1. An Opening

My car broke down on the way to the airport while en route to my first job as a psychiatrist, in Yellowknife, Northwest Territories. I steered to the side of the road, propped opened my hood, and prodded around the engine a bit while waiting for the mechanic to arrive. But I’m not sure what I was looking for… I don’t know how cars work at all. Gas gets injected somewhere and a controlled explosion happens, and the energy created is translated into making the wheels turn. Super! So when I looked down at the smoking mess of steel and wires, the most informed statement that captured my understanding of the mechanism was “yup, that’s an engine.”

And this is what looking at maps of central Africa is like for me. I look at the political and topographical features on the map, with labels indicating population, climate, language groups and so on. I see, on various geo-political sites, such as the UN or Médécins sans Frontières (MSF) websites, maps with symbols indicating that a village was destroyed in this place, or that a refugee camp was been set up in another. But in the end, it remains abstract, so removed from my experience that it has more in common with a video-game image than real life. This is a problem.

Steven Cohen Forensic Psychiatrist 1CHAD

Steven Cohen Forensic Psychiatrist  2CHAD

When I finally got the call from the MSF project coordinator in Chad, I was thrilled! I had been waiting a few months for word on where in the world I may be placed, and what type of project it would be. Friends whom I’d recently met at the week-long training session in Bonn, Germany, were picking up posts in Somalia, Pakistan, Papua New Guinea and Sudan.  So when the call came through, and I was offered the position of Mental Health Officer (MHO) in Hadjer Hadid, Chad, I quickly threw it into Google Maps to find out where it was. But just as sure as the mechanic’s “it’s your alternator” was not particularly informative for me, looking at a map does not come close to capturing what is happening on the ground, along Chad’s eastern border with the Darfur region of Sudan.

Steven Cohen Forensic Psychiatrist  choices_part_1

Steven Cohen Forensic Psychiatrist  choices_part_3

Steven Cohen Forensic Psychiatrist  choices_part_4

To be sure, I’ve got a lot of questions, and volunteering with Médecins Sans Frontières is in great part an attempt to do some good work while trying to get some answers. This blog will be, I hope, a rummaging-around and working-through of ideas that will track this project. Writing is like a dialogue with a close friend, with whom you can explore new mind-spaces—toying with ideas, excavating hidden assumptions, and challenging them. One of the long-dead German philosophers of whom I’m so fond is Schopenhauer. Reading him doesn’t make you happy, but his words do shake you up. He once said something like: “the closing years of life are like the end of a masquerade party, when the masks are dropped.” Well, I don’t want to wait until the “closing years,” I want to know now. What is life like in these places that flicker across our news-headlines? What is this “mask” of which Schopenhauer spoke, and how does it obscure some things and illuminate or shift the focus on other things? If, I tell myself, I can stop choking on the silver spoon of bourgeois complacency long enough to comprehend this, if only in a small and trifling way, it will be invaluable.

It started like this:

One day, bored out of my tree while sitting in a medical school class class, I decided to figure out who I was. Not in some deep existential way, but rather in the bare-bones description of my categories: colour, nationality, gender, socio-economic status, etc. This was going to tell me how I came into the world, and maybe help me temper and accommodate for my origins as I tried to understand other peoples’ ways of being in the world.  Or, more likely, it was just a way to inject amusement into a dull lecture on the kidney.

Steven Cohen Forensic Psychiatrist  ClearUpFewThings

After twenty minutes of soul-less description, I was handed down from the gods of chance and circumstance my position: I’m a WWHUUMMP. (a White Western Heterosexual Urban Upper-middle-class Male Medical Professional).

Now that that’s clear, and rather unsettlingly conservative-sounding, let’s start with a couple of those questions…

How can a psychiatrist WWHUUMMP parachute into central Africa and expect to do anything useful?

I’m dead serious on this one… I lie awake at night pondering this, and find my mind going back to it when I walk through the hospital halls or wait for a bus at the end of a day. Even my dreams (made eerily vivid and wonky by an anti-malaria drug that’s well-known for causing nightmarish effects) have been rife with themes of displacement, inadequacy, and unfamiliar surroundings leading to misunderstanding, futility, and danger.

Another question, also asked by *many* of my shrink-colleagues, goes something like this:

*Tense sigh* These people have suffered such incomprehensibly intense, sustained, and unpredictable trauma, and the situation remains horrendous!! What do you say to a person who has lost his or her family, community, and livelihood?! What do you say to the woman who has been repeatedly raped when going out at night to collect firewood, and will continue to do so because her children will die without cooked food?! What do you say to say to a child who has been orphaned, neglected, and abused?! What can a psychiatrist do?!?

Where to begin? For starters, witnessing and advocacy work are in themselves crucial. The words on this screen will tell a story that I believe needs to be heard. And field-experience lends credence to this and other humanitarian pursuits.  But it still does not answer the question of what I will do and say, through translators or in my minimally functional French (and zero Arabic), that will make a difference. I hear words and catch-phrases such as “community-wellness-building,” “psychosocial programmes,” and “rehabilitation.” I’ve used them for years, too. But what will they mean in Farchana or Bredjing refugee camps, which at 20-30,000 people, are larger than some of the cities in which I have recently been working? I don’t know yet, and am finding it frustratingly difficult to find real answers in the vast literature out there on humanitarian and crisis mental health work. All agree, though, that the burden of psychological suffering is massive; there is much to do.

I appreciate anyone who reads these words and takes part in the dialogue, in one form or another. I leave for Chad in mid-January, and am bristling with excitement, hope and uncertainty.

Speak Your Mind