Although post-traumatic stress disorder (PTSD) has been included in the Diagnostic and Statistical Manual of Mental Disorders since 1981, it has long remained a diagnosis restricted almost exclusively to war veterans and refugees within the North American medical context. However in recent years, increasing attention has been focused on the mental health of civilian populations in conflict regions around the world and the potential for psychological trauma has emerged as a widespread concern. The McGill Trauma and Global Health (TGH) program was created in response to this growing concern and, since its inception in 2007, has developed a number of research and action programs in Guatemala, Nepal, Peru, and Sri Lanka. Through partnerships between McGill, the Douglas Institute – a McGill affiliated mental health institute –, research teams, and other stakeholders in these countries, the TGH program has contributed to the expansion of knowledge regarding trauma and has established a number of successful on-the-ground initiatives in the field of mental health.
The TGH program states as its ultimate objective, “to reduce the mental health burden of civilian populations” faced with adverse environmental and political conditions and to “foster the process of healing, psychosocial rehabilitation and recovery, and generate improved mental health policies and services in the participating countries.”
Hanna Kienzler, PhD Candidate with the department of Anthropology at McGill and research assistant with the TGH program since 2007, explains that the broad objectives of the program are based on the philosophy and belief that “psychosocial reactions to violence, conflict, and other traumatic experiences are very much embedded in the social, cultural, political, and socioeconomic context and require different action.”
While the programs in each of the four countries are based on the same three-pronged model comprised of “research and documentation, capacity building, and knowledge transfer,” Kienzler emphasizes that the TGH program does not aim to create “exported guidelines,” but rather maintains that the practical application of the programs is culturally specific. This is ensured by the participation of a diverse group of researchers, doctors, nurses, psychologists, and community health workers from each of the countries in the TGH program. Further, the three-pronged program model provides extensive practical training programs, research and training scholarships, publishing opportunities for scholars from low-middle income countries, and access to otherwise restricted academic publications.
While a great deal of research occurs at the Douglas Institute in Montreal, Kienzler stresses that the most important activities happen in the participating countries. In Peru, research and relief teams have continued to respond to the aftermath of a major earthquake in 2007, as well as to the effects of inter-ethnic conflict. In Guatemala there has been training in diagnosis and distress management for counselors working with victims of violence. Interestingly, midwives play a large role in healthcare provision in Guatemala and have been active participants in the TGH program, receiving training in the identification of and response to distress. In Nepal, where there are many victims of torture, a pre-existing mental health program has been expanded to include a community-based psychosocial element that focuses on the individual’s role in a wider network. Research in Sri Lanka has focused on tsunami survivors and the team’s response to traumatic experiences of those living in refugee camps. The research team has already published a book on mental health and well-being based on the experiences of communities affected by the tsunami and conflicts within Sri Lanka.
Through its initiatives and partnerships, the TGH program has re-imagined and expanded definitions of trauma and contributed to increased efficacy of therapeutic intervention and treatment. While PTSD is defined by a particular set of symptoms and a narrow diagnostic criteria which often “decontextualizes human experience,” as Kienzler stated, the TGH program has encouraged an integrated, holistic approach to understanding and responding to trauma which stretches beyond the medical imagination.