By Biz Herman

Each year, on the evening of March 25th, students at Dhaka University in Bangladesh reenact the massacre that occurred on that night in 1971, carried out by the Pakistani army against the university's faculty and student body. The attack was the first phase of Operation Searchlight, an ambush on the residents of then-East Pakistan, and it marked the start of a nine-month conflict referred to in Bangladesh as the Liberation War. Survivors from that night recount tanks rolling through the streets and rounds of bullets being fired throughout the night. Sharmeen Murshid, a Bangladeshi writer and activist that grew up in the university area, with a professor father and a politician mother, recalled that the following morning “when daylight came, we could see how terrible everything looked—dead bodies everywhere.”

As the war progressed, the violence reached nearly every corner of the country, with estimates of between 300,000 and three million people killed. Men and women across the nation mobilized to protect their families and homes, forming guerrilla forces and taking up arms. An estimated 30 million Bangladeshis were internally displaced during the war, and hundreds of thousands of women were raped by Pakistani soldiers. The conflict eventually ended on December 16, 1971, with a Bangladeshi victory achieved with help from the Indian army.

The war serves as the defining moment of national identity in Bangladesh, powerful in its ability to simultaneously evoke both victim and victor narratives. Its memory is publically celebrated in national holidays and monuments, mobilized for political purposes, and held up as an instance of good triumphing over evil in the birth of a nation. The chronicle can be recited by heart by its citizens, as if it were a storybook.

Privately, however, individuals have their own recollections of the war—more complicated narratives of struggle, loss, confusion, hope, trauma, even a coming of age. These personal details are not reflected in the official remembrances, which leave little room for deviations from the dominant memory.

In their own stories of living through the war, as recounted to the author in hundreds of interviews conducted from 2010 to 2011, Bangladeshis emphasize that because of the way the war is memorialized, individual traumas remain unaddressed nearly five decades after its conclusion. One prominent Bangladeshi activist recalled loved ones she had lost to Pakistani forces, but also a friend killed by Bangladeshi guerrilla fighters; his tall stature and light skin made the guerrilla fighters mistake him for a Pakistani, and he was killed on the spot. In retelling the story, she began to cry. Even though she had reflected on the war for decades, she had never been allowed to openly name her own personal traumas.

Forty-seven years after the war, political violence persists in Bangladesh, and the nation’s democracy faces significant challenges, with strikes, political violence, and persecution of dissident voices and political opponents impacting daily life and democratic processes. Similar patterns are seen in other post-conflict societies—peace is achieved, but that peace is neither stable nor robust.

Experts and academics often explain the instability by pointing to weak institutions, undeveloped political parties, a lack (or excess) of natural resources, and social ills like persistent crime as causes of failed reconciliation, but they seldom consider the impact of the psychological after-effects of conflict. Yet, psychology and neuroscience research has yielded an increased understanding of the legacy of violence and trauma on brains and bodies, which may help to explain why and how stable peace works or fails after conflict. “We know from research that living through a war, that having strong enemies, that being victimized actually changes the way you think,” said Mike Niconchuk, Senior Researcher at Beyond Conflict. “Beyond the way you think, it changes aspects of brain chemistry; being a victim of conflict can affect the size of parts of your brain.”

Thus, even in places where people and communities desire to work together, psychological and physiological factors can impede the ability to participate in healing and reconciliation processes—both at the individual and community levels. And, in post-conflict societies where there is no space or support for reconciling past traumas, and where there is no way to examine the effect of exposure to and participation in violence, the after-effects can persist for decades beyond a war’s conclusion.

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Research on the ways in which mental health and individual experiences of war affect peacebuilding is scant, for several reasons. First, there is what scholars call a “unit of analysis” problem. Peace is considered a national, or at least sub-national issue, whereas mental health is commonly conceptualized as an individual-level issue. Second, there is a discipline problem. Mental health is most often regarded as a problem outside the realm of scholars of political science or government, while scholars of psychology or neuroscience regard war as outside the scope of their work. Third, mental health is widely under-addressed in post-conflict situations in general, since physical safety and health are often seen as the most pressing concerns.

Increasingly, such boundaries are being challenged. But the research is still preliminary, and many questions remain unanswered.

Predictably, the few studies that have begun to examine the links between individual exposure to conflict and prospects for peace have reached somewhat divergent findings. Political scientists have found that individuals exposed to violence are more likely to support reconciliation efforts. Psychologists, on the other hand, have found that adverse responses to exposure to violence, characterized by post-traumatic stress disorder (PTSD), decrease support for reconciliation and increase support for continued violence.

This discrepancy suggests that perhaps it is not enough to understand how living through violence impacts the prospects for peace, but rather how individual responses to living through violence impact the prospects for peace.

It makes sense that people would respond differently to living through war, but this notion has often been absent both from academic research and popular narratives. In reality, people have vastly different reactions to exposure to traumatic events, from adverse responses characterized by the onset of PTSD or other trauma-related disorders on one end of the spectrum, to no change in functioning at the middle, to post-traumatic growth, or  functioning that exceeds that of pre-trauma exposure, on the other end.

For those individuals who react adversely to being exposed to trauma, the onset of PTSD can emerge fairly immediately after the conflict, or anytime in the years to come. The precise symptoms differ from person to person, but they may include nightmares, flashbacks, intrusive thoughts, and outbursts of anger. Importantly, PTSD is commonly characterized by what psychologists call “abnormal threat reactivity.” This, most commonly, is a kind of hypervigilance, in which individuals have a heightened threat response, such that stimuli that individuals with a normal threat response would be able to identify as non-threatening (for example, fireworks) trigger a full threat response in persons with a hypervigilence. (Sometimes, PTSD can be characterized by the opposite, or a shutting down of threat reactivity, such that individuals do not react to actual threats with appropriate vigilance or fear.)

