Sierra Leone Post-visit Report

by April Naturale, PBB CEO

5.22.09

It is a long way from Boston, USA to Freetown in Sierra Leone on the continent of Africa. The return seems even longer. The time spent interacting with the Sierra Leoneans was anything but tiring. If there were ever a people who exemplify an ability to overcome adversity, at least on a psychological level, Sierra Leoneans seem to be that people.

It’s almost seven years since the war here ended. It is known as one of the most barbaric wars with some of the worst of atrocities known to man having been committed for years from one end of the country to the other. The worst part of the story is that much of the inhumane acts were committed by children forced under threat of death and dismemberment along with mind-numbing drugs.

The first actions taken by most families and non-governmental organizations that entered the country to help was to reunify loved ones. This included disarmament and demobilization and well as rehabilitation and reintegration of those youth who had been so cruelly pulled from their communities and psychologically tortured. Rebuilding the physical structures continues, but this country is largely dependent on aid just to survive with the basic supports such as food and safety.

Sierra Leone has historically been on the lowest end of the human index scale and is largely dependent on aid. The war exemplified their pre-existing problems. And now, ten years later, the country, and these vulnerable children and youth, are still at risk. Some of those who were associated with armed forces and armed groups have lost their families, lost limbs and many lost their sense of self. They were pulled out of school, away from family and forced (directly and indirectly) to enact atrocities upon each other, those they loved and their country. Many still suffer with substance abuse problems as a result of being shot up with drugs by rebels threatening to cut off an arm or kill them if they didn’t participate.

Returning to a life after war has found most of these youth without a completed education or skills to contribute to community life. Many were too afraid or ashamed to return to what family may have been left. Others were not accepted back into their communities.

There is opportunity to help those who remain hopeful that they and their families might build some normal semblance of a life. I met two students who were full of life and hope–Dominic and Benjamin. They are lucky, but still at risk of the threat of violence due to the fragile peace in Sierra Leone and the neighboring fighting forces.

Others are not so lucky. Their families don’t have the funds to send them to school. They don’t even have the funds for proper clothing.

I asked Biawama (I know I’m not spelling his name right; top) if he went to school and after a brief silence, with a bowed head he said yes. Clearly he had not been there along with Dominic and Benjamin, but he was ashamed to say no. Bomoi (bottom) had chores to do. I helped him carry his two heavy bottles of water. He had no English at all which was an indication he was not attending school. English is required at all levels in Sierra Leone and the children are the most proficient.

Psychology Beyond Borders plans to return to Freetown in September and continue planning with local psychosocial organizations and our collaborators at the Research Program on Global Adversity as to how to move forward. Education, skills building, counseling, community psychoeducation …these are all our early ideas that show an evidence-informed chance of actually helping. Keep posted for our follow up activities and check out the website for the next podcasts from former child soldiers.

New PBB Board Members

by Betsy Davis, PBB Administrative Assistant

We would like to welcome three new members to our Board of Directors: Dr. Amina Tareen (UK/Pakistan), Ms. Jacqueline Jacobsen (Seattle, WA), and Mr. Bill McLellan (Austin, TX). We are thrilled to have these individuals join the PBB team as we work towards our goal of alleviating psychological suffering around the globe.

DR. AMINA TAREEN (UNITED KINGDOM / PAKISTAN)

Child and Adolescent Psychiatrist, Barnet Enfield and Haringey Mental Health Trust

Dr. Tareen is an Honorary Consultant for the Special Education and Training Centre for Mentally Handicapped Children in Lahore, Pakistan. She received her education in Pakistan before moving to the UK to obtain her MRC Psych and CCST specialization in child and adolescent psychiatry. Dr. Tareen has extensive research and teaching experience in both the UK and Pakistan, including investigations of PTSD in children, the development of community-based and mental health services in Pakistan, and new ways of screening children for cognitive or developmental disabilities in Pakistan.

