Historical Trauma and Cultural Scripts of Trauma among Trauma Survivors in Rwanda and East-Africa

Worldwide many people are exposed to natural disasters and man-made traumas that are known to have different short and long-term post traumatic consequences on their life. So far, Post-Traumatic Stress Disorders (PTSD) is the most well-known disorder shown by many scientists and clinicians as a result of aversive traumatic exposure. To date, its diagnostic criteria are well defined and different interventions have developed in many western countries. However, recent research has revealed other specific symptoms that are not covered by PTSD criteria especially in population that were exposed to cumulative and collective manmade traumas like genocide, slavery, and colonization. This is the case of symptoms of unresolved grief across generations identified in Indigenous America by Maria Yellow Horse Brave Heart referred to as Historical Trauma (HT). In the same vein, literature have indicated that the research, assessment, and treatment of PTSD was mostly influenced by western culture, norms, values, and beliefs while there are other perceptions and expressions of post traumatic experiences in different cultures referred to as Cultural Scripts of Trauma (CST) that might be overlooked while focusing only on PTSD symptoms.

In East Africa particularly in Rwanda, people were exposed to cumulative and collective manmade traumas, and it is obvious that they can have similar symptoms resulting from historical trauma that are being overlooked due to paucity of research. Furthermore, there is a need to identify how trauma survivors in Rwanda and East Africa with reference to their cultural values perceive and express their post traumatic experiences. The extension of cross-cultural research on long term consequences of trauma is still a scientific gap this time.

Therefore, the purpose of this thesis was to extend the literature on long-term consequences of trauma in Sub-Saharan Africa by conducting research on historical trauma sequalae in a different sample rather than Indigenous America and by identifying elements of the cultural scripts of trauma among Rwandan and East Africa trauma survivors.

Three studies which are the components of this thesis were conducted to achieve that purpose. The first study was a systematic review on clinically relevant historical trauma sequalae. The aim of this study was to explore global advancement of literature in historical trauma and its semantic space concepts. The second study was conducted based on the gaps identified by the first study. Hence, this study developed and validated a new psychological instrument of Clinical Aspects of Historical Trauma (CAHTQ) by using 261 Survivors of genocide against Tutsi’ participants. The last study was conducted to assess cultural scripts elements in Rwanda and East Africa by using 27 experts in the domain of cultural clinical psychology and 64 trauma survivors in East African countries.

Taken together, the results of these studies have indicated that the historical trauma concept has a high potential for new research in the field of Global Mental Health. However, the concept still needs further development like standard features and assessments in additional contexts than its original fields of application with Indigenous Americans. The second study started to bridge that gap by developing a psychological measure using survivors of genocide against Tutsi. The final questionnaire includes 20 items and five subscales. The items demonstrated good internal consistency, Cronbach’s α = .91, and the confirmatory factor analysis demonstrated a very good fit of the model to the data.

The results of the last studies and clinical experiences have indicated that East African population have their own way of perception and expression of post traumatic experiences. Therefore, the last study assesses elements of cultural scripts of trauma in Rwanda and East African countries. The results of this study revealed 270 elements of the cultural scripts of trauma grouped into 7 categories including cognitive appraisals, worldview, interpersonal relationships, body-related, growth, changes in family interest and management and others. Cultural values that served as reference to these post traumatic perceptions and expressions consisted of holding the sadness, Christianity, community reputation, solidarity, social connectedness, social cynicism and reproductiveness among others.

As conclusion, the results of this thesis extended post-traumatic stress literature by further develop the concept of historical trauma and highlighting the role of culture in perceptions and expressions of post traumatic sequalae. Although there are limitations and future directions that need to be taken into considerations by future research, but these results can be the catalyst of future post traumatic interventions especially in East African countries.