Beyond Trauma is an interdisciplinary initiative for an inclusive approach to mental health and wellbeing in the Middle East. Founded by medical anthropologist Dr Orkideh Behrouzan, the project was launched in 2014 with an interdisciplinary workshop in London, followed by the publication of its inaugural special issue Beyond Trauma in Medicine Anthropology Theory. Through research, education, and practice, Beyond Trauma aims to bring together critical insights from practitioners, scholars, creative, and policymakers, towards a better understanding of the psycho-politics of mental health and wellbeing in the region.
Beyond Trauma is by definition an interdisciplinary space, inviting and showcasing a willingness for mutual dialogue across various disciplinary frameworks (clinical, political, historical, biological, or environmental). It approaches health and well-being as both biological/medical as well as socio-political entities shaped beyond the clinical encounter; thus requiring an open and meaningful engagement with a variety of disciplines. Beyond Trauma underscores, for example, why and how art, literature, cultural studies, politics, and history are not only relevant to, but in fact essential for informing any meaningful healthcare policymaking. Or that psychiatry cannot single-handedly deliver positive outcomes when it is divorced from political, social, and historical understandings of its clinical landscape. Mental health, in other words, is more than a clinical matter. And clinical categorizations (such as trauma) have implications beyond the clinical encounter.
Beyond Trauma is inherently concerned with (and aims to respond to) an ongoing crisis of representation. The region is increasingly essentialized, misrepresented, intervened upon, and commonly reduced to ‘conflict’; what ethics of engagement such representations engender? What do we really mean when we talk about ‘the Middle East’? How much do we know about its diverse clinical pedagogies? The speed with which the region is changing both urges and warns against quick analysis. It calls for long-term, in-depth, and interdisciplinary approaches that go beyond analysing everything Middle Eastern through the lens of religion, conflict, or trauma. There is a need for our sustained and committed attention to individuals’ and communities’ experiences, sense of well-being, and integrity. Beyond clinical interventions and policy, we need to understand what remembering and being remembered means when moral textures of societies are disrupted and structures of reverence and remembrance are obliterated. Above all, we need to ask what is at stake – culturally, historically, and politically – when mental health becomes an area of inquiry and intervention in the region.
In this TEDx Talk video, Orkideh Behrouzan talks about her research and the journey that led to the creation of the initiative, explaining its aim to disrupt how we conventionally think about mental health, the Middle East, and the relationship between individual and collective memories.
TEDxUCLWomen, Dec 1st 2018, Bush House, London
Beyond ‘Trauma’ is a response to the pressing need to rethink prevailing discourses of ‘Mental Health’ in the context of the Middle East. Its broad aim is to engage in an ethical and pedagogical examination of what we assume we know about both mental health and the region. At stake are a number of conceptual frames, both in the social sciences and in psychological disciplines, that no longer seem helpful, yet remain dominant in mental health care practice and policy making. This initiative aims to bring together viewpoints that go beyond the limits of dominant global health paradigms characterized by an individual-centred emphasis and approaches that focus on trauma and PTSD. A critical conversation about the cultural meanings and situated experiences of psychological conditions, as well as the uncritical appropriation of diagnostic categories seems to be long overdue. Beyond Trauma underscores the ethical, clinical, and political implications of a One Size Fits All approach to mental health and psychological wellbeing in the Middle East.
In calling the initiative ‘Beyond “Trauma”’, the aim is to challenge the competing disciplinary assumptions that underlie the term and that pathologize and determine the parameters of ‘healthy’ reactions to ‘unhealthy’ conditions. One concern is that ensuing diagnostic labels (such as PTSD) and classifications (such as the DSM), themselves widely contested even in Western biomedicine, individualize and de-socialize experiences and phenomena that are fundamentally social and political. This initiative is also sensitive to the violence inherent in the very process of identifying trauma and the politics of exclusion in applying taxonomies of experience. Such practices risk masking, erasing, and trivializing the experience of some while reinforcing the conditions that created the so-called trauma in the first place. This is by no means to overlook the individual burden and medical conditions that traumatic experiences inflict on individuals. On the contrary, the point is to ask what cultural and historical forces and moral tensions shape the reality of such [clinical] pain and how to best address them.
