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Ananda Galappatti

What is a Psychosocial Intervention?


Mapping the Field in Sri Lanka1

Ananda Galappatti

The psychosocial field in Sri Lanka suffers from a situations of conflict such as in Sri Lanka.
lack of consensus about what precisely constitutes a The signing of a ceasefire agreement
psychosocial intervention, also at a global level. By between the Sri Lankan Government and
using a number of available frameworks and exam- militant Liberation Tigers of Tamil Eelam
ples of practice in Sri Lanka, the author attempts to in February 2002 and a subsequent peace
demonstrate how it is possible to include the wide process has not reduced this trend; in fact,
range of existing interventions under the ‘umbrella’ the burgeoning discourse of ‘post-conflict’
category psychosocial. Finally, through the exposi- reconstruction, rehabilitation and reconcili-
tion of an emerging conceptual framework offered by ation has moved psychosocial work even
the Psychosocial Working Group (Ager & Strang, closer to the centre of the humanitarian and
2001), the article suggests measures that could development sector in Sri Lanka. This is
form the basis for a broad understanding of psy- demonstrated by the unprecedented atten-
chosocial intervention in contexts such as Sri Lanka. tion given to psychosocial issues within the
formal peace process (e.g. the 2002 guide-
Keywords: psychosocial intervention, defi- lines of the Subcommittee on Immediate
nitions, conceptual frameworks, Sri Lanka. Humanitarian and Rehabilitation Needs,
and 2003 deliberations of the
Introduction Subcommittee on Gender), civil society
The past decade has seen a steady growth deliberations (e.g. the 2003 Road Map
in the number of initiatives in Sri Lanka Workshops on Humanitarian Concerns
which can be described as ‘psychosocial’ and an Integrated Framework for
interventions related to its long-standing Reconciliation by the Berghof Foundation
ethnic conflict or other political violence. and the Centre for Policy Alternatives) and
This seems to be the result of heightened recent donor policy frameworks (e.g. 2002
global2 and local awareness of the psycho- needs assessments reports by the United
logical toll exacted by modern conflicts. Nations Development Program and the
Driven by compelling accounts of suffering Canadian International Development
and the considerable donor and media Agency).
interest in these issues, international and
local institutions have become increasingly
involved with psychosocial programming in

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What is a Psychosocial Intervention? Mapping the Field in Sri Lanka1


Intervention 2003, Volume 1, Number 2, Page 03 - 17

Calls for a Definition of ers felt there was not yet adequate expertise
‘Psychosocial Interventions’ or evidence on which to judge other more
There is little dissent within the humanitar- radical approaches and so simply wished
ian sector of Sri Lanka about the need for for a broad definition of psychosocial work
psychosocial interventions on behalf of con- that could include and map the existing
flict-affected persons. However, there is activities. (Galappatti, 2003c).
growing concern and debate about the legit- Workers also felt that this ambiguity about
imacy and effectiveness of the various activ- ‘what psychosocial work is’ could hinder
ities being carried out to address this need. the design and implementation of pro-
The heightened debate around this issue is grammes, as well as hamper the monitoring
predictable, given the significant funds at and evaluation of these – both pressing con-
stake for both implementing agencies and cerns within the psychosocial sector in Sri
the donors who support them. The recent Lanka.
disagreements and conflicts about what Clearly, the process of defining what is a
types of interventions can be considered psychosocial intervention is fraught with
‘psychosocial’ often result in calls for a subtle and overt competition between alter-
clear, common definition to settle these dis- native perspectives and interest groups –
putes. both locally and globally. For donors, poli-
In the course of a recent policy-building ini- cy-makers, bureaucrats and non-aligned
tiative facilitated by the author, involving psychosocial personnel, choosing a single
over 200 psychosocial personnel through- definition with which to work presents con-
out the island, a number of participants siderable difficulties. However, it is also
articulated the ‘need to define what is clearly clear that a lack of clarity about the sector
meant by psychosocial and [to establish] criteria in could dissipate the enthusiasm and
order to create some common understanding’ resources that currently exist for supporting
(Galappatti, forthcoming in 2003). The psychosocial interventions. A recent work-
lack of this common understanding, they shop involving influential humanitarian
felt, was a source of conflict between per- agency heads and civilian policy-makers
sonnel and projects whose differing underscored this prospect, with participants
approaches often clashed in the field or at declaring that ‘a clearer idea is needed of
humanitarian gatherings. Some psychoso- what constitutes psycho-social interventions
cial personnel felt strongly that notions of before firm progress can be made in this
psychosocial work in Sri Lanka were often area’ (Berghof Foundation & Centre for
limited to counselling alone, and felt the Policy Alternatives, 2003).
need to expand popular understanding to
include a range of other community-devel- Recognising that at the heart of the debate
opment activities (see section on Diversity about ‘what is a psychosocial intervention?’ lies
in Psychosocial Interventions below) that both profound disagreement and often con-
they regarded as more appropriate forms of fusion about how the field is constituted,
intervention. However, others expressed a this article attempts to map out the psy-
desire to limit the boundaries of the defini- chosocial field of Sri Lanka in a number of
tion to exclude particular interventions, ways that may clarify the boundaries and
which they considered either as barely psy- fault-lines of the sector. This form of map-
chosocial or potentially harmful. Still oth- ping may provide a basis for a pluralistic

