Trauma, Mental Health & Psycho-social Well-being: Psycho-social Well-being & Peacebuilding Processes

The need to heal trauma in post-conflict societies
An under-developed field in peacebuilding studies and practices

This section examines the needs to confront and heal trauma in post-conflict societies, emphasizing three main dimensions:

The impact of long-term exposure to violence;
The intergenerational effects of trauma or 'historical trauma'
Helping to survivors to go on with their lives.

Despite growing evidence of the individual and collective consequences of trauma, concrete actions to address these invisible wounds are considered by many experts as still often inadequate, if not entirely missing. The field of trauma studies is growing, but it is still relatively new and its findings often do not enter the plans of national and international groups engaged in post-war recovery programs. The discussion also remains largely disconnected from the overall peacebuilding community. The section develops these points and also provides some key references regarding the right to mental health and freedom from mental harm in international law.

The right to mental health and freedom from mental harm in international law

These documents work to guarantee the rights, as detailed below, with respect to the right to mental health and freedom from mental harm in international law.

African Charter on Human and Peoples Rights
Article 16: 1. Every individual shall have the right to enjoy the best attainable state of physical and mental health.

Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment
Article 1: For the purposes of this Convention, the term torture means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.

Article 14: 1. Each State Party shall ensure in its legal system that the victim of an act of torture obtains redress and has an enforceable right to fair and adequate compensation, including the means for as full rehabilitation as possible. In the event of the death of the victim as a result of an act of torture, his dependants shall be entitled to compensation. 2. Nothing in this article shall affect any right of the victim or other persons to compensation which may exist under national law.

International Covenant on Economic, Social and Cultural Rights
Right to Mental Health Article 12: 1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

Universal Declaration of Human Rights
Right to Social Services Article 25: (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The need to heal trauma in post-conflict societies

There is an identifiable need to confront past trauma and support the healing process in post- conflict societies. Dr. Vamic Volkan, a U.S. psychiatrist, has described the nature of the difficulties faced by 'traumatized societies' as 'psychobiological degeneration'. This includes "the loss of basic trust in the order of things, difficulty in mourning, and difficulty in reversing a sense of helplessness and humiliation. Terrifying new social patterns, such as aggression, domestic violence, prostitution, rape, kidnapping, youth gangs, and organized criminality tend to increase. Morality becomes more 'flexible' in such settings, and some individuals increasingly rely on 'magical thinking', such as belief in spells against illness. The breakdown of societies involved in serious ethnic conflict is also often accompanied by human destruction of the natural environment."¹ It is important to note that some of the elements described by Volkan such as "magical thinking" are consistent with cultural beliefs that may help individuals and communities to cope with the trauma.

The impact of long-term exposure to violence

"On the broader level, societies caught up in long-term violent conflict can also undergo serious changes as a result of long-term exposure to violence. New social patterns may emerge, such as widespread prostitution, rape, and domestic violence. Violence experienced by specific social and ethnic groups can reinforce a sense of group identity and victimization, and can encourage the emergence of markers of group identity, expressed through dress, language, and social practices. Specific traumatic events, termed chosen traumas, may become transformed or glorified in the retelling to subsequent generations and may be used to incite revenge and justify efforts to restore the honor or dignity of the victimized group." ² Volkan's notion of chosen trauma shows the potential consequences of unprocessed blows to a peoples sense of identity and self-esteem. "This underlying dynamic of unresolved traumatic wounds underscores the importance of a societal mourning process in order that a population may leave its traumatic memories behind...As trauma specialists van der Kolk & McFarlane note, the costs of the re-enactment of trauma in society, in the form of child abuse, (domestic abuse), continued violence, and lack of productivity, are staggering."³

The intergenerational effects of trauma or 'historical trauma'

