Summary: The chapter analyses the rise of international disaster psychology in relation
to humanitarian politics. It explores how developments within donor countries and their
humanitarian sectors at the end of the Cold War shaped the growth and character of
international disaster psychology. The aim of the chapter is threefold. First, the chapter
discusses the contemporary Western ethnopsychology and the psychologising of life
experiences in donor countries. Second the chapter examines the crisis of belief in the aid
sector and how this has facilitated the psychologising of disaster relief. Third the chapter
outlines problems with the international psychosocial approach and argues for the
importance of social meaning for recovery after disaster.
Introduction
International disaster psychology work expanded rapidly in the last decade. In the 1980s
international emergency responses were often synonymous with famine relief. Yet in the
1990s the image of the traumatised victim displaced the famine victim as the iconic
figure of suffering in the disaster literature. Before the end of the Cold War psychosocial
intervention did not feature in international humanitarian work, but within a few years
psychosocial programmes had become standard in disaster relief. The chapter analyses
the rise of international disaster psychology in relation to humanitarian politics.
International disaster relief is not apolitical (Macrae, 2001; de Waal, 1997), nor is disaster
psychology work as an aspect of international disaster relief. The nature of humanitarian
aid proffered to disaster-affected populations is entwined with the relationship of
international humanitarian organizations, overwhelmingly Western, to their own societies
and governments. The chapter explores how developments within donor countries and
their humanitarian sectors at the end of the Cold War shaped the growth and character of
international disaster psychology. The aim of the chapter is threefold. First, the chapter
discusses the contemporary Western ethnopsychology and the psychologising of life
experiences in donor countries. Second the chapter examines the crisis of belief in the aid
sector and how this has facilitated the psychologising of disaster relief. Third the chapter
outlines problems with the international psychosocial approach and argues for the
importance of social meaning for recovery after disaster.
Western ethnopyschology
The rapid growth of international disaster psychology has essentially been spurred by
developments within Western donor countries. These developments have encouraged the
application of psychological models to social problems alongside changed cultural
expectations about how people cope with adversity. Psychology has come to dominate
how Western societies conceptualise experiences and its influence is not confined to
professionals. Psychology‟s dominance arises from how the personal emotions are the
standpoint from which people today in Western societies understand their lives as a
consequence of atomisation and the erosion of tradition and shared political or communal
beliefs.
As personal feelings have come to the fore, Western emotional norms have shifted from
emotional reserve to openness. Yet the Western individual of today is not a robust
creature for all its cult of the self (Furedi, 2003; Lasch, 1984). Instead individuals appear
insecure and disorientated by the loss of communal bonds and beliefs. Individuals‟
psychological security is related to the security of their relationships and communal
purpose. Selfhood is bound up with what the philosopher Charles Taylor calls „an
orientation towards the good‟ or a moral, philosophical or political framework (Taylor,
1989). The psychoanalyst Erik Erikson‟s identification theory sets out the importance of
individuals‟ identification with other people and a conception of the good for their own
development, also suggesting reasons for the contemporary crisis of selfhood (1968,
1980). Strong beliefs and relationships foster strength of character. However posttraditional, post-political and post-modern Western societies lack both strong beliefs and
relationships that foster strength of character (Furedi, 2003; Lasch, 1984; Sennett, 1998).
Relativism rather than conviction, suspicion rather than belief, mistrust rather than trust
typify the Western outlook today along with a growing scepticism over the possibility of
human progress and its gains. The weakened sense of personal or communal purpose has
fostered a more passive, plaintive personality type prone to demoralisation. These
characteristics influence the social and personal impact of disasters.
People‟s lives have a tenuous coherence and they feel psychologically vulnerable in the
face of any obstacles or setbacks. Victor Frankl, whose logotherapy is expressly
concerned with „the will to meaning‟, identifies an existential vacuum underlying many
contemporary psychological disorders (Frankl, 1992). Psychological insecurity is
illustrated by the widespread diagnosis of post-traumatic stress disorder (PTSD) in the
West. PTSD has been insightfully analysed as a disorder of meaning, which represents an
acute manifestation of the general cultural insecurity over identity and meaning (Bracken,
2002; Young, 1995). The psychological fragile personality seems to find meaning in the
diagnosis of PTSD as a disorder that captures contemporary existential fears (Furedi,
2003; Nolan, 1998, pp. 9-17). Cultural critics have diagnosed Western society today as a
„post-traumatic culture‟ (Farrell, 1998). However, if PTSD is understood as a disorder of
meaning (Bracken, 2002), this suggests both the culturally specific appeal of PTSD
counselling and its limitations in addressing both individual and the wider social crisis of
meaning.
