addressing collective trauma: conceptualisations and ... · graphic account of collective trauma as...

Copyrig

Somasundaram

Addressing collective trauma:conceptualisations and interventions

Daya Somasundaram

Complex situations following war and natural

disasters have a psychosocial impact not only on the

individual, but also their family, community and

the larger society. Fundamental changes in the func-

tioning of the family and community can be observed

as a result of these impacts. At the family level, the

dynamics of single parent families, lack of trust

amongmembers, changes in signi¢cant relationships

and child rearing practices are seen. Communities

tend to be more dependent, passive, silent, without

leadership, mistrustful and suspicious. Additional

adverse e¡ects include the breakdown of traditional

structures, institutions and familiar ways of life,

and deterioration in social norms, ethics and loss of

social capital. Collective trauma canbe studied using

sophisticated multilevel statistical analysis, with

social capital as a marker. A variety of community

level interventions have been tried, though a scienti-

¢cally robust evidence base for their e¡ectiveness

has yet to be established.This article advocates that

post disaster relief, rehabilitation and development

programmes need to address the problem of collective

trauma, particularly using integrated holistic

approaches.

Keywords: collective trauma, disasters,public mental health, war

IntroductionDisasters, both natural andmanmade, causea variety of psychological and psychiatricsequelae, ranging from adaptive andresilient coping responses in the face of cata-strophic events and understandable nonpathological distress to maladaptive behav-ioural patterns and diagnosable psychiatricdisorders (Green, Friedman & de Jong,2003). In addition, disaster stricken commu-nities often experience disruption of family

ht © War Trauma Foundation. Unautho

andcommunity life, work, normal networks,institutions and structures.Short and long termmental health problemscan hamper rehabilitation e¡orts bydelaying recovery with poor motivation,di⁄culties in normal functioning, workingcapacity, relationships, and family life.Additionally, the western tradition of seek-ing help from a counsellor or psychologistcan be culturally inappropriate within acollectivistic community (Yeh, Arora &Wu, 2006). Equally, cognitive behaviourtherapy (CBT), the most validated psy-chotherapy for posttraumatic stress disorder(PTSD) in the western world, may not beapplicable in non western communities(Wilson, 2007; de Jong, 2011). Within lowincome and poor resource settings that lacktrained mental health workers, yet havemassive populations who have experiencedtrauma, western individual therapies wouldnot be feasible. However, public mentalhealth, community based programmes andculturally sensitive methods would beappropriate (deJong, 2011).In addition, there is less recognition orunderstanding of the e¡ects disasters haveat the supra individual, family and com-munity levels, which maybe more salient incollectivistic societies (Somasundaram,2010).Thoughavariety of innovative psycho-social interventions at collective levels (Psy-chosocial Working Group, 2003) have beentried, as described regularly in this journal,robust scienti¢cally acceptable evidence inthe form of quantitative, randomised con-trolled trials (RCT) studies for their e¡ec-tiveness are yet to be established (Tankink,2014). Thus, the conceptualisation andtheory of collective impacts and acceptance

rized reproduction of this article is prohibited.43

Copyrig

Addressing collective trauma: conceptualisations and interventions

Intervention 2014, Volume 12, Supplement 1, Page 43 - 60

of e¡ective community level interventionshave not yet enteredmainstreampsychologyor psychiatry.Modern health related approaches have awestern medical illness model perspectivethat is primarily individualistic in orien-tation (de Jong, 2004). Geertz (1983, p. 59)described the western concept of the individ-ual self as ‘...a bounded, unique, more or less

integrated . . .whole... a peculiar idea within the

context of world cultures’. In contrast to westerndualism, which separates the body from themind and the individual from society (redu-cing phenomena to the micro level), otherepistemological approaches and ways ofexperiencing the world, society, self andbody tend to incorporate these poles intoan integrated whole, known as a ‘social body’(Scheper-Hughes & Lock, 1987). Accordingto Losi (2000, p. 13), ‘The term ‘egocentric self ’

refers to an understanding of the individual being

as a self-contained, autonomous entity...This idea

disregards the social origins of mental illness. Most

of the world’s populations, however, hold a more

socio-centric conception of the self,where individuals

exist within networks of social relationships’.Signi¢cantly, the central teaching ofBuddhism is of annatta, that there is no self,no essential, underlying substance, whileHindu metaphysics points to a di¡erentperspective of the self, that it is a pale re£ec-tion of the universal self (Haritayana, 2008).Collective events and consequences mayhave more signi¢cance in collectivistic com-munities than in individualistic societieslike the USA and Australia. It may also beimportant to bear in mind that societiesare, by their very nature, in £ux and chan-ging.With modernisation and globalisation,collectivistic societies are also increasinglybecoming more individualistic and consu-mer oriented.There may also be traditionalsubcultures within the bigger, individualisticculture. In collectivist societies, the individ-ual becomes embedded within the familyand community so much so that traumaticevents are experienced through the largerunit, with the impact alsomanifestingat that

ht © War Trauma Foundation. Unautho44

level. The family and community are partof the self, their identity and consciousness.The demarcation or boundary between theindividual self and the outside becomesblurred. For example, withinTamil families,close strong bonds and cohesiveness withinnuclear and extended family contexts meansthey function and respond to external threator traumaas aunit, rather thanas individualmembers. They share the experience andperceive the event in a particular way.During times of traumatic experiences, thefamily will come together in solidarity toface the threat as a whole and will providemutual support and protection. Over time,the family will act to de¢ne and interpretthe traumatic event, give it structure andassign a common meaning. They will alsoevolve strategies to cope with the stress.There are variations in manifestation,depending on responsibilities and roleswithin the family. For example, in the father’srole and responsibilities when mothers andwomen were killed in the tsunami, or in themother’s when males were killed, detained,tortured or disappeared during the war,and personal characteristics, meant thatsome became scapegoats, usually childrenor the elderly, in the family dynamics thatensued.We were able to observe these dynamicsboth after the tsunami (Somasundaram,2014), and during the war (Somasundaram,2010). As a result, in these cases, it was moreappropriate to speak of family trauma,rather than of individual personalities.Similarly, within theTamil communities, thevillage and its people, way of life andenvironment provided organic roots, a sus-taining support system, nourishing environ-ment and network of relationships. Thevillage traditions, structures and institutionswere the foundations and framework fortheir daily life. In theTamil tradition, a per-son’s identity is de¢ned, to a large extent,by their village or uur of origin (Daniel,1984). Their uur more or less places the per-son in a particular socio-cultural matrix. A

rized reproduction of this article is prohibited.

Copyrig

Somasundaram

word of caution is necessary if trying toromanticise or idealise the family, neigh-bourhood, village, collective and com-munity. These are, in reality, vague,amorphous terms, and encapsulate consider-able variation among members, as well asnegative dynamics like scapegoating, mar-ginalisation, exclusion, or not being allowedto take part in asocial activities, and hege-monic (being dominated by an other socialgroup or organisation) tendencies. It is alsovery di⁄cult to de¢ne community and col-lective with precision, as the lines of demar-cation will invariably breakdown (Van dePut et al.,1997).

PTSDPTSD has been constructed as a conditionthat a¥icts the mind ormanas of the individ-ual self ( jiva), the traumatic event impactingon the individual psyche to produce thePTSD.The core symptoms of traumatisationinclude: re-experiencing or reliving the trau-matic event in the present, avoidance ofreminders and hyper arousal (Maerckeret al., 2013). However, PTSD does not ade-quately capture or explain the extent, norwider rami¢cations of traumatic events onfamilies and communities, particularly innonwestern collectivistic cultures (Hofstede,2008; de Jong, 2004; Nisbett, 2003). Rathersocieties, communities and cultures shape,frame and remakes traumatic experiencesto determine representations,manifestationsof su¡ering through idioms of distress, andchanges in social processes and dynamics(Kleinman, Das & Lock 1997). The socialbody (Scheper-Hughes & Lock,1987) or col-lective unconscious (Jung, 1969) becomesthe site of the collective trauma.A better understanding of supra-individuallevels can be sought through the ecologicalmodel of Bronfenbrenner (1979) with themicro, meso, exo and macro systems. Inother words, the individual nested withinthe family, which is nested within the com-munity, which is nested within the widersociety (Hobfoll, 1998; Dalton et al., 2007).


