De mentale ar efter den voldsomme uafhængighedskamp mod Indonesien, der kulminerede i 2002, og interne opgør i 2006, der sendte 100.000 på flugt, har sat sig dybe spor i befolkningen.Det viser et studie fra et australsk universitet.
DILI, 30 June 2014 (IRIN): Repeated bouts of violence in Timor Leste’s (Østtimor) recent past and a persistent sense of injustice have had a lasting mental health impact, new research shows. Researchers say recovery may require more than therapeutic interventions.
Results from a 2004-2010 mental health study showed that the conflict leading to Timor-Leste’s 2002 independence had lasting mental health effects, and communal violence in 2006 which left 100,000 displaced exacerbated the situation.
“Our research shows that the strongest predictor, by far, of post-traumatic stress disorder [PTSD] is feelings of preoccupation with injustice related to multiple incidents,” Belinda Liddell, a psychology professor at the University of New South Wales in Sydney and research director on the study, told IRIN.
“For example, if a respondent reported his brother had been disappeared during the Indonesian occupation, then also that he was now frustrated because his neighbour had received a pension [pay-out] from the government and he hadn’t, that quadrupled the likelihood of him presenting with PTSD.”
Liddell and her colleagues assessed more than 1,000 adults in a mix of rural and urban settings in Timor-Leste in 2010.
In 2004 researchers found 2.3 percent of participants exhibited PTSD. “That rate was much lower than one would expect,” said Liddell, pointing to a 2010 article in the Journal of the American Medical Association that surveyed data from 181 mental health surveys across 40 countries and found an average PTSD rate among conflict-affected people of around 30 percent.
However, six years after the initial study in Timor-Leste, Liddell and her team found that 16.7 percent of respondents showed PTSD. The pattern, she explains, is linked to both repeated experiences of violence and protracted experiences of injustice.
The solutions, researchers say, involve more than diagnoses of disorders.
Trauma
“Our staff hear stories even today about the violence in 1999,” said Manual dos Santos, director of PRADET, a psychosocial recovery and development NGO in Dili, referring to the bout of violence that ravaged the country after a majority vote in a UN-administered independence referendum officially severed ties with Indonesia.
“People witnessing their families being killed are still dealing with the mental aspect of that experience,” he said.
Mental health services in Timor-Leste, along with other infrastructure and social services, are weak. There were no specific mental health services in the country prior to 1999.
In a 2008 assessment that employed the Inter-Agency Standing Committee’s (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings, researchers noted that the country needed 300 mental health workers to provide appropriate care, but had only 15 at that time.
The government’s 2011-2015 Mental Health Strategy acknowledges the ongoing – though improving – mental health service gap, and lists “post-conflict issues”, including past experiences of violence, torture and persecution, death or disappearance of family members, and loss property, as risk factors for mental disorders.
However, some observers say the focus on trauma as a pathological issue might distract from the tangible causes and solutions.
Emily Toome of RMIT University in Melbourne whose research investigates how trauma is understood in Timor-Leste argued:
“Conditions diagnosed at the level of the individual have their grounding in broader socio-political contexts.”
In a 2013 conference paper, Toome argued that the focus on psychological trauma as a potential trigger for renewed inter-personal tension or violence may be over-emphasizing diagnostic and clinical solutions, saying “remedies aimed at the psyche that come at the expense of the material may pose a greater threat to a sustainable and secure community.”
Toome told IRIN: “It’s important to tease apart local meanings of suffering across mental and material dimensions, as well as structural and… spiritual.”
Injustice-related mental health outcomes
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