When affliction occurs, it can provide the context in which certain forms of life become either valorised or pathologized. Depending on what gets pathologized and what gets valorised, institutions and politicians may create or instrumentalize certain strategies of living and political projects. From Hezbollah’s identity politics of solidarity in Lebanon, to Iranians’ mobilization of Shiite frameworks during the Iran-Iraq War, to European narratives of heroism in the First World War that inhibited the acknowledgement of psychic pain, institutionalized narratives often fluctuate between the extremes of heroism and victimhood. But the space ‘in between’ is where individuals carve out strategies of living and construct fragments of agency. Beyond Trauma turns to those spaces and invites an interdisciplinary, bottom-up, culturally situated approach to such human condition. What means are available – culturally, clinically, or historically – for people to work with or through psychological pain? What helps people to sustain a moral life outside rigid clinical and cultural categories, while also acknowledging, respecting, and empathizing with people’s embodied experiences? How can we incorporate, for example, collective acts of remembering and the powerful legacy of oral cultures into therapeutic interventions? What clinical possibilities do cultural analysis and historical accountability offer to practitioners and policy makers?
Engaging with the situated forms of knowledge and practice and the cultural resources of each context is a first step for expanding therapeutic possibilities; as is therefore engaging with the social sciences, arts, and humanities as windows into the subjective experiences of inhabiting [ruptured] spaces of everyday life. Another step would be to evaluate the current state of mental health care systems that are in place, the struggles and opportunities of psychiatry’s interactions with various Middle Eastern societies and their medical pedagogies, and the ethical stakes of researching the pain of others. This requires a critical and reflexive assessment of the role of the outsider in such ecologies of uncertainty. In order to overcome several binaries – patient-practitioner, global-local, and cultural-biological – we need to incorporate the situated knowledge of practitioners, whose experiences cannot be divorced from the conditions in which they live and work. There is a need to better understand the region’s various health care infrastructures and diverse ways in which mental health and well-being are understood, practiced, and conceptualized.
Beyond Trauma is a call for conversation and action across disciplines and expertizes that share a common concern with the human condition and the construction of a moral life. It seeks a wide network of critical thinkers and on-the-ground practitioners to collectively generate theoretical, practical, and policy-relevant insights that are culturally situated. This is a platform to expand the conversation, connecting research and education to practice and practical experience to scholarship, in order to set a new innovative baseline for how Mental Health and the everyday realities of the Middle East are, and should be, understood represented, and addressed.
In 2014, Orkideh Behrouzan organised the interdisciplinary event, ‘Beyond “Trauma”: Emergent Agendas in Understanding Mental Health in the Middle East’. The event was funded by the Wellcome Trust and the FXB Center for Health and Human Rights and the School of Public Health at Harvard University. It brought together prominent scholars, mental health practitioners, and human rights experts from across three continents, alongside a large audience of local mental health practitioners, Middle East scholars, graduate students, writers, and artists. The event opened with a keynote lecture by the co-founder of Physicians for Human Rights and distinguished Professor Jennifer Leaning (Harvard University). Speakers then presented works on Iran, Afghanistan, Iraq, Lebanon, and Palestine (including works by Hanna Kienzler, Veena Das, Omar Dewachi, Nadje Al-Ali, Lamia Moghnieh, Sa’ed Adel Atshan, Zuzanna Olszewska, Rita Giacaman, Orkideh Behrouzan) and drew on angles as diverse as human rights, psychiatry, public health, war, gender, migration, occupation, and humanitarianism. The event showcased a truly interdisciplinary dialogue that went beyond the limits of disciplinary frameworks, methodologies, and mind-sets. One of the outcomes of this event was the publication of the 2015 Special Issue Beyond Trauma in Medicine Anthropology Theory.
Please see here for a complete list of participants and the aims of the workshop. Please see here for the Beyond Trauma Special Issue including some of the works presented at the workshop, as well as commentaries by Anthropologists Michael Fischer and Veena Das.