The Bronfenbrenner model ¢ts the WorldHealth Organization (WHO) de¢nition ofhealth andwellbeing, which also emphasisesthe need to lookbeyond themicro or individ-ual level:

‘Health is a state of complete physical, mental,(familial),1 social, (cultural), (spiritual)

and (ecological) wellbeing, and not merely

an absence of disease or infirmity’.

- WHO (1948, Preamble to Constitu-tion)2

More recently, a growing consensus hasemerged on the need to look at these widerdimensions in order to understand thedynamics of the e¡ects of disasters, and todesign interventions at di¡erent systemiclevels (Harvey,1996; deJong,2002; Psychoso-cial Working Group, 2003; Landau & Saul,2004; Hoshmand, 2007; Macy et al., 2004).This paper attempts to describe the phenom-ena of collective trauma, the systemic natureof forces that cause or convey trauma andtheir impact on family, community andsocietal systems (de Jong, 2011; Hoshmand,2007), and community level interventions(Harvey,1996; Macy et al., 2004).

Collective traumaThe phenomena of collective trauma,described in the ¢rst article of the ¢rst issueof this journal3 (Somasundaram, 2003),initially became clear to the author whenworking in the post war recoveryand rehabi-litation context of Cambodia (Van de Putet al., 1997). During the Khmer Rougeregime, all social structures, institutions,family, educational and religious orderswererazed to ‘ground zero’ deliberately (so as to‘rebuild a just society anew’!) (Vickery, 1984).Awhole generation missed out on schoolingand education. Mistrust and suspicionarose among family members as childrenwere forced to report on their parents tothe authorities. The essential unity, trustand security within the family system, the


Copyrig


Intervention 2014, Volume 12, Supplement 1, 3 - 60

basic unit of society, were broken.The com-munal trauma continued during the sub-sequent decade with the invasion byVietnam. These events in Cambodia high-lighted the impact on families and commu-nities, and illustrated how they respondand act during extreme situations, in cultu-rally resonant ways (Hinton, 2007). Similarchanges at the family and community levelsbecame discernable within the northernSri Lanka (Somasundaram,2014), as a resultof the armed struggle between 1982 and2009. At the family level, the dynamicsof single parent families, lack of trustamong members, and changes in signi¢cantrelationships and child rearing practiceswere seen. Communities tended to be moredependent, passive, silent, without leader-ship, mistrustful, and suspicious. Additionaladverse e¡ects included the breakdown oftraditional structures, institutions andfamiliar ways of life, and deterioration insocial norms and ethics. Previously KaiErikson (Erikson, 1976; 1979) had given agraphic account of collective trauma as ‘loss ofcommunality’, following the Bu¡alo Creek dis-aster in the USA (where a dam burst and£oods impacted a population of 5,000people).He andcolleagues described the‘bro-ken cultures’ in North American Indians andthe ‘destruction of the entire fabric of their culture’due to forced displacements and disposses-sion from traditional lands into reservations,separation of families, massacres, loss ofway of life, relationships and spiritual beliefs(Erikson & Vecsey,1980). Similar tearing ofthe‘socialfabric’hasbeen described in Austra-lian indigenous populations (Milroy, 2005).Maurice Eisenbruch used the term ‘culturalbereavement’ to describe the loss of culturaltraditions and rituals in Indochinese refu-gees in the US (Eisenbruch, 1991). Morerecently, a number of discerning workers inthe ¢eld have been drawing attention to theimportance of looking at family (Landau& Saul, 2004; Tribe, 2004; Ager, 2006) andcultural dimensions (de Jong, 2002; 2004;Miller & Rasco, 2005; Ager, 2006; Silove &


Steel, 2006) following disasters. Collectivetrauma has also been described byAbramo-witz (2005) in six Guinean communitiesexposed to war, and by Saul (2014) after9/11in the USA. Saul (2014) de¢nes collectivetrauma as a larger social impact, occurringat multiple levels, with‘shared injuries to a popu-lation’s social, cultural, and physical ecologies’,emphasising the ‘impact of adversity on relation-ships, families and communities and societies at

large’ and the loss of social trust. Maercker& Horn (2012) have also put forward aninterpersonal and socio-ecological model oftrauma, where the multi-level interactions,relationships and social processes are takeninto account.Refugees and migrants from collectivisticcommunities remain either locked into theirrelationships with extended families andkinship groupsback home, or who have beendisplaced to neighbouring countries andsu¡ering feelings of responsibility andguilt at leaving extended families behind(Somasundaram, 2011). Modern technologykeeps the collective trauma alive andpresentin their lives. They maintain close contactthrough mobile phones, keep abreast of cur-rent news through television, internet, othermedia and other travellers. In fact, theycontinue to live more within their home net-work, undergoing all the uncertainty, inse-curity, terror, agony and trauma of thoseleft behind, than in the reality around themin the new, host country. An adverse eventback home has an immediate and immensee¡ect on the family. A parent, sister, brotheror child sobbing over the phone, or the soundof gun¢re and explosions in the background,would haunt them for weeks.These refugeesand migrants would experience the con-sequences of a suicide bomb attack withintheir countryof originbeing shownontelevi-sion, as if it was happening to them. Forexample, the £are up of ¢ghting in Iraq in2014 spread a deep sense of gloom, despairand reactivated many past traumaticmemories in migrant Arabic communities.Migrant communities spend much of their


Copyrig

Somasundaram

time, money and e¡ort in trying to bringthose left behind across to the host country.Long drawn out visa procedures, unfriendlyauthorities and common refusal of asylumapplications were shown to compound a col-lective sense of helplessness, futility and cul-tural bereavement for their home culture(Eisenbruch, 1991; Bhugra,Wojcik & Gupta2011). Individual level trauma therapy inthe host country for the migrant will beinsu⁄cient or appropriate with this vividpresence of the ongoing collective trauma.Wilson (2004) talks of the unconsciousmani-festation of collective trauma as the trauma

archetype that is universal and common toall cultures. Yael Danieli (2007) has writteneloquently about the trans-generationaltransmission of trauma:‘massive trauma shapesthe internal representation of reality of several gener-

ations, becoming an unconscious organizing prin-

ciples passed on by parents and internalized by

their children’.The trauma can be transmittedthrough epigenetic processes,4 parent^childinteractions, family dynamics, socioculturalperpetuation of a persecuted ethnic identitybased on selective, communal memories(Wessells & Strang, 2006) or ‘chosen traumas’5

