Many people encounter traumatic events in their lifetime, particularly those living in contexts of war or violent conflict. It is estimated that about 22% of people who live in conflict-affected areas of the world live with a mental health condition, such as depression, anxiety or post-traumatic stress disorder. Of these, 9% have moderate-to-severe conditions. These findings come from an analysis of data from 129 studies presented in the renowned medical journal Lancet and covers 39 countries that have experienced conflicts in the last decade.
Often, we say that people are ‘traumatised’ as a result of having experienced life-threatening events. The focus on trauma helps to identify responses to traumatic experiences and to identify suitable clinical interventions. However, by focusing only on trauma, a reductionist lens is applied to the wide range of possible consequences of conflict and thus to their resolution. Rather than viewing traumatic experiences only with a psychological and emotional lens on the past, we should simultaneously have a more holistic socio-political lens on the broader context. The focus on trauma is helpful for people with severe mental health problems that have resulted from extreme events such as violent conflict. However, the limitations of using a predominantly western clinical approach is that it tends to place too much emphasis on individual emotional expression and recovery. In order to effectively repair the long-term effects of conflict, social reconstruction, psycho-social wellbeing and cultural rituals need to form central components of any social recovery process.
“Communities emerging out of conflict experience violence and injustice long after the guns go silent and peace agreements have been signed.”
Having experienced traumatic events is different from being traumatised. Fortunately, about 80% of people can overcome hardship situations and do not develop long-term psychological consequences. They show resilience. This is the ability of individuals and societies to cope, adapt and “bounce back” from adverse events. Some people develop new skills in dealing with such painful and distressing experiences. This is called “post-traumatic growth”. Recovering from trauma can lead people to develop skills or insights that they didn’t know they had or wouldn’t ordinarily have developed. However, traumatic events tend not to happen in isolation and the on-going strain of dealing with multiple compounding stressors (especially in contexts of ongoing violent conflict) can adversely affect resilience.
Conflict and mental health
The relationship between experiences of violent conflict, daily stressors and mental health is complex. Research shows that daily stressors — the cumulative routine challenges that people face in their daily lives — are often far more exacting than we give them credit for. These include the day-to-day social and economic struggles such as getting to and from work using arduous and expensive public transport means, putting food on the table, paying school fees and obtaining affordable quality health care. The ongoing structural violence, which is common in post-conflict contexts, has the potential to cause significant stress which in turn results in psychological problems such as anxiety, depression, fear and difficulty connecting to other people.
Communities emerging out of conflict experience violence and injustice long after the guns go silent and peace agreements have been signed. Narratives of oppression and painful memories implant themselves in family histories and are passed down from one generation to the next. Physical places and systems of oppression take decades to rebuild and transform; thereby continuing to wreak havoc in society long after their official dismantling. Conflict erodes interpersonal trust and trust in institutions. As a result, relationships break down and the general lack of justice and accountability continue to erode social cohesion. This tends to result in feelings of despair, helplessness and social isolation which negatively impact on mental wellbeing and thus on people’s social and economic circumstances. These heightened levels of stress impact not only on the psychological wellbeing of individuals but often ripple out into families and society at large, contributing to repeated cycles of violence. Domestic violence, self-harm and substance abuse tend to form part of these cycles of violence and create further harm in society. As such, the impact of trauma is not limited to the past. Rather, it lingers in the present and is compounded by ongoing direct and structural violence and the absence of hope for a better future.
Coming to terms with the past is often connected with the ability to resume one's daily activities. These activities create space for people to continue the rhythm and safety of their daily lives and creates the possibility of regaining hope for a desired future. Having a vision of the future gives people a sense of continuity. In order to be effective, recovery efforts need to be targeted at all levels of society: at the individual level, at the interpersonal level between people, in families and at a community level. Inter-agency and interdisciplinary efforts need to take into consideration the damage done at the sociocultural, religious, political, or economic level, all of which add to confusion and despair. A holistic approach to healing and recovery must simultaneously include the sustainable rebuilding of livelihoods. For example, a 2019 study conducted by TPO Uganda illustrates that dialogue initiatives are unlikely to be successful when peoples’ basic needs are not met.
Given the above, it may seem self-evident that the fields of peacebuilding and mental health and psycho-social support (MHPSS) should work closely together in their respective efforts to help society recover after violent conflict. However, this is not yet the case. Assumptions, stereotypes, a lack of knowledge about the other field and stigma about mental health continue to hamper integration. The Cape Town-based Institute for Justice and Reconciliation (IJR) is working with practitioner partners from both fields in Kenya, Zimbabwe and South Africa to co-create an integrated practice which links the fields from the outset with the aim of generating more sustainable outcomes for both fields. Understanding the extent to which violent conflict affects individuals and society at large requires a holistic view of the individual within society as well as the context which shapes that society.
While the trauma lens is helpful in providing specialised care to those who need it, a more holistic lens creates the possibility to prevent the internalisation of the harmful effects of structural violence. Using a strength-based holistic approach in which all storylines are acknowledged, and connections are fostered, contributes to individual and collective wellbeing. There cannot be a peaceful society without peace of mind.
Marian Tankink (Medical anthropologist; Netherlands), Yvonne Sliep (Community health specialist; South Africa) and Friederike Bubenzer (Senior Project Leader, Institute for Justice and Reconciliation; South Africa) are researchers on an IJR project working to link mental health and psychosocial support (MHPSS) and peacebuilding. For more information see www.ijr.org.za/publications.
The opinions expressed in this article are those of the author(s) and do not necessarily reflect the views of SAIIA.
(Main image: Displaced women who have lost their husbands in the ongoing civil war in South Sudan discuss their psychological problems in a group session organised by the International Organisation of Migration in the the Protection of Civilians (PoC) in Bentiu, South Sudan, on 16 February 2016. — Albert Gonzalez Farran /AFP via Getty Images)
