| Eleanor
Roffman, Ed.D.
Presented by
Eleanor Roffman, Ed.D.
Other peoples have been victims of occupation, displacement and ethnic cleansing. However, the experience of Palestine is unique in several ways: the duration of the occupation; the collective impression many Westerners have of Arabs that are shaped by dominant cultural paradigms; the uncritical support for Israel that shapes attitudes and beliefs about Palestinians; and the characterization of the relationship between the two. Edward Said (1999) has suggested that the relationship is understood as being irreconcilable; the Israelis don't want to acknowledge Palestinian rights and the Palestinians are clutching to a way of life that has been destroyed. The result is that several generations of Palestinians have grown up being denied basic human rights. This paper explores
psychosocial healing models in war-torn settings. It suggests approaches
and offer reflections that may be useful models in the siege and
post-siege experience in Gaza. My research has focused on situations in
which the conditions of disempowerment, expulsion, internal expulsion, and
ethnic cleansing define the struggle, and in which pro-active community
building projects and interventions highlight efforts to rebuild and to
heal. Models are drawn from the experiences of those who have worked to
develop psycho-social support programs in Bosnia-Herzegovina, Kosovo,
South Africa, and the experiences of First Nation people in the North
American continent. Everyone is traumatized in war, however, women experience war differently than do men. Rape and sexual abuse are tools of war. Without a political analysis, neither the work within the field of trauma nor the work within the movement to end violence against women would be able to exist. The conceptual models presented have been developed from within a psychological framework that acknowledges the relationship between mental health and the values of a clinical work fueled by commitments to human rights and social justice. Most of the models presented focus on the importance of remembering, and the power of narrative. This is significant because dominant cultural institutions can minimize and marginalize the importance of the stories of everyday people. The telling of the stories from multiple perspective allow for more than one truth to be told and for the subjective reality of the narrator's language to be heard. The use of narrative honors and values the words of those whose stories are being told. It is an opportunity to bear witness and to reclaim dignity through the expression of voice. It is a healing agent in providing a record of acknowledgement of not only of pain and suffering but of resistance and resilience. Janet Haaken (1998) addresses a process of transformative remembering, a process in which the memory serves the interest of bridging the past to a future form of self-knowledge. Throughout the literature on healing the connection is consistently made between the experience of loss of self knowledge (Wilson,1998; Schaeffer, 2006; Haaken, 1998 ) and the task of needing to redefine and re-establish one's self culturally, psychologically, and socially. Memory, as channeled through storytelling focuses on that reclamation of self-knowledge. One motivation for telling ourselves stories is to be able to connect with parts of ourselves or of our culture that is no longer in the present or has been suppressed. These memories are linked to narratives and relationships in an effort to connect what has happened to what is (Haaken 1998).
A Swedish women's peace and justice group, Kvinna till Kvinna (KtK) dedicated to supporting social, political and economic situations in conflict and post-conflict settings, offered their support to those in post-war Bosnia-Herzegovina. They collaborated on opportunities for healing and for building the strength necessary to believe in the future. They do not implement projects themselves but work with co-operating partners. They aim to provide a gender perspective on peace building and reconstruction projects (Weston, 2001). Their projects frame the traumatic losses associated with war and displacement within a psychosocial context and. Their trauma recovery projects are informed by the recovery model developed by Judith Herman (1992). Judith Herman suggests that the syndrome of complex trauma is the result of a "history of subjection to totalitarian control over a prolonged period" (Herman, 1992, p. 121). She has developed a recovery model that is centered on the "empowerment of the survivor and the creation of new connections" (Herman, 1992, p. 133). She stresses the power of healing relationships and addresses the role of integrity and trust in establishing relationships and in affirming the value of life. She proposes a three -stage model: establishment of safety, remembrance and mourning, and reconnection with ordinary life. (Herman, 1992). The organization KtK has
adapted Judith Herman's three stage trauma recovery model (Herman, 1992)
to a psychosocial group model that addresses the experiences of those
whose pain was caused by the impact of war and aggression; those whose
losses go beyond the most personal to include the destruction of home,
life plans and savings, social and cultural collapse. It is this
collective trauma that psychosocial support groups address as well as the
individual experience. KtK offers support in the interest of giving people
opportunities for healing and to build the strength to believe in the
future. They do not implement the projects themselves but work with
co-operating partners. They aim to provide a gender perspective on peace
building and reconstruction projects (Weston, 2001).
