The Other War

Excerpted from War Torn: Stories of Courage, Love, and Resilience, from Larson Publications

Sometimes I’d think I was staring right into the eyes of the beast, war trauma at its most pure. All the classic signs would be there: the nightmares and flashbacks, the racing heart and that terrible flood of adrenaline coursing through the body at all hours, making it impossible to ever truly be at ease. A door slams in the distance and it’s like a gun just fired; there’s terror in the eyes, hands clench the arms of the chair in fearful anticipation.

If you’re living through a situation of recurrent threat, it can be adaptive to be on perpetual edge; you never know when danger might return and you want to be ready to act. Problems arise when the risk is finally gone, and the body and mind don’t register the new reality. The starship Enterprise is still on red alert and there isn’t a Klingon for light-years around. Keep those shields up, Scotty. Aye, Captain.

Most of the time I’d be right about the diagnosis. ptsdTrauma symptoms aren’t hard to spot, and matching them up against the criteria in psychiatry’s diagnostic cookbook, the Diagnostic and Statistical Manual (DSM) isn’t exactly rocket science.

The problem was, sometimes it wasn’t war trauma at all, or at least not the kind of war I’d be thinking of. Our clients had escaped ethnic cleansing, they’d been in concentration camps, watched their homes go up in flames and their loved ones go down in violence, hunger, and disease. They arrived in Chicago as refugees from hell, and it was natural to assume that their trauma symptoms were the result of everything they’d just survived.

Most of the time that was true. But not always. Or at least, there were layers, other sources of trauma that weren’t so readily apparent.

There were times, for example, that we’d get so focused on what happened in Bosnia that we’d overlook an altogether different sort of war that at least a few of our clients were still in the middle of. It was the violence that some women were contending with at home, the beatings and sexual assaults and sheer terror of daily life in the supposed safety of their Chicago refuge. It made the war in Bosnia seem like a distant nightmare. I don’t think it was very common, but it was real, and it could be as ugly as anything that had happened back home.

ESCAPE

Clinicians are fond of writing about their successes, but as the late Argentine psychologist Eduardo Pavlovski once wrote, we can learn as much from our “stumbles” as our achievements.[i] I suppose in the end this story turned out as well as it could have, and the clinic staff really went the distance to see this one through; it just took a while to get there. In the meantime, a young Bosnian child lost his capacity for speech while watching his mother get raped daily in their small apartment on the north side of Chicago.

I’ve been reading and writing about the impact of war on civilians for twenty years, and in the hundreds of papers I’ve read, I could count on two hands the number that mention family violence. I don’t know why, but it’s been missing from the conversation. That’s changing, and a growing number of organizations are trying to figure out how to deal with intimate partner violence and child abuse in war-affected communities. For the most part, though, the violence of war overshadows the violence that happens in people’s homes. The former draws our attention and concern, while the latter leads us to look away uneasily, if we see it at all.

telegraph.co.uk

And maybe that’s the key difference: we actually see war, it’s right out there: bombs destroying houses, soldiers killing villagers, buildings set on fire. It’s a public experience, and we feel entitled, compelled even, to document it, ask about its impact, intervene in some way. But the violence that occurs within families is hidden from view. We’re less likely to see it, and a lot less likely to ask about it. Researchers routinely go into war zones or refugee camps with questionnaires that assess people’s exposure to all manner of war-related violence, and then they measure symptoms of PTSD and assume they’re documenting the traumatic effects of war. To an extent, of course, they are. The violence of war can certainly be traumatic. But this approach yields a distorted picture. Family violence can give rise to exactly the same symptoms of psychological trauma as war, and the PTSD we’re seeing may have as much to do with abuse in the home as it does with political violence in the street. It’s not just researchers who fall prey to this oversight; clinicians too see the violence of armed conflict and assume that trauma symptoms are the result of that conflict. Could be, but maybe there’s more going on.

Which brings me to Alma and her young son Tarik, and their nightmare in Chicago.

I came into the case just around the time things really spun out of control. That was the day we got a call from a psychiatric nurse in a nearby hospital, telling us that Alma was in their emergency room, acutely suicidal and possibly psychotic. Could we please come and speak with her? Their only translator was a janitor who spoke just a few words of Bosnian, and they were having a hard time communicating.

