Inge Missmahl brings peace to the minds of Afghanistan

翻译人员: Zhang Jing 校对人员: Chaoran Yu

So I want to tell you a story -- an encouraging story --

我想给大家讲个故事，很鼓舞人心，

about addressing

是有关解决

desperation, depression and despair in Afghanistan,

阿富汗的绝望和抑郁的故事，

and what we have learned from it,

以及我们从可学到

and how to help people

如何帮助人们

to overcome traumatic experiences

克服创伤经历留下阴影的办法，

and how to help them to regain some confidence

及如何帮助他们找回自信

in the time ahead -- in the future --

和对未来的自信

and how to participate again in everyday life.

以及如何重新参与到日常生活中。

So, I am a Jungian psychoanalyst,

我的职业是心理分析师，

and I went to Afghanistan in January 2004, by chance,

由于偶然的机会，我在2004年7月去了趟阿富汗，

on an assignment for Medica Mondiale.

去做一项医学调查。

Jung in Afghanistan --

这就是荣格在阿富汗—

you get the picture.

你们看到了这张照片。

Afghanistan is one of the poorest countries in the world,

阿富汗是世界上最贫穷的国家之一，

and 70 percent of the people are illiterate.

百分之七十的人民都是文盲。

War and malnutrition kills people

战争和营养不良不仅扼杀了他们的生命，

together with hope.

还扼杀了希望。

You may know this from the media,

你可能从各种媒体中知道了这点。

but what you may not know

但是你可能不知道的是

is that the average age of the Afghan people is 17 years old,

阿富汗人的平均寿命是17岁，

which means they grow up in such an environment

这意味着

and -- I repeat myself --

我再重复一遍

in 30 years of war.

他们从小生长在长达30年的战争中。

So this translates

他们的生活环境是

into ongoing violence,

持续的战争，

foreign interests, bribery,

外国利益集团的觊觎、商业贿赂、

drugs, ethnic conflicts,

毒品、宗教冲突、

bad health, shame, fear

糟糕的健康状况、羞愧、恐惧

and cumulative traumatic experiences.

以及持续的创伤经历。

Local and foreign military

当地和外国部队

are supposed to build peace together with the donors

的任务仅仅是与捐款人、

and the governmental and non-governmental organizations.

政府和非政府组织一起建立起和平的秩序。

And people had hope, yes,

人民有一些希望，

but until they realized

但是当他们认识到

their situation worsens every day --

他们的处境每日都在恶化—

either because they are being killed

或许是被射杀

or because, somehow,

或许，

they are poorer than eight years ago.

变得比8年前更加贫穷。

One figure for that:

有一个数字能够说明这种情况：

54 percent of the children under the age of five years

五岁以下的儿童中有百分之五十四的人都饱受

suffer from malnutrition.

营养不良症的折磨。

Yet, there is hope.

然而，他们仍然是有一丝希望的。

One day a man told me,

一天，一个阿富汗人告诉我，

"My future does not look brilliant,

“我的前途并不光明，

but I want to have a brilliant future for my son."

但是我希望我的儿子能有灿烂的前程。”

This is a picture I took in 2005,

这是我在2005年拍的一张照片，

walking on Fridays over the hills in Kabul,

那天是周五，我在喀布尔山上散步时拍下了它。

and for me it's a symbolic picture

对我来说，这是一张有象征意义的照片

of an open future for a young generation.

象征着年轻一代的远大前程。

So, doctors prescribe medication.

作为医生，是要开药方的。

And donors

捐赠人的责任就是

are supposed to bring peace

实现和平，

by building schools and roads.

重建道路和学校。

Military collect weapons,

军队没收了武器，

and depression stays intact.

但是绝望仍然在那里，

Why?

为什么会这样呢？

Because people don't have tools

因为人们没有掌握解决、

to cope with it, to get over it.

克服绝望的手段。

So, soon after my arrival,

所以，我一到那里，

I had confirmed something which I had already known;

就证实了一些我之前了解到的信息，

that my instruments come from the heart of modern Europe, yes.

虽然我使用的治疗手段来自先进的欧洲，

However, what can wound us

但是，我们可以设想，那些伤害我的，

and our reaction to those wounds --

以及我们对创伤的反应—

they are universal.

对所有人都是一样的。

And the big challenge

最大的挑战是

was how to understand the meaning of the symptom

如何去理解症状在这种特殊文化中的

in this specific cultural context.

特殊意义。

After a counseling session, a woman said to me,

在一次咨询中，一位女士对我说，

"Because you have felt me, I can feel myself again,

“因为你说出了我的感受，我也重新找回了自己，

and I want to participate again

我愿意重新参与到

in my family life."

家庭生活中。”

This was very important,

这非常重要，

because the family is central

因为家庭

in Afghans' social system.

是阿富汗社会的核心。

No one can survive alone.

任何人都无法脱离他人生存。

And if people feel used, worthless and ashamed,

如果人们感觉自己被利用了，没有价值，感到很羞愧，

because something horrible has happened to them,

那是因为很多可怕的事情发生在他们身上，

then they retreat, and they fall into social isolation,

之后他们就会退缩，变得孤立于社会之外，

and they do not dare to tell this evil

并且他们不敢把他们这种罪恶的感受

to other people or to their loved ones,

告诉他们所爱的人或者其他人，

because they do not want to burden them.

