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September 2006
Heartache and Healing
Psychology Professor Ken Miller works with refugees around the globe,
from Guatemala to Afghanistan to Sri Lanka. Amid the suffering, he finds
signs of hope. |
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Associate Professor of Psychology Ken Miller spent part of his summer in
a Sri Lankan village where residents are so fearful of being attacked
after sundown that they head into the jungle or to other villages every
single night for sleep.
On the night of September 18, 1999, members of the Tamil Tigers, many of
them young women, entered the Sinhalese village of Gonagala and
slaughtered 44 people in their homes, including several children.
Seven years later, the memories remain powerful, and with renewed
fighting in the island nation's northern and eastern regions, so do the
fears that it could happen again.
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Professor Ken Miller interviews a villager in
Gonagala, where a massacre took place in 1999. |
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Come morning, however, the villagers of Gonagala filter back home and
start their work in shops and rice paddies; their children walk to
school in bright uniforms discussing their plans to become teachers,
farmers, or doctors someday. "There is a resilience to the human spirit
that's just extraordinary,'' says Miller. "There's this insistence
(that) ' We will not stop living our lives.'"
In 15 years working with victims of organized violence, Miller has been
troubled by the depth and magnitude of human suffering -- and buoyed by
the courage and resilience of the people enduring it. From Guatemala to
Bosnia to Afghanistan and beyond, his academic work has come to revolve
around the theme that Western mental health professionals can't assume
they know what war-affected people in different cultures need in order
to heal and rebuild their lives. Instead, these professionals need to develop methods
of intervention and measures of well being that make sense within each
culture. To accomplish this, Miller says, they need to shift gears,
leave behind assumptions and carefully listen to the concerns of local
communities.
Part of his work in Sri Lanka, conducted with Dr. Gaithri Fernando of
Cal State L.A., involved assessing the psychosocial needs of 700 Sri
Lankan teens from the three main ethnic groups: Sinhalese, Tamils and
Muslims. Using a mixture of methods ranging from small focus groups and
a children's photography project to a large-scale survey, Miller is
hoping the data collected (and still being processed) will allow the
researchers to create culturally-appropriate needs assessment tools and
will aid the development of useful interventions geared toward children.
Miller and Fernando also spent considerable time in the village of Gonagala, where the 1999 massacre took place, filming a documentary
about the experience of the community and its remarkable resilience.
They are currently looking for funding to complete the production of the
film.
The Sri Lanka research follows his recent work in Afghanistan, where,
with anthropologist Patricia Omidian, Miller trained a team of
Afghans to conduct interviews with community members, asking them to
identify indicators of distress and wellbeing by describing people they
knew who had suffered because of the war and who were either still
suffering or were now doing well. This led to the development of the
23-item Afghan Symptom Checklist, which was administered to 320 people
throughout the capital.
Children on the streets of Kabul. |
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Through this method, Miller discovered that Afghans were "much more
likely to describe their war-related distress in terms of jigar khun,
(dysphoria associated with experiences of loss and other hardships),
asabi (a combination of nervousness and anger) and fisha-e-bala
(feeling highly pressured or stressed)," according to a
soon-to-be-published research paper Miller co-authored. The development
of this checklist is discussed in two forthcoming papers: The Afghan
Symptom Checklist: A Culturally Grounded Approach to Mental Health
Assessment in a Conflict Zone" and "Beyond Trauma-focused Psychiatric
Epidemiology: Bridging Research and Practice with War-affected
Populations." Both papers will appear in the October 2006 issue of the
American Journal of Orthopsychiatry.
In recent years, Westerners working in war-and-disaster-torn nations
have tended to focus on measuring and addressing symptoms of Post
Traumatic Stress Disorder, which was originally noted in Vietnam War
veterans and received formal recognition as a psychiatric disorder in
1980. Symptoms run from nightmares to intrusive images to sleep
troubles.
The big question, says Miller, is whether PTSD is a universal
phenomenon. Certainly, some of the symptoms may be experienced in trauma
victims the world over. But there may be other, more culturally specific
ways of experiencing and expressing distress, says Miller.
"You want to be able to talk to people about distress in ways that make
sense it them,'' says Miller, co-editor of the 2004 book The Mental
Health of Refugees: Ecological Approaches to Healing and Adaptation.
"If you have the belief that you already know how suffering is expressed
and what people's concerns are, why would you bother going in asking
people what their concerns are and how they experience distress?"
Miller notes that PTSD draws on the Western psychological notions that
1) people expect the world to be just and 2) traumatic events shatter
that view. But that "just world hypothesis" may not hold be relevant in
nations where people live in conditions of continuous violence and
profound inequality, says the professor.
In many cases, it turns out that refugees and other survivors of
violence and disaster tell professionals they need practical help to aid
their well-being. In Sri Lanka, for example, children living in refugee
camps have some very fundamental needs such as temporary housing that
snakes can't get into, access to water, privacy and protection from
sexual abuse. In Afghanistan, people cite poverty, social isolation and
separation from family, as well as safety issues.
The specific problems vary, but this emphasis on concrete measures is
something Miller has encountered over and over since he started in this
field working with Guatemalan refugees in 1991. There he quickly learned
"you had to deal with what was going on in people’s day-to-day lives,”
he says.
This creates a new role for the helpers from the West. Miller sees their
task as one of helping to strengthen social support networks weakened by
disaster or violence. It’s a matter of helping local organizations
develop interventions that work best in their setting.
The good news, Miller says, is that research shows community-level
volunteers can be just as effective as highly-trained professionals at
helping people recover from impact of organized violence and
displacement. What strikes him is how communities find ways to survive
and bounce back, defying the tragic images that fill the news. “It’s so
empowering to see communities regain their hope, to seeing healing
happen, to see social networks return,” Miller says.
This evidence of human resilience encourages Miller to keep at work that
can bring him into contact with horrifying realities. “It’s something
that gives my life meaning,” he says. “It’s a tiny drop in the ocean –
but it’s a drop.”
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