title: Silencing distressed children in the context of war in northern Uganda: an analysis of its dynamics and its health consequences.
abstract: Children in northern Uganda who are the focus of this article were born and raised in the context of war. The research presented here is based on a one-year ethnographic study (2004-2005) with children aged 9-16 years. Various qualitative and quantitative methods used in this study were geared to this age group. A grounded theory approach was followed to trace the reasons for the silencing of their distress. Throughout the study a child actor perspective was implemented: children were approached as social actors capable of processing social experience and devising ways of coping with life. We found that their lives were characterized by high rates of exposure to extreme events, such as deaths, child abductions, disease epidemics, gender-based violence and poverty. As a consequence, their level of emotional distress was high. However, they did not readily speak about their distress. The article identifies and analyses a complex set of reasons for children's distress and its silencing by the children themselves and other members of society. A distinction is made between the processes of victim blaming, self blaming, mimetic resilience and mirroring resilience. In addition, the consequences of the silencing children are presented. Children expressed their emotional suffering primarily in physical aches and pains and used pharmaceuticals and herbal medicines to minimize their distress. The result was a medicalization of psychological distress. In conclusion, we reflect on the necessity of a multi-pronged approach to address children's distress.
authors.affiliation: Gulu University, Faculty of Medicine, P.O.Box 166, Gulu, Uganda. Electronic address: Akellograce@hotmail.com.
authors.forename: Grace
authors.initials: G
authors.lastname: Akello
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands; Department of Sociology and Cultural Anthropology, University of Amsterdam, The Netherlands.
authors.forename: Ria
authors.initials: R
authors.lastname: Reis
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands.
authors.forename: Annemiek
authors.initials: A
authors.lastname: Richters
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010146:Pain / Q000209:etiology; D004364:Pharmaceutical Preparations; D008517:Phytotherapy; D036301:Qualitative Research; D013315:Stress, Psychological / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D014454:Uganda; D014857:Warfare
chemical_list: D004364:Pharmaceutical Preparations