Madness or sadness? Local concepts of mental illness in four conflict-affected African communities
Open accessAbstract
BACKGROUND: Concepts of 'what constitutes mental illness', the presumed aetiology and preferred treatment options, vary considerably from one cultural context to another. Knowledge and understanding of these local conceptualisations is essential to inform public mental health programming and policy. METHODS: Participants from four locations in Burundi, South Sudan and the Democratic Republic of the Congo, were invited to describe 'problems they knew of that related to thinking, feeling and behaviour?' Data were collected over 31 focus groups discussions (251 participants) and key informant interviews with traditional healers and health workers. RESULTS: While remarkable similarities occurred across all settings, there were also striking differences. In all areas, participants were able to describe localized syndromes characterized by severe behavioural and cognitive disturbances with considerable resemblance to psychotic disorders. Additionally, respondents throughout all settings described local syndromes that included sadness and social withdrawal as core features. These syndromes had some similarities with nonpsychotic mental disorders, such as major depression or anxiety disorders, but also differed significantly. Aetiological concepts varied a great deal within each setting, and attributed causes varied from supernatural to psychosocial and natural. Local syndromes resembling psychotic disorders were seen as an abnormality in need of treatment, although people did not really know where to go. Local syndromes resembling nonpsychotic mental disorders were not regarded as a 'medical' disorder, and were therefore also not seen as a condition for which help should be sought within the biomedical health-care system. Rather, such conditions were expected to improve through social and emotional support from relatives, traditional healers and community members. CONCLUSIONS: Local conceptualizations have significant implications for the planning of mental-health interventions in resource-poor settings recovering from conflict. Treatment options for people suffering from severe mental disorders should be made available to people, preferably within general health care facilities. For people suffering from local syndromes characterized by loss or sadness, the primary aim for public mental health interventions would be to empower existing social support systems already in place at local levels, and to strengthen social cohesion and self-help within communities.
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Recent qualitative studies point to mental health problems as very broadly being viewed as 'madness' or 'sadness'.
“Recent qualitative studies [25, 26] point to mental health problems as very broadly being viewed as ‘madness’ (severe mental disturbances associated with aggressive and bizarre behavior) or ‘sadness’ (difficulties associated with psychosocial causes such as loss, bereavement and deprivation).”
From Mental health and psychosocial support for South Sudanese refugees in northern Uganda: a needs and resource assessment (2016) · cites this paper as [25]
Studies in primary care settings have suggested that depressive, anxiety, and somatic symptoms may be different presentations of a common latent phenomenon and may require common therapeutic approaches.
“Studies in primary care settings have indeed suggested that depressive, anxiety, and somatic symptoms may be different presentations of a common latent phenomenon 80 and may require common therapeutic approaches, 81 leading some to propose a higher-order category of 'common mental disorders.' 82”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [80]
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Cites
Basics of Qualitative Research: Grounded Theory Procedures and Techniques.
Ellis, C., Strauss, A., & Corbin, J. M. (1992) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2074814 · Cited by 29,279 · see citing works
Basics of Qualitative Research: Grounded Theory Procedures and Techniques
Long, D. R., Strauss, A., & Corbin, J. M. (1993) · Modern Language Journal · doi:10.2307/328955 · Cited by 17,612 · see citing works
