Jan. 2014 Newsletter: Peace/Justice & Issue of Mental Health

Welcome to the January 30, 2014 edition of this Peace&Justice action email!

After missing a few months, it will be good to get back to the regular action-oriented newsletters in a couple of weeks.  This newsletter, however, is the first in an occasional series to focus on a broader topic.  As promised well over a year ago, the first topic is the issue of mental health.

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PEACE, JUSTICE AND THE ISSUE OF MENTAL HEALTH
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This newsletter is primarily action-oriented.  But this section is the first topic in a new, occasional feature that will try to cover more in-depth or provide a broader perspective on a topic.  Given that stacks of books are written about any general topic, the goal of such a section is quite modest and can do no more than to expand slightly on a couple of topics within the fuller spectrum.  That was one reason why this feature was delayed until this newsletter had an accompanying blog (its address is at the top) – please consider using the blog to supplement or critique the ideas presented.

Our first focus deals with the issue of mental health and its far-reaching consequences. Mental health is not usually categorized directly as a peace and justice issue.  But individually people dealing with mental health problems are often marginalized or stigmatized, and thus as such it is becomes a peace and justice concern.  And as noted below, it is also a peace/justice concern in more standard ways.  This section will provide a few introductory comments and then highlight the current status and hopeful directions.

 

INTRODUCTORY POINTS

This section assumes that humans consist of incredibly complex layers that we have barely begun to understand.  This century holds great possibilities to unlock some of the chains that have held people in misery and have even brought about their death due to a primitive understanding of mental health. But noted below, it won’t come without much struggle, since concepts, framings and images will continue to be debated, refined and sometimes discarded.

This article assumes that attitudes are changing in the Western world, although we are in its early stages.  The above chains stem from an inherited worldview that either looked down upon those with mental health issues because they simply lacked the will to change, or worse, for other circumstances, relegated them to some incomprehensible deranged world, where they were locked away and out of sight.  Either way, if people were even aware of their (or their family’s) condition, it was kept hidden if possible, because it meant being ostracized and marginalized.  The shifts are occurring at two levels.  Within academia and the medical professions, there have been significant advances over the last 60 years, sketched below. As is often the case, it takes 10- 20 years for such changes to filter down to the general public.  Thus generally within society we are grappling with removing the stigma from these conditions (this is good), based on research from a decade or more ago.  Yet at the same time, due to the immediacy of the internet, we are also influenced by the current academic dynamics and its in-flux debates.  Due to this double level of dynamics, and the resulting bewildering array of attitudes that currently swirl around us, this article is structured around two anchoring affirmations (see further below).  They are meant to be the most basic and suitably affirming and empowering affirmations possible, given our current stage of progress.

 

GENERAL TOUCHSTONE OF WELL-BEING

Given that the ultimate touchstone of this newsletter is the notion of Well-Being, and thus also as preamble, I want to start by sketching the notion of a “well-adjusted person.”  I will use extremely broad brush strokes, given that this newsletter goes out to a few differing cultures, but then will hone in more specifically on Western society and North America in particular.

The well-adjusted person: This is no monotone, but includes the full diversity of people, from gregarious to quiet, wild risk-takers to cautious types, action-oriented to contemplative to research focused.  The common threads are that:

  • They have no desire or need to harm anyone including themselves;
  • They have a basic sense of dignity and self-respect;
  • They have a basic sense of fairness and compassion for others; and
  • They have a basic openness to life.

They will remain very human, with the failures, scars, and sadness that go along with times of joy, etc.   Wide diversity remains – any such person will exhibit either more, or less, of any of the above aspects, than someone else.  The chief point is that while carrying and at times exhibiting the lesser side of being human, such dynamics do not go beyond certain bounds nor impair basic functioning (and, as discussed below, to the extent “bounds” can be defined, for the past many decades that is traditionally the domain of the mental health professions).  In addition, to help keep clear all the shades of gray, many people along the continuums of various mental health dis-orders can fit quite well into the above extremely broad characterizations.  As framed within this article, well-being is the broadest category which includes aspects well outside any individual.  Within that, mental health informs a few of the aspects of well-being, as defined in the above link.

