Activities
Last Updated: April 13, 2009
Just as there is a variety of actors working on post conflict trauma and mental health issues, there is also a wide array of programs to aid in psychosocial recovery efforts. Along with more traditional national mental health programs, support to hospitals and community mental health centers or training of local specialists, methods for psychosocial intervention can be diverse and include "creative expression through arts and storytelling; the development and promotion of self-help groups; assisting with the completion and reburial rituals; an emphasis on re-training, re-education and re-skilling; the reintegration and reunion of individuals dislocated from communities and families; counseling and group support; information dissemination and connecting people to resources; and at times simply focusing on creating a safe environment where those affected by conflict can meet, network, share experiences and focus on establishing new routines."1
Intergovernmental programs and initiatives
The primary goals and objectives of intergovernmental programs are to raise awareness and discussion of the importance of mental health care programs in post-conflict situations and to aid in improvements of such programs. These initiatives highlight global efforts in mental health care after conflict and provide a forum for governments and international organizations to pool and share ideas and commitments; discuss resources, challenges, and potential solutions; and to gain invaluable knowledge from other experiences with mental health and trauma programs worldwide.Often, governments in a particular region may confront similar issues with respect to healing their populations after conflict. Such initiatives also allow for consistency in mental health policies and programs for the region. For instance, Bosnia and Herzegovina professionals have benefited from a project involving other countries from the Balkans, providing them opportunities to learn from the experiences of countries that share some political and economic characteristics of post conflict societies in transition.2
Health ministers of post-conflict nations meet on mental health recovery
On 3 and 4 December 2004, for the first time in history, over fifty ministers of health from post-conflict countries assembled to endorse an evidence-based, scientific mental health action plan for the mental health recovery of those affected by mass violence. The idea and importance of undertaking such an historic initiative was an outgrowth of a meeting held in Sarajevo in September 2002, hosted by HPRT, the Fulbright Foundation and the Ministries of Health of Bosnia and Herzegovina, and attended by ministry officials from numerous post-conflict countries, including Cambodia, Indonesia, Peru, Rwanda and Uganda, as well as scholars, scientists, international policy makers and representatives from WHO, the World Bank, the UN Children's Fund, The Vatican and the Ministries of Foreign Affairs of the United States, Japan and Italy. All participants sealed a commitment to the historic mission of creating a global scientific mental health action plan, unique in its development, scope and adoption.
Source: Richard F. Mollica and Laura McDonald. Project 1 Billion: Health Ministers of Post-conflict Nations Act on Mental Health Recovery UN Chronicle 2003.
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National governmental programs
In the wake of mass violence, a national government confronts issues of recreating or reconstructing societal infrastructure on many fronts. The necessity and urgency for mental health services after conflict are compounded as populations surpass typical levels of mental health needs. A government may elect to reconstruct its former mental health program, whose services and physical infrastructure have been often destroyed in the country's turmoil, or to reform or create a new comprehensive program suited to the current state of its country and populations. The World Health Organization (WHO) recommends that, in the wake of mass violence, services to help populations deal with post-conflict traumas be incorporated into national mental health programs.3Objectives of a national mental health program are generally to promote mental health and mental health services, to make mental health programs accessible, to prevent mental ill health, to provide mental health treatment, and to rehabilitate those with severe mental illnesses.4 To accomplish such goals, a national mental health program may utilize hospital facilities or may establish a network of community mental health centers throughout the country. Sustainable national mental health programs must also include the training of mental health workers, including doctors and psychiatric nurses, psychologists, psychiatrists, social workers, and therapists. Training may be conducted through studies at the country's universities. Individuals may be sent abroad to acquire expertise or experts from abroad may be brought to the country by the government, NGOs or international organizations, in order to train locals in mental health services in general, and/or in trauma-related services in particular.
National governments confront several challenges in creating or reforming national mental health services from design to implementation. Such challenges include how to best reach isolated populations or those in remote areas, how to promote mental health services among populations unaccustomed to relating to issues in that way, how to overcome the stigma associated with mental ill health in some cultures, how to diversify mental health services to be helpful to diverse populations, and how to cope with lack of resources including finances, professional skills, and physical infrastructure.
