Recently, a professor of psychiatry at Harvard Medical School told me of a conversation he had with a Syrian physician who worked for years treating survivors of the civil war there before eventually resettling in the United States. In describing the impact of the war on the Syrian people, he stated that the diagnosis of PTSD could not fully capture the mental health consequences. Rather, he suggested that the world needs a new label for the extremity of the impact. He proposed calling it Human Devastation Syndrome. Consider these statistics. According to the World Health Organization (2002), 1.6 million people worldwide die of violence every year, and 100,000-200,000 of these deaths are the result of political conflict, with 40-50 political conflicts occurring at any one time resulting in 60 million refugees and internally displaced people (Uniform Collateral Data Portal [l-UCDP]/ Peace Research Institute [PRIO] as cited in Hamber, 2021). In short many, many people around the globe are suffering from the political violence that results in the type of devastation the Syrian physician witnessed (Uniform Collateral Data Portal Peace Research Institute).
The 20th anniversary of the 9/11 attacks on the United States is an opportunity to reflect on much of what we know about the role of healing from political violence. What have we learned since that time? We have come a long way in building an evidence base for the use of group interventions to treat trauma. But the evidence based for group-based treatment of natural and human-caused disasters, particularly political violence, has lagged.
What is our role as group psychologists and group psychotherapists in promoting the recovery from political violence? In his keynote address to the recent Institute for Disaster Mental Health conference, Brandon Hamber discussed lessons learned from his work on psychosocial recovery from political violence in settings such as South Africa and Northern Ireland (Hamber, 2021). Through this work, he has established that the psychological impact of political violence extends beyond the direct exposure to violent acts and the resulting trauma symptoms. Political violence often destroys (intentionally so) the safety of our social and psychological space, and shakes the targets’ worldview and their reality. As examples, Hamber cited the deliberate targeting of traditionally safe civilian spaces such as hospitals, the use of “disappearing” people that also includes destroying birth records and other evidence of victims’ existence, and discursive techniques designed to break social ties, such as the use of the term “cockroaches” in the build-up to the Rwandan genocide. In other words, political violence destroys physical places, but it also destroys the social life that occurs in those places. It is a destruction of connection, community, and belonging.
Another key lesson from Hamper’s work over the past several decades is that traumatic experiences are reinterpreted by survivors at different times based on the changing context in which recovery is taking place. Context is an ongoing mediating variable between trauma exposure and outcome; each shift in context has an impact on the meaning and impact of the original trauma for the survivor. For example, successful peace negotiations after years of political violence may be seen as healing at the collective level, but may leave individual survivors feeling betrayed, misunderstood or left behind. Hamber refers the impact of a changing context on survivors of political violence as “sequential trauma.”
As I listened to Hamper’s talk, my mind immediately went to the important implications of these characteristics of political violence for the further development of group-based interventions to treat its survivors. While I am sure there are more, here is what I have come up with so far. First, as noted by Hamber (2021), we can’t just treat “the trauma that happened in the past.” Intervention models for treating political violence must address sequential trauma by addressing the mediating impact of a constantly changing context. This is likely to be particularly true in settings in which political violence is layered onto, or concurrent with, other natural or human-caused disasters; the current situation in Haiti is but one of many current examples from around the globe.
Yet even beyond this, we must envision new ways of promoting healing in settings impacted by political violence. Individual and small group treatment of individual trauma symptoms and related conditions are clearly necessary but not sufficient. When in addition to mass exposure to death and destruction, the social fabric of a place has been destroyed, what is needed are interventions that go beyond traditional treatment. Hamber (2021) referred to the need for interventions that support “the reconstruction of the bonds of society.” Or as the Syrian physician might ask, how do we treat Human Devastation Syndrome? I am convinced that together as group psychologists and group psychotherapists we have in our collective knowledge and skill sets the tools to do better in this regard.
References
Hamber, B. (2021, September). Healing and change: Psychosocial issues and dealing with political violence. Keynote address at the Institute for Disaster Mental Health Conference. New Paltz, NY.
World Health Organization (2002). World Report on Violence and Health. Retrieved from https://www.who.int/violence_injury_prevention/violence/world_report/en/abstract_en.pdfopens in new window