Wednesday, December 2, 2009

WOUNDED RUSSIA





I meet with police psychologists to discuss problems in Moscow.

WOUNDED RUSSIA
TEAM TRAVELS TO MOSCOW TO HELP HEAL VICTIMS OF VIOLENCE

        Since the breakup of the Union of Soviet Socialist Republics, a major problem has been the conflict-ridden Caucasus, an area in the south of the former Soviet Union where a multitude of ethnic loyalties continued to exist despite occupation by Russian troops. When the Soviet Union collapsed in 1991 many regions that had been kept quiescent under the stern hand of Russian rule broke out in open conflict, and various groups have lurched from one ethnic conflict, coup or rebellion to the next.
        The International Center for Psychosocial Trauma had sponsored seminars for professionals in trauma-battered places like Bosnia, Rwanda and Oklahoma City. One of the best seminars in which I have participated was May 15-22, 1998, in Moscow. This time our group trained professionals mainly from the conflict-ridden Caucasus, mental health workers who were helping victims overcome the psychological damages inflicted by war, revolution, ethnic cleansing and just plain hatefulness.
        Most noted by the U.S. media has been Chechnya, where war erupted when the citizens refused to admit it was a part of Russia and Soviet President Boris Yeltsin sent in the Russian army to subdue them. The soldiers dispatched were underfed, ill-trained, poorly equipped and poorly led conscripts. The outcome was 80,000 people dead, cities destroyed, and a standoff with no definite agreement as to Chechnya’s status. There continued to be a terrorist presence in the area that made it dangerous for outsiders, even those connected to humanitarian agencies.
        At the dissolution of the Soviet Union three Transcaucasus territories became independent countries—Armenia, Azerbaijan, and Georgia. These countries, however, remained in the Russian sphere of influence as members of the Commonwealth of Independent States. From 1988 to 1994 Armenia and Azerbaijan battled over a region of Azerbaijan called Nagorno-Karabakh, which had primarily Armenian residents. Elements of ethnic cleansing made this war particularly vicious.
        Within Georgia there have been outbreaks of civil war, and two ethnic minority territories—Abkhazia and South Ossetia—have attempted to secede. The Georgian government took military action to prevent this. All of these conflicts have resulted in villages and towns being destroyed and the creation of 1.3 million refugees.

The Seminars
         As the 50-plus participants introduced themselves, I was overwhelmed by the amount of experience they had in dealing with people who have been traumatized. Their introductory statements indicated they expected substantial training from us, and I hoped we “experts” could give it to them.
        Arshad Husain, the leader of our team and a child psychiatrist from the UMC Medical School, led the first day’s presentations on factors influencing vulnerability and resilience to psychosocial trauma, and Joseph Lamberti, emeritus professor of psychiatry at UMC, spoke on understanding individual and family loss and grief.
        At the next morning’s program we used small, leaderless discussion groups. The purposes of the session were threefold:
· Form a working community where professionals with different political orientations would get to know each other and see what they had in common.
· Train participants in some basic small group techniques.
· Get participants to provide a listing of the most important problems they face.

        Our translator cautioned us that starting the morning by mixing ethnic groups might result in strong emotional reactions since they had so recently been on opposite sides of a conflict. Our biggest concern was that the Chechnyans would have trouble with some of the other participants. We decided it was worth the risk and that we would start them with non-controversial topics. The introductory questions we gave them were: What is especially attractive in your area, that is, what are you most proud of? What are you least proud of? What particular patient/student comes to mind when you are thinking about what you want to know?
        To our delight and surprise, within 15 minutes the participants who were previously enemies were talking like old friends. In one group, teachers from Georgia communities that had been fighting each other who had not spoken in six years formed close working relationships. The conflicting parties felt they related well because they were professionals and their professionalism overrode some of their differences. They now feel they are a neutral group and understand each other’s problems. Part of their comfort with each other was their shared nostalgia for peaceful times. Some of the members were already proposing regional meetings to stay in contact with each other. Because of this new-felt closeness, they resisted breaking into new groups.
        Nevertheless we reshuffled, placing them in groups based on professional identification, and had them generate problems, then pick one from their list and have a problem solving session. The verbal reports from each of the groups went on too long. It was not as bad as in Bosnia, but no one seemed to know how to say anything in a short direct fashion. On the other hand, it did mean they want to be heard and understood.