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Hospitals and mental health community centers
Historically, psychiatric hospitals or primary care hospitals with mental health units were the main infrastructure for treating mental illness. In some countries and regions, such facilities remain the backbone of national mental health programs. Such facilities still confront tremendous challenges particularly in the wake of mental health and trauma in post-conflict societies. In Uganda, for example, the Butabika Hospital Complex has been the national referral hospital providing primary mental health services to communities around the hospital up to a 30 kilometer radius.5 Additionally, psychiatrists from Butabika Hospital provide support supervision to other hospitals in order to improve mental health services. Nonetheless, a central hospital providing mental health services has the disadvantage of reaching fewer people in need of treatment than would otherwise be possible through a network of mental health programs in community centers throughout a country. Indeed, recognizing this issue, the Ministry of Health in Uganda has made efforts to establish mental health care service in select regional hospitals and to focus training to alleviate the shortage of mental health providers in many areas.Similarly, other countries have made efforts to improve the quality and outreach of mental health care by establishing a good working relationship between mental health services at the provincial hospital and the psychosocial Intervention at the grassroots level. Such efforts not only improve the access to services but also enable the network of community mental health clinics to focus on integrative approaches to healing in each community. The World Health Organization (WHO) recommends integrating mental health interventions into local primary health care.6
Go to Case Studies: Bosnia and Herzegovina: Community mental health centers in post-war
and Cambodia: The Community Mental Health Program
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Training psychologists, health care or mental health professionals and healers
While NGOs and international organizations often flock to post-conflict areas to provide psychosocial services, there have been many efforts to train locals to provide trauma and mental health services after conflict. These are critical to the sustainability of programs and services. Mental health workers who may benefit from this training include psychologists, psychiatric doctors and nurses, trauma specialists, and community leaders.National governments have focused resources on educational programs at the university level, creating, for instance, masters program in clinical psychology and therapeutics as well as specialties in psychiatry in medical schools. Additionally, locals are often sent abroad to partake in seminars and university programs for professional training.
Many NGOs, foreign universities, and religious organizations have established training programs and seminars in which they train locals in post-conflict regions.
In July 1997, an international conference called "Trauma Recovery Training: Lessons Learned" was held in Zagreb, Croatia; the publication of 38 of the key contributions presented at that conference offers a critical review of the lessons learned in terms of training for trauma recovery and important insights.7
One of the key issues presented by most training is related to their relatively short duration and the lack of supervision or follow-up after their completion. As a consequence, newly trained individuals are left with an overwhelming job and little support.8
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Developing psychosocial education at large
Teachers, religious leaders, human rights workers, para-professional and volunteers are also playing important roles in supporting survivors cope with their trauma.9 Therefore, an increasing number of training programs target those groups. Scholar and practitioner Barry Hart has particularly highlighted how crucial it was for leaders to get an understanding of trauma and its impact on people's "physical, emotional, cognitive and spiritual states, along with insights to its historical and/or most recent causes."10 Leaders need to know about the effects of trauma and methods of recovery, and the important role they can play in providing the physical and emotional space for healing to take place. Barry Hart has made specific recommendations regarding essential points to include in these educational programs.11Go to Case Studies: Bosnia and Herzegovina: Community mental health centers in post-war; Cambodia: The Community Mental Health Program; Human rights promotion and protection; Religion
Examples of Training Programs
The International Capacity-Building Project of the International Rehabilitation Council for Torture Victims (CVT)
International Capacity-Building Project works with 16 treatment centers throughout the world to expand their capacity to provide high-quality services to torture survivors. The goals of the program are to make each center more stable organizationally and financially; to expand the centers clinical capacity; and to help them develop effective advocacy campaigns, including community outreach and public education. The participating treatment centers are located in Bangladesh, Bulgaria, Cambodia, Ethiopia, Guatemala, India, Kenya, Kosovo, Namibia, Nepal, Pakistan, Palestine, Peru, Romania, Rwanda, South Africa and Uganda.
For more information:
International Rehabilitation Council for Torture Victims (CVT)
Eastern Mennonite University Seminars on Trauma Awareness and Resilience
Seminars on Trauma Awareness and Resilience (STAR) began as a response to the events of September 11th and have now equipped more than 5,000 leaders from 62 countries with tools to address a range of situations that are caused or influenced by traumatic events.
Multidisclipinary Approach to Trauma Healing
STAR combines the latest in trauma research, personal self-care and innovative strategies for ending the cycles of victimhood and violence within local, national and global communities. Participants have found that STAR equips them with tools to address a range of situations that are caused or influenced by traumatic events.
Framework
The STAR framework draws on the fields of neurobiology, psychology, restorative justice, conflict transformation, peacebuilding, and religion/spirituality. STAR expands practices related to trauma, justice, peacebuilding, spirituality and security and shows the importance of integrating these concepts on personal, community and societal levels.
