All posts by Elena E Bengochea

Trauma and Violence: From Liberia to Katrina

The debate surrounding the importance of mental health is complicated by personal experience and the aggregate prevalence of mental disorders. In America, we focus on treating mental health on a case-by-case basis through psychiatric services that utilize therapy and prescription medication. Individuals who have the resources and information can seek out treatment from health care providers to unpack traumatic experiences or other sources of emotional stress.

But what happens to our conception of trauma and the treatment of mental illness when conflict arises, and a thousand people in Monrovia are killed in less than a month? What, if anything, can be done to assess and “diagnose” the experience of trauma on a population level?

Abramowitz examines the experience of Liberians after the nation’s second civil war, and explains the struggle for people to regain, reconstruct, and reconfigure their identities in the aftermath of extreme violence. She defines trauma as “a rupture of the self,” and describes the need for people to cope with their experiences in order to build new lives in the midst of pervasive cultural and social uncertainty (Abramowitz). The collective memory of thousands of people who were witness to the most horrid acts of violence committed against their family members and communities now had to negotiate social values and terms of peace whilst dealing with immense emotional suffering.

To understand the mental health needs of this “traumatized nation” using the western model of a per person, by request basis would be a mistake. Health care services provided by NGOs and government agencies must be proactive in recognizing symptoms of mental illness and recommending treatments.

Yet, these solutions are complicated by the link of trauma and violence to poverty and socioeconomic disparity. It is often asserted that mental illness requires resources that low-income nations cannot afford, and usually conflict torn places do not have secure institutions to deliver services anyway. Additionally, social stigmas associated with mental disorder discourage people to question or report their emotional states, and diminish the opportunities of the mentally ill in employment, education, and marriage (Farmer 217). Not only that, but co-morbidities between mental illness and communicable disease mean that the burden of all disease is compounded on those worst off in the world.

Socioeconomic disparity can also serve as a lens to understand the parallels between the experience of trauma in post conflict countries and the trauma from natural disasters. Violence and disaster both produce conditions that affect people on a mass scale, especially poor people, and lead to the deprivation of torn communities. The stress from disaster and violence are both characterized by uncertainty and existential crisis – not knowing where your family is, not knowing if they are okay, not knowing what will happen to you tomorrow.

For example, in the aftermath of a devastating earthquake in Nepal in April of 2015, the rate of suicide increased by 41% over a period of three months since the event, according to police data (“Suicide Rate Surges Post Quake: Report”). It has been studied that in places where disasters occur, the initial shock and trauma usually subsides within a year. This has the implication that the suicide rate will normalize in Nepal soon after the earthquake. However, the case of hurricane Katrina conveys that different chronic problems persist long past the initial disaster event. A recent survey reports that ten years later 47.7% of participants were living with PTSD in New Orleans (Kelley). Though many studies done in the past of survivors of previous hurricanes “showed quicker and more complete recovery from mental disorders,” the high rate of PTSD in Katrina victims stands out as a failure of services to return to New Orleans (Kelley). Additionally, the survey validates the need for consistent mental health treatment beyond the first years that follow a disastrous event.

The relationship between violence and disaster reveals the complexity and extensive domain of trauma experienced by large populations. Paul Farmer points to one solution that can address this trauma by singling out successful, low cost programs in Ecuador and Colombia that train primary care workers in the recognition and treatment of mental disorders (Farmer 219). He quotes Arthur Kleinman about the standard practices of mental health that can be utilized across cultures, “serious psychiatric disorders such as schizophrenia and depression are recognizable around the world, even if they differ in their course and convey different meanings depending on the local context” (Farmer 224). This offers some hope for the abilities of communities to incorporate mental health testing into their current routines in a way that is practical and substantive. If the world is going to continue to see large-scale violence and natural disasters, and we know that it will, then mental illness is not just a nation-state issue; it is global issue and should be included in the determination of the UN’s Millennial Development Goals.

 

Discussion Questions:

  1. Are western practices of therapy and psychiatry appropriate blueprints from which to model mental health services in low-income, post-conflict nations?
  1. As world temperatures rise and the effects of climate change continue to impact populations, the rates of violence are expected to increase. In the case of Syria, it is claimed that drought led to the insurrection and political instability that has produced millions of IDPs and refugees. And in the case of Nigeria, it has been argued that drought created the conditions of instability that were exploited by Boko Haram (Shockman). Do you think climate change will have a role in the violence and rates of trauma-related illnesses of the future?

Outside Sources:

Kelley, Kendra. “10 Years After Hurricane Katrina, Mental Trauma Remains.” Mississippi News Now. WorldNow and WDAM, 31 Aug. 2015. Web. http://www.wdam.com/story/29837949/10-years-after-hurricane-katrina-mental-trauma-remains

Shockman, Elizabeth. “Is Global Warming Contributing to the Current Refugee Crisis?” Pri.org. Public Radio International, 28 Sept. 2015. Web. <http://www.pri.org/stories/2015-09-27/global-warming-contributing-current-refugee-crisis>.

“Suicide Rate Surges Post Quake: Report.” The Kathmandu Post, 9 Sept. 2015. Web. <http://kathmandupost.ekantipur.com/news/2015-09-15/suicide-rate-surges-post-quake-report.html>.