Effects of war: moral knowledge, revenge, reconciliation, and medicalised concepts of “recovery”
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7372.1105 (Published 09 November 2002) Cite this as: BMJ 2002;325:1105
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Dr. Mills, yopu wrote:
"Incidentally, my neighbourhood is replete with several torture
survivors. One could not meet more ever-smiling, well-adjusted and
intelligent new Canadians. In each case, "recovery" is not part of
personal vocabulary... instead, there is mention of "having to roll
through unpleasant symptoms for a time" -- as though the process was
merely a big bore."
I'd like to suggest that as long as we depend on the say-so of self-
declared or Refugee Board-declared victims, we will be unable to come up
with a useful understanding of the phenomenon. Since you feel that your
anecdotal evidence is of value in this discussion, allow me to add mine as
well: As a "new Canadian" and someone who has done a stint as an
interpreter for the IRB, I can confirm that Toronto's neighbourhoods are
also replete with much more than just several people who made entirely or
partially bogus claims about torture and persecution.
This, of course, doesn't mean that all or even most refugees are
liars; only that the research pool may be seriously tainted by an unknown
and possibly unquantifiable proportion of bogus claimants with well-
developed stories. I'm sure you can well imagine how this may affect
research based on individual case histories or statistics. Until objective
and systematic means are found to verify claims, I'm afraid that the old
addage, "garbage in - garbage out," will bedevil any well-intentioned
efforts to gain an understanding of the phenomenon.
Competing interests:
None declared
Competing interests: No competing interests
Greetings
For some years, I have admired Derek Summerfield's publications on
subjects of mental health, contemporary war zones, and just what becomes
of refugees encountering mental health care in the West, or for that
matter 'on the ground' via NGO activities.
I have yet to locate a sentence in Dr. Summerfield's work to which I
take exception and his different articles have been extremely helpful with
regard to my work on mental health in our Canadian Tamil community of
200,000.
Toronto is a city of more than 130 ethnic groups, many of them "war-
affected", whose occasional members rather collide with a psychiatric and
human services community rather indoctrinated by PTSD models, as produced
in American Veterans Administration hospitals of yesteryear. In
conversation with Tamil patients, I've several times wished to scream when
hearing of ridiculously ignorant pronouncements on their NORMAL views of
life, the world and human nature, as made by physicians or others never to
have visited a Third World war zone.
I agree whole heartedly with the other responses to Dr. Summerfield's
article, including what we ought to have learned from survivors of
Japanese prison camps or any similar ordeal... Anger is a perfectly
healthy, resilient emotion, often converted to most constructive ends in
persons all of us have known in the UK, Canada or other countries in which
Survivors have eventually resettled.
Perhaps one needs to have known survivors of wars in childhood in
order to take a saner view of just what becomes of war-survivors ... or
rather, what does Not become of many war survivors, as the Toronto medical
community can seem so blessedly unaware.
Incidentally, my neighbourhood is replete with several torture
survivors. One could not meet more ever-smiling, well-adjusted and
intelligent new Canadians. In each case, "recovery" is not part of
personal vocabulary... instead, there is mention of "having to roll
through unpleasant symptoms for a time" -- as though the process was
merely a big bore.
PTSD? my eye!
Fortitude, self-awareness, courage? Yes!
Here's to Dr. Summerfield, and may he keep airing his "controversial"
views on "unsettling" questions.
Yours Sincerely
Megan S. Mills PhD
Competing interests:
None declared
Competing interests: No competing interests
Congratulations, once again, to Derek Summerfield. I worked for many
years in the Transkei, in an area where we never had fewer than a dozen
assault victims in the ward, the mortuary was always full and a local man
told me he went round every evening gathering up the corpses and taking
them 'home'. Yet the children and were totally untouched by the violence
surrounded them as were most of the adults.
I came to believe there were two reasons for this. One the very
strong community spirit. Every aspect of every event was chewed over in
endless conversations and when the husband of a young, pregnant nurse was
murdered the whole hospital comforted her and so many people went to the
funeral a double decker bus was needed to convey them. The second was the
acceptance of war and violence as a way of life. My angry demands,'Why
don't you do something about it' were met with bewilderment. 'That is how
life is'
But there is something remarkable about South Africa. Not so much the
lack of resentment about apartheid, very many 'whites' were firmly on the
side of the Afrcans, but the extraordinary way in which the country came
together after the AngloBoer War. Men who returned from guerilla fighting
to find their farms burned, their livestock's bones scattered over the
veld and their wives and children dead in the concentration camps joined
to build a new country. If we knew how that was achieved it could prove a
model for many more lands.
Competing interests:
None declared
Competing interests: No competing interests
My grandparents were prisoners of war when Hong Kong was occupied by
Japan during World War II. They have not forgiven their captors nor do I
disagree given the stories they have told my parents and they to me.
Their resentment is towards the generation that were responsible.
Their resentment continued partly due to the fact that they never saw
their captors arrested nor put to trial nor apologised. My personal
feelings are reinforced by learning that Chinese were dissected alive and
used as biological warfare guinea pigs on the Chinese mainland.
However, we as a family do not resent the generations that followed.
We have Japanese products e.g. TV. but we will never forget. I am alive
today because of luck that my grandparents weren't killed by a Japanese
soldier in a fit of pique.
I have only treated one Japanese patient so far, and although the
stories do run in my mind approaching her, I gave the patient the same
care, manners, and attention as I do anyone else.
One of my colleagues who is Jewish also had stories passed onto her
about Nazi concentration camps, but treated another colleague who was
German as a friend.
Wars do not end when a peace treaty is signed. It will carry on in
the memory of those that survive. I feel that it may that more than one
generation for recovery, and I will let my children to decide for
themselves how they feel.
In a way because of war, and my grandparents stories, I know that the
world can be a very bad place. So I treat people as people to make it a
little better and respect life as the most precious thing anyone can have.
I knew this since I was 5 years old and it inprinted a maturity I would
neverwise have.
The ultimate purpose of war is peace wrote Sun Tzu in the Art of War.
It is true. Britain is now America's most loyal ally. Britain no longer
fights Germany nor France. But there always be war and there will always
be victims.
If there is counselling now available then all the better. Just don't
expect any results any time soon.
Competing interests:
None declared
Competing interests: No competing interests
Trauma problems as individual or relational?
I have been reading with interest the debate on the characterisation
and treatment of torture and war trauma. There appears to be a particular
emphasis on the suitability or otherwise of western ethnocentric
approaches, revolving around the familiar issues of medicalisation,
individualisation and christianisation of the problem.
I have become curious recently as to whether trauma is often best
addressed by seeing it as a relational issue: eg how have you found your
relationships with people to be affected since you had these experiences?
Which relationships are most profoundly affected? What about your
experience of relationship with your ethnic origin, your family or
cultural group, your land, your ancestors, your deities?
How willing have others been to come to terms with your story? What
effort has the rest of the world gone to, to reach out to you and show you
concern and help? What have others shown you by what they have done or
not done? What has stood out to you among the things that others have
done?
I would be interested in whether other workers with extreme trauma
have followed these lines of questioning
Competing interests:
None declared
Competing interests: No competing interests