 

SPECIFIC TOUCHSTONE OF MENTAL HEALTH

An informal definition of mental health is “the psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment.”  Thus, in terms of the focus, here, on mental health, the key concept is in establishing those “bounds” on the one side of which something is a normal, though painful, condition of life; to the other side of which something becomes a clinical diagnosis.  More on this in a moment, but in the context of this article it is important to raise a crucial, anchoring affirmation.

 

OVERALL AFFIRMATION:

People dealing with mental health issues should be given the same dignity and respect due everyone else, and specifically, given the same regard and support as anyone dealing with a physical illness.  There should be no stigma or marginalization; rather there should simply be an exploration of symptoms leading either to its resolution, or if such does not exist yet, to its management within the context of normal living.

This broad affirmation is meant to cover the full spectrum of those dealing with mental health issues. What follows are two refining affirmations within that broad umbrella – those dealing primarily with biochemical aspects, and those dealing primarily with traumatic circumstances.  Naturally life does not completely fit into two such neat compartments, but the key point here is that among all the layers that make us who we are at a given point, there are those who do fit within these two broad categories and for whom the following refining affirmations need to be clearly raised. [and please feel free to go to the Blog and add any other areas that you feel should be included in Part II of this article, should such ever be contemplated].

 

AFFIRMATION: PART ONE:

There are clinical diagnoses that have nothing to do with “choice” or “will”, but are the result of varying complex interactions of biochemical and other factors.

For example, could there ever be someone with stronger will, grit and determination than the only person in history to win multiple Olympic medals in both the Summer and then Winter Olympics?  Her name is Clara Hughes and a couple of years ago she revealed how she suffered from deep depression through much of her life.  If she couldn’t “will” herself out of it – and she couldn’t – then no one can.  Clinical depression is an illness not a choice or weakness.  The same can be said for many other conditions – bipolar, seasonal affective disorder, and so on.

Awareness of this affirmation is essential, firstly to those who suffer such conditions, so that they recognize they are not at fault and are not alone but should simply seek the clinical help as they would for any medical condition.  Secondly, it is necessary for friends and family, so that they recognize and provide support for this reality.  Thirdly it is crucial for society at large to come to this awareness – in North America a shift is slowing occurring but much too slowly – so that the marginalization and stigma disappear.  Until you have seen or experienced it, it is hard to imagine the power of “shame”.to immobilize and silence oneself, feeling so unworthy or ashamed, cued by the seemingly unattainable “normal” world around oneself.  This backdrop of an utterly misplaced sense of “choice” or “will” arises from our inherited medieval views, and for the sake of all, we must ensure this affirmation overwhelms such antiquated and harmful notions.

The second part of the affirmation is further below.

 

DIGGING DEEPER

With this basic affirmation to anchor us, it is also important to raise up the much murkier context within which we find ourselves as we go through the 21st century.  The mental health profession – for instance in the U.S. it would include the American Psychiatric and also Psychological Associations – is mandated with determining what constitutes a clinical diagnosis.  It is a field that holds enormous promise – many insights have already been of great benefit.  But it is also fraught with much controversy.  The U.S. profession’s basic touchstone or “bible” is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).  The first one – DSM-1 – came out in 1952. [It should be noted that the DSM is not the only “bible”; the World Health Organization system of diagnosing mental health conditions is called ICD-10 (International Classification of Diseases)].

Firstly, insights do not simply happen – they are part of a process that starts with an awareness of the inadequacy of current paradigms, the grappling for better explanations, the testing of them, refining them, and so on.  An example of this would be the mental health profession’s history of grappling with the topic of homosexuality.  Officially classified as a mental disorder in 1952 (DSM-1: a “sociopathic personality disturbance”), by 1973 and then 1986 the profession had dramatically changed to viewing it as a normal variant of human sexuality (see Sketch of DSM Views of Sexuality [PDF]). Thus it took 21 plus another 13 years to settle the status of this issue.

Secondly, this essential back-and-forth process to gain insight has become vastly more complex over the last several years as science has greatly expanded its repertoire of tools available for exploration.  From neuroscience to epigenetics, it has expanded both the possibilities for greater insight and further blurred lines that had been distinct.