Almost all opinions of psychiatrists and psychologists coincide in emphasizing the intergenerational effects of trauma.⁴ When individuals, families and societies cannot cope with their (past) trauma, there is a high likelihood that they will pass it on to the next generation. Collectively, "societies transformed in these ways by long-term conflict can become engaged in highly (self)-destructive political dynamics in which they become locked in unending conflict with their hated enemies. In such cases, reconciliation will not be achieved through the signing of a peace treaty alone but will also require adjustments at a more fundamental psychological level."⁵ This transgenerational trauma is also sometimes referred to as 'historical trauma,' and requests specific healing processes.⁶

"It is quite common to observe that members of the generation immediately succeeding the one that endured periods of extreme violence have trouble making sense of entire segments of their lived experience or even of their own identity as a result of the silence maintained by their parents and, more generally, by the adults of the community."⁷ Here, official discourses and initiatives may play as important a role as more targeted psychosocial programs. "The public narrations of the past, those that are authorized or official, such as celebrations, commemorations, and monuments, can lend meaning to individual memories and give to the new generation the possibility of facing the 'unthinkable': the attempt to make a whole society disappear. But official memories can, conversely, mutilate personal memories."⁸

The potential cycle of violence and trauma is of central concern for peacebuiding but this link remains debated among specialists and gaps in knowledge remain to actually assess its impact.⁹

Helping survivors to go on with their lives

At the individual level, it is said that healing psychological wounds should make it unnecessary for victims of trauma to engage in 'defensive' violence.¹⁰ "The point of trauma counseling should be to help somebody digest their experience, so freeing themselves from some of its often unconscious effects and hence making them better able to determine their own future. It is a goal that the person tortured does not him/herself become a torturer, but going beyond that it is for the person who has been traumatised to decide whether to forgive, whether to press for the prosecution of those who caused the traumatisation, or whether to concentrate on rebuilding a new life."¹¹ Indeed, the processes of reconciliation and healing appear to be cyclical and reinforce each other, ultimately contributing to the prevention of future violence.¹² In other words, the genuine interest of peacebuilding in trauma work is to find ways to help survivors go on with their lives without wanting to take revenge or acting upon fear from revenge. Yet, too often, trauma work may be misunderstood if not "misused" as a "shortcut" for reconciliation processes.¹³ Indeed, the aim is much broader than simply avoiding revenge. Psychological healing is essential for victims of trauma to regain a sense of dignity and self-worth, and get on with their lives, feelings that are necessary for citizens to successfully contribute to a democratic society.¹⁴ Official discourses and initiatives as part of reconciliation programs may also play an important part in that process. "Public acknowledgement of the events should allow the survivors and victims' relatives to engage in a mourning process."¹⁵ Go to Memorialisation, Historiography and History Education

An important notion referring to that process is the notion of resilience as an individual's capacity to adapt, survive, and bounce back during or after hardship and adversity. This capacity comes from individual characteristics (the possession of mental and biological coping strategies which effectively reduce the stress of an event or lessen the physiological responses) as well as effective social and family supports. When a group is attacked, the threat may be cognitively framed differently; "strength, resilience and the need to survive...to protect dependents" may be emphasized and support greater resilience of members of the group.¹⁶

Another dimension to consider is the perpetration induced traumatic stress-- since perpetrators as well as victims are traumatized by acts of violence.¹⁷ In the case of the perpetrators, it is the violence inflicted on others that traumatizes them. To "provent" future conflicts, in the words of the scholar John W. Burton, in the sense of anticipating and avoiding violent conflicts, the perpetrator has to be factored into the equation.¹⁸ This dimension is particularly important in the process of reintegrating former combatants, including former child soldiers.

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An under-developed field in peacebuilding studies and practices

"The international community is just beginning to take heed of mental health issues, which belong at the fore of recovery efforts. However, despite growing evidence of the consequences of trauma, concrete actions to address these 'invisible wounds' are unexpectedly still often inadequate, if not entirely missing, from paradigms of assistance and development employed by relief and development organizations in post conflict transition. Their absence weighs heavily on the prognosis for future peace in war-torn societies, particularly since it is precisely those individuals who have experienced the 'trauma of war' who are expected to play a key role in the reconciliation, recovery, peacebuilding and rehabilitation process in the often tenuous aftermath."¹⁹

A growing number of non-governmental organizations have tried to develop interventions that take into consideration these dimensions through innovative approaches involving cultural and artistic tools. But these interventions remain relatively marginal in peacebuilding practices.

