Aim
To investigate the local validity of Western mental illness concepts, specifically depression and
PTSD, in two rural Rwandan communities by examining whether these diagnoses align with
local perceptions of mental health issues following the 1994 genocide.
Procedure
1. Data Collection on Local Perceptions
o 40 local participants were interviewed using free listing, where they named and
described mental health issues caused by the genocide.
2. Identification of Symptoms
o The data were analyzed using inductive content analysis to identify common
mental health symptoms.
o Two major syndromes were identified:
▪ Guhahamuka (mental trauma)
▪ Agahinda gakabije (grief)
3. Key Informant Interviews
o Traditional healers and local leaders (7 individuals) were interviewed for further
validation of the identified disorders.
4. Pile Sorting
o A set of symptom cards (including both local and DSM symptoms) was given to
healers for sorting based on similarity.
o Three DSM depression symptoms—lack of trust, loss of intelligence, and mental
instability—were consistently included in local classifications.
5. Adaptation and Validation of Questionnaire
o A questionnaire was developed using local symptoms and tested for credibility.
6. Community Survey and Diagnosis
o 93 individuals with mental health concerns were identified and assessed:
▪ 70 were diagnosed with agahinda gakabije by local healers.
▪ 30 tested positive for depression using the new questionnaire.
o In a broader survey of 368 adults, results showed:
▪ 17.9% met DSM criteria for depression
▪ 41.8% reported agahinda gakabije
Results
• Many of the Western diagnostic symptoms of depression and PTSD were recognized by
the Rwandan communities but were categorized into local syndromes with additional
symptoms not included in DSM criteria.
• Agahinda gakabije had a strong conceptual relationship with depression in the West,
similar to the connection between grief and depression in Western psychology.
Conclusion
• The study showed that Western concepts of mental illness are not fully applicable cross-
culturally without adaptation.
• Depression-like disorders exist in Rwanda, but their symptoms and classifications differ
from DSM definitions.
• This supports the emic approach to diagnosis, which incorporates local cultural
perspectives rather than imposing Western psychiatric models.
Evaluation
Strengths
• Cultural Sensitivity: Used an emic approach, incorporating local perspectives to improve
diagnostic accuracy.
• Triangulation: Multiple research methods (free listing, interviews, pile sorting, and
surveys) strengthened credibility.
• Practical Impact: Findings helped tailor mental health interventions in Rwanda post-
genocide.
Weaknesses
• Reliance on DSM Comparisons: The study still compared local disorders to Western
concepts, which could introduce bias.
• Limited Generalizability: Findings were based on only two rural Rwandan
communities—they may not apply to other cultures or even other parts of Rwanda.
• Translation Issues: Potential loss of meaning when translating symptoms between
languages.
• Cultural Dynamism: The study treated Rwandan culture as static, though mental health
perceptions evolve over time.