(Volkan, 1997), narratives, songs, drama,language, political ideologies and institu-tional structures.The term collective trauma represents thenegative consequences of mass disasters atthe collective level, that is on the social pro-cesses, networks, relationships, institutions,functions, dynamics, practices, capital andresources; to the wounding and injury tothe social fabric (Somasundaram, 2014).The long lasting impact, at the collectivelevel, or the tearing of the social fabricwouldthen result in social transformation (Bloom,1998) of a sociopathic nature, this could becalled be called collective trauma.Table 1 explores the characteristics of collec-tive trauma across seven dimensions: disas-ters; causal conditions; ecological contexts;signs and symptoms; coping strategies; con-sequences; and community level interven-tions. The ‘x’ in the Table, between causal


conditions and ecological context, indicatesthe interaction between psychosocial (PS)e¡ects of the disaster and what are some-times called the indirect PS e¡ects thatabsorbed within the PS ecological context.Families and communities cope with the dis-aster in a multitude of adaptive and nonadaptive ways that can result in a variety ofpsychosocial problems, or in positive resili-ence and growth.We have found that when the family and/orcommunity regained their equilibrium andhealthy functioning (seeWHO de¢nition ofhealth above), there is often improvementin the individualmember’s wellbeingaswell.A sense of community (communality orsocial cohesion) provided by social supportand strong relationships among communitynetworks act as a vital protective factor forindividuals and families facing disasters,andaids in their recovery. It is alsobecomingclear through studies that social and culturalvalues, beliefs and perceptions shape howtraumatic events impact on the individual,family and community, and the way theyrespond (Wong & Wong, 2006; Wilson &Tang, 2007). The meaning attributed to theevent(s), the historical and social context,as well as community coping strategiesdetermines the impact and consequences oftrauma. For example, ¢rm traditional andreligious beliefs and social support has beenshown to be a protective factor against thee¡ects of trauma. Equally, community cop-ing and resilience help individuals andfamilies deal with and recover from thedestructive e¡ects of disasters. Therefore,family or community members may jointogether in collective coping to pool resources,act cooperatively to share the burden ofresolving a single or common problem atthe family (extended family) or communitylevels respectively, exclusively, or in combi-nation. Abramowitz (2005) found that mem-bers of communities that had developedwholesome collective narratives and resistedsocial disintegration had fewer post traum-atic symptoms and distress compared to


Copyright © War Trauma Foundation. Unauthorized reproduction of this article is prohibited.

Table1.

Collectivetrau

matheo

reticalm

odel

Disasters

Cau

salcon

dition

sEcologicalcon

text

Sign

s&symptom

sCop

ingstrategies

Con

sequ

ences

Com

mun

itylevel

Intervention

s

�Man

mad

e(e.g.w

ar)

�Displacem

ents

�So

cialchaos,

uprooting

�Insecurity

�Silence,withd

rawal,

isolation,

Benum

bing

�Negative

�Psychosocialedu

cation

-aw

areness

�Natural

(e.g.Tsuna

mi)

�Sepa

ration

s�Breakdownof

socialstructures

andinstitutions

�Terror

�Su

spicion

�Dependency,learned

helplessness,p

assivity

�Training

ofcommun

ity

workers

�Massive

destruction

�Un/un

der

employment,

poverty

�Im

punity,social

injustice

�‘Fight,£

ight

orfreeze’,

survival,escap

e,suicide

�Losso

ftrust,p

aran

oia

�Com

mun

ityintervention

s-Family,

�Multipledeaths

�Starvation,

hung

er,m

alnu

trition

�Breakdownof

lawan

dorder

�Culturalpractices,ritu

als

�Despa

ir,d

isbelief,

amotivation,ho

pelessness

�Group

s

�Injuries

�Lackofmedical

care,d

iseases,

epidem

ics

�Inequity,

discrimination

�Adaptation,facing

thechalleng

e,problem

solving

�Losso

fcom

mun

ality,

decreasein

socialcohesion,

tearingofsocialfabric,

Losso

fsocialcap

ital

�Encou

rage

indigeno

uscoping

strategies,

culturalritualsa

ndceremon

ies

�Losses

�‘Repressiveecolog

y’,

violence,torture,

abdu

ctions,detention

s,disapp

earances,

extrajud

icialk

illings

�Helplessness,

hopelessness

�Po

sitive

�Exp

ressive(emotive,

creative)metho

ds

�Cultural&

social

bereavem

ents

�Rum

ours,

disinformation

�Adaptivechan

gesin

mem

ory,refram

ing,

meaning,realism

�Psychosocialrehabilitation

,multi-sectorial

collabo

ration

,networking

�Resilience,forbearan

ce,

newnetw

orks,friendship,

relation

ships,ho

pe

�Promoteresilience

�Regeneration,

developm

ent,prog

ress

�Prevention



48

Copyrig

Somasundaram

communities that had narratives of aban-donment, isolation, disregard of communityrituals and social supports and the dis-location of local morals and ethics.

Acceptance of the concept and impactof collective traumaThe concept of collective trauma is nowbeing introduced, for the ¢rst time in amod-ern mental health diagnostic classi¢cation,in the draftof theWHOInternationalClassi-¢cation of Diseases (ICD) 11th revision’sguidelines6 for PTSD under cultural con-siderations:

‘Large-scale traumatic events and disastersaffect families and society. In collectivistic or

sociocentric cultures, this impact can be pro-

found. Far-reaching changes in family and

community relationships, institutions, prac-

tices, and social resources can result in con-

sequences such as loss of communality, tearing

of the social fabric, cultural bereavement and

collective trauma. For example, in indigenous

and other communities that have been perse-

cuted over long periods there is preliminary

evidence for trans-generational effects of

historical trauma.

Supra-individual effects can manifest in a

variety of forms, including collective distrust;

loss of motivation; loss of beliefs, values and

norms; learned helplessness; anti-social beha-

viour; substance abuse; gender-based vio-

lence; child abuse; and suicidality.These

effects, as well as real or perceived family and

social support, can also impact on individual

resilience and outcomes’.

Though both the American Diagnostic and

Statistical Manual of Mental Disorders (DSM)and WHO ICD classi¢cation systems havetraditionally been exclusively individualbased, it is argued that a collective approachbecomes paramount from a public men-tal health perspective where large popu-lations are a¡ected and where resourcesare limited.7 Further, community based


approachesmaybemore e¡ective andmean-ingful in collectivistic societies, as shownabove. Community level interventions(Harvey, 1996; Macy et al., 2004), particu-larlymental healthandpsychosocial support(MHPSS), can be used to help communitiesa¡ected by disasters. Several suggestions ofpractical implications and examples aregiven later.

Social capital as a proxy for collectivetraumaSocial capital encompasses community net-works, relationships, civic engagement withnorms of reciprocity and trust in others thatfacilitate cooperation and coordination formutual bene¢t (Cullen & Whiteford, 2001).Fundamentally, it looks at social institutions,structures, functions, dynamics andthequal-ity and quantity of social interactions. It isa re£ection of social cohesion, the glue thatholds society together. Theoretically, posi-tive social capital would increase the com-munity’s capacity to withstand disasters,its resilience and ability to respond con-structively.The construct of social capital is becomingincreasingly recognised as an important fac-tor in mental health (Cullen & Whiteford,2001; McKenzie & Harpham, 2006; Scholte& Ager, 2014). Disasters such as a massivenatural catastrophes or chronic civil warcan lead to a depletion of social capital(Kawachi & Subramanian, 2006; Wind &Komproe, 2012). According to Bracken &Petty (1998), modern wars deliberatelydestroy social capital assets in order to con-trol communities. The covert goals maybecome elimination or cooption of leaders,as well as control and coercion of groups,media, governance structures and institu-tions, which leads in the ¢nal analysis, tothe minds of ordinary people.Communities under stress manifest withsocial disorganisation, unpredictability, lowtrust, fear, high vigilance, low e⁄cacy, lowsocial control of antisocial behaviours andhigh emigration which lead to anomie (the


Copyrig



breakdown of social bonds between anindividual and the community), learnedhelplessness, thwarted aspirations, low self-esteem and insecurity. Social pathologies,like substance abuse, violence, gender basedviolence and abuse, and child abuse can allincrease, as can health problems like heartdisease, depression, stress related conditions,behaviours contributing to chronic illnessand reduction in immunity to infection andcancer, also all develop with breakdown ofsocial capital (Cullen & Whiteford, 2001).Civil con£ict causes community trauma bythe creation of a ‘repressive ecology’, based onimminent, pervasive threat, terror and inhi-bition that causes a state of generalised inse-curity, terror and rupture of the socialfabric (Baykai et al., 2004).As social capital and collective traumaappear to share many commonalities, at thisearly, preliminary stages of research into col-lective trauma, loss of social capital couldserve as a useful proxy for collective trauma.Parameters such as social cohesion, trust,network densities, perceived and receivedsocial support, relationships, structural andcognitive social capital and collective e⁄-cacy can be quanti¢ed and studied usingsociometric analysis (a quantitative methodfor measuring social relationships), multi-level approaches and social modelling statis-tical techniques (McKenzie & Harpham,2006; Kawachi & Subramanian, 2006;Wind & Komproe, 2012). Signi¢cant socialparameters can help to operationalise collec-tive trauma. Interventions can be designedto foster social capital by improving theseparameters through rebuilding relationshipsand networks, trust, civic participation, col-lective e⁄cacy and cohesion.