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Ananda Galappatti

understanding of the field, within which 1. Provision of explicitly psychological or medical-


competing and alternative approaches may ly therapeutic services, such as psychologi-
all be acknowledged. It seems prudent to cal counselling, befriending (i.e. sup-
pursue this approach to developing greater portive listening and allowing for the
clarity and depth of understanding of the ventilation of emotions), art and drama
psychosocial field, rather than to simply therapy, assessment for PTSD and
subscribe to a single framework or ‘camp’, referral for medical or counselling serv-
which may fail to recognise certain signifi- ices, physiotherapy, or occupational
cant manifestations of psychosocial suffer- therapy. This may also involve provid-
ing or the value of particular interventions ing children with resource books to
to deal with these. A shared understanding explore their feelings related to conflict,
of difference is unlikely to bridge deep and or visiting families in their homes to
meaningful divisions within the field, but it talk about their problems.
may allow for better accommodation of 2. Awareness raising and psycho-education,
diverse approaches within it. Whilst this through providing information on trau-
article concerns itself with the field of psy- ma and methods of coping with symp-
chosocial intervention in Sri Lanka, many toms, or discussion on issues related to
of the issues discussed may have relevance violence and conflict, training parents
to other conflict situations. and caregivers to help children manage
stress, or advising persons with particu-
The Diversity of Psychosocial lar symptoms or problems to seek out
Interventions local service providers.
Confusion about ‘what is a psychosocial 3. Interpersonal skills development for community
intervention’ often stems from difficulties in members, often in the form of guidance
recognising psychosocial interventions by for conflict mediation, communication,
their external form. In 2001, a directory was listening or problem solving.
compiled of 71 separate projects being im- 4. Social activities to support the expression of
plemented in Sri Lanka that identified feelings and thoughts, such as providing
themselves as ‘psychosocial initiatives’ opportunities for interaction, dialogue,
(Psychosocial Working Group, 2001). trust-building and sharing of experi-
Although this directory was not comprehen- ences or using theatre to explore atti-
sive in its account of interventions by local tudes and values etc. These are often
and international organisations, analysis of associated with activities related to
the directory’s contents reveals a remarkably material needs, such as regular meet-
varied range of projects being implemented ings for members of revolving loan
under the ‘umbrella’ category psychosocial. schemes.
In submissions to the directory, the under- 5. Mobilisation of existing social networks in the
lying theoretical principles, methodologies, community, through promoting sharing
tools or processes considered to be the of work between community members,
active ingredients in this range of interven- establishing children’s clubs, support-
tion types were poorly elaborated and often ing effective traditional coping strate-
not made explicit. Nevertheless, it was pos- gies, running workshops to mobilise
sible to identify the following psychosocial children’s own resources in relation to
strategies as central to particular projects: specific problems.

