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The Psychological Consequences of Conflict

Interview by Lindsay Morgan

For people impacted by war and displacement, what are the long-term mental and social consequences of trauma—and what can be done to help them? In the latest episode of Talking Policy, Lindsay Morgan interviews Biz Herman, a UC Berkeley doctoral student and IGCC alumna, who studies the psychological consequences of conflict. Biz shares insights from the recent Human Security, Violence, and Trauma (HSVT) conference; and reflects on the relationship between trauma and justice, how trauma from political violence is similar and different from other kinds of trauma, and the societal impacts of collective traumaand what that means for peacebuilding.

news_biz-herman.jpgFor each conflict we read about in the news—whether in Afghanistan, Gaza, or Yemen—there are hundreds, if not thousands, of people experiencing hardship, loss, and trauma. Unlike a lot of the global policy issues we talk about on this podcast, trauma is something we can all get our heads around to a certain degree. As someone who has worked extensively on this topic, can you give us a fuller sense of what we're talking about when we talk about trauma?

Sure, and thanks again for having me. I’m really glad that conversations about psychology and mental health are being incorporated into security studies, because when we talk about peace and security, we're talking about human beings. So you have to think about mental health and wellbeing. It affects most everything we do and is at the root of a lot of behaviors and attitudes we are interested in as social scientists.

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), trauma exposure is defined as a direct personal experience of an event that involves actual death or serious injury or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about an unexpected or violent death, serious harm, or threat of injury or death experienced by a family member or other close associate.

So, it can be something you experience personally. It can be something you see happen. Or it can be something you learn about that happens to someone you love.  

How common is trauma?

The vast majority of people will have at least one traumatic experience in their lifetime, but not everyone responds the same way. That variation is where a lot of research is being done—to understand why certain people who live through the same potentially traumatic experience respond in different ways.

On the first day of the HSVT conference, Richard Tedeschi said that trauma is something that calls our assumptions and beliefs into question. And the challenge then is whether you can reconstruct those beliefs, which gets at the question of why some people are more resilient than others.

I came to this work from working as a journalist on a project that focused on women who had been involved in conflict around the world. The conflicts varied widely; the time periods varied widely; the experiences varied widely. But for all the women I interviewed, the experiences had been formative, and continued to inform their lives, in really different ways.

Some had a new sense of purpose and went on to pursue careers in public service or in politics, or dedicated themselves to raising their kids in a really different way from how they had been raised. Some of them had ongoing stress and clearly presented with what would be described as PTSD [post-traumatic stress disorder]. And some were able to incorporate the experience into their life narrative, and it was something they viewed as firmly in their past.

There are a range of responses, in other words, and though we have ideas about why certain factors might predispose people to have better or more adverse responses to trauma, the causes of that variation are largely unknown.

How is trauma from political violence similar or different from trauma caused by other sources?

That's an open question in research. There's been a lot of good research on the differences between acute trauma and chronic trauma. So, living through a single traumatic experience that starts and stops versus living through either chronic traumatic experiences or the constant possibility of traumatic experiences.

Our bodies respond differently to a singular trauma than they do to chronic trauma—things like living in a war zone or being forcibly displaced and having to resettle and having ongoing environmental stressors. PTSD from acute trauma presents as being hyper aroused, having high threat reactivity, or having nightmares or flashbacks. Your body can't stay in that elevated state all the time, though, so when you’re exposed to chronic trauma, as a survival mechanism, your body will often downregulate, and instead of hyper arousal, you might present as shutdown and disconnected. 

A lot of your work looks at the ways in which trauma impacts intergroup relations and political participation and the prospects for reconciliation and peace building. How does trauma affect societal relations?

In the Za’atari Refugee Camp—which is the world’s largest camp for Syrian refugees—we evaluated a novel psychoeducational program called the Field Guide for Barefoot Psychology, which was developed with Beyond Conflict in partnership with Questscope. We collected a wide array of both psychological indicators and outcomes that political scientists are interested in—things like intergroup dynamics and trust and prosociality.

One thing that came out of that was a relationship we hadn't really thought of before, which was the relationship between emotion regulation and intergroup dynamics. People who reported being better able to emotionally regulate themselves—being able to identify the emotions they were feeling and calm themselves down—reported better intergroup dynamics than those who reported worse emotional regulation. Intuitively, that makes sense. If you feel grounded within your own brain and body, your interpersonal relations are going to be better.

Although we can’t say anything causal about this, one of the trainers shared that, when he first got to Za’atari camp, there were a lot of small skirmishes happening, especially between young people in the camp.  As there was gradually more space provided to deal with some of the traumas they had experienced and to address some of the adverse mental health implications that had arisen as a result, those interpersonal dynamics improved.

In refugee camps, I assume there’s a strong emphasis on meeting people’s basic physical needs first. Does mental health get short shrift?

There is this idea that you can deal with mental health stuff once you get everything else taken care of—that physical needs come first, and mental health is secondary. But that dichotomy doesn't exist. When you think about the way mental health impacts interpersonal dynamics and the importance it has in people's being able to integrate into their communities, it's vital and it's indispensable. And it needs to be prioritized in that way.

Wars might end, but that doesn’t mean the trauma is necessarily over. Yet peacebuilding begins in that context. How does collective trauma impact the potential for peacebuilding? Especially since, the stakeholders involved in peace building don’t necessarily have mental health expertise.

