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HROC—What Are We Really Doing?
A Discussion between Peter Yeomans, Laura Shipler Chico, and Dave Zarembka

This discussion began because Peter Yeomans is planning graduate level research which he will do on the HROC program in Burundi. This is follow-up/improvement of the research he did in 2005 on the HROC program. The discussion is much deeper than the usual descriptions we share of the workshops and stories/testimonies of the participants and facilitators.

From Dave to Peter and Laura:
Here are my comments on your research idea.

An elderly Masai man might look at Kilimanjaro and say, “There surely isn’t as much snow on Kilimanjaro as there was when I was a kid.” If you told him that the glaciers are melting all over the world like this and that this is due to global warming, he would understand immediately (and be better informed than George Bush). The fact that the concept of global warming came from the US would have no significance for him since he can see the evidence right in front of him.

As you sit down to dinner tonight with turkey, mashed potatoes, and corn on the cob, do you think, “Tonight I am being a Native American”? Are you a Muslim when you use the concept of “zero”?

I made this same mistake when I first went to Africa in 1964. One of the teachers at the school got married. As I watched the wedding I divided everything up into what was traditional (leading the woman with all her possessions from her village to the man’s village, the Twa buffoon whom I knew very well playing the “fool”, etc) and those that came from the West—the church wedding with the bride dressed in a white gown, etc. But when I asked the groom, he didn’t at all look at this as I was. He said, “This is the way we do things—we have a church wedding and then we bring the bride to my house.” In other words they had integrated what they liked into a workable whole for them.

It is a complete myth that there are “traditional” societies that don’t change. All societies are in a constant state of flux (even in the old days when there was not much communication between different groups). Putting this another way, youth have always been innovating things from their stodgy elders. Even Amish society is not static.

There is an almost mythical belief in the US that old African traditions and culture are better than our modern society. This is why folks like the Masai so much. (Read Out of Africa to get a real good sense of the “noble savage” concept which is part of the US image of Africa.) But as Adrien Niyongabo has said, some traditions are not good and have to go. Wife beating, for example, which 150 years ago was the “tradition” in the US also. What I think the Rwandans and Burundians are doing (which Americans seem very reluctant to do) is to assess the condition of their society and decide what has to change—and so frequently, this means to drastically change their own behavior with their spouse, children, other family members, neighbors, and enemies!!! In truth this is how society really does change for the better. It is as if they act upon the transforming power much more than Americans, who usually put the blame on what is going wrong on larger outside forces.

What might be really interesting is to forget what is “Western” and what is “African” and see what people in Africa think/describe/consider important about trauma and its effects. Are these thoughts, descriptions, etc., the same as a similar group of people in the US? If not, where are the differences? This could lead to learning what is cultural and what is universal which would be a very important question to answer not only for Rwanda/Burundi but also for the US.

From Peter to Dave and Laura:
Thanks for your thoughtful email about the research question. I agree with your comments about the nature of cultures and how they interact. I know that my time in the Great Lakes really helped me shift from a notion of cultures being distinct and different and in need of protection to a perspective of how dynamic they really are. In the first AVP workshops in Burundi, I remember feeling almost apologetic about introducing new ideas, and was then so struck by how the participants indicated a hunger for new ideas and a great confidence that they would adapt these ideas appropriately. It helped me see that cultures are always evolving, and as much as cultures deserve respect and acknowledgment as different, all cultures are also in need of critique and the offering of new ideas. The whole thing is ever-changing and the boundaries are much blurrier than people sometimes think

While cultures do overlap and blur around the edges, I’m sure you’d agree that there are differences too. And while some trauma seems to be definitely biologically based and therefore truly universal, there is really interesting work that supports the idea that an experience of trauma is substantially shaped by cultural factors. Studies have shown that when people really believe in the cause they are fighting for (e.g. Israeli soldiers) they are less likely to have symptoms of trauma. Or in Guatemala, where people who experience intrusive memories and dreams (that we would call PTSD symptoms) react to these dreams positively as sources of comfort. The dreams carry different cultural meaning for them than they would for most Americans.

Most important, I am enthusiastic about being able to help demonstrate the effectiveness of HROC through scientific methods with the hope that it earns more support for the program; I believe we share that common purpose. I know that as a student I am coming at this from an academic perspective which has both advantages and disadvantages. The advantage is that I can help to answer some questions with a rigorous methodology to which funders and some of the public will respond. The disadvantage is that academia can sometimes get caught up in the methods and precision and overlook the real purpose of things.

