Trauma, Survival and Resilience in War Zones

The psychological impact of war in Sierra Leone and beyond

David Winter, Rachel Brown, Stephanie Goins, Clare Mason

• Editorial: Routledge
• Año: 2015
• ISBN:
  9781317628620
• Edición: 1
• Categoría: Psychology
• Categoría: Clinical Psychology

This book, based upon a series of psychological research studies, examines Sierra Leone as a case study of a constructivist and narrative perspective on psychological responses to warfare, telling the stories of a range of survivors of the civil war. The authors explore previous research on psychological responses to warfare while providing background information on the Sierra Leone civil war and its context.

Chapters consider particular groups of survivors, including former child soldiers, as well as amputee footballers, mental health service users and providers, and refugees. Implications of the themes emerging from this research are considered with respect to how new understandings can inform current models of trauma and work with its survivors. Amongst the issues concerned will be post-traumatic stress and post-traumatic growth; resilience; mental health service provision; perpetration of atrocities; and forgiveness. The book also provides a critical consideration of the appropriateness of the use of Western concepts and methods in an African context.

Drawing upon psychological theory and rich narrative research, Trauma, Survival and Resilience in War Zones will appeal to researchers and academics in the field of clinical psychology, as well as those studying post-war conflict zones.

Part 1
Background

Chapter 1
A typical encounter in Freetown

One of us (David) was walking to his hotel in Freetown one Sunday when he was greeted with a shout of ‘How de body?’ ¹ by a very smartly dressed man wearing a suit and the extravagant shoes (in this case, perhaps made of crocodile skin) that are popular in Sierra Leone. David returned the greeting (‘De body fine!’ ²), and then did a ‘double take’ as he became aware that the man looked familiar. The realization then dawned that he was someone, whom we shall call Samuel, who on every one of David’s six visits to Freetown had always magically appeared on his first or second day in town, wherever he might be, and had asked to be hired as his ‘minder’. Reminders of the legacy of the civil war were never far away in Freetown and its outskirts: occasional skirmishes between opposing political factions; graffiti advertising gangs with names such as Blade Squad, Murder Inc., One Shot Squad, Black Sword, and Terror Squad; and makeshift roadblocks manned (or ‘boyed’) by youths demanding money, through which one would drive without stopping if one were feeling brave enough. Despite these, and despite the pitch-blackness of the nights, unlit by electricity, David rarely felt any more need of a minder in Freetown than in the English village in which he lives. Nevertheless, he used to give Samuel a few thousand leones ³ (and a Star beer on the occasions when he would again suddenly appear in any bar where David happened to be trying to have a quiet drink after a long, hard day) to be his official minder, largely in order to obtain some relief from Samuel’s constant insistence on David’s need for such protection and his own need for the money with which this would provide him.

While, to be honest, David generally found Samuel’s chatter tiresome and tried to avoid him, this Sunday was different, as David was curious about the dramatic change in his appearance from the rather disreputable-looking character with whom he was more familiar. David therefore asked why he was dressed so well, and he said that he did this every Sunday in order to go to church and obtain forgiveness from God for what he had done in the war. David’s curiosity was further aroused, and they agreed to continue the conversation the next day. It went like this:

Samuel:	The war normally it has affected many Sierra Leoneans. And then the ones like me they forced me to fight in the war. And then when when I’m fighting the war I do much killing and then the rebels, Kamajor, ^4 and then the rebels and the SLA ^5 and … then they’re killing each other and then by the end they asked us to come together and then finish with the war. By then there was big trouble … because there was more more, more killing more, more, more catastrophe many, many, many problems in Sierra Leone people don’t have nothing to eat, people are eating dogs, many people to be crazy, locked up, getting mad, many, many.
David:	How old were you when they forced you to fight?
Samuel:	I was just 11, 12 years and a half.
David:	What happened?
Samuel:	Well, they catch me in the village in a raid during the night the rebels and then they catch the young girls and young boys; they say you must join us and then they forced them into sexual abuse the ladies, the young girls, take them to the forest. They say if you don’t go with us we kill you. And they give me gun, give my colleagues gun, basically we join them.
David:	And what did they force you to do?
Samuel:	They forced me to fire, they say to attack ECOMOG, ^6 Nigerian soldiers, we must launch attack, we must fight against them, they are enemies.
David:	So you were using the gun when you were 12?
Samuel:	Yes, I was using the gun, they gave me the biggest gun to carry. I was a young boy and they forced me to shoot and I killed.
David:	How many did you kill?
Samuel:	Many, many people, maybe 50, maybe 100 people I killed. I saved my parents because when I fight none of them die but we suffered because we don’t have nothing to eat.
David:	People who know you fought with the rebels, how do they feel about you now?
Samuel:	Normally now they think I’ve changed because I’m trying to get my family, I have my baby, and I get my wife, so they think I’ve changed and then I used to go to church because I want to be a godly man. I used to go to church every Sunday.
David:	During the war how, how did you feel about yourself?
Samuel:	During the war, because they give me drugs I was very nasty but now I appreciate the way I feel because I feel good and Sierra Leone is peaceful so we need help from the outside world to help us so Sierra Leone can be a good place.