The psychologisation of human experience today is not simply led by professionals, but
is also facilitated by individuals seeking social recognition through diagnosis (Shaw and
Woodward, 2003). Diagnosis as social recognition accords with the standpoint of the
demoralised and atomised individual. Diagnosis also epitomises how social action has
mutated into professional intervention at the level of the individual as political activism
has receded. At the same time, social improvement is increasingly tackled by policymakers through self-improvement strategies enhancing self-esteem and perfecting
interpersonal communication skills rather than the massive New Deal-type initiatives of
previous eras (Giddens, 1994; Samuels, 2001). Public policy interest in emotional
communication further accords with new business methods requiring flexible „soft‟ skills
to facilitate communication and adaptability in fast moving markets (Sennett, 1998).
From school pupils becoming playground peacemakers to self-esteem coaching for the
unemployed to staff development training for self-awareness, there is a converging
demand for individuals to be trained in „emotional literacy‟.1
Emotional literacy has
become central to strategies seeking to enhance personal performance or improve the
social environment. Organisations increasingly provide preventive therapeutic
programmes even where individuals do not ask for psychological support. Culturally
individuals are expected to need professional emotional assistance to cope with any
changes in their lives.
Proponents argue that these trends should be welcomed as creating a more caring
environment, and enhancing emotional sensitivity and expression (Giddens, 1994;
Kraemer and Roberts, 1996; Orbach, undated; Samuels, 2001). Yet critics have drawn
attention to the coercive potential of emotional management and the risks of estranging
people from their emotions under the instrumentalisation or „McDonaldization‟ of the
emotions (Mestrovic, 1997, p. 146; see also Hochschild, 1983; Furedi, 2003; Stearns,
1986). The stress on the importance of psychological well-being for social well-being is
leading to the emotions, not simply behaviour, becoming more regulated in public policy
and business practice. Emotional management involves the validation of specific
emotional norms and the invalidation of others towards the development of a specific
model of the self. This model of the self not only embodies the notion of the self as
psychologically vulnerable, but tends to pathologise the previous ideal type of the self as
the robust self-disciplined character. Notably, passion and anger tend to be viewed with
suspicion and have been singled out for treatment in Western emotional management
approaches which seem fearful of spontaneous expression (Furedi, 2003; Nolan, 1998;
Stearns and Stearns, 1986). Under contemporary Western emotionology, unregulated
expression appears to be associated with emotional dysfunctionality.
A fear of emotional dysfunctionality arising from untreated trauma is one imperative that
drives mass trauma counselling programmes. Another imperative for mass trauma
counselling programmes is how therapy has now become an integral part of public ritual
in Western societies, conferring social recognition of suffering. The next section explores
the social role of counselling in contemporary Western emotionology.
Social role of counselling
The changed cultural expectations and political climate have meant both greater
receptivity to therapy and therapy acquiring a new public significance. The
psychologically-disposed culture has encouraged the proliferation of counselling and
mediation services and professionals. Significantly, therapeutic rituals rather than
religious rituals now dominate the contemporary culture. If diagnosis confers social
recognition, therapy authenticates claims. Strikingly today any media report of a crime or
tragic incident states how the victims are being offered counselling to underscore the
seriousness of their suffering. Thus a BBC radio news report on the recent tragic
drowning of Chinese cockle-pickers in Britain stated how the survivors were receiving
counselling „which indicates […] how difficult things have been for them.‟2 Here we see
how Western cultural expectations of emotional vulnerability and the need for therapeutic
intervention are being projected onto people from other societies. Significantly legal
advocates have found that asylum seekers to Britain or other European states are
expected to exhibit trauma or doubt is cast on the authenticity of their claims to refugee
status. Well-prepared asylum claims now almost invariably highlight how the applicant is
suffering from PTSD and has required counselling.
Therapists have been characterised as the new priesthood supplanting religious figures as
guardians of social norms (Nolan, 1998). Religious observance too has become
therapeutised with prayer and religious services adopting therapeutic forms and
justifications. The therapeutic approach as a form of religion suggests how social
expectations of psychological fragility have become normative. On the one hand, by
demonstrating psychological vulnerability and seeking therapy, people show that they are
responsible caring citizens in today‟s ethos. On the other hand, individuals not displaying
psychological vulnerability or dismissing counselling risk being branded as uncaring and
socially reckless. In Britain, the traditional stiff upper lip is vilified rather than endorsed
today. Even the British royalty is not excused from the precepts of contemporary
emotionology. Members of the royal family were attacked in the British media for being
undemonstrative in public at Diana‟s death. In turn, unemotional reporting in the face of
tragic events is increasingly unacceptable (Mayes, 2000). In the contemporary therapeutic
culture, emotional reserve risks being equated with unfeeling and denying the suffering
of victims. Likewise, the buzz and excitement experienced in disaster relief work is
becoming socially unacceptable to express as transgressing therapeutic precepts. The
cultural validation of psychological vulnerability as an empathetic reaction helps account
for the apparent growth of secondary trauma among the emergency services today. norms
discussed above. In today‟s therapeutic culture, relief workers may find themselves under
cultural pressure to express psychological vulnerability as an expression of empathy
towards victims in a disaster. Tellingly secondary stress disorder has been outlined by the
Dart Center for Journalism and Trauma as an „empathic response that affects people such
as therapists and journalists when they become overwhelmed by others‟ traumatic
experiences‟ (http://www.dartcenter.org/selfstudy/index.html). However, the professional
or wider cultural validation of vicarious psychological vulnerability as an empathetic
response does not necessarily represent a more compassionate professional outlook.