From Laura to Dave and Peter:
Not long after arriving in Rwanda, I became fascinated by the difference in the way that the world of “emotions” are conceptualized and understood in my cultural framework and in Rwanda. I think of emotions as abstract ideas in a way — I get a feeling (often, a physical feeling) which I then quickly ascribe to certain emotions (joy, stress, fear, etc.). When I started working in Rwanda, particularly when we started the Healing Companion training, one idea I had of how to be a good listener is to show compassion for someone’s emotions, and to show compassion, I usually articulate what those emotions might be (“I can imagine that you must be feeling incredibly frustrated at not being able to ...,” etc.). But what I found myself thinking is that the people we were working with do not have a large “emotional vocabulary.” This is what I was thinking because people were simply not conceiving of the emotions in a given situation in the same why I was, and certainly were not articulating them in the way I thought would be helpful.

Human emotions are human — we all are subject to them, but the way we conceive of them, the way we express them, and therefore the way that we understand them in ourselves and others, can vary quite dramatically from culture to culture. There are some things that seem to cross lines — crying is something that is almost a biological response to intense sadness or anger. We all love, we all grieve. But how we explain that to ourselves can be very different. In Rwanda, people usually meld physical well-being, material well-being and emotional well-being into one huge thing — or the categorizations between those are drawn in such different ways that I still haven’t figured them out.

For me there is no question about one thing — I regularly saw relief on the faces of our participants when they said that they had thought they were crazy but now they understood what they had been experiencing — and that it was trauma. I also know that there is something kind in helping people name and normalize the thing which is tormenting them; in helping them to break it down into manageable pieces. I think that Dave is saying that it is happening already — people in Rwanda and Burundi wouldn’t have been as taken with the concept of trauma if it didn’t somehow ring true to their human experience. That perception is certainly reinforced by what I witnessed in our work there.

On the other hand, I once read a statistic that in the US, college-educated women are more likely to suffer PTSD than women with a high school education. My supervisor asked why we thought that was: people with more money have more time to wallow, suggested one colleague. People who know what PTSD is might be more likely to experience it, suggested another — and isn’t this exactly your research question, Peter? Has it changed much? What I remember you describing is that you were wondering whether, once exposed to education about trauma, people were more likely to suffer from it.

Personally, I think it’s a good question. Like Dave, I would like to know how those who have suffered violence and war – and have not been exposed to any workshops – describe, understand, and explain what they have been experiencing. I think that the answer to that question will strengthen our work in HROC. Then, I am interested in the next question; do those explanations help folks move toward recovery? Do they hinder recovery? Are they neutral? For example, many explain symptoms in terms of demons and being possessed by demons, but if prayer and exorcism don’t work — people are left feeling evil and helpless.

There are many variables to consider. But the one that stands out is, how will you, in your study, control for stigma? Many of our participants say that they thought they were crazy, but now they see their symptoms as normal. Thus, it would be natural to hide symptoms if you think you are crazy and to talk about them once you hear that they are normal and others are going through a similar thing. I think that this will be a big hurdle to overcome in the research.
I am very interested in your research question, Peter, because in Rwanda I felt constantly humble in the face of the overwhelming hurt there. I believe in our work, I believe it helps. I certainly hope that by introducing the concept of trauma we were not in some ways helping to create it. But Rwanda is such a wounded place, and sometimes Theoneste [Bizimana] and I would sit and just admit that we didn’t know what to do. Beneath each layer that we peeled off there was more pain and more suffering aching to be eased. Each time we developed a new approach there was a new tide of need that threatened to drown us. Or drown me, I should say. Theoneste always seemed to stay afloat, and Solange, and Adrien and the others who use their own lives to become the living breathing pumping heart at the core of the work.

Whatever you find out, I hope that it can help HROC continue to become better at what it does, at what it strives to do. I hope it can uncover the vastness of our differences as it ties us inextricably to one another in our fundamental humanness.

From Dave to Peter and Laura:
Here are some comments. I doubt ignorance is bliss. I remember some research from way back that young women who had been sexually abused by family members thought it was normal, but when they went into therapy and learned that this was abnormal behavior they had a breakdown. Would they have been better off continuing to think that sexual abuse was normal? Wouldn’t this make it more likely that they would abuse their children?

My great-grandfather had three brothers who all fought in the Civil War, all were wounded, all became alcoholics, and all died rather young. I am sure all of them had PTSD, but of course the concept was not around then. Would they have been helped if the concept and therapy were available? I would think so. Certainly they wouldn’t have been worse off.

If a man stops beating his wife and children and starts talking to them, if a mother stops beating and yelling at her children and begins listening to them, a profound change has occurred. I have often wondered if the listening lessons in both HROC and AVP aren’t really the crux of the workshop. People who have been wounded deeply withdraw into themselves which means that they are not listening to others. To be reminded that to listen and communicate is peacemaking is important. How many times have we heard a participant say, “I thought I was the only one who went through this and now I see that other people had even worse experiences.” So perhaps the listening that occurs in the workshops is the “magic” that makes whatever happens work. They are drawn out of the isolation of their on sorrow.

