TEDGlobal 2010
Inge Missmahl: Bringing peace to the minds of Afghanistan
Inge Missmahl bringer fred til Afghanistans sind
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Da jungianske analytiker Inge Missmahl besøgte Afghanistan, så hun de indre sår af krig - udbredt fortvivlelse, traumer og depression. Og dog, i dette land på 30 millioner mennesker, var der kun to dusin psykiatere. Missmahl fortæller om sit arbejde med at hjælpe til at opbygge landets system af psykosocial rådgivning, der fremmer både individuel og måske national healing.
Inge Missmahl - Analytical psychologist
By building psychosocial care into the primary health care system in Afghanistan, Inge Missmahl offers hope to a society traumatized by decades of conflict and insecurity. Full bio
By building psychosocial care into the primary health care system in Afghanistan, Inge Missmahl offers hope to a society traumatized by decades of conflict and insecurity. Full bio
Double-click the English transcript below to play the video.
00:16
So I want to tell you a story -- an encouraging story --
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Jeg vil gerne fortælle jer en historie, en opmuntrende historie,
00:19
about addressing
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om at italesætte
00:21
desperation, depression and despair in Afghanistan,
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desperation, depression og fortvivlelse i Afghanistan,
00:24
and what we have learned from it,
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og hvad vi har lært af det,
00:26
and how to help people
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og hvordan man kan hjælpe folk
00:28
to overcome traumatic experiences
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med at overvinde traumatiske oplevelser,
00:32
and how to help them to regain some confidence
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og hvordan man kan hjælpe dem med at genvinde en vis tillid
00:35
in the time ahead -- in the future --
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i den kommende tid -- i fremtiden --
00:37
and how to participate again in everyday life.
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og hvordan man kan deltage i hverdagen igen.
00:41
So, I am a Jungian psychoanalyst,
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Jeg er jungiansk psykoanalytiker,
00:43
and I went to Afghanistan in January 2004, by chance,
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og jeg tog til Afghanistan i januar 2004, ved en tilfældighed,
00:47
on an assignment for Medica Mondiale.
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på en opgave for Medica Mondiale.
00:50
Jung in Afghanistan --
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Jung i Afghanistan --
00:52
you get the picture.
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kan I se det.
00:55
Afghanistan is one of the poorest countries in the world,
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Afghanistan er et af de fattigste lande i verden,
00:58
and 70 percent of the people are illiterate.
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og 70 procent af befolkningen er analfabeter.
01:01
War and malnutrition kills people
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Krig og underernæring dræber folk
01:03
together with hope.
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sammen med håb.
01:05
You may know this from the media,
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Du kender det måske fra medierne.
01:07
but what you may not know
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Men hvad du måske ikke ved
01:09
is that the average age of the Afghan people is 17 years old,
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er, at den gennemsnitlige levealder for det afghanske folk er 17 år,
01:12
which means they grow up in such an environment
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hvilket betyder, at de vokser op i et sådan et miljø
01:15
and -- I repeat myself --
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og -- jeg gentager mig selv --
01:17
in 30 years of war.
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i 30 års krig.
01:19
So this translates
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Så dette udmønter sig
01:21
into ongoing violence,
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i igangværende voldshandlinger,
01:23
foreign interests, bribery,
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udenlandske interesser, bestikkelse,
01:25
drugs, ethnic conflicts,
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narkotika, etniske konflikter,
01:28
bad health, shame, fear
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dårligt helbred, skam, frygt
01:31
and cumulative traumatic experiences.
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og kumulative traumatiske oplevelser.
01:34
Local and foreign military
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Lokal og udenlandsk militær
01:36
are supposed to build peace together with the donors
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formodes at skabe fred sammen med donorerne
01:39
and the governmental and non-governmental organizations.
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og de statslige og ikke-statslige organisationer.
01:42
And people had hope, yes,
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Og folket havde håb, ja,
01:44
but until they realized
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indtil de opdagede
01:46
their situation worsens every day --
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at deres situation blev værre dag for dag --
01:48
either because they are being killed
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enten fordi de bliver dræbt,
01:50
or because, somehow,
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eller fordi de på en eller anden måde,
01:53
they are poorer than eight years ago.
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er fattigere end for otte år siden.
01:56
One figure for that:
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Et tal for det:
01:58
54 percent of the children under the age of five years
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54 procent af børnene under 5 år
02:01
suffer from malnutrition.