Arguably the phenomenon represents a more self-centred response in which
professionals‟ attention has become subtly re-oriented towards their feelings towards the
victims‟ suffering rather than the victims‟ suffering. Amidst this validation of
psychological vulnerability, it should perhaps be restated that professionals becoming
overwhelmed by what they see is not very useful for victims who need practical actions
to be undertaken to alleviate their situation.
Since counselling routinely accompanies ordinary life events, it is not surprising that
counselling should become a standard response in disasters both domestically and
internationally. Therapeutic responses are devised on the assumption of vulnerability,
with debriefing teams being sent to an area and proactively giving counselling, not
waiting for individuals to request support. Salutogenic studies, which explore people‟s
resilience, are relatively rare in the trauma literature and have been overlooked in disaster
planning in recent decades (Almedom, 2004; Waysman et al, 2001). This neglect is
unsurprising culturally since salutogenic approaches go against the grain of contemporary
Western emotionology. Western emotional norms validate even virtual experiences as
inducing trauma requiring psychological intervention (Coward, 2001). That individuals at
risk of psychological emotional trauma now encompass those who see disaster scenes on
the television demonstrates the normalisation of psychological vulnerability in Western
societies. Various Western universities, for example, discussed offering counselling over
the Iraq War to students at their institution whose only encounter with war was liable to
be through their television sets. Trauma counselling has become culturally expected so
that even close communities with effective informal networks invite professional support.
In this vein, a mass trauma debriefing programme for all pupils and their parents was
immediately proposed at an English Lincolnshire village school following the shooting
dead of a pupil by a fellow pupil.3 Yet by all accounts the rural village enjoyed good
social networks that belied the need for mass professional support. Indeed the local
Lincolnshire NHS trauma centre considered the proposal for a mass debriefing
programme inappropriate for the community and declined to undertake one. For the
efficacy of mass psychological debriefing programmes is increasingly questioned, not
just in cross-cultural psychology but more broadly (Rose et al, 2003a, 2003b; Ørner and
Schnyder, 2003; Sensky, 2003a). The continuing advice of the Cochrane Review has
been that, „There is no current evidence that psychological debriefing is a useful
treatment for the prevention of post traumatic stress disorder after traumatic incidents‟
(Rose et al, 2003b). However such is the cultural expectation of the need for professional
intervention that this advice may be ignored. The BBC, for example, decided to press
ahead with debriefing counselling for its journalists reporting on the Iraq War.
Irrespective of whether people appear resilient, they are presumed in the prevailing
therapeutic model to require preventive therapeutic support. Proponents are selfconsciously eschewing reference to „traumatised community‟ for „affected community‟
and „victims‟ for „survivors‟ so as not to pathologise and demean populations.4
Nevertheless these semantic changes do not signal a rolling back of psychosocial
programmes and their pathologisation of populations, rather a pathologising of the
meaning of survival and resilience. In the model, resilience too is understood as a
condition, which requires professional assistance to process emotions and thus effectively
pathologised. For the model tends to conflate the experience of distress with emotional
dysfunction requiring therapeutic management (de Jong et al, 2000), As such, trauma
counselling programmes may be experienced as an education into vulnerability. That
professional interventions should have become the norm even for tight-knit communities
illustrates how the therapeutic ethos lacks confidence in ordinary people‟s capacity to
support each other. The prevailing therapeutic model ignores or at best pays lip service to
the fact that how people respond to tragic events is influenced by communal, political or
religious beliefs and networks, and cannot be reduced to the scale of casualties
(Shepherd, 2000). Crucially the model ignores how the very experience of tragedy may
actually bring people together and counter social atomism and re-invigorate fragmented
communal ties (Joseph et al, 1993). Disaster may actually foster social integration rather
than social disintegration that help support people in their adversity. Again the model
conceptualises the impact of war solely in terms of causing social disruption,5
ignoring
how mobilising for war including civil war requires mobilising a constituency and that
communal identities have historically commonly been forged through the very experience
of war (Duffield, 2001; Wrong, 1994). In other words, although war may break particular
social ties, equally war depends on mobilising social ties and may therefore strengthen
those ties and support networks.
We do not have to go back many decades to see very different emotional norms
operating. The present expectation of vulnerability may be compared to past validation of
resilience. Popular magazines such as the Picture Post in Britain saw featuring stories of
dignity and heroism among ordinary people as part of their mission. The Welsh Aberfan
landslide disaster of 1966, killing over a hundred children and adults, exemplifies past
stoicism. Therapy was not provided to the bereaved families, while the surviving children
were returned to classes as soon as practically possible to avoid them dwelling on the
tragedy (Furedi, 2003, p. 19). The villagers were commended in the media coverage at
the time for how well they were supporting themselves. Such responses would be
unthinkable and condemned today. Indeed Aberfan and other past disasters are being reinterpreted in line with present emotionology, resulting in retrospective demands for
trauma counselling to deal with the tragedy. But would trauma counselling have eased the
bereaved community‟s suffering? Would teams of counsellors coming to the village have
been experienced positively or negatively as „disaster tourists‟, the many outside visitors
who the villagers were wary of and disliked?
