Paper short abstract:

Due to living in a context of prolonged armed conflict, people in Gulu district have been exposed to extreme wartime events and very poor living conditions. In their dire circumstances, they mainly talked about their many physical complaints. This raises the question of how children cope with their emotional suffering; interventions implemented, and how to evaluate those interventions.

Paper long abstract:

This study analysed why children exposed to extreme war-related events were reluctant to discuss their emotional suffering or only shared it through somatic complaints. A survey and qualitative ethnographic methods were employed to assess perspectives of children aged 9-16 years in 2004-2005 about common illnesses they experienced and their quests for therapy. Key informants included 2 psychiatrists, 5 nurses, 5 clinical officers, 2 paediatricians, 15 counsellors, 28 primary school teachers, and 13 clinic owners. They were regularly interviewed to assess medicines commonly used for complaints symptomatic of psychological suffering.

Children and adult interviewees were reluctant to share their suffering. This could be because they were silenced through downplaying/trivialising their experiences. People we counselled by telling people in distress about the others' or counsellor's own comparatively worse experiences, which they had managed to 'work through'. Complaints symptomatic of emotional suffering were diagnosed as, malaria and hysteria. Victims of gender based violence were blamed for what happened instead of holding perpetrators accountable. People who did not share their mental distress were rewarded with praise. Sufferers of emotional distress therefore only narrated experiences with somatic complaints, including stomach aches, sleeplessness, disturbances by cen (evil spirits), and nightmares. They used ready to access pharmaceuticals called medicines of sleep, analgesics and atika plants (Labiate species) to minimise their suffering.

Professional and indigenous approaches in dealing with emotional suffering contributed to the silencing of this suffering and its subsequent presentation in legitimised somatic idioms. Presenting emotional suffering as aches and pains led to over-use of pharmaceuticals, medicalising psychosocial problems.