Depression, somatization and the “new cross-cultural psychiatry”
Kleinman, A. M. (1977) · Social Science & Medicine (1967) · doi:10.1016/0037-7856(77)90138-x · Cited by 1,153 · see citing works
Human resources for mental health care: current situation and strategies for action
Kakuma, R., Minas, H., van Ginneken, N., Dal Poz, M. R., Desiraju, K., Morris, J. E., Saxena, S., & Scheffler, R. M. (2011) · The Lancet · doi:10.1016/s0140-6736(11)61093-3 · Cited by 979 · see citing works
Nichter, M. (1981) · Culture Medicine and Psychiatry · doi:10.1007/bf00054782 · Cited by 789 · see citing works
Scale up of services for mental health in low-income and middle-income countries
Eaton, J., McCay, L., Semrau, M., Chatterjee, S., Baingana, F., Araya, R., Ntulo, C., Thornicroft, G., & Saxena, S. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60891-x · Cited by 698 · see citing works
Mental health and psychosocial support in humanitarian settings: linking practice and research
Tol, W. A., Barbui, C., Galappatti, A., Silove, D., Betancourt, T. S., Souza, R., Golaz, A., & van Ommeren, M. (2011) · The Lancet · doi:10.1016/s0140-6736(11)61094-5 · Cited by 625 · see citing works
Simons, R. C., & Hughes, C. C. (1985) · Springer eBooks · doi:10.1007/978-94-009-5251-5 · Cited by 452 · see citing works
Burundi: Ethnic Conflict and Genocide
Lemarchand, R. (1996) · Cited by 416 · see citing works
Nichter, M. (2010) · Culture Medicine and Psychiatry · doi:10.1007/s11013-010-9179-6 · Cited by 389 · see citing works
Dua, T., Barbui, C., Clark, N., Fleischmann, A., Poznyak, V., van Ommeren, M., Yasamy, M. T., Ayuso-Mateos, J. L., Birbeck, G. L., Drummond, C., et al. (2011) · PLoS Medicine · doi:10.1371/journal.pmed.1001122 · Cited by 384 · see citing works
Self-citationTrauma, War, and Violence: Public Mental Health in Socio-Cultural Context
de Jong, J. T. V. M. (2002) · Kluwer Academic Publishers eBooks · doi:10.1007/b109606 · Cited by 348 · see citing works
Murray, L. K., Dorsey, S., Bolton, P., Jordans, M. J., Rahman, A., Bass, J., & Verdeli, H. (2011) · International Journal of Mental Health Systems · doi:10.1186/1752-4458-5-30 · Cited by 326 · see citing works
Self-citationThe Epidemiology of a Folk Illness: Susto in Hispanic America
Rubel, A. J. (1964) · Ethnology · doi:10.2307/3772883 · Cited by 294 · see citing works
Values and Psychiatric Diagnosis
Sadler, J. Z. (2004) · Oxford University Press eBooks · doi:10.1093/med/9780198526377.001.1 · Cited by 246 · see citing works
Explanatory models of mental illness in sub-Saharan Africa
Patel, V. (1995) · Social Science & Medicine · doi:10.1016/0277-9536(94)00231-h · Cited by 233 · see citing works
Culture, disease, and healing : studies in medical anthropology
Landy, D. (1977) · DigitalGeorgetown (Georgetown University Library) · Cited by 226 · see citing works
The Culture-bound syndromes : folk illnesses of psychiatric and anthropological interest
Simons, R. C., & Hughes, C. C. (1985) · D. Reidel , Sold and distributed in the U.S.A. and Canada by Kluwer Academic Publishers eBooks · Cited by 211 · see citing works
The Great Lakes of Africa: Two Thousand Years of History
Schoenbrun, D. L., Chrétien, J.-P., & Straus, S. (2003) · The International Journal of African Historical Studies · doi:10.2307/3559391 · Cited by 180 · see citing works
A Qualitative Study of Mental Health Problems among Children Displaced by War in Northern Uganda
Betancourt, T. S., Speelman, L., Onyango, G., & Bolton, P. A. (2009) · Transcultural Psychiatry · doi:10.1177/1363461509105815 · Cited by 175 · see citing works
Rapid ethnographic assessment: Applications in a diarrhea management program
Bentley, M. E., Pelto, G. H., Straus, W. L., Schumann, D. A., Adegbola, C., de la Pena, E., Oni, G. A., Brown, K. H., & Huffman, S. L. (1988) · Social Science & Medicine · doi:10.1016/0277-9536(88)90168-2 · Cited by 168 · see citing works
Hinton, D. E., & Good, B. J. (2020) · Stanford University Press eBooks · doi:10.1515/9780804771115 · Cited by 167 · see citing works
Alem, A., Jacobsson, L. H., Araya, M., Kebede, D., & Kullgren, G. (1999) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1999.tb10693.x · Cited by 160 · see citing works
