TEDGlobal 2010
Inge Missmahl: Bringing peace to the minds of Afghanistan
Inge Missmahl donosi mir dušama Afganistana
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Kada je Inge Missmahl, analitičarka koja svoj rad zasniva na Jungovim učenjima, posjetila Afganistan tamo je ugledala unutrašnje rane koje ostavlja rat - široko rasprostranjen očaj, traumu i depresiju. No tome usprkos, u ovoj zemlji koja broji 30 milijuna ljudi, bilo je tek dva tuceta psihijatara. Missmahl govori o svojem radu kroz koji pomaže izgraditi sustav psihosocijalnog savjetovanja u Afganistanu, promičući osobno, a možda i nacionalno, izliječenje.
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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Želim vam, dakle, ispričati priču, jednu ohrabrujuću priču
00:19
about addressing
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o suočavanju s
00:21
desperation, depression and despair in Afghanistan,
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očajavanjem, depresijom i očajem u Afganistanu
00:24
and what we have learned from it,
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i o tome što smo iz njega naučili
00:26
and how to help people
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i kako pomoći ljudima
00:28
to overcome traumatic experiences
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da prevladaju traumatična iskustva
00:32
and how to help them to regain some confidence
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i kako im pomoći da povrate dio povjerenja
00:35
in the time ahead -- in the future --
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u vremenu koje dolazi -- u budućnosti --
00:37
and how to participate again in everyday life.
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i kako da iznova sudjeluju u svakodnevnom životu.
00:41
So, I am a Jungian psychoanalyst,
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Ja sam, dakle, Jungovska psihoanalitičarka
00:43
and I went to Afghanistan in January 2004, by chance,
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i u Afganistan sam otišla slučajno, u siječnju 2004. godine,
00:47
on an assignment for Medica Mondiale.
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na zadatku za Medicu Mondiale.
00:50
Jung in Afghanistan --
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Jung i Afganistan --
00:52
you get the picture.
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razumijete što hoću reći.
00:55
Afghanistan is one of the poorest countries in the world,
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Afganistan je jedna od najsiromašnijih zemalja u svijetu,
00:58
and 70 percent of the people are illiterate.
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i 70 posto stanovništva je nepismeno.
01:01
War and malnutrition kills people
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Rat i pothranjenost ubijaju ljude,
01:03
together with hope.
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ali ubijaju i nadu.
01:05
You may know this from the media,
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Ovo ste možda i doznali iz medija.
01:07
but what you may not know
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No ono što možda ne znate
01:09
is that the average age of the Afghan people is 17 years old,
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jest da je prosječna životna dob afganskog stanovništva 17 godina
01:12
which means they grow up in such an environment
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što znači da odrastaju u takvom okruženju
01:15
and -- I repeat myself --
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i -- kao što si ponavljam --
01:17
in 30 years of war.
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u ratu koji traje 30 godina.
01:19
So this translates
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Ovo se prevodi
01:21
into ongoing violence,
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u neprekidno nasilje,
01:23
foreign interests, bribery,
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strane interese, mito,
01:25
drugs, ethnic conflicts,
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drogu, etničke sukobe,
01:28
bad health, shame, fear
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loše zdravlje, sram, strah,
01:31
and cumulative traumatic experiences.
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i kumulativna traumatična iskustva.
01:34
Local and foreign military
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Lokalne i strane vojne snage
01:36
are supposed to build peace together with the donors
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trebale bi graditi mir u suradnji s donatorima
01:39
and the governmental and non-governmental organizations.
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te vladinim i nevladinim organizacijama.
01:42
And people had hope, yes,
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I ljudi su imali nadu, da,
01:44
but until they realized
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dok nisu shvatili
01:46
their situation worsens every day --
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da njihova situacija postaje sve gora iz dana u dan --
01:48
either because they are being killed
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bilo zato što ih se ubijalo,
01:50
or because, somehow,
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ili zato što su, nekako,
01:53
they are poorer than eight years ago.
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siromašniji nego što su bili prije osam godina.
01:56
One figure for that:
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Jedna brojka govori u prilog tome:
01:58
54 percent of the children under the age of five years
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54 posto djece mlađe od pet godina
02:01
suffer from malnutrition.
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pati od pothranjenosti.
02:03
Yet, there is hope.