JACQUELINE M. JACOBSEN (UNITED STATES OF AMERICA)

Vice President of Investments, UBS Financial Services

Ms. Jacobsen is a financial advisor in Seattle, Washington. She is currently the Vice President of Investments for UBS Financial Services. Ms. Jacobsen has spent much of the last 20 years between Austin and Seattle, gaining experience specifically in investment management, financial planning, and estate planning, among other areas. As a Financial Advisor, Ms. Jacobsen prides herself on her ability to tailor her investment strategies to the needs of her clients, forming relationships with them that allow her to best advise them in their unique financial situations. She is registered in 19 different states across the United States.

BILL McLELLAN (UNITED STATES OF AMERICA)

Vice Chairman, Treaty Oak Financial

Mr. McLellan is an accomplished Senior Executive with a proven record of developing highly successful business organizations. He also has an extensive background in the health care industry, having served as the Executive Director of LifeWorks, the largest social service agency in Austin, and being on the Board of Directors for a wide range of health care institutions. Mr. McLellan also spent many years with the 3M Corporation, working from several different levels to develop their health care products. He is also an established member of the Austin community through his involvement with a number of civic and community organizations.

The PBB Staff is thrilled to have these new Board members on our team and we look forward to working with them on our current and future projects!

Q: When is conflict not really conflict?

A: When it’s to your benefit to say it isn’t.

I’ve just returned from the 32nd annual meeting of the International Society for Political Psychology, a strange society that brings together people from a variety of different backgrounds all interested in the ways that political processes affect and can be affected by human psychology.  Among the many excellent talks that were presented here, one in particular posed an interesting question for the domain that Psychology Beyond Borders works in.  Andrew Livingstone, a researcher from Cardiff University, along with colleagues Alex Haslam and Joseph Sweetman, has been doing work on the question of how groups come to label their interactions as conflicts or not conflicts.  Their presentation discussed their research.

Think of some disagreement you’ve had with a friend, leading to a tense discussion.  Was that discussion an argument?  Were you in conflict?  Obviously, the decision to call that interaction an argument or not has some impact on your perception of your relationship with your friend.  Now imagine you had the same discussion with your boss, or a coworker.  Now, is that same discussion an argument?  Livingstone and colleagues’ work suggests that whether or not you think it is depends on your status relationships.  Conflicts are inherently messy, and they upset the status quo.  Moreover, the term “conflict” implies that all the actors in the process are active in shaping the interaction, giving a certain degree of control to both people.  Both of these things are likely to be distressing to the higher-status person in the interaction.  Those with high status benefit from the status quo, and on balance they’re likely to prefer to see themselves as having a greater degree of agency and impact on any interaction than those with lower status.  Therefore, it’s protective of their status and self-esteem for them to prefer to avoid the label of “conflict” and instead see provocative interactions as not a big deal, or not a significant disagreement.  Livingstone and colleagues demonstrated this – showing that members of high-status groups were significantly less likely to perceive confrontation from low-status groups as “conflict.”  This doesn’t mean that they don’t retaliate – in fact, transgression by low-status groups lead to a significant increase in the desire to retaliate by acting to harm the low-status group.  But only covertly, not in any overt way that might be perceived as acknowledging the conflict.

How is this relevant to PTSD and the work of PBB?  Two ways.  First, it shows the way that intergroup conflicts can play out and lead to intergroup aggression.  If a low-status group agitates for some change in the system, then this research suggests that the inclination of the high-status group will be to ignore it or dismiss their complaints – overtly – but for violence and indirect responses against the lower status people to increase.  The protests in Iran and the response of the mullahs to these protests are impacted by a variety of different psychological and sociological factors, but it’s probable that at least part of the violent response comes from the fact that it’s in the high-status groups’ best interest to dismiss the protestors’ complaints as illegitimate.  As a result, the protests are dismissed as the complaints of bad losers, similar to soccer fans whose team has lost, while at the same time violent attacks by civilian militias ramp up.  To acknowledge that there is a conflict would be granting a status to the protestors that the authorities don’t want.

