Using a critical ethnographic design, the study examined cultural understandings of mental illness in a fragile context of pastoralist Karamoja, north-eastern Uganda. Karamoja is a particularly sensitive geographic part of Africa. The area is characterized by armed conflict, famine and suffering amidst chronic poverty. Also, after decades of political marginalization, economic neglect and social exclusion, security remains fragile. And with turbulence in the great Lakes region, Karamoja has potential to impact peace progress in Uganda and elsewhere in the great Lakes region. To understand how these dynamics influence people's understanding of mental illness in Karamoja, data were collected using six complementary qualitative methods. These include participant observation, conversations, life history interviews, focus group discussions, key informant interviews and secondary data review. Data were analysed using Atlasti. The triangulation of the methods and data sources enabled a comparison of multiple perspectives and enhanced the validity of the study.