The cultural change is often regarded as a sign of a more sensitive culture. Yet the
presumption for the need for mass counselling is insensitive to the disruptive
consequences of professionals descending on an area and managing people‟s grief – as if
people do not grieve properly unless supervised by professionals. The normalisation of
mass counselling programmes implicitly disparages how family, friends and neighbours
respond to each other in the wake of a tragedy. An unspoken mistrust of the community‟s
moral and emotional capacity to comfort the bereaved underlies the imperative to bring in
professional support. Even where a community appears fragmented, the very experience
of disaster may pull a community together (Rogers, 1993), but this phenomenon is
overlooked in current disaster psychology. The parachuting in of professionals to manage
people‟s feelings according to the prevailing professional emotional script unwittingly
distances people from each other. The dominance of professional intervention represents
a technical quick fix that individualises the experience of disaster and interrupts how
communal bonds are remade in shared experiences and reciprocal relationships.
The psychiatrist Sally Satel has explored the lessons of 9/11 for professional trauma
responses (Satel, 2001; Satel and Sommers, 2002). Satel has described the responses to
9/11 as a „missed opportunity‟: missed in the sense that although mass psychiatric
damage among New Yorkers did not materialize, the professional therapeutic responses
ran the risk of suggesting to individuals a pathological interpretation of normal reactions
(sleeplessness, crying) and encouraging them to think of themselves as defeated or sick.6
The responses were a missed opportunity in another sense: although the mass trauma
predicted did not materialise, the professional therapeutic responses disrupted the
potential renewal of a shared communal outlook and purpose, which could have been
galvanised by the horrific act. Instead the professional responses reinforced the culture‟s
atomised nature instead of challenging it. Hence, the efficacy of mass trauma counselling
is questionable not just at the level of the individual but at the communal and national
level. The dominant therapeutic model, even in its newly-declared affirmation of
resilience, invites people both to see themselves as unable to move on without
professional support and to focus inwards on their personal feelings. Whether individual
or group therapy, the therapeutic model tends to affirm personal passivity and disengage
people from social action through which society could transcend disaster.
In summary, what I am questioning here is not simply the dangers of imposing Western
disaster psychology on non-Western societies, but equally problems with contemporary
Western disaster psychology for Western societies. Nevertheless, controversial
therapeutic programmes continue to be promoted for disaster-affected populations
globally and influence international humanitarian responses. Furthermore today‟s
politicisation of disasters in the international sphere tends to attribute the disaster to some
fault of the community. We will see below how the concept of complex (political)
emergency in international aid work questions the capacity of the affected community to
rehabilitate itself without outside intervention.
Crisis of humanitarianism
The rise of international disaster psychology programmes was further propelled by
developments within the humanitarian sector. Humanitarian organisations have become
increasingly important voices in public discourse since the end of the Cold War with the
erosion of previous political affiliations. The US writer David Rieff has described
humanitarianism as „the last coherent saving ideal‟ of the West (Rieff, 2002, p. 120).
Humanitarianism‟s appeal to empathy for people suffering corresponds with the
prevailing ethos of Western societies. Personal emotions are the standpoint from which
people today in Western societies understand their lives and empathy has become a key
principle of ethical behaviour in Western countries, lacking strong beliefs following the
erosion of traditional values and ideologically-based politics.
Yet the focus on humanitarianism over the last decade has involved fundamental
questioning of its mission, even as humanitarian programmes have massively expanded.
Modern humanitarianism was born out of an aspiration to recognise a common humanity
transcending political, national or social differences. But, as I will return to below, a
tension lurks in charitable or welfare provision between the affirmation of a common
humanity versus a judgement as to worthiness of the recipient, that is, a tension between
the provision of aid to the needy and their moral reform. Notably Western individualism
has been disposed to understand social problems in terms of personal character. To be
dependent on charity has frequently been associated with a failing of character, but
traditional humanitarianism did not make the character of the recipients an issue as their
plight in war or disaster was regarded as exceptional and temporary due to no fault of
their own. However, the humanitarian debates of the last decade have led to new attention
to be paid to the character of recipient communities.
The broader loss of confidence in donor societies has eroded confidence in
humanitarianism, and cast doubt on the validity of humanitarian work and the
humanitarian recipient alike. Humanitarianism as a symbolic gesture of empathy from
donor to recipient informs humanitarian ideals, but, as former Oxfam official Tony Vaux
acutely observes, altruistic motives and actions not underpinned by convictions become
subject to endless doubt (Vaux, 2001, p. 1). The humanitarian sector was markedly
riddled with doubt over its mission in the 1990s, notwithstanding its public standing and
impressive growth. Indeed the very high profile of humanitarianism and the support aid
organisations received from official donors created unease among humanitarian workers.
