Torture and trauma in post-conflict East Timor

People and the Planet Conference Proceedings

Given the failure of many peace-building operations to ensure a sustainable peace, it is perhaps not surprising that the prospect of retaliatory violence in post-conflict societies is frequently identified as a security and development concern. Drawing on a critique of the so-called 'therapeutic security paradigm', this paper critically examines discourses of traumatization in Timor-Leste. At one level, it is noted that the bio-psychological model of 'trauma' can be incongruous with East Timorese notions of health, widely understood as being socially embedded and relational, rather than biological and individual. On another, the paper argues that there is no one-to-one correlation between experiencing events that might be classified as 'traumatic' and going on to suffer a pathological traumatization. Individual and community resilience should not be underestimated, and the rationale for international supervision of 'traumatized' societies should be questioned. Therapeutic interventions, such as the East Timorese Commission for Truth and Reconciliation, may be a pragmatic option given the lack of international support for pursuing criminal justice or financial reparations. However, remedies aimed at the psyche that come at the expense of the material may pose a greater threat to sustainable and secure community than does pathological traumatization, particularly at this time of acute social change.

Journal of Traumatic Stress, 2010

There is growing acknowledgment that research in the postconflict field needs to include a focus on social conditions. The authors applied structural equation modeling to epidemiologic data obtained from postconflict Timor-Leste, to examine for links involving potentially traumatic events and sociodemographic factors (age, gender, educational levels, and unemployment) with psychological symptoms and functioning. Exposure to trauma and lack of education emerged as most relevant with psychological distress impacting on education in the urban area. Age and gender exerted influences at different points in the model consistent with the known history of Timor. Although based on cross-sectional data, the model supports the relevance of past trauma, posttraumatic distress, and postconflict social conditions to functioning in societies such as Timor-Leste.

BMC Psychiatry, 2017

BackgroundPost-traumatic stress disorder (PTSD) is the most widely assessed form of mental distress in cross-cultural studies conducted amongst populations exposed to mass conflict and displacement. Nevertheless, there have been longstanding concerns about the universality of PTSD as a diagnostic category when applied across cultures. One approach to examining this question is to assess whether the same factor structure can be identified in culturally diverse populations as has been described in populations of western societies. We examine this issue based on an analysis of the Harvard Trauma Questionnaire (HTQ) completed by a large community sample in conflict-affected Timor-Leste.MethodCulturally adapted measures were applied to assess exposure to conflict-related traumatic events (TEs), ongoing adversities, symptoms of PTSD and psychological distress, and functional impairment amongst a large population sample (n = 2964, response rate: 82.4%) in post-conflict Timor-Leste.ResultsC...

Peskiza foun kona-ba Timor-Leste / Novas investigações sobre Timor-Leste / New research on Timor-Leste /Penelitian baru tentang Timor-Leste, 2018

Following widespread violence during the Indonesian occupation and later socio-political crisis in Timor-Leste, concerns were expressed that trauma posed a threat to individual and societal wellbeing. However there is not always clarity in how post-conflict trauma is defined, nor consensus about how it should be responded to. In this paper I present an overview of existing literature on trauma in Timor-Leste and introduce the early direction of my doctoral research on this topic. Putting forth some of my unanswered questions, I invite discussion of different ways that trauma is understood, talked about and addressed by various locals and foreigners in Timor-Leste.

The Lancet Global Health, 2014

Background Little is known about the eff ect of recurrent episodes of communal violence on mental health in countries recovering from mass confl ict. We report results of a 6-year longitudinal study in post-confl ict Timor-Leste assessing changes in mental health after a period of communal violence.

Local-Global, 2012

Understanding / Hatene kona ba / Compreender Timor-Leste 2019 - TLSA Conference Proceedings, 2020

In this paper I describe what I have identified during my doctoral research fieldwork as four main ways that “trauma” (particularly as related to past conflict) is conceptualised and addressed in contemporary Timor-Leste. First, there are prevailing lay understandings of trauma as fear; second, a psychological or psychiatric category of trauma as pathological mental distress or disorder; third, descriptions of women’s trauma as the embodied legacy of experiences that are often silenced and stigmatised within existing social structures; and finally, local cultural accounts of madness or other enduring suffering arising from events during the war, which while not using the word trauma bear conceptual similarities. These four notions of trauma are not exclusive (nor exhaustive), and I give examples of both synergies and tensions between them, suggesting that failures to take these into account can potentially heighten people’s suffering.

Intervention, 2008

JAMA, 2009

ASS CONFLICT AND DISplacement continue to affect large numbers of people worldwide. 1 In 2007, the United Nations High Commissioner for Refugees documented 16 million refugees, 26 million internally displaced persons, and 12 million stateless persons. 2 Yet controversy about the mental health needs of conflictexposed populations persists, 3 a problem that is magnified by the wide variability in rates of the most commonly studied psychiatric conditions among affected populations, namely, posttraumatic stress disorder (PTSD) and depression. Prevalence rates for PTSD have ranged from 0% in a conflict-affected region of Iran 4 to 99% in Sierra Leone 5 and between 3% and 86% for depression across surveys. 6,7 Identifying the potential methodological and substantive factors that are associated with this variation is vital to determining with any accuracy rates of mental health problems of conflict-affected populations. Methodological factors, particularly the approach used for sampling and diagnosis, appear to exert a large influence on the prevalence rates yielded by surveys. 8 An outstanding question, how-Author Affiliations are listed at the end of this article.

Conflict and Health, 2016

Background: Some evidence showed that multidisciplinary rehabilitation in Western countries is effective for treating war-related trauma, but it remains unclear whether this approach is applicable to civilians living in resource-poor countries affected by war. In 2012-14, Danish Institute against Torture (DIGNITY) conducted a randomized controlled trial (RCT), in partnership with Kosova Rehabilitation Centre for Torture Victims (KRCT), to examine the effects of multidisciplinary intervention among victims of torture and war in Kosovo. Methods: A single-center, randomized, parallel-arm, single-masked, waiting-list controlled trial was implemented in northern Kosovo. Thirty-four participants meeting the recruiting criteria were randomized to either intervention group, which received integrated treatments plus a once-daily multivitamin, or the waiting list group, which received multivitamin alone. The integrated treatments consisted of 10 weekly individual 60-min sessions of cognitive behavioral therapy (CBT), based on an adapted prolonged exposure therapy manual, an individual 20-min breathing exercise with an emWave biofeedback device, and 90-min group physiotherapy. The waiting list group also received the same treatment after the intervention group had completed their sessions. Outcome assessments were conducted at 3, 6 and 9 months after baseline assessment. Outcomes measures consisted of 4 subtypes: mental, emotional, physical health, functioning and social outcomes, i.e. PTSD, depression, anxiety, chronic pain, anger and hatred expression, body mass index, handgrip strength, standing balance, income, employment rate and disability score. Results: Over 1/3 of PTSD cases were successfully treated. Inconsistent patterns with mental health and chronic pain outcomes were observed while there was a definite impact of intervention on functioning and social outcomes, i.e. the employment rate, which increased nearly 15 %, and the monthly wage, which rose 45-137 %. There was also a noticeable improvement in handgrip strength and disability score; the feelings of anger and hatred diminished. However, most of these changes did not reach statistical significance. Conclusions: The impact of bio-psycho-social intervention is likely sensitive to the context of postwar economy in Kosovo and the treatment goals. The potential for improving the emotional well-being and employment outcome in victims was demonstrated. A larger scale RCT in a similar setting is needed, with close monitoring of treatment integrity and data reliability. Trial registration: Clinicaltrials.gov (NCT01696578).