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lider af underernæring.
02:03
Yet, there is hope.
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Men stadig er der håb.
02:06
One day a man told me,
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En dag fortalte en mand mig,
02:08
"My future does not look brilliant,
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"Min fremtid ser ikke strålende ud,
02:10
but I want to have a brilliant future for my son."
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men jeg vil have en strålende fremtid for min søn."
02:14
This is a picture I took in 2005,
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Dette er et billede jeg tog i 2005,
02:16
walking on Fridays over the hills in Kabul,
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gående på fredage over bakkerne i Kabul.
02:19
and for me it's a symbolic picture
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Og for mig er det et symbolsk billede
02:21
of an open future for a young generation.
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på en åben fremtid for den unge generation.
02:27
So, doctors prescribe medication.
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Læger ordinere medicin.
02:31
And donors
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Og donore
02:33
are supposed to bring peace
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forventes at bringe fred
02:35
by building schools and roads.
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ved at bygge skoler og veje.
02:40
Military collect weapons,
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Militæret samler våben,
02:42
and depression stays intact.
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og depression forbliver intakt.
02:45
Why?
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Hvorfor?
02:47
Because people don't have tools
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Fordi folk ikke har værktøjer
02:49
to cope with it, to get over it.
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til at klare det, til at komme videre.
02:54
So, soon after my arrival,
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Kort efter min ankomst,
02:56
I had confirmed something which I had already known;
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havde jeg bekræftet noget, som jeg allerede vidste,
02:59
that my instruments come from the heart of modern Europe, yes.
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at mine instrumenter kommer fra hjertet af det moderne Europa, ja.
03:02
However, what can wound us
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Men, hvad der kan såre os,
03:04
and our reaction to those wounds --
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og vores reaktion på disse sår --
03:06
they are universal.
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det er universelt.
03:08
And the big challenge
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Og den store udfordring
03:10
was how to understand the meaning of the symptom
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var hvordan man skal forstå meningen med symptomerne
03:13
in this specific cultural context.
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i denne specifikke kulturelle context.
03:16
After a counseling session, a woman said to me,
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Efter en consultation, sagde en kvinde til mig,
03:19
"Because you have felt me, I can feel myself again,
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"Fordi du har følt mig, kan jeg føle mig selv igen
03:22
and I want to participate again
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og jeg har lyst til igen at deltage
03:24
in my family life."
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i mit familieliv."
03:27
This was very important,
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Dette var meget vigtigt
03:29
because the family is central
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fordi familien er central
03:31
in Afghans' social system.
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i afghanernes sociale system.
03:34
No one can survive alone.
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Ingen kan overleve alene.
03:37
And if people feel used, worthless and ashamed,
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Og folk føler sig brugt, værdiløse og skammer sig,
03:40
because something horrible has happened to them,
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fordi noget frygteligt er sket med dem,
03:43
then they retreat, and they fall into social isolation,
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så trækker de sig tilbage og isolere sig socialt,
03:46
and they do not dare to tell this evil
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og de tør ikke fortælle dette onde
03:49
to other people or to their loved ones,
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til andre folk eller til dem de holder kær
03:52
because they do not want to burden them.
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fordi de ikke ønsker at bebyrde dem.
03:54
And very often violence is a way to cope with it.
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Og meget ofte er vold en måde at håndtere det.
03:58
Traumatized people also easily lose control --
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Traumatiserede folk mister også let kontrollen --
04:01
symptoms are hyper-arousal and memory flashbacks --
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symptomerne er hyper-ophidselse og hukommelse flashbacks --
04:03
so people are in a constant fear
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så folk er i konstant frygt for,
04:05
that those horrible feelings of that traumatic event
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at disse forfærdelige følelser fra den traumatisk begivenhed
04:08
might come back unexpectedly,
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måske kommer tilbage uventet,
04:10
suddenly,
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pludseligt,
04:12
and they cannot control it.
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og de kan ikke kontrolere det.
04:15
To compensate this loss of inner control,
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For at kompensere for tabet af indre kontrol
04:18
they try to control the outside,
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prøver de at kontrolere det der ligger udenfor,
04:21
very understandably -- mostly the family --
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meget forståeligt -- mest familien --
04:23
and unfortunately,
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og uheldigvis,
04:25
this fits very well
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passer dette godt
04:27
into the traditional side,
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ind i den traditionelle side,
04:30
regressive side, repressive side,
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regressive side, undertrykkende side,
04:32
restrictive side of the cultural context.
