The focus of this paper is the intercultural process through which Open Mole and trauma-related mental illnesses are brought together in the postconflict mental health encounter. In this paper, I explore the historical dimension of this process by reviewing the history of Open Mole, and the ways in which it has been interpreted, acted on, and objectified by external observers over the last half-century. Moving into Liberia’s recent war and postconflict period, I examine the process by which Open Mole is transformed from a culture-bound disorder into a local idiom of trauma, and how it has become a gateway diagnosis of PTSD-related mental illnesses, and consider how it is produced as an objectified experience of psychiatric disorder in clinical humanitarian contexts. By studying how Open Mole is transformed in the humanitarian encounter, I address the structure and teleology of the humanitarian encounter and challenge some of the foundational assumptions about cultural sensitivity and community-based mental health care in postconflict settings that are prevalent in scholarship and practice today.
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This study’s findings were provided to HI in an internal report at the conclusion of field research.
Sources cited in this paper document reports of Open Mole across diverse population centers, including Zorzor, Gbarnga, Beh Town, Gbama Town, Gohgan Town and Bopalu.
Reports in this paper include Open Mole complaints coming from women from Bassa, Gola, Loma, Kpelle and Kissi ethnic groups.
One Open Mole specialist I worked with, Abraham, was employed on an as-needed basis as a chauffeur for a car-rental company in Monrovia, Liberia. His range of Open Mole medications included three remedies, learned from a healer who drew from Gio and Dan healing traditions. The first, “Everlasting Leaf,” or jagli, also called Gio, was taken from a tree, beaten into a paste, inserted into a leaf and squirted into the nose three times a day for 6 days. The second remedy, called “Leh,” involved charring the leaves of a different tree, turning the charred remnants into a paste, shaving the top of the head and adhering the paste to the scalp. The powerful remedy could not be applied with bare hands and burned terribly when applied “because the place on your head is soft.” It needed to be left on for 3 days and then reapplied for 3 days, for a total period of six to 9 days of treatment. It was purported to put the skull back together; make everything hard and put everything in place. If it was applied for more than the recommended 9 days, or if the patient had a weak resistance, it was so strong that it could kill the patient. The third remedy was called “the root of the pepper tree,” or Gio ma jalagru, a topical solution squeezed directly into the eyes. Abraham applied this remedy only when the Open Mole was creating vision problems.
I was able to purchase off-license remedies for ‘worriness,’ ‘can’t sleep’ and ‘thinking too much’ from markets at most of the communities I visited with the HI Psych Team.
The only other organization in Liberia providing psychiatric care is also self-funding its own efforts.
I discuss this phenomenon in a publication in progress.
Though over-the-counter pharmaceutical solutions for Open Mole are rarely discussed publicly, my initial findings suggest that self-medication for Open Mole and “worriness” is widespread. Medications including diazepam (valium), sleeping pills, ayurvedic sedatives from Indian pharmaceutical companies and alternative Chinese medicines prescribed for ‘worriness’ and ‘blood pressure’ are widely available in rural markets and urban shops. It has been difficult to collect data on this topic. My informants suggested that there is a fair amount of shame and stigma associated with drug dependency—a moral reflection, perhaps, on the role that narcotics and marijuana played in the behavior of soldiers during the war. However, there is every reason to believe that the medication of somatic symptoms of distress is a widespread practice in towns and villages across Liberia.
Figures include four cases of comorbid diagnoses, including two cases of Open Mole with PTSD/Open Mole with depression, one case of Open Mole with PTSD/Open Mole with anxiety, and one case of Open Mole with anxiety/Open Mole with depression.
By comparison, in the United States, haloperidol is used to manage symptoms of psychosis, schizophrenia, hyperactivity, aggression and delirium, but not PTSD, depression or anxiety. In clinical care in the United States, the typical dosage of haloperidol is 1–5 mg (up to 10 mg) every four to 8 h, about five to eight times the incredibly low dosage that Margaret is receiving.
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Abramowitz, S.A. Trauma and Humanitarian Translation in Liberia: The Tale of Open Mole. Cult Med Psychiatry 34, 353–379 (2010). https://doi.org/10.1007/s11013-010-9172-0
- Open Mole
- Transcultural psychiatry
- Culture-bound syndromes
- Idiom of distress
- Community-based mental health
- Humanitarian intervention