Address mental health to fight dependency syndrome in post-conflict northern Uganda
By Okot Benard Kasozi (Published 22nd July 2016)
Mental health is globally recognized as one of the leading causes of disability. However, a significant number of professional and non-professional stakeholders have trouble drawing connections between the implications of poor mental health status and some of the current socio-economic and conflict issues in Uganda that continue to dwindle citizens’ active participation in national development and harmonious co-existence. In northern Uganda, which suffered from brutal armed insurgencies and mass displacement for decades, the nature of the relationship between deep-seated dependency syndrome and mental health remains a challenge.
Dependency syndrome is commonly understood as common/collective attitude and belief by people (in this case former Internally Displaced Persons - IDPs) that they cannot solve their own problems by themselves and with their own/generated resources without outside help (from the governmental and non-governmental agencies). This belief is seen to have been reinforced by prolonged dependency on charity during the periods of the war in which people were largely confined to IDP camps and unable to pursue their usual livelihoods. There can be little doubt that this period, for many, lasted more than a decade, and formidably undermined the resourceful role of community contributions and capacity for participation in post-conflict recovery.
The government spearheaded transition from peace to recovery and development has not fully addressed some of the lingering issues, particularly the dependency IDPs carried with them to their respective villages. This is due to challenges adapting from the past situation where humanitarian agencies provided free emergency support to IDPs including food, clothing, medicine, water and other amenities. As a result, people appear to have lost creativity for active participation to improve their living standards and welfare. Currently, a large number of returnees still beg and yearn for free support from stakeholders while apparently forgetting about the entrepreneurial space and fertile land owned individually and communally.
However, while such dependence on outside support was for years a fact, many political and professional stakeholders wrongly attribute current symptoms of dependency syndrome to laziness. The real root of the problem now, ten years after IDPs began to return to their home areas, may instead be the unaddressed psychosocial needs of war trauma survivors.
Outcry from service providers to challenge the dependency has been marred by narrow interventions. For instance, service providers have been equipping people with livelihood skills, revolving funds, and micro-credit schemes without any attempt to deconstruct the beneficiaries’ mindsets or their underlying mental health. As a result, numerous failures have been registered. Government interventions, such as the Peace Recovery and Development Plan for Northern Uganda, have tended to focus more on “hardware” interventions than on the “software” of mental health.
To me, these attempts to address symptoms of dependency syndrome do not address the bigger underlying problem of mental health and psychosocial wellbeing of the returnees. Since 2007, I have engaged with IDPs and returnees with the Refugee Law Project’s Beyond Juba Project, the issues of depression and anhedonia particularly have been common ailments that many trauma survivors are grappling with due to unaddressed individual and collective war experiences, poor social support systems, lack of trauma focused interventions, environmental triggers, and the challenge of addressing livelihood issues and conflict drivers. Consequently, depression results in victims/survivors isolating themselves from people and support programs, losing interest in daily activities, lacking energy to participate in livelihood and income generating activities, behaving recklessly, and experiencing hopelessness.
Whereas depression seems to commonly be mentioned by stakeholders as a common mental health condition affecting conflict affected people in Northern Uganda, often times no mention is made about anhedonia which is both a mental health condition and also a core symptom of major depressive disorders. Anhedonia is a mental health condition that renders the sufferer decreased or no ability to feel pleasure and lose interest in productive and creative activities that he/she used to enjoy or gain from it significantly. There are two main types of anhedonia, namely social and physical. Social anhedonia manifests in social withdrawal, lack of relationships or withdrawal from previous relationships, negative feelings toward self and others, reduced emotional abilities, difficulty adjusting to social situations, a tendency toward showing fake emotions. Physical anhedonia can be seen in a loss of libido or a lack of interest in physical intimacy, persistent physical problems and somatic complaints.
Overall it can be seen that anhedonia manifests in the inability of the sufferer to experience pleasure from activities they previously found enjoyable. Therefore, it is unjust to brand a person suffering from these mental health symptoms as “lazy”; the condition goes beyond physical symptoms on the body. Depression shatters social networks and support systems, kills the motivation to be productive; and drags the sufferer into a pool of constant sadness and negative thoughts.
If these psychosocial conditions are not fully understood and addressed, dependency syndrome will continue to negatively affect all spheres of life and development in Uganda. There is an urgent need to draw the attention of researchers, program and policy designers, and stakeholders to revisit the link between mental health, productivity, and citizen participation in national development. Mental health and psychosocial support needs to be mainstreamed as a very specific and cross cutting intervention. Mental health is not only essential for individual well-being, but also essential for enhancing human development including economic growth and poverty reduction.
The writer (Okot Benard Kasozi) works for RLP as Senior Psychosocial Research and Advocacy Officer under the Conflict, Transitional Justice and Governance Programme