TEDGlobal 2010
Inge Missmahl: Bringing peace to the minds of Afghanistan
英琪·密斯莫尔(Inge Missmahl)： 给阿富汗人带来心灵宁静
Filmed:
Readability: 4.3
423,728 views
当荣格学派心理分析师英琪·密斯莫尔访问阿富汗时，她看到了战争对阿富汗人内心造成的创伤——普遍的绝望、创伤综合症以及抑郁。然而在这个有三千万人口的国家，只有几十个心理分析师。英琪讲述了她在阿富汗帮助阿富汗建立心理咨询系统，治愈个体乃至整个民族创伤的工作。
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 --
0
1000
3000
我想给大家讲个故事，很鼓舞人心，
00:19
about addressing
1
4000
2000
是有关解决
00:21
desperation, depression and despair in Afghanistan,
2
6000
3000
阿富汗的绝望和抑郁的故事，
00:24
and what we have learned from it,
3
9000
2000
以及我们从可学到
00:26
and how to help people
4
11000
2000
如何帮助人们
00:28
to overcome traumatic experiences
5
13000
3000
克服创伤经历留下阴影的办法，
00:32
and how to help them to regain some confidence
6
17000
3000
及如何帮助他们找回自信
00:35
in the time ahead -- in the future --
7
20000
2000
和对未来的自信
00:37
and how to participate again in everyday life.
8
22000
3000
以及如何重新参与到日常生活中。
00:41
So, I am a Jungian psychoanalyst,
9
26000
2000
我的职业是心理分析师，
00:43
and I went to Afghanistan in January 2004, by chance,
10
28000
4000
由于偶然的机会，我在2004年7月去了趟阿富汗，
00:47
on an assignment for Medica Mondiale.
11
32000
3000
去做一项医学调查。
00:50
Jung in Afghanistan --
12
35000
2000
这就是荣格在阿富汗—
00:52
you get the picture.
13
37000
3000
你们看到了这张照片。
00:55
Afghanistan is one of the poorest countries in the world,
14
40000
3000
阿富汗是世界上最贫穷的国家之一，
00:58
and 70 percent of the people are illiterate.
15
43000
3000
百分之七十的人民都是文盲。
01:01
War and malnutrition kills people
16
46000
2000
战争和营养不良不仅扼杀了他们的生命，
01:03
together with hope.
17
48000
2000
还扼杀了希望。
01:05
You may know this from the media,
18
50000
2000
你可能从各种媒体中知道了这点。
01:07
but what you may not know
19
52000
2000
但是你可能不知道的是
01:09
is that the average age of the Afghan people is 17 years old,
20
54000
3000
阿富汗人的平均寿命是17岁，
01:12
which means they grow up in such an environment
21
57000
3000
这意味着
01:15
and -- I repeat myself --
22
60000
2000
我再重复一遍
01:17
in 30 years of war.
23
62000
2000
他们从小生长在长达30年的战争中。
01:19
So this translates
24
64000
2000
他们的生活环境是
01:21
into ongoing violence,
25
66000
2000
持续的战争，
01:23
foreign interests, bribery,
26
68000
2000
外国利益集团的觊觎、商业贿赂、
01:25
drugs, ethnic conflicts,
27
70000
3000
毒品、宗教冲突、
01:28
bad health, shame, fear
28
73000
3000
糟糕的健康状况、羞愧、恐惧
01:31
and cumulative traumatic experiences.
29
76000
3000
以及持续的创伤经历。
01:34
Local and foreign military
30
79000
2000
当地和外国部队
01:36
are supposed to build peace together with the donors
31
81000
3000
的任务仅仅是与捐款人、
01:39
and the governmental and non-governmental organizations.
32
84000
3000
政府和非政府组织一起建立起和平的秩序。
01:42
And people had hope, yes,
33
87000
2000
人民有一些希望，
01:44
but until they realized
34
89000
2000
但是当他们认识到
01:46
their situation worsens every day --
35
91000
2000
他们的处境每日都在恶化—
01:48
either because they are being killed
36
93000
2000
或许是被射杀
01:50
or because, somehow,
37
95000
3000
或许，
01:53
they are poorer than eight years ago.
38
98000
3000
变得比8年前更加贫穷。
01:56
One figure for that:
39
101000
2000
有一个数字能够说明这种情况：
01:58
54 percent of the children under the age of five years
40
103000
3000
五岁以下的儿童中有百分之五十四的人都饱受
02:01
suffer from malnutrition.
41
106000
2000
营养不良症的折磨。
02:03
Yet, there is hope.
