Karen Abbs, in recent years you have been working as a psychotherapist in the Central African Republic, Darfur, Iraq and South Sudan, places in the throes of protracted civil wars. What has been your impression of the people you met?

There is a clear impact of the trauma they have been going through, but there is also incredible sense of hope. What me kept doing this work was the people's big amount of resilience.

What exactly is that?

It is the ability to bounce back from very difficult situations and to maintain hope that one day things could be better. For example, I was running a workshop in Darfur. Everyone had lost their villages. From a Western perspective, you would think life is finished, that they had lost everything. I did an art project and they made incredible pictures of their dreams and their hopes. They dreamt of going back to their villages, rebuilding them despite the difficult things that had happened to them. They still believed that there is a future. This concept that you keep going despite the fact that something difficult happened to you is resilience.

How do people react to the daily insecurity they face in conflict zones, when life is so unpredictable that they often don't know what will happen to them the next day?

Once I did a drawing with a community in the Central African Republic. On the drawing you can see the sections titled “security” and “insecurity”. I hadn’t known what had happened to this community beforehand. I was in the North Eastern part, on the border of CAR and Darfur. The Janjaweed, the notorious forces on horseback fighting mostly in Darfur, had come over the border. So what that picture shows that the Janjaweed came into the village and they took all of the children into a hut and burned them. On the picture you see the location of the hut where the children were burned.

I was working in a hospital, part of it had a feeding centre attached where children were nourished. A group of children came in and one of the children was particular. She would just sit all day and stare and refuse to eat, and the mother acted that way as well. You could see in their faces there was extreme trauma. Shutting down, not eating, not caring for yourself, they are all physical aspects of the trauma. Later we found out: The mum and the little girl have witnessed the children been burned.

Could you help them?

What we were able to do was to train counsellors locally. The local therapist gave them space to cry and help them, so they started to eat, the mother cared for her daughter, they could go home. What the story illustrates, is that the absolute terror some people are living through makes them freeze. These two, having lost family members, had to shut down. But over time, with help, they were able to recover.

You use drawings? Does this allow you to go beyond interviews?

I use this method a lot. My original training is in art therapy. I found out that art is very helpful in contexts were there is not a language for feelings. The psychological language, such as the Western concepts of psychology, is difficult to translate. But by using art, having people draw images of their experiences and how they are feeling helps them to create a kind of transcending language. If people, for example, hadn't drawn the image of the village, I wouldn’t have known the story.

The psychological language from Western countries might be difficult. Have you looked at how local traditions deal with trauma?

Yes, very closely. Especially in the Central African Republic. It is really important to work with counsellors to understand how stress is expressed in that local context, and how traditional methods help. We don’t want to come in with a colonial Western model that replaces the local model that works. That’s why we use local counsellors.

What have you personally learnt through your work in the field?

First it means learning about how people manifest stress. A woman came into a hospital. She was convulsing. She had what appeared to be a psychotic episode or an epileptic fit. One of the orderlies, a woman, went and got her a bowl with some feathers and some smoke. She put smoke over the woman and just talked to her a little bit. Then one of our counsellors talked with her. The underlying issue was she was not being taken care properly by her husband. He wasn’t looking out for the family. She hadn’t had what she needed. She expressed this through her convulsion and the shock would draw attention to the issue. She got help and afterwards her husband was asked to give her a charm, as a way to show that he understands the problem: to show he would look after her. This was all done following traditional methods. And after we followed these practices, the woman was absolutely fine. So you have to trust very much in the local methods that are working.

So your job consists in designing a method in each case, in keeping with local customs?

Exactly. What was discovered is: suffering is universal, we all suffer in some way when something difficult happens to us, but how we express this suffering differs according to our culture. There are some principals of psychotherapy that you can bring in: Universal points like if we have trauma, we have bad experience from that trauma, like shock or a numbing or nightmares or flashbacks. This is the universal principal that you can apply. But then how you work with people is adaptable to the local context.

The Central African Republic has a history of coup d’etat, of rebellion, of violence and is described as a failing state. As a psychotherapist, how do you approach to countries like this?

One has to analyse the political structures, the political events underway in these countries. My way of psychotherapy has always been to trust in the skill of the locals. That's why I don't go in directly to deliver psychotherapy, but rather I train locals. Something that often slips in conflict is social cohesion. People die and some people are fighting which disintegrates the social cohesion that would help the people to maintain the psychological robustness. So we have people in the communities who are trained in how to have helpful conversations that can help to restore that social cohesion.

In terms of the politics: One key rule for NGOs is: Don't get mixed up in the political. You must maintain your neutrality to help people who are impacted by what is going on politically. 

When you are working how do people react to you? How difficult is it to avoid colonial stereotypes of white people helping poor blacks?

I think it is really important not to go in as an expert, but to go as one more member of the team. I may have some expertise around psychotherapy and torture, but the local people have the expertise on the cultural elements and local contacts.

What does it do to societies when such a high percentage of the population suffered trauma or experienced violence?

If you have on-going trauma, your ability to cope with stress reduces. If you’re not speaking about your trauma, it can become difficult to cope with its impact. There is a combination of two things in conflict areas. Chronic stress and of daily stress: for example someone suffers from not having enough food and also because someone in the family had died. This impacts on you physically. As I was working in the hospitals, a large amount of the people had headaches, stomachaches and all sorts of pains. Their bodies were manifesting what was going on around them.

What do you think when you observe countries that have high levels of security?

Something I do see in the West is that the more secure we are, the wealthier we are, the more we begin to worry about everything. There is a lack of psychological well being in the West.  We are worried about our self-actualization, asking ourselves questions like: Am I doing the right job? Rather than thinking: Oh I am living really a fantastic life, I have security.