Struggling to Be a “Happy Self ”? Psychotherapy and the Medicalization of Unhappiness in Uganda by Julia Vorhölter This article is an ethnographic study of emergent discourses, practices, and institutions focused on mental health and psychotherapy in Uganda. It compares the recent rise of a psy-dispositif in two very different settings: postwar northern Uganda, which has become a hub for international trauma interventions, and Kampala, the capital, where a small group of Ugandan psychotherapists has established a number of private practices, which mainly cater to the (upper) middle classes. The article investigates the meanings of happiness and suffering in these different contexts and asks who seeks psychotherapy and why. It shows how in the context of novel discourses on mental health, and related to changing lifestyles and images of the self, new struggles to be happy are taking place, albeit in very class- and place-specific ways. Consequently, unhappiness and psychosocial suffering are becoming reasons for seeking therapy, at least for some. Such a medicalization of unhappiness, manifested most prominently in the popular idiom of depression, reflects a global trend and has led to the soaring consumption of antidepressants and rising popularity of psychotherapy, particularly in the United States. As such, this article seeks to make a contribution to recent anthropological debates on happiness, suffering, and global mental health. A contemporary Western belief holds that the absence of hap- piness is a sign of ill-health and abnormality. This medicali- zation of unhappiness, manifested most prominently in the popular concept of depression, 1 seems to have reached un- precedented levels—especially in the United States, where the American Psychiatric Association recently attempted to pa- thologize grief as a new mental disorder (Kleinman 2012). The idea of happiness as an important goal of human existence is already captured in the Declaration of Independence. Lately, however, happiness seems to have become even more: a fun- damental marker of what it means to be a healthy and normal self. Subsequently, the absence of happiness is taken as a reason for medical and psychological interventions, which is reflected in the soaring consumption of antidepressants and the rising popularity of psychotherapy. Ongoing debates on global mental health have contributed to the worldwide spread of Western medicalized notions of unhappiness and therapies to cure it. Based on ethnographic research, this article examines the case of Uganda. I analyze how, in the context of novel discourses and practices of mental health care, including a growing popularization of psycho- therapy and related to changing lifestyles and images of the self, new struggles to be happy and new meanings of suffering have emerged. Discussed will be the following questions: What are the meanings of (un)happiness and suffering in different contexts? For whom does the absence of happiness become present? What kinds of strategies and therapies, if any, do people from different (class, age, gender) backgrounds seek to deal with suffering and unhappiness? I will argue that meanings of and dealings with suffering have been reframed in Uganda through the recent emergence of a psy-dispositif, 2 that is, new forms of knowledge, institu- tions, and practices that embody and represent psychological expertise. Suffering, a very broad term used to delineate vari- ous aspects of human misery and affliction, is now commonly understood as psychosocial suffering or, even more narrowly, unhappiness. Both are increasingly taken as reasons for med- ical and psychological interventions, indicated, for instance, by the spread of new diagnostic (and popular) categories such Julia Vorhölter is a Scientific Associate at the Institute of Social and Cultural Anthropology at Göttingen University (Theaterplatz 15, 37073 Göttingen, Germany [julia.vorhoelter@sowi.uni-goettingen.de]). This paper was submitted 15 XII 16, accepted 1 III 18, and electronically published 21 II 19. 2. “Psy” is defined by Rose (1999) as the “heterogeneous knowledges, forms of authority and practical techniques that constitute psychological expertise” (vii). Dispositif is defined by Foucault (1980 [1977]) as “a thoroughly heterogeneous ensemble consisting of discourses, institutions, architectural forms, regulatory decisions, laws, administrative measures, scientific statements, philosophical, moral and philanthropic proposi- tions . . . a sort of—shall we say—formation which has as its major function at a given historical moment that of responding to an urgent need” (194f.). 1. It is important to note the difference between the broad popular idiom of depression and clinical definitions of depression as per DSM (Diagnostic and Statistical Manual for Mental Health) or ICD (Inter- national Classification of Diseases). q 2019 by The Wenner-Gren Foundation for Anthropological Research. All rights reserved. 0011-3204/2019/6002-0003$10.00. DOI: 10.1086/702337 194 Current Anthropology Volume 60, Number 2, April 2019 This content downloaded from 137.111.162.020 on April 28, 2019 14:40:56 PM All use subject to University of Chicago Press Terms and Conditions (http://www.journals.uchicago.edu/t-and-c).