Community level interventionsTraditionally, post disaster interventionshave been conceptualised and categorisedinto rescue, relief, rehabilitation, recon-struction and development, dependingprimarily on the time course after dis-aster. Di¡erent organisations, government


departments and international bodies likeinternational nongovernmental organis-ations (INGOs) and the UN have all beenresponsible for the implementation of inter-ventions, depending on the phase of the dis-aster. The phase of long-term, post disasterinterventions, deal with issues surroundingresettlement, rehabilitation and develop-ment issues, as well as long term mentalhealth consequences, like unresolved grief,depression, alcohol abuse, suicide, and atthe community level, collective trauma.The Inter-Agency Standing Committee (IASC)

Guidelines (2007) recommend consideringthe socio-political and cultural contexts inorder to maximise the participation oflocal populations, building available localresources and capacities, and integratingclose collaboration between support systemswhen responding to disasters.The community and its members need tobe able to bene¢t from the developmentalprogrammes being undertaken. Economicrecovery will not be su⁄cient; people need‘to reconstruct communities, re-establishing social

norms and values’ (Weerackody & Fernando,2011). International law recognises the Prin-ciple of Restitutio ad integrum (a restoration tooriginal condition) for the redress of victimsof armed con£ict to help them reconstitutetheir destroyed ‘life plan’ (Villalba, 2009;Evans, 2012). This justi¢es the need forrehabilitation as a form of reparationclari¢ed by the UN ‘Basic Principles and

Guidelines on the Right to a Remedy and

Reparations for Victims’ as taking ¢ve forms:restitution, compensation, rehabilitation,satisfaction and guarantees of nonrepetition(UN General Assembly, 2005). This shouldalso include psychosocial rehabilitation(Somasundaram, 2010).The widespread problem of collectivetraumatisation following disasters is mostcost e¡ectively approached through com-munity level interventions, or sociotherapyas has occurred, for example, in groupsettings in post con£ict Rwanda (Scholte &Ager, 2014). Furthermore, community based


Copyrig

Somasundaram

approaches will enable interventions toreach a larger target population, as well asundertake preventive and promotional pub-lic mental health activities at the same time.Individuals and families can be expected torecover andcopewhencommunitiesbecomefunctional, activating healing mechanismswithin the community itself. The WHO(2003) and other international organisationscreated the Sphere Project Humanitarian Charter

and minimum standards when dealing withmental and social aspects of health (SphereProject, 2004). Aworldwide panel of traumaexperts (Hobfoll &Watson et al., 2007) haveidenti¢ed restoring connectedness, socialsupport and a sense of collective e⁄cacy as


Context e.g.

Environment

Human rights

Politics

Governance

Religion

Primary prevention

Secondary prevention(Treatment)

Tertiary prevention(Maintenance treatment)

Figure 1: Conceptual model for psychosocial an

essential principles in interventions aftermass trauma.A comprehensive and useful conceptualmodel (Figure1) for psychosocial andmentalhealth interventions is the inverted pyramid(de Jong, 2002). At the top of the pyramidare societal interventions designed for anentire population, such as laws, public safety,public policy, programmes, social justice,and a free press. Descending the pyramid,interventions target progressively smallergroups of people. The next two layers in the¢gure concern community level interven-tions, which include public education, sup-port for community leaders, developmentof social infrastructure, empowerment,


Society-at-large/(Inter)national

policy

Public educationcapacity building

Communityempowerment

self-help groups

Family &individual

family interventioncounselingmedication

Levels of intervention

dmental health interventions (deJong, 2002).

51

Copyrig



cultural rituals and ceremonies, servicecoordination, training and education ofgrass root workers and capacity building.The fourth layer are family interventions,which focus both on the individual within afamily context and on strategies to promotewellbeing of the family as a whole. The bot-tom layer of the pyramid concerns interven-tions designed for the individual withpsychological symptoms or psychiatric dis-orders.These one to one interventions include psy-chiatric, medical, and psychological treat-ments, which are the most expensive andlabour intensive approaches and requirehighly trained professional sta¡. Someexamples of community level interventions,which are mass public mental healthstrategies and approaches that are hypothes-ised towork through social healing processesand dynamics are given in Box 1.Psycho-education Basic informationabout what has happened, where help canbe obtained, instructions about availableprogrammes and assistance is essential. Psy-cho-education about trauma for the generalpublic, what to do and not to do, canbe donethrough the media, pamphlets and popular


Box1: Community approaches

� Psycho-education, awareness� Training of community workers� Public mental health promotiveactivities

� Encourage indigenous copingstrategies

� Cultural rituals and ceremonies� Community interventions

o Familyo Groupso Expressive methodso Rehabilitation

� Prevention

Source: (Somasundaram, 1998)

52

lectures. These are essentially public mentalhealth information that empowers commu-nities to look after themselves in (post)disa-ster situations. A pamphlet we have usedextensively during the war, post war andpost tsunami is an adaptation of the pamph-let, ‘Coping with Stress’, issued after the AshWednesday ¢res,8 published by the RoyalChildren’s Hospital and Prince HenryHospital in Australia.Training community mental healthworkers Community level workers andhuman resources can be trained toincrease local awareness on how to deal withcommon mental health and psychosocialissues (de Jong, 2002; Somasundaram& Jamunanantha, 2002; Somasundaram,2014). At the same time as they addressindividual level problems where necessary,such as through counselling or referral forprofessional mental health treatment, com-munity level workers are also trained tothink andwork at the family andcommunitylevels (Somasundaram, 1997). They do thisby strengthening and expanding; existingresources and capacities; capacity buildingof primary health care workers to deal withcommon mental health issues; and engen-dering local participation, networks,relationships, leadership, decision making,planning and implementation to rekindlecollective hope, trust and e⁄cacy to rebuildcommunity agency and resilience.As the functioning family is the basicbuilding block and foundation of most com-munities, it would be essential for thecommunity workers to promote restorationof functioning family units.They couldworkwith families to help them trace missingmembers, partake in cultural grievingceremonies for the dead, improve relation-ships, correct misunderstandings amongmembers, re-establish hierarchical responsi-bilities, create income generating opportu-nities for the family and generallyencourage unity and positive dynamics.Problems of domestic violence, child abuse,alcoholism, unwanted pregnancies, extra