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What is a Psychosocial Intervention? Mapping the Field in Sri Lanka1


Intervention 2003, Volume 1, Number 2, Page 03 - 17

6. Supportive practices for child development, in logical treatment of torture survivors or


the form of play activities, creating pos- use of manuals for establishing and
itive social and physical environments, running activity gardens for children.
meeting early childhood developmental 11. Provision of training on issues such as
needs for stimulation, skill-building and child rights, non-violent conflict resolu-
socialisation. tion and mediation in communities,
7. Skills training to improve material security prevention of torture, guiding small
and sense of self-sufficiency, in the form of business entrepreneurs, peace-building
vocational training for young adults, or social and spiritual awakening, for
educational activities, business skills persons such as NGO personnel,
development and motivational work- lawyers, teachers, community leaders,
shops for widows or child-focused mine religious leaders, prison officials, mem-
awareness programmes. bers of the Sri Lankan armed forces
8. Provision of material and other support to and members of religious communities.
remove structural threats to well-being, such 12. Improving links and interchange between
as provision of food and material sup- resources and support services through
plies, prevention of sexual abuse and networking initiatives, such as the
injury by landmines, obtaining birth establishment of a database of psy-
certificates for children to give them chosocial personnel, the development
access to education and other services, of a directory of current psychosocial
or provision of low-interest revolving initiatives and the facilitation of a dis-
credit loans, accommodating children cussion and networking forum.
in orphanages, facilitating socio-eco-
nomic support to families of service- Significant sources of psychosocial support
men, public campaigning to protect in Sri Lanka that were strikingly absent in
children from the effects of armed con- this directory of formal humanitarian initia-
flict, implementing integrated develop- tives are traditional healing and cultural
ment projects for rural communities or practices, which are often central to peo-
‘protective accommodation’ and reha- ple’s lives in conflict-affected communities.
bilitation for ex-combatants Common examples of such practices might
9. Strengthening of spiritual dimension, include the consulting of oracles, purifica-
through involvement in religious activi- tion through fire-walking, ritual ceremonies
ties and spiritual education. to appease the anger of gods and participa-
10. Provision of psychology-oriented skills training tion in significant local temple festivals.
for personnel such as counsellors,
teachers in conflict zones, midwives, The diversity represented by these different
childcare and social service officers, activities and strategies for psychosocial
healthcare workers, ‘psychosocial’ intervention, whilst celebrated by some, has
workers and ‘befrienders’, on issues been the basis of regular disagreements
such as counselling for trauma, meeting within the humanitarian community in Sri
the early childhood development needs Lanka. Amongst humanitarian personnel
of children in conflict zones, eclectic and institutions there has been little consen-
strategies for psychosocial support, use sus on the relative merits of these alterna-
of applied theatre techniques, psycho- tive strategies – with outright rejection and

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Ananda Galappatti

ridicule of particular approaches being an group relationships and acculturation


extreme example of these differences of (Ager, 1999). Theories from developmen-
opinion. tal psychology are also applied widely in
the context of children (and adults) exposed
Debates to conflict, particularly in relation to social-
The difficulties in developing a shared defi- isation and cognitive development. The
nition of psychosocial interventions have fields of social and medical anthropology
roots in the sometimes bitter global debates have sought to unravel the systems of
about the very nature of the psychosocial meaning used by sufferers, indigenous prac-
effects of conflict. Within the global litera- titioners and external healers, and favour
ture, it is clearly recognised that there are the explanatory models and contextually
competing perspectives that seek to define embedded, traditional practices of conflict
psychosocial consequences of armed con- survivors (e.g. Lawrence, 1998). Whilst
flict. Amending slightly on the categories this quick sketch is a vast over-simplifica-
suggested by Ager (1999), it is helpful to tion of what these complex disciplines have
view the most influential perspectives as offered to the psychosocial sector, it may
loosely associated with the following fields: illustrate how particular psychosocial inter-
• Psychiatry ventions clearly draw insights and practices
• Counselling Psychology both consciously and unwittingly from
• Social Psychology powerful bodies of knowledge. Of course,
• Developmental Psychology it is important to note the existence of sig-
• Social/Medical Anthropology nificantly distinct approaches driven by mar-
& Traditional Folk Knowledge ginalized knowledge bases such as those of
Each of these fields has particular theoreti- radical feminist therapy, liberation psycholo-
cal assumptions, concepts or preoccupa- gy or various globalised ‘alternative’ healing
tions that frame its understanding of psy- practices (eg. Papic´, 2003; Martín-Baró,
chosocial impacts. For example, in the case 1994; Galappatti, 2003b). It can be enlight-
of contemporary mainstream psychiatry, ening to profile more deeply the theoretical
Post-Traumatic Stress Disorder (PTSD) has bases that underpin particular activities, and
become the, ‘most frequently screened-for field personnel sometimes find this activity
psychiatric diagnosis, as well as a concept useful to bring some order to the diverse
utilised in the planning of many interven- (competing) perspectives that are brought to
tion programmes’, and other biomedical bear on psychosocial suffering. At the very
conditions are also often recognised as least, it may clarify how projects differ fun-
being associated with experiences of con- damentally in their notions about what con-
flict (Ager, 1999). Counselling or psy- stitutes a psychosocial problem, an appro-
chotherapeutic views focus on a range of priate intervention and a successful out-
issues depending on the particular school come, because of the distinct schools of
within each area, although they tend to con- thought that they draw from.
centrate on issues of emotion, problem-solv-
ing, relationships and identity related to Whilst it has been possible to integrate
individual experience. Social psychology some elements of these analytical perspec-
offers insights and concepts that are con- tives or schools of intervention, such as
cerned more with social identity, inter- those derived from psychiatry and coun-