STAR activities honor multi-faith participation and the important interaction of those from diverse backgrounds in the US and around the world. The website gives access to the STAR Toolkit for people who plan to work in areas affected by traumatic events including natural or manmade disasters.
Supporting Trauma Recovery by Empowering Teachers of Collective Healing STRETCH Program Anahata International
The three-pronged approach (1) establishes a yoga teacher/healer exchange that recruits certified yoga instructors in the United States to engage in efforts abroad for one to three months at a time, (2) provide 200-hour International Yoga Alliance-approved teacher training to local young adults with the potential and drive to help their own communities overcome conflict, (3) facilitate advanced training for certified yoga teachers wishing to specialize in trauma recovery and peace-building.
A specific example of that kind of educational effort that shows the large variety of approaches developed in the field is forgiveness education (related to forgiveness therapy), an approach developed by psychologist Robert Enright and the International Forgiveness Institute. Forgiveness therapy takes the light of analysis off of the patient and puts it on the one who acted unfairly. "The ultimate effort in such therapy is to effect a deeper understanding and appreciation of the perpetrator, the one who traumatized. The paradox is realized when the patient begins to heal as a result of understanding and reaching out to the perpetrator. Our research shows strong effect sizes for emotional health following such therapy in the form of reduced depression, anxiety, and anger and an increase in self-esteem and hope." 12 For the past seven years, the International Forgiveness Institute has been involved in forgiveness education in Milwaukee's central city and in Belfast, Northern Ireland. Such approaches also suggest that "healing from trauma does not start with the trauma, but begins long before the trauma happens."13 In that sense, communities can develop a base of knowledge and competence that can support trauma healing and community renewal. Go to Reconciliation
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Healing and supporting peacebuilders and mental health professionals
An increasing attention has been paid to the trauma experienced by mental health professionals working with survivors,14 as well as by peacebuilders at large. The work conducted by Nancy Sider at EMU's Center for Justice and Peacebuilding is particularly important to that respect. Various programs have been developed to foster resilience in aid workers in war-recovery zones. Ensuring that they know what to expect, and set realistic goals for themselves and their organization. It is important that aid workers have support available, and take appropriate amounts of rest and diversion. Team members need to be sensitive enough to recognize when a colleague is overwhelmed or emotionally abreacting. More generally, those caring for post-war victims need information about traumatic reactions so that they know what to expect, how to offer positive support, and what not to do.Similar programs have been developed to assist families and community leaders and care providers in post-war countries. Sometimes the goals extend beyond supporting the traumatized patient to working to prevent further communal violence and hatred. At their best, these provide ideas and tools which people can adapt to their own setting, their culture and spiritual beliefs. The Eastern Mennonite University Seminars on Trauma Awareness and Resilience (STAR) have developed many tools to support such process.
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Community-oriented efforts
Historically, programs to heal trauma centered on the individual and the individual's healing process primarily by way of mental health services. Today there are many multi-disciplinary integrated programs geared towards healing communities after conflict; this does not mean that community efforts did not exist before but, most of the times, they received very little outside support, including from more conventional mental health services and professionals. Community programs typically underscore the notion that victims' needs are multifaceted and cannot be considered in isolation from their daily social circumstances.
Community programs often focus on the advantage of being able to establish supportive groups that enable victims to identify with one another, feel safe and tend not to label or stigmatize individuals for the trauma endured. Community mechanisms are also designed to help build individuals confidence and increase their ability to participate in community development. Many programs put an emphasis on an integrated approach to provide support (individual, family, group therapy or alternative where culturally relevant) and often include a multidisciplinary approach in addition to mental health counseling. For instance, they provide support to address adverse environmental conditions like housing and/or pharmacological assistance where required. They also typically engage in efforts of outreach and education as many organizations are involved in education programs in schools. Organizations engaged in such efforts often attempt to liaise with other organizations, including human rights NGOs, local police, legal and para-legal institutions.
Such integrated programs are applied particularly in response to refugee related trauma,15 community-based programs in areas where massive violence has affected communities, and in programs targeting war-affected children by combining trauma healing and education. Community efforts generally intend to be culturally sensitive and tap into local resources in the community.
