1. Massive Community Violence: Collective “Trauma”

2. Definition of “Trauma” “Trauma” was initially a medical term referring to a wound. However, it also began to be used to refer to an emotional wound. By definition, emotional trauma is "emotional shock producing a lasting effect on a person" (Oxford, 1980, s.v. "trauma").

3. Emotional Trauma Thus today trauma is often used to refer to a deep emotional wound or psychological pain that arises in response to a stressor outside of the range of usual human experience such as torture, assault, and various forms of violence and abuse. A person may become “traumatized” as a result of exposure to such a stressful event if that event overwhelms a person's coping mechanisms.

4. Exposure to potentially Traumatic Situations vs “Being Traumatized” Trauma is defined by the subjective experience of the survivor. Two people could undergo the same event and one person might be traumatized, while the other person remained relatively unscathed. It is not possible to make blanket generalizations such that "X is traumatic for all who go through it" or "event Y was not traumatic because no one was physically injured." You cannot assume that the details or meaning of an event that are most distressing for one person will be same for another person.

5. de Jong et al. The Prevalence of Mental Health Problems in Rwandan and Burundese Refugee Camps. Using “Western” measures (but intended to be generic – General Health Questionnaire), prevalence of serious mental health problems estimated at 50% (even if as low as 24%, at least 90,000 persons w/”problems”); Group and community level interventions are called for (ex: psycho-ed campaigns or therapeutic community activity centers).

6. Bolton P (2001). Local Perceptions of the Mental Health Effects of the Rwandan Genocide. Ethnographic methods of data collection based on Rwandans’ own perceptions – wanted to know “are Western concepts of mental health and illness valid with this population?”; “mental trauma” (Guhahamuka) and “grief” (Agahinda) syndromes similar to depression (w/ some components of PTSD) and additional local symptoms; (see pg 246 symptom lists); Traditional healers were also asked for inputs.

7. Massive Community Violence HOW TO ADRS THE NEEDS WHEN THE POTENTIAL NUMBERS OF THOSE IN NEED APPEAR OVERWHELMING? 1. Do you believe that, following such massive community violence, communities and/or groups and individuals have the capacity to heal themselves? 2. Do you think that under such circumstances everyone would be “traumatized”? 3. Can you think of interventions that might assist those most in need of healing and promote increased capacity of communities to heal themselves?

8. Case study Rwanda – survivors of massive community violence 1. First consider who (individual, family, group, community) is the client and these same potential levels of intervention… 2. Discuss the individual in context and the potential impact of the environment on the individual and vice versa. 3. To what extent does this client appear to be experiencing subjective distress, personal discomfort, and/or functional impairment? How might this client define their own situation? 4. Identify apparent risk factors and protective factors, and coping skills. 5. Consider what type of intervention strategies might be helpful to this particular client and why. Remember the broad goals of all interventions.