Unfortunately I am not much of a researcher—I have always wanted to do things and let others to the research—likewise I majored in history, but find it much more interesting to be involved in the real world of today than write about history. But helping folks to put Rwanda and Burundi back together after the war and genocide is so much more immediate and important. The more we learn about what we are doing, the better tool HROC will become. In your research, Peter, there is the academic criteria which you must use (and this is important), but there is also the informal education we all can get about what this all means.

I just wrote Val an email where I said that I thought HROC workshops (much more than AVP workshops) are spiritual (or religious). God has forsaken these wounded people (“God goes around the world doing good, but he fell asleep in Rwanda”—Tutsi survivor) and they have to find their God again which they do by seeing that of God in the others in the workshop including their enemies.

From Dave to Laura:
Since I am in a theoretical mood, before I have to go back to doing the mundane details of AGLI work, in your Nyamata report you have the comment:

Some see genocide as an extreme result of psychological projection: when one group projects all that is hated about itself onto another group, the target group comes to represent all that is bad and shameful and evil about ourselves. Then it becomes not only possible but necessary to exterminate.

I have found this to be extremely thought provoking. Can you add more to this idea so that I can understand (and think) about it more? I am wondering if this is not what the US is doing with “radical Islamic fundamentalists,” i.e., when we are talking about them we are really talking about ourselves.

From Laura to Dave:
To put it simply, someone once told me that every time I criticize someone, I should just add three little words to the end of my sentence: “just like me.” It is eerie how consistently it works! This is psychodynamic theory – beginning with Sigmund Freud, continuing with Anna Freud (his daughter) and others. The theory talks about the defense mechanisms the mind or psyche sets up to protect the ego – or sense of self. Among these defense mechanisms are things we have all heard of – denial, acting out, intellectualization, etc. One of the most basic ones is “projection” – projecting that which we don’t like about ourselves onto someone else or a group of people, in order to preserve our own positive self-image. Absolutely, when folks in the US talk about radical Islamic fundamentalists, we are really talking about ourselves – I absolutely agree that this is part of the complex swirl of why it has been possible to sucker the American public into this war between civilizations. When we listen to how Bush characterizes the “enemy” and we add the three little words, “just like us” to the end, frighteningly, it almost always works.

From Peter to Laura and Dave:
This is becoming a rich conversation and my thoughts and questions are stimulated by both of your emails. Here are some thoughts and reactions to both of your emails. Laura, your description of how emotional, material, and physical well-being is melded into one, resonates with me as something I have tried to put into words, but have not ever been successful. This difference in sense of “feeling” is the background or context to this whole discussion.

In both of your emails you seemed to point to possible mechanisms in the workshop responsible for its beneficial effect. Sounds like one such mechanism might be the listening that goes on independent of whether models from outside are presented or not. Sounds like another might be reconnecting to a sense of purpose. It seems that there might be multiple mechanisms at work. You both suggest that foremost it hinges upon the experience of normalization of distress. People no longer feel crazy or alien; people are helped to overcome a stigma about being public with the “feelings” they are having. It seems that the presentation of outside models and a facilitated process in which people are encouraged to disclose those “feelings” may contribute to both this normalization and sense of relief. Which approach makes the main contribution? Are they best in tandem? I imagine that the presentation of new ideas about how these “feelings” are part of an identified construct like PTSD definitely helps to break the ice and prompt people into disclosure and a process that serves to mutually normalize the experiences/feelings. Could a careful facilitation that was true to the experiences and perspectives of the participants be equally powerful?

Laura was talking about crying as an example of a universal emotional reaction. I would venture that a good number of the symptoms in the Western trauma model are universal and would even show up when you ask people open-ended questions without any hint of what you are looking for (once we are able to overcome the stigma Laura mentioned). As we were talking in earlier emails, there is still the question of the cultural meaning of those symptoms. Western critics of the PTSD model say that while it helps to normalize symptoms, it can also contribute to increased expectations of having problems, as opposed to a more resilient response. The US military in Iraq is currently using a controversial strategy of telling soldiers who have experienced near-death combat situations that “you can now expect some normal reactions (= PTSD symptoms) to this abnormal and horrendous event you’ve been through; you need to rest but soon you will be able to return to your duties.” It sounds heartless, but may in fact help a soldier in the long run. They are trying to ensure that the soldier still maintains a level of functioning instead of getting over-identified with the idea that they now have a perhaps uncorrectable problem. I say all this to suggest that another aspect of what might shape outcomes is not whether an outside or “inside” model is facilitated, but HOW the symptoms are contextualized. If a Burundian woman (or an American woman) learns that they have PTSD symptoms, their next question might be, “What does that MEAN about me? Other people seem to have this too and that is a huge relief. Now I have a name for it, but what does this mean about me? Am I sick and unable to do my work or am I still capable?” I really have no idea what sort of message the facilitators attach to the symptoms. Given the Western reputation for psychological disability, I can only imagine that the Burundian facilitators present the model with a message of “Yes, you have this, and you can continue to go on” - much more so than sometimes happens in American culture. Might the risk of implying long-term problems be greater when introducing an outside model than when only soliciting participant perspectives on their distress AND their ability/necessity to carry on? As in the study Laura mentioned, people who can afford to be struck down by trauma may be more likely to experience long-term problems. With Burundians being that much more on the edge of survival to begin with, functionality in the face of distress is probably much greater.

