War and mental health: a brief overview
The belief that distress, caused by traumatic experiences during violent conflicts, is a precursor for psychological disturbance is called into question in this week's BMJ.
In the third of four BMJ articles looking at conflict and health, Derek Summerfield, from the Department of Psychiatry at St George's Hospital, London argues that there is no such thing as a universal response to highly stressful events. He warns that labelling the human response to such events as "post-traumatic stress disorder" - regardless of personal, social and cultural variables - is a serious distortion, which may generate large overestimates of the numbers needing treatment.
Research shows that although some victims do develop significant psychiatric and social dysfunction, the relation between traumatic experiences and outcomes is not clearcut. For instance, in Iraqi asylum seekers in London, poor social support was more closely related to depression than was a history of torture. War is not a private experience, says the author and the social recovery of survivor populations - rather than medical intervention - should form the major thrust of humanitarian programmes, he argues.
The scale of mental disorders in developing countries remains sketchy, says the author. More research is needed on possible links between chronic illness and unresolved grief or cultural alienation, the impact of Western psychiatry on different cultures, and how or why individuals become psychological casualties. Many questions remain unanswered, but the complex relation between mental health and culture means researchers must beware of projecting findings from one population to another, concludes the author.
Contacts:
Derek Summerfield, Honorary Senior Lecturer, Department of Psychiatry, St George's Hospital Medical School, London SW17 0RE