A Critique of seven assumptions
behind psychological trauma programmes
in war-affected areas.
Social Science and Medicine 48 (1999) 1449-1462
Programmes costing millions of dollars to address 'posttraumatic stress'
in war zones have been increasingly
prominent in humanitarian aid operations, backed by UNICEF, WHO, European
Community Humanitarian Office
and many nongovernmental organisations. The assumptions underpinning this
work, which this paper critiques with
particular reference to Bosnia and Rwanda, reflect a globalisation of Western
cultural trends towards the
medicalisation of distress and the rise of psychological therapies. This
paper argues that for the vast majority of
survivors posttraumatic stress is a pseudocondition, a reframing of the understandable
suffering of war as a
technical problem to which short-term technical solutions like counselling
are applicable. These concepts aggrandise
the Western agencies and their 'experts' who from afar define the condition
and bring the cure. There is no evidence
that war-affected populations are seeking these imported approaches, which
appear to ignore their own traditions,
meaning systems, and active priorities. One basic question in humanitarian
operations is: whose knowledge is
privileged and who has the power to define the problem? What is fundamental
is the role of a social world,
invariably targeted in today's 'total' war and yet still embodying the collective
capacity of survivor populations to
mourn, endure and rebuild.
Because of copyright reasons I can not publish the entire article here, although
I think that it is not correct that Dr. Summerfield does not make this article
available on the Internet
Since it is essential for the debate, I will however cite here the seven
assumptions as Dr. Summerfield analyses them.
It is important that it is understood that Dr. Summerfield criticizes each
of these assumptins in a documented way, and I think 'the field' has to respond
to these critical remarks in a convincing way before it can move on to impose
itself in communities after armed conflict. With 'a convincing way'
I mean that it either gives arguments to refute Dr. Summerfields remarks,
and does so in an open debate with Dr. Summerfield, or, that it adjusts it's
assumptions to defendable ones, and remodels the intervention projects accordingly.
behind current psychological trauma programmes:
- Experiences of war and atrocity are so extreme and distinctive that
they do not just cause suffering, they cause 'traumatisation'.
- There is basically a universal human response to highly stressful
events, captured by Western psychological frameworks.
- Large numbers of victims traumatized by war need professional help.
- Western psychological approaches are relevant to violent conflict
worldwide. Victims do better if they emotionally ventilate and 'work through'
- There are vulnerable groups and individuals who need to be specifically
targeted for psychological help.
- Wars represent a mental health emergency: rapid intervention can
prevent the development of serious mental problems, as well as subsequent
violence and wars.
- Local workers are overworked and may themselves be traumatized.