In terms of the first stage, that of establishing safety, the researchers in Bosnia found that, " the greatest need of war traumatized people is to find a space in which trust in fellow human beings can be reestablished and where normal human relations can be formed" (Agger & Mimica as cited in Weston, 2001). KtK established women's centers in which such groups could support this process. It is in such a place where one can feel listened to and cared for so that the revealing of memories can be safely shared. The Bosnian women felt comfortable sitting around and talking, but this approach is not applicable to all cultures. In some cultures, such as with many Native Americans, rituals practice prevails over conversation. However one engages, sharing with others is vital to the next step, mourning. In order to mourn one must be able to express anger, rage, and hatred. These group settings have provided this opportunity. As Judith Herman suggests in
Trauma and Recovery,
In Herman's model the mourning stage is one in which the individual can experience their sense of loss and integrate that awareness into a sense of self, so that the prevailing sense of loss no longer is central to a sense of identity. Mourning can come in waves. It is not a linear process. To mourn is not to forget but to have a place to put the losses, so that life can begin again. Finding energy to go on with life, dealing with survivorship when loved ones have died is part of this process. Those who have been severely traumatized may also need individual therapy to cope with the intensity of their feelings.
The recovery process is underway when one can imagine a future of a reconstructed society. The clinicians in KtK abandoned Herman's third category of reconnection with ordinary life, because there was no ordinary life with which to connect. This stage was replaced with reconstruction, a social rebuilding of a decimated society. People who have been challenged by the control of their daily lives by mean spirited and life threatening brutal acts need to construct a sense of meaning and to create an ego-integration process, that is being able to construct meaning out of their experiences and if that is not possible, to create a sense of understanding of the impact of these acts on one's sense of self. A team of interviewers gathered information about the emotional impact of the women survivors of war in Bosnia. The gatherers of the information did not classify the reactions of the women as disorders as presented in DSM categorization, but as reactions, natural responses to unnatural acts (Weston, 2002). This framing is applicable to men as well. The reactions were organized into groupings according to emotional response. These groupings included: re-experiencing, withdrawal/numbing, arousal/flashback and self-persecution, much like that described by Judith Herman in Trauma and Recovery (1992). The researchers found that self-persecution was the least experienced category, the women did not blame themselves for their losses. In their survey of women, the respondents expressed feelings of exhaustion, feeling robbed of important years of their lives, a sense of vulnerability, and the grief associated with deep personal losses (Weston, 2002). In the Bosnian study, the women who lost their homes attached symbolic significance to that loss and had greater stumbling blocks to overcome. When questioned, 83% of post-war Bosnian women agreed that the atrocities need to be made public but they questioned the safety to do so. Before the war, in the former Yugoslavia, 70% of the women worked outside the home. After the war, 14% of women had jobs outside their homes. Of those who were working, many did not receive salaries regularly. What came through in their conversations in groups was the healing nature of working, feeling a sense of being needed and part of the reconstruction of the society.
The second part of Weston's model, the rebuilding phase, is more reflective of the integration of material concerns with socio-cultural factors. The goal is to empower by providing education, income generating projects and job training. In one study after the war in Bosnia, the greatest cause of depression among women was unemployment (Walsh,1997). Women who feel marginalized can gain a sense of membership from having an education, and from study and training groups in secure settings so they can assert their priorities and agendas. The knowledge women have gained from war needs to influence the reconstruction of their societies. A new life requires a participatory economy, a way to have a sense of future and to participate in making that future.
Rituals that assist the societal mourning process help people to commemorate and heal. Aside from monuments, museums and days of recognition, a process of rebuilding a sense of justice has to include an analysis of the trauma and violence and a willingness to expose those who have participated in creating the war as well as a condemnation of the violation of human rights that has taken place. Cleansing rituals for public places, testimony archives, and oral history projects are ways that have been effective, especially in the face of the slowness of international courts and the establishment of commissions. When people cannot find work, cannot speak to what has happened to them, cannot trust their governments to help them, and when systems of justice are not in place, healing is hampered and symptoms of PTSD are greater (Weston, 2002). Reconciliation is a slow process that can take many generations. What can be learned from the Bosnia- Herzegovina post-war work is that healing has many dimensions, personally and politically, and that when women are contributing to their society by being part of the reconstruction and rebuilding process they are creating new lives for themselves as well as for their countries. Psychosocial support programs that acknowledge the power of remembrance, community based efforts to heal, as well as needed approaches to education and training will integrate citizens into the deep task of rebuilding and visioning a just society.