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Ipak, ima nade.
02:06
One day a man told me,
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Jednoga dana jedan mi je čovjek rekao,
02:08
"My future does not look brilliant,
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''Moja budućnost ne izgleda sjajno,
02:10
but I want to have a brilliant future for my son."
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ali ono što želim jest sjajna budućnost za mog sina.''
02:14
This is a picture I took in 2005,
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Ovo je slika koju sam snimila 2005. godine
02:16
walking on Fridays over the hills in Kabul,
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u svojim šetnjama petkom preko kabulskih brda.
02:19
and for me it's a symbolic picture
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I za mene ona predstavlja simboličnu sliku
02:21
of an open future for a young generation.
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otvorene budućnosti koja čeka mlađu generaciju.
02:27
So, doctors prescribe medication.
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Dakle, doktori propisuju lijekove.
02:31
And donors
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I donatori
02:33
are supposed to bring peace
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bi trebali donijeti mir
02:35
by building schools and roads.
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gradeći škole i ceste.
02:40
Military collect weapons,
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Vojska prikuplja oružje,
02:42
and depression stays intact.
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i depresija ostaje netaknuta.
02:45
Why?
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Zašto?
02:47
Because people don't have tools
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Zato što ljudi nemaju vještine koje bi im omogućile
02:49
to cope with it, to get over it.
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da se nose s time, da to prevladaju.
02:54
So, soon after my arrival,
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Tako sam, ubrzo nakon svojega dolaska,
02:56
I had confirmed something which I had already known;
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bila potvrdila nešto što sam otprije znala
02:59
that my instruments come from the heart of modern Europe, yes.
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da moj instrumentarij dolazi iz srca moderne Europe, da.
03:02
However, what can wound us
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No, ono što nas ranjava,
03:04
and our reaction to those wounds --
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i naša reakcija na te rane --
03:06
they are universal.
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one su univerzalne.
03:08
And the big challenge
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I veliki izazov bio je u tome
03:10
was how to understand the meaning of the symptom
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kako razumijeti značenje simptoma
03:13
in this specific cultural context.
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u specifičnom kulturološkom kontekstu.
03:16
After a counseling session, a woman said to me,
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Nakon terapijskog sastanka, jedna mi je žena rekla,
03:19
"Because you have felt me, I can feel myself again,
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''Stoga što ste vi osjetili mene, ja mogu iznova osjetiti samu sebe,
03:22
and I want to participate again
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i želim iznova sudjelovati
03:24
in my family life."
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u mojem obiteljskom životu.''
03:27
This was very important,
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Ovo je od iznimne važnosti,
03:29
because the family is central
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jer obitelj je u središtu
03:31
in Afghans' social system.
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afganistanskog društvenog sustava.
03:34
No one can survive alone.
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Nitko ne može preživjeti sam.
03:37
And if people feel used, worthless and ashamed,
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I ako se ljudi osjećaju iskorišteni, bezvrijedni i posramljeni,
03:40
because something horrible has happened to them,
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stoga što im se dogodilo nešto užasno,
03:43
then they retreat, and they fall into social isolation,
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povuku se, i potom padnu u društvenu izolaciju
03:46
and they do not dare to tell this evil
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i ne usude se pričati o tom zlu
03:49
to other people or to their loved ones,
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drugim ljudima ili svojim najbližima,
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because they do not want to burden them.
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jer ih ne žele opterećivati.
03:54
And very often violence is a way to cope with it.
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I nasilje je vrlo često način na koji se s time nose.
03:58
Traumatized people also easily lose control --
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Isto tako, traumatizirani ljudi lako izgube kontrolu --
04:01
symptoms are hyper-arousal and memory flashbacks --
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povišena nadraženost i bljeskovi sjećanja simptomi su toga --
04:03
so people are in a constant fear
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tako da su ljudi u stalnome strahu
04:05
that those horrible feelings of that traumatic event
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od toga da bi se užasni osjećaji vezani uz traumatični doživljaj
04:08
might come back unexpectedly,
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mogli vratiti neočekivano,
04:10
suddenly,
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iznenada,
04:12
and they cannot control it.
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i da ih neće moći staviti pod kontrolu.
