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.
我要告訴各位一個故事,一個鼓舞人心的故事, 將讓各位了解 充斥著絕望和失望的阿富汗, 我們能從中學到什麼, 以及如何幫助人們 克服過去受過的創傷, 還有如何在往後的日子,也就是未來, 讓這裡的人們重獲信心, 並再度回到正常的生活裡。 我是屬於聯合公會的心理治療師, 在偶然的機會下,我在2004年1月來到阿富汗, 為蒙帝亞勒醫療團隊(Medica Mondiale)服務。 榮格(Jung)在阿富汗..(註:圖中左下的男士,知名心理學家) 你們都知道那裡的情形。 阿富汗是世界上最窮的國家之一, 有70%的人是文盲。 戰爭和營養不良不但奪走了生命, 也扼殺了希望。 你也許從其他媒體得知這些資訊。 但你所不知道的是 阿富汗人民的平均年齡才17歲, 那是因為他們生長在這個環境 我再重覆一次 他們生長在這已經打仗30年的環境裡。
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.
這環境讓暴力事件 不斷發生, 外國團體對利益的覬觎,賄賂事件, 毒品,種族衝突, 糟糕的健康條件,羞恥,恐懼, 這些累積更多心理的創傷。 當地和外國的軍隊 應該要與那些捐贈機構、政府和非政府組織 一起建構和平的環境。 這樣人們才有希望,沒錯, 但是,當地人們目前只覺得 他們每天生活一天比一天糟, 因為,除了要擔心丟掉性命之外, 更因為,不知怎麼, 他們比8年前還要窮困。 有一個數字是這樣顯示的: 5歲以下孩童有54% 營養不良。
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.
不過,還是有希望的。 有天某個人告訴我, "我的未來是看不到光明的, 但我希望我兒子能有個燦爛的未來。" 這張照片是我在2005拍攝的, 某個星期五,喀布爾上的小山丘一景。 對我來說,這是一張 為年輕一代開創未來的象徵性照片。
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.
就像醫生要針對病因開處方配藥一樣。 捐贈者 透過蓋學校和鋪設道路 帶來和平。 軍隊沒收了武器, 但,絕望仍然在當地揮之不去。 為什麼? 因為當地的居民沒有掌握 應付絕望的工具。 所以,在這趟旅程之後, 我就更加確認了那些我已經知道的事情, 我的治療手法是來自最先進的歐洲地區, 然而,那些會對我們產生創傷的行為, 還有我們對這些創傷的反應, 是放諸四海皆準的。 所以,最大的挑戰就是 了解這些症狀,在這特殊的文化內涵中 所代表的意義。 在一次的心理諮詢後,一位女人對我說: "因為妳能體會我的感受,讓我又重新感受自己, 我希望能再重新回到 過去的家庭生活。" 這非常重要, 因為在阿富汗,家庭 是社會系統的重心。
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.
在這裡沒有人能獨自生活。 而這裡的人經常會感到自己被利用、毫無價值和羞愧, 是因為有些可怕的事情發生在他們身上, 於是他們開始退縮,陷入一種社會孤立的情況, 因為他們不敢把這種罪惡感 告訴其他人或是他們所愛的人, 因為他們不想成為別人的包袱。 這種壓抑,通常就會訴諸暴力來紓解。 心理受創的人很容易失去控制, 這種人的症狀,是過度警覺和不斷回想過去, 人會處於一種常態性的驚嚇狀態, 過去的受創事件所帶來的恐懼感 會在無預警的情況下出現, 是突然的出現, 沒有辦法控制。 為了去補償這種內在控制的損失, 他們會試著去控制外在環境, 這外在環境大多都是家庭,非常合理, 非常不幸的, 這也將整個文化內涵 轉入一個更為傳統、 更落後、更壓抑、 更受限的環境下。 所以,丈夫會開始毆打妻子, 父母會開始歐打小孩, 打過之後,他們又會感覺很糟。 他們根本不想這麼做,但事情就是這樣發生了。 他們就這樣失去了控制。 這種絕望感 會一直不斷出現,甚至逐漸變成常態, 如果我們不能阻絕這種暴力的迴圈, 它就會變成下一代中理所當然的事情。 這種現象已經有出現一些了。
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.