On the way to the hospital, my Bosnian colleague gave me some background. The clinic staff had assumed Alma’s symptoms of PTSD were the result of the war in Bosnia. They’d asked about what the family had lived through before they escaped: the bombings, the attacks on their village, the constant state of fear, the loss of everyone and everything they’d left behind. Her distress made sense against that backdrop, and it looked a lot like the PTSD and depression we saw in so many of the refugees who came into the clinic. The staff had recommended counseling and medication; she took the pills, and met with a counselor periodically.

It’s not to say there weren’t signs, indications of something darkly amiss in the family. She came in with bruises a couple of times, and admitted that Almir, her husband, had hit her. He swore that he loved her, she said, and left it at that.

Arriving at the hospital, we found Alma alone in a small room, crying and frightened. We decided to ask directly about the violence at home. Alma was quiet for a moment. Then she nodded, and began to speak. This formerly reticent woman barely paused to inhale as she described two years of being imprisoned in her home with her six-year-old son, Tarik. She told us her husband had been sexually assaulting her nearly every day in front of the boy since they’d arrived in Chicago. He’d threatened to kill them if she ever told anyone what was happening or tried to escape. She said that Tarik had once been a lively, talkative child, but was now mute, and had begun wetting himself again. Alma was convinced there was no way out, and had recently become suicidal. Her husband brought her to the ER when he thought she might actually kill herself.

And so we began the process of helping Alma and Tarik escape once again from a world of violence. The first step was getting them to a shelter for battered women and their children.

Flashback: I’m standing with a Bosnian colleague and six cops outside the door to the small apartment where Alma, Almir, and Tarik live. It’s dark in the hallway, and the eight of us barely fit on the narrow landing. As one of the policemen knocks repeatedly on the door, the lone policewoman turns to me and asks skeptically, “If she was really being abused, why didn’t she just leave?”

Before I can respond, the door opens. Almir, looking filthy and disheveled, is pulling his pants up as he gazes warily at the group of armed police staring back at him. I wonder aloud to my colleague whether he was raping Alma when we arrived. No way to know. But he has nowhere to run, and so, looking stunned and dismayed, he opens the door in surrender, allowing us to enter. A moment later he’s in handcuffs, being led downstairs to a police car. He’ll be out on bail by the end of the day, but that’ll give us enough time to get Alma and Tarik to the shelter. By the time he walks free, they’ll be safely out of the home.

During the next three months, my colleagues from the clinic made frequent visits to the shelter to help Alma and Tarik begin to heal from the trauma they’d endured. Gradually, Tarik began to speak again and stopped wetting himself. In time he began to smile with excitement when we came to visit and was eager to play. His recovery was quite remarkable to witness, given the two wars he’d endured in his brief time on the planet. Alma’s healing was a slower, more painful process, but the look of terror we’d seen in the emergency room gradually disappeared and you could see her beginning to relax.

We all knew there was no way she and Tarik would be safe in Chicago once they left the shelter. Alma asked if we could help her find money to leave the area and make a new start elsewhere. They had friends, she said, who would keep them safe. The shelter staff generously raised the funds, and three months after escaping from their one room nightmare, Alma and Tarik left Chicago to begin the next chapter of their lives in exile.

Needless to Say…

…And yet it bears saying (again): Even in populations affected by armed conflict, there are other sources of psychological trauma than war itself. In recent studies of communities affected by war, family violence turns out to be as strongly related to mental health as direct exposure to the violence of war.[ii] But such studies are still rare; what happens within the privacy of people’s homes is considered, well, private, too personal to ask about, or simply not relevant to understanding the impact of war.

And so we ask about rape by soldiers, witnessing explosions, abductions and beatings by one militant group or another. And the violence of a husband’s abuse or a parent’s rage lives on below the radar of our well-intended aid.

~~~

[i]. Eduardo Pavlovsky, Cuestionamos (Buenos Aires: Ediciones Granica 1971).

[ii]. A. Al-Krenawi, R. Lev-Wiesel, & M Sehwail, “Psychological Symptomatology Among

Palestinian Children Living with Political Violence,” Child and Adolescent Mental Health 12 (2007): 27-31. See also C. Catani, E. Schauer, E., & F. Neuner, F. “Beyond Individual War Trauma: Domestic Violence Against Children in Afghanistan and Sri Lanka,” Journal of Marital and Family Therapy 34 (2008): 165-176.

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