Recently I had the pleasure to be host to Joseph Kalisa, clinical psychologist from Rwanda. Joseph co-edited the remarkable book Land of a thousand stories.* Kalisa and colleagues describe a narrative, imagery approach to what people experience in the aftermath of the genocide.**
Many of those interviewed in the book call it a decolonization process. Before the colonial period, wellness in Rwanda was fundamentally based in families and communities. The introduction of ‘modern western type’ structural approaches to health care became itself a source of suffering. The DSM diagnostic system is counterproductive in Rwanda. It fuels stigmatization and social rejection and diminish and devalue individual and collective local knowledges. The exclusion and diminishment of people’s local knowledge is even a key contributor to psychic misery.
The Land of a thousand stories is an inspiring book full of descriptions of original ways to honor incredibly painful stories of destruction and isolation, but also of stories of resistance and resilience. In it Rwandan narrative practitioners share how they use local ways of responding to profound social sufferings and mental health struggles. The book contains interviews with care providers and descriptions of how to work within communities and collectivities, for example how 'solidarity camps' with young adolescent children survivors were organized.
We learnt we were there not to give solutions, but to accompany people in finding their own ways to overcome their situation. We were in it together. Because we are also survivors, we listen in ways that show we are not afraid of their stories.
We would spend a period of one or two weeks together, sleep, eat, cry and dance together. We went back to our traditional ways of speaking, using Rwandan proverbs rich with metaphors, and useful tools in supporting people dealing with their challenges and problems. Identifying the issue that needs to be addressed and describing it clearly in the person’s own words and language is a vital step towards finding an effective solution. Not reducing it in pathological concepts.
The first part of the process is about them identifying that thing that has been created in them by the situation (the problem). Drawing that thing. The second step is drawing their sense of who they are, their identity. I like to evoke the five senses. If you can not see it, can you hear or smell or taste it? And with what can you replace (heal) it? I also use a Rwandan proverb everybody knows: ‘the farmer must identify the stone that can harm their hoe.’ Telling the person, you can be expert on solving your own problem. (Chaste Uwihoreye, clinical psychologist).
Gardening is an important part of culture; many Rwandans are engaged with cultivating the land and 72% of the working population is employed in agriculture. Beata Mukarusanga, therapist and trainer at SOS Children’s Villages Rwanda, describes the use of the garden metaphor, inviting people to reflect on experiences of gardening and on how concepts relating to gardening like spreading manure, weeding and harvesting might represent the process of raising children or other life experiences and values. Introducing this metaphor allowed us to build on the Indigenous knowledge of the farmers.
Songs have been significant throughout history in helping those experiencing hardships. In the mental health peer work of OPRAMAMER, members engage in singing and dancing before speaking about hard things affecting their lives. As each member of the group reflected on songs of survival and sustenance, we all joined in miming the song, singing and dancing.
Working with physical pain. Sometimes children can draw their pain but not give any voice to it. Then you can ask ‘If you had anything to tell this pain, what would you tell it?’ (Sister Seraphine Kaitesirwa, narrative practitioner and marriage and family therapist).
A very moving chapter is about the lives of children born out of rape. Women who were pregnant after rape and did not want to abort the child, were often banished by their families. The children had to live with shame, guilt and identity conflicts that had resulted from things they did not participate in or choose. They were often not loved and treated as children of killers. They were not considered victims of genocide and therefore did not benefit from survivors funds for expenses like school fees, even though their mothers were so poor and could not afford school fees or other social basics (Adelite Mukamana, clinical psychologist).
The book is an inspiring ode to the survival power of people. Listening to the intensely deep personal stories of people is the great message of this rich book. Honoring what people experience inside and what gives them the power to survive, regardless of diagnosis, pathological models, labels and protocols. In my opinion, this book also represents a great message for the practice of current Western mental health care. In many a case DSM diagnoses do have a contra-productive side to it. These diagnoses are often considered as illnesses whose symptoms need to be treated in a certain, protocolary manner, without giving full consideration and attention to what particular happens inside the person. If the person's own story is not heard and acknowledged, diagnoses and protocol treatments stand in the way of real therapy and healing. The true inner story has to be identified before the person can connect with his self-strengthening resources.***
Jan Taal, May 2025
* Land of a Thousand Stories. Rwandan Narrative Therapy and Community Work. Edited by Joseph Kalisa, Beata Mukarusanga & Serge Nyirinkwaya. 2022. Adelaide: Dulwich Centre Foundation.
** In 100 days in 1994 somewhere between 600.000 and 1.000.000 of the Tutsi ethnic group, as well as some moderate Hutu and Twa were killed and many more injured and/or orphaned. The genocide was marked by extreme violence, with victims often murdered by neighbors, and widespread sexual violence, with between 250,000 and 500,000 women raped. 100,000 children lost their parents.
*** Taal, J. (2022). Imagery in Therapy, Counselling and Coaching. https://shorturl.at/y4eN4