Economisation of life worlds is resulting in increasing mental suffering worldwide. Social problems are often individualised in the process, classified as mental illness and treated with drugs. Emancipatory psychosocial work is a critical challenge to these tendencies. The medico international symposium in May 2012 provided an opportunity for thoughtful discussion.
At the symposium, Berlin psychologist and former medico staff member Karin Mlodoch developed central categories for emancipatory psychosocial work. In her view, it is a matter of developing an approach and a language focusing on solidarity, empathy and partisanship for the victims of violence and the socially excluded and marginalised. Her examples were the Kurdish Anfal widows, women who survived the 1988 attacks by the Iraqi army on hundreds of Kurdish villages. More than 100,000 men and women disappeared, and the fate of many is still unresolved. Since 1988, Mlodoch has worked repeatedly with these women, in the Haukari Association among other groups. medico is also supporting this work. Mlodoch gave a vivid presentation showing how political terror, social exclusion and economic deprivation placed these women in extremely stressful situations. 'But the women survived. They have raised their children without male or social support.' As Mlodoch put it, 'Their most important resource was their shared suffering and collective structures.' Strengthening these resources is still a central component in psychosocial support. Comparing this with approaches that only address the personal mental states of the affected individuals, Mlodoch noted, 'It is true that traumatic memories still dominate the women's stories. Many of them suffer from severe psychosomatic symptoms. But they never define these symptoms as traumatic. For them, they are normal reactions to what they've experienced. How can you not have nightmares if you've watched three children die in your arms?' Mlodoch associated decisive progress with the far-reaching improvement in the women's socioeconomic situation resulting from the overthrow of the Hussein regime in Iraq. The women have not given up their collective ties, and they are finding a new relationship to reality. 'The focus is shifting from those they have lost to their own situation, from the victims to the survivors.'
Psychosocial support like this, which takes into account the political and social context while caring for individual suffering, has been the starting point for medico's work for more than 30 years. As many of the papers at the symposium noted, there is significant pressure today on such a political and emancipatory approach. The struggle to understand and analyse stands in conflict with the norms, discourses and standardisation procedures which are fashionable today in psychosocial work. For example, Usche Merk, a medico specialist in psychosocial work, noted at the symposium that currently 'narrative exposure therapy' (NET), a technique developed by University of Konstanz researchers, is promising quick results, particularly for large population groups exposed to traumatic experiences, such as the civil war in Rwanda. The claim is that traumas can be healed in only four to six sessions through quick and detailed confrontation with the worst experiences. Authorities gladly accept this model, as it saves costs and is quickly available.
Antidepressants as routine therapy
The global unleashing of capitalism has meant that the rules of the market economy have invaded the last remaining corners of the earth. There has been a rapid increase in mental suffering in the postcolonial societies of the global South as well. This trend is due in part to misguided concepts of development based on so-called entrepreneurship models, centred on the individual. Instead of promoting e.g. cooperative communities or establishing tax-financed social security systems, many aid programmes continue to focus on getting individuals 'fit for competition', for example through microcredits. In parallel with the increasing in mental suffering, we are seeing an explosion of psychopathological diagnoses which tie the suffering to the individual. At the symposium, Stefan Ecks, a medical ethnologist at the University of Edinburgh, reported that physicians in India prescribe antidepressants as a matter of routine. They explicitly justified this by explaining that globalisation, social insecurity and the disintegration of families made patients depressed. The increase in diagnoses such as depression, ADHS, PTSD reflects not only the growing anxiety in the wake of globalisation, but also an extremely questionable individualisation of social ills.
The symposium also made it clear that other knowledge, different practices and alternative attitudes can be found in counselling agencies, institutions and aid facilities. The participants (many of them experts) made use of the opportunity to formulate options for language and action. First and foremost, the anxiety in the wake of globalisation requires political answers. This also includes resolving the question of what are appropriate forms of psychosocial aid: fast, results-oriented intervention or aid directed at the individual, which builds on the resources and self-healing abilities of those affected, and which accordingly raises social and political questions. There was strong agreement here: in view of the neoliberal assault on the psyche, it is high time to repoliticise trauma work. (Katja Maurer)
Detailed documentation of the symposium is available at www.medico.de/symposium
In 2012 medico promoted nearly 30 projects in the psychosocial area.
Self-help against isolation: NEAS in Sierra Leone
The Network of Ex-Asylum Seekers Sierra Leone (NEAS) is an organisation of people deported from Germany. In Sierra Leone, they frequently met new rejection. Ignorance of Germany's restrictive asylum policy has led to a widespread belief that the deportees had committed crimes in Germany. Families respond with disappointment to their destitute returning relatives, many break off contact. Overcoming this isolation is one of the goals of NEAS, as a place where those affected can share and help each other. NEAS tries to weaken prejudices through public events. In late 2012, it organised a migration forum in the capital, Freetown, where the discussion included the infamous practices of the German authorities – who finance travel by Sierra-Leone government delegations whose function is to attest to the citizenship of the refugees – the requested (deportation) travel documents are even issued for sick people. As an initial victory, government representatives invited NEAS to the Ministry of Foreign Affairs and promised to review their concerns in detail. NEAS has been supported by medico since its foundation in 2011.
Revolution gives courage: the Al Nadeem Center in Egypt
After the revolution in Egypt at the start of 2011, the Muslim Brotherhood government dissolved Mubarak's much-feared state security apparatus. However, they left in place many military and police officials who had been involved in torture and crimes of violence. Experience of the ability to break social taboos and the power of the rulers enabled the victims to speak out. In November 2012, thousands demonstrated in Cairo against the culture of impunity, among them Aida Saif Al-Dawla, director of the Al Nadeem Center, medico's new partner in Cairo. In her speech, the human rights proponent accused President Morsi of 150 proven cases of torture within just a hundred days of taking office. The Al Nadeem Center offers psychological counselling to victims of torture, helps women with gender-specific and often domestic violence, and assists African refugees in Egypt. Undaunted, the Center (which is headed by women) criticises the constitutional assembly, which is dominated by religious parties. The rights of women must not be restricted, and an absolute ban on torture must finally be given constitutional status.