Perhaps more importantly though, this research also shows the reasons why some conflicts between equally matched opponents, such as world war II, are easily presented as war while other conflicts including mismatched opponents, such as Vietnam, attract the official titles of “police action.”  Of course, this psychological pressure is not the only reason for drawing such a distinction, but it does point to some psychological processes that may encourage members of high-status groups to downplay and ignore some kinds of conflict.   This is likely to have a strong impact on the experience of those who fought in these conflicts.  A good understanding of what conflict is intended for and what it can achieve can help to improve meaning-making, providing a context where the survivor can explain why they went through the traumatic event.  As discussed before, this can have a strong effect on the long-term impacts of the traumatic events.  This research can help to explain why the veterans of Vietnam returned to the US to find a society that was not much interested in validating their experiences or dwelling on the war.  To overtly acknowledge the conflict as a conflict, instead of a police action or the US troops as “advisors” would be to put the US and the Vietcong on too equal of a playing field.  The psychological pressure is to dismiss this, robbing the veterans of the meaning they might get from framing the conflict as a war.

The words we choose when we describe situations are important.  They act as frames, guiding us to view the situation in one light or another.  Whether we choose these words intentionally or they simply reflect underlying psychological processes, the language we use both reflects and affects our processing of information.  Something to think about, the next time you find yourself trying to decide if an interaction you just had counts as an argument or not.

Episode 4: Naomi Tutu, International Peace and Human Rights Activist

Click here to listen to Episode 4 of Beyond Fear: Managing the Psychology of Terror

How can Western non-profits engage in true partnership with international organizations to achieve social change? What themes in activism and relationships are emerging amongst young people? What vital role can Psychology Beyond Borders play in global human rights work?

In Episode 4 of “Beyond Fear,” Naomi Tutu, international peace and human rights activist, addresses these questions and speaks about her experiences with international psychology, the role of partnership in international aid work, and the crucial importance of Psychology Beyond Borders in today’s world.

Naomi also shares stories from her life, including the moment she stepped into her own voice as an advocate for human rights, and what projects are the current focus of her passionate work.

The challenges of growing black and female in apartheid South Africa have led Nontombi Naomi Tutu to her present work as a passionate advocate for peace and human rights. She has an extensive background addressing the human rights of women and the global problem of intimate violence.

Ms. Tutu is the third child of Archbishop Desmond and Nomalizo Leah Tutu. She was born in South Africa and has also lived in Lesotho, the United Kingdom and the United States. She was educated in Swaziland, the US and England, and has divided her adult life between South Africa and the US.

Naomi’s father, the Most Reverend Desmond Tutu, has been an active member of the clergy since he was ordained in Johannesburg in 1961. He served as the General Secretary of the South African Council of Churches from 1978 to 1985, during which he led great efforts in opposing apartheid and striving for racial reconciliation. For this work, he was awarded the Nobel Peace Prize in 1984. In 1996, he was appointed as Chair of the Truth and Reconciliation Committee in South Africa by President Nelson Mandela. Since fulfilling these duties, he continues to be involved in social justice efforts, sharing his wisdom and experience through activism in academic institutions, governmental groups, and humanitarian organizations.

Growing up the ‘daughter of…’ Reverend Tutu has offered Naomi Tutu many opportunities and challenges in her life. Most important of these has been the challenge to find her own place in the world. She has taken up the challenge and channeled the opportunities that she has been given to raise her voice as a champion for the dignity of all.

Naomi Tutu’s professional experience ranges from being a development consultant in West Africa, to being program coordinator for programs on Race and Gender and Gender-based Violence in Education at the African Gender Institute at the University of Cape Town. In addition, she has taught at the Universities of Hartford and Connecticut and Brevard College in North Carolina.

She has also led Truth and Reconciliation Workshops for groups dealing with different types of conflict. Together with Rose Bator, she presents a workshop titled Building Bridges dealing with issues of race and racism. The two also lead women’s retreats through their organization Sister Sojourner. They are also writing a book provisionally titled I Don’t Think of You as Black: Honest Conversations on Race and Racism.

