All posts by Sarah Hays

Trauma and Violence

Increased conflict in developing nations has caused a surge in trauma-related mental health issues around the world. With significantly less access to funds and resources, lesser-developed nations are facing a monumental problem in combating the proliferation of mental health issues. A lack of understanding surrounding mental health only exacerbates social issues for patients suffering from mental disabilities in developing countries; they fear speaking out and ultimately receive sub-par care, if they are lucky enough to get any whatsoever.

In her book, Searching for Normal in the Wake of the Liberian War, Sharon Abramowitz examines the societal impacts of trauma as a result of war. She describes how the Liberian people who are not suffering from mental disability view others around them as “not normal,” or “totally traumatized” (65). Due to the lack of mental health education, Liberians believe trauma is a step on the “continuum of mental illness”, which begins with a person being normal, and results in insanity and ultimately death. While one may be quick to jump to the conclusion that the Liberian opinion of mental health is an uneducated one, I do believe that they accurately describe at least one social aspect of mental disability. To some extent, Liberians understand the debilitating effect an untreated mental disability can have on one’s livelihood. However, the understanding of mental health is quite limited, as many Liberians also believe that “people experiencing severe trauma or psychosis must have seen or done something to have incurred this terrible fate,” and the mental disability must be “God’s punishment” (79). A mental disability not directly caused by war or some other horrific event does not appear to fit within the Liberian description of trauma.

Farmer et al.’s Reimaging Global Health offers a more broad definition of mental health conditions, claiming that they are not all “neatly packed as disease[s],” like PTSD is in the developing world (222). Many people across the world suffer from PTSD; it is a very crippling disorder. However, not all mental health conditions are PTSD, and trauma does not necessarily develop into PTSD. Providing care to a plethora of mental health conditions is essential. The example of Valentine from the Abramowitz’s book depicts someone who is not directly traumatized from fighting in the Liberian War, but rather from living day to day during a time of conflict. I would argue that “traumatization” has much more to do with his social situation than direct violence However in places such as Liberia, that form of a mental health condition is not well understood. The problems and inequality that people face everyday can have just as great of an effect on mental health as one catastrophic event. I found the study published by The Lancet to be incredibly interesting, as it explained that “mental disorders increase the risk of both communicable diseases … and noncommunicable diseases” and that alternatively these diseases increased the risk of developing a mental disorder (215). Healthcare funding in developing nations should focus on both mental health and disease in order to most effectively care for patients.

Perhaps the most glaring obstacle to providing widespread care for mental health disorders is self-reporting, as social stigmas prevent many from seeking help. This lack of self-reporting is echoed in Mark Anderson and Achilleas Galatsidas’ article for The Gaurdian entitled “Mental Healthcare 50 Times More Accessible in Wealthy Countries”. Many people who suffer from mental illness do not come forward, due to shame. “They feel if they disclose that they have a mental disorder they will be discriminated against” and their societal value will decrease (Anderson). While almost one in ten people have a mental health disorder, the world’s poorest countries have a dearth of mental health workers. The need for mental health care is only rising with the “increasing prevalence of conflicts and natural disasters,” which increases stress on developing communities (Anderson). Mental health needs to be given a higher level of priority, on par to that of diseases such as HIV/AIDS, malaria, and TB in developing countries.

It is challenging to emphasize care of mental health issues when there is no distinct treatment. The gap in our medical knowledge of how to best care for patients suffering from mental health disabilities is expansive. Our best chance of bridging this gap is integrating our clinical understanding with ethnographic studies of populations in developing nations to understand who is suffering and why. Providing mental health care is an incredibly complicated task; one that developed nations have yet to understand. I would argue the only way to currently provide care to developing nations is by training local traditional healers and medical professionals. While we may never be able to quell violence and its associated trauma, with greater scientific and cultural understanding we may be able to provide care for enduring mental health problems and better grasp the growing mental health crisis.

Discussion Questions:

  • In Searching for Normal in the Wake of the Liberian War, Abramowitz highlights the result of mental disorders and trauma postwar. Attention is only paid after a traumatic event has occurred, not before. Would it have been beneficial to this population to provide mental health care and education before violence ensued? Should mental health care be provided as a preventative measure in developing countries? If so, how can that be achieved?
  • What is the best way to determine if mental health care provided to developing nations is “adequate” or helpful? With communicable and noncommunicable diseases there is either treatment or disease. However, with mental health disorders there is no direct cure. How do NGO’s, the WHO, or developing nations themselves deem a public mental health effort as successful?

Outside Source:

Anderson, Mark and Achilleas Galatsidas. 2015. Mental Healthcare 50 Times More Accessible in Wealthy Countries. The Guardian, 20 July 2015. http://www.theguardian.com/global-development/datablog/2015/jul/20/mental-healthcare-world-health-organisation.

Class Readings:

Abramowitz, Sharon. 2014. Searching for Normal in the Wake of the Liberian War. Philadelphia: University of Pennsylvania Press. (Ch. 3)

Farmer et. al. Reimagining Global Health. p 213-225