每個人都需要一個對未來的憧憬。 而阿富汗人民對未來的憧憬 已經被打碎了。 讓我重述剛剛那位女人的話: "因為妳能體會我的感受, 讓我又重新感受自己。" 關鍵點就在同理心。 要有人見證 在你身上所發生的事情。 要有人能感受你所感受到的。 要有人注意你並聆聽著你。 每個人都必須要能了解 這些發生在他們身上的事情已經發生了, 而且這也有可能發生在別人身上。 讓每個人都能說: "雖然這種不幸的事情發生在我身上, 但我能與它共存,我能應付這種情況, 並從中學習。 我應該要為孩子 甚至我的孫子 創造燦爛的未來, 我不需要把我那13歲的女兒早早嫁出去。" 這種早嫁女兒的情形常常出現在阿富汗。
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.
有些事情是可以現在就完成的, 即使現在阿富汗的環境相當惡劣。 於是我開始思考有關心理諮詢的計畫。 當然,我需要的就是資金協助。 在喀布爾的某天晚宴, 我坐在一位非常紳士的男士旁邊, 他問我,該怎麼做對阿富汗才是好的。 我快速的跟他講解, 我希望訓練一批心理社會諮商師, 我希望能有一個這樣的機構,然後向他解釋原因。 那天晚宴結束後,那個男人留下了他的聯絡方式, 然後說:"若你真的想這麼做,請聯絡我。" 這位男士,在當時是德國慈善社(Caritas Germany)的負責人。
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.
因此,我就與德國慈善社發起了一個為期三年的計畫, 我們訓練了30名阿富汗男女, 我們在喀布爾創建了15個諮詢中心。 這是我們手工繪製的宣傳招牌, 散佈在喀布爾45個地方。 目前已經有11000人前來機構諮詢,搞不好更多。 前來的人有70%重拾正常生活。 和這些傑出的阿富汗團隊合作, 創造了這樣令人興奮的成果。 他們直到今日都還是與我緊密合作。 我們發展出一種符合當地文化的 社會心理諮詢療程。 從2008年到今日, 我們已經獲得 實質上的改變與進步。
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.
歐盟在喀布爾的代表團, 到這裡來請我就任於 歐盟的公共衛生部門 並推廣這種治療方法。 我們獲得了成功。 透過這種系統下的社會心理關懷專案, 和社會心理諮詢師, 我們重新修正了個人健康服務環節上的 心智健康的部份。 這也意味著,我們要重新訓練所有的心輔師。 現在,我們已經有了訓練手冊, 這能讓我運用在歐盟的健康部門, 這套系統目前被納入 阿富汗心智健康的策略方案之一。
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.
我們已經在境內三個省的部分醫院 開始執行這種方案, 各位將是第一批看到執行成果的人。 我們都想知道這方案的執行成果。 各位可以看到, 所有的病人都有憂鬱症的症狀, 嚴重性有高有低。 紅線是用一般傳統方式的治療, 也就是透過醫生開的藥物來治療。 而所有的症狀 都沒獲得減輕,甚至更糟。 綠線是透過社會心理諮詢的方式來治療, 不透過任何藥物。 各位可以看到憂鬱症狀幾乎完全消失, 社會心理的壓力也顯著的降低, 這是有機可循的, 因為,根本你沒有辦法移除社會心理的壓力 你只能學著如何去面對、減輕這種壓力。 這個結果讓我們非常開心, 因為我們有顯著的證據 證明這套方法有效。
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.
各位看到的這張照片, 這是在北阿富汗的一個醫療機構, 每天早上你都會看到這種大排長龍的景象。 但醫生只有3到6分鐘診斷一位病人。 現在這種情形已經改變了。 現在他們到診所, 是因為他們想要減輕那短暫的焦慮感, 他們只是想找人談談, 討論一些問題, 討論身上的一些重擔 然後找出解決方案,從自身找出可利用的資源, 並學習利用這些東西,解決家庭衝突, 同時,獲得一些對未來前景的信心。
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.
我想跟各位分享一段小故事。 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) "若我們在幾年前見面, 我們大概會想殺了對方。 而現在,你正在幫助我 重獲對未來的信心。" 另一位諮詢師在訓練後對我說: "我從不曉得為什麼全村人都被殺死了,只有我活下來。 但我現在知道了。 因為,我是 阿富汗新和平社會的一份子。" 這就是帶領我繼續向前邁進的動力。 這對和平與種族和解 具有解放性和政治上的貢獻。 同時,我認為 沒有這套社會心理療程, 沒有這種 人性化的計畫, 我們就沒辦法建立公民社會。
I thought it was an idea worth spreading, and I think it must be, can be, could be replicated elsewhere.
我認為這套方法是值得散播的, 而我也認為這套方法 是必須、是可以被複製在任何地方運行的。
I thank you for your attention.
謝謝各位。
(Applause)
(掌聲)