42
108000
3000
然而，他们仍然是有一丝希望的。
02:06
One day a man told me,
43
111000
2000
一天，一个阿富汗人告诉我，
02:08
"My future does not look brilliant,
44
113000
2000
“我的前途并不光明，
02:10
but I want to have a brilliant future for my son."
45
115000
4000
但是我希望我的儿子能有灿烂的前程。”
02:14
This is a picture I took in 2005,
46
119000
2000
这是我在2005年拍的一张照片，
02:16
walking on Fridays over the hills in Kabul,
47
121000
3000
那天是周五，我在喀布尔山上散步时拍下了它。
02:19
and for me it's a symbolic picture
48
124000
2000
对我来说，这是一张有象征意义的照片
02:21
of an open future for a young generation.
49
126000
3000
象征着年轻一代的远大前程。
02:27
So, doctors prescribe medication.
50
132000
3000
作为医生，是要开药方的。
02:31
And donors
51
136000
2000
捐赠人的责任就是
02:33
are supposed to bring peace
52
138000
2000
实现和平，
02:35
by building schools and roads.
53
140000
3000
重建道路和学校。
02:40
Military collect weapons,
54
145000
2000
军队没收了武器，
02:42
and depression stays intact.
55
147000
3000
但是绝望仍然在那里，
02:45
Why?
56
150000
2000
为什么会这样呢？
02:47
Because people don't have tools
57
152000
2000
因为人们没有掌握解决、
02:49
to cope with it, to get over it.
58
154000
3000
克服绝望的手段。
02:54
So, soon after my arrival,
59
159000
2000
所以，我一到那里，
02:56
I had confirmed something which I had already known;
60
161000
3000
就证实了一些我之前了解到的信息，
02:59
that my instruments come from the heart of modern Europe, yes.
61
164000
3000
虽然我使用的治疗手段来自先进的欧洲，
03:02
However, what can wound us
62
167000
2000
但是，我们可以设想，那些伤害我的，
03:04
and our reaction to those wounds --
63
169000
2000
以及我们对创伤的反应—
03:06
they are universal.
64
171000
2000
对所有人都是一样的。
03:08
And the big challenge
65
173000
2000
最大的挑战是
03:10
was how to understand the meaning of the symptom
66
175000
3000
如何去理解症状在这种特殊文化中的
03:13
in this specific cultural context.
67
178000
3000
特殊意义。
03:16
After a counseling session, a woman said to me,
68
181000
3000
在一次咨询中，一位女士对我说，
03:19
"Because you have felt me, I can feel myself again,
69
184000
3000
“因为你说出了我的感受，我也重新找回了自己，
03:22
and I want to participate again
70
187000
2000
我愿意重新参与到
03:24
in my family life."
71
189000
3000
家庭生活中。”
03:27
This was very important,
72
192000
2000
这非常重要，
03:29
because the family is central
73
194000
2000
因为家庭
03:31
in Afghans' social system.
74
196000
3000
是阿富汗社会的核心。
03:34
No one can survive alone.
75
199000
3000
任何人都无法脱离他人生存。
03:37
And if people feel used, worthless and ashamed,
76
202000
3000
如果人们感觉自己被利用了，没有价值，感到很羞愧，
03:40
because something horrible has happened to them,
77
205000
3000
那是因为很多可怕的事情发生在他们身上，
03:43
then they retreat, and they fall into social isolation,
78
208000
3000
之后他们就会退缩，变得孤立于社会之外，
03:46
and they do not dare to tell this evil
79
211000
3000
并且他们不敢把他们这种罪恶的感受
03:49
to other people or to their loved ones,
80
214000
3000
告诉他们所爱的人或者其他人，
03:52
because they do not want to burden them.
81
217000
2000
他们不想连累这些人。
03:54
And very often violence is a way to cope with it.
82
219000
3000
通常人们用暴力来解决这些困扰。
03:58
Traumatized people also easily lose control --
83
223000
3000
精神上受创伤的人容易失去控制——
04:01
symptoms are hyper-arousal and memory flashbacks --
84
226000
2000
其症状就是易激惹和不断回想过去——
04:03
so people are in a constant fear
85
228000
2000
所以这些人生活在持续的恐惧中
04:05
that those horrible feelings of that traumatic event
86
230000
3000
发生创伤事件时恐怖的体验
04:08
might come back unexpectedly,
87
233000
2000
会没有预兆地，
04:10
suddenly,
88
235000
2000
突然地再现，
04:12
and they cannot control it.