Humanitarians found it hard to cling to a belief that their work was altruistic and
improved the lives of recipients. A raft of publications were written highly critical of
humanitarianism, notably Mary Anderson‟s Do No Harm: How aid can support peace –
or war (1999), Ian Smillie‟s The Alms Bazaar: Altruism Under Fire (1995), Michael
Maren‟s The Road to Hell (1997), Timothy Morris‟ The Despairing Developer (1991),
John Prendergast‟s Crisis Response: Humanitarian Band-Aids in Sudan and Somalia
(1997), David Rieff‟s A Bed for the Night: Humanitarianism in Crisis (2002), David
Sogge‟s Compassion and Calculation (1996), Fiona Terry‟s Condemned to Repeat?: The
Paradox of Humanitarian Action (2002), Tony Vaux‟s The Selfish Altruist and Alex de
Waal‟s Famine Crimes (1997) to name some of the more prominent critiques. Damning
reports on aid work also seeped into newspapers and magazines which compared
humanitarians to imperial missionaries of the nineteenth century (The Economist, 2000;
Jenkins, *). Even popular culture, where humanitarian work had been treated as
sacrosanct, have voiced criticisms. The cartoon Southpark conspicuously ridiculed
humanitarian activities in its Stavin‟ Marvin episode which portrays humanitarianism as a
overblown industry leeching off others‟ suffering and harming its purported beneficiaries.
Some of the most trenchant attacks on humanitarianism have strikingly come from within
the humanitarian sector: Michael Maren, for example, has worked for USAID, Tony
Vaux for Oxfam, and Fiona Terry is a director of research for Médecins Sans Frontières.
These accounts testify to a profound internal crisis of legitimacy whose particular
character facilitated the adoption of psychosocial work. The humanitarian crisis of
legitimacy revolved around three themes: humanitarian principles, the bureaucratisation
of aid and the efficacy of material aid. Many aid workers were dismayed at the
technologies of humanitarian relief as the sector grew and feared that humanitarianism
was becoming driven by the expediencies of organisational growth rather than altruism
(Maren, 1997). The perception that the technologies of aid were becoming dehumanising
was exacerbated by questions over the usefulness of humanitarian aid work. Was relief
work doing any good or was it even doing harm? The altruism of aid organisations could
no longer be taken for granted and challenged the motives of individual aid workers too.
Vaux writes of the „selfish altruist‟ (Vaux, 2001), Rieff of the „moral alibi‟ (Rieff, 2002,
p. 96). Racked by self-doubt, empathy for the suffering of others had become an
insufficient guide to action.
New codes of conduct were developed in the 1990s, but definitive principles to inform
work proved elusive. The very preoccupation with codes spoke of disorientation within
humanitarianism: uncertainties with its mission and mistrust of aid workers.
Humanitarianism was charged with being short-termist and jeopardising people‟s longterm security. Accounts such as Mary Anderson‟s Do No Harm (1999), Fiona Terry‟s
Condemned to Repeat? (2002) or Alex de Waal‟s Famine Crimes (1997) have drawn
attention to how humanitarian aid could aggravate crises, destabilize precarious local
economies and fuel conflicts. The cry that „we are part of the problem‟ is a sentiment that
runs through humanitarian accounts of the last decade. As Vaux explores, „providing a
few sack of food was virtually the same as providing a Kalashnikov rifle‟ in conflict
situations where humanitarian aid would be exchanged for weapons (Vaux, 2001, p. 82).
It has long been argued that there are „no humanitarian solutions to humanitarian
problems‟, however the earlier aspirations for international development have not come
to fruition and have been abandoned. The prospect of significant material advancement of
the world‟s population is off the international policy agenda. Populations in the South
remain far more vulnerable to natural disasters than post-industrial populations as the
devastating Bam earthquake of 2004 testifies. Instead of development eradicating
humanitarian disasters, a state of humanitarian crisis has become normalised, while
humanitarian aid has become a key form through which Northern countries relates to the
South. At the same time, humanitarian relief has become burdened with developmental
responsibilities as international development has retreated.
Arising from this developmental burden, the greatest attacks on the aid sector of the last
decade have been on their traditional emergency relief work, condemned as short-termist
and irresponsible. Furthermore, having normalised a state of humanitarian crisis as
characteristic of particular societies, moral concerns over the character of recipient
societies and their rehabilitation now pervade humanitarian work with its additional
developmental responsibilities. Critics have typically argued that humanitarian
organisations need to reflect on their role, how aid may create dependency, reinforce
inequitable structures and address how humanitarian relief might address the root cause
of disasters and promote developmental and human rights goals (Anderson, 1999). Yet
the developmental burden being placed on humanitarianism arose out of despair with the
development project itself. Unsurprisingly, the experience of repeated disasters and longstanding conflicts with little prospect of material transformation together with the
questioning of humanitarian principles and efficacy of aid have demoralised
humanitarianism and humanitarians. As one UN official is quoted as saying, „This will be
the third time I‟ve rebuilt this place […] I can‟t see doing it a fourth time‟ (in Rieff, 2002,
p. 22).