Naomi holds an MA in International Economic Development from the Patterson School of Diplomacy and International Economic Development   at the University of Kentucky. She received an honorary doctorate from Bentley College in Waltham, MA, in 2007. In addition, she was awarded an Honorary Doctorate by the Universal Orthodox College of Ogun State, Nigeria in 1985.

In addition to speaking, Naomi Tutu is a consultant to two organizations that reflect the breadth of her involvement in issues of human rights. The organizations are the Spiritual Alliance to Stop Intimate Violence (SAIV), founded by renowned author Riane Eisler and Nobel Peace Prize Laureate Betty Williams, and the Foundation for Hospices in Sub-Saharan Africa (FHSSA).

Ms. Tutu is a single mother of three children and currently lives in Nashville, TN.

Click here to subscribe to the Beyond Fear: Managing the Psychology of Terror podcast in iTunes.

Produced by Psychology Beyond Borders
Edited by Emotion Technology
Hosted by Jennifer Gandin Le

Right Here in the U.S.

By April Naturale, PBB CEO

Throughout the US, there are areas of the country where people raise families without electricity, telephones or running water. Such circumstances exist in pockets in most states in the nation-NY, California, South Dakota, North Carolina and Florida are some examples. When we talk about resilience, one state that should be held as an example of this is Alabama. Because they are such an economically poor state, they access all of the national supports that are available. Alabama is one of the most well prepared states when it comes to disasters and were even quite self sufficient after Katrina wiped out the coastal areas of Gulf Shores and headed into Mobile. They had just completed training over 250 crisis counselors two weeks before Katrina. When asked how they were managing the storm’s effects they replied, “It’s awful-the worst we’ve ever seen-but we know what we’re doing.” PBB conducted a day and half disaster response training update for the  Alabama statewide response teams including public health, mental health/substance abuse and emergency services staffs June 15 and 16th.The recipients were as attentive and interested in this subject. The training will be available via the Center for Disease Control’s (www.cdc.gov) videoconferencing network.

PBB Board of Director featured in an UC-Irvine online article

Psychology Beyond Borders’ Board of Directors member, Dr. Roxane Cohen Silver is featured in the University of California-Irvine’s website with an article titled “Taking Coping Skills Global”. The UC-Irvine article addresses Dr. Silver’s work with PBB on teaching coping skills to communities in Yogyakarta, Indonesia impacted by the 2006 earthquake.  Dr. Silver is a professor in the Department of Psychology and Social Behavior and the Department of Medicine at the University of California, Irvine. An international expert in the field of stress and coping, Dr. Silver is a member of the Academe and Policy Research Senior Advisory Committee of the U.S. Department of Homeland Security where she provides ongoing advice to the Department of Homeland Security on the psychological impact of terrorism and disasters. She is a leading researcher on both the acute and long-term physical and psychological impacts of fear and terror. PBB greatly appreciates Dr. Silver’s contribution to our work and mission! Click here to read the article about Dr. Silver’s work.

Welcome new PBB Board Member Merle Friedman

By Laurie, PBB Administrative Officer

The PBB staff would like to welcome Dr. Merle Friedman to our Board of Directors.

Merle is a clinical and corporate psychologist and a consultant to corporate leaders in South Africa. She was Co-founder of the International Society for Traumatic Stress Studies, and was Co-founder of the South African Institute for Traumatic Stress . As Professor Friedman, she spent five years lecturing at the school of Psychology at WITS University before opening her own consulting firm, Psych-Action. She has extensive experience working with senior management teams throughout the country. Merle is frequently invited to speak at conferences around the world on topics such conflict, traumatic stress, and empowerment issues. She has also consulted closely with chief negotiators of the South Africa peace process, i.e. Rolf Meyer and Cyril Ramaphosa.    With her help and expertise PBB will continue to grow accomplish our mission.  Welcome Merle, on behalf of the staff at Psychology Beyond Borders we look forward to working with you.

Can political commitment protect people from PTSD?

