Legacies of civil wars: A 14-year study of social conflicts and well-being outcomes in farming economies.

Community processes to address fractured social relationships and well-being remain the least examined dimensions in studies of legacies of civil wars. This article addresses these limitations by analyzing how the wartime and postwar generations have negotiated the legacies of the civil war (1976-1992) in a farming economy region in Mozambique. Based on a 14-year (2002-2015) study of community courts in Mozambique, we analyzed the types of social conflicts and the associations with gender, age, risk factors, self-described health impairments, and the timing of farming activities. We identified n = 3,456 participants and found that perennial sources of disputes were related to family formation and maintenance, defamation, accusations of perpetration of serious civil wartime violations, mistrust, debts, and domestic violence. Furthermore, conflict relations were associated with gender, age, risk factors, and health problems. This study concludes that civil wars have lasting multifaceted legacies, but generational tensions, availability of community institutions, and economic resources shape social relationships and well-being outcomes while averting revenge cycles among civilian war survivors.

Agricultural cycle and the prevalence of posttraumatic stress disorder: a longitudinal community study in postwar Mozambique.

The influence of physical activity on the prevalence and remission of war-related mental disturbances has never been systematically evaluated. This study examined the influence of participation in the agricultural cycle on the posttraumatic stress disorder (PTSD) prevalence and correlated symptoms longitudinally in post civil war Mozambique. Prevalence rates were examined in the end and the outset of the agricultural cycle in a community population (N = 240). The agricultural cycle, which is characterized by fluctuations in physical activities, social connectedness, and the sense of purpose in life influences the PTSD prevalence and correlated symptoms. By studying the influence of the agricultural cycle on PTSD prevalence, severe PTSD cases that fail to respond to the agricultural cycle can be identified, and subsequently evaluated regarding the need for specialized care.

'Why are there so many drums playing until dawn?' Exploring the role of Gamba spirits and healers in the post-war recovery period in Gorongosa, Central Mozambique.

In the wake of a civil war, local resources can play a potential role in shaping the recovery process by providing both old and new exegeses for the disturbing effects of the past. Using the case of Gorongosa, this article aims to explore the ways in which the war has impacted upon traditional medicine by creating Gamba spirits that cause havoc but can also transform the psychosocial hurts of war survivors. Historically, traditional healing practice was under the sole responsibility of the Dzoca, an ancestral spirit that for generations was embodied in living people through lineage descent to exercise its healing powers. There is consensus among healers that the Gamba spirit and healers emerged after the war and are rapidly spreading throughout Gorongosa. I explore the emic theories to explain the Gamba's puzzling origins and the role they are currently playing in Gorongosa.

Testimony ceremonies in Asia: integrating spirituality in testimonial therapy for torture survivors in India, Sri Lanka, Cambodia, and the Philippines.

This study explores the therapeutic implications of including culturally adapted spiritual ceremonies in the process of testimonial therapy for torture survivors in India, Sri Lanka, Cambodia, and the Philippines. Data were collected through an action research process with Asian mental health and human rights organizations, during which the testimonial method was reconceptualized and modified to include four sessions. In the first two sessions, community workers assist survivors in the writing of their testimony, which is their narrative about the human rights violations they have suffered. In the third session, survivors participate in an honour ceremony in which they are presented with their testimony documents. In the fourth session, the community workers meet with the survivors for a reevaluation of their well-being. The honour ceremonies developed during the action research process came to employ different kinds of symbolic language at each site: human rights (India), religious/Catholic (Sri Lanka), religious/Buddhist (Cambodia), and religious/Moslem (Philippines). They all used embodied spirituality in various forms, incorporating singing, dancing, and religious purification rituals in a collective gathering. We suggest that these types of ceremonies may facilitate an individual's capacity to contain and integrate traumatic memories, promote restorative self-awareness, and engage community support. Additional research is needed to determine the method's applicability in other sociopolitical contexts governed by more Western-oriented medical traditions.

The epidemiology of spirit possession in the aftermath of mass political violence in Mozambique.

In this article we assess the prevalence rates of harmful spirit possession, different features of the spirits and of their hosts, the correlates of the spirit possession experience, health patterns and the sources of health care consulted by possessed individuals in a population sample of 941 adults (255 men, 686 women) in post-civil war Mozambique in 2003-2004. A combined quantitative-qualitative research design was used for data collection. A major study outcome is that the prevalence rates vary according to the severity of the possession as measured by the number of harmful spirits involved in the affliction. The prevalence rate of participants suffering from at least one spirit was 18.6 percent; among those individuals, 5.6 percent were suffering from possession by two or more spirits. A comparison between possessed and non-possessed individuals shows that certain types of spirit possession are a major cause of health impairment. We propose that knowledge of both local understandings of harmful spirit possession and the community prevalence of this kind of possession is a precondition for designing public health interventions that sensitively respond to the health needs of people afflicted by spirits.

When the war was over, little changed: women's posttraumatic suffering after the war in Mozambique.

This article explores the psychosocial effects of women's prolonged exposure to civil war in the center of Mozambique. Using a combination of quantitative and qualitative methods, 91 women were assessed for posttraumatic stress symptoms and psychosocial indicators of ill health. The results indicate that for the majority of the women in this study, traumatic experiences are sequential processes. Their ill health ranges from symptoms of posttraumatic stress to episodes of spirit possession (gamba), affecting women's capacities to conceive and raise children, and marginalizing their social position. A careful analysis of the specific problems and needs of women in postwar contexts is recommended, along with a systematic examination of the effectiveness of the available resources that may play a role in boosting trauma recovery in this group of women.

Testimony method to ameliorate post-traumatic stress symptoms. Community-based intervention study with Mozambican civil war survivors.

BACKGROUND: The effectiveness of the testimony method has not been established in rural communities with survivors of prolonged civil war. AIMS: To examine the effectiveness and feasibility of a testimony method to ameliorate post-traumatic stress symptoms. METHOD: Participants (n=206) belonged to former war zones in Mozambique. They were divided into a case (n=137) and a non-case group (n=69). The case group was randomly divided into an intervention (n=66) and a control group (n=71). Symptoms were measured during baseline assessment, post-intervention and at an 11-month follow-up. RESULTS: Post-intervention measurements demonstrated significant symptom reduction in both the intervention and the control group. No significant differences were found between the intervention and the control group. Follow-up measurements showed sustained lower levels of symptoms in both groups, and some indications of a positive intervention effect in women. CONCLUSIONS: A remarkable drop in symptoms could not be linked directly to the intervention. Feasibility of the intervention was good, but controlling the intervention in a small rural community appeared to be a difficult task to accomplish.