Many programs have also been developed to train community leaders, refugees or displaced persons themselves to provide psychosocial support.16 They generally involve methods of self-healing and self-care to cope with post conflict trauma. "Several measures encourage self-healing [and include] engaging in altruistic acts, working to provide for oneself (rather than accepting long-term handouts), spirituality (but not necessarily formal religion), humor, physical exercise, relaxation techniques and good nutrition. Empathic communication between healer and patient also has restorative power, as does the creation of beauty, e.g., making art, tending a garden, keeping a journal, creating puppet theater. Recalling dreams, and understanding what they are trying to teach, can also help."17There has also been significant emphasis on mind-body awareness as it relates to self-care and healing trauma.18
Targeted programs, training and materials have also been developed for specific groups, among them children and youth. For instance the Eastern Mennonite University Seminars on Trauma Awareness and Resilience (STAR) has developed training and resource materials for adults who work with children and youth who have experienced violence and trauma. Non-governmental organizations such as Save the Children have also developed resource materials on that topic. A number of different approaches to psychosocial interventions with regard to children in war-affected areas have emerged. "At one end of the spectrum we find interventions from a curative point of view, aiming at psychosocial and psychological treatment of war-affected children. The approach is strongly trauma-oriented, helping children deal with the stressful experiences they faced. At the other end, we find an approach that is more preventive in nature. Rather than focusing on past experiences, interventions address the consequences of war and its present challenges. They aim to help children develop healthily within their social context, thereby protecting them from future mental and social disorders."19 Other approaches include the developmental approach towards psychosocial intervention which looks at people from a broader perspective, as part of a wider social fabric of relationships and structures. "Derived from concepts used in developmental psychology like system theory, this approach is grounded in the collectivist culture societies of non-Western populations."20 Some developmental programs focus on normalizing and restoring stable living conditions, e.g. rehabilitation of schools, community rites, etc. Other programs are more specialized, helping groups of children deal with specific situations through various methods, which often include creative exercises such as drawing and play. Yet other programs focus on children's social environment, supporting and informing parents and teachers to help them support the children. Developmental programs are future-oriented, geared towards the structural strengthening of children's psychosocial well-being.
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Symbolic and spiritual healing
Symbolic acts, objects and rituals can have great healing power, particularly if they are personalized and culturally relevant.21 Community healing in itself is also "a matter of mobilizing cultural resources aimed at restoring collective memory, encouraging personal narratives and accounts, re-integrating child soldiers into their community, or re-establishing links to the dead whose bodies were not treated with the dignity and the rituals worthy of a human being."22 Indeed, rituals are particularly important when the dead have not been given proper burial, In addition to the impediment to a proper mourning process, this absence has strong symbolic consequences in most cultures. Rituals to honor the dead and specific rituals to accompany programs of excavations are especially important to that respect. More broadly, rituals help to transform worldviews and enable people to make sense of the larger conflict. At times when worldviews are crumbling, rituals can create new ways of thinking and dramatically alter the ways people see the world. They can also make conflict less destructive by reframing the issues at stake and allowing people to approach problems in new ways. Some believe that ritual may actually change the physical structure of the brain, prompting it to process information differently. Symbolic forms of communication such as rituals are thought to have the power to penetrate, integrate, and communicate between different parts of the body and brain.23Many adults and children who are found to be vulnerable in the aftermath of conflict have been displaced many times, had to take refuge in a neighborhood conflict or participated at some point as a combatant. Yet, they often get little support to cope with their different troubles which can have many consequences to their families and their immediate environment. Rituals and symbols can often be helpful in such contexts. In different countries, cleansing ceremonies and traditional rituals have been used to reintegrate former child soldiers and displaced people; they are designed to bring purity and reported to support the healing process in a community context. Go to Children and Youth and Reconciliation
Go to Case Studies: Northern Uganda: Healing and reintegration rituals; Northern Uganda: Girl combatants dealing with trauma and shame through rituals and prayers; Mozambique: Community reintegration of child soldiers and traditional rituals
Different forms of beliefs play a role in the reconstruction and transformation of a social and ideational world as survivors reconstruct meaning that will allow them to continue, using whatever cultural resources are at hand. Anthropologist Kimberly Theidon's work on post-massacre rebuilding in Peru, for instance, "shows how evangelical Christian perspectives have been adopted by indigenous communities as explanatory of their own experiences, lending meaning to the intense emotions and grief that surround the experience of massacre, and-- through the concept of repentance-- re-incorporating combatants. These Christian perspectives are not seen as separate from or replacing other, more 'traditional' perspectives, but rather as of a piece with them as they are incorporated into a syncretic whole."24 Those are unintended impact of the religious presence. But, a large number of projects do also advance religion and spirituality as a means of healing in post-conflict areas. Faith-based organizations help provide emotional and spiritual support to war-affected communities.25 Many of them have developed trauma healing programs. Religious actors and faith-based organizations can also help support rituals that will symbolically communicate a sense of transformation. Similarly, educational institutions like the Eastern Mennonite Universitys Center for Justice and Peacebuilding have developed training programs which include a spiritual component that has often been disconnected from trauma healing. It is important to note that in that specific case, the program honors multi-faith participation and the important interaction of those from diverse backgrounds.26 It is also worth remembering that rituals are not necessarily religious. However, religions can provide resources from different traditions that make sense for local actors and communities. Go to Religion
Programs utilizing symbolism to foster healing have also included activities around the building of monuments, museums, parks, official statements, naming of official buildings, apologies, and reparations programs. All these activities that take part of the 'reconciliation' programs and those dealing with memorial work have a strong connection with trauma work and should be conceived as such.