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restriktive side af den kulturelle kontekst.
04:36
So, husbands start beating wives,
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Mænd begynder at banke deres koner,
04:39
mothers and fathers beat their children,
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mødre og fædre banker deres børn,
04:41
and afterward, they feel awful.
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og bagefter har de det forfærdeligt.
04:43
They did not want to do this, it just happened --
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Det var ikke det de ville. Det skete bare.
04:45
they lost control.
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De mistede kontrollen.
04:48
The desperate try
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Det desperate forsøg på
04:50
to restore order and normality,
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at genoprette orden og normalitet,
04:53
and if we are not able to cut this circle of violence,
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og hvis vi ikke er i stand til at stoppe denne cirkel af vold,
04:57
it will be transferred to the next generation without a doubt.
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vil den uden tvivl blive overført til den næste generation.
05:00
And partly this is already happening.
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Og det sker til dels allerede.
05:03
So everybody needs a sense for the future,
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Alle har brug for en fornemmelse for fremtiden.
05:06
and the Afghan sense of the future
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Og den afghanske fornemmelse for fremtiden
05:08
is shattered.
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er smadret.
05:12
But let me repeat the words of the woman.
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Men lad mig gentage hvad kvinden sagde.
05:15
"Because you have felt me,
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"Fordi du har følt mig,
05:17
I can feel myself again."
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kan jeg føle mig selv igen".
05:20
So the key here is empathy.
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Så nøglen er empati.
05:22
Somebody has to be a witness
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Nogen skal være vidne
05:24
to what has happened to you.
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til hvad der er sket med dig.
05:26
Somebody has to feel how you felt.
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Nogen skal føle hvad du har følt.
05:29
And somebody has to see you and listen to you.
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Nogen skal se og høre dig.
05:34
Everybody must be able
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Alle må være i stand til
05:36
to know what he or she has experienced is true,
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at vide hvad han eller hun har oplevet er sandt.
05:40
and this only goes with another person.
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Og det sker kun med en anden person.
05:43
So everybody must be able to say,
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Så alle må være i stand til at sige,
05:45
"This happened to me, and it did this with me,
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"Dette skete for mig, og det gjorde dette ved mig,
05:48
but I'm able to live with it, to cope with it,
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men jeg er i stand til at leve med det, til at klare det,
05:50
and to learn from it.
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og at lære fra det.
05:52
And I want to engage myself
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Og jeg ønsker at engagere mig
05:54
in the bright future for my children
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i mine børns lyse fremtid
05:56
and the children of my children,
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og mine børnebørns,
05:58
and I will not marry-off my 13 year-old daughter," --
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og jeg vil ikke gifte min 13 årige datter væk" --
06:01
what happens too often in Afghanistan.
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hvilket sker alt for tit i Afghanistan.
06:04
So something can be done,
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Så noget kan der gøres,
06:06
even in such extreme environments as Afghanistan.
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selv i så extreme miljøer som Afghanistan.
06:09
And I started thinking about a counseling program.
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Og jeg startede med at tænke over et rådgivnings program.
06:12
But, of course, I needed help and funds.
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Men jeg havde, selvfølgelig, brug for hjælp og midler.
06:14
And one evening,
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Og en aften,
06:16
I was sitting next to a very nice gentleman in Kabul,
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sad jeg ved siden af en meget rar herre i Kabul,
06:18
and he asked what I thought would be good in Afghanistan.
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og han spurgte mig hvad jeg troede ville være godt i Afghanistan.
06:21
And I explained to him quickly,
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Og jeg forklarede ham hurtigt,
06:23
I would train psycho-social counselors,
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at jeg ville træne psyko-sociale rådgivere,
06:26
I would open centers, and I explained to him why.
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jeg ville åbne centre, og jeg forklarede ham hvorfor.
06:30
This man gave me his contact details at the end of the evening
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Denne mand gav mig sine kontaktoplysninger da aftenen var slut
06:33
and said, "If you want to do this, call me."
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og sagde: "Hvis du vil gøre det, så ring til mig".
06:36
At that time, it was the head of Caritas Germany.
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På det tidspunkt var jeg leder af Caritas Tyskland.
