On 27 February 2002 communal riots struck Ahmedabad, in the state of Gujarat in west India, and continued for 3 months. It is estimated that over 1200 people were killed in the riots, several thousands were injured, and more than 30 000 households and around 100 000 individuals were internally displaced to relief camps. The aim of our study was to document the mental health of women living in these relief camps, and to elicit open-ended descriptions of experiences of their emotional and cognitive worlds, in their own language. Our objective was to use emic data to study whether the women's experiences approximated the hallmark symptoms of the clinical construct of post-traumatic stress disorder (PTSD), a diagnostic category that has been criticised as having limited cross-cultural validity (Reference PatelPatel, 2000).

METHOD

We conducted in-depth interviews with 55 women in relief camps in the city of Ahmedabad to elicit their subjective experiences of the trauma and associated emotional experiences. These were recorded verbatim in the local language. The interviews were preceded by an introductory comment: ‘Events like riots may generate strong feelings and distress. Talking about this may help relieving this. Once you tell us about your experience we may consider what we can do to reduce your distress by further talking and/or medication.’ Open-ended questions were: ‘What were you doing at the time of riots?’ ‘What happened to you; what did you see, hear, smell and what did you do?’ ‘What were your feelings at that time?’ ‘How are you feeling now?’ ‘What are the effects of riots on your mind?’ Informed consent was obtained for each interview. Medications and counselling were given if a formal mental state examination following the interview revealed the presence of a mental disorder.

RESULTS

Three narratives are presented below to illustrate these experiences.

DISCUSSION

Post-traumatic stress disorder has been the focus of a number of studies from developing countries in populations exposed to a diverse range of traumatic events such as earthquakes, cyclones, ethnic conflict, bombs and forced migration (e.g. Reference Sharan, Chaudhary and KavathekarSharan et al, 1996; World Health Organization, 2002; Reference De Jong, Komproe and Ommerende Jong et al, 2003). These studies have mainly relied on quantitative methods. Despite this evidence base, there are criticisms regarding the validity of PTSD as an ‘invented diagnosis’, the medicalisation of psychological distress and stigmatisation based on the diagnosis (Reference SummerfieldSummerfield, 2001). Eisenbruch (Reference Eisenbruch1991) argues that it is impossible to define and measure complex human experiences such as alterations of affect, consciousness, self-perception and perception of perpetrators without correcting for culture. There is a need for better understanding of how trauma reactions vary across cultures.

We describe here the findings of in-depth interviews to study the emotional experiences of women who had been exposed to extreme trauma. The three narratives presented in this paper are typical of the narratives we elicited from most women. These narratives not only vividly illustrate the experiences that are typical of the symptoms of PTSD as described in psychiatric nosology – notably re-experiencing, avoidance and hyperarousal – but also express their association with the traumatic events. Thus, when women were asked what they thought had caused their current emotional distress, they invariably mentioned two factors: gham (bereavement) and sadma (sudden trauma). The women had sought the help of a mental health provider team, indicating that they associated their experiences with a mental illness. We believe that these observations provide support for the cross-cultural validity at least of the core symptoms associated with the psychiatric category of PTSD.