WHEN I FIRST started my career, as a young graduate student volunteering on a mental health project among Mayan communities in the highlands of Guatemala, I learned quickly that the concept of neutrality was largely irrelevant in that context of extreme political repression and genocide. There were powerful forces—the army and its special forces, the paramilitary death squads, and the economic elites on whose behalf they both worked—who regarded any support to impoverished rural communities as subversive. In the eyes of the state, neutrality was not an option: you were either with the government, or you were against it.
But it wasn’t just the government’s view that made neutrality impossible. There was no way to work with affected communities from a position of political neutrality. It would have seemed absurd. How could you not have a position on the physical violence they had endured, and the structural violence that denied them access to land, education, and healthcare, and still hope to develop relationships of trust? You had to align yourself with people's struggle for justice. That didn’t mean taking up arms. It just meant acknowledging the oppressive conditions that prevailed in the country, and making clear that you understood who was behind the violence. You really were staking out a position by aligning yourself with the suffering and survival of indigenous and other oppressed communities, and by working to support their healing, resilience, and dignity. In the best sense of the word, you did become subversive, by opposing (and thus subverting) a terribly destructive regime. Not surprisingly, that could be a dangerous stance; numerous friends and colleagues were threatened, driven into exile, abducted and tortured, or killed.
From what I came to understand, it was much the same in apartheid-era South Africa. Colleagues like Andy Dawes and others were writing about the impossibility of neutrality, the absurdity of refusing to take sides—as though it didn’t matter who was doing what to whom or why. Indeed, some South African writers suggested that youth participation in organized resistance to apartheid might, in the long run, be more adaptive than passive acceptance of the oppressive status quo—even though in the short-term such resistance could actually increase young people’s distress and risk of injury. Not something western psychologists were talking much about, because peaceful protests in the west were generally not met with the fire of automatic weapons or the electric prods of sadistic torturers (although the young marchers in Selma and other civil rights protests certainly faced grave risks).
If you look at the writing—research and clinical—from Latin America and South Africa, and also some of the powerful voices from Palestine, and compare it to the literature of western psychiatry and psychology as it has confronted the devastation of armed conflict in various regions of the world (and among refugees on its own shores), you’ll notice it has a decidedly different feel. The latter is more medicalized, speaking primarily in the sterile and apolitical language of clinical psychopathology. The groups perpetrating the violence may be named (or they may not be), but there is often an effort to avoid any impression of advocacy. We treat the victims of violence, but for perhaps legitimate reasons, we seldom speak of the oppressive conditions of everyday life—the profound structural violence—that organized violence so often serves to maintain. Nor do we discuss who benefits from the violence, or the international actors, including our own governments, that may have a hand in its perpetuation.
SOMETIMES, OF COURSE, there’s no particular side one feels compelled to take, other than that of civilians caught in the middle of equally heinous warring groups. I think of the competing militias that fought brutally for control of Afghanistan during that country’s civil war in the mid-1990s. Who were the good guys, the ones not engaged in the wanton rape and killing of civilians, not raining rockets down on residential neighborhoods?
And of course, advocating for social change—except in the most general terms—risks violating the humanitarian principle of neutrality, and may limit our access to communities in need of support—as happened when NGOs were evicted from Sudan for criticizing the genocidal government in Khartoum. And then there's the funding issue. Funders such as USAID may be happy to support programs that treat the trauma of war; they may, however, be less happy when recipients of their funds name American military actions or weaponry as major sources of the trauma they are treating.
So yes, there are very practical reasons to adopt a tone of neutrality. And yet, I can’t help but feel something is lost in doing so. Of course, there will always be a need for the neutrality of the International Committee of the Red Cross (ICRC); they fill an essential niche, and that neutrality gains them access to people and places no one else can get close to. But for the larger mental health and psychosocial (MHPSS) community, I wonder whether we have become like lung surgeons, treating cancer but unwilling to advocate for a reduction in smoking. I think of the wonderful public health parable: Two guys are fishing in a stream when a baby comes gurgling down the rapids, drowning. They leap in to save the infant, and place her gently on the shore. Two minutes later, another baby comes gurgling down the stream. And on and on, all afternoon, until the shore is lined with rescued babies. Finally, one friend says to the other, “I’m leaving! No more of this.” “What?!” his friend replies in dismay. “You’re just going to let these children drown?” “No, of course not” his friend replies. “I’m going upstream to stop whoever is throwing them into the water.”
The link between mental health work with war-affected communities and advocacy for social and political change has grown ever thinner over the years. I wonder, what has been gained, and what, importantly, has been lost.
I invite you to follow my posts (and share your thoughts) here and on my blog, "Dispatches from the Field", at https://drkenmiller.wordpress.com/ where you can also find excerpts from my new book, War Torn: Stories of Courage, Love, and Resilience (Larson Publications). Please also check out my blog The Refugee Experience on Psychology Today.