Trauma Treatment for Children in War Build-up of an evidence-based large-scale mental health intervention in North-Eastern Sri Lanka Dissertation zur Erlangung des akademischen Grades Doktor der Naturwissenschaften (Dr. rer. nat.) Eingereicht an der Mathematisch-Naturwissenschaftlichen Sektion der Universität Konstanz Fachbereich Psychologie von Elisabeth Schauer MA/MPH Konstanz im Februar 2008 Tag der mündlichen Prüfung: 02.Juni 2008 1. Referent: Prof. Dr. Brigitte Rockstroh 2. Referent: Prof. Dr. Frank Neuner 3. Referent: Prof. Dr. Axel Meyer 2 Never doubt that a small group of thoughtful committed people can change the world. Indeed, it is the only thing that ever has. Margaret Mead 3 4 AC KNO WLE DGM ENT For you, the heroes, for your passionate struggle and infinite dedication. Know that nothing is ever in vain. It is the path of love and there is no other. Deep pain will be there and the fire of anger, utter helplessness and sadness as silent as tombs. Our weapon is presence that’s all, unconditional presence, courage, vision, witnessing and at times radical acceptance. The roads are unknown but don’t forget we are always together - never alone. We know that we have reached when there is freedom, peacefulness, joy and safety. To you, heroes of the here and now, the beautiful people, who work for this in so many places, hidden and open, punished and acknowledged. Be compassionate, especially to yourself. This work is a product of uncounted people – their hard work, dedication, commitment, vision, compassion, friendship and beauty all over the world. To thank them and to pin point their contribution here is the best part, probably also the most difficult. If I have forgotten aspects of your work, or even dear people, please do accept my apology. Great gratitude goes first of all to you Brigitte (Prof Dr Rockstroh), my thesis advisor, you are a woman of complete integrity and knowledge. Thank you for trusting in me and for supporting me unconditionally all throughout. Next my gratitude goes to my colleagues in Sri Lanka. I want to thank Mrs Kohila Mahendran, our Sri Lankan Master trainer, teacher, guide, friend and counsellor. If it was not for your brilliant mind and utter dedication, we could have never done this. You are a beautiful soul. Next of course my gratitude goes to the 150 Master Counsellors and more than 1500 Befrienders, who were trained in the course of this project. It is difficult not to mention you all by names, but you know that you and your narratives of life experiences are part of my personal life memory and will always be. You are the carriers of sheer healing my friends and I cannot thank you enough for giving this task your full dedication. It was an unforgettable experience to work with you and most of all to learn from you. There is a lot more to do for us together. Dear friend Mr Sundaram Divakalala. You know that this was only possible because of your incredible skills as a master administrator. You can move mountains and you moved them for us and what’s more, for the children of the Northern-East who you care for like a loving father. Dear Michael (Dr Hirth), thank you for believing in us and for supporting us all along the way. You had a clear vision for the rehabilitation of the North-Eastern Provinces and you implemented it without wavering. What determination. 5 Thank you Professor Daya Somasundaram for your open mind and constant support. I know we were difficult people at times however you stood by us like a mentor. A very special thank you for inviting us to refill our ‘batteries’ with yoga and silent times by the ocean. Thank you Dr Sambasivamoorthy Sivayokan for your support in one of the most difficult enterprises in Mullaitivu. Your peaceful nature and smart mind were a true contribution. You have taught us all what it means to persevere in circumstances of total destruction. There is a special place in my heart for our driver in Sri Lanka Mr Singham. Thank you for keeping us safe, for bearing with our difficult female wishes and demands and for advising us in the right moments. You were our big protector and with you we went gladly any place. May you be blessed. Now to all those who were on-site in Sri Lanka Thomas (Prof Dr Elbert), how to express my gratitude to you with the right words? You are a beautiful visionary of a better tomorrow and all I hope is that your time and energy will last infinitely to keep making your perfect contribution. I dare to say ‘thank you’ also on behalf of all the people we try to serve through our work. You are surely making this world a better place. Thanks for your pioneership on the island and for your continuous support to this project. Claudia (Dr Catani), my dear sister in the struggle, colleague, friend, indigo girl. I cannot thank you enough for supporting this project, its people and me. You are one of the smartest women I know and one of the most vibrant. To have you alongside with scientific and heartfelt advise and hands-on support was a lifesaver. Thanks for all the sweat, tears and laughs, thanks for all the unforgettable times spent. You dear Frank (Prof Dr Neuner) thanks of course for your crystal clear academic input, but most of all for being this truly sincere friend of the heart through the years, silently observing, always supportive and loving, never judging and ever accepting of me. There is a lot of work and experiencing left for us, do you know? Maggie (Dr Schauer-Elbert) my all and ever. You are smart, kind, loving, wise, patient and all knowing. Thanking you for supporting me in this scientific and personal enterprise is nothing compared to thanking your for being my twin sister. With you, beautiful sister, it all makes sense. Thanks for having paved the way for this project on your first mission and for hanging in there during the second project phase, which was a time of great personal change and challenge for you. Dear Martina (Ruf), thank you for being there after the tsunami catastrophe and thank you in fact for always being there for any type of emergency as well as every day support. You are a woman who will make a significant difference for the most hurt and troubled children of this world in time to come, I am sure of that, since you have already started. 6 Dear Bianca (Huschka) woman of the first hour. Guess we won’t forget those Vanni times and the struggle with the extremely difficult ‘outer forces’, including the heat while data entry. You are a brave girl and I have enjoyed your company and colleagueship greatly. Any time again. Dearest Hakon (Stenmark), our ‘polar’ vivo, thank you for coming a long way from the arctic circle to this tropical place of challenge. You feel to me like a rock in the stormy seas of emotions and having you close by is ever so safe and inspiring to me. Dearest Liz (Prof Dr Wieling), I am not sure when it started, but it was basically love at first sight. Thank you for contributing your expert knowledge on family therapy to the teacher counsellor group, which they have so long waited for. We need a lot more of it. Patience (Dr Onyut), my long lost friend. We had good times and great times, we also had the lowest of it. I want to thank you for making this long journey to Sri Lanka, its culture and people and for having contributed with knowledge, elegance and hard work to the success of this project. I wish for you to find the happiness and peace that you so deserve. Thank you Susanne (Dr Schaal) for coming to help with the final post-tests in times of big insecurity. And thank you Nadja (Jacob) for having had the stubborn willingness and courageous spirit to come and stay back alone and to relate so soulful to the local staff during times of hardship. Without the two of you we could not have finished our research. Dear Claudia (Schneider), it was great to have such a beautiful and smart student (at the time), expert (today) on board. It was wonderful to see your involvement and heartfelt dedication for the people of Sri Lanka. I know you have won the hearts of all the counsellors, including ours. Dearest Dorle (Hensel-Dittmann) and Britta (Balliel) it was on super short notice, but you were ready to make time and space for our teacher training course in Jaffna. Thank you for being such flexible, knowledgable and supportive team mates and for being ready to pull along with all daily tasks, including diagnostic post-tests and saree advice. Same goes for you, dear Christine (Klaschik) and Evangelia (Dr Saleptsi). You were pioneers of the first hour and you gave it all your heart and energy. And also great thanks to you Silke (Dr Gotthardt) for readily facilitating a workshop with the teacher counsellor and expert group of the tsunami task force South in Colombo. Dear Peter (Dr Banholzer), we needed a medical doctor on our tsunami mission and you were instantly ready to join. Thank you for having come during a most difficult time, where everything was unstructured and we had to live by the day. Your patient spirit, ability to completely engage in a foreign culture without any judgement or reservation was simply great.