'Psychological first aid': education is essential in post-conflict situations.

Speaking to the 2,000 participants of the 56th Annual DPI/NGO Conference in New York, Nila Kapor-Stanulovic addressed the psychological aspects of human security and dignity. She experienced first-hand the effects of multiple armed conflicts in the Balkans and treated patients affected by the crises in Bosnia and Herzegovina and in Macedonia. She pointed out that she had been a recipient, as well as a provider, of psychological aid, at times filling both roles simultaneously. Although it had not been easy, Ms. Kapor-Stanulovic explained that the most difficult times were those when she was only receiving such support due, she believes, to the sense of helplessness that results from having encountered traumatic experiences. She strongly endorses the idea of helping victims restore a feeling of being somebody. An expert in "emergency psychology" which includes crisis intervention techniques, post-trauma interventions and psychosocial rehabilitation, she is continuing her work to ameliorate the consequences of the armed conflicts in the former Yugoslavia.

Biko Nagara of the Chronicle spoke with Ms. Kapor-Stanulovic on 10 September.

On the psychology of dignity and security

Dignity and security within the context of psychology have been addressed but never fully explored. The psychological aspects of life are frequently disregarded by humanitarian agencies and non-governmental organizations (NGOs) because psychology is often associated with illness and psychopathological problems. When I say that I am a psychologist, it is these kinds of problems people tend to associate me with. Psychology, however, is intended for people who have suffered and endured crises, causing a loss of dignity. It is very important to break the misconception that psychology and psychosocial rehabilitation are aimed only at a small number of sick individuals

On upgrading the role of psychological welfare

The United Nations is primarily concerned with physical survival, which is indeed a priority. Nevertheless, psychosocial welfare has assumed too much a secondary position. Having worked for the United Nations Children's Fund (UNICEF). I understand that the problems are many, while staff and resources are limited More attention should be paid to questions relating to non-physical survival. We need to disseminate basic knowledge of psychosocial assistance and rehabilitation. It should be understood that we are not here to treat sick people; we are here to promote the well-being of the general population and the recovery of those affected by man-made and natural disasters, such as armed conflicts, poverty, hunger and diseases.

On psychological first aid

Psychological first aid is a relatively new concept, which is as important as medical first aid. When someone is bleeding, you don't immediately take that person to a specialist; you do something to stop the bleeding and then take him/her to a specialist. Likewise, you do not take a person who is in need of immediate psychological assistance for psychoanalysis or psychotherapy. Everybody should know the basic principles of psychological first aid to help others recover faster and better from a crisis. What I did in my country and in other places was to make a list. Psychological first aid is a very simple concept that can be broadcast over the radio or printed on brochures and leaflets for anyone to learn and apply. During the NATO bombing of Yugoslavia, I asked local radio stations to explain one principle of psychological first aid every evening for one minute before the news.

It took just one minute over twenty consecutive evenings to describe twenty valuable aid techniques. It is thus simple and inexpensive to publicize such first aid to everyone who is listening to the radio or watching television. People who are empathetic, motivated and willing can apply it without training, while others may need very basic training.

On the long-term effects of collective traumatization

Collective traumatization is a more complex issue. In some countries, like Afghanistan and Iraq or my native Serbia, virtually everybody is traumatized because they have all been affected by a crisis. One can only try to support their recovery by re-establishing dignity, self-worth and appreciation for life and individuals; some will recover on their own, while others will not. Unfortunately, people tend to return to violence soon after being exposed to chronic, continuous trauma. Thus, the future is very bleak for countries where the population has been heavily traumatized as a whole. In many post-conflict countries, crime increases, especially among the youth; one cannot expect young people to understand and embrace tolerance once they have been exposed to the violent acts of others People, especially the young, come to believe that war, anger and hatred are acceptable ways of dealing with others I don't know exactly what should be done, and so far I don't see any serious willingness to invest in the necessary rehabilitation programmes. Priority has been given to housing, food and medicine, and people therefore will remain traumatized.

On cycles of violence In post-conflict countries

A generation who endures years of brutality will simply take violence as a model of behaviour in relating to other people, so this is a long-term problem--it doesn't stop when the first episode of violence ends. I know from my own country that one cannot just introduce peace in a post-war environment. Although the international community removed our President, who was a dictator, young people continue to be aggressive towards others and we are having great difficulty in introducing programmes to change their beliefs about how conflicts should be resolved. Several programmes on peaceful conflict resolution and tolerance have been implemented, but they cannot reach everyone, Bombs, however, did reach the whole population five years ago, and now huge efforts are required to remedy the damage done in a short time.