Local Perceptions of the Mental Health Effects of the Rwandan Genocide
Bolton, P. A. (2001) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200104000-00006 · Cited by 141 · see citing works
Conceptions of Psychosis in Four East African Societies1
Edgerton, R. B. (1966) · American Anthropologist · doi:10.1525/aa.1966.68.2.02a00070 · Cited by 136 · see citing works
Negotiating local knowledge : power and identity in development
Pottier, J., Bicker, A., & Sillitoe, P. (2003) · Cited by 130 · see citing works
South Sudan: from revolution to independence
LeRiche, M., & Arnold, M. (2013) · Choice Reviews Online · doi:10.5860/choice.50-6414 · Cited by 120 · see citing works
Aidoo, M. (2001) · Health Policy and Planning · doi:10.1093/heapol/16.2.206 · Cited by 116 · see citing works
Life after Violence: A People's Story of Burundi
Uvin, P. (2008) · Cited by 108 · see citing works
Ventevogel, P., van de Put, W., Faiz, H., van Mierlo, B., Siddiqi, M., & Komproe, I. H. (2012) · PLoS Medicine · doi:10.1371/journal.pmed.1001225 · Cited by 102 · see citing works
Self-citationKhoury, N. M., Kaiser, B. N., Keys, H. M., Brewster, A.-R. T., & Kohrt, B. A. (2012) · Culture Medicine and Psychiatry · doi:10.1007/s11013-012-9270-2 · Cited by 97 · see citing works
Lay Concepts of Depression among the Baganda of Uganda: A Pilot Study
Okello, E. S., & Ekblad, S. (2006) · Transcultural Psychiatry · doi:10.1177/1363461506064871 · Cited by 97 · see citing works
Life after violence: A people’s story of Burundi
Uvin, P. (2009) · doi:10.5040/9781350221130 · Cited by 96 · see citing works
Questions of Competence: Culture, Classification and Intellectual Disability
Ramcharan, P. (2001) · Journal of Applied Research in Intellectual Disabilities · doi:10.1046/j.1468-3148.2001.00042.x · Cited by 88 · see citing works
Concepts of mental illness and medical pluralism in Harare
Patel, V., Musara, T., Butau, T., Maramba, P., & Fuyane, S. (1995) · Psychological Medicine · doi:10.1017/s0033291700033407 · Cited by 86 · see citing works
Development of a multi-layered psychosocial care system for children in areas of political violence
Jordans, M. J. D., Tol, W. A., Komproe, I. H., Susanty, D., Vallipuram, A., Ntamatumba, P., Lasuba, A. C., & de Jong, J. T. V. M. (2010) · International Journal of Mental Health Systems · doi:10.1186/1752-4458-4-15 · Cited by 78 · see citing works
Self-citationScholte, W. F., Verduin, F., Kamperman, A. M., Rutayisire, T., Zwinderman, A. H., & Stronks, K. (2011) · PLoS ONE · doi:10.1371/journal.pone.0021819 · Cited by 77 · see citing works
Values and psychiatric diagnosis
Sadler, J. Z. (2004) · Oxford University Press eBooks · doi:10.1093/med/9780198526377.003.0011 · Cited by 77 · see citing works
Lay accounts of depression amongst Anglo-Australian residents and East African refugees
Kokanović, R., Dowrick, C. F., Butler, E., Herrman, H., & Gunn, J. M. (2007) · Social Science & Medicine · doi:10.1016/j.socscimed.2007.08.019 · Cited by 71 · see citing works
Posttraumatic idioms of distress among Darfur refugees: Hozun and Majnun
Rasmussen, A., Katoni, B., Keller, A. S., & Wilkinson, J. (2011) · Transcultural Psychiatry · doi:10.1177/1363461511409283 · Cited by 71 · see citing works
Disease classification in rural Ghana: Framework and implications for health behaviour
Fosu, G. B. (1981) · Social Science & Medicine Part B Medical Anthropology · doi:10.1016/0160-7987(81)90021-1 · Cited by 70 · see citing works
South Sudan: from revolution to independence
Zink, J. (2013) · Canadian Journal of African Studies / Revue canadienne des études africaines · doi:10.1080/00083968.2013.829958 · Cited by 67 · see citing works
The Great Lakes of Africa: Two Thousand Years of History
Gerhart, G. M., Chrétien, J.-P., & Straus, S. (2004) · Foreign Affairs · doi:10.2307/20033882 · Cited by 62 · see citing works
The Validity of DSM-IV Dissociative Disorders Categories in South-West Uganda
Van Duijl, M., Cardeña, E., & De Jong, J. T. V. M. (2005) · Transcultural Psychiatry · doi:10.1177/1363461505052666 · Cited by 62 · see citing works
Kufungisisa (thinking too much): a Shona idiom for non-psychotic mental illness.
