TEDGlobal 2010
Inge Missmahl: Bringing peace to the minds of Afghanistan
Inge Missmahl為阿富汗的心智帶來平和。
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榮格心理學派學者Inge Missmahl參訪過阿富汗後，窺見了戰爭所帶來的內心創傷---處處瀰漫著絕望、創傷和憂鬱。然而，在這個人口3千萬的國家裡，卻只有24位心理治療師。Missmahl談到她的工作就是協助建立一個國家級的心理諮詢系統，不但能夠讓個人心智有所提升，或許，也能治癒這個國家的傷痛。
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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我要告訴各位一個故事，一個鼓舞人心的故事，
00:19
about addressing
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將讓各位了解
00:21
desperation, depression and despair in Afghanistan,
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充斥著絕望和失望的阿富汗，
00:24
and what we have learned from it,
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我們能從中學到什麼，
00:26
and how to help people
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以及如何幫助人們
00:28
to overcome traumatic experiences
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克服過去受過的創傷，
00:32
and how to help them to regain some confidence
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還有如何在往後的日子，也就是未來，
00:35
in the time ahead -- in the future --
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讓這裡的人們重獲信心，
00:37
and how to participate again in everyday life.
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並再度回到正常的生活裡。
00:41
So, I am a Jungian psychoanalyst,
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我是屬於聯合公會的心理治療師，
00:43
and I went to Afghanistan in January 2004, by chance,
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在偶然的機會下，我在2004年1月來到阿富汗，
00:47
on an assignment for Medica Mondiale.
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為蒙帝亞勒醫療團隊(Medica Mondiale)服務。
00:50
Jung in Afghanistan --
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榮格(Jung)在阿富汗..(註：圖中左下的男士，知名心理學家)
00:52
you get the picture.
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你們都知道那裡的情形。
00:55
Afghanistan is one of the poorest countries in the world,
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阿富汗是世界上最窮的國家之一，
00:58
and 70 percent of the people are illiterate.
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有70%的人是文盲。
01:01
War and malnutrition kills people
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戰爭和營養不良不但奪走了生命，
01:03
together with hope.
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也扼殺了希望。
01:05
You may know this from the media,
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你也許從其他媒體得知這些資訊。
01:07
but what you may not know
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但你所不知道的是
01:09
is that the average age of the Afghan people is 17 years old,
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阿富汗人民的平均年齡才17歲，
01:12
which means they grow up in such an environment
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那是因為他們生長在這個環境
01:15
and -- I repeat myself --
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我再重覆一次
01:17
in 30 years of war.
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他們生長在這已經打仗30年的環境裡。
01:19
So this translates
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這環境讓暴力事件
01:21
into ongoing violence,
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不斷發生，
01:23
foreign interests, bribery,
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外國團體對利益的覬觎，賄賂事件，
01:25
drugs, ethnic conflicts,
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毒品，種族衝突，
01:28
bad health, shame, fear
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糟糕的健康條件，羞恥，恐懼，
01:31
and cumulative traumatic experiences.
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這些累積更多心理的創傷。
01:34
Local and foreign military
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當地和外國的軍隊
01:36
are supposed to build peace together with the donors
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應該要與那些捐贈機構、政府和非政府組織
01:39
and the governmental and non-governmental organizations.
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一起建構和平的環境。
01:42
And people had hope, yes,
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這樣人們才有希望，沒錯，
01:44
but until they realized
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但是，當地人們目前只覺得
01:46
their situation worsens every day --
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他們每天生活一天比一天糟，
01:48
either because they are being killed
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因為，除了要擔心丟掉性命之外，
01:50
or because, somehow,
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更因為，不知怎麼，
01:53
they are poorer than eight years ago.
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他們比8年前還要窮困。
01:56
One figure for that:
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有一個數字是這樣顯示的：
01:58
54 percent of the children under the age of five years
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5歲以下孩童有54%
02:01
suffer from malnutrition.