The International Organization for Migration (IOM) provides services to mobile populations and is often on the front line providing community based support and assistance with healing from past traumas. The Psychosocial and Trauma Response Project for the Displaced and Refugees from Kosovo (PTR) (Carballo, 2003) recognized the need for professionals to provide counseling. There are a scant number of psychiatrists and psychologists in this area, so the creation of this training program supported increased care to those affected by war and migration. This project, like the Kvinna Till Kvinna project, does not emphasize individual responses but rather community building activities. Most international aid workers are trained in western oriented models that often rely on three principles: the ego-centered self, the mind/body dualism and the concept of culture as epiphenomenal (Lewis-Fernandez & Klienman 1994). In contrast to the concept of ego-centered self, the authors present a sociocentric concept of self, one in which the social networks are the sources of attributions of sense of worth. The experience of suffering in the west is usually divided into psychopathological categories, organic and psychological. The authors present, as more common in other parts of the world, an integrated experience in which the spiritual is a key component. The concept of culture that is particular to western thought is one that separates biology from other phenomena that influence belief systems such as conceptions of illness, and healing. Workers in this training program were encouraged to think about wellbeing in a more holistic way, collectively and psychosocially. Clinically, the project developed an integrative family and community therapy model. In the PTR training program, counselors in training were asked to define trauma. As one can imagine, the definitions have a range of meanings dependent on cultural and social factors. The program developers relied on an explanation provided by Becker, from the Instituto Latino Americano in Chile, to provide the framework Extreme trauma is: The authors emphasize the importance of each community deciding for itself
what trauma means within their context. The efforts of this training were
to redirect the individualistic approach and to reconsider it in a
socio-political context. Throughout the training the students were
encouraged to consider human rights within each dimension of the training
and to consider that healing cannot take place in the absence of these
rights.
The Exiled Body theater project is an example of the Archives of Memory project (Losi, 2001). This project's purpose was to apply theater techniques to investigate the memory of the body. The components included a photography exhibit, a filmed documentary, and a collaborative performance between counselors and participants. The underlying principle of this theater work is that the suffering individual is expressing the impact of harm that is meant for the targeted group. This shifts the weight from the individual to the social network. The process of this project, as described by Michelle Losi (2001), highlights the following: the contractual relationship between trainees and counselors; the understanding of body language including body self-consciousness; enhanced participants listening skills; and the relationship of the personal to historic and social contexts. Losi goes on to articulate the major themes of this work which are body memory, understanding the changing of the body through trauma and through witnessing violence, and the role that fear plays not only in society but within families as well. The goal of this project is to support and document the experiences of individuals as members of a cultural group so that there would not be one official memory, so that differing recollections would not be lost, so that voices could be reconstructed and the accounts of ordinary people would survive.
Jean Marie Lemaire (2001) in the PRT Proceedings, presents the example of rape and its impact. Rape breaks connections, family bonds, and the ties of an individual to her family, community and society. To Lemaire, bonds are the medium of therapy. Her work encouraged clinicians in training to observe families within their social context and to train their observational skills to identify bonds within families and to ascertain where the strength lies. At times there may be role reversals or shifts. Children may be the supporters of the parents rather than the other way around. Bonds are both the medium and the target of this therapy. Professionals were trained to recognize residual resources, the strength of historical, emotional and physical bonds. The training articulates what a bond is, from both a theoretical and clinical perspective. This approach supports family members in understanding what their bonds are, how they experience support from each other or not, how they show or do not show concern for each other, as well as the recognition of comfort and joy. Lemaire gives as an example a story of an 11year old boy who was able to comfort his mother when no one else could. However, the immensity of this role took its toll on his school behavior and performance. In this situation the clinician observed the family, talked to other members of the community and was able to draw upon the insight of neighbors to provide help for the classroom teacher. The residual resource in this example is the collective strength of the community and the approach is a process oriented one. In the same vein, Eisenbruch (2001 in Losi) discusses his approach in Cambodia, an approach in a country that had no psychiatrists but did have community shamans. Local trainees were educated on how to assess suicidality and determine potential dangers. Having no success with traditional psychological models, the team Eisenbruch was part of abandoned what they came prepared to do, and entered the villages and observed the rituals, dance and theater, in order to understand how the local population understood their losses and risks. As in Cambodia, the work in Bosnia-Herzegovina and Kosovo reflects the potential strength of community creations and psychosocial support mechanisms that integrate cultural sensitivity with social needs from within a social justice political perspective.