89
237000
3000
没有办法控制。
04:15
To compensate this loss of inner control,
90
240000
3000
为了弥补这种内在的失控感，
04:18
they try to control the outside,
91
243000
3000
他们就会试图控制外界事物，
04:21
very understandably -- mostly the family --
92
246000
2000
这很容易理解，他们通常控制的就是家庭—
04:23
and unfortunately,
93
248000
2000
不幸的是，
04:25
this fits very well
94
250000
2000
在他们的控制之下，
04:27
into the traditional side,
95
252000
3000
整个文化变得更加传统，
04:30
regressive side, repressive side,
96
255000
2000
更加落后和压抑，
04:32
restrictive side of the cultural context.
97
257000
3000
有了更多的约束。
04:36
So, husbands start beating wives,
98
261000
3000
丈夫开始打妻子，
04:39
mothers and fathers beat their children,
99
264000
2000
爸爸妈妈打孩子，
04:41
and afterward, they feel awful.
100
266000
2000
打过之后，他们又感觉很糟糕。
04:43
They did not want to do this, it just happened --
101
268000
2000
他们并不希望这样做，但是事情就那么发生了。
04:45
they lost control.
102
270000
2000
一句话，他们失去了控制。
04:48
The desperate try
103
273000
2000
我们竭尽全力在做的
04:50
to restore order and normality,
104
275000
3000
修补和复原工作，
04:53
and if we are not able to cut this circle of violence,
105
278000
4000
如果无法打破这个暴力循环，
04:57
it will be transferred to the next generation without a doubt.
106
282000
3000
这种暴力毫无疑问会传给下一代。
05:00
And partly this is already happening.
107
285000
3000
事实上，事情已经在这么发生了。
05:03
So everybody needs a sense for the future,
108
288000
3000
所以每一个人都要心系未来。
05:06
and the Afghan sense of the future
109
291000
2000
阿富汗人未来的观念
05:08
is shattered.
110
293000
3000
是非常弱的。
05:12
But let me repeat the words of the woman.
111
297000
3000
但是让我重复一遍那位女士的话。
05:15
"Because you have felt me,
112
300000
2000
“因为你说出了我的感受，
05:17
I can feel myself again."
113
302000
3000
我重新找回了自己。”
05:20
So the key here is empathy.
114
305000
2000
所以关键是共享情绪。
05:22
Somebody has to be a witness
115
307000
2000
需要有人目睹
05:24
to what has happened to you.
116
309000
2000
你所经历的。
05:26
Somebody has to feel how you felt.
117
311000
3000
需要有人体会你的感受。
05:29
And somebody has to see you and listen to you.
118
314000
3000
需要有人关注你，倾听你。
05:34
Everybody must be able
119
319000
2000
每个人都必须知道，
05:36
to know what he or she has experienced is true,
120
321000
4000
发生在他们身上的事情已经发生了。
05:40
and this only goes with another person.
121
325000
3000
在别人身上也有可能发生。
05:43
So everybody must be able to say,
122
328000
2000
每个人都要能够说，
05:45
"This happened to me, and it did this with me,
123
330000
3000
“这件事确实发生了，它对我造成了影响，
05:48
but I'm able to live with it, to cope with it,
124
333000
2000
但是我可以和它和平共处，我能够处理好它，
05:50
and to learn from it.
125
335000
2000
并且从中学习，
05:52
And I want to engage myself
126
337000
2000
我想为我的孩子
05:54
in the bright future for my children
127
339000
2000
打造一个光明的前程
05:56
and the children of my children,
128
341000
2000
以及我孩子的孩子，
05:58
and I will not marry-off my 13 year-old daughter," --
129
343000
3000
我不会把13的女儿嫁出去。”
06:01
what happens too often in Afghanistan.
130
346000
3000
—这种事情在阿富汗经常发生。
06:04
So something can be done,
131
349000
2000
所以我们能够做一些事情，
06:06
even in such extreme environments as Afghanistan.
132
351000
3000
即使在阿富汗这样极端的环境中也是可以做的。
06:09
And I started thinking about a counseling program.
133
354000
3000
我开始设想开展一个咨询项目。
06:12
But, of course, I needed help and funds.
134
357000
2000
当然我需要助手和资金。
06:14
And one evening,
135
359000
2000
一天晚上，
06:16
I was sitting next to a very nice gentleman in Kabul,
136
361000
2000
在喀布尔，当我坐在一位善良的绅士旁边时，
06:18
and he asked what I thought would be good in Afghanistan.
