Effects of war: moral knowledge, revenge, reconciliation, and medicalised concepts of "recovery"

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Abstract
War as illness or as moral problem The task that faces victims of war and atrocity is often spoken of as a “healing” or “recovery” through “processing” (of traumatic experience), “acceptance,” and “coming to terms with the past.” This posits an unduly mechanistic and medicalised view of human experience that suggests that the pathological effects of war are found inside a person and that the person recovers as if from an illness. Thirty years of civil war in Northern Ireland has had no significant impact on referral rates to mental health services.7 Elsewhere too, data that suggest that psychiatric morbidity is higher in populations exposed to war than in those not exposed are lacking. Nonetheless, as an effect of war, “trauma” seems to be displacing hunger as the issue of concern among the public; and Western approaches to mental health are seen as an automatic part of the humanitarian response, even for victims of war in non-Western countries.8 Yet “talk therapy” implicitly aims to change not just a person's behaviour but their mind—the way a person construes. Such therapy trades on an ethos of acceptance: it is the person, not the society, that is meant to change; a truism is that “successful” therapy moves the world view of the client closer to that of the therapist.9 The traditions of the clinic are for political and moral neutrality. Whose interpretations of the world will count at this critical moment? “We are not mad, we are betrayed,” was the response of one refugee approached by researchers for the pilot of a mental health project intended for Bosnians in Britain.10 This statement aimed to reassert the problem as moral and collective rather than medicopsychological and individual. At issue here are the limitations of a discourse in which the effects of war and atrocity come to be represented as a person's illness and vulnerability. Like other kinds of crisis—a serious accident or a diagnosis of cancer—war generates moral knowledge that may throw into question a person's assumptions about the world and their values and priorities. War victims—who carry the bitter knowledge that no limits exist for what can be done to people without power—beg resonant “why?” or “why me?” questions that address a moral domain. Medical science is good at answering “how?” questions—technical questions—but it only deals with “why?” questions through impersonal statistics and epidemiological studies.11 Patients may be alone in their need to find a social and moral meaning for what they have experienced. Victims of war may have to struggle with whether “recovery” and “acceptance” are merely markers of their own impotence and humiliation or whether, worse still, they are an acquiescence in injustice by themselves, by people they know, and, frequently, by the Western led world order that, behind the rhetorical screen of “human rights,” retains the realpolitik of “business as usual.” Trauma programmes certainly can be seen cynically by those for whom they are intended, they can be experienced as patronising or indeed as a form of pacification. In Bosnia, people derisively referred to the aid delivered to them through a model that did not offer physical protection, restitution, or justice as “bread and counselling.”12