[10] The racism and violence that occurred during the United States occupation of Haiti, which began in 1915, inspired black nationalism among Haitians and left a powerful impression on the young Duvalier.

[16] In 1946, Duvalier aligned himself with President Dumarsais Estimé and was appointed Director General of the National Public Health Service.

In 1949, he served as Minister of Health and Labor, but when Duvalier opposed Paul Magloire's 1950 coup d'état, he left the government and resumed practicing medicine.

He resorted to noiriste populism, stoking the majority Afro-Haitians' irritation at being governed by the few mulatto elite, which is how he described his opponent, Déjoie.

[13] In July 1958, three exiled Haitian army officers and five American mercenaries landed in Haiti and tried to overthrow Duvalier; all were killed.

[23] In the name of nationalism, Duvalier expelled almost all of Haiti's foreign-born bishops, an act that earned him excommunication from the Catholic Church.

[6]: 81–82  His physician believed that he had suffered neurological damage during these events, harming his mental health and perhaps explaining his subsequent actions.

In other incidents, Duvalier ordered the head of an executed rebel packed in ice and brought to him so he could commune with the dead man's spirit.

[6]: 85 [17] The New York Times commented, "Latin America has witnessed many fraudulent elections throughout its history but none has been more outrageous than the one which has just taken place in Haiti".

In his early years, Duvalier rebuked the United States for its friendly relations with Dominican dictator Rafael Trujillo (assassinated in 1961) while ignoring Haiti.

The Kennedy administration (1961–1963) was particularly disturbed by Duvalier's repressive and totalitarian rule and allegations that he misappropriated aid money, at the time a substantial part of the Haitian budget, and a U.S. Marine Corps mission to train the Tonton Macoute.

Duvalier publicly renounced all aid from Washington on nationalist grounds, portraying himself as a "principled and lonely opponent of domination by a great power".

[10][29] Duvalier attempted to exploit tensions between the U.S. and Cuba, emphasizing his anti-communist credentials and Haiti's strategic location as a means of winning U.S. support: Communism has established centres of infection ... No area in the world is as vital to American security as the Caribbean ... We need a massive injection of money to reset the country on its feet, and this injection can come only from our great, capable friend and neighbor the United States.

Duvalier enraged Castro by voting against the country in an Organization of American States (OAS) meeting and subsequently at the United Nations, where a trade embargo was imposed on Cuba.

Cuba answered by breaking off diplomatic relations and Duvalier subsequently instituted a campaign to rid Haiti of communists.

In April 1963, relations were brought to the edge of war by the political enmity between Duvalier and Dominican president Juan Bosch.

The Dominican president reacted with outrage, publicly threatened to invade Haiti, and ordered army units to the border.

[10] Many educated professionals fled Haiti for New York City, Miami, Montreal, Paris and several French-speaking African countries, exacerbating an already serious lack of doctors and teachers.

Some of the highly skilled professionals joined the ranks of several UN agencies to work in development in newly independent nations such as Ivory Coast and the Congo.

[citation needed] The government confiscated peasant landholdings and allotted them to members of the militia,[12] who had no official salary and made their living through crime and extortion.

[12] Nonetheless, Duvalier enjoyed significant support among Haiti's majority black rural population, who saw in him a champion of their claims against the historically dominant mulatto elite.

In an effort to make himself even more imposing, Duvalier deliberately modeled his image on that of Baron Samedi, one of the lwa, or spirits, of Haitian Vodou.

[12] The most celebrated image from the time shows a standing Jesus Christ with a hand on the shoulder of a seated Papa Doc, captioned, "I have chosen him".

A prevailing rumor in the capital, according to The New York Times, was that his son had removed his remains upon fleeing to the U.S. Air Force in a transport plane to Paris the day before.

[44] Duvalier, however, dismissed the piece and referred to its author as "a cretin, a stool pigeon, sadistic, unbalanced, perverted, a perfect ignoramous [sic], lying to his heart's content, the shame of proud and noble England, a spy, a drug addict, and a torturer".

[47] The first authoritative book on the subject was Papa Doc: Haiti and its Dictator by Al Burt and Bernard Diederich, published in 1969,[48] though several others by Haitian scholars and historians have appeared since Duvalier's death in 1971.

One of the most informative, Patrick Lemoine's Fort‑Dimanche: Dungeon of Death, dealt specifically with victims of Fort Dimanche, the prison which Duvalier used for the torture and murder of his political opponents.

[49] In 2007, John Marquis wrote Papa Doc: Portrait of a Haitian Tyrant,[50] which relied in part on records from a 1968 espionage trial in Haiti to detail numerous attempts on Duvalier's life.