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Justice, truth and reparations as healing components
While some studies show that "PTSD and depression in war survivors appear to be independent of sense of injustice arising from perceived lack of redress for trauma [and that f]ear of threat to safety and loss of control over life appeared to be the most important mediating factors,"27 it is generally considered that transitional justice measures can play a role in healing processes.28 At the individual level, the prosecution of war criminals can bring healing and closure to victims and enable them to rebuild healthy social relationships and to resume normal lives. Two specific transitional justice mechanisms are more directly concerned by that healing: Truth & Reconciliation Commissions and reparations programs.The Truth and Reconciliation Commissions: There has been much debate as to whether the process and procedures of truth commissions heal the trauma of society and/or individuals or whether they re-injure victims by eliciting and revisiting the trauma through testimony.29 "Testimony to trauma then is a process involving individual recovery of memory about the past, regaining voice and re-establishing self identity through narration...A major problem with the formula 'revealing is healing' is that it blurs quite distinct processes of individual and social healing after large-scale violence.30Some studies have, for instance, presented alarming findings regarding (re)traumatization,ill-health, isolation, and insecurity dominating the lives ofthose who testified.31 The extent to which the process would be therapeutic for individuals has been largely discussed in the case of the Truth and Reconciliation Commission in South Africa, one of the most researched and debated from this point of view. 32 Some psychological analyses have explicitly presented the TRC as able to serve some of the functions of a healing ritual.33 "The TRC, by creating an accurate picture of the past, could liberate individuals and broader society from this skewed view of humanity constructed solely around the inhuman legacy of South African society. Furthermore, by creating a realistic perspective of past human rights abuses, individual and collective cognitive recovery could be aided by allowing survivors to accept what happened to them and deal with their resultant emotional responses. Importantly, through acknowledgement and uncovering the roots of the traumatic incident it could also serve to absolve the feelings of guilt and personal causal responsibility that survivors often experience after traumatic event."34 But how this process was actually fulfilled remains debated, in particular by survivors themselves. This is true in particular among associations of victims and survivors of violence, as in the case of the Khulumani Support Group, which was formed in 1995 by survivors and families of victims of the political conflict of South Africa's apartheid past.35
The role of truth commissions is also discussed in relation to cultural differences in expressing trauma. "While Western approaches to trauma rely primarily on 'verbalized remembering,' some traditional societies have nonverbal methods for expressing and addressing trauma. More specifically, legal trials and truth commissions may 'honor' victims in Western terms by providing them with a public forum for revealing their suffering, but eliciting victims' testimony through highly structured processes may not be culturally sensitive or appropriate in some settings. Additionally, storytelling-- an important component of various transitional justice mechanisms-- can take different forms in different cultures. In South Africa, which established the first truth commission to sponsor public hearings, victims' testimonies conveyed a narrative of violence and suffering that made it difficult to deny the abuses of the apartheid regime. In other societies recovering from conflict, such as Mozambique, storytelling does not focus on traumatic events but instead on resilience, healing, and successful efforts to outsmart the more powerful. Further, the needs of storytellers may change over time. As one participant noted, some rape victims in Bosnia, having told their stories, now want to forget and to no longer be identified only as victims."36
The few existing studies with regard to judicial actions similarly call for cultural awareness. As one study indicates, "only some of the survivors who have seen those responsible for their abuse brought to trial have found comfort, and some have experienced additional distress."37
In fact, "more research is needed to establish if and how the operation of different transitional justice interventions affect the psychological states of survivors of violent conflict...[...]Given existing evidence, it is too soon to conclude that judicial initiatives have therapeutic benefits for most survivors."38 The current prevalent perception that transitional justice mechanisms have salutary psychological effects on individuals and societies is "based largely on anecdotal data and media accounts rather than on carefully constructed evidence."39
At best, a single transitional justice mechanism can begin these processes and may only be successful if carried out in tandem with other social reconstruction efforts.40 The role survivors play in these mechanisms is also an important factor as they are often kept outside of the process.41
