IMHO Mental Health Development Efforts in Sri Lanka and Ethiopia

MENTAL HEALTH DEVELOPMENT EFFORTS IN SRI LANKA AND ETHIOPIA – IMHO 2012 ALAN KROHN, PH.D. PSYCHOANALYST, CLINICAL PSYCHOLOGIST UNIVERSITY OF MICHIGAN DEPARTMENT OF PSYCHIATRY

IN BOTH SETTINGS A UNIQUE INTEGRATION • COMBINATION OF DIDACTIC, LECTURE FORMAT, CLINICAL SUPERVISION, AND PSYCHOTHERAPEUTIC/PSYCHOEDUCATIONAL/CO NVERSATIONS WITH STUDENTS ABOUT THEIR OWN TRAUMA • SECURITY PROVIDED BY BEING AN OUTSIDER, LIKE THERAPIST BEING NOT BEING A FRIEND OR FAMILY MEMBER IN ANY PSYCHOTHERAPY

ETHIOPIA TRAINING • HEALTH AND MENTAL HEALTH NEEDS ASSESSMENT TRIP UNDER IMHO IN FALL OF 2010 UNDER DIRECTION OF MR. GREG BUIE • ASSESSMENT OF HOSPITALS, CLINICS, SCHOOLS IN ADDIS ABABA, BAHIR DAR, GONDAR AND SIMEON MOUNTAIN AREAS • DID TWO WORKSHOPS: ONE ON INTERVIEWING MEDICAL AT BAHIR DAR AND OTHER PATIENTS AND ONE ON WORKING WITH GERIATRIC PATIENTS AT GONDAR TEACHING HOSPITAL

UNIVERSITY OF GONDAR CLINICAL PSYCHOLOGY PROGRAM • MET DR. YEMATAW WONDIE ON FIRST TRIP • DEVELOPED A MEMORANDUM OF UNDERSTANDING BETWEEN U OF GONDAR AND IMHO AND DEVELOPED A PLAN TO DO AN INTENSIVE 2 WEEK COURSE ON PSYCHODYNAMICS, INCLUDING A PRACTICUM USING PATIENTS AT U OF GONDAR TEACHING HOSPITAL

TRAINING AT GONDAR DONE IN OCTOBER 2011 • CONDUCTED BY ME AND THREE WEEKS LATER

BY DR. WILLIAM NIXON, ANOTHER PSYCHOANALYST – HIS PORTION CONDUCTED IN ADDIS USING PATIENTS AT AMANUELLE SPECIALIZED HOSPITAL (MENTAL HOSPITAL)

ORIENTATION OF TRAINING • TEACHING BASIC CLINICAL INTERVIEWING AND DIAGNOSTIC SKILLS • TEACHING BASIC PSYCHODYNAMIC CONCEPTS ADAPTED TO WORKING IN A BRIEF OR INTERMEDIATE WAY WITH PATIENTS • EVOLUTIONARY, CONDITIONING AND BRAIN NEUROSCIENCE FINDINGS INTEGRATED INTO THE CORE PSYCHODYNAMIC APPROACH

EFFORTS IN SRI LANKA • TEACHING BASIC MENTAL HEALTH AND INTERVIEWING CONCEPTS TO SOCIAL WORKERS AT SHANTHIHAM • Worked closely with Mr. Wijeyaratnam Canagaratnam • TEACHING AROUND STUDENTS CASES AND ALSO SPEAKING TO THEIR OWN STRUGGLES HAVING LIVED THROUGH THE TERRIBLE TIMES DURING THE WAR

CONSULTED WITH DR. SIVAYOKAN • MET WITH MEDICAL STUDENTS FOR A WIDE RANGING DISCUSSION THE CENTERED ON THE CHALLENGES OF DISCUSSING IMPORTANT AREAS WITH PATIENTS THAT CULTURE MAY NOT ORDINARILY APPROVE OF: SEXUAL FUNCTIONING, SEXUAL ORIENTATION, FOR EXAMPLES • ALSO HOW TO BROACH WITH PATIENTS THAT PROBLEMS MAY HAVE A PSYCHOLOGICAL COMPONENT

FIELD VISITS • DID FIELD VISITS TO AND CONSULTATIONS AT A PSYCHIATRIC HALFWAY HOUSE AND A RESIDENTIAL TREATMENT FACILITY FOR CHILDREN

