By Ishita Madan

Along with providing resources such as food, shelter, clothing, and medical care to disaster areas and war torn regions, it has also become increasingly common to provide mental health care in certain regions. Doctors Without Borders has made it a point to hire psychologists, and the mental health of children in particular has become a priority. Yet many mental health professionals fall short of their goals. This may be partially due to mental illness manifesting itself very differently in these areas than would be understood in a western context. While Maslow’s hierarchy is not necessary accurate – populations facing death via warfare or starvation still exhibit a need for emotional connection – in many of these areas mental illnesses such as PTSD have become a way of life. Rather than being seen as isolated, bizarre behaviors the way they might be in a middle class Western context, populations become acclimated to living with PTSD, and being exposed to it. As there is a lack of adequate resources and treatment, many have learned to adapt to mental illness. However, there can be challenges when it comes to adapting to peace. What does this show us about the nature of PTSD and also state violence?

PTSD is extremely prevalent in many communities throughout the world. In Gaza, Bosnia, and inner city areas in the United States, it is common for an individual to suffer from this mental illness. A long range study of children of the Bosnian war, as documented in the book Then They Started Shooting determined that many had adapted to living with mental illness to the point where it did not register as abnormal to the average Bosnian child to experience flashbacks or feelings of inconsolable rage. Rather than being seen as maladaptive behavior, it was seen as a natural part of life many people experienced, similar to how the average middle class American is acclimated to experiencing anxiety over exams. It is unpleasant but not out of the ordinary. Notable cases of mental illness arose when there were additional factors in the child’s life, such as domestic violence, sexual abuse, or the death of a close relative or friend. In these cases, the trauma they experienced socially isolated them, and the consequences were more severe.

Adjusting to peacetime was also a difficult process. For some, such as a child named Amala, the end of the war provided her no reprieve, as her father’s violent nature had been exacerbated by it. In the following years, she developed severe depression and had one suicide attempt. For another child, named Nina, the end of the war came with new responsibilities. Her previously agreeable father had grown angry and volatile. Nina had felt a loss of innocence for many years at this point, and reacted by becoming a pillar of support for her family. This family leads us to understand that the end of crises, or removing a family from a violent situation is not a final resolution. People acclimated to instability, conflict, and state violence may find the coping mechanisms they’ve developed do not transfer effectively to peacetime, and in fact create discordance in their lives. Children, in particular, may feel older than they truly are, attempting to support their families or, in extreme scenarios, attempting to take their lives.

What we can learn from these cases is that removing families from conflict zones is not enough, and the subsequent psychological problems may not always be understood in traditional terms. Psychological disturbance in children must sometimes be treated without being approached as mental illness, as they may see their symptoms as common, even reasonable responses to their upbringing. Families must be supported actively even during peacetime, not only because of PTSD but because peacetime itself can be a stressor to those acclimated to violence. Through taking these case studies into account, mental health support in conflict zones will improve drastically.