Reparations: Healing may also be assisted by reparations programs which help to alleviate a sense of injustice in post-conflict societies by aiming to repair harm done and seeking to make amends through monetary or other means of compensation or restitution. "At an individual level, financial reparations and other acts of reparations (e.g. building a monument) have the potential to play an important role in any process of healing, coping with bereavement, and addressing the impact of violence for victims... Reparations can serve as focal points in the grieving process, i.e. as a place of object (e.g. memorial garden or memorial) that can serve as a physical or visual representation of what was lost, allowing individuals space to channel their emotions and address them in a focused or specific way. This can aid recovery by allowing individuals to focus exclusively on their grief through symbol. Reparations (such as the building of a memorial), and even compensation payments in some instances, can also symbolically mark the point of moving on to a new phase and symbolize an individuals mastery over the past." 42 Additionally, the establishment of a massive reparations program can help victims combat feelings of isolation and silence which often result from political violence. Victims can even lead to feelings of recognition by the state which can in turn lead to civic trust and engagement.43
Still, "psychologically, the victims and survivors have to deal with the inner reality of what they have lost and the impossibility of it being externally replaced."44 While less common, psychosocial support and mental health services may also be specifically incorporated through a reparations program. In South Africa, a counseling program was supposed to accompany the TRC work but it was largely deficient and left many victims isolated with their trauma. Go to Memorialisation, Historiography and History Education
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Coping with loss and trauma through the arts
The arts have been used as a creative means to address trauma and reconciliation in post-conflict societies, for both communities and individuals.45 The term 'arts' includes a broad range of creative processes such as music, theatre, story telling, dance, and visual arts. Therapists have been using arts techniques with a variety of populations, including, but not limited to, children, and in different circumstances, including in post-war situations. Art therapy is considered by many professionals as an effective means of expressing the experiences of fear, loss, separation, instability and disruption. Most creative therapy techniques use arts-based processes to facilitate the release of trauma and emotions at the individual level. Throughout the world, several well-known international non-governmental organizations and local organizations and community groups have used arts-based processes in community-oriented psychosocial programs to work through unresolved emotions. Their documentation and more systematic study have begun.46 Manuals have been created for running individual or group art therapy sessions addressing the specificities of working in crisis areas, the importance of sensitivity to cultural issues and other specific challenges, such as the difficulties of working through translators.47 There is still not enough development of theory about the application of the arts-based approaches beyond the interpersonal level or field research to measure their impact on the peacebuilding processes, in particular in the healing components of the programs. Some examples of such field investigations and experiences as well as additional resource information are given below in the case study section.Go to Bibliography: Key Resources on Art & Conflict Transformation and Memorialisation, Historiography and History Education
1. David Bloomfield, Teresa Barnes and Luc Huyse, eds., Reconciliation after Violent Conflict: A Handbook (Sweden: International Institute for Democracy and Electoral Assistance (IDEA), 2003), 83.
2. Abdulah Kucukalic, M.D., Ph.D., Alma Dzubur-Kulenovic, M.D., Ismet Ceric, M.D., Ph.D., Lars Jacobsson, Alma Bravo-Mehmedbasic, M.D., Ph.D. and Stefan Priebe, M.D., Ph.D., "Regional Collaboration in Reconstruction of Mental Health Services in Bosnia and Herzegovina," Psychiatric Services 56 (November 2005):1455-1457.
3. World Health Organization, "Mental Health Emergencies: Mental and Social Aspects of Health Populations Exposed to Extreme Stressors" (Geneva: WHO, 2003).
4.Kucukalic, et al., "Regional Collaboration in Reconstruction of Mental Health Services in Bosnia and Herzegovina."
5. The Butabika Hospital Website
6. World Health Organization. Mental Health Emergencies: Mental and Social Aspects of Health Populations Exposed to Extreme Stressors (Geneva: WHO, 2003).
7. Dean Ajdukovic, ed., Trauma Recovery Training: Lessons Learned, Zagreb: Society for Psychological Assistance, 1997.
8. Communication with Jeannie Annan, July 14, 2008.
9. Communications with Barry Hart, May 15, 2008 and Yael Danieli, October 1st, 2008.
10. Barry Hart, "Peacebuilding Leadership in Traumatized Societies," in Peacebuilding in Traumatized Societies, eds. Barry Hart (Lanham, Boulder, New York, Toronto, Plymouth, UK: University Press of America, 2008), 120.
