Trauma descriptions and lived experiences: a phenomenological exploratory study among patients with severe mental illness in Botswana.

backgroundThe definition of trauma used in current diagnostic and classification systems excludes culturally influenced conceptualizations of trauma, which may not involve an immediate threat to life or physical injury but a set of adversities and stressors. A culturally sensitive definition of trauma may contribute to increased identification of those at risk of developing trauma sequelae resulting in timely interventions. This formulation is particularly important for individuals living with mental disorders. The objective of this paper was to explore trauma descriptions and experiences among patients with severe mental illness (SMI) in Botswana to extend a phenomenological understanding of trauma within SMI context in Africa.

methodsIndividual in-depth interviews were conducted among 20 patients with SMI. The Life Events Checklist and the Childhood Trauma Questionnaire were utilized as prompts for eliciting traumatic experiences.

resultsPatients with SMI in Botswana focused on the effects of exposure to various potentially traumatic events to conceptualize descriptions of trauma. Trauma experiences consistent with the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) such as physical assault and sexual violence were reported by the participants as well as those outside of the formal nosology, such as stressful work environments where an individual is not rewarded for work done and spiritual stressors emanating from conflicts between family religious backgrounds and personal religious beliefs leading to resistance to fulfil ancestral obligations such as becoming a traditional healer. Some participants reported overwhelming and uncontrollable experiences associated with ancestral assignments such as frightening visions of negative future events. Furthermore, mental health services-related stressors, such as forced treatment, poor hospital conditions and the experience of psychotic symptoms, were identified as traumatic.

conclusionThe lived experiences of patients with SMI in Botswana underscore the relationship between clinical, cultural, and systemic factors that trigger continuous traumatic stress. This study highlights the importance of considering subjective and cultural experiences when managing those who have been exposed to trauma. The findings further add to the literature about traumatic experiences among those with SMI in Africa. CLINICAL TRIAL NUMBER: Not applicable.