Patel, V., Simunyu, E., & Gwanzura, F. (1995) · PubMed · Cited by 59 · see citing works
Applied Health Research-Manual: Anthropology of Health and Health Care
Hardon, A. P., Boonmongkon, P., Streefland, P. H., Tan, M. L., Hongvivatana, T., van der Geest, S., van Staa, A., & Varkevisser, C. M. (2005) · UvA-DARE (University of Amsterdam) · Cited by 59 · see citing works
The Mandinka Nosological System in the Context of Post-Trauma Syndromes
Fox, S. H. (2003) · Transcultural Psychiatry · doi:10.1177/1363461503404002 · Cited by 57 · see citing works
Teuton, J., Dowrick, C. F., & Bentall, R. P. (2007) · Social Science & Medicine · doi:10.1016/j.socscimed.2007.03.055 · Cited by 54 · see citing works
Niehaus, D. J. H., Oosthuizen, P., Löchner, C., et al. (2004) · Psychopathology · doi:10.1159/000077579 · Cited by 51 · see citing works
Negotiating Local Knowledge: An Introduction
Pottier, J. (2003) · SOAS Research Online (SOAS University of London) · Cited by 50 · see citing works
Jenkins, R. (1999) · Cambridge University Press eBooks · doi:10.1017/cbo9780511621734 · Cited by 49 · see citing works
Conceptualizing Psychosis in Uganda
Teuton, J., Bentall, R. P., & Dowrick, C. F. (2007) · Transcultural Psychiatry · doi:10.1177/1363461507074976 · Cited by 47 · see citing works
Muga, F. A., & Jenkins, R. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0334-0 · Cited by 47 · see citing works
Roberts, B., Damundu, E. Y., Lomoro, O., & Sondorp, E. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-518 · Cited by 42 · see citing works
Culture And Common Mental Disorders In Sub-Saharan Africa
Patel, V. (2013) · Psychology Press eBooks · doi:10.4324/9781315826455 · Cited by 40 · see citing works
Problems in communication in transcultural psychiatry
Kortmann, F. (1987) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1987.tb02836.x · Cited by 40 · see citing works
Negotiating Local Knowledge: Identity and Power in Development
Pottier, J., Sillitoe, P., & Bicker, A. (2003) · Cited by 38 · see citing works
Closing the gap between psychiatric epidemiology and mental health in post-conflict situations
de Jong, J. T., & Komproe, I. H. (2002) · The Lancet · doi:10.1016/s0140-6736(02)08729-9 · Cited by 34 · see citing works
Slow cookers and madmen: competence of heart and head in rural Uganda
Whyte, S. R. (1999) · Cambridge University Press eBooks · doi:10.1017/cbo9780511621734.007 · Cited by 25 · see citing works
(Disaster) Public Mental Health
de Jong, J. T. V. M. (2011) · Wiley eBooks · doi:10.1002/9781119998471.ch6 · Cited by 22 · see citing works
Chrétien, J.-P. (2003) · Cited by 12 · see citing works
Do conflict-affected societies need psychiatrists?
Silove, D. M. (2012) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.112.108480 · Cited by 11 · see citing works
Des noms et des hommes; aspects psychologiques et sociologiques du nom au Burundi
Collard, C., Ntahombayé, P., & Ntahombayé, P. (1985) · Canadian Journal of African Studies / Revue canadienne des études africaines · doi:10.2307/485075 · Cited by 4 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Whyte SR Questioning Misfortune: The Pragmatics of Uncertaintly in Eastern Uganda 1997 Cambridge: Cambridge University Press
- Good CM Ethnomedical Systems in Africa: Patterns of Traditional Medicine in Urban and Rural Kenya 1987 New York, NY: Guilford Press
Cited by
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Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104 · see citing works
“Thinking too much”: a systematic review of a common idiom of distress
Kaiser, B. N., Haroz, E. E., Kohrt, B. A., Bolton, P. A., Bass, J. K., & Hinton, D. E. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.10.044 · Cited by 287 · see citing works
Kane, J. C., Ventevogel, P., Spiegel, P., Bass, J. K., van Ommeren, M., & Tol, W. A. (2014) · BMC Medicine · doi:10.1186/s12916-014-0228-9 · Cited by 141 · see citing works
Self-citationFaregh, N., Lencucha, R., Ventevogel, P., Dubale, B. W., & Kirmayer, L. J. (2019) · International Journal of Mental Health Systems · doi:10.1186/s13033-019-0312-9 · Cited by 120 · see citing works
Self-citationRasmussen, A., Keatley, E., & Joscelyne, A. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.03.015 · Cited by 87 · see citing works
Explanatory models of depression in sub-Saharan Africa: Synthesis of qualitative evidence.