Copyrig

Somasundaram

marital relationships, suicide and self-harm,as well as di⁄culties of the elderly andwidows, could all be addressed within thefunctioning family structure, as well as atthe community level.A sense of agency and control, determiningtheir own future and a belief in their collec-tive e⁄cacy has to be restored to familiesand communities (Norris et al., 2008). It isonly by creating a sense of community, col-lective e⁄cacy and con¢dence that socialcapital can be increased, leading to a gaincycle (Hobfoll,1998) where communal trust,motivation and hope are re-established.Linking social capital where communitieshave access to power, decision making andresources are vital for building resilience,particularly among disadvantaged andmar-ginalised community members, such asminorities, aboriginal and indigenous popu-lations (Kirmayer et al., 2009). Even wheretheydo not have direct access to power, com-munities can navigate adverse structures ofpower by changing subjectivities (Linde-gard, 2009) through collective narrativesand creative arts. Negative aspects like lackof trust and uncertainty would need to beaddressed. E¡orts will need to be directedat rebuilding social capital through com-munity networks, relationships, responsibil-ities, roles and processes.At the same time, community workers haveto work towards creating opportunity struc-tures for education, vocational and skillstraining and capacity building, particularlyfor youth and income generating pro-grammes. It is by establishing someeconomic stability, livelihood and access toresources that families and communities willregain their dignity, faith and hope.Improvement in mental health and psycho-social wellbeing would motivate the popu-lation, and enable better participationin rehabilitation and development pro-grammes.Cultural rituals and ceremonies It canbe expected that communities will regaintheir natural resilience when performing


customary rituals, observe ceremonies likeremembrance days and partake in com-munity gatherings and festivals. Althoughsome of these ritual maybe performed foran individual, they often involve the familyand community, and thus set in motionfamily and community processes anddynamics. They give opportunities forexpression of communal emotions, providerelief from the grief and guilt, create faith,meaning and social support and networks.Wilson (2007,1989) describes the Sweat LodgePuri¢cation Ceremony among NativeAmericannations toheal alteredmaladaptive states fol-lowing war trauma. Patricia Lawrence(2000) highlighted the psychosocial value ofthe traditional oracle practice of ‘vakuucholuthal’ in eastern Sri Lanka, particularlyin cases of disappearances, where thefamilies are told what has happened to thedisappeared person in a socially supportiveenvironment. In cases of detention by thesecurity forces in northeastern Sri Lanka,the relatives take vows (nethi kadan)at Tem-ples to various Gods, which they will ful¢lif the person is released. The practice ofThuukkukkaavadi, a propitiatory ritual invol-ving hanging from hooks, have increaseddramatically after the war and maybeespecially useful after detention and torture(Derges, 2009; 2013). In the post war contextof strict military prohibition against psycho-social programmes,9 Kovalan Koothu (a popu-lar folk drama), provided a therapeuticoutlet and was performed all over theVanni in northern Sri Lanka with largeattendances and community participation(Jeyashankar, 2011; Somasundaram &Sivayokan,2013). Similarly, in the traditionalfolk form of Opari (lament), recent experi-ences and losses from the Vanni war wereincorporated into community grief perform-ances (Duran, 2011).Encouraging and teaching cultural relaxa-tion methods at the community level isanother useful method to regain resilience(Somasundaram, 2002; Hobfoll et al., 2007).As we found during the war and after the


Copyrig



tsunami, creative arts are valuable conduitsfor the expression of emotions (Wilson &Drozdek, 2004), ¢nding meaning and devel-oping community narratives (Somasun-daram, 2007). However, ritual cleansingceremonies like mato oput in northernUganda (Allen, 2008) and various psycho-social interventions in Liberia (Abramo-witz, 2014) both post war contexts, can alsobe performed with the aim of imposing ill-conceived political agendas, traditionaljustice and ‘post con£ict peace subjectivities’.Prevention Preventive medicine uses largescale public healthmeasures to protect popu-lations and eradicate or mitigate causativeagents of collective trauma.Tragically, muchof the deaths, destruction and psychosocialconsequences caused by natural disasterscan be avoided or at least, mitigated. Thisis eventruer formanmade (or technological)disasters and war. In many cases of naturaldisasters, poor and excluded communitiesare often located within vulnerable areas,warnings were not issued or followed, orplans forgotten. In the heat of battle, prota-gonists usually fail to maintain maps ofwhere they laid landmines as they areexpected to do by international convention,making it very much harder to de-mineand protect civilians during resettlement.Wars and con£ict can be prevented and psy-chosocial wellbeing ensured by appropriatecon£ict resolutionmechanisms (Rupesinghe& Anderlini, 1998), equitable access toresources (Stewart, 2001), power sharingarrangements, social justice and respect forhuman and social rights (PsychosocialAssessment of Development and Humani-tarian Interventions (PADHI), 2009).Techniques such as torture and disappear-ances cause long-term sequelae in individ-uals, families and communities, which canbe prevented if international conventions,humanitarian law and treaties are observed.Health workers in areas of con£ict havestarted emphasising that as health pro-fessionals, we need to consider ethics andtake a principled stand for victims and


society (Armenian, 1989; Zwi & Ugalde,1989). At times, these could involve consider-able risks, as this author has been labelled a‘traitor’ by di¡erent protagonists to the con-£ict in Sri Lanka for advocating for basichuman rights and exposing violations thatdiscreetly and nonviolently challenge wholesystems of unhealthy power andworld views(Somasundaram, 2014).As conceptualised byJoop deJong (2002), atthe top of the inverted pyramid of interven-tions (Figure 1) and therefore most e¡ectiveand a¡ecting whole populations, thereshouldbe plans at local, provincial, national,regional and international levels for dis-aster preparedness and emergency response,because many disasters a¡ect multiple com-munities, regions or entire countries. Suchplans are typically formulated by commit-tees at the appropriate level, and mayinvolve collaborative e¡orts between formalemergency management agencies, publichealth agencies and citizen groups. Healthprofessionals should be members of thesecommittees and participate in the planning.There should be regional and internationalmechanisms to protect civilians in times ofcon£ict and/or when powerful leaders andstates overstep boundaries of good govern-ance andobservationof basic rights. Increas-ing powers to the UN Security Council andGeneral Assembly to intervene with sanc-tions and peace keeping forces. The Inter-national Conventions and Court,and theprinciples of Right to Protect (R2P) (Evans,2008), are both promising developments.Therefore, preventive measures would haveto address those at the top, the governanceprocesses and culture. Jung (1947) inacknowledging political, social, economicand historical reasons for war, describeswar as an epidemic of madness, as an anima-tion of the collective unconscious where theinherent evil is projectedonto the neighbour-ing tribe, the ‘other’. The only way to prevent‘outbreaks of the collective unconscious’ is to bringit into consciousness, to develop insight andunderstanding. Political leaders have always


Copyrig

Somasundaram

been able to manipulate public opinion tosuit their power aspirations and rule accord-ing to their agenda. Even in so called func-tioning democracies, political leaders havebeen able to sell and mobilise an unwillingpopulace to go to war and train recruits todo the killing (Woodward, 2002;Woodward,2004; Somasundaram, 2009) In the longterm, there is a need to create a‘culture ofpeace’by social peacebuilding (Large, 1997), andreducing horizontal inequalities10 (Stewart,2001) that lead to war.

ConclusionThe e¡ects of disasters, particularlymassive,chronic trauma goes beyond the individualto the family, community and wider society.Social processes, dynamics and functioningcan be changed fundamentally by disasters.It is important to recognise the manifes-tations of collective trauma, so that e¡ectiveinterventions at the community level canbe used in these complex situations. Inte-grated holistic community approaches thatwere founduseful in rebuilding communitiesare: creating public awareness, training ofgrass root workers, encouraging traditionalpractices and rituals, promoting positivefamily and community relationships andprocesses, rehabilitation and networkingwith other organisations.

ReferencesAbramowitz, S. (2005). The poor have becomerich, and the rich have become poor: collectivetrauma in the Guinean Languette. Social ScienceandMedicine, 61, 2106-2118.