Samuel’s story encapsulates much of the experience of living in Sierra Leone, and in other countries in post-conflict situations. First, one never knows whether the affable façade with which one is presented conceals a darker past. Literally, one never knows whether the hand that one is shaking may have taken many lives (in the case of Samuel, probably more than the 50 to 100 to which he admitted) or inflicted unspeakable atrocities. Indeed, victims of such atrocities may find themselves in daily contact in their communities with the perpetrators of these.

Also apparent is some of the confusion that was experienced in a conflict in which various different groups (e.g. rebels, Kamajors, the SLA and ECOMOG) were killing each other, and in which some of this killing was done by children, who were often faced with a choice between killing and being killed. As in Samuel’s case, a degree of self-esteem could be maintained by viewing one’s actions as having been carried out under duress or the influence of drugs. His account also reveals a desire to move on to a more peaceful life, both for himself and his country, albeit, as is repeated again and again in the stories of war survivors, with a need for outside help. In addition, it indicates that others have been unable to show the same resilience but instead may find themselves locked up and ‘crazy’.

All of these trajectories will be evident in the accounts that we shall present, but first we shall review the literature on the psychological effects of warfare and provide more of a background to the situation in Sierra Leone.

Notes

1 How’s the body?

2 The body’s fine!

3 1 English pound = approximately 6,400 leones.

4 Originally secret society members, with supposed supernatural powers, who fought as a civil defence group in the civil war.

5 Sierra Leone Army.

6 Economic Community of West African States Monitoring Group.

Chapter 2
Psychological responses to warfare

Warfare has been taking place across the world for an inordinate number of years. Widespread death and injury inevitably result. For both combatants and civilians, war presents numerous traumatic experiences. Traumatic events can threaten an individual’s perception of self and the world. Because much of psychology’s knowledge of the impact of trauma stems from individuals seeking help, it has often been assumed that a pathological response is the most common. In reality, the majority of people are resilient to trauma and continue to live emotionally positive and fully functioning lives. This is not to underestimate the very severe difficulties of those who develop post-traumatic stress disorder; rather, it recognizes that not everyone reacts to trauma in the same way. Why some individuals demonstrate resilience, others progress to post-traumatic growth, whilst yet others are affected by post-traumatic stress disorder is a reflection of the heterogeneity and uniqueness of life experiences. It is, therefore, imperative to be sensitive to the cultural context of the individuals and situations concerned. This chapter provides an overview of relevant literature, highlighting the most salient issues concerning the psychological responses to warfare.

Resilience in the face of trauma

Initial research into the psychology of traumatic events focused on psycho-pathological responses (Hobfoll, Mancini, Hall, Canetti & Bonanno, 2011). However, there is now overwhelming evidence that most people respond to trauma with minimal disruption to their overall functioning and, instead, demonstrate resilience (Bonanno, Westphal & Mancini, 2011). According to Masten (2011), resilience can be defined as the capacity to withstand or recover from significant challenges that threaten stability, viability or development. Bonanno, Westphal and Mancini (2011, p. 513) more specifically define it as ‘an outcome pattern following a potentially traumatic event (PTE) characterized by a stable trajectory of healthy psychological and physical functioning’. Empirical data led Bonanno (2004) to propose that whilst there is a natural heterogeneity to the human response, most of this can be captured in a set of four prototypical outcomes. These have been found to be remarkably consistent across a number of studies (Bonanno, 2012):

Prototypical trajectories of adjustment following a PTE (and relative prevalence) (Bonanno, 2004; Bonanno, Westphal & Mancini, 2011).

