Guest editors:
Lioba Lenhart
Institute of Peace and Strategic Studies, Gulu University, Uganda
Susan Reynolds Whyte
Department of Anthropology, University of Copenhagen, Denmark
The two-decade war between the Lord’s Resistance Army (LRA) and the Government of Uganda (1986-2006) in the northern part of the country has taken its toll on individuals, as well as society. Tens of thousands of children and youth were abducted and recruited into the ranks of the LRA. Civilians suffered extreme forms of violence, killings, rape and mutilations. Ultimately, some ninety percent of the population of northern Uganda was forced to live in camps for Internally Displaced People (IDP). Today, after ten years of peace, the people of northern Uganda still have to cope with their difficult past.
The significant rate of mental illness in post-war northern Uganda, which is among the highest worldwide (Businge 2008), can be attributed to the prolonged experience of war, internment, continuous poverty and lack of future prospects (Ssebunnya et al. 2009). Yet the weakened health care system does not recognise mental health as a priority (Kagolo 2012, Kigozi et al. 2010). Many people suffer from posttraumatic stress disorder, anxiety disorder, depression, bipolar affective disorder and schizophrenia. Substance abuse and alcoholism are widespread. The suicide rate is particularly high among young people (cf. Deleu & Porter 2011, Okudi 2014, Owich 2015, Pham et al. 2009, Roberts et al. 2008, Tumwebaze 2014, Vinck et al. 2007). Although reports and figures demonstrate the desolate situation of mentally ill people in northern Uganda, the state budget for health care and services is still insufficient to finance adequate programmes (Kigozi et al. 2010).
Society lacks knowledge and understanding of the problems of mentally ill people, who are confronted with prejudice, stereotypes and stigmatisation every day. Many mentally ill people have become victims of abuse, neglect and exploitation. Families and relatives are overwhelmed and do not know how to cope with the tremendous physical and emotional demands. They sometimes restrain their mentally ill family members for hours, days, weeks and even months so that they can carry out their everyday work such as cultivating the fields, but also to protect the mentally ill from danger. Moreover, many neighbours react in a hostile way, because they fear the ‘weird and strange behaviours’ of the mentally ill, and even discriminate against family members who help care for them. Persistent abuse and stigmatisation in the workplace and school force mentally ill people to leave employment and education, which in turn reinforces the already high level of poverty among them (MDAC & MHU 2014a).
Only a few people resort to biomedical psychiatric care. Mental illness is often associated with spirit possession or attributed to past offenses. For this reason, traditional healers who cast out spirits are in many cases the first and often the only ones addressed for help. Others use services provided by Christian churches such as intense prayer sessions in search of healing. In all these settings, human rights violations have been reported (MDAC & MHU 2014a, 2014b, Ssebunnya et al. 2009).
The contributions to this JPSS Special Issue on Mental Health in Post-War Northern Uganda offer perspectives from psychology and social science. They are concerned with the situations of mentally ill persons and their families, the attempts at treatment, and the conditions that affect mental health in this post-conflict setting.
Kamila Krygier examines the extent to which human rights legislation is being implemented to secure the situation of people with mental health problems. Her research found that mental illness is widely recognised as a serious community concern. Yet attitudes are often unsympathetic and biomedical service provision is gravely deficient.
Sung-Joon Park addresses post-traumatic stress disorder (PTSD), a mental condition that has attracted increasing attention in the wake of war and disaster (Fassin & Rechtman 2009). Specifically, he relates the scientific language and standardised measures of PTSD to the exceptional, often traumatic, circumstances of everyday life in northern Uganda. He suggests that the simplicity conveyed by the language of PTSD creates misrepresentations that can actually prolong states of disorder.
Adrian Sutton explores the psychodynamics of forgiveness after conflict. While many in northern Uganda have extolled the virtues of forgiveness and some claim that it has positive effects on mental health, Sutton takes a more nuanced approach, questioning its therapeutic use as a mechanism for achieving well-being. Rather, he argues, it is one aspect of an emergent state of equanimity that some people gain after being victimised.
Kamilla Bjørkøe Jensen and Mia Jess present a study of one of the many forms of loss that affect mental states in northern Uganda: the ambiguous loss of abductees who have not returned. Their families live in a state of uncertainty, not knowing if they are dead or alive; they are subject to the suspicion of their neighbours that the missing people might be living in the bush as LRA rebels. Fieldwork with these families revealed the ways in which they tried to manage life in this liminal situation.
Karin van Bemmel’s research on nodding syndrome deals with the quest for therapy pursued by the parents of children afflicted with a disease they associate with the war. Whether it is a form of epilepsy (and thus categorised as mental illness in the Ugandan treatment framework) or in some way the result of violence, the condition resembles other mental health problems in that treatment is so elusive.
Together these articles describe and analyse an area of health care that merits continuing and critical social science research.
References
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