Searching for Normal in the Wake of the Liberian War. Sharon Alane Abramowitz
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prioritized translated directly into space, manpower, technological sophistication, and public access. Mental health received far less attention than the tremendous movement of refugees and internally displaced persons in 2006, but oddly, UNHCR officials argued that mental health interventions were key to the postconflict recovery, while WHO officers contended that it was “not a priority.”
When I arrived in Liberia to conduct my research, I broadly wanted to understand the relationship between individual trauma and collective trauma in Liberia’s postconflict recovery. Just a few years before, I had spent two years (2000–2002) as a Peace Corps volunteer in the northern Korhogo region of neighboring Côte d’Ivoire, where I stood by as a witness to a republic in crisis while its populace talked itself into civil war. Prior to that, I had worked in domestic violence, rape crisis, and transitional residence programs for women and abused teenage girls in the United States. From these experiences, I became intellectually concerned with the empirical linkages between collective trauma and individual trauma, and with questions of survivorship, recovery, and reconstruction. With my newfound understanding of violence as a process of social change that took peaceful social spaces and opened possibilities for violent social action, I wondered how a country could reverse this process and, in effect, talk itself out of war and into a new form of social experience—postwar peace.
More intimately, my interest in this research emerged from my own inheritance of intergenerational trauma from Jewish parents, grandparents, and great-grandparents who had fled from pogroms, hid from Hitler, struggled under postwar anti-Semitism, rejected Israeli citizenship, and built a life in America, the new world. I wanted to understand how it was possible to rebuild a life, a people, and a nation after undergoing some of the worst crimes against humanity modernity could offer. Liberia gave me a path to gain insight into the road my family had taken. Trauma, to me, meant more than suffering. It meant managing suffering while making choices, planning for the future, struggling with the present, and holding on to the redemptive possibilities of hard work, hope, and renewal. Thinking of my grandparents, I had the sense that recovery from trauma had little to do with healing or therapy; it happened after fifty years, at the end of a family dining room table covered with food, when the survivors looked out protectively over three generations of descendants. Recovery meant autobiography, and even at the end of survivors’ lives, it was never complete.
My plan had been to act as a participant-observer of one humanitarian NGO’s mental health, trauma-healing, and psychosocial projects to study how Liberians understood their own experiences of war and reconstruction, and to examine how Liberian and humanitarian understandings worked themselves out in humanitarian practice. But soon after I arrived in Liberia, I learned that my contact, a Norwegian program officer, had left the country for six months. No one knew how to get in touch with her. The NGO was totally unprepared for my arrival, and it was utterly uninterested in hosting me. That plan was no longer an option.
As an anthropologist, the political economy of life in Monrovia made the management of basic needs nearly impossible. Living on a fixed stipend from a research grant, I found that rents in Monrovia were as high as rents in London, Tokyo, and San Francisco. My mobility and housing options were severely constrained by my gender and my lack of affiliation with a humanitarian organization. Consequently, I relocated eight times during my year of fieldwork: I shared dim apartments behind barbed-wire-covered walls, hotel rooms, short-term local housing under the constant surveillance of bandits, and I was secretly offered couches in friends’ embassy compound apartments, UNMIL bases, and NGO guest houses. Leaving my various residences on foot, I was routinely physically assaulted, verbally abused, or threatened, like many of the Liberians around me.
Directions
In order to get started, I called the only friend I had in the country, a consultant for UNMIL and the United Nations Children’s Fund (UNICEF), who set me up with a place to live and a general sense of the geography of the capital. With her help, I conducted an institutional inventory of international and local NGOs that reported having provided mental health and psychosocial interventions in their international media literature, marketing materials, and on their websites. Although NGOs often reported on the activities that they classified as psychosocial: ex-combatant education and retraining, GBV counseling, psychosocial curricula for elementary schools, civil society training, and human rights training, by 2006, most NGOs had ceased mental health and trauma-healing activities, and were intensely averse to providing financial, labor, or logistical support for mental health or psychiatric services. Few organizations were willing to claim any explicit involvement in mental health, and most took pains to separate themselves from those activities in situ, “on the ground.” Instead, in interviews, expatriate and Liberian NGO workers repeatedly used the phrase “destroyed human capacity” interchangeably with the word “trauma” in order to evoke a summary of the total human destruction wrought by the Liberian war.
To follow the meaning of psychosocial intervention in Liberia’s postconflict reconstruction, my research gradually expanded from interventions that could narrowly be defined as mental health and psychosocial to a consideration of any program or action that was classified, by anyone, as “mental health” or “psychosocial.” My emerging ambition was to study mental health and psychosocial intervention in a multiscalar and processual way, using a multisited ethnographic approach (Falzon 2009; Hannerz 2003). I first sought to examine the implementation and governance of mental health and psychosocial interventions vertically, from global and national decision makers, to Liberian and expatriate psychosocial and mental health workers, to Liberian program beneficiaries, and to Liberians who were excluded from psychosocial interventions (Marcus 1995). I also sought to examine mental health and psychosocial interventions cross-sectionally by looking at the experience of humanitarian/local interactions around psychosocial intervention at the point of their convergence in daily life.
The goal of this chapter is to contextualize the mental health and psychosocial interventions described in the remainder of this book in the prewar, wartime, and postconflict histories of Liberian mental health, trauma-healing, and psychosocial rehabilitation. Therefore, the primary task of this chapter is to write a “history of the present” for Liberian mental health in order to provide a framework for understanding the postconflict paradigm that emerged after 2003 by following the discontinuities, conflicts, and uncertain progress toward the creation of a Liberian national mental health policy, a WHO priority for national mental health systems. As the processes of humanitarian coordination, prioritization, and distribution of resources unfolded, they revealed the uncertainties and ambiguities of the postconflict moment. These processes were rooted in a dynamic of global-local engagement that was fractious, complicated, and bidirectional, and always filled with a sense of unknown ends (see Chapter 4).
In the data collected for this chapter, nearly all of the historical material from the era before 2004 is the result of archival work, retrospective interviews, and publicly available NGO documentation (also known as the gray literature). In contrast, nearly all of the material post-2005 is based on participant observation, key informant interviews, and a careful process of cross-validating informants’ accounts with NGO, local informant, documentary, and international sources. This process of tracking down the “living history” of humanitarian implementation was a side pursuit to my multisited ethnographic fieldwork, in which I tracked mental health, psychosocial, and trauma-healing interventions in clinics, hospitals, NGO offices, government ministries, shantytowns, rural villages, and UN bases. My research transected four counties in Liberia (Montserrado, Bong, Lofa, and Nimba), and in them, I tracked patients with mental illness from clinics to hospitals; studied the financial and physical flows of aid from the capital to the country’s “most-affected areas” (Nimba, Bong, and Lofa counties); and followed the movement of mental health workers through their various assignments. I tracked the movement of policy documents through institutional hands, the gradual expansion of safe space, the availability of over-the-counter psychoactive medications from local markets to urban ghettos, and the usage of psychiatric medications inside and outside of mental health facilities. In my characterization of “the psychosocial” as a nonhuman actor that has agency, yields symbolic, interactional, and material effects, and creates logics of momentum, expertise, and resources in the decentralized, deinstitutionalized, and heterogeneous context of