ResearchOnline@JCU This file is part of the following work: Hasamoh, Alisa (2017) Trauma and gender in natural disaster and conflict contexts: a comparative study of Aceh, Indonesia and the Deep South of Thailand. PhD thesis, James Cook University. Access to this file is available from: https://doi.org/10.25903/5b5feaf48b850 Copyright © 2017 Alisa Hasamoh. The author has certified to JCU that they have made a reasonable effort to gain permission and acknowledge the owner of any third party copyright material included in this document. If you believe that this is not the case, please email [email protected] Trauma and Gender in Natural Disaster and Conflict Contexts: A Comparative Study of Aceh, Indonesia and the Deep South of Thailand Thesis submitted by Alisa Hasamoh Thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy in the College of Arts, Society and Education, James Cook University November 2017 ii Acknowledgements First and foremost, I would like to express my deepest gratitude to my primary academic advisor, Prof Stewart Lockie and my co-supervisor, Dr Theresa Petray, for all kinds of support and guidance throughout the research. You are excellent mentors. Thank you for all your assistance, encouraging my research, allowing me to grow as a sociologist researcher, accompanying me on this adventure and helping me journey through difficult times in my life. Your advice on my research has been invaluable. I would also like to extend a ‘thank you’ to a range of people who assisted me through correspondence, particularly Prof. Virasakdi Chongsuvivatwong from Prince of Songkla University, Hat Yai Campus, Thailand for his assistance in helping me to access my fieldwork in the Deep South of Thailand and Aceh, Indonesia, providing advice, comments and feedback to my thesis; Teuku Samsul Alam the ex-President of Community Health Nursing Department, Syiah Kuala University, Banda Aceh, Indonesia, for his advice, enable me to access Aceh communities; Miss Nurjannah Nitura, psychologist from Syiah Kuala University, Banda Aceh, Indonesia, for providing very useful suggestions and accommodation. Greig Rundle and Gillian Procter from Tasmania, Australia, friends, mentors and English teachers who helped me improve my ability of overall English skills long before I become a PhD student and while I was studying. In respect of the fieldwork activities, an enormous number of people need to be recognized and thanked. I would like to thank all of my friends and key informants in Aceh, Indonesia and the Deep South of Thailand. Thank you for the trust and invaluable information. A special thanks to interpreters and research assistants, namely, Elviana Isfani, Fithri Ramadhani, Siti Rahmah, WanAdenan Haron and Lamai Managarn. I acknowledge the team members from the Deep South Relief and Reconciliation Foundation (DSRR) and Deep South Coordination Center (DSCC), Thailand. I appreciate your help and valuable experience in the natural disaster and conflict areas. Finally, I particularly thank my family members, my father Adul Hasamoh and my mother Pasuk Hasamoh, for their patience and all kinds of support. iii Statement of the Contribution of Others Nature of Assistance Contribution Supervision Professor Stewart Lockie Dr Theresa Petray Financial support The program Strategic Scholarships for Frontier Research Networks (Specific for Southern region) of Thailand’s The Office of the Higher Education Commission JCU the Higher Degree Research Enhancement Scheme (HDRES) Thesis formatting and copy editing Greig Rundle iv Content Note Before reading this thesis, readers should read the warning statement below. Research reported in this thesis involved collecting the stories of people who have experienced natural disasters and violent conflict in order to promote the values of peace and development. Some of the material in this thesis may have an adverse effect on readers. The thesis contains explicit reference to experiences of violence and psychological trauma which may be potentially triggering and unsuitable for: people who have experienced conflict people who have experienced natural disasters people who have experienced other social problems, such as sexual abuse or domestic violence Some readers may be affected by the narratives contained in this thesis despite the writer’s efforts to avoid gratuitous reference to violence and trauma in the content. In the event reading evokes an emotional experience of traumatic events, suggestions are to: stop reading take time off and return later skip reading the section in question Any reader who has experienced traumatic events or PTSD should consider not reading this thesis. The benefit of this thesis is that it identifies sources of psychological trauma after examining descriptions of their experiences by people who have experienced particular natural disasters and conflict, along with other social problems. This is sociologically important in order to better understand at a macro level how trauma is experienced in general, by humans in natural disaster or conflict situations or similar. v 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. vi 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.