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What is a Psychosocial Intervention? Mapping the Field in Sri Lanka1


Intervention 2003, Volume 1, Number 2, Page 03 - 17

selling, or counselling and developmental Nations agencies. The lack of an accessible


psychology, serious obstacles to this process alternative ‘southern’ literature means that
have been posed at an epistemological level even local authors reluctant to posit their
in some areas – with the major battles being writings on Sri Lanka in the context of a
waged between positivist psychiatry/bio- ‘northern’ world-view say they find this
medicine and the constructivist perspectives impossible to avoid, ‘given the extent to
commonly associated with social and med- which First World concepts have infiltrated
ical anthropology (Bracken & Petty 1998, the core of professional and academic think-
Kleinman, 1995). The fundamental differ- ing in this country, (even [their] own)’
ences in how these disciplines (and their (Samarasinghe & Galappatti, 1999).
sub-disciplines and various schools of Whilst the ‘northern institutions’ often pro-
thought) view human experience some- duce material that can be used locally, this
times make the reconciliation of these per- does not necessarily address issues that are
spectives seem impossible. central to the debates and difficulties of
The opposition of biomedical and anthro- work in conflict-affected regions such as Sri
pological approaches has also been charac- Lanka. Whilst the nature of global knowl-
terised as a clash between the discourses of edge flows and the processes of obtaining
‘trauma’ and ‘resilience’. As Inger Agger so international humanitarian assistance have
succinctly puts it, ‘the ‘resilience discourse’ meant that local concerns appear to follow
often includes a rights-oriented approach trends in the global literature, they often
associated with interventions that respect have their own particular spin. For exam-
and protect the rights of the local culture ple, the ‘trauma’ vs. ‘resilience’ debate of
and traditions, whilst the ‘trauma discourse’ the global north was transformed into a
is associated with application – and some- ‘counselling approaches’ vs. ‘community-
times imposition – of western, medically- development approaches’ dispute in Sri
oriented interventions’ (Agger, 2000). Lanka (Samarasinghe, 2002). What, in the
As the international humanitarian agenda ‘north’, is a clash on the basis of underlying
has become increasingly concerned with theoretical or political assumptions, in Sri
the psychosocial consequences of war, the Lanka, is fuelled by disagreements of prac-
often heated debate over practice and dis- ticability in the field. Euro-American argu-
course has resulted in a fast-expanding lit- ments about whether cognitive restructur-
erature on the field. However, the literature ing through talk-therapy is a culturally valid
related to this has largely been produced practice to export to the ‘south’ are replaced
within institutions of the global north, with by Sri Lankan disputes about whether pri-
relatively fewer contributions made by vate counselling sessions risk being seen as
scholars, professionals or activists living in secretive activities and could cause danger-
the ‘southern’ countries where the majority ous intrigues in a village context (Bracken
of long-standing violent conflicts currently 1998, Galappatti 2003c).
take place. Consequently, the major
debates in the field tend to revolve around
issues of interest and concern to the ‘north-
ern’ institutions of knowledge-production,
whether research institutions, non-govern-
ment humanitarian organisations or United