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營養不良。
02:03
Yet, there is hope.
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不過，還是有希望的。
02:06
One day a man told me,
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有天某個人告訴我，
02:08
"My future does not look brilliant,
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"我的未來是看不到光明的，
02:10
but I want to have a brilliant future for my son."
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但我希望我兒子能有個燦爛的未來。"
02:14
This is a picture I took in 2005,
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這張照片是我在2005拍攝的，
02:16
walking on Fridays over the hills in Kabul,
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某個星期五，喀布爾上的小山丘一景。
02:19
and for me it's a symbolic picture
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對我來說，這是一張
02:21
of an open future for a young generation.
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為年輕一代開創未來的象徵性照片。
02:27
So, doctors prescribe medication.
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就像醫生要針對病因開處方配藥一樣。
02:31
And donors
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捐贈者
02:33
are supposed to bring peace
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透過蓋學校和鋪設道路
02:35
by building schools and roads.
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帶來和平。
02:40
Military collect weapons,
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軍隊沒收了武器，
02:42
and depression stays intact.
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但，絕望仍然在當地揮之不去。
02:45
Why?
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為什麼?
02:47
Because people don't have tools
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因為當地的居民沒有掌握
02:49
to cope with it, to get over it.
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應付絕望的工具。
02:54
So, soon after my arrival,
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所以，在這趟旅程之後，
02:56
I had confirmed something which I had already known;
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我就更加確認了那些我已經知道的事情，
02:59
that my instruments come from the heart of modern Europe, yes.
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我的治療手法是來自最先進的歐洲地區，
03:02
However, what can wound us
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然而，那些會對我們產生創傷的行為，
03:04
and our reaction to those wounds --
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還有我們對這些創傷的反應，
03:06
they are universal.
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是放諸四海皆準的。
03:08
And the big challenge
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所以，最大的挑戰就是
03:10
was how to understand the meaning of the symptom
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了解這些症狀，在這特殊的文化內涵中
03:13
in this specific cultural context.
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所代表的意義。
03:16
After a counseling session, a woman said to me,
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在一次的心理諮詢後，一位女人對我說：
03:19
"Because you have felt me, I can feel myself again,
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"因為妳能體會我的感受，讓我又重新感受自己，
03:22
and I want to participate again
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我希望能再重新回到
03:24
in my family life."
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過去的家庭生活。"
03:27
This was very important,
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這非常重要，
03:29
because the family is central
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因為在阿富汗，家庭
03:31
in Afghans' social system.
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是社會系統的重心。
03:34
No one can survive alone.
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在這裡沒有人能獨自生活。
03:37
And if people feel used, worthless and ashamed,
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而這裡的人經常會感到自己被利用、毫無價值和羞愧，
03:40
because something horrible has happened to them,
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是因為有些可怕的事情發生在他們身上，
03:43
then they retreat, and they fall into social isolation,
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於是他們開始退縮，陷入一種社會孤立的情況，
03:46
and they do not dare to tell this evil
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因為他們不敢把這種罪惡感
03:49
to other people or to their loved ones,
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告訴其他人或是他們所愛的人，
03:52
because they do not want to burden them.
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因為他們不想成為別人的包袱。
03:54
And very often violence is a way to cope with it.
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這種壓抑，通常就會訴諸暴力來紓解。
03:58
Traumatized people also easily lose control --
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心理受創的人很容易失去控制，
04:01
symptoms are hyper-arousal and memory flashbacks --
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這種人的症狀，是過度警覺和不斷回想過去，
04:03
so people are in a constant fear
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人會處於一種常態性的驚嚇狀態，
04:05
that those horrible feelings of that traumatic event
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過去的受創事件所帶來的恐懼感
04:08
might come back unexpectedly,
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會在無預警的情況下出現，
04:10
suddenly,
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是突然的出現，
04:12
and they cannot control it.
