An expert witness recently gave testimony on the intermingled nature of Christian and traditional African spiritual practices in Uganda. Doctor Catherine Abbo, Witness P-445, told Trial Chamber IX that it is a common thing for people in Uganda to practice Christianity hand in hand with cen and orongo. Cen and orongo are both forms of spirit possession.
The cross examination of Witness P-445 began on Tuesday, March 27,2018 after Defence lawyer, Abigail Bridgman took the floor to question the witness.
Speaking about depression, Dr Abbo told the Court that masking of symptoms of depression can occur but it is also associated with a culture that tends to mask not only symptoms but also interactions.
Using Uganda as an example, she explained to Trial Chamber IX of the ICC that people from the Central part of Uganda can mask the symptoms better than those from the North and East hence physicians dig deeper during diagnosis while dealing with people from Central part of Uganda.
Stressing her point, Dr Abbo said that people from the Central part of Uganda could smile at you while harboring the intention to kill you.
Here are excerpts of the exchange in Trial Chamber IX between Defence lawyer Abigail Bridgman and Doctor Abbo:
Bridgman: When analyzing one of the post surrender videos of Mr Ongwen you termed him as a contained person what do you mean?
Abbo: By containment I meant looking at the video he was self-composed, he was in touch as of here and now and he didn’t need external effort to help him calm down.
Bridgman: Yesterday you talked of decompensation is this same as clinical distress?
Abbo: Let me go back to what I understand by decompensation you what you have just asked, clinical distress and what I understand. Decompensation this is a term used in the area of those who might have had a chronic illness and they are on treatment functioning well they get a revert that interferes with their functioning then the symptoms of the illness comes back and they have to go back to the hospital. What you call clinical distress, I would understand that it warrants intervention. It is a new term to me so I will try to clarify what you mean by Clinical distress.
Judge Bertram Schmitt: Miss Bridgman have you come up with a new term?
Bridgman: No, It came through the testimony of Professor Mezey. If I understood you well for the case of Mr Ongwen there is nothing to show that he was in a kind of treatment for mental disorder for us to refer to his conduct as decompensation. Am I getting you wrong on this?
Abbo: He (Ongwen) has been accessed and there are experts saying that he has mental illness. Let me say that, something might have dropped that and that’s why we are seeing that.
Bridgman: Can someone be a catholic and practice ‘cen’ and ‘orongo’?
Abbo: Yes, that is a common thing in Uganda people holds and practice both views
Bridgman: With your background and specialisation, is it true that in most African language there are no appropriate terms to describe depression symptoms?
Abbo: I think that I wouldn’t say there are no appropriate words. I believe that cultures can describe how people feel in their own way, the way they understand it.There might not be a word that would directly translate to depression but the depressive symptoms can be described. Human beings whenever they are able to describe how they feel.
Bridgman: Miss Abbofrom your cultural experience, can the concept of ‘cen’ be an attempt to explain an alienation of soul and mind?
Abbo: Yes. It could be. It is for us clinicians and physicians to diagnose what we need…Masking of symptoms of depression can occur but it is also associated to a culture that tends to mask not only symptoms but also interactions. In Uganda some people who come from different parts can mask the symptoms like people from the Central part, whereas people from the North and East where I come from they put it out to your face. The people from the central can smile at you but inside they want to kill you. So when people from Central Uganda come (for diagnosis) we dig deeper.
Bridgman: In the LRA when you were silent you were presumed to be planning to escape. For someone like Mr Ongwen who lived in that environment for a while can it have an impact on how he presents today?
Abbo: When I have watched the videos(of Mr Ongwen) and what I picked from the case notes of the clinicians who looked after him, I think that much of what Mr Ongwen expresses are true feelings like what I see in the video when he is interacting with others. When he is expressing happiness it is really happiness. I have not seen what contradicts his inner self from what he is expressing. If the impact is there it is minimal.
Bridgman: In Professor De Jong’s reports he talks about suicide. I want you to comment about Mr Ongwen alleged conduct that he would go to battle hoping to be killed or he challenged Mr Kony now and then hoping to be killed?
Abbo: These kind of statements are not unusual in my clinical experience. If someone makes these statements when accessing them I would like some understanding. I would like to make sure to see if I am dealing with someone eminently suicidal. I would ask more questions, like “if you are hoping to be killed and you were not killed how it made you feel, how did you make it to go till now. I would not take it at a face value. By what is happening here I cannot comment.
Bridgman: During Dr Mezey’s testimony we heard about PTSS are you familiar with this stuff?
Abbo: I am familiar with Post-traumatic stress symptoms this is when someone has symptoms that do not make criteria for a full Post- Stress traumatic Disorder. For me this is how I understood it.