他们不想连累这些人。

And very often violence is a way to cope with it.

通常人们用暴力来解决这些困扰。

Traumatized people also easily lose control --

精神上受创伤的人容易失去控制——

symptoms are hyper-arousal and memory flashbacks --

其症状就是易激惹和不断回想过去——

so people are in a constant fear

所以这些人生活在持续的恐惧中

that those horrible feelings of that traumatic event

发生创伤事件时恐怖的体验

might come back unexpectedly,

会没有预兆地，

suddenly,

突然地再现，

and they cannot control it.

没有办法控制。

To compensate this loss of inner control,

为了弥补这种内在的失控感，

they try to control the outside,

他们就会试图控制外界事物，

very understandably -- mostly the family --

这很容易理解，他们通常控制的就是家庭—

and unfortunately,

不幸的是，

this fits very well

在他们的控制之下，

into the traditional side,

整个文化变得更加传统，

regressive side, repressive side,

更加落后和压抑，

restrictive side of the cultural context.

有了更多的约束。

So, husbands start beating wives,

丈夫开始打妻子，

mothers and fathers beat their children,

爸爸妈妈打孩子，

and afterward, they feel awful.

打过之后，他们又感觉很糟糕。

They did not want to do this, it just happened --

他们并不希望这样做，但是事情就那么发生了。

they lost control.

一句话，他们失去了控制。

The desperate try

我们竭尽全力在做的

to restore order and normality,

修补和复原工作，

and if we are not able to cut this circle of violence,

如果无法打破这个暴力循环，

it will be transferred to the next generation without a doubt.

这种暴力毫无疑问会传给下一代。

And partly this is already happening.

事实上，事情已经在这么发生了。

So everybody needs a sense for the future,

所以每一个人都要心系未来。

and the Afghan sense of the future

阿富汗人未来的观念

is shattered.

是非常弱的。

But let me repeat the words of the woman.

但是让我重复一遍那位女士的话。

"Because you have felt me,

“因为你说出了我的感受，

I can feel myself again."

我重新找回了自己。”

So the key here is empathy.

所以关键是共享情绪。

Somebody has to be a witness

需要有人目睹

to what has happened to you.

你所经历的。

Somebody has to feel how you felt.

需要有人体会你的感受。

And somebody has to see you and listen to you.

需要有人关注你，倾听你。

Everybody must be able

每个人都必须知道，

to know what he or she has experienced is true,

发生在他们身上的事情已经发生了。

and this only goes with another person.

在别人身上也有可能发生。

So everybody must be able to say,

每个人都要能够说，

"This happened to me, and it did this with me,

“这件事确实发生了，它对我造成了影响，

but I'm able to live with it, to cope with it,

但是我可以和它和平共处，我能够处理好它，

and to learn from it.

并且从中学习，

And I want to engage myself

我想为我的孩子

in the bright future for my children

打造一个光明的前程

and the children of my children,

以及我孩子的孩子，

and I will not marry-off my 13 year-old daughter," --

我不会把13的女儿嫁出去。”

what happens too often in Afghanistan.

—这种事情在阿富汗经常发生。

So something can be done,

所以我们能够做一些事情，

even in such extreme environments as Afghanistan.

即使在阿富汗这样极端的环境中也是可以做的。

And I started thinking about a counseling program.

我开始设想开展一个咨询项目。

But, of course, I needed help and funds.

当然我需要助手和资金。

And one evening,

一天晚上，

I was sitting next to a very nice gentleman in Kabul,

在喀布尔，当我坐在一位善良的绅士旁边时，

and he asked what I thought would be good in Afghanistan.

他问我，你认为什么对阿富汗最有帮助。

And I explained to him quickly,

我飞快地向他讲，

I would train psycho-social counselors,

我想培训心理社会咨询师，

I would open centers, and I explained to him why.

我想开办培训中心，然后我向他解释了为什么产生这种想法。

This man gave me his contact details at the end of the evening

就在那个晚上那位先生给了我他的联系方式

and said, "If you want to do this, call me."

并且说，“如果你决定开始做，请打我的电话。”

At that time, it was the head of Caritas Germany.

当时，他是慈善德国（Caritas Germany）的负责人。

So, I was able to launch a three-year project with Caritas Germany,

所以我得以与慈善德国携手启动了为期三年的项目，

and we trained 30 Afghan women and men,

我们训练了30个阿富汗人，

and we opened 15 counseling centers in Kabul.

在喀布尔开设了15个咨询中心。

This was our sign -- it's hand-painted,

这是我们的宣传标牌，是手绘的。

and we had 45 all over Kabul.

我们在喀布尔有45个这样的标牌。

Eleven thousand people came -- more than that.

一万一千人来到这些咨询中心，或许更多。

And 70 percent regained their lives.

