Can Healing Therapies Go Global? No Health without Mental Health Researchers and aid workers in war torn and developing countries usually focus on malnutrition, disease and high child death rates. However, they are now starting to focus on mental health with the realisation that mental health is not separate from general health. Many people think of mental illness as something inherent to our fast-paced modern life, but some psychiatric conditions are actually more widespread in developing countries. The many wars across our globe are mostly in developing countries, and this violence is leading to Post Traumatic Stress Syndrome (PTSD), which hinders recovery and healing after the war has stopped. It is characterised by fear, over arousal and vivid replays of the traumatic event. Across Southern Asia, new mothers suffer from depression more often than they do in richer countries Recent psychotherapy trials have achieved remarkable success in improving both of these: the lives of war survivors and poor mothers with post-natal depression. The keys to a workable program include training ‘ordinary’ citizens to be counsellors, and in some cases, disguising the remedy as something other than a fix for emotional troubles. Wholing a PTSD-Shattered Life A remarkable German psychologist, Frank Neuner, based in a Ugandan refugee camp  with 14 400 African refugees (mostly from Rwanda) has been providing extraordinary help. Take, for example, the case of 13-year old Mohammed Abdul. Four years before coming to the camp in Uganda he had been caught up in the civil war in his home country of Somalia. He was still having nightmares and flashbacks. When he was 9 years old, a crowd fleeing a street shooting trampled him, putting him in the hospital for 2 weeks. A month later he saw the results of the massacre: 20 dead bodies floating in the ocean. Soon after that, a soldier shot him in the leg, knocked him unconscious, then raped his best friend, a girl named Halimo. Whilst recovering in the hospital, Abdul became overwhelmed by fear and by guilt for not having helped Halimo. He felt rage: he mistook people he knew well for the rapist and threatened to kill them.  When he fled his homeland a few months later and ended up in the Ugandan refugee camp he said that he felt as though there were two personalities living in side him: a smart, normal kid, and another one that was crazy and violent. Under the innovative care of Neuner, Abdul’s flashbacks and nightmares disappeared. It took just four 60 to 90 minute therapy sessions. He was still easily frightened but no longer felt out of control. The doctors felt that he was ‘cured’.  The approach that Frank Neuner used was ‘narrative exposure therapy’ which coaxes trauma survivors to assimilate their troubling memories into their life stories and thereby regain some emotional balance. Owing to the lack of mental health professionals, Neuner and his team recruited refuges from the camp. Anybody who could read or write and be empathetic was a candidate. Because nearly one-third of the Rwandan refugees and half of the Somalis suffered from PTSD, many of the future counsellors would need to be treated themselves first. In PTSD, distressing experiences are not in harmony with the person’s life story. Once the memories are activated the brain interprets it as though it is happening in the present moment. The brain is not aware that it is just a memory. Nehner’s approach focuses on bringing the memory to where it belongs and connecting it to the life history of the person. Recruiting the Locals The refugee therapists spent six weeks learning to help other patients shape their lives into a coherent story, incorporating major traumas into the narrative. The strategy worked. Seventy percent of those who received therapy no longer showed significant PTSD symptoms 9 months later. This compared to a 37 percent recovery rate for a group of untreated refugees. Empowering New Mothers in Pakistan In Rawalpindi, a rural district of Pakistan, 30% of new mothers become depressed. This is approximately twice the rate of depression in the developed world. Postnatal depression cannot only harm the baby’s emotional development but also its physical development. Most of the new mothers consider their symptoms to be just the fate of being poor, but many also believe that it is due to black magic, Many women are worried about talking about their problems because they do not want to be labelled as ill. What is also disturbing is that Rawalpindi has only THREE psychiatrists for its more than 3.5 million residents!! A British psychiatrist, Atif Rahman, has managed to get around such stigmas and barriers by recruiting government employees known as ‘lady health workers’. They have been taught to integrate mental health therapy into their home visits to new mothers. These workers visit homes about 16 times a year to give advice on baby feeding and child rearing. Rahman’s approach is is based on cognitive psychotherapy. The lady health worker tries to correct distorted and negative thinking either by discussing them openly or by suggestive other behaviours. For example, if a mother says she cannot afford to feed her baby healthy food, the lady health worker would question that and suggest small changes over time to improve the baby’s diet.  A year after giving birth, mothers who received this psychologically sensitive advice showed half the rate of major depression of those who received traditional health visits. Further Information If this has inspired you to know more about how psychotherapy is helping global health then please take a look at www.globalmentalhealth.org. There are scientific articles here too.