Bridgman: You told us when you were the head of forensic unit butabika hospital. Are there any other mental facilities?
Abbo: That is the only national referral hospital but there are mental units in regional referral hospitals in Gulu, Arua hospital, Mbale.I have out been master of medical anthropology students and not the undergraduates.
Bridgman: Are you aware of any research conducted on the population on Northern Uganda regarding PTSD?
Bridgman: In your practice how many child soldiers have you treated?
Abbo: Not many but I prefer not to talk about this here.
Bridgman: Could you provide us with approximate numbers?
Abbo: Two. I worked with them not as children but after they have come from the bush as adults.
Bridgman: Were any of these adults accused of committing crimes or were they just patients?
Abbo: Some were patients, colleagues.
Bridgman: Dr Mezey in her testimony said Post traumatic avoidance is a refusal to talk. In Mr Ongwen’s situation there is ample evidence that he is more than willing to talk of his experience in the LRA. Since Mr Ongwen talks about his experience this does not preclude that he manifests symptoms of Post Traumatic disorder. Correct?
Abbo: Under avoidance there are points there and they all talk about how you can avoid the space,place,people,talking.The avoidance is not just one(talking) it can be either of one that is listed. It is possible that one can have avoidance symptoms and then they talk about other symptoms that do not invoke anxieties they can talk on other things and avoid particular areas that can invoke fresh memories. It depends what he was talking about. It is not an all or nothing situation, it is variable. The person accessing is the one that pulls out for us this variabilities and concludes for us.
Bridgman: In Professor’s De Jong’s report at page 13.In the second paragraph, he (the doctor) asked what he did to become a commander. There is something in parenthesis that appears to be his opinion, “he (Ongwen) is frowning, giving long answers seems somehow agitated and angry. Does this show anxiety?
Abbo: From this interpretation this is anger and being upset rather than anxiety. If he (Dr De Jong) said that he was shaky and sitting at the edge, it would indicate anxiety but this to me seems its anger and being upset.
Bridgman: For a child abducted at 10(years) how can you access personality changes?
Abbo: You need to have a baseline and information on how this person could be functioning which assessment talked about yesterday. But we have a general understanding of how humans should function. We are looking at someone’s response in terms of if they have a family, whether they are carrying out what they should in certain time, how they react to certain situation, what are those things he was doing and he is not doing any more. I looked at the statement where he (Ongwen) said how they prayed and this helped him cope. He had family in the bush he valued is family and children, he wants to die because of his family. Life did not look meaningless.
Bridgman: Is there a difference between mood and affect, if yes what is the difference?
Abbo: Some pysicaitrist think there is no difference but clinically when we say mood we speak of a sustained inner feeling .Affect is a momentary thing. Like I said before it varies some write it as mood/affect and some say there is difference.
Bridgman: In your report you admitted you did not examine Mr Ongwen. You worked from the presumptions of the experts. Why did you choose to work on these presumptions?
Abbo: Yes because I did not examine him
Bridgman: Doctor Abbo for your patience. This marks the end of my questioning but like I mentioned earlier, the lead counsel has follow up questions.
(Krispus Ayena Odongo stands up to question the witness)
Odongo: I want to start from the premise Dr Abbo that you are a certified specialist in child and adolescent psychiatry, you wrote your PHD thesis on traditional healers, you are specialized on PHD level transcultural psychiatry. Before I put some specific questions to you I will put some general questions to you. You mentioned apart from Prof De Jong, Ovuga and Akena on their interview on Ongwen you did not have evidence on his childhood till adulthood?
Odongo: Dr Abbohow did you then come to the conclusion from what is on record, is without recognizing any limitation that the complex interaction of the individual, physical environment and psychological interactions had gone well?
Abbo: From an assessment one can make inference. Even without any information you can meet an adult and know whether they had good childhood.
Odongo: I don’t know if you are aware that Ongwen comes from Cherom that is part of Lamogi. Maybe you may have known that Lamugo experience in 1912 what was called Lamugo rebellion. Suppose Mrs Abboyou went to the origin or birth of Ongwen and discovered he was told that the people in Lamogi believe in spiritualism and this shapes the views and opinions were formed by that. This is a child that goes face to face with spiritualism (in the bush).Could this have helped change your conclusion that the complex interaction between the individual social and ecological factors were favourable by the time he was abducted?
Abbo: No it could have changed that.
Odongo: Let’s talk of mental illness versus mental defect. A religious person taking a suicidal mission would you call that person a normal person or ill or may he have a defect in his mind?
Abbo: I would have to a carry a full psychiatric evaluation to say if it is normal or not
Judge Bertram Schmitt: We conclude the hearing for today. We will continue tomorrow.