A critique of seven assumptions behind psychological trauma programmes in war-affected areas
Abstract
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 nongovernmental organisations. The assumptions underpinning this work, which this paper critiques with particular reference to Bosnia and Rwanda, reflect a globalisation of Western cultural trends towards the medicalisation of distress 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 to which short-term technical solutions like counselling are applicable. These concepts aggrandise the Western agencies and their 'experts' who from afar define the condition and bring the cure. There is no evidence that war-affected populations are seeking these imported approaches, which appear to ignore their own traditions, meaning systems, and active priorities. One basic question in humanitarian operations is: whose knowledge is privileged and 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 still embodying the collective capacity of survivor populations to mourn, endure and rebuild.
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An assessment measure developed for North American and European populations cannot be assumed to be valid and accurate in a different cultural context.
“We cannot assume that an assessment measure developed for North American and European populations will be valid and accurate in a different cultural context (Lewis-Fernandez and Kleinman, 1995; Summerfield, 1999).”
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- Authors
- Summerfield, D.
- Corresponding author
- Summerfield, Derek
- ORCID
- Summerfield, Derek
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 1999-05
- Volume
- 48
- Issue
- 10
- Pages
- 1449-1462
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2082317339
- Cited by
- 987
- References
- 0
- Citations by year
- 2026: 30 · 2025: 19 · 2024: 18 · 2023: 26 · 2022: 35 · 2021: 34 · 2020: 70 · 2019: 35 · 2018: 45 · 2017: 57 · 2016: 33 · 2015: 54 · 2014: 56 · 2013: 39 · 2012: 43
- FWCI
- 54.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- UNICEF
- Topics
- Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- post-traumatic stress disorder, war-affected populations, humanitarian aid, psychotherapy, Western cultural imperialism, Bosnia, Rwanda, mourning, collective resilience
- MeSH terms
- Adolescent, Adult, Altruism, Child, Counseling, Data Collection, Europe, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Mental Health Services, Stress Disorders, Post-Traumatic, United Nations, Warfare, World Health Organization, Program Evaluation, Program Development
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