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沒有辦法控制。
04:15
To compensate this loss of inner control,
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為了去補償這種內在控制的損失，
04:18
they try to control the outside,
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他們會試著去控制外在環境，
04:21
very understandably -- mostly the family --
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這外在環境大多都是家庭，非常合理，
04:23
and unfortunately,
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非常不幸的，
04:25
this fits very well
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這也將整個文化內涵
04:27
into the traditional side,
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轉入一個更為傳統、
04:30
regressive side, repressive side,
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更落後、更壓抑、
04:32
restrictive side of the cultural context.
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更受限的環境下。
04:36
So, husbands start beating wives,
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所以，丈夫會開始毆打妻子，
04:39
mothers and fathers beat their children,
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父母會開始歐打小孩，
04:41
and afterward, they feel awful.
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打過之後，他們又會感覺很糟。
04:43
They did not want to do this, it just happened --
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他們根本不想這麼做，但事情就是這樣發生了。
04:45
they lost control.
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他們就這樣失去了控制。
04:48
The desperate try
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這種絕望感
04:50
to restore order and normality,
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會一直不斷出現，甚至逐漸變成常態，
04:53
and if we are not able to cut this circle of violence,
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如果我們不能阻絕這種暴力的迴圈，
04:57
it will be transferred to the next generation without a doubt.
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它就會變成下一代中理所當然的事情。
05:00
And partly this is already happening.
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這種現象已經有出現一些了。
05:03
So everybody needs a sense for the future,
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每個人都需要一個對未來的憧憬。
05:06
and the Afghan sense of the future
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而阿富汗人民對未來的憧憬
05:08
is shattered.
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已經被打碎了。
05:12
But let me repeat the words of the woman.
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讓我重述剛剛那位女人的話：
05:15
"Because you have felt me,
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"因為妳能體會我的感受，
05:17
I can feel myself again."
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讓我又重新感受自己。"
05:20
So the key here is empathy.
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關鍵點就在同理心。
05:22
Somebody has to be a witness
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要有人見證
05:24
to what has happened to you.
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在你身上所發生的事情。
05:26
Somebody has to feel how you felt.
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要有人能感受你所感受到的。
05:29
And somebody has to see you and listen to you.
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要有人注意你並聆聽著你。
05:34
Everybody must be able
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每個人都必須要能了解
05:36
to know what he or she has experienced is true,
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這些發生在他們身上的事情已經發生了，
05:40
and this only goes with another person.
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而且這也有可能發生在別人身上。
05:43
So everybody must be able to say,
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讓每個人都能說：
05:45
"This happened to me, and it did this with me,
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"雖然這種不幸的事情發生在我身上，
05:48
but I'm able to live with it, to cope with it,
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但我能與它共存，我能應付這種情況，
05:50
and to learn from it.
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並從中學習。
05:52
And I want to engage myself
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我應該要為孩子
05:54
in the bright future for my children
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甚至我的孫子
05:56
and the children of my children,
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創造燦爛的未來，
05:58
and I will not marry-off my 13 year-old daughter," --
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我不需要把我那13歲的女兒早早嫁出去。"
06:01
what happens too often in Afghanistan.
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這種早嫁女兒的情形常常出現在阿富汗。
06:04
So something can be done,
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有些事情是可以現在就完成的，
06:06
even in such extreme environments as Afghanistan.
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即使現在阿富汗的環境相當惡劣。
06:09
And I started thinking about a counseling program.
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於是我開始思考有關心理諮詢的計畫。
06:12
But, of course, I needed help and funds.
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當然，我需要的就是資金協助。
06:14
And one evening,
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在喀布爾的某天晚宴，
06:16
I was sitting next to a very nice gentleman in Kabul,
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我坐在一位非常紳士的男士旁邊，
06:18
and he asked what I thought would be good in Afghanistan.
