note on privacy, pseudonyms, and sensitivity: My use of pseudonyms is inconsistently applied throughout. When referring to public leaders (such as prominent Liberians who appear widely in global media), I do not use pseudonyms unless I have been explicitly requested to do so by interviewees. In the case of private Liberian citizens or Liberian NGO workers carrying out their routine functions under my participant-observer gaze, pseudonyms are applied and identifying information has been changed to protect individuals’ privacy. I have chosen not to change the name of certain international NGOs, like the Carter Center, or Liberian institutions like the Mother Patern College of Nursing and Social Work, because the domain of mental health in Liberia is sufficiently narrow that it would constitute an awkward deception to try to mask institutional identities. However, at the request of several NGOs, I have changed the names of their organizations to reflect concerns regarding their global reputations.
Lastly, I want to preemptively disclose to readers that much of the ethnography involves accounts of highly sensitive topics like forced displacement, rape, child abandonment, and murder. Those who may find this material too difficult to read may want to consider reading my other publications in lieu of this book.
Chapter 2
Clusters, Coordination, and Health Sector Transitions
Orientations
In September 2006, I climbed up and down the back staircases of the World Health Organization (WHO) in Monrovia after receiving a referral from UNHCR. I was looking for the authorities responsible for managing the implementation of trauma-healing and mental health services in Liberia, but at the senior levels of the WHO’s country offices, the Ministry of Health and Social Welfare (MOHSW), and the few professional offices of psychiatry and psychology, no one wanted to talk to me. I was lost, embarrassed, and worried that someone was going to notice me and kick me out of the building. After hundreds of efforts to request audience with the various leaders reported to be involved in Liberia’s mental health coordination, I was at an impasse.
Soon, two Indian GIS experts who worked for UNMIL helped me find my way to the appropriate office, and I noted the striking difference between the UNHCR’s offices and the WHO’s offices. During my interviews with UNHCR officers, I was seated in a spacious, clean, blue-carpeted and white-walled office with intense air-conditioning; while at the WHO, the office of the Liberian staffer responsible for mental health was dim, narrow, and covered with papers and news clippings, and it was stiflingly dank and humid. The spatial metaphor was apparent: in on-the-ground humanitarian action, how services were prioritized translated directly into space, manpower, technological sophistication, and public access. Mental health received far less attention than the tremendous movement of refugees and internally displaced persons in 2006, but oddly, UNHCR officials argued that mental health interventions were key to the postconflict recovery, while WHO officers contended that it was “not a priority.”
When I arrived in Liberia to conduct my research, I broadly wanted to understand the relationship between individual trauma and collective trauma in Liberia’s postconflict recovery. Just a few years before, I had spent two years (2000–2002) as a Peace Corps volunteer in the northern Korhogo region of neighboring Côte d’Ivoire, where I stood by as a witness to a republic in crisis while its populace talked itself into civil war. Prior to that, I had worked in domestic violence, rape crisis, and transitional residence programs for women and abused teenage girls in the United States. From these experiences, I became intellectually concerned with the empirical linkages between collective trauma and individual trauma, and with questions of survivorship, recovery, and reconstruction. With my newfound understanding of violence as a process of social change that took peaceful social spaces and opened possibilities for violent social action, I wondered how a country could reverse this process and, in effect, talk itself out of war and into a new form of social experience—postwar peace.
More intimately, my interest in this research emerged from my own inheritance of intergenerational trauma from Jewish parents, grandparents, and great-grandparents who had fled from pogroms, hid from Hitler, struggled under postwar anti-Semitism, rejected Israeli citizenship, and built a life in America, the new world. I wanted to understand how it was possible to rebuild a life, a people, and a nation after undergoing some of the worst crimes against humanity modernity could offer. Liberia gave me a path to gain insight into the road my family had taken. Trauma, to me, meant more than suffering. It meant managing suffering while making choices, planning for the future, struggling with the present, and holding on to the redemptive possibilities of hard work, hope, and renewal. Thinking of my grandparents, I had the sense that recovery from trauma had little to do with healing or therapy; it happened after fifty years, at the end of a family dining room table covered with food, when the survivors looked out protectively over three generations of descendants. Recovery meant autobiography, and even at the end of survivors’ lives, it was never complete.
My plan had been to act as a participant-observer of one humanitarian NGO’s mental health, trauma-healing, and psychosocial projects to study how Liberians understood their own experiences of war and reconstruction, and to examine how Liberian and humanitarian understandings worked themselves out in humanitarian practice. But soon after I arrived in Liberia, I learned that my contact, a Norwegian program officer, had left the country for six months. No one knew how to get in touch with her. The NGO was totally unprepared for my arrival, and it was utterly uninterested in hosting me. That plan was no longer an option.
As an anthropologist, the political economy of life in Monrovia made the management of basic needs nearly impossible. Living on a fixed stipend from a research grant, I found that rents in Monrovia were as high as rents in London, Tokyo, and San Francisco. My mobility and housing options were severely constrained by my gender and my lack of affiliation with a humanitarian organization. Consequently, I relocated eight times during my year of fieldwork: I shared dim apartments behind barbed-wire-covered walls, hotel rooms, short-term local housing under the constant surveillance of bandits, and I was secretly offered couches in friends’ embassy compound apartments, UNMIL bases, and NGO guest houses. Leaving my various residences on foot, I was routinely physically assaulted, verbally abused, or threatened, like many of the Liberians around me.
Directions
In order to get started, I called the only friend I had in the country, a consultant for UNMIL and the United Nations Children’s Fund (UNICEF), who set me up with a place to live and a general sense of the geography of the capital. With her help, I conducted an institutional inventory of international and local NGOs that reported having provided mental health and psychosocial interventions in their international media literature, marketing materials, and on their websites. Although NGOs often reported on the activities that they classified as psychosocial: ex-combatant education and retraining, GBV counseling, psychosocial curricula for elementary schools, civil society training, and human rights training, by 2006, most NGOs had ceased mental health and trauma-healing activities, and were intensely averse to providing financial, labor, or logistical support for mental health or psychiatric services. Few organizations were willing to claim any explicit involvement in mental health, and most took pains to separate themselves from those activities in situ, “on the ground.” Instead, in interviews, expatriate and Liberian NGO workers repeatedly used the phrase “destroyed human capacity” interchangeably with the word “trauma” in order to evoke a summary of the total human destruction wrought by the Liberian war.
To follow the meaning of psychosocial intervention in Liberia’s postconflict reconstruction, my research gradually expanded from interventions that could narrowly be defined as mental health and psychosocial to a consideration of any program or action that was classified, by anyone, as “mental health” or “psychosocial.” My emerging ambition was to study mental health and psychosocial intervention in a multiscalar and processual way, using a multisited ethnographic approach (Falzon 2009; Hannerz 2003). I first sought to examine the implementation and governance of mental health