11. Ibid.
12. Communication with Robert Enright, August 12, 2008.
13. Communication with Robert Enright, August 12, 2008 and Robert D. Enright, Elizabeth A. Gassin, Jeanette A. Knutson, "Waging Peace Through Forgiveness Education in Belfast, Northern Ireland: A Review and Proposal for Mental Health Improvement of Children." Journal of Research in Education 13, no. 1 (Fall 2003): 1-11.
14. Comments by Yael Danieli, October 1st, 2008 and Yael Danieli, ed., Sharing the Front Line and the Back Hills: International Protectors and Providers, Peacekeepers, Humanitarian Aid Workers and the Media in the Midst of Crisis (Amityville, New York: Baywood Publishing Company, Inc. 2002); Yael Danieli, "Groups for mental health professionals working with survivors," in Psychological Effects of Catastrophic Disasters: Group Approaches to Treatment, eds. L.A. Schein, H.I. Spitz, G.M. Burlingame, P.R. Muskin & S. Vargo (Binghamton, NY: The Haworth Press Inc., 2006): 841-876.
15. UNHCR, "Planning for Optimal Mental Health: Responding to Refugee Related Trauma," in Refugee Resettlement: An International Handbook to Guide Reception and Integration, 231-244 (Geneva: UNHCR and Victorian Foundation for Survivors of Torture, 2001).
16. Binta Barry and Nancy L. Pearson, "Rebuilding Communities: Training Trauma Survivors to Help Communities Heal after Atrocities" (Minnesota: New Tactics Project of the Center for Victims of Torture, 2004).
17. Kathy Briccetti, "Doctor says 'debriefing' delays healing of trauma," San Francisco Chronicle, December 31, 2006, citing Richard Mollica, Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World (2006).
18. For example, Dr. James Gordon's Healing the Wounds of War Program emphasizes such techniques. For more information about the Center for Mind-Body Medicine in conflict-torn areas such as the Gaza Strip, Israel, Kosovo, and Bosnia, visit "Trauma, Healing, and Mind-Body Medicine in the Middle East," Middle East Institute (7 March 2006).
19. Brechtje Kalksma-van Lith, Donatien de Graaf, Eveline Jansveld and Ans de Jager, State of the Art: Psychosocial Interventions with Children in War-Affected Areas (Amsterdam: War Child Holland, 2007), 7.
20. Ibid, 8.
21. For a general reference on the subject, see Lisa Schirch, Ritual and Symbol in Peacebuilding (Bloomfield, CT: Kumarian Press, 2005).
22. Batrice Pouligny, Bernard Doray and Jean-Clment Martin, "Methodological and ethical problems: A trans-disciplinary approach," in Pouligny et al., After Mass Crimes: Rebuilding States and Communities, 20.
23. Schirch, Ritual and Symbol in Peacebuilding.
24. Culbertson and Pouligny, "Re-imagining peace after mass crime: A dialogical exchange between insider and outsider knowledge," 273; see also Kimberly Theidon, "Intimate enemies: Reconciling the present in post-war communities in Ayacucho, Peru," in Pouligny et al., After Mass Crimes: Rebuilding States and Communities, 97-121.
25. Tsjeard Bouta, S. Ayse Kadayifci-Orellana and Mohammed Abu-Nimer, "Faith-Based Peace-Building: Mapping and Analysis of Christian, Muslim and Multi-Faith Actors" (The Hague: Netherlands Institute of International Relations (Clingendael), November 2005).
26. "About STAR," Seminars on Trauma Awareness and Resilience.
27. Metin Basoglu, MD, PhD; Maria Livanou, PhD; Cvetana Crnobaric, MD; Tanja Francikovic, MD, PhD; Enra Suljic, MD; Dijana Ðuric, BSc; Melin Vraneic, MD, Psychiatric and Cognitive Effects of War in Former Yugoslavia: Association of Lack of Redress for Trauma and Posttraumatic Stress Reactions, The Journal of the American Medical Association 294, no. 5 (2005): 580-590.
28. See for instance Yael Danieli. "Essential elements in healing from massive trauma: Some theory, victims' voices, and international developments," in Reparations: Interdisciplinary Inquiries, J. Miller & R. Kumar eds., 307-322 (Oxford: Oxford University Press, 2007).
29. Barsalou, Trauma and Transitional Justice in Divided Societies.
30. Michael Humphrey, "From Terror to Trauma: Commissioning Truth for National Reconciliation," Social Identities 6, no. 1 (2000), 9.