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In the reality of fieldwork, only very few Mapping Service Delivery


local humanitarian personnel (even at a Orientations in Sri Lanka
management level) have any meaningful The ‘orientation’ of a psychosocial inter-
engagement with the global humanitarian/ vention often has profound implications for
academic debates coming out of ‘north’- its pre-occupations related to problem-defi-
based institutions. The knowledge being nition, choice of intervention, nature of
produced is inaccessible as it is rarely in the ‘healing’ relationships and desired out-
local language, unlikely to be available wide- comes. According to Isabel Rodríguez-
ly or cheaply in developing countries and Mora (1999), it is possible to identify the
because only a tiny proportion of workers following three distinct, but not exclusive3,
have an education that has informed them of orientations towards psychosocial program-
the fields of knowledge on which the debate ming within Sri Lanka:
is based. The difficulty faced by workers, • Mental Health
bureaucrats and policy-makers in Sri Lanka • Community-Development
has been that their exposure to psychosocial • Social Justice / Human-Rights
work has often been in the context of a sin- Mental health approaches tend to identify
gle organisation, a single international expert explicitly ‘psychological’ consequences of
or a single local guru. Often the theoretical war or armed conflict and attempt to pro-
basis for the work being done is not dis- vide support to survivors on this basis of
cussed in depth with them, leaving them understanding. Most of these services use
unable to relate this work to any other that frameworks borrowed from psychiatry,
they may come across in the future. clinical psychology and client-centred coun-
Therefore, someone who has been running selling to understand the suffering encoun-
programmes aiming to produce cathartic tered, and draw from systems of primary
reactions in clients would be unable to recog- mental health care, varieties of talk therapy
nise as legitimately psychosocial another that and sometimes pharmacological interven-
aims primarily to build practical day-to-day tion to treat the symptoms experienced by
relationships between clients in a difficult individuals and groups. These activities,
neighbourhood. This again points to the which emerged in the late 1980s and early
striking difference between the tools and 1990s, were implemented by the first gener-
bodies of knowledge available to local and ation of psychosocial projects and institu-
‘global’ practitioners. tions and still remain the most widely
Whilst it is still very helpful to recognise the recognised forms of intervention today. In
links between global knowledge bases and Sri Lanka, the dominant manifestations of
local interventions, it is important to note this approach remain counselling and psy-
that both knowledge and its effects are trans- cho-education (or ‘awareness raising’) activ-
formed within the context of each specific ities, which are greatly promoted within
conflict situation. An exposition and discus- rural settings by both non-government and
sion of relevant knowledge bases and state agencies. With regard to services for
debates with humanitarian personnel, espe- children, there is a particular fascination
cially in the context of familiar local projects, with arranging play activities that aim to
can provide them with useful conceptual facilitate emotional support and problem-
tools with which to make sense of the diver- solving, as well as cognitive and moral
sity of approaches in the field. development.

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Community development approaches, in contrast to psychosocial programming with people


the medical model, draw less heavily from affected by violence. Indeed, many organisa-
biomedical perspectives and rely rather more tions have taken great pains to keep their
on insights from social psychology and work apolitical, avoiding activities that are
anthropology. Indeed, these approaches overtly or consciously political. This has
emerged in the mid-1990s from a distinct dis- sometimes been choice forced on institutions
satisfaction with the applications of ‘trauma’ by the very real dangers of addressing vio-
frameworks within the Sri Lankan context, lence in the context of war. However, in
and with the counselling and medical treat- other instances, the lack of attention to the
ment approaches to support (Galappatti, political dimensions of people’s suffering can
2003a). The community-development be attributed to a failure to grasp the signifi-
approach was often driven by the recogni- cance of this facet of conflict-related experi-
tion that material and social conditions of life ences or often to an institutional inability to
played a central part in creating and main- negotiate the deeply-rooted political divisions
taining suffering, and that people seldom that pervade even the humanitarian agencies.
understood their suffering in psychological Although a number of psychosocial initia-
terms. Programmes therefore employed tives have grown out of human rights
strategies to support psychosocial resilience activism, there has at times been a curious
and well-being through making qualitative separation of ‘psychosocial’ support servic-
improvements in the social and material es from concurrent advocacy, legal interven-
environment of communities affected by tion or socio-economic assistance.
conflict (Samarasinghe, 2002). Importantly, Psychosocial services are often characterised
they also attempted to integrate supportive by a reductionist symptom-based ‘treatment-
or therapeutic principles into diverse main- provision’ approach to support that seems at
stream development and reconstruction odds with notions of demonstrating solidar-
activities such as building infrastructure, sup- ity with survivors, favouring their testimony
plying material relief, developing livelihoods, and affirming their right to justice. It is
reconstituting social institutions or mobilis- important however to underline that some
ing communities (Jareg, 1996; Galappatti, psychosocial work stemming from activism
1999). Here what is crucial is not only what around issues of disappearance, torture and
types of community development activities displacement has eschewed ‘expert’ psycho-
are carried out, but also fundamentally how logically-oriented interventions in favour of
they are implemented. The approach is rem- collective activities which focus on resist-
iniscent of that which has already been ance and campaigns for social change. It is
advocated by progressive thinkers in relation also possible that many individual workers
to the fields of feminist research and devel- try to address the dimension of social justice
opment, where again it is not so much the and political struggle within the privacy of
methods employed that set them apart from their own practice, rather than through
patriarchal approaches, but rather precisely risky public intervention or commentary. A
how methods are employed and for what rare example of the latter can be seen in
purpose they are used. Daya Somasundaram’s writings from
Interestingly, relatively few psychosocial ini- Northern Sri Lanka (Hoole et al, 1992;
tiatives in Sri Lanka have adopted an explic- Somasundaram, 1998; Somasundaram,
itly social justice or human rights orientation to 2000).