 

CURRENT CONTROVERSY / COMPLEXITY

The current state – continuing to use the U.S. as a touchstone – is well illustrated by the newly revised Manual (DSM-5), released earlier this year.  It has been so controversial that it has resulted in numerous petitions and calls for boycotts (for example: Concerns from author of DSM-IV; and also: Concern/petition from U.K.).  The basic issue, oversimplified, is whether the more granular view that can be seen, should lead one toward seeing things as more, for instance, biochemically derived, or whether these reductionist tendencies are going too far, leading to lower thresholds for a diagnosis, more categories, and overall in many cases to over-medication.   Here is a quote to give a flavour of the debate:

The problem . . . {is the concept that} . . . mental illness is neurobiological, and that psychosocial factors are not that important.  This . . . has led to a serious over-prescription of medications.
Here, I think of a friend who went to see a psychiatrist during his divorce, and emerged from his first session with a diagnosis for “soft bipolar” disorder and prescription for anti-psychotics. Love, loss, guilt, thwarted dreams, sudden shocks, mounting pressures, these are slings and arrows, not chronic disease. [Globe and Mail, April 2, 2013]

 

To be clear, most everyone acknowledges that there are conditions that are created by biochemical imbalances and best addressed through medications that attempt to rebalance things (and hence the anchoring affirmation).  The main controversies lie beyond that.  This article will raise several aspects (and not directly linked to DSM-5).

1. Early stages of discourse, and guideline: there is simply the fact that we are in the early stages of this next level of discovery and discourse.  As noted it can take years or decades for a hypothesis to emerge as a clear insight.  Within that, the mental health / medical / scientific communities must grapple with the relationships around root cause(s), symptoms, diagnoses, treatments and results.

For those caught in such circumstances during this back-and-forth phase, a good guideline would be to work with your mental health professional, etc.  That is, on the one hand, their expertise should be recognized.  On the other hand, one should not be afraid to probe the bigger picture and current possible paths, questioning where a path is quite solid versus simply being the best hypothesis at the moment.  Some mental health practitioners are glad and even relieved to acknowledge areas where insight is not yet well-grounded, etc.  The internet, when used well via responsible websites, can be a source of seeing where the edges of an issue currently are, though one must guard against irresponsible sites which can post misleading, false and even harmful information.  One must also guard against the difference between being well-informed and being an expert (though, as noted below in the “20,000 word essay”, even “expert” can be a controversial term).

2. Issue of power:  There is the role of power, particularly Big Pharma (that is, the dynamics that form around the intersection of the giant multi-national pharmaceutical companies, political manipulation, corporate espionage and consumerist media and PR dynamics), a topic unto itself.  Insight occurs most often after years of research, which requires funding.  Fortunately some funding and support come without strings attached.  But the chief Big Pharma contours are: (a) that some research becomes determined by the funder’s priorities. This can skew the direction that research goes; (b) Big Pharma is large enough to sponsor its own research people, which at times can have an intended motivation to distort emerging insights; (c) As the stakes get higher, political dynamics can kick-in such as influence peddling, which can delay or distort regulatory policies as well as combining with PR efforts to deliberately distort facts. By analogy, the tobacco industry is a good example of such tendencies.    Insight will eventually emerge – tobacco does cause lung cancer – but when Big “Industry” uses its resources to fund pseudo-science plus joins that with political influence, the valuable insight can be delayed for years, causing terrible suffering.

Because of the above reductionist aspects, we find almost anything can be medicated.  But that doesn’t mean everything should be.   and we have Big Pharma that loves to find revenue avenues.  Thus we find ourselves in the swirl of modern medicine.  I am so thankful we have attained the level we have but I still call it primitive, and the process should be approached with clear eyes.  The responsible side of the drug business has produced many wonderful and live-saving medicines, but the enormous scope and power of the huge complex called Big Pharma requires watchdogs and vigilance.

Other sources of power that play into this controversy are the institutions themselves.  In this case that includes both the American Psychiatric and Psychological Associations, as well as all the pressures within academia itself.  The “20,000 word essay”, below, gives a little sense of the buffeting that can occur within and among the associations and also academia.  In addition, insurance companies have a stake in these dynamics, although that is not explored here.

