Hello Mark,

Thanks for your answer. We hope that the faxing will work! I will transfer your message to Behailu, the Ethiopian anthropologist who is at the moment really into the CIDI.

Let me first clarify however, that I am not really connected to the CIDI-Work here. The project I am doing here is called 'The Collective Trauma Project' and it tries to approach those traumatic experiences in communities of displaced that can not be directly traced back to individual experiences, but to 'social shock'. (in the sense that for instance the jewish community that was not in the extermination camps is still shocked - into the third generation- by the experience).

I am preparing some writings on the subject with Dr. Daya Somasundaram who is working in Cambodia (but on holiday right now). (By the way, are you following the happenings in Cambodia?) If you are interested we could send you some every once in a while. What I have seen about the 'clustering' in idioms of distress is from an article that Maurice Eisenbruch has written (is writing, I am not sure) on idioms of distress in Cambodia.

As to your question. What are the practical consequences?

I do not pretend to have a direct answer to your question, since I was not working with local idioms of distress 'as such', but I will try to write one anyhow, because I feel that we should have worked with the concept. So please consider this answer as a probe into the field for me too.
As I ended my first writing to you, this depends entirely to the definition that you give to your own position in the field.

Currently I am involved in a debate with Ivan and Joop on this, because they seem to want me to do some research, while I want to do intervention, using the results of research. In this debate I use the term scientist, or researcher, versus interventionalist.

If you are a scientist, who hopes to stay out of the field that is being studied as much as possible, (being objective, or inter-subjective), there are for instance interesting ways of using statistical techniques like multi variate analysis, to cluster groups of local idioms of distress and compare the physical and mental state of the people in those clusters with the diagnosis that would be given to them according to DSM 5-R and see if you can find any overlap in these groups. If so, it would mean that the local healers have in a way learned to handle distress in a way that is parallel to our western way, if not, you are on the verge of discovering a new insight in healing (unless you have also diagnosed that healing after distress in this system usually leads to more distress or death.) I think that this is what Maurice is after.

If you are, however an interventionalist (as I consider myself to be), you could, again, within the field define your position, somewhere between the two extreme fields of cultural superiority and cultural relativism. (Let's put it bluntly, between brackets, and produce some sweeping statements to clarify the over-theoretical phrase. a)The American or Chinese way, to consider whatever you are doing by definition as the superior way, and z)the Dutch way, to consider everything you are doing by definition as inferior, and therefore always wanting "to learn from the culture you are in", to "respect cultural ways of handling trauma", even if it is clear, like in Africa, that trauma's are mainly used to prepare the grounds for new war.)

Somewhere between a) and z) as I feel it, must be a realistic position that recognises that we in our western culture with the holocaust in our cultural heritage, cannot directly boast to have the solutions, and on the other hand does recognise the fact that you ARE working in a strange culture with the pretence to be useful. Therefore alone you must at least have an idea what valuable stuff you have to offer, since as an expatriate you are being paid many times what  local healers would take to do your job.

Having set this position for your self, it is immediately clear what you are going to do:
- making an inventory of local idioms of distress and analysing them as signifiers of the local health-negotiation.
- making an inventory of your own idioms of distress in the current situation (What causes you to feel distress here, what do you want to change)
- entering into the local health negotiation. The more you operate from a platform of superiority, the more you will be in direct competition with the local healers, eventually wiping them out on the base of evident success with the clients. If less, you may become a local colleague, ending up with your local niche in mutual respect, and if even less superior, you would end up as a student of local healers, returning to your country within the new-age mood.

What is 'analysing' the local idioms of distress'?

As I said, I think that each 'idiom of distress' is in a way a reflection of the current state of a healing negotiation.

So, when here in Addis the displaced express their distress, they will use idioms that are coined by the relief-industry. The healing party in that industry has taught them that offerings are largely material, and therefore they will express their distress in those terms: they will need new roofs for their tents, medicaments, food. They would never speak in terms that indicate, for instance, depression, because until now that kind of expression of distress never had any result. This, of course, we (IPSER) are now changing, and the displaced will integrate our idiom 'in' their distress - if they feel that we are adequate in some way.

Does this mean that also their distress is extended?

If we work in the right way, we hope of course, not. We hope that a new cluster develops in the idioms, to which we intend to connect new 'healers' and that the total of people that experience 'healing' is accordingly augmented.

We must therefore add one new concept to our 'idioms of distress' framework, the concept of 'exit'.
Ideally, each cluster in the idioms of distress is centred around some healing process, or healer, who represents an exit from the field of distress. A healer must always pretend to have the key to such an exit, whether he really feels to have one, or not. In the last case, he is either convinced that the distress is an illusion (which idea is an exit in itself), or fake, or on the other hand he may be fake himself.

Each idiom of distress is also the reflection of a cosmology in which illness is understood. When people therefore complain about 'worms, crawling under the skin' (Cambodia, Eisenbruch) the worms are symbols in a very specific cosmology. In some form or other the worms, or the agent that moves the worms will appear in the other idioms too, permitting us to reconstruct the cosmos in which healers and clients are experiencing distress. Each cosmos also defines area's of distress and well-being.
Individuals can move from the well-being area into the distress-area through 'entry's' and 'exits' that again are essential elements in the distress-management.

In our case, here in Addis, for instance, the relief organisations have in fact been agents that created an 'entry' into a distress-area while they were thinking that they were creating an exit. This was the result of mis-interpreting the nature of the distress, by superimposing their own idioms of distress over a displaced population that was a) politically defined (in opposition to the by definition 'innocent' character of a victim in our terminology), and b) African (and therefore experienced physical hardship in another way than the western observer would expect).

A possible sense of well-being (because of having escaped alive) was therefore turned into a sense of distress (because the relief-industry felt they could offer relief for this distress, or, more cynical, because the relief-industry could raise money on the issue.)

As I wrote to you before, from the idioms of distress (i.e. 'innocence')it is easy to reconstruct a christian/technological cosmology here. partially this will probably also be the case in your situation. Yet you seem to encounter more expressions of 'feeling' than I hear here up till now. For me, the only expression in that direction is 'we have lost all hope', but for me this expression feels like one that is manipulating (or provocating) the, again Christian, relief-giver who cannot tolerate the absence of hope.

Then, after analysing the existing idioms, I bring my own idioms into the local situation. This process has to do with
-translation
-projection
-creation
 

1) translation: I translate for instance 'hope' in my own vocabulary into: 'future for the children' here. On the one hand this is narrowing my original concept, on the other hand I feel that in this Ethiopian context, the future of the kids also represents in a symbolical way 'personal hope', a meaning that does not (more) exist in the current west.

2) projection: I use projection to 'recognise' my idioms of distress on the population I want to work in. For instance, I see passivity, and I name it 'Loss of self', or 'loss of identity', because these are categories that I feel confident in: I have an 'exit' possibility connected to these idioms. Whether this exit will be effective in this population, I am going to find out.

3) Creation: I have created the term 'professional victimship' in order to create a counter-idiom to the term victim. What I see is people that are 'impersonating the victim that the relief-worker wants to see' in order to gain their livelihood.

Of course there is a relation to the existing idioms of distress. These form the body in which I insert mine, and in the process existing idioms can be taken over, modified or erased.
In this way, ideally a new cosmology is created in which my reality as a healer is integrated with that of the clients here and as many of the local healers as possible.
This is necessarily true for the clients, but not necessarily for (all the) healers.

Bon, C'est enough por aujourd'hui.

greetings,

Marc-Jan