Trauma and gender in natural disaster and conflict contexts: a comparative study of Aceh, Indonesia and the Deep South of Thailand

Abstract

This thesis investigates connections between psychological trauma, disaster and social relationships in the context of two sites with recent experience of natural disasters and violent conflict: first, Aceh, Indonesia, which was heavily impacted by the 2004 Indian Ocean tsunami and experienced almost thirty years of secessionist conflict between 1976 and 2006; and second, the Deep South of Thailand, which was impacted by storm surge on 11 November 2010 and which has experienced ongoing separatist insurgency since 2004. The broad aim of this study was to sociologically examine how people experienced and responded to the emotional and mental health impacts of natural disasters on top of violent conflict, including the ways in which these experiences and responses were shaped by a variety of social relations including gender, ethnicity, family and institutional arrangements for healthcare. Additionally, this research aims to find out more about how psychological trauma has been influenced by other social problems. These aims contribute both to sociological understanding of disasters and conflict and to the ways in which governments and aid organizations respond to interacting sources of psychological trauma. Psychological trauma is deeply experienced through the bodies and affective practices of human action and yet simultaneously conceived and introduced through the professional discourses of medical-psychological sciences and relief agencies in Aceh and the Deep South of Thailand. In this manner, the thesis treats psychological trauma as both a personal and a collective, a material and a symbolic, phenomenon. Descriptive research methods – including semi-structured interviews and observation – were used to investigate and describe the experiences of people exposed to natural disasters while living in a conflict situation. More than 300 participants were interviewed from the two research sites. Visual sociology was also used as a means to explore the experience of psychological trauma, to involve participants who found it difficult to explain their experiences, and to connect across languages. The results show how the effects of violent conflict and other existing social problems (such as social inequality), along with cultural and religious beliefs, are embedded within the psychological trauma associated with natural disasters. The traumatic impacts of disasters, in other words, cannot be dissociated from those who experience violent conflict or social inequality. Across both sites, people reported common symptoms of psychological trauma – guilt, grief, nightmares, sadness, anger, insomnia, social withdrawal, forgetfulness, body freezing, shock, panic attacks, anxiety, feelings of helplessness, hopelessness, emptiness, loss and avoidance. While participants could describe how symptoms such as these changed over time it was clear that the relationships between sources and symptoms were varied and complex. The impact of traumatic events was mediated by social institutions and processes in a number of important ways. Grief, for example, associated with the loss of spouses, children and parents were compounded by changes in family and parenting roles forced upon survivors. Many respondents were poorly prepared to assume caring responsibilities and struggled with cultural and gender role expectations as well as with low levels of institutional and extended family support. Injury and disablement introduced additional stresses to families as respondents struggled with stigma (and associated feelings of shame and weakness), dysfunctional sexual relationships, family conflict and violence and disruption to livelihoods. For young people, anxiety and mental health symptoms associated with exposure to traumatic events were compounded by adults' emotional reactions – the grief of parents amplifying fears over security and safety. Sexual abuse, forced recruitment as child soldiers, and other forms of exploitation added layers of complexity to the psychological trauma experienced by young people. The experience was also mediated by interaction with psychological trauma with healthcare actors, include modern healthcare, local healthcare and family healthcare toward people who have mental illness. Patients were stigmatized by their illness in different social contexts. Male patients were stigmatized as lazy, unemployed, drug addicted, aggressive and poorly educated. Female patients were stigmatized as divorced and associated with rape and domestic violence. Lock-up with Pasung and other forms of abuse and neglect intensified the psychological trauma experienced by patients, as did the restriction of medical resources – medical staff, budgets, supplies and equipment. Psychological trauma symptoms are hard to identify due to stigmatization, social discrimination, stereotyping, local cultural beliefs, and violent conflict history. While psychological trauma is often treated as the domain of psychology or health, it is simultaneously a sociological phenomenon and needs to be understood within the context of social relationships and networks. The outcomes of this research make a significant contribution to sociological understanding of how people experience and respond to emotional and mental health impacts of interacting sources of psychological trauma including natural disasters and violent conflict. Moreover, it is socially significant in terms of identifying the social factors that cause or amplify symptoms of mental illness following traumatic events.