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Home arrow Language & Literature arrow The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health

Concluding Remarks

Violence in its many forms is pervasive, ancient, infinitely various, and a central fact of human life, but also poorly understood in general (Whitehead 2004). In this chapter, we have introduced different approaches that aim to provide a better understanding of the consequences of violence from various angles, focusing on its communicative role, symbolic use, performative quality, and lived experience. We have shown that violence in contexts of war has been linked to physical and, particularly, mental health problems. A strong focus on PTSD and depression based on Western diagnostic practices has largely shaped the response to trauma-related health problems leading to the development of different kinds of trauma-focused responses ranging from psychotherapies to various pharmaceutical interventions. However, critical scholars have shown that such approaches lack evidence on their long-term effects and demonstrate that mental health problems are intricately connected to social, economic and cultural dimensions of life. Such recognition has complicated our understanding of the causation, development, and treatment of violence-related distress.

Having a better understanding of the ways in which individuals and communities express their suffering and distress and the influence this has on their lives could help health providers to tailor therapeutic interventions more effectively to the needs and expectations of their patients. There is a great danger of over-medicalizing or over-psychologizing forms of post-violence distress, which are complexly overdetermined by the socioeconomic, political, and cultural dimensions of post-conflict societies. Anthropologists have shown that interventions that attempt to address health—and especially mental health—without engaging with these social determinants often fail to deliver aid that is meaningful to the intended beneficiaries, and can even cause unintended consequences insofar as they pathologize victimized populations and distract from substantive issues of restorative justice and political reform (Biehl and Locke 2010). While one-size-fits-all technoscientific or medical solutions to the social and personal consequences of societal violence may be elusive, the subjects of interventions reveal that we may have much to learn about the determinants of their suffering—and their resilience—before we can begin to deliver forms of care and support that are truly multidimensional and thoughtfully adapted to cultural difference. Ethnographic methods, with their commitment to cultural humility and deep forms of listening, surely have a central role to play in this process.

We do not deny that trauma-focused approaches have their place in the complex process of healing the psychological wounds of war and violence, but suggest that alone they are not sufficient and may lead to important unintended consequences. It is important to be attuned to the fact that suffering as well as recovery are resolved in a social context as “familial, sociocultural, religious and economic activities (...) make the world intelligible” (Almedom and Summerfield 2004, p. 386). With this understanding, trauma-focused approaches could possibly be reserved for very severe cases of mental illness while other forms of distress could be addressed meaningfully through locally developed (bottom-up) and socially integrated approaches addressing the often difficult to grasp combinations of social, emotional, physical, and cultural dimensions. This, in turn, can only be achieved through interdisciplinary approaches in which clinicians and other interventionists work closely with researchers from the health and social sciences. In the decades to come, it will be crucial to build connections across health, social welfare, education, and economic sectors while paying close attention to cultural and religious beliefs and practices in order to address the effects of societal violence on bodies, minds, and societies more effectively.

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