Creating a Mental Health Infrastructure in a War-Torn Land

"This is a very big human catastrophe, and it has the potential of being even larger," says Dr. Daniel Creson. Dr. Creson has just returned from the refugee camps along the Albania-Kosovo border. It was his second trip to Albania, but he has taken over 40 trips to some of the world's most strife-ridden countries - Bosnia, Northern Ireland and the Gaza Strip in Israel.

Dr. Creson is a professor in the department of psychiatry and behavioral sciences at The University of Texas-Houston Medical School and a clinician and researcher at the Harris County Psychiatric Center and the UT Mental Sciences Institute. He is a recognized authority in family and community therapy.

Dr. Creson has a real interest in cultures - he has a doctorate in anthropology - especially the cultural issues and responses in war-torn countries. He initially became involved with responses to traumatic events here in the U.S., assisting victims of industrial accidents.

"In 1992 I went to Sarajevo as a representative of the Health Science Center with a group of British doctors and helped set up a program to train the social workers and mental health professionals already there in post-traumatic stress disorder. That program runs itself still," says Dr. Creson. United Nations studies have shown that three-quarters of the children in Sarajevo have actually seen someone get injured or killed, and half of the children believed their lives to be in danger. "So that kind of situation makes you want to help; it makes you want to keep going back," he says.

"I began to feel that psychiatry might not be sufficient in explaining some kinds of behavior. Most of the clinical sciences are geared to look for pathology," says Dr. Creson. "We assume the majority of behavior falls within the `normal' range; otherwise, `pathology' has no meaning. The biological, social and environmental go together to fashion behavior and make the underpinnings of what is `normal' or `abnormal.' But this violence in the Balkans - well, there are all kinds of points of views. In the end, the political leaders have utilized emotional symbols - in this case, religion and national history - to raise the fervor of the populace and to demonize the `enemy'."

Dr. Creson consulted with the Children's Christian Fund as that group established what would become an award- winning program in Angola for children. The system for promoting self help within refugee camps is implemented there and is the model for use in Albania; it is a good model for post-traumatic stress disorder, Dr. Creson believes. It is `normal' to have emotional problems after having been through what most of the refugee camp children have been.

"Rather than create a disease model, we want to develop a model to help them get on with their lives," says Dr. Creson. "This is especially needed to support the mothers who are very stressed by trying to hold their families together."

What is important in Dr. Creson's model is that it can be reproduced, as it was in Sarajevo. "We begin by training the social workers and mental health professionals - who are already doing a great job considering the situation. The very best of these trainees then go on and teach others. It is essential that we create something which is overseen by the people of that community and something that will last. Helping to create a mental health infrastructure has a far greater effect than my providing direct care."

The refugee camps along the Albania border have a varied mix of inhabitants - professionals from the urban areas, farmers, mechanics, separated families. And it's a tenuous situation. "You have over 400,000 refugees going into a country that is already the poorest in Europe, is small - about the size of Connecticut - and has abysmal infrastructure, roads which are practically non-existent," says Dr. Creson. "And while we may think there is a lot of support for the ethnic-Albanians from Kosovo by the Albanians in Albania, there are significant differences between the two groups. There is considerable stress and strain between them." Dr. Creson pauses for a moment. "The situation will be horrendous if the camps are still full when winter comes."

"What struck me on this visit was the ability of people to cope. You hear the horror stories, of course. I'm thinking of a little boy who asked, "Tell me why they cut my father's neck like a chicken's.'

"But we are resilient, and children are especially so. Some of them may have significant problems, but most of the kids will be okay."

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©2006 Texas Medical Center

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