Beyond Trauma pp 17-29

Part of the The Plenum Series on Stress and Coping book series (SSSO)

| Cite as

Addressing Human Response to War and Atrocity

Major Challenges in Research and Practices and the Limitations of Western Psychiatric Models
  • Derek Summerfield

Abstract

According to studies undertaken for the International Symposium of Children and War in 1983, 5% of all casualties in World War I were civilians, 50% in World War II, and over 80% in the Vietnam war (UNICEF, 1986). In current armed conflicts, over 90% of all casualties are civilians, typically from the poorest sectors of society. What predominates is the use of terror to exert social control, if necessary by disrupting the fabric of grassroots social, economic, and cultural relations. The target is often population rather than territory, and psychological warfare is a central element. Atrocity, including public execution, disappearances, torture and sexual violation, is the norm, and those whose work symbolizes shared values are also targeted: community leaders, priests, health workers, and teachers. These strategies, frequently played out on the terrain of subsistence economies, can be devastatingly effective. Mozambique, Angola, Sudan, Somalia, El Salvador, Guatemala, Nicaragua, Peru, Afghanistan, Iraq, Iran, Indonesia, the Philippines, Sri Lanka, the Israeli occupied territories, and the former Yugoslavia have all provided examples of this pattern of war or civil conflict in the past decade. At present, the United Nations High Commission for Refugees counts about 18 million refugees who have fled across an international frontier, though there are at least as many again, no less destitute, who are internally displaced. There have been an estimated 150 wars in the Third World since 1945, which have left 22 million people dead. So far, we have learned little of the health and social costs for the millions left behind, let alone the patterns of their distress and adaptation over time.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abu Hein, F., Quota, S., Thabet A., & El Sarraj, E. (1993). Trauma and mental health of children in Gaza. British Medical Journal, 306, 1130–1131.PubMedCrossRefGoogle Scholar
  2. American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders. ( 3rd ed. ). Washington, DC: Author.Google Scholar
  3. Baker, R. (1992). Psychosocial consequences for tortured refugees seeking asylum and refugee status in Europe. In M. Basoglu (Ed.), Torture and its consequences (pp. 83–106 ). Cambridge: Cambridge University Press.Google Scholar
  4. Bettelheim, B. (1960). The informed heart. New York: Free Press.Google Scholar
  5. British Medical Association. (1992). Medicine betrayed—The participation of doctors in human rights abuses. London: Zed Books.Google Scholar
  6. Centers for Disease Control Vietnam Experience Study. (1988). Health status of Vietnam veterans: 1. Psychosocial characteristics. Journal of the American Medical Association, 259, 2701–2707.Google Scholar
  7. Eisenbruch, M. (1991). From post-traumatic stress disorder to cultural bereavement: Diag-Google Scholar
  8. nosis of Southeast Asian refugees. Social Science and medicine,33(6), 673–680.Google Scholar
  9. Fine, J. (1993). Torture in Israel and the occupied territories. Lancet, 342, 169.PubMedCrossRefGoogle Scholar
  10. Freud, A., & Burlingham, D. (1943). War and children. New York: Ernst Willard.Google Scholar
  11. Harrell-Bond, B., & Wilson, K. (1990). Dealing with dying: Some anthropological reflections on the need for assistance by refugee relief programmes for bereavement and burial. Journal of Refugee Studies, 3(3), 228–243.Google Scholar
  12. Kinzie, J., & Sack, W. (1991). Severely traumatized Cambodian children: Research findings and clinical implications. In F. Ahearn & J. Athey (Eds.), Refugee children: Theory, research and services (pp. 92–105 ). Baltimore, MD: Johns Hopkins University Press.Google Scholar
  13. Kleinman, A. (1987). Anthropology and psychiatry: The role of culture in cross-cultural research on illness. British Journal of Psychiatry, 151, 447–454.PubMedCrossRefGoogle Scholar
  14. Martin-Baro, I. (1990). War and the psychosocial trauma of Salvadoran children. Posthumous presentation to the Annual Meeting of the American Psychological Association, Boston.Google Scholar
  15. Mollica, R., Wyshak, G., & Lavelle, J. (1987). The psychosocial impact of war trauma and torture on Southeast Asian refugees. American Journal of Psychiatry, 144, 1567–1572.PubMedGoogle Scholar
  16. O’Brien, L., & Hughes, S. (1991). Symptoms of post-traumatic stress disorder in Falklands veterans 5 years after the conflict. British Journal of Psychiatry, 159, 135–141.PubMedCrossRefGoogle Scholar
  17. Patios Institute. (1988). War wounds: Development costs of conflict in southern Sudan. London: Patios.Google Scholar
  18. Siward, R. (1989). World military and social expenditures. Washington, DC: World Priorities.Google Scholar
  19. Solkoff, N. (1992). The Holocaust: Survivors and their children. In M. Basoghu (Ed.), Torture and its consequences (pp. 136–148 ). Cambridge: Cambridge University Press.Google Scholar
  20. Summerfield, D. (1991).“ The psychosocial effects of conflict in the Third World, Development in Practice, 1(3),159–173.Google Scholar
  21. Summerfield, D., & Flume, F. (1993). War and posttraumatic stress disorder: The question of social context. Journal of Nervous and Mental Disease, 181, 522.PubMedCrossRefGoogle Scholar
  22. Summerfield, D., & Toser, L. (1991). “Low intensity” war and mental trauma in Nicaragua: A study in a rural community. Medicine and War, 7, 84–99.Google Scholar
  23. Swartz, I., & Levett, A. (1989). Political repression and children in South Africa. Social Science and Medicine, 28, 741–750.PubMedCrossRefGoogle Scholar
  24. UNICEF. (1986). Children in situations of armed conflict. New York: Author, E/ICEF.CRP. 2.Google Scholar
  25. White, G., & Marsella, A. (1982). Introduction. In A. Marsella & G. White (Eds.), Cultural conceptions of mental health and therapy (p. 9 ). Dordrecht: Reidel.Google Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Derek Summerfield
    • 1
    • 2
  1. 1.Medical Foundation for the Care of Victims of TortureLondonUK
  2. 2.Department of Community PsychiatrySt. George’s Hospital Medical SchoolLondonUK

Personalised recommendations