PROBLEMS IN THE NORTH • LEARNED OF THESE FROM DR. SIVAYOKAN, MR. WIJE, DR. ANNIS (PRESIDENT OF SHANTHIHAM) AND PSYCHIATRIC SOCIAL WORKERS. • IN THE TRAINING WE DISCUSSED HOW TO ADDRESS THESE

PSYCHOLOGICAL PROBLEMS IN THE NORTH POST-WAR • TRAUMA OF LOSS, DISPLACEMENT, INJURY, • ONGOING TRAUMA CAUSED BY UNRELENTING FEAR OF GOVERNMENT, LTTE, • FEAR OF NOT BEING ABLE TO TAKE CARE OF CHILDREN

PROBLEMS CONTINUED • PROBLEMS RESULTING FROM NOT KNOWING IF “DISAPPEARED” LOVED ONES ARE ALIVE OR DEAD, IMPRISONED OR TORTURED. • AFTER EFFECTS OF MORAL HAZARD: BEING FORCED TO COMMIT ATROCITIES UNDER THREAT TO ONE’S OWN LIFE • WITNESSING ATROCITIES AND NOT BEING ABLE TO SPEAK OUT

PROBLEMS IN NORTH • COUNTRY IS CELEBRATING AND ACTING AS IF THERE IS FAIRNESS AND PEACE WHEN MANY TAMILS CONTINUE TO FEEL DISENFRANCHISED • “SURE WE’RE FREE, WE’RE FREE TO SHUT UP”

PROBLEMS OF ADOLESCENTS DURING WAR AND POST WAR • PROBLEMS OF ADOLESCENTS, ESPECIALLY TAMIL BOYS IN THE NORTH – SENSITIVE AREA THAT INVOLVES THE TAMIL DIASPORA • EFFECTS ON BOYS OF TRAUMA, HELPLESSNESS AND FORCED DEPENDENCE ON FAMILY IN TIMES OF WAR – LEADS TO EFFORTS TO FEEL POWERFUL AND INVULNERABLE

ADOLESCENT BOYS CONTINUED • USE OF ALCOHOL, REBELLIOUS BEHAVIOR, DANGEROUS AND MOTORBIKES TO QUIET FEELINGS OF HELPLESSNESS AND TO TRY TO FEEL POWERFUL • ALSO USE OF A MILITARY IDENTITY – BEING A SOLDIER, GOING TO WAR AGAIN, TO FEEL STRONG. STORIES OF DIASPORA STOKING THESE FIRES (WHETHER TRUE OF NOT, THESE NEED TO BE ADDRESSED AND DISCUSSED BY THE DIASPORA)

TROUBLING REPORTS WHICH I CANNOT EVALUATE • AS A PSYCHOANALYST MY WORK INVOLVES UNEARTHING PROBLEMATIC FAMILY SECRETS, SUCH SECRETS CAN WREAK HAVOC WITH FAMILIES • SAME IN LARGER COMMUNITIES: REPORT THAT PEOPLE IN THE TAMIL DIASPORA WISH TO REIGNITE THE WAR IN ORDER TO BE ABLE TO CLAIM THAT THEIR RELATIVES SHOULD BE ALLOWED TO IMIGRATE TO US OR UK DUE TO THEIR STATUS AS PEOPLE DESERVING ASYLUM DUE TO WAR

GRACE CARE: ORPHANAGE, ELDER HOME, NURSERY SCHOOL • CONSULTED WITH MANY PEOPLE THERE, EVALUATED SOME OF THE CHILDREN PSYCHOLOGICALLY, AS WELL AS SOME OF THE ELDERS • MADE SOME RECOMMENDATIONS FOR SPECIFIC STUDENTS AND ELDERS AS WELL AS SUGGESTIONS ABOUT POLICY AND PROCEDURES. REPORTS WRITTEN TO DR. NARESH GUNARATNAM AND MR. JAMES MITCHELL, BOTH REMARKABLE LEADERS OF GRACE IN ALL ASPECTS

THANKS TO IMHO • WOULD LIKE TO THANK, MR. GREG BUIE, IMHO, AND ITS MEMBERS FOR THEIR HELP AND SUPPORT OF STRUGGLING PEOPLE EVERYWHERE AND FOR THEIR SUPPORT OF ME AND MY WORK