Mayston, R., Frissa, S., Tekola, B., Hanlon, C., Prince, M., & Fekadu, A. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.112760 · Cited by 82 · see citing works
Killikelly, C., Bauer, S., & Maercker, A. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01957 · Cited by 71 · see citing works
Tol, W. A., Augustinavicius, J., Carswell, K., Brown, F. L., Adaku, A., Leku, M. R., García-Moreno, C., Ventevogel, P., White, R. G., & van Ommeren, M. (2018) · Global Mental Health · doi:10.1017/gmh.2018.14 · Cited by 69 · see citing works
“‘Thinking too much’ is a cultural concept of distress that has been repeatedly identified in a wide range of settings (Kaiser et al., 2015), including in qualitative studieswith refugees from southern Sudan before independence (Coker, 2004; Goodman, 2004) and South Sudan (Ventevogel et al., 2013).”
BackgroundSelf-citationAdaku, A., Okello, J., Lowry, B., Kane, J. C., Alderman, S., Musisi, S., & Tol, W. A. (2016) · Conflict and Health · doi:10.1186/s13031-016-0085-6 · Cited by 66 · see citing works
“Recent qualitative studies [25, 26] point to mental health problems as very broadly being viewed as ‘madness’ (severe mental disturbances associated with aggressive and bizarre behavior) or ‘sadness’ (difficulties associated with psychosocial causes such as loss, bereavement and deprivation).”
BackgroundWeissbecker, I., Hanna, F., El Shazly, M., Gao, J., & Ventevogel, P. (2019) · An Uncertain Safety · doi:10.1007/978-3-319-72914-5_6 · Cited by 61 · see citing works
Self-citationRasmussen, A., Ventevogel, P., Sancilio, A., Eggerman, M., & Panter-Brick, C. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-206 · Cited by 48 · see citing works
Self-citationIndigenous medicine and biomedical health care in fragile settings: insights from Burundi
Falisse, J.-B., Masino, S., & Ngenzebuhoro, R. (2018) · Health Policy and Planning · doi:10.1093/heapol/czy002 · Cited by 23 · see citing works
Fine, S. L., Kane, J. C., Spiegel, P. B., Tol, W. A., & Ventevogel, P. (2022) · BMC Medicine · doi:10.1186/s12916-022-02371-8 · Cited by 20 · see citing works
Self-citationTorre, C. (2023) · London School of Economics and Political Science (LSE) · doi:10.21953/lse.00004557
Sexual and gender-based violence against South Sudanese refugees in Uganda: a mixed-methods study
Michaelsen, S. (2025) · Université de Montréal · doi:10.71781/1596
- Authors
- Ventevogel, P., Jordans, M., Reis, R., & de Jong, J.
- Affiliations
- HealthNet TPO (NL)
- Leiden University Medical Center (NL)
- Corresponding author
- Ventevogel, Peter
- Venue
- Conflict and Health
- Published
- 2013-02-18
- Volume
- 7
- Issue
- 1
- Pages
- 3-3
- ISSN
- 1752-1505 (ISSN-L)
- PMC
- PMC3605182
- OpenAlex
- W2169194420
- Cited by
- 174
- References
- 63
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 16 · 2023: 14 · 2022: 16 · 2021: 16 · 2020: 19 · 2019: 10 · 2018: 18 · 2017: 7 · 2016: 7 · 2015: 12 · 2014: 11 · 2013: 3
- FWCI
- 16.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Conflict and Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
- Keywords
- psychosis, depression, anxiety disorders, etiology of mental disorders, traditional healers, social support, post-conflict mental health, resource-limited settings, Burundi, South Sudan, Democratic Republic of the Congo
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