PTSD is invoked in the context of a discourse that is dominated by ideas of an innocent and victimized ‘child soldier’. My discussion suggests that this discourse might not necessarily mirror the FAP’s [formerly abducted person’s] own view of his past. The concept of PTSD is based on assumptions, some of which should be challenged in the context of northern Uganda. Parker, reflecting on mental health in the context of north-east Africa, writes: ‘One of the most important issues which requires attention includes the following: PTSD is imbued with culturally culturally specific conceptions of normality and deviance and it is thus difficult to make appropriate diagnosis’ (Parker 1996).
An essential feature of PTSD is an aetiological event in the past – a distressing experience that lies outside the range of usual human experience. The problem, of course, is that what my informants would consider a usual experience is probably quite distinct from the usual human experience of someone living in the Western world. In fact, the narratives presented here suggest that even within their own life the idea of normality is a shifting category.
Another issue is that the disorder works within a temporal framework: the disagnosis of PTSD follows the logic of a traumatic event in the past that is connected to the present in forms of defined symptoms. As Young puts it: ‘[PTSD’s] distinctive pathology is that it permits the past (memory) to relieve itself in the present […] The space occupied in the DSM-III classificatory system depends on this temporal-causal relation: aetological event –> symptoms.’ (Young 1995).
In Uganda, narratives of PTSD go hand in hand with ideas that locate the FAP’s traumatic experiences in the past with the LRA. An alternative view suggested in this chapter emphasizes the periods of transition. While one period of transition takes place with the LRA after abduction, another distressing time might be experienced after return from the bush when the LRA fighter witnesses further threats and the breakdown of the moral space in which he acted as an LRA combatant. Thus, what could be described as a traumatizing time lies not only in the FAP’s past with the LRA, but also in the present. To diagnose PTSD against a background of continued insecurity, terror and fear is difficult, Parker writes: ‘- especially as some of the primary symptoms may be adaptive responses to particularly awful circumstances.’ (Parker 1996).
These are excerpts from Ben Mergelsberg’s chapter in The Lord’s Resistance Army: Myth and Reality. I’ve never really thought about Post-Traumatic Stress Disorder as a cultural construct, but it makes a lot of sense, especially since what constitutes traumatic events is rooted in what one perceives as normal. More importantly, Mergelsberg makes the important distinction that many returned abductees are still in the midst of what could be labeled traumatic events. After spending much of their lives, and indeed very formative years, growing up in the culture of the LRA, they have been uprooted – voluntarily or not – and are stuck in a transition into a new community with new rules and new behaviors. Can one suffer from post-traumatic stress disorder while still in a state of trauma, or is what we see there something different? Especially in the context of Mergelsberg’s wider argument – that returnees are balancing two separate worlds: one as rebel and one as civilian – it’s something to keep in mind when trying to understand what happens to returnees as they adapt to life out of the bush – with or without rehabilitative services.
Having worked with northern Uganda-based experts on the topic, there is no doubt that the constructs used in PTSD scales are culturally appropriate. A recent study validated several instruments. The issue here is less about cultural construct, but rather the expansion of the definition of PTSD to apparent trauma resulting from patterns of exposure that go beyond the “event – response” sequence and includes on-going exposure.
Northern Ugandans we interview clearly define this range of experience as “unusual” or “abnormal” – from abduction to coercion to living in camps – even if these experiences are frequent/chronic, or widespread. We are still working through three waves of data collection in northern Uganda that included measures of symptoms of PTSD. The fact that we find rapid rates of decline in prevalence of symptoms of PTSD suggests in our opinion that what we measure is an acute response to potentially traumatic events that may have the symptoms of PTSD but ultimately needs to be defined differently.
That’s really interesting. I’m very new to the literature on PTSD – how does your data collection define PTSD? Or do you only measure symptoms that could be linked to PTSD? From what Mergelsberg cites, I think it’s clear that the event-response sequence needs to be expanded.
I quoted the passage about returnees being in the midst of a traumatic transition from child soldier to civilian, but there’s also the fact that many child soldiers that escaped or were rescued ended up in the IDP camps, where perhaps a different type of trauma was being inflicted on the civilians. This transition from one form of insecurity to another could very well be different from other types of traumatic events. Again, I’m only just now turning towards this aspect of the conflict so I’m not sure if it deserves to be a totally different classification or merely part of an expanded understanding of PTSD. Very eager to see what your findings are.