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Support services provided by ethno-national- Defining the Psychosocial ‘Realm’:


ist groups and organisations associated with The Provision of a New Conceptual
the military or government armed services Framework by the Psychosocial Working
often have little difficulty using explicitly Group
political ideas to frame the suffering of com- As the relatively young field of humanitari-
batants and civilians. Whilst this may be a an psychosocial intervention has expanded
powerful and meaningful form of support to over the past two decades, drawing from
survivors who share the dominant political more disparate knowledge bases and taking
ideologies held by these organisations, it new forms in implementation, the need for
may be silencing and even threatening to a ‘grand’ framework to explain the field has
those survivors who do not hold the same become more urgent. As discussed above,
beliefs to be true. Equally, avoidance and for the psychosocial sector in Sri Lanka this
denial of survivors’ own politicised under- need may be building up into a crisis of
standings of suffering can be problematic. identity and of survival.
In the present day context of an ongoing Both within Sri Lanka and elsewhere, the
peace-process between the government of Sri most common definition of ‘psychosocial’ is
Lanka and the Liberation Tigers of Tamil that which originated from a UNICEF-
Eelam (LTTE), there is growing interest in sponsored symposium in 1997, which states
developing psychosocial interventions to sup- that ‘the term ‘psycho-social’ underlines the
port a transition into post-conflict life. It is close relationship between the psychologi-
possible that attempts to provide support in cal and social effects of armed conflict, the
the context of processes of justice and/or rec- one type of effect continually influencing
onciliation will force greater engagement the other’ (McCallin, 1999 and UNICEF,
with the complex role of the political in medi- 1997 – see Box 1.).
ating experiences of suffering and healing.

Box 1. Definition adopted by the participants in the Symposium on the Prevention of


Recruitment of Children into the Armed Forces and Demobilization and Social
Reintegration of Child Soldiers in Africa, organized by UNICEF in cooperation with
the NGO Sub-group of the NGO Working Group on the Convention on the Rights of
the Child, Cape Town, 30 April 1997 (UNICEF, 1997)

The term ‘psycho-social’ underlines the close relationship between the psychological and social effects of
armed conflict, the one type of effect continually influencing the other.

By ‘psychological effects’ is meant those experiences which affect emotions, behaviour, thought, memo-
ry and learning ability and how a situation may be perceived and understood.

By ‘social effects’ is meant how the diverse experiences of war alter people’s relationships to each other,
in that such experiences change people, but also through death, separation, estrangement and other loss-
es. ‘Social’ may be extended to include an economic dimension, many individuals and families becom-
ing destitute through the material and economic devastation of war, thus losing their social status and
place in their familiar social network.