04:15
To compensate this loss of inner control,
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Kako bi nadomjestili gubitak unutrašnje kontrole
04:18
they try to control the outside,
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pokušavaju kontrolirati izvanjski svijet,
04:21
very understandably -- mostly the family --
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razumije se -- uglavnom unutar obitelji --
04:23
and unfortunately,
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i nažalost,
04:25
this fits very well
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to se vrlo dobro uklapa
04:27
into the traditional side,
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u tradicionalnu stranu,
04:30
regressive side, repressive side,
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regresivnu stranu, represivnu stranu,
04:32
restrictive side of the cultural context.
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restriktivnu stranu kulturološkog konteksta.
04:36
So, husbands start beating wives,
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Tako supruzi počinju tući supruge,
04:39
mothers and fathers beat their children,
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majke i očevi tuku svoju djecu,
04:41
and afterward, they feel awful.
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i nakon toga se osjećaju grozno.
04:43
They did not want to do this, it just happened --
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Nisu željeli to napraviti. Jednostavno se dogodilo.
04:45
they lost control.
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Izgubili su kontrolu.
04:48
The desperate try
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Očajnički pokušaj
04:50
to restore order and normality,
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da vrate red i normalnost,
04:53
and if we are not able to cut this circle of violence,
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i ako nismo sposobni prekinuti taj krug nasilja,
04:57
it will be transferred to the next generation without a doubt.
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on će se, bez sumnje, prenijeti na iduću generaciju.
05:00
And partly this is already happening.
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To se dijelom već i događa.
05:03
So everybody needs a sense for the future,
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Tako da je svima potreban osjećaj za budućnost.
05:06
and the Afghan sense of the future
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A afganistanski osjećaj za budućnost
05:08
is shattered.
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je slomljen.
05:12
But let me repeat the words of the woman.
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Ali, dopustite mi da ponovim riječi te žene.
05:15
"Because you have felt me,
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''Stoga što se vi osjetili mene,
05:17
I can feel myself again."
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ja mogu iznova osjetiti samu sebe.''
05:20
So the key here is empathy.
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Znači ključna stvar ovdje je empatija.
05:22
Somebody has to be a witness
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Netko mora biti svjedok
05:24
to what has happened to you.
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onoga što vam se dogodilo.
05:26
Somebody has to feel how you felt.
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Netko treba osjetiti vas, ono što ste vi osjetili.
05:29
And somebody has to see you and listen to you.
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I netko vas mora vidjeti, mora vas poslušati.
05:34
Everybody must be able
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Svatko mora biti sposoban
05:36
to know what he or she has experienced is true,
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pojmiti da je ono što je on ili ona iskusila istinito.
05:40
and this only goes with another person.
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A to je jedino moguće uz drugu osobu.
05:43
So everybody must be able to say,
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Stoga svatko mora biti sposoban reći,
05:45
"This happened to me, and it did this with me,
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''Ovo se dogodilo meni, i učinilo mi je to,
05:48
but I'm able to live with it, to cope with it,
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ali sposoban sam živjeti s time,
05:50
and to learn from it.
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nositi se s time i učiti iz toga.''
05:52
And I want to engage myself
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I želim se uključiti
05:54
in the bright future for my children
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u svijetlu budućnost za moju djecu
05:56
and the children of my children,
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i djecu moje djece,
05:58
and I will not marry-off my 13 year-old daughter," --
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i neću udati svoju 13-godišnju kćerku'' --
06:01
what happens too often in Afghanistan.
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što se i prečesto događa u Afganistanu.
06:04
So something can be done,
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Znači da je moguće nešto napraviti,
06:06
even in such extreme environments as Afghanistan.
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čak i u takvim ekstremnim okruženjima kakav je Afganistan.
06:09
And I started thinking about a counseling program.
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I počela sam razmišljati o terapeutskom programu.
06:12
But, of course, I needed help and funds.
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Ali trebala sam, dakako, pomoć i sredstva.
06:14
And one evening,
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Jedne sam večeri
06:16
I was sitting next to a very nice gentleman in Kabul,
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sjedila pored jednog vrlog gospodina u Kabulu,
06:18
and he asked what I thought would be good in Afghanistan.
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i on me pitao što bi bilo dobro za Afganistan.
