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Abramowitz - 2005 - The poor have become rich , and the rich have become poor Collective trauma in the Guinean Languette.pdf | Psychological Trauma | Posttraumatic Stress Disorder

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ARTICLE IN PRESS Social Science & Medicine 61 (2005) 2106–2118 www.elsevier.com/locate/socscimed The poor have become rich, and the rich have become poor: Collective trauma in the Guinean Languette Sharon A. Abramowitz Depar
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  Social Science & Medicine 61 (2005) 2106–2118 The poor have become rich, and the rich have become poor:Collective trauma in the Guinean Languette Sharon A. Abramowitz  Department of Anthropology, Harvard University, Cambridge, MA, USA Available online 24 August 2005 Abstract This paper uses Kai Erikson’s (Everything in its path: the disaster at Buffalo Creek. Simon & Schuster, New York,1978) definition of collective trauma to interrogate the symptom reports and narrative accounts of six Guineancommunities attacked by Sierra Leonean and Liberian RUF forces in 2000–2001. These data, collected in 2003, foundhigh rates of fear, physical anxiety, emotional anxiety, depression, physical distress, sadness, and post-traumatic stressdisorder-related symptoms across all communities, but found lower rates of distress among communities that haddeveloped collective narratives of resistance to violence, or had concertedly resisted post-conflict social change.Communities with higher rates of distress tended to report community narratives of violence and post-conflict sociallife, which emphasized abandonment, isolation, disregard of community rituals and social supports, and the dislocationof local moral worlds. This study argues that the physical and emotional symptoms of trauma-related mental illness arearticulations of collective trauma and represent the physical and emotional manifestations of the destruction of localmoral worlds. It illuminates the processes by which violence inverts social experience, and argues that the socialdimensions of trauma have long-term consequences for post-conflict reconstruction. r 2005 Elsevier Ltd. All rights reserved. Keywords:  Mental health; Guinea; PTSD; Social suffering; Violence; War ‘‘People are dying of heartsickness and loneliness.’’— Quote from an elderly woman in Guekedou, 2003 Introduction In recent years, the number of wars that target civilianpopulations has surged, leading to the proliferation of displaced and suffering persons, and the development of multiple disciplinary paradigms for understanding thesepersons psycho-social trauma in the context of massviolence. In the course of competition for resources andexpertise claims, a false paradigmatic opposition hasemerged that pits psychological (see De Jong et al., 2001;Mollica, Wyshak, & Lavelle, 1987; Eisenbruch, 1991; Momartin, Silove, Manicavasagar, & Steel, 2001) and biomedical (Goenjian et al., 2003; Zayfert, Dums, Ferguson, & Hegel, 2002; Redgrave, 2003) understand- ings of trauma, in the form of post-traumatic stressdisorder (PTSD), against sociological and anthropolo-gical (Young, 1995; Das, Kleinman, & Lock, 1997; Summerfield, 1999; Pedersen, 2002) understandings of  social suffering, which embeds explanations of distressin contexts of political instability, ecological deteriora-tion, physical and economic hardship, social disruption,and emergency migration. This opposition obscures,rather than elucidates, the experience, dynamics,and consequences of trauma amongst war-affected ARTICLE IN PRESS www.elsevier.com/locate/socscimed0277-9536/$-see front matter r 2005 Elsevier Ltd. All rights reserved.doi:10.1016/j.socscimed.2005.03.023  Corresponding author. 32 Van Wickle Road, EastBrunswick, NJ 08816, USA. Tel.: +9087056099. E-mail address:  saabramowitz@yahoo.com.  populations, particularly the ways in which traumaticexperience imposes a variety of functional limitations onthe post-conflict lives of survivors of mass violence(Mollica, 1999). This paper attempts to resolvethis analytical disjuncture by demonstrating how,under conditions of collective violence, symptoms of psycho-social and somatic suffering may in factbe the articulation of collective trauma, as well asmanifestations of individual emotional and physicaldistress.Significantly, PTSD and social suffering research havebeen noticeably absent among West African civilianpopulations affected by the political conflicts in