A critique of seven assumptions behind psychological trauma programmes in war-affected areas

Programmes costing millions of dollars to address 'posttraumatic stress' in war zones have been increasingly prominent in humanitarian aid operations, backed by UNICEF, WHO, European Community Humanitarian Office and many non governmental organisations. The assumptions underpinning this work, which t his paper critiques with particular reference to Bosnia and Rwanda, reflect a globalisation of Western cultural trends towards the medicalisation of d istress and the rise of psychological therapies. This paper argues that for the vast majority of survivors posttraumatic stress is a pseudocondition, a reframing of the understandable suffering of war as a technical problem t o which short-term technical solutions like counselling are applicable. The se concepts aggrandise the Western agencies and their 'experts' who from af ar define the condition and bring the cure. There is no evidence that war-a ffected populations are seeking these imported approaches, which appear to ignore their own traditions, meaning systems, and active priorities. One ba sic question in humanitarian operations is: whose knowledge is privileged a nd who has the power to define the problem? What is fundamental is the role of a social world, invariably targeted in today's 'total' war and yet stil l embodying the collective capacity of survivor populations to mourn, endur e and rebuild. (C) 1999 Elsevier Science Ltd. All rights reserved.