Peace making circles is a cultural practice of early First Nation peoples of the North American continent. This practice has been durable enough to survive the genocide and repressive relationships of native peoples to American colonists. Circles are not neutral; they are intentionally and consciously rooted in a shared value system. Some of the common values are respect, honesty, inclusion, compassion, safety, and the value of healing. Not unlike therapy, the space of a circle is a sacred space that engages in rituals and ceremonies. In Native American culture the circle can include a centerpiece, consisting of objects of importance to the participants. A "keeper" and perhaps a "co-keeper" facilitate the process. Keepers do not manage the movement of the group, as does a therapist, but do set the tone and monitor the pace (Connors, 2007). Each circle creates its own safety guidelines. These guidelines are a set of promises made to the group by each member. A talking piece or object is used to ensure respect between speakers and listeners. The talking piece is passed around the circle and the one holding the piece gets to speak. Decisions within a circle are made by consensus. Circles can be implemented for various reasons such as problem solving, talking circles, and healing circle (Boyes-Watson, 2001). In Africa, courage circles have been implemented in the interest of examining what peace can mean to nations that have been without it, and to create stabilization within communities in the face of external chaos. In the Sudan, which has suffered more than 50 years of war, oppressors and the oppressed shared in circles that acknowledged the courage of both groups to be willing to engage in this process (Machar 2007). In South Africa, Nelson Mandela's Commission on Young People at Risk employed a strength-based perspective that is integral to the peace-making circle. The work of this commission acknowledged the impact of interrupted development on young people and the role of circles in restoring justice and connections within communities. Within circles members can practice bonding, attachment, connection, listening and responding. The sense of displacement that permeates refugee experiences, the experience of those living under siege and occupation can be addressed in peacemaking circles. Also, in this group structure youth and elders can learn from each other in ways that may not have been possible before (Cartwright, Shearing & Jenneker 2004). Among the Aboriginal communities in Canada, circles are formed to address the struggles within their society. Anti-social behavior is understood as a symptom of a deeper identity crisis. In order to heal a reaquaintance must take place between the injured, their families and their history (Blue & Rogers Blue, 2001). In the words of a First Nation elder: Part of the healing, the very beginning of that healing is to know who I am. The only way to know who I am is to know where I come from, so I got to learn that culture, what ever it is that I have, the culture that I was born into. I have to learn that and learn the history of that culture, learn the traditions, the values, the teachings the ceremonies, the language. The more I learn that, the more I learn about myself. The more I learn about myself, the more I know where I can go. (Blue and Rogers Blue, 2001, pg. 69 in Frederiksen, 2005).
This paper has addressed a range of approaches from Judith Herman's survivor groups to the psychosocial support groups of KtK in Bosnia-Herzegovina, the endeavors of the Archives of Memory in Kosovo, the Exiled Body theater project, the focus of bonding therapy and the impact of circles and restorative justice in community building. All of these approaches have relied on the value of a strengths-based approach. This approach to therapeutic community psychosocial support building relies on the belief that we can develop creative ways to do clinical work that attend to people's strengths, their abilities to be collaborators in their healing, and their cultural protective factors. Instead of looking for the signs of disorders, strength-based counseling looks for and brings to consciousness the signs of wellbeing. Difficulties are not denied but they are not the whole picture of a person, a family, and a social system. All of these are resources and the primary setting is the community (Rapp& Goscha ,2006, as cited in McCormack 2007). These approaches rely on the basic belief that people can grow and change, have knowledge about their difficulties, that they have a culture and a community, and that the healing process is a collaborative enterprise. Therapists can assist clients in knowing and assessing their strengths, their capacity for resilience, and their innate and developed coping mechanisms. Relationships and their power can impact community building and healing. Groups of people who have been victims of ethnic cleansing and internal displacement need supportive environments in which to address their pain. The recording, the accounting of the past, the cultural images, symbols and metaphors that develop within psychosocial support groups contribute to the sustainability of a culture under stress as well as to the necessary first steps required to move into a culture whose survival engenders pride and whose future is built upon that pride and continual renewal and growth.
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Vol.1, November 2000. |