Searching for Normal in the Wake of the Liberian War. Sharon Alane Abramowitz
the conflict. After Jensen’s departure, the MHPCC’s ownership transitioned into a joint chairmanship led by Sister Barbara Brilliant, dean of Mother Patern College, and Dr. Brown, which they held for the next five years.
Finally, Jensen developed and circulated a draft mental health policy to include in Liberia’s national mental health plan, a crucial document for facilitating the health sector’s transition from humanitarianism to development, but without Dr. Brown’s authorship, the documents were viewed as invalid. After Jensen left, the document was lost, as were the completed needs assessments, mental health policy justifications, and network contacts for Liberians and expatriates working on mental health and psychosocial issues. While deputy ministers at MOHSW continued to assure me that mental health was important but “not a priority,” mental health continued to be excluded from coordination at the uppermost levels of the Liberian health sector.
2007–2009: Mental Health as a “Non-event”
At the end of 2006, I sat in another air-conditioned, blue room in a quiet corner of JFK Hospital, in the new resource center for the MHPCC. Empty bookshelves and new office furniture, computers, and printers were shoved against a wall, waiting to be used. Behind me were plastic-wrapped printers and chairs, and to my left sat my friend Frank Joscheck, the German psychiatric nurse running Grant Hospital for Cap Anamur. Attendees also included delegates from USAID, the Mother Patern College of Nursing and Social Work, Cap Anamur, CVT, Dr. Brown, a delegate from the WHO, and representatives from Action Against Hunger and MDM. My presence there was unusual but ignored—Frank had insisted that I come as his guest and as a researcher, and no one else seemed to mind.
Before the meeting opened, Dr. Brown turned to Frank to ask him if he could get him atypical antidepressants not readily available in Liberia. Frank muttered a diplomatic response but complained later to me that Dr. Brown wanted to use Frank’s NGO to gain access to “good drugs” for Brown’s private practice. Frank was particularly annoyed because his own hospital was barely able to obtain these drugs and because Dr. Brown had been invited many times to advise the hospital on matters of care but regularly refused—and then asked for favors.
The meeting commenced with two items on the agenda: (1) the requirements for social work certification and (2) the drafting of the national mental health policy. The first issue soon became a quagmire of dissent. On the issue of certification, MHPCC members were reacting to the efflorescence across the country of thousands of Liberians who claimed to be “trauma counselors” after participating in one of the hundreds of “trauma-healing” training sessions that had taken place during and after the war. In the entrepreneurial environment of postwar Liberia, “trauma counselor” was a new professional category that could be potentially exploited, and many people carried TOT completion certificates as evidence of their professional credibility. The issues of ethics, qualifications, and professional competency were at stake. MHPCC members feared that “fake” Liberian trauma counselors waving worthless certificates of training completion were a threat to traumatized Liberians. They had good reason to worry. Several participants had heard reports of charlatans, acting as trauma healers, who engaged in Sister Sarah–like human rights abuses like “beating the demons” out of people experiencing posttraumatic stress. Under the guise of counseling, trauma healers in churches, in private practice, or as community members were also reported to be involved in recommending exorcisms, beatings, starvation, sexual violence, witchcraft ordeals, and religious shaming (see Heaner 2010).
Although these reports were still just rumors, the MHPCC felt a strong need to consolidate professional authority around the title “counselor” to prevent the domain of mental health from becoming an object of ridicule. The debate, this day, was over the MHPCC’s recommendations on the length and types of training, formal or informal education, and professional experience that would merit the title “counselor.” Ultimately the goal was to bureaucratically mainstream thousands of Liberian counselors into a singular regulatory structure.
The MHPCC’s efforts to develop national standards for counseling and accreditation soon devolved into a nasty case of infighting. One NGO, CVT, recommended that strict state regulations be bypassed or amended, given the institutional flux of the postconflict moment. As long as meaningful and effective efforts were being made to build human and institutional capacity, CVT—a trainer and employer of dozens of Liberian psychosocial workers—felt that on-the-job training and expatriate professional supervision should be recognized as the equivalent of a formal university degree.
While trauma-healing NGOs wanted “their counselors” to be recognized as full-fledged professionals, colleges and social work organizations wanted counseling accreditation to fit within broader training and regulatory frameworks for nursing and social work. The Mother Patern College of Nursing and Social Work and the National Social Worker Association of Liberia asserted that the Liberian state had always existed, that it continued to exist during the war, and that ignoring formal processes of accreditation and credentialing was yet another attempt by the international community to undermine and deny recognition of the sovereignty of the Liberian state. They suggested that failing to recognize and engage with the state and to support formal educational institutions, certification processes, and oversight mechanisms might be an implicit attempt to keep the Liberian state dependent on humanitarian assistance and authority. The future of the state and the success of the postconflict reconstruction were entirely dependent on repositioning the state and local tertiary institutions at the center of regulation.
This debate reflected a core ideological divide about the role of the state in postconflict reconstruction. While some humanitarian aid organizations attempted to bypass state structures in the training and management of their labor force or, as Sister Barbara said, “pretended there is no state,” other institutions sought to integrate their institutional protocols into the state structure, with the explicit goal of strengthening the legitimacy of the state. However, rival institutions argued—quite reasonably—that many Liberians who lacked access to institutions of higher education during the war had transformed their professional experiences in trauma counseling into highly skilled vocations. They noted that these psychosocial workers had been intensively trained “in the field,” had received substantial NGO guidance and supervision, and had a valuable and specific skill set. Consequently, they felt that in the new world of postconflict Liberia, there should be an occupational location for this new kind of counselor.
With the MHPCC at an impasse on the issue of professionalization, Dr. Brown, the meeting cochair, introduced the question of drafting a national mental health policy for Liberia. For many months, the minister of health and social welfare had held the MHPCC responsible for drafting a policy document, which, in a sense, affirmed their status as a “shadow cluster.” But little progress had been made. At this meeting, Dr. Brown asked the group to list the domains of health care and social service provision that fell under mental health and psychosocial legislation. Attendees began to list areas that mostly reflected existing humanitarian funding priorities: psychiatric care, drug and alcohol abuse, mental health, trauma healing, psychosocial support, gender-based violence, ex-combatant rehabilitation, human rights, and so forth. The discussion turned to other departments and ministries that were also claiming the mantle of “rehabilitation”—like the Ministry of Youth and Sports and the DDRR offices. Soon Dr. Brown reminded everyone in the room that he wasn’t getting paid to manage mental health in Liberia, and the meeting was adjourned with a few general action points identified but with no clear plans for finalizing a draft of the document.
According to several meeting participants, by 2006 disputes like these had become routine and the MHPCC was deemed irrelevant—even by its members. Whereas initially most NGOs implementing psychosocial services felt compelled to participate in the MHPCC, by 2006, the committee had been reduced to a just a few international NGOs and local institutions. Important Liberian NGOs providing mental health and psychosocial care, like the LWF/WS and the National Ex-Combatant Peacebuilding Initiative (NEPI), were absent, were unaware of, or had long ignored the MHPCC. Under the joint leadership of Sister Barbara and Dr. Brown, the MHPCC’s monthly meetings failed to yield meaningful coordination, and in 2008 the MHPCC was defunct.
Since 2004, the MHPCC’s sole achievement had been to obtain funding for the psychosocial resource center within JFK Hospital where the