31. This has also been reported in the case of Rwandan Gacaca Courts; women in particular have been reported to be threatened and harassed before, during, and after giving testimony in the gacaca; see Karen Brounus,"Truth-Telling as Talking Cure? Insecurity and Retraumatization in the Rwandan Gacaca Courts," Security Dialogue 39, no. 1 (2008): 55-76.
32. Cheryl De La Rey and Ingrid Owens, "Perceptions of Psychosocial Healing and the Truth and Reconciliation Commission in South Africa," Peace and Conflict: Journal of Peace Psychology 4, no. 3 (1998): 257-270; Brandon Hamber, "Do Sleeping Dogs Lie? The Psychological Implications of the Truth and Reconciliation Commission in South Africa," seminar presented at the Centre for the Study of Violence and Reconciliation, Johannesburg, July 26, 1995, 4-5; Alfred Allan & Marietjie M. Allan, "The South African Truth and Reconciliation Commission as a Therapeutic Tool," Behavioral Sciences and the Law 18, no. 4 (2000): 459 477.
33. Brandon Hamber, "The Burdens of Truth: An Evaluation of the Psychological Support Services and Initiatives undertaken by the South African Truth and Reconciliation Commission," American Imago 55, No 1 (Spring 1998), 9-28; See also Hamber, "Do Sleeping Dogs Lie? The psychological implications of the Truth and Reconciliation Commission in South Africa."
34. Hamber, "Do Sleeping Dogs Lie? The psychological implications of the Truth and Reconciliation Commission in South Africa," 4-5.
35. See for instance the results of a research undertaken with members of the Khulumani Support Group in the region of Western Cape: Beatrice Pouligny, Shirley Gunn, and Zukiswa Khalipha, "Breaking the Silence: A Luta Continua. An art project about memory and healing in post-Apartheid South Africa" (Cape Town, South Africa: Human Rights Media Centre, 2007).
36. Barsalou, Trauma and Transitional Justice in Divided Societies.
37. Jamie OConnell, "Gambling with the Psyche: Does Prosecuting Human Rights Violators Console Their Victims?," in Harvard International Law Journal 46, no. 2 (Summer 2005), 340.
38. Judy Barsalou, "Managing Memory: Looking to Transitional Justice to Address Trauma," in Peacebuilding in Traumatized Societies, ed. Barry Hart (Lanham, Boulder, New York, Toronto, Plymouth, UK: University Press of America, 2008), 41.
39. Ibid.
40. Ibid.
41. Personal communication with Nahla Valji, 28 November 2008. An illustration of how these perceptions may work is given in a research project undertaken with survivors of the apartheid regime, members of the Khulumani (to speak out, in Zulu) Support Group in the Western Cape who used scrapbooks, body-maps, photographs, memory cloths, drawings, paintings, art banners and film to tell the stories and talk about their frustration with the TRC work: see Pouligny, et al., "Breaking the Silence: A Luta Continua. An art project about memory and healing in post-Apartheid South Africa."
42. Brandon Hamber, "Narrowing the Macro and Micro," in The Handbook of Reparations, de Greiff, ed., 566.
43. Ibid.
44. Ibid, 581.
45. Beatrice Pouligny, "Understanding Situations of Post Mass Crime by Mobilizing Different Forms of Cultural Endeavors," paper presented at the19th IPSA World Congress Durban, July 1, 2003.
46. Marian Liebmann, ed. Arts Approaches to Conflict (Bristol: Jessica Kingsley Publishers, 1996); Renos K. Papadopoulous, "Political Violence, Trauma and Mental Health Interventions," in Art Therapy and Political Violence, Debra Kalmanowitz and Bobby Lloyd, eds., (United Kingdom: Routledge, 2005), 14-34; M. Shank with L. Schirch, Strategic Arts-Based Peacebuilding, Social Justice Journal: Anthropology, Peace and Human Rights (2006); Baby Ayindo,"Arts Approaches to Peace: Playing our Way to Transcendance?" in Peacebuilding in Traumatized Societies, ed. Barry Hart (Maryland: University Press of America, 2008), 185-203.
47. See for instance, Fiety Meijer, Coping with loss and trauma through art therapy (Training manual), (The Netherlands: Institute for Art Therapy & Expressive Psychotherapy, 2006) available at "International Training Art Therapy and Trauma," Institute for Art Therapy and Expressive Psychotherapy; some methodological tools are also accessible at "Re-Imagining Peace after Massacres."
