When the war never ends: conceptual limitations, contextual differences and implications for interventions in continuous traumatic stress in Sub-Saharan Africa.

Considerable knowledge has been generated on the symptoms, course, therapy, and care of survivors of traumatic experiences since posttraumatic stress disorder (PTSD) was added to the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) in 1980. Notwithstanding this improved understanding, there is still disagreement over the definition, characteristics, and expression of PTSD in various settings. The aim of this paper was to offer a perspective on the limitations of the current conceptualization of mental health problems associated with continuous traumatic stress (CTS), considerations of contextual and cultural differences, and their implications for interventions. Particularly, this perspective aimed to address the generalization of Western therapies in non-Western societies, as well as the limitations of traditional rituals and ceremonies, and their limitations in the treatment of mental illness in the context of unending violent conflicts in Sub-Saharan Africa (SSA). In many traditional societies in SSA, trauma is experienced and symptoms are appraised based on the culture of survivors, demonstrating the importance of context in the conceptualization of CTS and the design of interventions. Psychological therapies in the majority of Western societies are based on symptom reduction, which are limited in the context of CTS and traditional cultures. The perspective also discusses different ecosystems in the treatment of trauma using Western and traditional society approaches, as well as the unique nature of the violent conflicts in SSA, and suggests a way forward. Finally, we discuss whether Western evidence-based therapies that are locally and culturally grounded and traditional rituals and ceremonies are mutually exclusive, particularly in the context of CTS and mass trauma that uniquely affect individuals, families, communities, and different subpopulations.