137
363000
3000
他问我，你认为什么对阿富汗最有帮助。
06:21
And I explained to him quickly,
138
366000
2000
我飞快地向他讲，
06:23
I would train psycho-social counselors,
139
368000
3000
我想培训心理社会咨询师，
06:26
I would open centers, and I explained to him why.
140
371000
3000
我想开办培训中心，然后我向他解释了为什么产生这种想法。
06:30
This man gave me his contact details at the end of the evening
141
375000
3000
就在那个晚上那位先生给了我他的联系方式
06:33
and said, "If you want to do this, call me."
142
378000
3000
并且说，“如果你决定开始做，请打我的电话。”
06:36
At that time, it was the head of Caritas Germany.
143
381000
3000
当时，他是慈善德国（Caritas Germany）的负责人。
06:41
So, I was able to launch a three-year project with Caritas Germany,
144
386000
3000
所以我得以与慈善德国携手启动了为期三年的项目，
06:44
and we trained 30 Afghan women and men,
145
389000
2000
我们训练了30个阿富汗人，
06:46
and we opened 15 counseling centers in Kabul.
146
391000
3000
在喀布尔开设了15个咨询中心。
06:49
This was our sign -- it's hand-painted,
147
394000
3000
这是我们的宣传标牌，是手绘的。
06:52
and we had 45 all over Kabul.
148
397000
3000
我们在喀布尔有45个这样的标牌。
06:55
Eleven thousand people came -- more than that.
149
400000
2000
一万一千人来到这些咨询中心，或许更多。
06:57
And 70 percent regained their lives.
150
402000
3000
其中百分之七十的人重新找到了生活重心。
07:00
This was a very exciting time,
151
405000
2000
这是个激动人心的经历，
07:02
developing this with my wonderful Afghan team.
152
407000
3000
与我的阿富汗团队一起完成。
07:05
And they are working with me up to today.
153
410000
2000
至今我们仍然在一起工作。
07:07
We developed a culturally-sensitive
154
412000
2000
我们找到了符合当地文化的、
07:09
psycho-social counseling approach.
155
414000
3000
心理社会咨询方法。
07:12
So, from 2008 up until today,
156
417000
3000
所以，从2008年上半年至今，
07:15
a substantial change and step forward
157
420000
2000
我们取得了
07:17
has been taking place.
158
422000
2000
实质性的进步。
07:19
The European Union delegation in Kabul
159
424000
3000
喀布尔的欧盟代表团
07:22
came into this and hired me to work
160
427000
2000
来到这里邀请我去工作
07:24
inside the Ministry of Public Health,
161
429000
2000
到公共健康部门
07:26
to lobby this approach --
162
431000
2000
推广这种方法。
07:28
we succeeded.
163
433000
2000
我们成功了。
07:30
We revised the mental health component
164
435000
3000
我们重新阐释了
07:33
of the primary health care services
165
438000
2000
主要的健康关怀服务中的心理健康部分
07:35
by adding psycho-social care
166
440000
2000
在系统中加入了心理社会关怀
07:37
and psycho-social counselors to the system.
167
442000
3000
以及心理社会咨询。
07:40
This means, certainly, to retrain all health staff.
168
445000
3000
这就意味着有必要重新教育那些健康关怀服务人员。
07:43
But for that, we already have the training manuals,
169
448000
3000
我们已经有了培训手册，
07:46
which are approved by the Ministry
170
451000
3000
通过了部里的审核，
07:49
and moreover, this approach is now part
171
454000
2000
此外，这种方法
07:51
of the mental health strategy in Afghanistan.
172
456000
3000
成为了阿富汗心理健康战略的一部分。
07:55
So we also have implemented it already
173
460000
2000
因此我们已经在
07:57
in some selected clinics in three provinces,
174
462000
3000
三个省中挑选出来的诊所中试用了这种方法，
08:00
and you are the first to see the results.
175
465000
3000
这是试验的结果，第一次对外公布。
08:03
We wanted to know if what is being done is effective.
176
468000
3000
我们希望了解到所做的是否有效。
08:06
And here you can see
177
471000
2000
从图表中我们可以看出，
08:08
the patients all had symptoms of depression,
178
473000
3000
所有的病人都有抑郁的症状，
08:11
moderate and severe.
179
476000
3000
或轻或重。
08:14
And the red line is the treatment as usual --
180
479000
2000
红线表示采用惯常的治疗手段——
08:16
medication with a medical doctor.
181
481000
2000
也就是药剂师开药。
08:18
And all the symptoms
182
483000
2000
所有的症状都没有改善、
08:20
stayed the same or even got worse.
