Measuring PTSD: Circumstances, the Language of PTSD, and Prolonged States of Disorder in Northern Uganda

 

Sung-Joon Park

Institute for Anthropology, Martin-Luther-University Halle-Wittenberg, Germany

 

Abstract

This article examines how trauma, a vague expression encompassing a wide array of debilitating circumstances, is conceptualised and measured as post-traumatic stress disorder (PTSD) in northern Uganda. More specifically, it examines the misrepresentations produced by the measurement of PTSD and asks what injuries are inflicted upon people’s everyday lives by these misrepresentations. The aim is to draw on Wittgenstein’s insistence that it is necessary to grasp the circumstances under which concepts and instruments are used in order to understand the misrepresentations that occur, in this case, around the use of instruments to measure PTSD. The paper discusses two cases of ordinary hospital days, where everyday research routines make disorder visible. It argues that these exceptional circumstances, with traumatising consequences on patients, provide critical insights into the inner workings of the apparatus of mental health and how this apparatus is intricately interwoven with the ordinary conditions of everyday life.

 

In this paper I examine how trauma, a vague expression encompassing a wide array of debilitating circumstances, is conceptualised and measured as post-traumatic stress disorder (PTSD) in northern Uganda.[1] More specifically, I attend to the apparatus of mental health research in northern Uganda, which deploys standardised instruments to assess what part of the population is at risk of PTSD.

After the end of the war in northern Uganda in 2006, studies on mental health revealed a high rate of PTSD in this region. These rates are of course statistical estimates, though they may not be unexpected after two decades of war, displacement, and encampment. Nonetheless, commentators like Morton Jerven question the accuracy of statistics in African countries arguing that donor assistance is often misled by ‘poor numbers’ (Jerven 2013). In this paper I suggest that a lack of accuracy is not the only problem haunting the measuring of PTSD in northern Uganda. On the contrary, the desire for accurate numbers is a driver for the development of more reliable techniques to test the validity of measuring instruments in mental health research. Moreover, these instruments underwrite the rapid proliferation of measurement systems in various fields of global governance (Merry 2011, Rottenburg et al. 2015). One of the reasons for this trend is that standardised measurement systems simplify complex problems for decision-making processes. In the case of PTSD, the instruments consist of a set of questions inquiring into the multiplicity of risk factors, which are weighed and calculated to assess PTSD cases and to compare PTSD rates across different places and populations. In this respect, numbers are not misleading, but, according to Wendy Espeland, simplifications are the very reason ‘why we value indicators so much and why we often feel they misrepresent us’ (Espeland 2015: 77, my emphasis).

>> View Full Text (PDF)


[1] I am very grateful for helpful and inspiring comments by Andrea Behrends, Siri Lamoureaux, Rene Umlauf and the anonymous reviewer.