The field of peace studies itself remains almost "completely disconnected from mental health studies, which in turn bifurcates along individual and collective perspectives, as well as between the camps that endorse and reject post-traumatic stress disorder (PTSD) approaches."²⁰ Until recently, very little had been documented about the relation between legal or paralegal processes (e.g., international tribunals, truth and reconciliation commissions) and social or psychological processes. In March 2004, the United States Institute of Peace organized a conference on Trauma and Transitional Justice in Divided Societies, and consequently published a special report which remains a key document on the subject.²¹ A few articles have also discussed the psychosocial implications of the Truth and Reconciliation Commissions, particularly in South Africa, or the Gacaca Courts in Rwanda.²² The link is also increasingly made when dealing with reparations.²³ But much more empirical studies and exchanges between practitioners are needed to ensure that this dimension actually informs peacebuilding strategies, in particular when dealing with reconciliation and nation building.

Go to Activities: Justice, truth and reparations as healing components

1. Judy Barsalou,"Training to Help Traumatized Populations," Special Report 79 (Washington DC: US Institute of Peace, December 2001).
2. Judy Barsalou, "Trauma and Transitional Justice in Divided Societies," Special Report 135 (Washington DC: US Institute of Peace, April 2005), 9.
3. Marta Cullberg Weston, "A Psychosocial Model of Healing from the Traumas of Ethnic Cleansing: The Case of Bosnia" (Kvinna till Kvinna Foundation, 2001), 13-14; Richard J. Goldstone, foreward, Between Vengeance and Foregiveness: Facing History after the Genocide of Mass Violence, by Martha Minow (Boston: Beacon Press, 1998); Vamik Volkan, The Need to Have Enemies and Allies, (NY: Jason Aronson, 1989); B.A. van der Kolk & A.C. McFarlane, Trauma and its Challenge to Society, in Traumatic Stress. The Effects of Overwhelming Experience on Mind, Body, and Society, B.A. van der Kolk, A.C. McFarlane, L. Weisaeth, eds. (NY: Guilford Press, 1996).
4. Yael Danieli, ed. International Handbook of Multigenerational Legacies of Trauma (New York: Springer, 1998); Eric Brahm, "Trauma Healing," Beyond Intractability (January 2004); Derek Summerfield, "The Psychological Legacy of War and Atrocity: The Question of Longterm and Transgenerational Effects and the Need for a Broad View," Journal of Nervous Mental Disorders 184 (1996): 375-377; Lykes, M. Brinton and Marcie Mersky, "Reparations and Mental Health: Psychosocial Interventions towards Healing, Human Agency, and Rethreading Social Realities," in The Handbook of Reparations, edited by Pablo De Grieff. (New York: 2006), 589-622.
5. Barsalou,"Trauma and Transitional Justice in Divided Societies," 9.
6. See different contributions in Peacebuilding in Traumatized Societies, ed. Barry Hart (Lanham, Boulder, New York, Toronto, Plymouth, UK: University Press of America, 2008) and also Joseph Montville, "The Healing Function in Political Conflict Resolution," in Conflict Resolution Theory and Practice, D. Sandole and H. Van der Merwe, eds. (Manchester: Manchester University Press, 1993): 11227.
7. Batrice Pouligny, Bernard Doray and Jean-Clment Martin, "Methodological and ethical problems: A trans-disciplinary approach," in After Mass Crimes: Rebuilding States and Communities, Pouligny et al., eds. (New York: United Nations University Press, 2007), 32. See also Yael Danieli, "The Treatment and Prevention of Long-term Effects and Intergenerational Transmission of Victimization: A Lesson from Holocaust Survivors and their Children," in Trauma and its Wake, C. R. Figley, ed., 295-313 (New York: Brunner/Mazel, 1985); Yael Danieli, ed., International Handbook of Multigenerational Legacies of Trauma (New York: Springer, 1998).
