Staff sergeant Spencer W. Rogers with refugees from Srebrenica, Bosnia-Herzegovina, site of a notorious massacre. These refugee's fathers were killed or missing during the Balkan wars. The photo was taken Jan. 30, 1998 by technical sergeant Paul R. Caron, U.S. Air Force.
Photo courtesy of the Department of Defense.
How to heal?
Another tack was various forms of "talk therapy" which rely on the theory that discussing traumatic memories would deprive them of their power. Talk therapy can work, but it can also trigger powerful memories, says Roger Garms, a Madison, Wis., psychologist. "You will always be walking a fine line, choosing whether to re-experience the events or shore up defenses. When the trauma is not too extreme, and there's a good ego structure, you want to work it through." If the trauma is too severe, or a translator is needed, or the person is psychologically fragile, he adds, "you work toward shoring up defenses so they will have the best life they can."
Talk therapy in groups was tried with survivors of concentration camps in Bosnia immediately after their resettlement in the Netherlands in 1992. In the short term, therapy seemed more effective than no therapy. But three years afterward, the diagnosis of PTSD was more common among the treated group. The author, a Croatian psychologist, found that older men were more resistant to treatment than younger ones (see "Follow-Up Study..." in the bibliography)
This bloody century has provided ample "raw material" for those wanting to heal victims of torture and abuse. The uneven results of the first systematic treatment -- psychoanalysis for Jewish Holocaust survivors -- led to experiments in new treatments. Some psychologists have tried to "flood" victims with memories and break the link between fearful stimulus and painful response.
Taking testimony
This reality, combined with rampant symptoms of psychological problems, has forced mental-health folks to improvise. In Chicago, about two-thirds of the 16,000 Bosnian refugees show "significant signs" of PTSD and depression, says psychiatrist Stevan Weine. Even though clinics are free and staffed by Bosnians, only 8 to 10 percent have visited them.
To help the untreated majority, Weine tried "testimony" therapy, which aims to exploit the ancient desire to tell a story. Weine says the Bosnians see the process not as therapy but as a chance to tell the world what they've experienced. "They say, 'I will not tell it as therapy. I will tell it because it's the truth and needs to be told, and I believe you will tell it in a responsible way.'" (The transcripts will go to an oral history archive at the Project on Genocide, Psychiatry and Witnessing at the University of Illinois, Chicago, which Weine directs. With the survivor's consent, they may be made available to war crimes tribunals.)
In the first systematic study of testimony psychotherapy on refugees, 20 Chicago Bosnians with PTSD described their experiences before, during and after "ethnic cleansing." After four to eight therapy sessions, only 75 percent were diagnosed with PTSD. Six months later, just 53 percent had the diagnosis (see "Testimony Psychotherapy..." in the bibliography).
Like the ethnic cleansing that caused the problems in the first place, testimony therapy is based on the society rather than the individual. Ideally, Weine writes, the "remembrances can be used to develop new collective understandings of history and communal identity that can better support peace and social trust."
How can mental-health professionals help people who don't recognize mental illness?
What happens when survivors don't want to enter therapy? Even in the United States, where seeing a mental-health worker is no longer tantamount to admitting insanity, therapy can be a tough sell. It's far rockier with refugees from some other cultures.