The crisis of humanitarianism, the normalisation of humanitarian crises and
humanitarianism‟s developmental burden all have implications for how aid recipients are
treated and influenced how their emotional wellbeing has been instrumentalised in
international aid policy. The normalisation and politicisation of disasters has meant that
humanitarian victims are no longer exempt from moral and political judgements. As
humanitarianism is burdened with developmental responsibilities so too is psychosocial
aid as part of contemporary humanitarian programmes. But before I examine this aspect
of disaster psychology work further, I will explore the attractions of psychosocial
programmes for humanitarian workers. An important appeal of psychosocial work has
been as a reaction against the bureaucratisation of aid and the treatment of people as
abstractions and undifferentiated victims. International trauma counselling seeks to
address how people and communities personally experience disaster or conflict. Western
relief workers are also imputing their feelings of vulnerability and demoralisation onto
disaster or conflict-affected populations. But populations do not simply experience
disasters passively, but do so within political, spiritual or moral frameworks. Groups or
individuals having a sense of purpose, whether from political or religious convictions,
communal duties, professional commitment or personal pride, may interpret distressful
experiences as challenges to be surmounted and tests of courage, rather than in just
negative terms (Bracken, 2002; Cherniss, 1995; Frankl, 1964; Waysman, 2001).
Relief workers in earlier decades have seemed extraordinarily resilient despite the
enormities of their mission. In the so-called golden age of humanitarianism in the 1970s
and 1980, relief workers enjoyed considerable personal independence in their role and
had tremendous confidence in the efficacy of their work as compared to present-day
relief workers. In contrast today, relief workers‟ dedication and sense of pride in the
humanitarian mission, which helped make previous generations of relief workers
remarkably resilient, have been severely strained by humanitarianism‟s crisis of
legitimacy. Relief workers have found themselves subject not just to new physical
hazards, but to new ethical and political attacks over their mission. The endless chasing
of grants and donor funding requirements as well as institutional responses to
humanitarianism‟s crisis involving more auditing mechanisms and paper work have
tended to constrain the autonomy previously enjoyed by relief workers and compound
general feelings of frustration and demoralisation in their work. More fundamentally the
meaning of humanitarianism has been thrown into doubt by attempts to create a robust
humanitarianism. The concept of humanitarian enforcement intended to invigorate
humanitarianism has risked imploding the very identity of humanitarian organisations as
humanitarians. If humanitarians can no longer be defined by their non-violence because
of their advocacy of military intervention, and Western military forces also define
themselves as humanitarians, then what is left of the humanitarian identity today? What
makes humanitarian organisations any different from any other organisation? The
accumulation of these developments makes it harder to feel humanitarian work
redeeming.
As a syndrome of meaning (Bracken, 2002, p. 187), the apparent growth of PTSD among
relief workers may be considered an extreme expression of the broader crisis of
legitimacy in humanitarianism. The importance of humanitarianism‟s crisis of legitimacy
has been neglected in the existing literature on PTSD in humanitarian staff. Analysis does
highlight the bureacratisation of aid work, but primarily draws attention to external
dangers and stressors, and the need to develop support systems and training for staff
(Eriksson et al, 2001; McCall and Salama, 1999; Smith et al, 1996). It has been
contended that aid workers experience more stressful emergencies today than earlier
„straightforward natural disasters‟ (Salama, 1999, p. 12), as if past emergencies were ever
straightforward. Yet the humanitarian emergencies of the past were potentially as
complex as today‟s so-called complex political emergencies. However, the Cold War
solidarist framework and humanitarianism‟s more tightly-defined mission of relief
simplified both the humanitarian goals and the ethical issues that humanitarian workers
were confronted with in their work. In essence, the solidarist framework assumed the
legitimacy of host governments and humanitarian organisations, and did not override
official representations of humanitarian disasters or investigate any political culpability in
creating or exacerbating the disaster. The Ethiopian famine of 1984, for example, was not
a straightforward natural disaster, but humanitarian responses treated the famine as if it
were rather than arising from a regional conflict involving the government (Vaux, 2001).
The today‟s concept of „complex political emergencies‟ would treat the Ethiopian famine
differently and complicate how humanitarian staff approached their mission. The new
responsibilities placed on humanitarian aid, the charge that aid may exacerbate crises and
the concept of humanitarian (military) intervention have all created new ethical dilemmas
and anxieties for humanitarian staff.