In neuroscience, studies have found that individuals with increased activity in the amygdala, the portion of the brain that governs threat awareness and fear responses, show increased wariness and distrust of outgroup members. Thus, for individuals who develop PTSD characterized by increased threat reactivity, those persons may be less willing to interact with individuals perceived as enemies, especially members of the outgroups with whom they had been engaged in conflict—precisely those with whom they may need to reconcile.

This neurological reality raises questions not only of how peace can be built, but also what kind of support may be needed as a foundation before individuals and communities can really start to address the traumas of war.

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In Jordan’s Zaatari refugee camp, which houses refugees that have fled the ongoing conflict in Syria, the wounds are fresh and the ability to move on is hampered, both physically (stringent rules restrict leaving the camp) and psychologically (access to any kind of mental-health or psychosocial support is severely limited).

In a recent small group conversation with Syrian refugees working with Questscope, an NGO that focuses on conflict affected youth, one Syrian refugee living in Zaatari responded to the question of what he would say if he could talk to the version of himself arriving at the camp four years ago. He answered that the idea that mental health is not a first-order need, like shelter or water, is unfounded. Without mental health and the ability to address the psychological wounds of war, he added, nothing else can be accomplished. He recalled all the issues among youth in the camp when they first arrived—violence and conflicts and unrest—but noted that after the community and local organizations began to provide both literal and figurative space to address the traumas that individuals had experienced, social networks began to reestablish themselves and violence gradually subsided.

In his 1943 paper, “A Theory of Human Motivation,” Abraham Maslow proposed that the various needs of humans can be ranked. Commonly referred to as Maslow’s Hierarchy of Needs, the concept is often presented as a pyramid consisting of five levels organized in order of their importance. Maslow theorized that the bottom four categories—biological and physiological needs, safety needs, love and belonging, and esteem—are “deficiency needs,” such that if they are not met an individual will feel anxiety in their absence. Further, these needs need to be largely met before self-actualization—the realization of one’s true self, the only “growth need,” and the one located at the top of the pyramid—can be realized.

Post-conflict relief is often structured to meet the bottom two levels of needs on Maslow’s Hierarchy of Needs, prioritizing shelter, water, food, and physical medical assistance. This is partly because these are the most obvious necessities in post-conflict situations, partly because they are the needs that the largest aid organizations are trained (and funded) to provide. “There’s no question of us treating physical injuries that we see in war, but yet we get so suspicious when we talk about mental injuries,” said Niconchuk.

Modern conflicts are, however, increasingly protracted, and those forcibly displaced experience increased limbo. According to the World Bank, two billion people currently live in places affected by fragility, conflict, and violence. Currently over 65 million refugees, asylum-seekers, and internally displaced persons are scattered across the globe. Most refugees in Zaatari have been there upward of four years; they are still not allowed to build permanent shelters, and a working sewage system was only installed two years ago (the camp was established in 2012).

Why is psychological well-being seen as something that can be addressed down the road? “Logic would say that you have to start to start by ensuring people’s survival…before you can undo the damage [to mental health] that was done by a lack of safety,” said Niconchuk. “And I understand that, but the reality of conflict zones is so different, and the creation of safety is such a subjective notion, that it could take decades to accomplish. Look at Afghanistan. Should we still not be taking care of mental health because it’s been 25 years of conflict?”

The ways in which environments do or do not support healing from traumatic exposure can have a substantial impact on individual responses, and therefore, prospects for peace.

When a refugee is resettled or a conflict ends, the trauma experienced during the war does not disappear. In fact, it can intensify. Individuals can be left feeling as if they are wrong or “crazy” to still feel anxious or depressed after escaping the immediate threat of conflict. They can be beset by feelings of loss or survivor guilt. They can feel more unsettled or unsafe in peace than in war.

Healing can take place in many ways. Telling one’s story and—importantly—being heard is one of the most accessible and most important modes of confronting trauma. Research has found that Narrative Exposure Therapy, which asks individuals to place past traumas within the larger narrative of their lives, allows such events to be integrated as part of a coherent life story. Non-clinical approaches have also adopted storytelling as a way to confront past traumas and reimagine future possibilities. #MeWe International Inc. works with young people affected by forced displacement, using storytelling to redefine a community’s narratives and to help youth envision themselves as change-makers.

“Storytelling is extremely important for self-awareness, for resilience building, and for forming prosocial relationships—that a person’s narratives are developed and a person exercises their right to form their own narratives, not just be a consequence to things, but to be a living, breathing choice,” said Mohsin Mohi-Ud-Din, Founder and CEO of #MeWe International Inc.

Yet, much of the existing research on the psychological after-effects of conflict comes from studies carried out in Western countries. Whether the findings from this body of research translates across cultures, and whether the known “gold-standard” PTSD treatments apply in all post-conflict societies is an open question. More research is needed to test the efficacy of locally established ways of addressing the legacies of violence and to train community leaders in facilitating treatments. There also needs to be more funding for this research. Only 0.4 percent of all development assistance for health worldwide is dedicated to mental health.

Whether violence is ongoing, as it is in Syria, or decades old, as it is in Bangladesh, deepening our understanding of how the psychological legacies of war affect healing among individuals and communities is key to knowing how to build lasting peace. With the new landscape of protracted conflicts and unstable peace, mental-health care is a first order need, and understanding the nuances in human responses to violence and trauma will amplify prospects for peace after more conflicts.

“Peace comes from people collaborating with others and creating something from nothing. That’s what makes humans human. That’s why we’ve survived—because we have that ability to create in a way that other creatures do not,” said Mohi-Ud-Din. “It’s where peace comes from, this concept of peace is an imagined reality, that for generations communities and peoples and cultures have been trying to build with their words and stories.”