06:21
And I explained to him quickly,
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I objasnila sam mu brzo
06:23
I would train psycho-social counselors,
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kako bih obučila psihosocijalne terapeute,
06:26
I would open centers, and I explained to him why.
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otvorila centre, i objasnila sam mu zašto.
06:30
This man gave me his contact details at the end of the evening
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Taj mi je čovjek dao svoje podatke na kraju te večeri
06:33
and said, "If you want to do this, call me."
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i rekao, ''Ako želite to sprovesti, nazovite me.''
06:36
At that time, it was the head of Caritas Germany.
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U to je vrijeme on bio na čelu Njemačkog Caritasa.
06:41
So, I was able to launch a three-year project with Caritas Germany,
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Tako sam dobila mogućnost pokrenuti trogodišnji projekt s Njemačkim Caritasom,
06:44
and we trained 30 Afghan women and men,
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i obučili smo 30 afganistanskih žena i muškaraca
06:46
and we opened 15 counseling centers in Kabul.
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te otvorili 15 savjetovališta u Kabulu.
06:49
This was our sign -- it's hand-painted,
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Ovo je bio naš znak. Nacrtan je rukom.
06:52
and we had 45 all over Kabul.
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Imali smo ih 45 diljem Kabula.
06:55
Eleven thousand people came -- more than that.
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Došlo je 11.000 ljudi -- više od toga.
06:57
And 70 percent regained their lives.
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I 70 posto iznova je vratilo svoje živote.
07:00
This was a very exciting time,
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Bilo je to vrlo uzbudljivo vrijeme,
07:02
developing this with my wonderful Afghan team.
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dok sam razvijala ovo sa svojim divnim afganistanskim timom.
07:05
And they are working with me up to today.
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I oni sve do danas rade sa mnom.
07:07
We developed a culturally-sensitive
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Razvili smo kulturološki osjetljiv
07:09
psycho-social counseling approach.
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psihosocijalan pristup terapiji.
07:12
So, from 2008 up until today,
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Tako da se od 2008. godine do danas
07:15
a substantial change and step forward
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događa jedna suštinska promjena
07:17
has been taking place.
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i korak naprijed.
07:19
The European Union delegation in Kabul
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Delegacija Europske Unije u Kabulu
07:22
came into this and hired me to work
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ušla je u ovo te su me zaposlili
07:24
inside the Ministry of Public Health,
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u Ministarstvu javnog zdravstva
07:26
to lobby this approach --
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kako bi zagovarala ovaj pristup.
07:28
we succeeded.
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Uspjeli smo.
07:30
We revised the mental health component
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Promijenili smo segment mentalnog zdravlja
07:33
of the primary health care services
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u primarnoj zdravstvenoj zaštiti
07:35
by adding psycho-social care
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pridodajući psihosocijalnu skrb
07:37
and psycho-social counselors to the system.
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i psihosocijalne terapeute u taj sustav.
07:40
This means, certainly, to retrain all health staff.
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To dakako uključuje ponovno obučavanje cjelokupnog zdravstvenog osoblja.
07:43
But for that, we already have the training manuals,
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No za to već imamo priručnike
07:46
which are approved by the Ministry
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odobrene od strane Ministarstva,
07:49
and moreover, this approach is now part
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i, štoviše, ovaj je pristup sada dio
07:51
of the mental health strategy in Afghanistan.
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strategije mentalnog zdravlja u Afganistanu.
07:55
So we also have implemented it already
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Tako da smo ga već uveli
07:57
in some selected clinics in three provinces,
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u odabrane klinike u tri provincije
08:00
and you are the first to see the results.
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i vi ste prvi koji će vidjeti njegove rezultate.
08:03
We wanted to know if what is being done is effective.
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Željeli smo doznati je li ono što se obavlja učinkovito.
08:06
And here you can see
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Iz ovog možete vidjeti
08:08
the patients all had symptoms of depression,
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kako su svi pacijenti imali simptome depresije,
08:11
moderate and severe.
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umjerene i ozbiljne.
08:14
And the red line is the treatment as usual --
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Crvena linija označava uobičajeni tretman -
08:16
medication with a medical doctor.
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lijekove propisane od strane liječnika.
08:18
And all the symptoms
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Svi su simptomi
08:20
stayed the same or even got worse.
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ostali nepromijenjeni ili se čak pogoršali.