Humanitarianism‟s crisis of legitimacy, rather than simply the severity of exposure to
danger or suffering in the field, needs to be taken into account in explaining the instance
PTSD among humanitarian staff. Mental health problems among humanitarian staff have
been a conspicuous feature of troubled missions where staff have been most demoralised
in their work. The Somalia mission of 1992 pointedly revealed humanitarianism‟s
disorientation and despair, even before the outrage over responses two years later in
Rwanda. Oxfam, for example, documented after its Somalia operation significant mental
health problems among its staff arising from a muddled and ill-fated mission in which
staff experienced „feelings of personal inadequacy to anger and disillusion with aid work”
(quoted in Vaux, 2001, p. 154). Rapid growth in trauma counselling for international aid
workers, peacekeepers, journalists and human rights workers has followed
humanitarianism‟s troubles in the 1990s. Yet counselling, irrespective of its cultural
resonance, cannot overcome a broader crisis of morale within humanitarianism or society
more generally.
Pathologising affected populations
Moreover, international psychosocial programmes may be expanding alienating
technologies by instrumentalising the emotions. This aspect touches on the allure of
psychosocial intervention for international aid thinking. Psychosocial approaches were
enthusiastically embraced as revitalising the international aid project in the wake of the
international development policy debacle. Psychosocial intervention is seductive in
aspiring to address the dual aspects of charitable and welfare provision - both the
suffering of recipients and their improvement – and seemingly overcoming the perils of
material aid attacked for feeding killers and creating dependency. I have already alluded
to how Western societies are disposed to understand society as the sum of its individuals
and equate reforming society with reforming individuals. The Anglo-American
therapeutic ethos essentially conceptualises social problems as rooted in a defective
ethnopsychology: improve the psychological well-being of people and how they interact
with each other and the social environment will be improved. Conversely when the
psychological well-being of people is threatened, their behaviour and their relationships
deteriorate, according to the model, creating a vicious cycle in which the social
environment is damaged. International reports typically link psychological suffering with
social instability (WHO, 2002, p. 6). Both preventive and curative psychosocial
interventions are therefore regarded as vital to rehabilitate populations whose culture and
personality is problematised as complicit in the crisis, especially war-affected populations
(Common Bond Institute, 2003; Volkan, 2001). Thus the agenda of international
psychosocial work is not simply concerned with relieving suffering, but prescribing a
particular emotional script to reform the recipient society. Consequently, the emotions of
disaster or war-affected populations have become a legitimate area of external
intervention under the prevailing therapeutic model which assumes universal
vulnerability, rather than general resilience, and has even redefined resilience and selfhelp as a condition requiring professional management. International psychosocial
thinking has become very critical about medicalised treatment models and has shifted to
more community-based activities. So, reports may speak of how „Psychosocial support is
not so much about treatment but about helping people to find their own strengths‟
(Rodenburg, 2004).
Unacknowledged by advocates is the disciplining aspects of international psychosocial
work, perhaps revealed in the reluctance to accept that a community might not want or
need therapeutic interventions. Again unacknowledged by proponents is the tension
between the psychosocial programmes goal to alleviate the psychological suffering of a
community, and rehabilitate a community. The recipient community has an ambiguous
place in the international therapeutic model because the ultimate causes of humanitarian
crisis are traced in international psychosocial thinking to the character of the community.
Indeed the very strength of communal relations in the face of crisis can be treated as an
obstacle to the community‟s rehabilitation when the community‟s problems are seen as
bound up with the character of its communal relations. Hence irrespective of whether a
community appears to be holding up it is deemed in need of psychosocial aid: for in not
admitting its psychosocial needs, as manifested in the crisis, the community is in denial
and storing up problems for the future.
The prevailing international therapeutic model is not only inappropriate to address the
needs of disaster-affected populations, but demoralises them as moral agents. More
significant perhaps than questions over the efficacy of the numerous international
psychosocial programmes is their insidious redefining of the problems facing preindustrial or semi-industrial societies globally in terms of their psychological state.
Psychological distress, for example, has been cited in a WHO report as the greatest health
problem facing people in Afghanistan (WHO, 2001). The diagnosis of mental health as
the worst health problem confronting Afghanistan, a country suffering one of the lowest
rates of life expectancy and highest rates of infant mortality, seems perverse. However,
the idea has gained currency in international policy through Western psychosocial
models‟ influence, which would conceptualises the crisis in Afghanistan in terms of
intergenerational cycles of psychosocial dysfunction. But is the humiliation and hazards
of Afghani women begging, for example, a psychological problem or a material one?
How do psychosocial programmes address the women‟s poverty driving their begging?
Of questionable efficacy, international psychosocial programmes may be experienced
negatively as stigmatising and compounding recipients‟ humiliation. Disaster or waraffected populations, aid officials acknowledge, may view trauma counseling
programmes as stigmatising and irrelevant to their needs (Wiles et al, 2000). In the high
profile Kosovo humanitarian operation in 1999, relief workers admitted seeing few
people who would regard themselves as suffering from any psychological disorder (Wiles
et al, 2000). Yet international psychosocial programmes have had little to offer these
cases. Indeed, the basic needs of the long-term mentally ill was surprisingly overlooked
even in the relatively resource-rich emergencies in South-East Europe for all the hype
over „traumatised populations‟ in the aid literature. This neglect belies the hopes of some
international aid officials that the new interest in trauma would help foster the interests of
the mentally-ill. Yet all the vast sums and concern poured into post 9/11 trauma
counseling has not discernibly furthered the interests of the long-term mentally ill on the
streets of New York. So there is little grounds for believing that the preoccupation with
trauma furthers the interests of the mentally ill elsewhere.