Abramowitz, S. A. (2014). Searching forNormal in theWake of the LiberianWar. Philadelphia: Universityof Pennsylvania Press.

Ager, A. (2006). What is Family? A World Turned

Upside Down- Social Ecological Approaches to Children

inWar Zones (38-62). N. Boothby, A. Strang & M.Wessells (Eds.). Connecticut: Kumarian Press.

Allen, T. (2008). Ritual (Ab)use? Problems withTraditional Justice in Northern Uganda. In: N.


Waddell & P.Clark (Eds.), Courting Con£ict? Justice,Peace and the ICC in Africa (47-54). London: RoyalAfrican Society.

Armenian, H. K. (1989). Perceptions from Epide-miological Research in an Endemic War. SocialScience&Medicine, 28, 643-647.

Baykai,T., Schlar, C. & Kapken, E. (2004). Inter-nationalTraining Manual on Psychological Evidence of

Torture. Istanbul: Human Rights Foundation ofTurkey.

Bhugra, D.,Wojcik,W. &Gupta, S. (2011). Culturalbereavement, culture shock and culture con£ict:adjustments and reactions. In: D. Bhugra & S.Gupta (Eds.), Migration in Mental Health (141^150). Cambridge: Cambridge University Press.

Bloom, S. (1998). By the crowdthey havebeenbro-ken, by the crowd they shall be healed:The socialtransformation of trauma. Posttraumatic growth:Positive changes in the aftermath of crisis. In: R.G. Tedeschi, C. L. Park & L. G. Calhoun (Eds.),Posttraumatic growth: Positive changes in the aftermath

ofcrisis (179-213).Mahwah,NJ:LawrenceErlbaumAssociates, Inc.

Bracken, P.,&Petty,C. (Eds.). (1998).RethinkingtheTrauma ofWar. London: Save the Children (SCF).

Bronfenbrenner,U. (1979).Theecologyofhumandevel-

opment: experiments by nature and design. Cambridge,MA: Harvard University Press.

Colletta, N. J. & Cullen, M. L. (2000). ViolentCon£ict and theTransformation of Social Capital Lessons

from Cambodia, Rwanda, Guatemala, and Somalia.Washington D.C.:World Bank.

Cullen, M. & Whiteford, H. (2001). The Inter-

relations of Social Capital with Health and Mental

Health. Commonwealth Department of Health and Aged

Care. Canberra: Commonwealth of Australia.

Dalton, J., Elias, M. & Wandersman, A. (2007).Community psychology: linking individuals and commu-

nities. Belmont, CA:ThomsonWadsworth.

Daniel,V. (1984). Fluid Signs-Being a Person theTamilWay. Berkeley: University of California Press.


Copyrig



Danieli,Y. (2007a). AssessingTraumaAcross Cul-tures from aMultigenerational Perspective. In: J.P. Wilson & C.S.-k. Tang (Eds.), Cross-Cultural

Assessment of PsychologicalTrauma and PTSD (65-90).NewYork: Springer.

Danieli,Y. (2007b). AssessingTrauma Across Cul-tures from aMultigenerational Perspective. In: J.P. Wilson & C.S.-K. Tang (Eds.), Cross-Cultural

Assessment of Psychological Trauma and PTSD (65-90). NewYork: Springer.

Derges, J. (2009). Eloquent bodies: con£ict andritual in northern Sri Lanka.Anthropology&Medi-

cine, 16, 27-36.

Degres, J. (2013) Ritual and Recovery in Post-Con£ictSri Lanka London: Routledge.

deJong, J. (2002).PublicMentalHealth,Traumaticstress and Human Rights Violations in Low-income Countries: A Culturally AppropriateModel inTimes of Con£ict, Disaster and Peace.In: J. deJong (Ed.),Trauma,War andViolence: Public

mental health in sociocultural context (1-91). NewYork:Springer.

deJong, J. (2004). Public Mental Health and Cul-ture: Disasters as a Challenge toWestern MentalHealth Care Models, the Self, and PTSD. In:J.Wilson and B. Drozdek (Eds.), Broken Spirits:The

Treatment of Asylum Seekers and Refugees with PTSD

(159-171). NewYork: Routledge.

deJong, J. (2011). (Disaster) PublicMentalHealth.Post-traumatic Stress Disorder. In D. Stein, M.Friedman & C. Blanco (Eds.), PostTraumatic StressDisorder (217-262). Oxford:Wiley-Blackwell.

Duran, L. (2011). Hari Sivanesan inJa¡na. In: H.Sivanesan (Ed.), World Routes Academy, 2011: The

Music of South India. London: British BroadcastingCorporation (BBC).

Eisenbruch,M. (1991). FromPost-Traumatic StressDisorder to cultural bereavement: Diagnosis ofSoutheast Asian Refugees. Social Science andMedi-

cine, 33, 673-680.

Erikson, K. (1976). Disaster at Bu¡aloCreek. Lossof communality at Bu¡aloCreek.AmericanJournalof Psychiatry, 133(3), 302-305.


Erikson, K. (1979). In theWake of the Flood. London:Allen Unwin.

Erikson, K. & C. Vecsey (1980). A report to thePeople of Grassy Narrows. In: C. Vecsey andR.Venables (Eds.), American Indian Environments-

Ecological Issues in Native American (152-161). NewYork, Syracuse University Press.

Evans, C. (2012).The Right to Reparation in Inter-

nationalLawforVictimsofArmedCon£ict.Cambridge:Cambridge University Press.

Evans,G. (2008).TheResponsibilityToProtect-Ending

Mass Atrocity Crises Once and for All. Washington,D.C Brookings Institution Press.

Geertz, C. (1983). Local Knowledge. NewYork: BasicBooks.

Green, B., Friedman, M. & de Jong, J. (Eds.).(2003). Trauma, Interventions in War and Peace:

Prevention, Practice, and Policy. NewYork: Kluwer/Plenum Press.

Haritayana. (2008).Tripura Rahasya or the Mystery

Beyond the Trinity [trans. into English by SwamiRamanananda] (Swami Ramananda, Trans.).Tiruvannamalai: Sri Ramanasramam.

Harvey, M. R. (1996). An Ecological View ofPsychological Trauma and Trauma Recovery.Journal ofTraumatic Stress, 9(1), 3-23.

Hinton, A. (2007).Terror andTrauma in the Cam-bodian Genocide. In: L. Kirmayer, R. Lemelsonand M. Barad (Eds.), UnderstandingTrauma (433-450). Cambridge: Cambridge University Press.

Hobfoll, S. (1998). Stress, culture, and community: thepsychology and philosophy of stress. NewYork: PlenumPress.

Hobfoll, S.E.,Watson, P., Bell C.C., Bryant, R.A.,Brymer, M.J., Friedman, M.J., Friedman, M.,Gersons, B.P., ,....Ursano, R.J. (2007). Five Essen-tial Elements of Immediate and Mid-Term MassTrauma Intervention: Empirical Evidence. Psy-chiatry,70(4): 283-315.

Hofstede, G. (2008). Cultures and organizations:

software of the mind. 1 & 2nd ed. New York:McGraw-Hill.


Copyrig

Somasundaram

Hoshmand, L. T. (2007). Cultural-EcologicalPerspectives ontheUnderstndingandAssessmentof Trauma. In: J. Wilson & C.S.-k. Tang (Eds.),Cross-Cultural Assessment of PsychologicalTrauma and

PTSD (31-50). NewYork: Springer.

Inter-Agency Standing Committee (IASC)(2007). IASCGuidelines onMental Health and Psycho-

social Support in Emergency Settings. Geneva: IASC.

Jeyasankar, S. (2011). Koothu transformation- a new

dimension of Eela Koothu. Chennai: Meaning¼community.