Liberia,Sierra Leone, Guinea, and Coˆte d’Ivoire. Notableexceptions to this rule are epidemiological surveys of traumatic experience, PTSD, and other trauma- relatedmental illnesses in Sierra Leone (Fox & Tang, 2000; de Jong, Mulhern, Ford, van der Kam, & Kleber, 2000; Me ´decins Sans Frontiers, 2000), which found wide-spread exposure to traumatic events and symptoms of depression, PTSD, and anxiety. In light of the enduring,severe, and brutal warfare that has characterized thisregion for more than a decade, ignorance about thesocial contexts and consequences of trauma will havemassive public health, political, social, and economicimplications. In addition to the problems posed by warand displacement, higher physical morbidity and mor-tality rates, significantly greater physical vulnerability,fewer resources, and tragic environmental and sanitationconditions (Desjarlais, Eisenberg, Good, & Kleinman, 1995), survivors of war have to overcome the social andemotional limitations produced by traumatic experience.Mollica (1999) identified six functional limitations of traumatic stress, including: the inability to perform dailylife skills and talents, physical injury, deterioratedintellectual performance, emotional exhaustion andphysical fatigue, inability to accomplish social relation-ships and fulfill obligations, and spiritual and moraldisillusionment. Individual PTSD and collective traumaseriously inhibit one of the most important social assetsin post-conflict reconstruction: individual and socialresiliency.The objectives of this paper are threefold: (1) toadvance the definition of collective trauma developed bysociologist Kai Erikson (1978), which positions socialtrauma as distinctive from, but overlapping with,individual trauma; (2) to report violence-related physicaland emotional symptoms of trauma, and indicators of collective trauma, collected from 6 war-affected Gui-nean communities on the Liberian and Sierra Leoneanborders; and (3) to link social histories of violence andreports of social change to traumatogenic, anxiety,depression, and somatic symptoms in an attempt toexplore the occurrence and implications of collectivetrauma, individual trauma, and their interaction in thesesix Guinean communities. Collective trauma Erikson made a significant contribution to thisdomain of research by defining the term  collectivetrauma , and by demonstrating the specific social path-ways through which collective trauma manifests itself. InErikson’s book,  Everything in its Path: Destruction of Community in the Buffalo Creek Flood  , he examined thetransformations in social relations resulting from the1972 Buffalo Creek mining disaster in Logan County,West Virginia. Erikson argued that the loss of life,property, and massive displacement created by the floodgenerated trauma on both the individual and thecollective level. Though it was possible for these twoforms of trauma to overlap, collective trauma, itself, wasa distinctive and widely pervasive phenomenon whichoccurred in response to social transformations resultingfrom an unforeseen, devastating event. Though traumawas often physically and emotionally articulatedthrough depression and post-traumatic stress symptoms,respondents identified these symptoms with the loss ordestruction of social connections and the loss of their‘‘social self.’’ Erikson defined collective trauma as, y a blow to the basic tissues of social life thatdamages the bonds attaching people together andimpairs the prevailing sense of communality. Thecollective trauma works its way slowly and eveninsidiously into the awareness of those who sufferfrom it, so it does not have the quality of suddennessnormally associated with ‘trauma.’ y [It is] a gradualrealization that the community no longer exists as aneffective source of support and that an importantpart of the self has disappeared. As people begin toemerge hesitantly from the protective shells intowhich they have withdrawn, they learn that they areisolated and alone, wholly dependent upon their ownindividual resources. ‘I’ continue to exist, ‘You’continue to exist, though distant and hard to relateto. But ‘we’ no longer exist as a connected pair or aslinked cells in a larger communal body.’’ (Erikson,1978, p. 154)Although Erikson’s definition of collective traumarests on a theoretically outmoded Durkheimian concep-tion of the ‘‘social,’’ his recognition of the significance of the destruction or the loss of a ‘‘social self’’ addsimportant analytical insight into our understanding of post-conflict mental health and social experience. In thispaper, I demonstrate that PTSD, long conceptualized asan individualized disorder, can inform our understand-ing of collective trauma. Towards this end, I presentfindings from a World Health Organization (WHO)emergency mental health assessment survey conductedamong 171 Guinean civilians in a war-affected region of the Guinean Languette during the summer of 2003. ARTICLE IN PRESS S.A. Abramowitz / Social Science & Medicine 61 (2005) 2106–2118  2107  Background The Guinean Languette ( English:  Parrot’s Beak) is ageo-political region of Guinea bound on its southernflanks by Liberia and Sierra Leone (see Fig. 1). Since thebeginning of the Liberian and Sierra Leonean conflicts,and most recently the civil war in Coˆte d’Ivoire, thesouthwest horn of West Africa has been characterizedby war, massive internal displacement and refugee flight,property destruction, a booming weapons economy anddiamond trade, and the presence of mercenary and childsoldiers. Guinea (est. pop. 9,030,220) 1 lies to the northof these three countries and has been functioning formore than 12 years as a haven and staging ground formassive humanitarian efforts targeting the refugeesdisplaced by these conflicts. During 2002 alone,205,000 Liberian refugees fled to Guinea or Coˆted’Ivoire, while 20,000 refugees from the civil conflict inCoˆte d’Ivoire fled to Liberia or Guinea, and 76,000refugees were repatriated to Sierra Leone. 2 Conse-quently, during the 1990s, major humanitarian assis-tance operations were centered in and around theadministrative prefectures of Guekedou and Macenta,with dozens of international organizations working toservice hundreds of refugee and transit camps operatingto care for over 1,000,000 refugees from Sierra Leoneand Liberia.These refugee camps and regional cities also served asoptimal sites for the Taylor-run Liberian RevolutionaryUnited Front (RUF) and its opposition, the UnitedLiberation Movement for Democracy in Liberia (ULI-MO- later split into ULIMO-J and ULIMO-K). TheRUF was run by Charles Taylor, and the ULIMOemerged in opposition to Taylor’s RUF, but later splitalong ethnic lines into Mandingo and Krahn factions.Both groups, uniformly referred to as ‘‘rebels’’ bycivilians, used these areas for forced conscription,volunteer recruitment, rearmament, training, commu-nications, housing, and basic needs provisions. Guinea’sPresident, Lansana Conte, played an active role inencouraging the support of some rebels against theRUF, as well as playing some rebel groups against eachother. The complex interplay of alliance, support, andopposition became incestuously confused along the theGuinean/Liberian/Sierra Leonean frontiers, with rui-nous consequences for the civilian populations.In 2000, relations gradually worsened between then-Liberian President Charles Taylor and Conte, as Taylorurged Conte to restrain rebel attacks against his armedforces and Conte denied any involvement. In mid-November, 2000, the Liberian based RUF launched anattack on the city of Macenta, which was followed 2days later by an attack on the city of Guekedou and aninvasion of the entire  Languette  region. Simultaneously,the Sierra Leonean arm of the RUF attacked the region. ARTICLE IN PRESS Fig. 1. Map of Guinean Languette Region (Me ´decins Sans Frontiers (MSF), 2001). 1 CIA World Fact Book, 2003. 2 UNHCR ‘‘Refugees by Numbers 2003.’’ UNHCR WEB-SITE: www.unhcr.ch/statistics S.A. Abramowitz / Social Science & Medicine 61 (2005) 2106–2118 2108  By March 2001, the Guinean army had regainedcomplete control of the Languette ,  and had formed amilitary cordon along its border areas to discouragefuture invasions.Between November 2000 and March 2001, SierraLeonean and Liberian forces attacked the communitiesof Yende, Guekedou, Tekulo, Nongoah, Katkama, andBodou (among others) and engaged in summaryexecutions, the burning of homes and property, foodthefts, destruction of crops and livestock, kidnappings,forced labor, sexual assault, public humiliation, and thedestruction of public markets, potable water sources andgovernment buildings. This resulted in population flight,a cholera epidemic, and many war or flight-relateddeaths. In addition to the individual psychologicaleffects of war and economic hardship on the region’sresidents, these attacks led to extreme political andhumanitarian isolation, economic devastation, anddeterioration of the social fabric. To date, no informa-tion beyond this study