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他問我，該怎麼做對阿富汗才是好的。
06:21
And I explained to him quickly,
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我快速的跟他講解，
06:23
I would train psycho-social counselors,
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我希望訓練一批心理社會諮商師，
06:26
I would open centers, and I explained to him why.
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我希望能有一個這樣的機構，然後向他解釋原因。
06:30
This man gave me his contact details at the end of the evening
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那天晚宴結束後，那個男人留下了他的聯絡方式，
06:33
and said, "If you want to do this, call me."
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然後說："若你真的想這麼做，請聯絡我。"
06:36
At that time, it was the head of Caritas Germany.
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這位男士，在當時是德國慈善社(Caritas Germany)的負責人。
06:41
So, I was able to launch a three-year project with Caritas Germany,
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因此，我就與德國慈善社發起了一個為期三年的計畫，
06:44
and we trained 30 Afghan women and men,
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我們訓練了30名阿富汗男女，
06:46
and we opened 15 counseling centers in Kabul.
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我們在喀布爾創建了15個諮詢中心。
06:49
This was our sign -- it's hand-painted,
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這是我們手工繪製的宣傳招牌，
06:52
and we had 45 all over Kabul.
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散佈在喀布爾45個地方。
06:55
Eleven thousand people came -- more than that.
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目前已經有11000人前來機構諮詢，搞不好更多。
06:57
And 70 percent regained their lives.
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前來的人有70%重拾正常生活。
07:00
This was a very exciting time,
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和這些傑出的阿富汗團隊合作，
07:02
developing this with my wonderful Afghan team.
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創造了這樣令人興奮的成果。
07:05
And they are working with me up to today.
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他們直到今日都還是與我緊密合作。
07:07
We developed a culturally-sensitive
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我們發展出一種符合當地文化的
07:09
psycho-social counseling approach.
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社會心理諮詢療程。
07:12
So, from 2008 up until today,
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從2008年到今日，
07:15
a substantial change and step forward
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我們已經獲得
07:17
has been taking place.
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實質上的改變與進步。
07:19
The European Union delegation in Kabul
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歐盟在喀布爾的代表團，
07:22
came into this and hired me to work
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到這裡來請我就任於
07:24
inside the Ministry of Public Health,
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歐盟的公共衛生部門
07:26
to lobby this approach --
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並推廣這種治療方法。
07:28
we succeeded.
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我們獲得了成功。
07:30
We revised the mental health component
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透過這種系統下的社會心理關懷專案，
07:33
of the primary health care services
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和社會心理諮詢師，
07:35
by adding psycho-social care
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我們重新修正了個人健康服務環節上的
07:37
and psycho-social counselors to the system.
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心智健康的部份。
07:40
This means, certainly, to retrain all health staff.
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這也意味著，我們要重新訓練所有的心輔師。
07:43
But for that, we already have the training manuals,
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現在，我們已經有了訓練手冊，
07:46
which are approved by the Ministry
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這能讓我運用在歐盟的健康部門，
07:49
and moreover, this approach is now part
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這套系統目前被納入
07:51
of the mental health strategy in Afghanistan.
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阿富汗心智健康的策略方案之一。
07:55
So we also have implemented it already
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我們已經在境內三個省的部分醫院
07:57
in some selected clinics in three provinces,
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開始執行這種方案，
08:00
and you are the first to see the results.
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各位將是第一批看到執行成果的人。
08:03
We wanted to know if what is being done is effective.
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我們都想知道這方案的執行成果。
08:06
And here you can see
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各位可以看到，
08:08
the patients all had symptoms of depression,
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所有的病人都有憂鬱症的症狀，
08:11
moderate and severe.
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嚴重性有高有低。
08:14
And the red line is the treatment as usual --
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紅線是用一般傳統方式的治療，
08:16
medication with a medical doctor.
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也就是透過醫生開的藥物來治療。
08:18
And all the symptoms
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而所有的症狀
08:20
stayed the same or even got worse.