3. The issue of alternative therapies:  Meditation or yoga may be more effective at reducing anxiety for some people.  Substituting “natural” ingredients for synthetic ones may work for a fraction of the cost and with less side-effects in dealing with some mental health issues.  Acupuncture may play a positive role in some cases.  This broad category of “Alternative therapies” is a spectrum that ranges from sensible solutions (in contrast to some unneeded and costly items that Big Pharma might push) to utterly outlandish and potentially harmful claims.  There is a swirl of ideas around the boundary between the body and mind. In the same way that we remain in early stages of understanding the biochemical side, we also have a poor understanding of how the mind or other seemingly non-reductionist dynamics play into our mental health.  And thus while there is promise there must also be caution, especially for those for whom the Basic Affirmation holds.  If something is truly biochemical in origin, there can be great danger in thinking the power of one’s mind can dramatically alter things – it becomes a variation of thinking one can “will” oneself out of something that is bio-chemical in nature.

4. Meta View:  There does exist the notion that anyone who is “well-adjusted” to a Western (or globalized), highly dysfunctional, meta-power manipulated, and destructive system, can hardly be considered to be in a healthy mental state.  At first blush this notion may seem to have no overlap, dealing with the grand dynamics of sociology, political philosophy, etc.  But the point does have some merit if the comparative microcosm of one’s own personal mental health might be influenced by the environment (both the physical one of the quality of the air, water, land; and the dynamics of a society’s worldview and ethos)   This newsletter’s anchoring around Well-Being leans heavily in that direction, although this form of dysfunction is largely in a realm beyond the scope of this essay to pursue.

5. Universal; and role of poverty:  As this essay now moves from the biologically-based mental health issues, above, to mental health issues that arise from circumstances, below, it should be noted that these are universal conditions.  Specifically, both forms occur in both developed and developing countries.  What varies are the ratios.  For instance, as indicated in the following link, the World Health Organization (WHO) indicates that a much higher percentage of people with severe mental disorders will receive treatment in developed countries (50–65 percent compared to 15-25 percent in less developed countries).  However, poverty, even in developed countries, reduces the percentage who receive treatment.
Rethinking Mental Health In Africa  [IRIN]

For example, it is estimated that 18,000 Indonesians are still shackled (’pasung’), largely in remote areas with no mental health services, even though it has been illegal since 1977.  About 19 million suffer from various mental health disorders (in a population of 242 million), and another million from severe psychoses.  The Indonesian government is trying to rectify this situation, given there is a much better understanding of the mental health field.  The prime obstacle is trained professionals, although societal stigma also plays a large role.
Mental Health & Shackling in Indonesia  [IRIN]

 

 

 

WHAT CAN BE DONE OVERALL?

The Basic Affirmation contains many general guidelines for action. In addition, within that is the phrase “given the same regard and support”:

Same Regard: This is the domain of a society’s ethos.  Action to change a worldview is best framed within the many stages and layers of the Process of Change model.  Awareness is the first stage, and as mentioned, there has been much movement, depending on location.  Regardless, while many brave people have publically made their illness known, the tipping point has not been reached where anyone would feel safe to disclose their status.  Writing articles, letters to editors and sharing with others remain a vital element to bolster this aspect.

Same Support: While this can and must include family and friend support, this is primarily the domain of politics – actions that invest in structures and policies that strengthen the support for mental health.  Many jurisdictions, when feeling fiscal pressure, decide mental health expenditures are a low priority and thus first to be cut.  Reversal of such wrong-headed calculus requires creation of or financial support for advocacy organizations, as well as such action as writing to one’s representatives, creating or supporting petitions in one’s area, or writing to media.  More actions are given at the end.

 

Related Articles:
[With such an enormous topic, I decided to keep this list minimal.  It simply gives a classic mainstream-critical view (New Internationalist) and also raises the role of media, which helps shape one’s worldview.  Beyond that it is more productive for one to do one’s own web search, within the above guidelines.]
DSM-5 Website
Mental Health & Social Views [New Internationalist]
Mental Health Facts (single page)  [New Internationalist]
Role of Media in Portraying Mental Illness [openDemocracy]

