The literature review shows that mental health is a consistent concern and it is unclear what interventions have been used in the past on child soldiers. Little is known about the psycho-social aspects of the Interim Care Centres that children were placed into prior to returning to their families. Studies indicate as well that the Liberian experience showed many children didn’t go to through the reintegration process, or that those who did ended up living as street children in the capital, Monovira (Meideios, 2005). Studies are lacking.
The literature also shows a preponderance of proponents of Westernized psychiatric medical models, which suggest child soldiers are suffering from Post Traumatic Stress Disorder (PTSD) (Bayer, Klasen & Adam, 2007; Oyuga, Oyok & Moro, 2008). For instance, in a study of 301 children that have been and forced to become soldiers, Derluyn Broekaert, Schuyten and de Temmerman (2004) describe the heinous crimes these children were forced to commit and the violence they were exposed to. Of the 71 children who agreed to complete a questionnaire to assess PTSD, 69 had clinically significant symptoms. These study samples are typically small, lacking generalizability and the suitability of the measures/indexes (i.e., the Harvard Trauma Questionnaire (HTQ)) to be used on children or on a non-Western population was not addressed.
Summerfield (1999) states “social healing and the remaking of worlds cannot be managed by outsiders”, p. 1461. Using Western-developed measures to diagnose PTSD (considered a pseudo-condition by many) is in itself of considerable debate beyond this current research. However, literature shows that PTSD diagnoses aggrandises Western agencies and so-called experts and pathologies distress. Besides, as Summerfield (1999) argues, there is no clear evidence that war-effected populations seek imported interventions that typically ignore their own traditions, meaning systems and priorities. This raises major issues for social work as we are acutely aware about the co-opting of knowledge by the privileged and who has the power to define the problem and the intervention.
Summerfield (1999) states that it is only recently that trauma paradigms have become fashionable within international humanitarian framework and for Western donors (the early 1980s manuals on refugee health made no mention of it). The medicalization of distress and grief (normal responses to traumatic events) by Western practitioners is not at all surprising, so focused as it is on individualism and the tendency to assume universality and applicability to non-Western contexts in what Kleinman calls category fallacy (quoted in Bracken, Giller & Summerfield, 1995, p. 1074) As Summerfield (1999) states, these top-down approaches transform the social and indigenous fluidity of the natural into a biological/medical-technical model. Consultants to NGOs such as World Health Organization (WHO) and UNICEF have portrayed war as a mental health emergency with claims that the epidemic PTSD needs to be treated. Trauma programs are not asked for by countries in the global south and, yet, hundreds of millions of dollars flow into programs that are without evaluation so that they in fact may do more damage or have enduring long-term negative effects on meaningful systems and traditional coping strategies. Summerfield (1999) shows compelling reasons why the conceptual foundations of Eurocentric discourse about post traumatic stress, counselling, and vulnerable groups are essentially problematic (and dangerous) in non-Western contexts.
Bracken, Giller and Summerfield (1995) proposes that we question the ethical assumptions in PTSD discourse – that of individuality, the universalism of western psychiatry and the limitations of Western models of therapy in the non-Western world. This narrow focus on the diagnosis and treatment of PTSD in such situations is inappropriate and may miss the most important determinants of the eventual outcome of such experiences for the people involved. The approach to mental illness is a reflection of a particular perception of individuality and in many non-Western cultures the notion of self and its relationships to others and to the outside world is different. Therefore, the experience and the explanation of illness are also different. The intra-psychic is not emphasized and thus plays a comparatively minor role in less egocentric societies. Greater weight is often given to “independent somatic processes, supernatural forces and social relations as causal agents”, p. 1085. Of particular relevance in war-torn countries is that the professional sector that may already be relatively undeveloped may be disseminated and Euro-centric practices may likely have very little influence on the ways in which these societies symbolically conceive illness. In such societies the local understanding of mental illness will be little affected by theories and approaches developed in the West, a situation obviously very different from the west, where psychiatry and psychotherapy are discussed daily in the popular media.
Unlike individualistic, modern Western pscychology (Gesellschaft skills), the traditional African post-war trauma healers locate the confused mental state and confusion with both the perpetrator and the community as a whole. Thus appeasement of the spirits of the dead is an imperative if the perpetrators of violence and brutality are to be cleansed of their transgression.
... the treatment is overwhelmingly based on Western psychological approaches in an African envirnoment that is drastically different from those in Europe or America. In these parts of the world, the definition and understanding of distress and trauma, its diagnosis and healing processes are totally different from those in Africa ... Western psychological healing methods locate the causes of psychological distress within the individual and therefore devise responses, which are primarily based on individual therapy
(Gbla as cited in Zack-Williams, 2006)
"In the context of exposure to significant adversity, resilience is both the capacity of individuals to navigate their way to the psychological, social, cultural, and physical resources that sustain their well-being, and their capacity individually and collectively to negotiate for these resources to be provided in culturally meaningful ways."
Dr. Michael Unger, Co-Director of the
Resilience Research Centre