On Friday, June 19th, the Ayatollah Khamenei made it clear that the Iranian government and citizen militias  would not shy away from using violence to put down the protests occurring in the country.  Although the protests had already been met with some violent responses, this was widely perceived as an announcement that the enforcement would be stepped up and that protestors would face much fiercer response.

From what we can see of the response to this speech, it’s clear that many of these protestors received this message with sadness, deep concern, and fear, but that their commitment to their movement did not waiver.  Throughout the past week, their fears have been validated.  Pictures and videos from Iran have shown the force being used against these protestors.  Brutal videos of young people dying in the streets of Tehran have stood testament to the violence that they are experiencing.  The impact of these experiences appeared in the short term to be to strengthen the movement rather than weaken it.  The deaths of those killed in the violence are quickly becoming symbols of the movement, statements that reinforce the protestors’ belief that they are fighting for what is right.

These protestors in Iran are demanding that the government live up to its promises of democracy.  This movement may have lasting impact on the political system inside Iran or internationally, but it’s too early in the process to tell.  However, it’s guaranteed to have a lasting impact on the people of Tehran who witness this violence.  Will the protestors on the street, facing brutal opposition and witnessing traumatic events, suffer the long-term effects of PTSD?  It’s certain that some will, but it’s also likely that most will not.  Research on the pathways that lead to PTSD suggest an interesting relationship between political commitment and traumatic events.

Metin Başoğlu, a researcher who studies the psychological impact of torture, conducted one of the best studies on this phenomenon when he and his colleagues compared Turkish prisoners arrested and tortured because of their commitment to political movements with prisoners arrested and tortured for non-political crimes (Başoğlu et al, 1997).  They found that even after accounting for the effects of education, socioeconomic status, and other effects, political prisoners suffered significantly less PTSD.  This is consistent with anecdotal reports from an Israeli colleague working in Gaza, who once told me that the people he worked with who truly, passionately believed in their cause – whether Palestinian or Israeli – may have experienced more traumatic events than others but “just don’t get PTSD.”

Why is this?  There is no certain conclusion that is accepted by all researchers, but one likely explanation has to do with *why* traumatic events cause PTSD.  Among the many physiological and psychological changes caused by threatening events, one has to do with people’s perceptions of the world.  Most people believe that the world is, overall, a fairly safe place filled with people who are on balance kind, that bad things are unlikely to occur, and that we have control over our own lives and experiences.  Traumatic events shatter this perception, and force people to very quickly assimilate a new worldview in which terrible things, uncontrollable things can happen (Foa, Steketee,  & Rothbaum, 1989). This adjustment can be difficult for many people, and can contribute to the post-trauamatic distress leading to the symptoms of PTSD.   For people committed to a political perspective and particularly for those who are activists working in oppressive regimes, however, it’s often the case that they do not have such a rosy worldview.  People committed to political activism by definition see some flaw or problem in the system or the group that they are working against.  To many activists, it is easy to see the group they are working against as cruel or uncaring or unwilling to acknowledge the harm that they do – and this is even easier when this belief is validated by violence used against the activists.  Because of their beliefs, the idea that the group the activists are working against might use violence is not a shock to their perspective, and when they experience torture or violence directed against their allies, it can serve to reinforce their beliefs that the opposing group is mistaken or evil.  This does not cause a significant change in their beliefs about the world, and hence may reduce the shock of their traumatic experiences by reducing that aspect of the impact of a traumatic event.

Does this mean that this kind of political commitment is a positive?  Not necessarily – the kind of commitment that leads someone to believe that those who disagree are evil enough that they might use force also makes it easy to demonize and ostracize the other perspective.  When the conflict is not at the point of direct violent conflict, and there is the possibility of collective problem solving, this kind of hardening of political perspectives can easily contribute to a cycle of extremism that makes it difficult for groups to come together to collectively solve problems (Seyle & Newman, 2006).  So what’s good for the individual might not be so good for society.  On the other hand, this is good news for those who stand up to oppressive regimes to demand their rights, and who take their experiences of violence and threats and turn them into increased justification for what they are fighting for.  This commitment, strengthened by the terrible events they undergo, may be the best thing for their mental health in the long run.