The last point you made is really important. It’s critical to bring in people who have expertise in different areas, so that ideas from mental health are incorporated in ways that are accurate and make sense. I can give a few examples.

In peacebuilding, programs will often frame healing from trauma as this end point. You go through a certain number of sessions, you get a certificate, and you’re healed. There can definitely be something cathartic about that, but it can create a sense of false hope. One thing that came up in the HSVT conference was the idea that healing from trauma is a journey. It's not an end point that you're trying to hit. It's often a lifelong process. 

A lot of peace building and reconciliation also starts at the point of: let's share our traumatic pasts. But asking people to share their traumatic experiences right off the bat can be counterproductive, especially if you're not going to provide follow-up care and you're not going to build trust.

What interventions exist to help people in populations who are dealing with trauma, particularly trauma emanating again from political violence, war, and forced displacement?   

The Field Guide uses storytelling and science to help people engage with common issues that arise as the result of living through and beyond forced displacement. Each chapter opens with a narrative. You follow the story of a brother and a sister—their lives before, through, and after forced displacement. The narrative allows people to engage in the issues without having to share their own traumatic experiences. Then the Field Guide goes into some of the scientific concepts touched upon in the narrative. It helps people understand why certain things might be happening in their brains and bodies—why your heart might be racing, why you might have trouble sleeping. One of the goals of the Field Guide is to make the science of trauma accessible to the people going through it. And then it's paired with self-care exercises that were adapted to make sure that they were contextually relevant and could be done in whatever context they'd be administered.

What have you been learning that you wish donor agencies and policymakers understood?

That there is a lot of resilience within communities, and the goal of assistance should be to figure out how to provide resources to build upon that resilience, as opposed to seeing these communities as fundamentally broken. And at the same time, we should acknowledge that if left unaddressed, adverse responses to mental health challenges can have really, really important societal effects.

Do we have any examples that show the consequences of neglecting mental health after conflict?

If you speak with people who have lived through conflict, especially in places where there is intergenerational conflict or cycles of violence, people will point to the fact that their parents experienced violence and that it was passed down to them. There's a lot of good epigenetic research on the effects of living through trauma and passing it down to future generations.

One of the things it would seem, intuitively, would help in recovery from trauma is bringing perpetrators to justice. But my guess is that in most conflicts, justice is not the norm. What happens when justice is unattainable?

The fundamental question is what do we mean by justice? An important way to get at that is to ask communities and individuals themselves. What does justice mean to them? What does peace building mean to them?  

There has been a push to “serve justice” by developing things like the International Criminal Court. But the process of testifying in court can actually be retraumatizing. I remember talking to someone who was involved in collecting evidence in Cambodia about atrocities committed by the Khmer Rouge. People had to provide their stories in detail—it was a very specific process—and were questioned about whether or not they were telling the truth. 

And it might deliver justice to only a few people; or it might deliver a symbolic justice to many people; or it might backfire entirely if the perpetrator is found not guilty, and people went through the process of testifying in court for nothing.

On the other hand, in Bosnia, I interviewed people who felt a lot of pride about the fact that, in the court cases there, it was the first time that rape was tried as a crime against humanity. People were proud that the country had been able to set that as an international norm.

I don't think there's a formula about whether specific approaches to justice lead to a feeling of justice.

Have you had the experience of asking a community or an individual what justice meant to them and their answer surprised you?

I spoke with women in Bangladesh who had been actively involved in the 1971 Bangladesh Liberation War. When thinking about how they might want to have their experiences memorialized, I expected that they would say: I want to be seen as a hero, or I don't want to be seen as a victim. What I heard instead was that they wanted the room to have the complexity of their lives be held up in public. Not necessarily a finite recognition of oneself as one or the other, hero or victim, but wanting their own experience to be held in the public narrative in all its complexity.

It's easier to think about wanting a statue or some sort of glorification of your experience. But just having the ability to talk openly in public about what you experienced is very, very simple and often not on the roster of things that we consider to be justice.

What are some of the challenges of doing research about trauma?

One of the things that really shone through during the conference were conversations about positionality, ethical research, and participatory research. All three of those issues came up on nearly every panel.

Dr. Rana Dajani opened her remarks on the second panel asking everyone to think about why they were engaged in this work—what identities were they bringing to it and why did they want to do it? No matter what your identity is, whether you're an outsider or an insider, everyone needs to ask themselves a set of questions to make sure that you’re not producing unethical extractive research.

In terms of thinking about what does it mean to do ethical research, we have IRB approval, but is that really ensuring that we're doing ethical work? Something that came up again and again, was that the most important thing is having community partners who can help you assess ethics questions. Things that often don't get flagged by the IRB are sometimes some of the most ethically challenging things. 

Another thing that came up, is how do you share your work? How can you bring results back to whomever you're working with? How can you make sure that you're doing that responsibly and accessibly and making sure that that's budgeted for? Ethical, participatory research has to be incentivized.

The conference on Human Security, Violence, and Trauma in the 21st Century: Psychological Response and Political Impacts of Civil War & Forced Migration, was organized by Cecilia Mo (UC Berkeley), Biz Herman (UC Berkeley), and Justine Davis (University of Michigan), as part of the UC Institute on Global Conflict and Cooperation annual Academic Conference Competition.

Learn more about the Human Security, Violence, and Trauma (HSVT) conference.