[The following 20,000 word essay is from Dr. Simon Sobo.  Schooled at the Albert Einstein School of Medicine, he started as a Freudian, but quickly became highly critical of that approach, at least until the overall pendulum swung so far away, that he felt “the baby being thrown out with the bathwater” and reversed his own path, advocating for at least some nuanced place for Freud.  Retired now, he spent his whole career grappling with DSM-III and then the transition to DSM-IV. This newsletter is in no position to assess his professional stance.  The purpose is solely to illustrate, in longitudinal form, the dynamics he saw and felt, which include the back-and-forth of ideas; many of the above power issues, some of which he had the honesty to admit he had either fallen for or been part of; and even questioning whether anyone should be called an “expert.”]
One Assessment of DSM-IV [20,000 words]

 

 

 

PART TWO: MENTAL HEALTH AND PERSONAL TRAUMA

There is a largely different form of mental dis-order that can arise within the peace/justice domain.  As opposed to the above situation, people here have no unusual biochemical or other factors that are responsible for the condition. This is the realm of the deeply traumatized victim  It is the world, for instance, of victims forced into being child soldiers; or victims of rape (often used as a weapon of war to demoralize a people); or as a witness to the slaughter of one’s family.  It is also the realm of being a soldier and being traumatized as a result.  Thus, as an example, Post-Traumatic Stress Disorder (PTSD) has entered our vocabulary, although its full impact is far from fully recognized.  Also, while PTSD is generally associated with war it is finding application within a much wider range of the human condition, such as domestic violence.

 

BASIC AFFIRMATION: PART TWO

Personal trauma, whether clearly identified or not, can produce clinical diagnoses that exhibit themselves in various ways (Post-Traumatic Stress Disorder, or PTSD, is the best known but not the only possible resulting disorder).

Similar to the first affirmation, awareness of such conditions is essential, firstly to those who suffer such disorders, so that they recognize they are not at fault and are not alone but should simply seek the clinical help as they would for any medical condition.  Likewise, it is necessary for the layers of friends and family, and of society at large, to recognize and provide support for this reality, and reduce the stigma around the issue.

 

CURRENT COMPLEXITY

Like the first affirmation, the notion of formal mental illness diagnoses arising from personal trauma, forms a spectrum, from clear cases through to increasingly controversial ones.  For instance, one dimension of the complexity is that people react differently to the same traumatic event.  The issue of resilience is but one aspect of the full picture about which we have an incomplete understanding.  Not every soldier develops PTSD.  That has been part of the difficulty of those who suffer with it – it can appear as though they are the weak ones.  Sadly, statistics such as those in the links below indicate how ravaging such a disconnected societal bravado can be, upon the individuals who commit suicide, and upon the soldiers’ families for the personality upheavals it can wreak on a family, even if it does not lead to suicide.  To reinforce our society’s abysmal lag in adequately responding to this, a few hours after I typed the previous sentence, the CBC indicated how three Canadian soldiers (who had fought in Afghanistan) had committed suicide that past week.

The term PTSD originated in the 1970s following the Vietnam war and was originally called post-Vietnam syndrome, though precursors to that would be “shell shock”, etc.  The broad contours are that following a traumatic event (which include feelings of intense fear, horror or helplessness) there are recurring flashbacks, avoidance or numbing memories of the event, and high levels of anxiety that last more than a month.  PTSD can also have a delayed onset, with symptoms not showing up until long after the precipitating cause.

Basic Clusters: Currently PTSD refers to a broader spectrum than simply the military domain, roughly forming three clusters, showing its expanded usage; those suffering from PTSD who are: (a) in the military; (b) in other professions who face traumatic scenes (for example, first-responders or disaster-relief workers); and (c) victims of violence, which includes victims within the dynamics involved in (a) or (b) [how many would that include among the millions in refugee or IDP camps which are sometimes still targeted, hiding in caves, surviving in temporary, dilapidated shelters and so on?], but also those who remain in the shadows, such as victims of domestic abuse.  Domestic abuse itself has barely emerged from being a taboo topic itself, depending on the culture, let alone acknowledging the spouses or children suffering PTSD as a result.