The call for therapeutic interventions as „preventive medicine‟ (Volkan, 2001), following
the precautionary principle of psychosocial risk management, even where populations
appear resilient, may perpetuate psychological ill-being by denying populations‟ own
coping strategies and creating unaccountable relations of dependency. As salutogenic
studies suggest (Waysman et al, 2001), those who view themselves as being in charge of
their fate are more likely to have positive outcomes. Ironically, however, the rise of
international psychosocial model has been bound up with the erosion of sovereign
equality in the international system and helped legitimise suspension of local political
control and the establishment of de facto international protectorates under the
international community, notably in Bosnia (Pupavac, 2004 forthcoming). International
dependency has been highlighted as negative for a population‟s psychological well-being
(de Jong et al, 1999). Longitudinal studies of mental health in these informal
protectorates must take into account loss of political control in their analysis.
Psychosocial interventions are correctly viewed with suspicion by many societies for
their premise is a mistrust of the populations‟ psychological and moral capacity, with
implications for their rights and freedoms.
The predominant international disaster psychology model only complicates recovery by
endorsing vulnerability and making resilience conditional on professional interventions.
The renunciation, even denunciation, of resilience in contemporary Western
emotionology has been validated until recently. The dangers of validating vulnerability
became apparent to policy-makers in the wake of the terrorist attack on the World Trade
Centre. A nervous, „post-traumatic‟ ethnopsychology is particularly susceptible to
terrorist strategies designed to promote fear. Policy has to address how people may be
discouraged from being resilient in present Western cultural sensibilities. Researchers at
the International Policy Institute of the War Studies Group at King‟s College London
have recommended „the need for an approach that clarifies people‟s values rather than
emphasising their vulnerabilities‟ (Durodie and Wessely, 2002). Their approach is useful
in recognising how a society‟s weak sense of social purpose makes people more
psychologically vulnerable. A relativistic age does not encourage the development of
strong characters fostered by the strong belief systems of the past. A loss of belief in
humanity and human progress informs the contemporary humanitarian agenda and the
malaise in Western societies more broadly and made it difficult to project an inspiring
vision globally. Psychological recovery can only be realised from the overall
circumstances and meaning of people‟s lives, and cannot be treated as a technical
problems deliverable through emotional literacy programmes (Summerfield, 2002).
However, the psychosocial aid package, as the new hope of humanitarianism,
humanitarianism itself the last hope of the West (Rieff, 2002), embodies a misanthropic
vision which casts doubt on the moral capacity of affected populations to recover.
Nevertheless, the breakdown of meaning and its expression in psychological vulnerability
is not universal. Western-inspired psychosocial programmes represent a global lesson
into vulnerability. The practical „problem focused coping style‟ common to non-Western
societies is far more useful than the „emotion focused coping style‟ of contemporary
Western therapeutic cultures in recovering from catastrophes (Summerfield, 2001).
Therapeutic approaches, focused on feelings rather than activities, can legitimise the
assumption of sick roles, furthering social disengagement and atomisation. A first step in
national and international policy should be the re-validation of resilience. Individuals or
groups should not be deemed in need of psychosocial preventive interventions simply
because they have been through distressing experiences. Against the prevailing
emotionology, it should be reiterated that distressing experiences may foster strength of
character and stimulate latent communal support networks (Joseph et al, 1993). There is
new interest in findings of resilience (Kendra and Wachtendorf, 2003; Rogers, 2003), but
one should be wary how resilience itself is being pathologised in international
psychosocial thinking as a condition that needs professional management. Even where
appeal to a shared belief system remains elusive, strength of character may be encouraged
by affirming people‟s professional abilities and courage displayed in emergency
situations. Voluntarism to encourage latent communal responsiveness and social action,
rather than fostering social disengagement in a sick role, could also be useful, but again
voluntarism has been affected by the declining belief in social progress, as I have
indicated in relation to the crisis of humanitarianism.
The lessons of resilience and social purpose are crucial for devising policies for disaster
and war-affected populations internationally and for developing national responses to the
new security threats confronting Western societies. Psychosocial interventions are
inadequate and inappropriate for the task. A sense of meaning and social purpose is
crucial to psychological well-being. The disorientation of the humanitarian mission
underlies the rise of PTSD among humanitarian workers and the impulse to manage the
psychology of war and disaster-affected populations. At the heart of the humanitarian
mission and modern ethics was the belief in the moral capacity of fellow human beings,
but the international psychosocial model‟s equation of traumatisation with dysfunction is
dehumanising and offensive. Affirmation of this core principle of humanism is
fundamental to the future of humanitarianism and resolution of the contemporary crisis of
social purpose and meaning.