This leads me to something I am really excited about adding to the next study. We all agree that trying to talk about “feelings” across translation is messy and imperfect. Even if it were perfect, it is only one aspect to assessing change in someone’s condition. Another big one is function. A doctor at John Hopkins, Paul Bolton, has being doing really excellent qualitative research (lots of open-ended questions and then categorical sorting of responses by local people) in Uganda and Rwanda. He has been using these methods to try to assess the degree to which depression holds up as a useful construct in those cultures. In the process, he has developed a measure of functioning based on the responses of hundreds of rural Ugandan and Rwandan responses to questions like “What are the basic things you need to do to take care of yourself, your family, and to be involved in your community?” The responses aren’t anything surprising (wash myself, go to market, go to community meetings, etc.) but the measure has been tested as a valid cross-cultural measure of assessment for this region. While Burundi is not Uganda and Rwanda, the rural lifestyle is certainly similar such that this measure would be a very useful complement to asking people about feelings. And wouldn’t it be exciting to document that the workshops helped people to improve, not just their feelings, but their functioning - their ability to participate in life and meet their responsibilities (though, as I said, I would guess functioning is relatively high already out of necessity). Anyway, I think this would be a great addition to the investigation.

From Laura to Peter and Dave:
Just a quick response, since I’m rushing around a bit. In Rwanda, to be honest, not that much of the conversation focuses on “symptoms.” That part of the workshop probably takes an hour at most. The vast majority of the time is spent looking at consequences in a fairly systemic way (consequences on the individual, family, community, and society, and how those interact). During the time on grief and mourning, when people share their stories, it is never about “symptoms”, but rather about the whole story — the losses, the daily struggles, the family relationships — it always is far more contextualized, and that happens very naturally.

From Dave to Peter and Laura:
Peter, you wrote, “With Burundians being that much more on the edge of survival to begin with, functionality in the face of distress is probably much greater.” I doubt this is true. Read page 8 of After the Guns Have Stopped—the story of Ciza Consile whose desire is to have her children back with her. Clearly she is not able to provide for them and I think it is probably both physically and emotionally. I doubt that she is functioning well on any level.

When I was at the Community Celebration in Ruyigi, the participant selected to make a presentation told the following story. There was a man in his community who was obviously crazy. He would take his clothes off and put them on his head, etc. After the HROC workshop, he decided to talk with this man. He found out that he had watched his wife and nine children being killed (and there was probably an awful lot of guilt in that he hadn’t protected them and that he had somehow survived, perhaps by running away in the forest). After listening to the man and understanding why he was behaving the way he was, he got him to settle down some. He continued to meet with the man and talk with him and he became at least more normal. Clearly this man was not functioning.

I am certain that the people who come to the HROC workshops are a selective group. First they are chosen by those organizing the workshop, and they are not likely to invite the kind of non-functioning people I have described above. Moreover even if invited, people may turn it down or not come if they are not ready. Recently in Rwanda, 9 out of 10 Tutsi survivors did not come to workshop because they did not want to meet “eye to eye” with the perpetrators. So another reason that the workshop succeed is because the people who show up are somehow ready—perhaps they have a feeling that something has to change in them, that the weight of what they have gone through needs relief—we get many testimonies where people say they feel “lightened” after the workshop, that they have shed a burden, a load. Carrying hatred, bitterness, anger, revenge, hostility around for a decade or more must destroy one’s soul.

From Peter to Laura and Dave:
I reread Ciza’ story. Your examples are sobering and it may well be that I overestimate how functional Burundians are after traumatization. I am also interested in what you wrote about the readiness that people have who actually come to the workshop. I think this is an important point and one that I hadn’t thought of before. These people have both distress and a readiness to try to address it, and to begin to heal. Not everyone is ready for a workshop.