On the relevance of education

Education is essential, but all young people cannot be reached through formal education, because many do not attend school. Some have just graduated, others are simply not attending classes, and these young adults will be leading the country for the next thirty years. You will never reach everybody, and this is a problem. I would like the world leaders to attend at least one course on peaceful conflict resolution offered by psychologists. World, community and religious leaders, as well as any figure of authority, should communicate to others that conflict is normal, but violence is abnormal. Conflict is a part of our lives--both professional and personal--but this does not mean that one should be violent to solve problems. It would be useful to keep in mind that every violent act leads millions of people to believe that violence is the only solution to a conflict; that would help solve much more than anything else. Although the United Nations is doing a lot, it does not have enough resources to reach entire populations

On the 56th Annual DPI/NGO Conference

It was very useful and pleasant to attend the DPI/NGO Conference. What I got from this meeting is that there is a strong force among NGOs to implement ideas and that many people are interested in improving and introducing these ideas into civil society. I feel much better: I realized I'm not a lonely Don Quixote but a part of a huge group that is trying to improve the world. It is a wonderful feeling.

NILA KAPOR-STANULOVIC iS professor of human development and mental health at the University of Novi Sad in Serbia and Montenegro. The first psychosocial officer for UNICEF dealing with children affected by armed conflicts and the adverse consequences of socio-economic transitions, she has continued to work since 1995 as a consultant to UNICEF offices in Armenia, Azerbaijan and Georgia. She received the International Humanitarian Award from the American Psychological Association in 1999 for her "activism in promoting mental health programmes in war-torn countries". She designed support programmes for the victims of polio epidemics in Kosovo and for earthquake victims in Italy, and conducted research on the consequences of bombing on mental health, following the aerial attacks by the North Atlantic Treaty Organization (NATO) during the 1999 conflict in the former Yugoslavia.

Mending the 'Broken Vessel' Psychological Well-being and Human Security

The importance of understanding the collective experiences faced by conflict and post-conflict societies and of implementing psychological approaches in addressing their problems is increasingly recognized by international civil society.

In discussions at the opening plenary of the 56th Annual DPI/NGO Conference, participants addressed the connections between collective trauma and loss of dignity with social conditions that prolong violence. "Cycles of violence do not occur in a vacuum", explained Pumla Gobodo-Madikizela, Professor of Psychology at the University of Cape Town, but are "symbolic of unacknowledged events that have been experienced in the past--a re-enactment of old scripts that are finding voice in the present". Speakers pointed out that deprivation of opportunities, economic degradation and collective traumatization destroy not only the individual but also the collective sense of dignity, which is transmitted across generations.

Organizations such as the International Red Cross and Red Crescent Societies are actively promoting psychological health in much of the world. Through psychological support programmes in North Africa and the Middle East, they are carrying out immediate and long-term aid aimed at women and children affected by violence. They are also conducting awareness campaigns to encourage community-based intervention and battle the cultural stigma attached to psychological needs. The International Society for Traumatic Stress Studies is working with the United Nations to develop better policies to address the psychological aspects of social and humanitarian work and, in collaboration with the Division for Social Policy and Development of the UN Department of Economic and Social Affairs, has produced a book entitled "Trauma Intervention in War and Peace: Prevention, Practice and Policy".

Afaf Mahfouz, Chair of the International Psychoanalytical Association Committee on the United Nations, said that while there is a need to increase the number of personnel trained in psychology--and the United Nations is seriously understaffed in this area--it is encouraging to see a shift in thinking towards "a psychological approach to development". By acknowledging the personal as well as social aspects of dignity, a psychological grounding can help explain some of the fundamental roots of tensions that lead to conflict. Commenting on the shattering effects of traumatic experiences on people's "sense of inviolable self worth". Director Joerg Bose of the William Alanson White Institute of Psychiatry, Psychoanalysis and Psychology described the resulting feeling as that of a "broken vessel". Recovery requires the construction of a new "sense of self", which often cannot be achieved alone. This is where the efforts of civil society are required, for there is a pressing need to provide compassion and counter the devastating effects of cycles of conflict and oppression.--Biko Nagara