Understanding people's mental health during war and other disasters
Astier M. Almedom, the Henry R. Luce Professor in Science and Humanitarianism at Tufts, is exploring these issues by examining the social and cultural factors that affect mental health in complex emergencies. Almedom's approach reflects the interdisciplinary nature of her work: Her faculty position is through the Department of Biology in the School of Arts and Sciences in partnership with the Feinstein Famine Center at the Friedman School of Nutrition.
Small but resilient
"Eritrea is a country marked by resilience," Almedom says. "It is very organized…not your typical image of chaos in an African country at war." Indeed, despite the upheaval that occurred during the 30-year war with Ethiopia, the liberation movement had paid a great deal of attention to everyday matters, such as education and health care. For example, children did not miss school, but instead attended classes in safe havens and underground shelters, even during bombing. Similarly, a high-tech hospital was set up underground in a liberated zone. This extraordinary level of organization by the local government continued during the 1998 to 2000 border war and, not surprisingly, had an impact on how the community members responded to their displacement.
Maintaining their spirit
Other survival mechanisms became evident as Almedom and her team conducted discussion groups that were segregated by sex. The women attributed their ability to cope to several factors, including faith in Qidisti Mariam (Saint Mary), who is believed to protect women; a feeling that they were still part of their larger community; and their ability to follow the news by listening to the radio.
Similarly, the men, who were not in military service for one reason or another, were grateful for the radio broadcasts and the regular meetings initiated by the administrators. They felt that their displacement was meaningful in terms of defending their country. Interestingly, the men were more forthcoming about their feelings than the women. "They wouldn't stop talking," Almedom says. Some spoke about their worries regarding their reputation, believing they might be blamed for the war. Others discussed their failure to accept the losses they incurred and their strong feelings of anger and desire to seek revenge. "All normal reactions," observes Almedom, "and not signs of being traumatized."
It's all about context
True to her interdisciplinary nature, Almedom says it is not an either/or proposition. "When doing a study, you must first look at the context. People often fly into the country [they're studying] and start asking questions they have brought with them in prepackaged questionnaires," Almedom says. "You must first listen and then ask questions. The 'we-know-it-all' model is so pervasive, even among anthropologists."
The study was a participatory investigation, which means that the participants supply information and then check that what they say has been understood correctly when the findings are presented to them during feedback sessions. For example, some of the women told Almedom that they had already been asked "too many questions about violence and trauma by other researchers." Almedom noted this as "research fatigue" and respected their wish to drop the subject. She points out that interviewers who are not properly trained to be sensitive to the participants can, in an ironic twist, inflict trauma.
Another issue in this field is how researchers characterize the participants' mental health. The label or diagnosis of "post-traumatic stress disorder" is still used widely in humanitarian circles. Almedom says that this term does not accurately assess people in complex emergencies across the world and is an artifact of the Vietnam era, when it was first used as a way for people to receive support and benefits. No doubt it was an important term then, but it does not reflect the multi-dimensional nature of mental health in dire situations. "In wars, in disasters, we should focus on the life lived by the survivors, not on what is happening in their heads," Almedom says. "Of course we cannot ignore war-induced shock and trauma, but not everyone suffers from clinical depression. If there aren't enough resources available, individuals will be susceptible to depression, but it shouldn't be a blanket assumption."
Oppression of the soul
This summer, Almedom will return to Eritrea to continue her study. Her co-investigator is Dr. Zemui Alemu, the director of the primary health care division of the Eritrean Ministry of Health. It is an alliance that represents her goal of influencing policy: "Involve [local] people from the beginning. People who work in policy will feel like they own it," thereby setting the stage for true collaboration.