Child Soldiers: Child soldiers deserves special mention (UNICEF estimates up to 300,000 in 30 conflicts).  They end up doubly traumatized.  Firstly in most cases they are abducted.  They either simply disappear or a militia will come through the village, and the child will be taken often after having watched his family killed, raped or tortured. Secondly they are traumatized again as the leaders force them either to be sex slaves or to kill others, the latter sometimes initiated by killing either family members, best friends, or villagers (so they feel there is no way to return home).  The overall topic is beyond the scope of this essay, other than to say that effort is being made on the ensuing mental health issues which are part of the DDR (demobilization, disarmament and reintegration into society) process.  For an overview, see Child Soldiers [IRIN];  and Strategies & Measures  [childrenandwar.org],  Psycho-social work [child-solider.org].  While youth are more resilient, far too few make it into good DDR programs, and even if successful, the broader environment that they graduate into (few jobs, ongoing civil strife) can ensnare them.

Mass Internal Targeting.: Finally, while all trauma is ultimately personal, there is the additional level of dynamics that occurs when an entire group is victimized, such as occurred with Pol Pot in Cambodia, the 1994 Rwandan genocide, and so on.  There are layers of dynamics, from the deliberate perpetrators, to the willing participants, to the participants who knew they otherwise would be killed themselves, to the purely innocent, etc.  While this horrific type of trauma individually will share the above issues, it has the additional problem that because it can tear an entire society apart, there is a less resilient normal societal network to support oneself.  As well, the perpetrator may still live down the street.  Thus Truth and Reconciliation Commissions (TRCs) were created, the best known being South Africa’s TRC, created in 1995 by Nelson Mandela and chaired by Archbishop Desmond Tutu.  In modern memory one might go as far back as the end of World War II, with its combination of the Marshall Plan and the Nuremberg Trials, as an early attempt to grapple with both restoration and justice, even given the multiple agendas at work.  Regardless, TRCs must be left as another huge future topic, except to make a couple of comments.  Firstly, in terms of the mental health of people, TRCs can help thousands of people, mottled as the outcome will be with such a blunt instrument.  But it is better for the world to be grappling and refining these processes, than not to hold them, if for no other reason than it reduces the historical revisionism that can occur.  Secondly, TRCs are almost always caught in the tension among truth, peace and justice.

 

 

WHAT CAN BE DONE OVERALL?

Preventive – the foundation:

One must start with the proper perspective.  Human-based circumstances have brought about the trauma, pain and even death alluded to in this section.  Being human-based, the goal must be the elimination of all such circumstances.  This should not be interpreted as naiveté, but as clarifying the heart of the problem.  Yes it resides in our humanness, something we can never eliminate.  But we are more than our baser instincts and also deeper than any self-serving, groundless idealism.

Insight – defined not simply as the knowledge to shape a more decent world for all, but the actual movement in that direction – remains possible.  Eliminating the circumstances, whether war or oppressive aspects of an inherited worldview, remain as complex and layered as the issues above. But the stance here is that some basic insight has occurred and more will continue (though, for instance, I would gauge at least another century would be needed before we might say we have moved “beyond war”;  Sample controversy: Trends Indicate Less War [Foreign Policy] versus Bad Methods In Thinking Less War [U.Chicago Conference paper]).

The scope is enormous.  When citizens of developed countries (such as Australia, Canada, U.K. and the U.S.) think of PTSD and/or the effects of war the first image is usually that of their soldiers.  That image is apt – they suffer and this article is about ending such suffering. But this newsletter also wants to raise up the remaining victims in war that remain in a target country, images that are less likely to emerge, due to a convoluted mix of physical and emotional distance, inability to get journalists in and stories out, desires of governments to move on (and hence not learn crucial lessons), and so on.  A sample: How do you heal an entire country suffering from shell shock?  [ForeignPolicy].

The same complexity is involved regarding other issues in this section, such as domestic abuse.  It involves changing a nation’s ethos.  The WHO estimates that 30% of women have suffered domestic abuse, physical or sexual; in North America the estimates are 23%.

While the scope is enormous, insight continues even as it did for the sea-changes needed to end slavery (with exceptions), or to give women status as humans and then voting rights and someday equal treatment everywhere.

Because the full scope of this issue is so huge, this newsletter frames a two-level approach, outlined below, whereby at one level we do address the overall issues via preventive actions, while at the same time speaking about the more immediate remedial actions needed for those suffering now.