06:41
So, I was able to launch a three-year project with Caritas Germany,
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Jeg var i stand til at starte et tre-årigt projekt med Caritas Tyskland,
06:44
and we trained 30 Afghan women and men,
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og vi trænede 30 afghanske kvinder og mænd,
06:46
and we opened 15 counseling centers in Kabul.
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og vi åbnede 15 rådgivningscentre i Kabul.
06:49
This was our sign -- it's hand-painted,
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Dette var vores skilt. Det er håndmalet.
06:52
and we had 45 all over Kabul.
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Og vi havde 45 over hele Kabul.
06:55
Eleven thousand people came -- more than that.
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11.000 mennesker kom -- mere end det.
06:57
And 70 percent regained their lives.
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Og 70 procent fik deres liv tilbage.
07:00
This was a very exciting time,
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Det var en meget spændende tid,
07:02
developing this with my wonderful Afghan team.
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at udvikle dette med mit vidunderlige afghanske team.
07:05
And they are working with me up to today.
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Og de arbejder med mig frem til i dag.
07:07
We developed a culturally-sensitive
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Vi har udviklet et kulturelt følsomt
07:09
psycho-social counseling approach.
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psyko-social rådgivnings metode.
07:12
So, from 2008 up until today,
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Fra 2008 til i dag
07:15
a substantial change and step forward
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har en væsentlig ændring og fremskridt
07:17
has been taking place.
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fundet sted.
07:19
The European Union delegation in Kabul
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Den Europæiske Unions delegation i Kabul
07:22
came into this and hired me to work
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kom med i det her og hyrede mig til at arbejde
07:24
inside the Ministry of Public Health,
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i ministeriet for folkesundhed
07:26
to lobby this approach --
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for at præge denne metode.
07:28
we succeeded.
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Det lykkedes.
07:30
We revised the mental health component
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Vi reviderede den mentale sundheds komponent
07:33
of the primary health care services
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i den primære sundhedpleje
07:35
by adding psycho-social care
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ved at tilføje psyko-social pleje
07:37
and psycho-social counselors to the system.
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og psyko-sociale rådgivere til systemet.
07:40
This means, certainly, to retrain all health staff.
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Dette betyder helt sikkert at man skal omskole al sundhedspersonale.
07:43
But for that, we already have the training manuals,
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Men det har vi allerede uddannelsesmanualerne til,
07:46
which are approved by the Ministry
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der er blevet godkendt af ministeriet
07:49
and moreover, this approach is now part
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og desuden er denne fremgangsmåde nu en del
07:51
of the mental health strategy in Afghanistan.
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af strategien for mental sundhed i Afghanistan.
07:55
So we also have implemented it already
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Så vi har allerede implimenteret den
07:57
in some selected clinics in three provinces,
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i nogle udvalgte klinikker i tre provinser,
08:00
and you are the first to see the results.
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og I er de første til at se resultaterne.
08:03
We wanted to know if what is being done is effective.
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Vi ville vide om det der bliver gjort er effektivt.
08:06
And here you can see
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Og her kan I se at
08:08
the patients all had symptoms of depression,
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alle patienterne havde symptomer på depression,
08:11
moderate and severe.
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i moderat og svær grad.
08:14
And the red line is the treatment as usual --
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Og den røde linje er behandling som sædvanlig --
08:16
medication with a medical doctor.
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medicin med en læge.
08:18
And all the symptoms
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Og alle symptomerne
08:20
stayed the same or even got worse.
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forblev de samme eller blev værre.
08:23
And the green line is treatment with psycho-social counseling only,
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Og den grønne linje er behandling med kun psyko-social rådgivning,
08:25
without medication.
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uden medicin.
08:27
And you can see the symptoms almost completely go away,
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Og I kan se at symptomerne næsten går helt væk
08:30
and the psycho-social stress has dropped significantly,
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og den psyko-sociale stress er faldet betydeligt,
08:33
which is explicable,
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hvilket kan forklares ved at
08:35
because you cannot take away the psycho-social stresses,
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man ikke kan fjerne psyko-social stress
08:37
but you can learn how to cope with them.
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men man kan lære at leve med det.
08:40
So this makes us very happy,
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Så dette gør os meget glade
08:42
because now we also have some evidence
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for nu har vi noget der beviser
08:44
that this is working.
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at det virker.
