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IS-3. Victims of War: Impact on Mental Health

Organizer: Stojakovic B. Milan,
Clinic of Psychiatry Banjaluka Republic of Srpska, Bosnia & Herzegovina

Symposium abstract
The symposium includes general information obtained in psychiatric emergency services about the impact of war on mental health. The participants will inform about their own experience in the disasters caused by war in the area of  ex Yugoslavia, in the regions of Georgia - Ossetia and Abkhazia, and the area of Chechenia. Special data will be given about the Posttraumatic stress disorder caused by war in the area of ex Yugoslavia, about the main psychological problems observed in Internally Displaced Persons in Georgia and about the psychotherapeutic assistance and psychosocial rehabilitation service being provided for Chechenian refugees.

IS-3.1.-CONSEQUENCES OF WAR: POSTTRAUMATIC STRESS DISORDER

Stojakovic, B. M. and Nikolovski*, D.N.
Clinic of Psychiatry Banjaluka, Bosnia-Herzegovina. *Institute of Public Health Pancevo, Yugoslavia

Investigation follows the appearance and evolution of Posttraumatic stress disorder (PTSD) due to stress caused by war in 200 hospitalized patients during the period October 1992- September 1994. Furthermore, a longitudinal study of these patients during the following four years has also been carried out. The study has shown that the most frequently diagnosed category of reactive states to war was PTSD, that was observed in 38.8% cases of hospitalized patients. The depressive reaction was present in conjuntion with PTSD in 56% of patients. The most frequent traumatic experiences which have caused PTSD were: 1) the experience of closeness of death; 2) dealing with wounded and massacred people; 3) exposition to physical torture, and 4) the sight of massacre. We have not found significant differences betweem military and civil patients in the appearance of typical symptoms of PTSD such as flash-backs, and avoidance of the situation which is associated with the trauma. However, it has been demonstrated that the differences in the occurrence and irreversibility of these mental disorders in military and civil patients are significantly different. Depression was more frequent in military patients, and anxiety was mainly diagnosed in civil patients. The analysis of the mental health during the period after PTSD has found changes in different parameters of general and specific social behavior. The symptoms of acute PTSD (with duration less than six months) were found in 11%, while chronic PTSD (with duration between six months and two years) were diagnosed in 64% of patients. Irreversible changes in personality have been found in 8.5% patients (with duration more than two years). Based on the present study, we propose a program of interventions in order to prevent the appearance of PTSD and other consequences of war stress. In conclusion, it is necessary to plan the protection of mental health during the postwar period.


IS-3.2.-Traumatised population of internally displaced persons and refugees: problem of relationship with the local society

Javakhishvili, D.
Foundation for the Development of Human Resources, Tbilisi, Georgia

As a result of inter-ethnic conflicts (1992-93), two important regions of Georgia - Ossetia and Abkhazia -have cut off and wave of 300000 Internally Displaced Persons (IDPs) emerged. Non Govermental Organisation Foundation for the Development of Human Resources(FDHR)+++ since 1995 implements project "Psychosocial Rehabilitation of Refugees and IDPs in Georgia" with financial support of Norvegian Refugee Counsel. According to our experience, the main psychological problems of IDPs are: 1.Victimisation - sense of being a victim, helplessness, decreased self esteem, loss of responsibility of one's own life and current events; 2.Enemy Image - generalized and dehumanized image of aggressor. As far as this aggressor (opposite part) is at unreachable distance for IDPs, enemy image may be compared with an empty frame of aggression, that "floats" around and
can fix itself on the first available object. The best target among surrounding persons is the "Other", the one different. That's why the latent tension between IDPs and locals exists. One of the problems needed special attention in process of psychological work, is relationships between IDP\refugees and local population. According to our experience, interaction of locals and IDP\refugees is characterized by some universal (common) stages: 1.Euphoria: refugees\IDPs are ineffably thankful for help and reception, while local population is full of compassion and readiness of helping them; 2. Crossing of interests: due to economical and social problems, the interests of IDPs\refugees and locals are crossing each other, tension and latent confrontation of parties start to appear. Important role in confrontation process plays mentioned above Enemy Image, peculiar for IDPs\refugess; 3. Confrontation: IDPs\refugees and locals start to blame each other or social, economical and other existing difficulties. Realization of existing confrontation - different overt conflicts takes place; 4. Alienation.: the parties keep at a distance from each other, confrontation is "frozen", but danger of conflict exists. IDPs\refugees became isolated from social life of local society. FDHR elaborated strategy and tactics of work on normalizing relationships between IDPs\refugees and local population, on overcoming IDPs\refugees isolation from social life.

IS-3.3.-Chechenian refugees: aggression - victimization cycle

Makhashvili, N.
Foundation for Development of Human Resources, Georgia.

The Foundation for Development of Human Resources (FDHR) has been providing psychotherapeutic assistance and psychosocial rehabilitation service to Chechenian refugees, who have been residing in Georgia since the recent war actions in Chechnia (autumn, 1999 ). The project is financed by Norwegian Refugee Council (NRC) and Red Cross and Red Crescent Federation. The observation method and deep examination of massive trauma on refugee population reveals the wide range of problems, which includes: feelings of estrangement and abandonment, anger, anxiety, suspicious and hostile attitude to "outer" world, victim-aggressor style of behavior, disorders of social functioning (inclination to conflicts, tendency to impulsive relief of aggression). We meet the different severe symptoms of Post Traumatic Stress Disorders (PTSD) both in adults and children. Members of Chechenian population share the "collective" memory of historical events of group victimization, which is transmitted to the new generations by the story-telling, "legends' and "myths", folklore samples. To avoid victimization feelings aggression reactions became the most "effective" self-defensive strategy. This may result the development of revengeful attitude and increased aggression in children, who are brought up by the "ideal models"- heroic warriors and fighters. Stemming from above mentioned, the especial importance is attached to the overcoming of victim-aggressor style of interaction, reinforcement of constructive coping strategies for dealing with trauma, reducing PTSD symptoms, cognitive reframing and helping the population to obtain the sense and new meaning to life. Combined, integrated methodology is elaborated by FDHR team, which is used both individually and in groups and is aimed to intervention at different "levels" of personality (identity, cognitive, emotional, behavioral) and interpersonal relations. Work is carried out with adult groups (teachers, medical personal, parents ), children and their families.