其中百分之七十的人重新找到了生活重心。

This was a very exciting time,

这是个激动人心的经历，

developing this with my wonderful Afghan team.

与我的阿富汗团队一起完成。

And they are working with me up to today.

至今我们仍然在一起工作。

We developed a culturally-sensitive

我们找到了符合当地文化的、

psycho-social counseling approach.

心理社会咨询方法。

So, from 2008 up until today,

所以，从2008年上半年至今，

a substantial change and step forward

我们取得了

has been taking place.

实质性的进步。

The European Union delegation in Kabul

喀布尔的欧盟代表团

came into this and hired me to work

来到这里邀请我去工作

inside the Ministry of Public Health,

到公共健康部门

to lobby this approach --

推广这种方法。

we succeeded.

我们成功了。

We revised the mental health component

我们重新阐释了

of the primary health care services

主要的健康关怀服务中的心理健康部分

by adding psycho-social care

在系统中加入了心理社会关怀

and psycho-social counselors to the system.

以及心理社会咨询。

This means, certainly, to retrain all health staff.

这就意味着有必要重新教育那些健康关怀服务人员。

But for that, we already have the training manuals,

我们已经有了培训手册，

which are approved by the Ministry

通过了部里的审核，

and moreover, this approach is now part

此外，这种方法

of the mental health strategy in Afghanistan.

成为了阿富汗心理健康战略的一部分。

So we also have implemented it already

因此我们已经在

in some selected clinics in three provinces,

三个省中挑选出来的诊所中试用了这种方法，

and you are the first to see the results.

这是试验的结果，第一次对外公布。

We wanted to know if what is being done is effective.

我们希望了解到所做的是否有效。

And here you can see

从图表中我们可以看出，

the patients all had symptoms of depression,

所有的病人都有抑郁的症状，

moderate and severe.

或轻或重。

And the red line is the treatment as usual --

红线表示采用惯常的治疗手段——

medication with a medical doctor.

也就是药剂师开药。

And all the symptoms

所有的症状都没有改善、

stayed the same or even got worse.

甚至加重了。

And the green line is treatment with psycho-social counseling only,

绿线表示仅仅采用了心理社会咨询的治疗方法，

without medication.

而没有吃药的效果。

And you can see the symptoms almost completely go away,

你可以从图上看到，症状基本消失了，

and the psycho-social stress has dropped significantly,

心理社会压力迅速地下降，

which is explicable,

这个结果也是可以解释的，

because you cannot take away the psycho-social stresses,

因为你不能消除所有的心理社会压力，

but you can learn how to cope with them.

但是人们能够学会如何减轻这种压力。

So this makes us very happy,

我们看到这个结果非常开心，

because now we also have some evidence

因为我们有了证据来证明

that this is working.

我们的方法是有效的。

So here you see,

如图所示，

this is a health facility in Northern Afghanistan,

这是阿富汗北部的一处健康服务中心，

and every morning it looks like this all over.

每天早上的情境都有点类似这样，

And doctors usually have three to six minutes for the patients,

但是医生一般只有三至六分钟来诊断一个病人。

but now this will change.

现在这种情况将得到改善。

They go to the clinics,

病人会去到诊所里，

because they want to cure their immediate symptoms,

因为他们想治愈那些短期的症状，

and they will find somebody to talk to

在那里他们会发现有人可以交流

and discuss these issues

讨论他们的病情

and talk about what is burdening them

讨论让他们感到压迫的因素是什么

and find solutions, develop their resources,

然后寻找治疗的办法，发掘他们自身潜藏的资源，

learn tools to solve their family conflicts

学习解决家庭冲突的办法

and gain some confidence in the future.

建立对未来生活的信心。

And I would like to share one short vignette.

我想与大家分享一个小故事。

One Hazara said to his Pashtun counselor,

一个哈拉扎人对他的普什图咨询师说，

"If we were to have met some years ago,

“如果我们很多年前相遇，

then we would have killed each other.

我们会杀死彼此。

And now you are helping me

现在你却来帮助我

to regain some confidence in the future."

让我对未来树立信心。”

And another counselor said to me after the training,

一个咨询师在培训结束后对我说，

"You know, I never knew why I survived the killings in my village,

“我一直不知道为什么村里的人都被杀死了，唯有我活了下来。

but now I know,

现在我知道了，

because I am part of a nucleus

因为我是

of a new peaceful society in Afghanistan."

阿富汗新和平社会的一份子。”

So I believe this kept me running.

我相信正是这些话语激励着我不断前进。

And this is a really emancipatory and political contribution

这的确是一种解放和政治运动

to peace and reconciliation.

其目的是实现和平和解。

And also -- I think --

我认为，

without psycho-social therapy,

如果没有心理社会疗法，

and without considering this

如果在人道主义活动中不考虑

in all humanitarian projects,

心理、社会的因素

we cannot build-up civil societies.

文明社会就无法建立起来。

I thought it was an idea worth spreading,

我认为这个观念值得传播，

and I think it must be,

也必须得以传播，

can be, could be replicated elsewhere.

能够在其他地方重复使用。

I thank you for your attention.

谢谢你们。

(Applause)

（掌声）