08:47
So here you see,
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Så her kan I se,
08:49
this is a health facility in Northern Afghanistan,
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dette er en sundheds klinik i det nordlige Afghanistan,
08:51
and every morning it looks like this all over.
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og hver morgen ser det sådan her ud over det hele.
08:54
And doctors usually have three to six minutes for the patients,
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Og læger har sædvanligvis tre til seks minutter til hver patient.
08:57
but now this will change.
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Men det vil ændre sig nu.
08:59
They go to the clinics,
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De tager til klinikkerne
09:01
because they want to cure their immediate symptoms,
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fordi de vil kurere deres umiddelbare symptomer
09:03
and they will find somebody to talk to
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og de vil finde nogen at snakke med
09:05
and discuss these issues
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og diskutere disse problemer
09:07
and talk about what is burdening them
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og tale om hvad der belaster dem
09:09
and find solutions, develop their resources,
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og finde løsninger, udvikle deres ressourcer,
09:12
learn tools to solve their family conflicts
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få værktøjer til at løse deres familiekonflikter
09:16
and gain some confidence in the future.
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og få en vis tro på fremtiden.
09:19
And I would like to share one short vignette.
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Og jeg vil gerne dele en kort historie.
09:23
One Hazara said to his Pashtun counselor,
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En Hazara sagde til hans pashtunske rådgiver:
09:27
"If we were to have met some years ago,
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"Hvis vi havde mødtes for nogle år siden,
09:30
then we would have killed each other.
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så ville vi havde slået hinanden ihjel.
09:32
And now you are helping me
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Og nu hjælper du mig
09:34
to regain some confidence in the future."
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til at genvinde en vis tro på fremtiden."
09:37
And another counselor said to me after the training,
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Og en anden rådgiver sagde til mig efter træningen:
09:40
"You know, I never knew why I survived the killings in my village,
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"Jeg har aldrig vidst hvorfor jeg overlevede drabene i min landsby,
09:44
but now I know,
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men nu ved jeg hvorfor,
09:46
because I am part of a nucleus
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fordi jeg er del af en kerne
09:48
of a new peaceful society in Afghanistan."
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af et nyt og fredeligt samfund i Afghanistan".
09:51
So I believe this kept me running.
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Så jeg tror, at dette holdt mig kørende.
09:54
And this is a really emancipatory and political contribution
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Og dette er et virkeligt emancipatorisk og politisk bidrag
09:57
to peace and reconciliation.
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til fred og forsoning.
10:00
And also -- I think --
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Og jeg tror også at
10:02
without psycho-social therapy,
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uden psyko-social terapi
10:04
and without considering this
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og uden at overveje dette
10:06
in all humanitarian projects,
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i alle humanitære projekter
10:08
we cannot build-up civil societies.
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kan vi ikke opbygge civile samfund.
10:11
I thought it was an idea worth spreading,
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Jeg synes at det var en idé der var værd at sprede
10:14
and I think it must be,
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og jeg tror at den må,
10:16
can be, could be replicated elsewhere.
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kan, kunne kopieres andre steder.
10:19
I thank you for your attention.
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Jeg takker for jeres opmærksomhed.
10:21
(Applause)
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(Bifald)
ABOUT THE SPEAKER
Inge Missmahl - Analytical psychologistBy building psychosocial care into the primary health care system in Afghanistan, Inge Missmahl offers hope to a society traumatized by decades of conflict and insecurity.
Why you should listen
From dancer to humanitarian by way of analytical psychology, Inge Missmahl's unusual life trajectory led her to Kabul in 2004, where she saw that more than 60 percent of the population were suffering from depressive symptoms and traumatic experiences -- hardly surprising in a country that had lived with ongoing violence, poverty, and insecurity for 30 years. In response, Missmahl founded the psychosocial Project Kabul for Caritas Germany, a project that trained Afghan men and women to offer psychosocial counseling in 15 centers throughout the city.
The project has offered free treatment to 12,000 clients to date, helping to restore self-determination and well-being while breaking down ingrained gender barriers and social stigma of mental illness. Psychosocial counseling is now integrated in the Afghan health system thanks to Missmahl's efforts. She now works on behalf of the European Union as Technical Advisor for Mental Health for the Afghan government, and is founder of International Psychosocial Organisation (IPSO), a network of experts dedicated to developing and implementing psychosocial programs in various contexts.
Inge Missmahl | Speaker | TED.com