PTSD and the PFC

by Betsy Davis, PBB Administrative Assistant

Ever since taking a cognitive psychology course in college, I have been fascinated with the Prefrontal Cortex, or PFC–an area of the brain located just behind the forehead. One of the PFC’s major functions, along with decision-making, working memory, and long-term planning, is inhibition, both cognitive and behavioral. On the behavioral end, it is this part of the brain that allows us to not say and do everything that pops into our heads. It can be argued that the PFC is a large component of our “humanity”–facilitating the social interactions and communal living that are so core to the human experience. Cognitive inhibition, on the other hand, is responsible for allowing us to focus and block out (or inhibit) other distractions. But how does it relate to PTSD?

Researchers are now looking into the link between lower inhibition (the inability to block thoughts or actions) and mental health. They are starting to see connections between inhibition and several disorders, such as Attention Deficit and Hyperactivity Disorder, Dissociative Identity Disorder, and–you guessed it–Post Traumatic Stress Disorder (PTSD). They are finding that individuals with PTSD are more likely to score lower on inhibition tests than other participants without PTSD.

Amir et al. (2002) used homographs (words with double meanings, such as “mug”) to assess two things: 1. the frequency of interpreting the words as their “threat” meaning and 2. the ability to inhibit the “threat” words. They found that traumatized participants with PTSD had significantly more trouble inhibiting the words interpreted as threats than did traumatized participants without PTSD.

Another common test used to assess inhibition is a modified Stroop paradigm, in which a participant is given a page containing trauma-related and emotionally neutral words, written in different colors. Participants are asked to inhibit–or block–the word meanings and only state the color of the writing. Studies have shown that participants with PTSD take a significantly longer time to name the color of the trauma-related words, as compared with both non-PTSD participant conditions and emotionally neutral words, indicating a decreased ability to block the meanings of trauma-related words.

An unmodified Stroop paradigm is a test of an individual's inhibition. Researchers calculate the time and errors while participants call out the colors of the text, not the words themselves.

All this being said, it is still unknown whether decreased inhibition is a risk-factor for developing PTSD or if PTSD somehow causes the PFC to no longer be able to inhibit trauma-related signals. Nevertheless, it is easy to see how an inhibition deficit could lead to  unending thoughts of the traumatic event and an inability to think about other things. This decreases one’s ability to cope normally and greatly hinders daily functioning. As the knowledge of this connection grows, researchers and clinicians will be able to inform the work of organizations such as Psychology Beyond Borders with new ways to treat and prevent PTSD. Perhaps there are hormones that can be given to boost PFC functioning? Or ways to practice and develop inhibition? Who knows where this knowledge will lead, but it is one more area on the trauma research frontier to keep an eye on because of the great potential for cognitive relief in post-trauma populations.

PBB Fellow Gaea Logan hosts Tibetan Spiritual Leader (part II)

By Betsy Payne, PBB Projects Officer

PBB Fellow, Gaea Logan provided additional information about Khen Rinpoche and the Tibetan spiritual leader’s history. According to Gaea, the Dalai Lama, the Panchen Lama and the Karmapa are the three highest ranking lamas in the Gelugpa tradition of Tibetan Buddism. Khen Rinpoche is the abbot of the Tashi Lhunpo monastery in exile, the relocated monastery of the Panchen Lama. The story of the Panchen Lama remains to be one of the most difficult issues facing Tibetan/ Chinese relations today especially as it is integral to the question of the selection of the next Dalai Lama. Historically it is the Panchen Lama who is said to recognize each next Dalai  Lama in a complex and hostorical process of selection.  However, the current Panchen Lama was abducted by the Chinese in 1995 at the age of 6 and is considered the worlds youngest political prisoner by supporters. His Holiness the Dalai Lama appointed Khen Rinpoche to the role of Abbot to his monastery, to stand in the role of the missing Panchen Lama while China appointed their own . The issue is a painful and delicate area of conflict for Tibetan /Chinese relations.