Jung, C. G. (1969).The Archetypes and the Collective

Unconscious.Princeton:PrincetonUniversityPress.

Jung, C. G. (1947). Essays on Contemporary Events.London: Kegan Paul.

Kawachi, I.&Subramanian, S.V. (2006).Measur-ing and Modeling the Social and GeographicContext of Trauma: A Multilevel ModelingApproach. Journal ofTraumatic Stress, 19(2),195-120.

Kirmayer, L. J., Sehdev, M.,Whitley, R., Dande-neau, F. S. & Isaac, C. (2009). Community resili-ence: Models, metaphors and measures. Journalof Aboriginal Health, 5(1), 62-117.

Kleinman,A.,V,Das,VandLock,M.(1997). Intro-duction. In A. Kleinman, V. Das & M. Lock(Eds.), Social Su¡ering. Berkeley: University ofCalifornia Press.

Landau, L. & Saul, J. (2004b). Facilitating Familyand Community Resilence in Response to MajorDisaster. In: F. Walsh & M. McGoldrick (Eds.),Living Beyond Loss (285-309). New York: W. W.Norton & Company.

Large, J. (1997)ConsideringCon£ict. FirstHealthas a Bridge for Peace Consultative Meeting,30-31 October 1997 Les Pensieres, Annecy. Gen-eva:WHO.

Lawrence, P. (2000).Violence, su¡ering, Amman:theworkof oracles in SriLanka’s easternwar zone.In: V. Das, A. Kleinman, M. Ramphele & P.Reynolds (Eds.),Violence and Subjectivity (171-204).Berkeley: University of California.


Lindegaard, M. R. (2009). Navigating terrains ofviolence: how South African male youngstersnegotiate social change. Social Dynamics: A Jour-

nal of African Studies, 35(1),19-35.

Losi, N. (2000). Understanding the needs of thedisplaced: some elements on the Kosovo case. In:N. Losi, C. Becker & C. Pillion (Eds.), PsychosocialandTrauma Response inWar-Torn Societies ^ The Case

of Kosovo. Geneva: International Organization forMigration (IOM).

Macy, R. D., Behar, L., Paulson, R., Delman, J.,Schmid, L. & Smith, S. F. (2004). Community-Based, Acute Posttraumatic Stress Management:A Description and Evaluation of a Psychosocial-Intervention Continuum. Harvard Review of Psy-

chiatry, 12, 217-228.

Maercker, A., Brewin, C. R., Bryant, R. A.,Cloitre, M., Reed, G. M., van Ommeren, M.,Humayun, A., Jones, L., Kagee, A., Llosa, A. E.,Rousseau, C., Somasundaram, D., Souza, R.,Suzuki, Y., Weissbecker, I., Wessely, S., First, M.B. & Saxena, S. (2013). Proposals for mental dis-orders speci¢cally associated with stress in theInternational Classi¢cation of Diseases-11. The

Lancet, 381(9878),1683-1685.

McKenzie, K. & T. Harpham, Eds. (2006). SocialCapitalandMentalHealth.London: JessicaKingsleyPublishers.

Maercker, A. & Horn, A.B. (2012) A Socio-inter-personal Perspective on PTSD: The case forEnviornmental and Interpersonal Processes.Clinical Psychology and Psychotherapy, doi: 10.1002/cpp.1085.

Miller, K. & L. Rasco (2005). An EcologicalFramework for Addressing the Mental HealthNeeds of Refugee Communities. In: K. Miller &L. Rasco (Eds.),TheMental Health of Refugees: Eco-

logical Approaches to Refugee Mental Health (1-64).NewYork: Lawrence Erlbaum.

Milroy,H. (2005).Australian IndigenousDoctors’Association (AIDA) submissions on the consulta-tive document: Preventative Healthcare andStrengthening Australia’s Social and EconomicFabric.


Copyrig



Nisbett, R. (2003).The Geography of Thought: How

Asians and Westerners Think Di¡erently and Why.NewYork: Free Press.

Norris, F., Pfe¡erbaum, B., Wyche, K. &Pfe¡erbaum, R. (2008). Community Resilienceas a Metaphor, Theory, Set of Capaticies, andStrategy for Disaster Readiness. AmericanJournalof Community Psychology, 41,127-150.

Psychosocial Assessment of Development andHumanitarian Interventions (PADHI) (2009). ATool, a Guide, and a Framework. Colombo: PADHI.

Psychosocial Forum of Consortium of Humani-tarian Agencies (CHA). (2008). A CommunityBased based model for Mental Health Service.Re£ections, 5(II),1-2.

Psychosocial Working Group (2003). PsychosocialIntervention in Complex Emergencies: A Conceptual

Framework. Univeristy of Edinburgh. Edinburgh,PsychosocialWorking Group.

Rupesinghe, K. & Anderlini, S. (1998). Civil wars,civil peace: an introduction to con¢ct resolution. London:Pluto Press.

Samarasinghe, G. (2014). Psychosocial Interven-tions in Sri Lanka - Challenges in a Post-WarEnvironment. In:D. Somasundaram (Ed.), ScarredCommunities. New Delhi: Sage.

Saul, J. (2014). CollectiveTrauma, Collective Healing:PromotingCommunityResilience in theAftermath ofDis-

aster. NewYork: Routlede.

Scheper-Hughes, N. & Locke, M. M. (1987). Themindful body: A prolegomenon to future work inmedical anthropology. Medical Anthropology Quar-

terly, 1(1), 6-41.

Scholte,W. F. &Ager, A. (2014). Social capital andmental health: connections and complexities incontexts of post con£ict recovery. Intervention,

12(2), 210-218.

Silove, D., Steel, Z. & Psychol, M. (2006). Under-standing community psychosocial needs after dis-asters: Implications for mental health services.Journal of PostgraduateMedicine, 52,121-125.


Somasundaram, D. (1997). Treatment of MassiveTraumadue toWar.Advances inPsychiatricTreatment,3, 321-331.

Somasundaram, D. (2002). Using traditionalrelaxation techniques in minor mental healthdisorders. InternationalMedicalJournal, 9,191-198.

Somasundaram, D. (2003) Collective Trauma,InternationalJournal of Mental Health, Psychosocialwork andCounselling inAreas of armedCon£ict,1 (1), 4-13.

Somasundaram, D. (2007). Collective trauma innorthern Sri Lanka: a qualitative psychosocial-ecological study. International Journal of Mental

Health Systems, 1(1), 5.

Somasundaram, D. (2009). Collective Violenceand War. In: N. Loucks, S. Holt & J. R. Adler(Eds.),Why we kill: understandingViolence across cul-

tures and disciplines. London:Middlesex UniversityPress.

Somasundaram, D. (2010a). Collective trauma inthe Vanni- a qualitative inquiry into the mentalhealth of the internally displaced due to the civilwar in Sri Lanka. International Journal of Mental

Health Systems, 4(22),1-31.

Somasundaram, D. (2010b). PreliminaryThoughts on Psychosocial Rehabilitation afterMass Atrocities. F. Freyenhagen & C. Ferstman(Eds.), Rehabilitation as a Form of Reparation Opportu-

nities and Challenges. Essex University, UK,REDRESS & Transitional Justice Network.

Somasundaram, D. (2011). CollectiveTrauma. In:D. Bughra & S. Gupta (Eds.), Migration in Mental

Health (151-160). Cambridge: Cambridge Univer-sity Press.

Somasundaram, D. (2014). Scarred Communities:

Psychosocial Impact of Man-Made and Natural Disasters

on Sri Lankan Society. SAGEPublications India.

Somasundaram, D. andJamunanantha, J. (2002).Psychosocial consequences of war ^ NorthernSri Lankan Experience. In: J. de Jong (Ed.),Trauma, War and Violence-Public Mental Health

in Socio-cultural Context (205-208). New York:Springer.


