Searching for Normal in the Wake of the Liberian War. Sharon Alane Abramowitz
upon laborers and participants? Do they have secondary effects upon the communities of program participants? Do they live into tertiary social strata, like the consciousness of the nation-state? How much counseling is needed, in what degree of dispersion, and with what frequency or continuity, for psychosocial interventions to yield measurable effects? Though it seems evident that social and psychological interventions implemented on a national scale are likely to have scale effects, neither researchers nor practitioners have registered those effects as scale effects or considered what those effects are.
Solving the problem of scale is particularly problematic because no humanitarian officer, agency, or oversight mechanism had ever rigorously researched, analyzed, or even inventoried the mental health, trauma-healing, and psychosocial interventions carried out under the humanitarian umbrella. What follows is a set of indicative facts that reveal the scale of sporadic and unmonitored interventions, even though they cannot give a full accounting of the breadth of mental health, trauma-healing, and psychosocial action that took place in and around Liberia during and after the war.
Trauma interventions were first introduced to the Liberian population in 1993, but by 2003 dozens of NGOs had arrived in Liberia to provide “trainings of trainers” (TOTs) for trauma healing and psychosocial rehabilitation.
In 1996, the Lutheran World Federation/World Service (LWF/WS) Trauma Healing Program initiated trauma-healing activities that continued throughout the war. Famous for its longevity, reach, and effectiveness, and for having employed Nobel Peace Prize winner Leymah Gbowee as a psychosocial trainer and trauma healer, the LWF/WS Trauma Healing Program routinely visited communities of 2,000–5,000 people to offer trauma-healing and psychosocial support, particularly in remote regions. One donor organization, Community Habitat Finance (CHF), noted in a 2007 report that during CHF’s few years of financial support to the LWF/WS Trauma Healing Program, it visited seventy communities in three districts on several occasions.
In 1996, in a Liberian refugee camp in Nonah, Guinea, the Lutheran NGO Action for Churches Together (ACT) also reported that it provided trauma-healing services to 12,000 Liberian refugees. Subsequently, ACT requested an additional $450,000 to continue mental health, trauma-healing, and psychiatric treatment in the N’Zerekore refugee camps from 2002 to 2005.
In 1997, thousands of ex-combatants participated in trauma-healing programs as part of the incomplete DDRR process to transition combatants from wartime to peacetime. In what might be called a secondary effect, several “graduates” of the DDRR ex-combatant rehabilitation program later created their own NGO, the National Ex-Combatant Peacebuilding Initiative (NEPI),2 which was actively involved in the psychosocial rehabilitation of thousands of ex-combatants during the post-2003 reconstruction period. Nearly ten years after the end of the war, in 2011, NEPI was still providing intensive psychosocial training to nearly one thousand at-risk youth (in partnership with a Yale University research initiative).
By 2006, in Liberia, MDM, a French medical humanitarian NGO, had a stable patient load of more than 250 long-term outpatient psychiatric patients, with many more coming in for short-term psychiatric consultation or counseling. MDM also managed “traditional women’s groups” meant to provide counseling, peer support, and mental health education; the groups numbered 15–100 women per community, in ten communities. On a given day, MDM mental health workers could expect to be visited by approximately 200 people in Gbarnga, and in a given month, they could expect to interact with approximately 1,000 people across their service area in Bong County.
Every NGO that provided trauma-healing, psychosocial, or mental health services claimed to have offered counseling, community education, and outreach to participants numbering in the hundreds or the thousands. Each of these NGOs also employed several dozen Liberian NGO employees to carry out these interventions in local languages and dialects, and their salaries and per diems supported families. As will be evidenced in Chapter 8, Some Liberian NGO employees adopted the trauma-healing framework as a personal calling, assumed the role of trauma counselor in their private lives, and circulated the language of trauma, reconciliation, and the new normal throughout their domestic and professional worlds. Perhaps hundreds of thousands of Liberian friends, family members, coworkers, and children came into secondary contact or were tertiary observers to the trauma-healing and psychosocial rehabilitation enterprise. As a result, though many trauma-healing and psychosocial programs have been lost to public recall, they’ve left an indelible social inscription upon Liberia’s social fabric.
Trauma Promises, Rehabilitation Effects
In the thousands of trauma-healing and psychosocial interventions offered around the globe, trauma healing and psychosocial rehabilitation are offered as the promised ends of therapeutic initiatives. But much of what we know about trauma, and about mental illness more generally, indicates that under extraordinary conditions of loss, violence, and instability, trauma-healing programs offer a path to containment—to limiting the ways in which past and present traumas interfere with a person’s ability to function or a society’s ability to move on, recover, and rebuild. As this book will illustrate, many trauma-healing and psychosocial interventions managed the grossest manifestations of trauma on individual and societal scales. Unlike the shell shock therapies for World War I soldiers, in which sufferers were promised a full and complete recovery through self-confession, electroshock treatment, and moral beratement (Shephard 2000, Young 1995) today trauma-healing programs in humanitarian settings often focus on the symptom—a woman’s social withdrawal, a man’s insomnia, a child’s fear of a knife or gun used in everyday life, a group of ex-combatants’ tendencies to become violent in arguments—rather than the root causes of suffering emerging from poverty, displacement, violence, and the insecurity of the postconflict moment. This begs the following questions: What range of social experience do trauma-healing projects purport to cover? How powerful are their effects? At what point of population saturation does the concept of trauma become localized or indigenized, and become an integral part of a postwar social fabric?
Elsewhere in the world, the language and conduct of trauma healing and psychosocial intervention have had unmeasured and unanticipated social effects. In Sri Lanka, for example, a medicalized discourse of trauma created space for the apolitical discussion of horrific experiences, but it also justified the unwelcome imposition of intervention from expatriate professionals (Argenti-Pillen 2002). In India-administered Kashmir, more than a decade of nonbiological trauma treatment has served as a platform for local humanitarian workers to inscribe themselves into psychiatric modalities of clinical care (Varma 2012). In Sarajevo, after the Bosnian war, NGOs involved in trauma healing became symbols of hope, institutional sites for making legal and moral claims on the state, and a locus of ambivalent experiences of humanitarian abandonment (Locke 2009).
Given the centrality of trauma discourses to the operation of humanitarian aid, and given the fact that at least half of all Liberians received some form of humanitarian aid at some point during the war, many Liberians living in Liberia today have little memory of a public discourse that does not include the word “trauma.” In everyday life, international NGO workers, international donors, and many Liberians like Agnes moved easily between thinking about trauma psychologically, as a consequence of exposure to traumatic events and experiences, behaviorally, as an idiom for various social pathologies, and morally, as an expression of national disorder. As I elaborate in Chapter 3, in Liberia, trauma was a part of the vernacular. One is put in mind of Daniel’s assertion that “what defines language is not solely the use of words, or even that of conventional signs; it is the use of any sign whatsoever as involving the knowledge or awareness of the relation of signification” (Daniel 1996). The vernacularization of the concept of trauma in Liberia reflects more than just the arbitrary imposition of a meaningless category of medicalization on a population; it spoke to the fact that the concept resonated deeply, and meant something powerful and intimate to a nation of people.
In contrast, expatriate managers in trauma-healing programs adhered to specific, Western understandings concerning the nature of trauma and the meaning of PTSD. They maintained that that the cause of trauma is an unconscious repression of memory derived from the incommunicable nature of suffering.