Topics
        The other professionals with us on the team and the topics they dealt with were, Debora Bell-Dolan, associate professor of psychology, UMC, therapeutic groups for grief and loss; Mike Pullis, professor of education, UMC, therapeutic classrooms; Venetta Whitaker, College of Education, UMC, working with violent, aggressive, at risk and reluctant learners. Examples of some of the groups run by Barbara Bauer, psychologist in private practice, and myself, follow.

Sexual violence: assessment and management
        Our session on sexual violence started off poorly. The group was 30 years behind the United States in its handling of and attitudes toward rape. The attitude of the Chechnya’s was particularly disturbing to us—rape of women is reported as very rare, they said, but if a virgin is raped, the rapist has a choice to marry her or be stoned to death. The woman’s opinion seems unimportant. We felt that could be enough of a threat to the women for them not to report rapes. In Chechnya, male prisoners of war and hostages are frequently raped as a way of proving the manhood of the victor.
         Russia, on the other hand admits to as much rape as in the United States, and violence in sex may be frequent. The latter part of our program went well. We had the participants practice normalizing post-traumatic stress symptoms of victims, and they role-played this well.

Helping the Helper
        This is a program Bauer and I designed to help professionals deal with the emotional problems that result from constantly working with other people’s pain. The participants resisted working in pairs, as is our usual practice in the exercises in this program. They preferred to work in larger groups because it gave them more opportunity to share information about their clients and themselves.
        We had some problems with the final assignment where we asked them to make a contract outlining what they will do to take better care of their own mental health. They seemed to have trouble understanding the concept of self care, and even after they understood it a small number of them refused to fill out a contract, saying it didn’t make sense because you couldn’t take better care of yourself until you had the money to do it with. Most, however, did fill out contracts and had them countersigned by a friend indicating what, when and how they would do something to take care of their mental health.

Guilt and anger in combatants: intervention and management
        We were surprised at the number of participants who showed up for this session: not only almost everyone from our regular program, but an added group of police psychologists in training from the Moscow Police Academy. The police psychologists in training were interested in combatant trauma, especially guilt and anger reactions connected with post-traumatic stress disorder. Some of the law enforcement officers they work with belong to SWAT teams who had been called for service in trouble spots like Chechnya and Afghanistan.
        There was a philosophical difference that confused us, and it wasn’t until the break that Dan, the Mennonite observer from the U.S., pointed it out. “We” the instructors “saw treatment as an individual choice by the client for his/her welfare. They saw it as something required by administrators to make the individual fit the system.”
        The longest discussion concerned what should be done with a member of a commando team who, after a friend was killed, deserted for three days and was not accepted by the group when he came back. We had them practice treating combatants who felt strong guilt over what had happened in battle, using rational approaches to show them they should not take much responsibility for what happened. For example, not being able to stop the killing of civilians or having a buddy killed who had replaced them on the firing line. We also lectured on and had them practice treating combatants when their guilt was justified by their actions.
The anger part of the program went especially well, and we emphasized methods that could be used for group treatment. Their questions indicated many of them probably will use some of the techniques we have introduced. A number of the participants indicated that for them this was our most important session.

The Participants
        Many of the participants seemed under trained, over experienced and struggling with their reactions to traumas. Anya from Chechnya was present at a kidnapping of outside aid people. When the terrorists first hit her apartment, she believed it was a test to find out what their reactions would be. It was some time before she realized the attack was real. She has nightmares and frequent flashbacks. When we suggested therapy, she said that the fate of the victims was unknown and that if she receives treatment her testimony at a trial might not be valid.
        Oliga, who had been with us in the United States last summer, was also going back to Chechnya, where the government has been known to display decapitated heads of alleged Russian agents.
        A great deal of interest was shown outside of class in us and our ideas. Usually someone in the vicinity spoke enough English to translate the questions and our answers. Many also talked to us on a personal level with much feeling of brotherhood of professionals. For example, one evening Bauer and I met with eight police psychologists, some from the Moscow academy, but most from Rostov. They had soda, potato chips, cake, tea, and vodka set up at a table around which we sat tightly packed. Most of their questions were directed at Bauer since they were mainly interested in selection problems and counseling issues viz a viz the impaired police officer, especially those who may be suffering from post-traumatic stress.
        Much emotion was expressed by these Russians, who indicated they like us and appreciate what we are doing. We were invited by the participants to several parties where they made passionate toasts and sang sad songs. They said they saw us being different from their own professors, whom they respect, but who do not have the same eagerness to communicate. They also say we put more of our souls into our teaching. Frequently the participants mentioned how much they would like to see us return or come to their part of the country. I feel fortunate in having the opportunity to touch others emotionally, but melancholy because the contacts are so short and unlikely to be repeated.

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