Copyrig

Somasundaram

Somasundaram, D. & Sivayokan, S. (2013).Rebuilding community resilience in a post-warcontext: developing insight and recommen-dations ^ a qualitative study in Northern SriLanka. InternationalJournalofMentalHealthSystems,

7, 3.

Sphere Project (2004). Humanitarian Charter and

Minimum Standards in Disaster Response. Geneva:Sphere Project.

Stewart, F. (2001).Horizontal Inequalities:ANeglected

Dimension of Development. Oxford: Centre forResearch on Inequality, Human Security andEthnicity, CRISE, Queen Elizabeth House, Uni-versity of Oxford.

Tankink,M. (2014). Fromtheeditor. . .questions ofevidence. Interventions, 12(2),168-170.

Tribe, R. (2004). A Critical Review of the Evol-ution of a Multi-level Community-based Chil-dren’s Play Activity Programme Run by theFamily Rehabilitation centre (FRC) ThroughoutSri Lanka. Journal of Refugee Studies, 17,114-135.

UNGeneralAssembly(2005).BasicPrinciplesandGuidelines ontheRight to aRemedyandRepara-tions for Victims of Gross Violations of Inter-national Human Rights Law and SeriousViolations of International Humanitarian Law.Resolution 60/147. NewYork, UNGeneral Assem-bly: para18.

Van de Put,W., Somasundaram, D., Eisenbruch,I., Kall, K., Soomers, R. & Thomassen, L.(1997). Facts and thoughts on the ¢rst years 1995-1996.Phnom Penh, Cambodia: Transcultural Psycho-social Organization.

Vickery, M. (1984). Cambodia: 1975-1982. Boston:South End Press.

Villalba,C. (2009).RehabilitationasaFormofRepara-tion under International Law. C. Ferstman (Ed.).London: REDRESS.

Volkan, V. D. (1997). Bloodlines: From ethnic pride

to ethnic terrorism. New York: Farrar, Straus, &Giroux.


Weerackody,C.&S. Fernando, Eds. (2011).Re£ec-tions on Mental Health andWellbeing. Learningfrom communities a¡ected by com£ict, dis-location and natural disaster in Sri Lanka.Colombo, People’s Rural Development Associ-ation.

Wessells, M. & A. Strang (2006). Religion asResource and Risk: The double-edged sword forchildren in situaitons of armed con£ict. In:N. Boothby, A. Strang & M. Wessells (Eds.), AWorld Turned upside Down- Social Eclological

Approaches to Children inWarZones (199-222). Bloom-¢ed, CT: Kumarian Press.

Wilson, J. (2004). The Broken Spirit: Posttrau-matic Damage to Self. In: J.Wilson & B. Drozdek(Eds.), Broken Spirits- The Treatment of Traumatized

Asylum Seekers, Refugees,War andTortureVictims (109-

158). NewYork: Brunner-Routledge.

Wilson, J. (2007). The Lens of Culture: Theore-tical and Conceptual Perspectives in the Assess-ment of Psychological Trauma and PTSD. In: J.Wilson&C.S.-K.Tang (Eds.),Cross-CulturalAssess-ment of psycholgicalTrauma and PTSD (3-30). New-York: Springer.

Wilson, J. P. (1989). Trauma, Transformation and

Healing: An Integrative Approach to Theory, Research

and Post-Traumatic Therapy. New York: Brunner/Mazel.

Wilson, J. & Drozdek, B. (Eds.). (2004). BrokenSpirits:TheTreatment of Traumatized Asylum Seekers,

Refugees,War and Torture Victims. New York: Brun-ner-Routledge.

Wind,T. & Komproe, I. (2012).The MechanismsThat Associate Community Social Capital withPost-DisasterMentalHealth:AMultilevelModel.Social Science&Medicine, 75,1715-1720.

Wilson, J. & Tang, C.S.-K. (Eds.). (2007). Cross-Cultural Assessment of psycholgoical Trauma and

PTSD. International and Cultural Psychology Series.NewYork: Springer.

Woodward,B. (2002).BushatWar.NewYork:Simon& Schuster.


Copyrig



Woodward, B. (2004). Plan of Attack. New York:Simon & Schuster.

Wong, P. & Wong, L. (Eds.). (2006). Handbook ofMulticultural Perspectives on Stress and Coping. Inter-

national and Cultural Psychology Series. New York:Springer.

WorldHealthOrganization (WHO) (2003).Men-

tal Health in Emergencies. Geneva:WHO.

Yeh, C., Arora, A. & Wu, K. (2006). A NewTheoretical Model of Collectivistic Coping. In:P.Wong&L.Wong (Eds.),HandbookofMulticultural

Perspectives on Stress and coping (56-72). New York:Springer.

Zwi, A. & Ugalde, A. (1989). Towards an Epide-miology of PoliticalViolence in theThirdWorld.Social Science&Medicine, 14, 633-646.

1 Thewords within parenthesis are my additions.In many collectivistic societies, the family wouldinclude extended family.2 Preamble to the Constitution of the WorldHealth Organization as adopted by the Inter-nationalHealthConference, NewYork,19-22 June1946, and entered into force on 7 April 19483 Then under its earlier name, ‘‘InternationalJournal of Mental Health, Psychosocial workandCounselling inAreasofarmedCon£ict’’, pub-lished fromJa¡na.4 Epigenetics refers to heritable changes in geneactivity that are not caused by changes in theDNA sequence, but can occur, for example, dueto environmental events or factors.5 If members of a group who have been trauma-tised have problems with competing certainpsychological tasks, theyconvey suchtasks to theirchildren. This is often connected with consciousand unconscious shared wishes that the nextgeneration(s) has to solve. The shared mentalrepresentation of the historical traumatic eventmay evolve intowhatVolkan calls a‘‘chosen trauma’’


(1997). This chosen trauma becomes a signi¢cantmarker for the large-group identity. It can beimportant for the development of a contry, theideology or political programmes.6 Unpublished document of the WHO ICD-11WorkingGroup on the Classi¢cation of DisordersSpeci¢callyAssociated with Stress.7 Although the author is a member of theWHOICD-11 Working Group on the Classi¢cation ofDisorders Speci¢cally Associated with Stress,reporting to the WHO International AdvisoryGroup for the Revision of ICD-10 Mental andBehaviouralDisorders, the views expressed in thispresentation are those of the author and, exceptas speci¢cally noted, do not represent the o⁄cialpolicies or positions of the International AdvisoryGroup or theWorld Health Organization.8 AshWednesday ¢res,were a series of bush¢resthatoccurred in south-easternAustraliaon16Feb-ruary 1983, which was Ash Wednesday in theChristian calendar.9 Apparently the authorities feared that psycho-social programmes would promote narrationsand other accounts of what happened that couldexposeandthenbeusedasevidence forwarcrimes(Somasundaram & Sivayokan, 2013; Samara-singhe, 2014).10 Horizontal inequalities refers to economic,social status, education, power and other markeddi¡erences between groups in a society. Thesehorizontal inequalities cancause civilwars (Stew-art, 2001).

Daya Somasundaram, MD (Sri Lanka),

FRCPsych (UK), FRANZCP (Aus), FSLCP

is Professor of Psychiatry, University of Ja¡na

and Clinical Associate Professor, Discipline of

Psychiatry, University of Adelaide & Consult-

ant Psychiatrist, Ja¡na and STTARS, Ade-

laide and SouthEastern Community Mental

Health Services,Mt. Gambier, SouthAustralia.

email: [email protected]


mailto:[email protected]

addressing collective trauma: conceptualisations and ... · graphic account of collective trauma as...

Documents