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However, this popular 1997 definition no Frontières, Holland; Mercy Corps; Save the
longer captures the deepening understanding Children USA; Solomon Asch Center,
of psychosocial suffering caused by armed University of Pennsylvania; Queen
conflict. For example, the understanding of Margaret University College, Edinburgh,
social effects is now often expanded to Centre for International Health Studies;
include the disruption or alteration of cultur- University of Oxford, Refugee Studies
al values, customary practices and social insti- Centre; and Harvard University, Program
tutions. Others have also argued that the def- in Refugee Trauma. One of the PWG’s sig-
inition does not adequately describe condi- nificant activities has been the development
tions of material deprivation that may be tan- of a conceptual framework to map the psy-
gibly experienced as suffering (Galappatti & chosocial field, as one strategy to address
Salih, forthcoming in 2003). The lack of flex- the ‘lack of consensus on goals, strategy and
ibility and dynamism of the above definition best practice that currently challenges the
has also meant that it is of marginal use to field of psychosocial intervention in com-
psychosocial practitioners in the field – apart plex emergencies’. Although the PWG’s for-
from providing a pithy response to the invari- mulations are still evolving in sophistication,
able queries about the meaning of the term an early draft of its conceptual framework
‘psychosocial’. offers some insights into what such a frame-
It is fortunate, therefore, that a group repre- work may offer to the field globally and to
senting both humanitarian and academic specific contexts such as Sri Lanka.
institutions is offering a new conceptual
framework that may be better able to cap- A paper entitled ‘Building a Conceptual
ture the emerging psychosocial field. Framework for Psychosocial Intervention in
Constituted in 2001, the Psychosocial Complex Emergencies: Reporting on the
Working Group (PWG) currently compris- work of the Psychosocial Working Group’
es members from the following institutions: by Alastair Ager and Alison Strang (2001)
Christian Children’s Fund; Columbia provides a glimpse of the working model
University, Program on Forced Migration (see Figure 1.)
and Health; International Rescue
Committee, Program for Children Affected Within this framework, the realm of the psy-
by Armed Conflict; Médecins Sans chosocial is seen to consist of three (some-

Figure 1. PWG Psychosocial Domains adapted in Colombo, April 2003.

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Ananda Galappatti

times overlapping and interwoven) domains, domains and their components. Taking
which can all be impacted on by the events into account these concerns, as well as some
and circumstances of conflict (see Box 2). of the constraints of translating concepts
into the local language, one group of psy-
The PWG suggests that these domains may chosocial workers developed a draft varia-
be useful as ‘lenses’ through which events tion on the PWG framework that captured
and circumstances in conflict situations may their own broad understanding of the realm
be viewed, in order to understand their psy- of the psychosocial (see Figure 2.).
chosocial significance to individuals and
communities. Attempts to map psychoso- As Jo Boyden (personal communication)
cial effects using this framework with psy- has pointed out, the psychosocial domains
chosocial workers in Sri Lanka have described above are often the source of the
demonstrated the simple, yet profound, conflicts that affect so many communities in
way in which it serves to organise (and the world today. Indeed, the psychosocial
legitimise) the range of issues being domains are often those that are intention-
addressed in the field. However, it is very ally targeted by one party to cause suffering
clear that many psychosocial workers felt to its enemy. The model offered by the
strongly that the framework failed to PWG offers not only the option of mapping
address the issue of material well-being, the various effects of conflict, but also the
which they felt was often intimately and opportunity to chart its causes and identify
inextricably linked to the other identified the specific areas where interventions
domains and the overall well-being of the should aim to have an impact. The paper
diverse individuals and communities they by Ager and Strang (2001) also provides a
work with. They also felt that cultural neat diagram to illustrate how the psy-
beliefs and practices helped construct the chosocial domains of an external agency or
significance and meaning of all other intervening community impact upon the

Box 2. Description of Psychosocial Working Group Domains, taken from Ager & Strang
(2001)

Human Capacity. Events can lead to a loss of ‘human capacity’ within the community. This domain
is taken to constitute such resources as the health and well-being (both mental and physical) of commu-
nity members, the skills and knowledge of people, their household livelihoods etc. (All of which may be
referred to as the ‘human capital’ of the community; Colletta & Cullen, 2000)

Social Ecology. Events also frequently lead to a disruption of the ‘social ecology’ of a community,
involving social relations within families, peer groups, religious and cultural institutions, links with civic
and political authorities etc. (All of which may be referred to as the ‘social capital’ of the community;
Colletta & Cullen, 2000)

Culture and Values. Events may also disrupt the ‘culture and values’ of a community, leading to a
sense of violation; challenging human rights; and undermining cultural values, beliefs and practices.
(All of which may be referred to as the ‘cultural capital’ of the community; Colletta & Cullen, 2000).

