond “Ch'jurnaaq”: Recognizing Maya Indigenous People's perceptions of psychosis and recovery in Santiago Atitlán, Guatemala

Psychotic conditions are major causes of disability in Latin America, where mental healthcare is mostly limited and inadequate. Indigenous People throughout this region experience additional barriers to mental health care, compounded by structural inequities and diverse health practices. This study in Guatemala described the Maya Indigenous People’s perceptions about psychosis, its symptoms, causes, responses to, and recovery. Results will inform the design of a community-led, culturally grounded program for people living with psychosis (PLWP). We conducted free listing and semi-structured interviews in Spanish or Maya Tz’utujil language. Participants were PLWP, family caregivers, community leaders, and mental health, traditional, and primary care providers. We followed Kleinman’s explanatory model and elicited locally meaningful recovery outcomes. Our team performed a matrix-based thematic analysis. We interviewed 30 participants. Key findings included (1) varying terms and understandings of psychosis symptoms and causes across participant subgroups; (2) extremely limited care, pluralistic treatment practices, and tensions between biomedical and traditional systems; (3) matching community expectations and recovery outcomes, with contrasting views between PLWP, who expressed hope, and family caregivers and providers, who expressed doubts and resignation; and (4) stigma as a cross-cutting barrier towards care and recovery across family-, community- and provider-levels linked to social exclusion among PLWP and family caregivers. Effective community programs must respond to local definitions of recovery, incorporate biomedical, traditional, and spiritual approaches, involve PLWP and family caregivers, and address stigma. Engaging Indigenous peoples’ practices in programs for PLWP can improve their acceptability, reach, and effectiveness. • Explored Indigenous Maya views of psychosis using Kleinman’s explanatory model framework • Observed tensions between biomedical and traditional treatment approaches • Recovery linked to community expectations of healthy individuals • Stigma was a major barrier to care and social participation