• (i) Resilience (35–65%)
  Resilience is typified by transient symptoms of minimum impairment followed, relatively soon after the PTE, by a stable trajectory of healthy functioning.
• (ii) Recovery (15–25%)
  Recovery involves initial elevated symptoms with some functional impairment, followed by a gradual return to normal levels of functioning.
• (iii) Chronic Distress (Post-Traumatic Stress Disorder [PTSD]) (5–30%)
  PTSD is characterized by a sharp elevation in symptoms and functional impairment that persist for a long time after the PTE.
• (iv) Delayed Distress (0–15%)
  Delayed distress is distinguished by moderate to elevated symptoms soon after the PTE, with a gradual worsening over time.

For many years a resilient response to a PTE was considered atypical, a result of heightened emotional strength or the converse, a complete numbing of emotions. Indeed, the view of the absence of distress and dysfunction as an abnormal reaction continues to persist amongst many of the lay public. Nevertheless, as Masten (2001) maintains, the capacity for resilience lies well within the range of ordinary human capabilities.

Whilst recovery may be considered in alignment with resilience, Bonanno et al. (2011) emphasize a contrasting path. They maintain that individuals experiencing recovery will, by definition, have suffered a level of acute distress before returning to normal functioning. In contrast, resilience is characterized by a minor and transient level of distress, with minimal function disruption.

Factors affecting resilience

As resilience is the prevailing response to a PTE, consideration of influencing factors must reflect the heterogeneity of the individuals and circumstances involved. In their investigation of the roles of demographics, resources and life stress, Bonanno, Galea, Bucciarelli and Vlahov (2007) suggest that no single factor is responsible for resilience. Rather, there is a ‘coalescence’ of various aspects. Certain factors, like personality, may be relatively stable over time, whilst others will vary (Hobfoll, 2002).

Personality

Although there is a widespread assumption that personality is responsible for resilience, Bonanno et al. (2011) warn against overestimating its role. Nevertheless, as Bonanno et al. (2011) discuss, in studies that have measured personality both pre- and post-PTE, high scores on perceived control (Ullman & Newcombe, 1999) and resilience trait (Ong, Fulluer-Rowell & Bonanno, 2010) or low scores on negative affectivity (Weems et al., 2010) and ruminative response style (Nolen-Hoeksema & Morrow, 1991) have been associated with enhanced post-event outcomes. Ego strength and optimism (Farber, Schwartz, Schaper, Moonen & McDaniel, 2000) have also been associated with resilience. However, caution must be employed because, as Tennen and Affleck (1999) point out, in studies where personality is measured post-event, apparent personality characteristics may in fact be an outcome of coping with adversity.

Environmental factors

Personality combines with aspects of the individual’s environment in facilitating resilience. Of the numerous factors involved, those of social and economic resources have to date received the greatest attention (e.g., Hobfoll, 2002). People who cope well with trauma have often been embedded in a supportive social context (Lepore & Revenson, 2006). This support can take many forms, ranging from emotional to informational, as described by Kaniasty and Norris (2009). Greater social capital, with greater access to social support, leads, in the majority of cases, to resilience in adversity (Saegert, Thompson & Warren, 2001).

Access to economic resources is often associated with resilience, with increased availability correlated with better adjustment (Brewin, Andrews & Valentine, 2000). Unfortunately, it is often the case that PTEs result in a decreased availability of resources (Hobfoll, 2002), which in turn reduces the prevalence of resilience in the affected population (Bonanno et al., 2007). Furthermore, war often occurs during or as a result of a breakdown in civil order, so many of those experiencing it may have previously been subjected to hardship, followed by limited support after the traumatic event.

Previous stressors

There is mixed information regarding previous experience of life stress and its association with resilience (Bonanno et al., 2011). For example, research has linked past and current stress with increased risk of PTSD (Brewin et al., 2000) and attendant decreased likelihood of resilience (Bonanno et al., 2007). However, Bonanno, Brewin, ...