08:23
And the green line is treatment with psycho-social counseling only,
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Zelena linija označava liječenje koje obuhvaća samo psihosocijalnu terapiju,
08:25
without medication.
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bez lijekova.
08:27
And you can see the symptoms almost completely go away,
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Kako možete vidjeti simptomi su gotovo u potpunosti nestali,
08:30
and the psycho-social stress has dropped significantly,
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i psihosocijalni je stres značajno opao,
08:33
which is explicable,
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što je objašnjivo
08:35
because you cannot take away the psycho-social stresses,
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jer nije moguće u potpunosti ukloniti psihosocijalni stres,
08:37
but you can learn how to cope with them.
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ali je moguće naučiti kako se s njime nositi.
08:40
So this makes us very happy,
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Ovo nas čini vrlo sretnima
08:42
because now we also have some evidence
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jer sada imamo i neke dokaze
08:44
that this is working.
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da naš pristup djeluje.
08:47
So here you see,
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Ovdje možete vidjeti,
08:49
this is a health facility in Northern Afghanistan,
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ovo je zdravstvena ustanova u Sjevernom Afganistanu
08:51
and every morning it looks like this all over.
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i svakoga jutra iznova izgleda ovako.
08:54
And doctors usually have three to six minutes for the patients,
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Doktori obično imaju od tri do šest minuta koje mogu dati pacijentu.
08:57
but now this will change.
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No sada će se to promijeniti.
08:59
They go to the clinics,
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Ljudi odlaze u klinike
09:01
because they want to cure their immediate symptoms,
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jer žele izliječiti neposredne simptome,
09:03
and they will find somebody to talk to
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i tamo će pronaći nekoga s kime mogu pričati
09:05
and discuss these issues
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i raspraviti stvari s kojima se suočavaju
09:07
and talk about what is burdening them
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i razgovarati o onom što ih opterećuje
09:09
and find solutions, develop their resources,
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i pronaći rješenja, razviti vlastite sposobnosti,
09:12
learn tools to solve their family conflicts
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naučiti vještine koje će im pomoći da razriješe obiteljske sukobe
09:16
and gain some confidence in the future.
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i dobiju pouzdanje u budućnost.
09:19
And I would like to share one short vignette.
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Htjela bih još podijeliti s vama jednu kratku vinjetu.
09:23
One Hazara said to his Pashtun counselor,
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Jedan Hazar rekao je svojem paštunskom terapeutu,
09:27
"If we were to have met some years ago,
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''Da smo se sreli prije koju godinu,
09:30
then we would have killed each other.
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ubili bismo jedan drugoga.
09:32
And now you are helping me
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A sada mi ti pomažeš
09:34
to regain some confidence in the future."
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da povratim povjerenje u budućnost.''
09:37
And another counselor said to me after the training,
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Jedan mi je drugi terapeut nakon obuke rekao,
09:40
"You know, I never knew why I survived the killings in my village,
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''Znaš, nikada nisam znao zašto sam preživio pokolj u svom selu,
09:44
but now I know,
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ali sada znam,
09:46
because I am part of a nucleus
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zato što sam dijelom jezgre
09:48
of a new peaceful society in Afghanistan."
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novog miroljubivog društva u Afganistanu.''
09:51
So I believe this kept me running.
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Vjerujem da me to nastavilo pokretati.
09:54
And this is a really emancipatory and political contribution
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I ovo je uistinu emancipirajući i politički doprinos
09:57
to peace and reconciliation.
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miru i pomirbi.
10:00
And also -- I think --
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Mislim, isto tako, da
10:02
without psycho-social therapy,
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bez psihosocijalne terapije,
10:04
and without considering this
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i bez da ovo uzmemo u obzir
10:06
in all humanitarian projects,
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u svim humanitarnim projektima,
10:08
we cannot build-up civil societies.
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ne možemo izgraditi građanska društva.
10:11
I thought it was an idea worth spreading,
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Smatrala sam da je ovo ideja koju vrijedi proširiti
10:14
and I think it must be,
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i mislim da mora biti,
10:16
can be, could be replicated elsewhere.
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može biti, ponovljena drugdje.
10:19
I thank you for your attention.
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Zahvaljujem vam na pozornosti.
10:21
(Applause)
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(Pljesak)
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