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What is a Psychosocial Intervention? Mapping the Field in Sri Lanka1


Intervention 2003, Volume 1, Number 2, Page 03 - 17

Psychosocial Domains

HUMAN Family SOCIAL


Mental & Peers Relationships/
CAPACITY
wll being Enviroment
Community
Knowledge Social services
& Skills Physical
Health
Cultural
Physical Practices &
Enviroment Values
Security /
Safety Religious Beliefs
Livelihoods
Material and and Economic CULTURE
Physical status
& VALUES
Situation

Figure 2. PWG Psychosocial Domains adapted in Colombo, April 2003.

nature of psychosocial interventions in con- problem analysis, declare its strategy or the-
flict-affected communities. oretical basis for intervention, articulate its
desired outcomes, provide a valid means
Future Possibilities for measuring these impacts and most
The exact composition of the domains importantly demonstrate a clear link
within the ‘psychosocial realm’ is likely to between each of these stages of interven-
remain a source of contention, with differ- tion. The value of a mapping tool like the
ent groups choosing to draw the bound- PWG framework is that it can be used to
aries loosely or more tightly. Although the trace the location of causal factors, psy-
PWG’s final formulation may differ from chosocial effects, interventions and evalua-
the framework presented in 2001, the tion schemes within the relevant domains –
group’s contribution has already been sig- a good basis for exploring the relative mer-
nificant in terms of providing an example of its of different approaches to intervention.
how multiple psychosocial approaches can Although it is unrealistic to expect that con-
be accommodated within one broad psy- sensus on good practice will easily emerge
chosocial ‘universe’. This kind of frame- from a field that is divided along funda-
work can clearly incorporate various serv- mental lines of epistemology and discipli-
ice delivery models, epistemologies and the- nary allegiances, bringing together diverse
oretical perspectives. approaches – even within a conceptual
The breadth and theoretical openness of model – may do much to clarify the possi-
the framework modelled by the PWG bilities for synergy. It is important that dif-
brings with it an imperative for psychoso- ferent schools of thought seek out a basis
cial interventions to define themselves in for interaction with each other, even if this
relation to others in the field. This type of search accentuates the clear fundamental
framework makes it easier to demand that disagreements or incompatibilities between
each intervention own up to its specific them. By so doing, psychosocial workers

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Ananda Galappatti

may achieve something far closer to real Unpublished Concept paper for the War-
exchange, cross-fertilisation or debate than Trauma & Psychosocial Support
they have enjoyed so far in the field. Programme, IWTHI Trust, Colombo.

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What is a Psychosocial Intervention? Mapping the Field in Sri Lanka1


Intervention 2003, Volume 1, Number 2, Page 03 - 17

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Ananda Galappatti

principles for NGO intervention and a irony and realism – acknowledging the way
critique of psychosocial trauma projects. that knowledge from the global south is rel-
Relief and Rehabilitation Network Paper egated to a marginal location of particulari-
14. London: Overseas Development ty, and that claims of globally relevant
Institute. knowledge in fact usually originate from
North America and Europe.
UNICEF (1997). Symposium on the Prevention 3
For example, since the mid-90s, there has
of Recruitment of Children into the Armed Forces been a growing appreciation of the different
and Demobilisation and Social Reintegration of traditional means of support, comfort and
Child Soldiers in Africa. Cape Town, South even healing. However, a lack of systemat-
Africa, (April) 1997. Report available ic interest has meant that these potentially
from UNICEF, New York. powerful resources and processes exist
mainly outside the realm of the humanitar-
ian psychosocial sector. There have been a
Ananda Galappatti is an independent psy- few attempts by local or international agen-
chosocial worker, usually based in Sri Lanka. cies to learn from traditional practices or to
Email: agalaps@hotmail.com use traditional resources to date, but hardly
enough to signal a trend. Of course, out-
side the formal humanitarian sector, numer-
1
Some of the material used here was ous service providers provide interventions
brought together during the Psychosocial based on folk knowledge and the resources
Policy Project, supported primarily with a of organised religion.
Grant for Research Collaboration in
Conflict Zones from the Program on Global
Security and Cooperation of the Social
Science Research Council, New York. The
project was also supported by subsidies of
project activities by individuals and organi-
sations in Sri Lanka too numerous to list
here. I am grateful for conversations with
Jo Boyden, Jason Hart and Alastair Ager,
who have influenced my thinking greatly
(although perhaps not always in the ways
they intended!). I am also grateful to the
members of the Psychosocial Working
Group for sharing some of their ongoing
formulations with me. My colleagues and
collaborators in Sri Lanka, particularly
Maleeka Salih and Sarala Emmanuel at the
Psychosocial Support Programme, also sig-
nificantly influenced me in developing the
ideas contained in this paper.
2
The terms ‘global’ and ‘local’ are used
throughout this paper with both a sense of

17