Finally, to reinforce this notion of complexity, over the last month yet another four Canadians from the military committed suicide.  A suicide here, another there, especially separated by over 2000 miles – they seem like tragic yet isolated events.  It can take time before people recognize a pattern.  Sometimes those patterns are recognized in the associated institutions but are ignored (and sometimes they do their best but lack adequate funding), and it is only when the pattern is brought to light, that proper remedial action occurs.  That said, at least in the developed countries the patterns are known, inadequate political and institutional action is an outrage, and an informed citizenry is the basic level to shift the direction toward more promising outcomes (recognizing that the “process of change” requires many layers to line up for success).

 

Preventive – the specifics:

  1. While basic conflict will always be part of what it is to be human, it does not follow that war is inevitable.  While many of our current structures and dynamics are set up to feed conflict and even war, we are also gradually developing a more adequate repertoire to resolve conflict before it turns to war, to create more suitable structures, to detect the early signs of genocidal tendencies, etc.  Support is needed for impetus in all layers: strengthening good governance, engendering nonviolent conflict resolution, alleviating poverty / empowering people, promoting independent media and watchdogs, and so on.
    [An example, related to the early warning signs of genocide, is occurring right now.  The conflict has deteriorated for months; the early signs were detected and reported.  Peacekeeping troops were sent in (by France and then Rwanda).  Things have somewhat stabilized.  The UN is considering further efforts, though it remains uncertain what will happen next.   See: Central African Republic and ‘Seeds of Genocide  ’[Reuters] ].

    While it needs another article to explore this avenue, it is important to raise the prevention of war in conjunction with eliminating the mental health issues that result.  Of course, war should be eliminated for its own numerous intrinsic values.  The above statement is meant to push mental concerns (PTSD, child soldiers, rape as a weapon of war, etc.) to their logical conclusion.  Without that, the cycle never ends.

    A basic corollary is that the significant mental issues arising from war indicate that we simply aren’t meant to harm one another.  Complex creatures that we are, it also indicates that we are good at doing harm and that the veneer of civilization remains far too thin.  A final note in the context of war and mental health is the article below on resilience training and the moral quandary that such work raises.

  2. Broad work is desperately needed to eliminate other domains where trauma occurs, such as domestic abuse.  This area, as was noted, is even farther behind, still emerging as a topic that had been taboo to talk about. The same process applies: raising awareness that a person’s basic safety is a universal right; providing programs that in the best case can keep families together, abused person(s) safe, while the dynamics fall in line with that universal right; and in the worst case, ensure the abused person’s safety while still trying to get any perpetrator to change or at least be prevented from harming others.
  3. The WHO has indicated 5 key barriers to increasing mental health services availability.  One needs to examine their own country as well as advocate for adequate and consistent global polices in the following areas:
    1. the absence of mental health from the public health agenda and the implications for funding;
    2. the current organization of mental health services;
    3. lack of integration within primary care;
    4. inadequate human resources for mental health;
    5. lack of public mental health leadership;
  4. Point (3) involves visionary leadership and financial support.  These are “common goods” issues and thus the domain of government.  Many countries are currently living under economic scripts that give low priority to mental health funding or off-load many responsibilities. Whether funding via taxes or some other mechanism, these mechanisms must be seen as a sacred trust, implying transparency, checks and balances and overall good governance (efficient, effective, robust). Pressed further, in today’s economic script, oversimplified, taxes are bad.  The more solid footing is that taxes are bad used badly.  But when used as above, they are a necessary and life-freeing strengthening of the social fabric.

Remedial:

  1. As noted, there are two organizations – the military and also the First Responders groups – that have or should have responsibility for helping identify and assist those with mental health issues arising from their profession.  Their priorities, funding and resources come from government.  Using the military as an example, the government is clearly far behind in adequately addressing these issues.  Pressure must be continued to rectify what in some sense is a betrayal – people heeding a government’s call (setting aside that whole issue itself) and afterward finding themselves insufficiently cared for.
  2. People with mental health issues (all types) are found in disproportionately high numbers on the streets and in prisons.  This calls for adequate mental health programs to prevent people from ending up there, and also once on the street, to having access to the proper treatment.  It further illustrates how primitive it is to have a punitive style justice system for mental health-based incidents.  Restorative justice must be the goal (& thus cross-cuts into both remedial and preventive sections).
  3. Child soldiers / Victims of rape: More support needs to be given to the organizations involved in this aspect of DDR programs (while sometimes this can be individuals donating to an organization, it is largely part of a nation’s foreign aid portfolio).  In countries suffering from child soldiers or victims of rape used as a weapon of war, there is little comprehensive work done on the extent of this victimization nor effectiveness of organizations trying to reintegrate such people back into society.  In overall mental health issues, the World Health Organization estimates that 75% to 85% of severe cases go untreated.
  4. Truth and Reconciliation Commissions: Their goal is that “the past no longer invades the present but informs the future.” Funding is needed for more research and efforts.  As noted above they have value but it is such a delicate balance.  The article below explores both the cathartic and re-traumatization effects on victims during the TRC effort in Cambodia, specifically pertaining to Duch, who was on trial as an instrumental person behind the Khmer Rouge atrocities.
    Cambodia: Study of Promise and Pitfalls of Truth-seeking  [IRIN]

 

Related articles:

US Soldiers: At Least 30% Suffer PTSD [Daily Beast]
US Soldiers: A Suicide every 65 Minutes [Forbes]
More US Soldiers Die From Suicide Than War [Project Censored]
Cambodia: One in Seven Suffer Some Form of PTSD [Al Jazeera]

Muddying the waters further, there have been attempts to try to prevent war trauma (called “resilience training”). The treatment is called “Positive Psychology” and has been written about in the American Psychologist Journal.  However one watchdog organization ponders whether the relationship between the APJ and the military may be too cozy:
Does American Psychologist Journal have too cozy a relationship with the US Military? {Project Censored]

 

 

FINAL OVERAL THOUGHTS

Hopefully anyone who is dealing with a mental health issue will find one of the three affirmations to be supportive.  Everyone should feel free to comment on the blog about any aspect of this article, in particular what one would want to see as Part II, if such might ever occur.

Raising the issue of mental health as a peace/justice issue is important in at least two ways.  Firstly, marginalization is a peace/justice issue. Thus it becomes a prime focus to stand with, provide support for, and advocate on behalf of those who suffer from the various forms of mental illness, whether an individual who is dealing with biochemical imbalances or an entire nation and the repercussions of war.

Secondly, a decent fair society – one in which all achieve well-being – is one which recognizes the interrelated nature of all these issues.  Foremost, freeing people from the entangled webs of mental health issues is good-in-itself.  Specifically it frees people, allowing their gifts and abilities to be expressed – wonderful goodness.  But it also, pragmatically, frees up the resources that were needed to help such people, and allows that energy to address other dimensions of global well-being.  For we still have a long way to go.

3 thoughts on “Jan. 2014 Newsletter: Peace/Justice & Issue of Mental Health

  1. Superb article- well documented, well written. glad to see mental health getting into the forefront!

    I would suggest though that instead of saying ‘committed’ suicide, you say ‘died by’ suicide.
    Committed, in and of itself, carries a stigma with deep roots in both religion and the law. It goes back to when suicide was a criminal offense, akin to murder and rape…as well as a sin, for which the RC church did not allow burial. The Christian Church treated suicide as a sin from the fifth century AD until the middle or late twentieth century. Most US states made suicide a crime until the twentieth century, in Canada until the 1970’s.

    Some people use the term ‘completed’ or ‘successful‘ for a suicide, but they are also very poor choices. Usually the words completed or successful are used to indicate good actions – but in the case of suicide, completed or successful would be the complete opposite…and a wrong action.
    Also to say ‘ incomplete’ for when an attempt failed suggests that living was the failure. The Canadian Association for Suicide Prevention recommends the adoption of the replacement terms “non-fatal suicide attempt” or “suicide attempt” instead of incomplete or unsuccessful suicides!

    • Great observation about wording on suicide – thanks! For myself, I now have stopped using the word ‘suicide’ in relation to those I consider pretty clearly biochemical in origin (such as S.A.D.; I would say that they died of SAD) – I don’t think ‘will’ has anything to do with it. I didn’t raise it in the article (other than to mention the unclear relation between body and mind) because it was already too long, and would raise yet another huge debate around the whole unclear area of ‘will’ in general, but would be a good section in a Part II (not that I’m currently contemplating a Pt II).

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