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都沒獲得減輕，甚至更糟。
08:23
And the green line is treatment with psycho-social counseling only,
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綠線是透過社會心理諮詢的方式來治療，
08:25
without medication.
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不透過任何藥物。
08:27
And you can see the symptoms almost completely go away,
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各位可以看到憂鬱症狀幾乎完全消失，
08:30
and the psycho-social stress has dropped significantly,
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社會心理的壓力也顯著的降低，
08:33
which is explicable,
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這是有機可循的，
08:35
because you cannot take away the psycho-social stresses,
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因為，根本你沒有辦法移除社會心理的壓力
08:37
but you can learn how to cope with them.
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你只能學著如何去面對、減輕這種壓力。
08:40
So this makes us very happy,
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這個結果讓我們非常開心，
08:42
because now we also have some evidence
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因為我們有顯著的證據
08:44
that this is working.
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證明這套方法有效。
08:47
So here you see,
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各位看到的這張照片，
08:49
this is a health facility in Northern Afghanistan,
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這是在北阿富汗的一個醫療機構，
08:51
and every morning it looks like this all over.
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每天早上你都會看到這種大排長龍的景象。
08:54
And doctors usually have three to six minutes for the patients,
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但醫生只有3到6分鐘診斷一位病人。
08:57
but now this will change.
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現在這種情形已經改變了。
08:59
They go to the clinics,
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現在他們到診所，
09:01
because they want to cure their immediate symptoms,
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是因為他們想要減輕那短暫的焦慮感，
09:03
and they will find somebody to talk to
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他們只是想找人談談，
09:05
and discuss these issues
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討論一些問題，
09:07
and talk about what is burdening them
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討論身上的一些重擔
09:09
and find solutions, develop their resources,
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然後找出解決方案，從自身找出可利用的資源，
09:12
learn tools to solve their family conflicts
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並學習利用這些東西，解決家庭衝突，
09:16
and gain some confidence in the future.
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同時，獲得一些對未來前景的信心。
09:19
And I would like to share one short vignette.
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我想跟各位分享一段小故事。
09:23
One Hazara said to his Pashtun counselor,
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一位哈扎拉族人，對他的普什圖族諮詢師說(註：在阿富汗2族為世仇)
09:27
"If we were to have met some years ago,
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"若我們在幾年前見面，
09:30
then we would have killed each other.
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我們大概會想殺了對方。
09:32
And now you are helping me
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而現在，你正在幫助我
09:34
to regain some confidence in the future."
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重獲對未來的信心。"
09:37
And another counselor said to me after the training,
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另一位諮詢師在訓練後對我說：
09:40
"You know, I never knew why I survived the killings in my village,
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"我從不曉得為什麼全村人都被殺死了，只有我活下來。
09:44
but now I know,
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但我現在知道了。
09:46
because I am part of a nucleus
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因為，我是
09:48
of a new peaceful society in Afghanistan."
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阿富汗新和平社會的一份子。"
09:51
So I believe this kept me running.
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這就是帶領我繼續向前邁進的動力。
09:54
And this is a really emancipatory and political contribution
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這對和平與種族和解
09:57
to peace and reconciliation.
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具有解放性和政治上的貢獻。
10:00
And also -- I think --
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同時，我認為
10:02
without psycho-social therapy,
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沒有這套社會心理療程，
10:04
and without considering this
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沒有這種
10:06
in all humanitarian projects,
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人性化的計畫，
10:08
we cannot build-up civil societies.
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我們就沒辦法建立公民社會。
10:11
I thought it was an idea worth spreading,
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我認為這套方法是值得散播的，
10:14
and I think it must be,
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而我也認為這套方法
10:16
can be, could be replicated elsewhere.
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是必須、是可以被複製在任何地方運行的。
10:19
I thank you for your attention.
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謝謝各位。
10:21
(Applause)
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(掌聲)
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