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