183
485000
3000
甚至加重了。
08:23
And the green line is treatment with psycho-social counseling only,
184
488000
2000
绿线表示仅仅采用了心理社会咨询的治疗方法，
08:25
without medication.
185
490000
2000
而没有吃药的效果。
08:27
And you can see the symptoms almost completely go away,
186
492000
3000
你可以从图上看到，症状基本消失了，
08:30
and the psycho-social stress has dropped significantly,
187
495000
3000
心理社会压力迅速地下降，
08:33
which is explicable,
188
498000
2000
这个结果也是可以解释的，
08:35
because you cannot take away the psycho-social stresses,
189
500000
2000
因为你不能消除所有的心理社会压力，
08:37
but you can learn how to cope with them.
190
502000
3000
但是人们能够学会如何减轻这种压力。
08:40
So this makes us very happy,
191
505000
2000
我们看到这个结果非常开心，
08:42
because now we also have some evidence
192
507000
2000
因为我们有了证据来证明
08:44
that this is working.
193
509000
3000
我们的方法是有效的。
08:47
So here you see,
194
512000
2000
如图所示，
08:49
this is a health facility in Northern Afghanistan,
195
514000
2000
这是阿富汗北部的一处健康服务中心，
08:51
and every morning it looks like this all over.
196
516000
3000
每天早上的情境都有点类似这样，
08:54
And doctors usually have three to six minutes for the patients,
197
519000
3000
但是医生一般只有三至六分钟来诊断一个病人。
08:57
but now this will change.
198
522000
2000
现在这种情况将得到改善。
08:59
They go to the clinics,
199
524000
2000
病人会去到诊所里，
09:01
because they want to cure their immediate symptoms,
200
526000
2000
因为他们想治愈那些短期的症状，
09:03
and they will find somebody to talk to
201
528000
2000
在那里他们会发现有人可以交流
09:05
and discuss these issues
202
530000
2000
讨论他们的病情
09:07
and talk about what is burdening them
203
532000
2000
讨论让他们感到压迫的因素是什么
09:09
and find solutions, develop their resources,
204
534000
3000
然后寻找治疗的办法，发掘他们自身潜藏的资源，
09:12
learn tools to solve their family conflicts
205
537000
4000
学习解决家庭冲突的办法
09:16
and gain some confidence in the future.
206
541000
3000
建立对未来生活的信心。
09:19
And I would like to share one short vignette.
207
544000
3000
我想与大家分享一个小故事。
09:23
One Hazara said to his Pashtun counselor,
208
548000
4000
一个哈拉扎人对他的普什图咨询师说，
09:27
"If we were to have met some years ago,
209
552000
3000
“如果我们很多年前相遇，
09:30
then we would have killed each other.
210
555000
2000
我们会杀死彼此。
09:32
And now you are helping me
211
557000
2000
现在你却来帮助我
09:34
to regain some confidence in the future."
212
559000
3000
让我对未来树立信心。”
09:37
And another counselor said to me after the training,
213
562000
3000
一个咨询师在培训结束后对我说，
09:40
"You know, I never knew why I survived the killings in my village,
214
565000
3000
“我一直不知道为什么村里的人都被杀死了，唯有我活了下来。
09:44
but now I know,
215
569000
2000
现在我知道了，
09:46
because I am part of a nucleus
216
571000
2000
因为我是
09:48
of a new peaceful society in Afghanistan."
217
573000
3000
阿富汗新和平社会的一份子。”
09:51
So I believe this kept me running.
218
576000
3000
我相信正是这些话语激励着我不断前进。
09:54
And this is a really emancipatory and political contribution
219
579000
3000
这的确是一种解放和政治运动
09:57
to peace and reconciliation.
220
582000
3000
其目的是实现和平和解。
10:00
And also -- I think --
221
585000
2000
我认为，
10:02
without psycho-social therapy,
222
587000
2000
如果没有心理社会疗法，
10:04
and without considering this
223
589000
2000
如果在人道主义活动中不考虑
10:06
in all humanitarian projects,
224
591000
2000
心理、社会的因素
10:08
we cannot build-up civil societies.
225
593000
3000
文明社会就无法建立起来。
10:11
I thought it was an idea worth spreading,
226
596000
3000
我认为这个观念值得传播，
10:14
and I think it must be,
227
599000
2000
也必须得以传播，
10:16
can be, could be replicated elsewhere.
228
601000
3000
能够在其他地方重复使用。
10:19
I thank you for your attention.
229
604000
2000
谢谢你们。
10:21
(Applause)
230
606000
11000
（掌声）
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