is available regarding thepsychological health of the resident population follow-ing these traumatic events.During this period, Guineans experienced torture bythe rebels, imprisonment, executions, violent harassmentand assault, deprivation of food and water, separationfrom family members, disease, and destruction of property. Many Guinean residents of this regionexperienced or witnessed atrocities including rape,forced acts of violence, forced labor, the abduction of children and relatives, and the public humiliation anddegradation of senior community members. Otherresidents fled their homes, and experienced the separa-tion and loss of family members through dislocation,abduction, murder, disease, dehydration, starvation,and exhaustion. Methodology The Center for Victims of Torture (CVT) developedand implemented this study at the request of theAnglican Archbishop of Conakry, Guinea, in 2003.The Kissidougou Bureau of the WHO providedfinancial support for the project. The objective of thestudy was to conduct an initial investigation of trauma-related mental illnesses among a sample of Guineanresidents who had been exposed to the violent attacks of Sierra Leonean and Liberian RUF during the periodDecember 2000 through February 2001. This study wascommissioned to provide exploratory data, which wasexpected to support a political effort to recruit mentalhealth and other NGO resources for the local residentsof the Guekedou region. 3 The author designed this studyto serve as a rapid assessment survey that would provideinformation on local residents’ exposure to traumaticevents, and to identify post-traumatic mental healthproblems requiring immediate assistance and interven-tion. The survey questionnaire included open andclosed-ended questions regarding material needs andliving conditions; changes in the community since the2000–2001 attacks; traumatic events witnessed orexperienced by the respondent; social resources; culturalpractices and attitudes towards emotional stress; avail-able mental health resources in the communitiessurveyed; and symptoms of psychological distresschecklists. All interviews were conducted verbally inFrench, Kissi, or Malinke/Mandingo, and were trans-lated and recorded into French or English by a memberof the research team. 4 Interviews were one and a half hours in length, on average, depending on the length of respondents’ answers and the initial time required forprospective explanation of the survey.The data presented here draw on two principalsources: structured survey interviews conducted byresearch team members, and ethnographic and interviewevidence collected by the author. In the course of the sixday research project, I conducted informal interviewswith community leaders, local residents, militants whohad participated in the rebel attacks, and recent arrivalsto the community. Due to time constraints, theethnographic information is undeniably limited. How-ever, some valuable information was obtained concern-ing the events of the attacks and the local memory of those events, public rituals, commemoration efforts,social life and social interaction, community morale,NGO and humanitarian assistance, local economicactivity, and public institutions (i.e., hospitals andschools).The research team conducted survey-driven inter-views. These interviews inquired about community-levelchanges since the 2000–2001 attacks, respondents’ expo-sure to traumatic events, social resources, culturalpractices, attitudes towards mental illness, availablemental health resources, and emotional distress symp-toms [in checklist format]. The framework for thesurvey’s symptom checklist components was derivedfrom the WHO’s  Rapid Assessment of Mental Health (Petevi, Revel, & Jacobs, 2001). The symptom checklist included 26 questions with ordinal responses. Includedsymptoms were selected from a combination of severalsources, including the Hopkins Symptom Checklist-25 ARTICLE IN PRESS 3 As of this writing, the author is not aware of any mental-health assistance in the Guekedou region. These data, despite(  footnote continued  )their demonstration of great suffering, were unable to mobilizeNGO assistance. 4 The research team consisted of five Liberian refugees trainedas CVT mental health counselors and group facilitators, oneGuinean CVT staff member, one Guinean researcher associatedwith an external NGO, the author. S.A. Abramowitz / Social Science & Medicine 61 (2005) 2106–2118  2109
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