8. Ibid, 33.
9. Communication with Jeannie Annan, July 14, 2008.
10. Ervin Staub, Laurie Anne Pearlman, Alexandra Gubin, and Athanase Hagengimana, "Healing, Reconciliation, Forgiving and the Prevention of Violence after Genocide or Mass Killing: An Intervention and its Experimentation in Rwanda," Journal of Social and Clinical Psychology 24, no. 3 (2005), 298.
11. "Demilitarising Minds, Demilitarising Societies," Committee for Conflict Transformation Support Newsletter 11.
12. "The Rwanda Project: Overview."
13. Communication with Dr. Simone Lindorfer, June 25, 2008.
14. Laurie Ann Pearlman and Ervin Staub, "Creating Paths to Healing," Trauma, Research, Education and Training Institute, 2002; Barsalou,"Trauma and Transitional Justice in Divided Societies."
15. Pouligny, et al., "Methodological and ethical problems: A trans-disciplinary approach," 32.
16. M. Konner, "Trauma, Adaptation, and Resilience: A Cross-Cultural and Evolutionary Perspective," in Understanding Trauma. Integrating Biological, Clinical and Cultural Perspectives, L.A. Kirmayer, R. Lemelson, & M. Barad, eds. (Cambridge: Cambridge University Press: 2007), 322.
17. See Rachael MacNair, Perpetration-Induced Traumatic Stress: The Psychological Consequences of Killing (Lincoln, NE: Authors Choice Press, 2005).
18. Communication with Barry Hart, May 15, 2008. On the notion of "prevention," see John W. Burton, Conflict: Resolution and Prevention (New York: St Martins Press, 1990).
19. Richard Mollica and Laura McDonald, "Old Stereotypes, New Realities: Refugees and Mental Health," UN Chronicle 2 (2002), 29.
20. Batrice Pouligny, Simon Chersterman, Albrecht Schnabel, eds. After Mass Crimes: Rebuilding States and Communities. (New York: United Nations University Press, 2007), 4.
21. Barsalou, "Trauma and Transitional Justice in Divided Societies."
22. See Michael Humphrey, "From Terror to Trauma: Commissioning Truth for National Reconciliation," Social Identities 6, no. 1 (2000), 9; Cheryl De La Rey and Ingrid Owens, "Perceptions of Psychosocial Healing and the Truth and Reconciliation Commission in South Africa," Peace and Conflict: Journal of Peace Psychology 4, no. 3 (1998): 257-270; Brandon Hamber, "Do Sleeping Dogs Lie? The Psychological Implications of the Truth and Reconciliation Commission in South Africa," seminar presented at the Centre for the Study of Violence and Reconciliation, Johannesburg, July 26, 1995, 4-5; Alfred Allan & Marietjie M. Allan, "The South African Truth and Reconciliation Commission as a Therapeutic Tool," Behavioral Sciences and the Law 18, no. 4 (2000): 459 477; Karen Brounus, Truth-Telling as Talking Cure? Insecurity and Retraumatization in the Rwandan Gacaca Courts." Security Dialogue 39, no. 1 (2008): 55-76.
23. See for instance: Brandon Hamber, "Narrowing the Micro and Macro: A Psychological Perspective on Reparations" in Societies in Transition and M. Brinton Lykes, Marcie Mersky, "Reparations and Mental Health: Psychosocial Interventions towards Healing, Human Agency, and Rethreading Social Realities," in The Handbook of Reparations, Pablo De Greiff, ed. (Oxford: Oxford University Press, May 2006); Yael Danieli, "Preliminary Reflections from a Psychological Perspective", in The Right to Restitution, "Compensation and Rehabilitation for Victims of Gross Violations of Human Rights and Fundamental Freedoms" T.C. van Boven C. Flinterman, F. Grunfeld & I. Westendorp, eds. Netherlands Institute of Human Rights, Special Issue 12 (1992): 196-213.

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