As much as possible, we attempted to involve everyone in the day-to-day operation of the houses and the Center. For example, residents were expected to help prepare meals and work in the garden, as well as being responsible for the upkeep of their own room. In the later stages of the project, once we had acquired sewing machines and looms, the women were also given the opportunity to make clothes or carpets during their spare time. Finally, staff and residents would assemble every week for a general meeting, in which dis-putes would be resolved, proposals tabled and schedules drawn up.
By the end of 1994, the project employed a total of 30 staff members, drawn from all ethnic communities and encompassing a wide range of competencies. Moreover, personnel were divided into four separate teams: Technical/administrative support, Therapies, Medical care, and Education. General staff meetings were held once a month, while therapists met on a weekly basis. I served as project coordinator, meeting with team managers on a regular basis in order to address key issues and engage in strategic planning.
112
Assault on the Soul: Women in the Former Yugoslavia
Of course, in assessing the project's structure and objectives, it bears emphasis that our original plan, when we first set out for Bosnia in June 1993, was more narrow in scope than that upon which we subsequently agreed.
How so? In short, while we had intended to focus our efforts solely upon those women who had been raped or sexually assaulted, it quickly became obvious to us that women in Bosnia were being victimized in any number of ways, sexually, physically and psychologically. Although it was this awareness that prompted us to refer to our project as a psychotherapeutic center for traumatized women and children, we were also aware of the dangers inherent in such a name, most notably that of obscuring women's suffering on account of rape and other forms of sexual violence. In the face of this risk, we have made it a priority to bring the issue out into the open whenever possible, both with the women who were taking part in the project and the public more generally.
When we first began work in the Tuzla area, we did not have a clear sense of how many of the women who came to the Center or whom we visited in the camps had been raped. We did not ask, though in some cases they would broach the topic themselves; in others we would simply guess. However, as we became more and more familiar with local conditions, we were left in no doubt of the full extent of women's victimization. Quite simp!y, not only had almost all of the women living in the camps been forced to flee their homes, but most had also witnessed the torture and killing of family members.
Indeed, we know of several cases where individuals had lost 30 or more male relatives, including husbands, fathers, brother and sons. If this were not traumatic enough in itself, many women were subsequently raped and tortured by militia forces, as well as being subjected to psychological humiliation by government officials and others.
Given this context, it is not surprising that the women bore terrible scars, at both the physical and psychological level. Among those who came to the Center, their symptoms were usually quite similar, encompassing loss of self-esteem, depression, mood swings, somatic illnesses and flashbacks, to name but a few. While in some instances we also encountered individuals with a distorted perception of reality or suffering from dissociative identity disorder, in all cases the scope for destructive behavior was considerable: many were addicted to one or more pharmaceutical drugs, while outbursts of extreme anger toward their children or other residents were not uncommon.
Although we had hoped at the outset to focus much of our attention upon the recovery of women and children traumatized by war, we soon discovered that the need for crisis intervention was such that at least some of our energies would have to be reoriented in this direction. Not only were there relatively few relief agencies operating in the area, but the refugee population was Gabriele Kramer
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immense, consisting of roughly 300,000 individuals (predominantly women, children and elders) living both in camps and in the town itself.
THE REALITY
I spent my first three months in Tuzla engaged in a frenzy of activity: obtaining permits, hiring staff, arranging for telephone and electrical hook-ups, buying furniture and countless other tasks. It was also at this time that I became aware of the size of the challenge that lay before me. Not only were bribes routinely demanded of us by public officials anxious to enrich themselves at our expense, but we were initially faced with considerable hostility on the part of refugee camp administrators, who were either unwilling to let us into the camps in the first place or insisted that any woman who returned with us to the Center would immediately lose all of her rights as a refugee.
Needless to say, this placed us in a ditiicult position, which we only managed to resolve with the assistance of Tuzla's mayor.
In the end, the Center welcomed its first residents on June 15th, 1994. The initial complement consisted of 18 women and 40 children; all were from the region surrounding Srebenica and most had lost the majority of their male relatives. From the very first day of the Center's operation, the work was at once difficult and empowering. Most of the staff had other jobs, and thus would spend part of the day working elsewhere, and part of the day at the Center. However, for all those whom we hired, the hard currency they earned played a crucial role in helping them meet their families' basic needs.
In light of the working conditions, not to mention the anxiety which many staff members experienced when thinking about their children at home or family members in other parts of the country, it should come as no surprise that we were forced to contend with interpersonal cont1icts within the organization, either between myself and employees, or between employees and residents. As one might imagine, language differences were especially problematic in this regard; only three staff-members could communicate in English or German, and my own language training was proceeding at a frustrat-ingly slow pace. Thus, not only was it impossible at first to engage in casual conversation with employees (since a translator was necessary for interaction to occur), but the risk of misunderstanding was omnipresent. However, the situation improved substantially once we began to offer personnel foreign language training, and once I became more confident about my own language abilities.
As I have already suggested above, the relationship between residents and stati members also proved to be problematic. In large part, this was due to the fact that most of our employees were from cities or towns, whereas the overwhelming majority of refugees, including those taking part in the project, 114
Assault on the Soul: Women in the Former Yugoslavia
had lived in rural areas before being displaced by the war. On the one hand, this meant that there were significant cultural differences between the two groups, with city-based women generally having far more scope to travel, obtain an education or pursue a career than their rural-based counterparts. On the other, the Bosnian countryside suffered disproportionately from the wartime violence, causing many of the refugees to resent city dwellers for escap-ing relatively unharmed, with their homes intact and their family members alive.
Psychotherapy is a relatively new t1eld in Bosnia. Individuals who wish to specialize in this discipline must travel either to Zagreb or Belgrade for the necessary training. As such, I had absolutely no luck in t1nding psychotherapists living in the Tuzla area who would be willing to become involved in the Center's work. In order to overcome this difficulty, I located a number of psychologists, social workers and educators and told them that I would help train them providing that they were willing to learn, and would be supportive of the life contexts of those with whom they would be working.
The first therapy session took place shortly after the Center opened. Needless to say, everyone involved was anxious and insecure, ensuring that we had plenty to discuss during our initial staff meeting. However, despite the fact that I was taking part in these meetings every week, it took some time before I realized that many key issues related to the work and the patients were simply not being addressed in an adequate fashion. It took even longer before it dawned upon me that I was part of the problem. Quite simply, the therapists were struggling with a number of challenges, the risk of secondary traumatization not least among them, and they needed a safe place where they could work things through without constantly feeling the need to prove themselves (as they did when I was present).
However, even as I acknowledged the importance of providing the therapists with adequate support and positive reinforcement, I lost touch with my own needs and boundaries. That is to say, I was so absorbed in fult1lling my responsibilities to the project-as coordinator, fund-raiser, psychotherapist, referee and resident strong woman-that I ignored the warning signals my body was sending me. In the end, it took a series of setbacks, including a medical operation in Germany and an attack by six soldiers in my home in Tuzla, before I started asking why I was not taking better care of myself.
Although this awareness did not lead me to make an immediate change in my lifestyle or activities, I began to devote more and more time to writing in my journal, as well as making a number of weekend trips to the coast in order to visit with a friend from Germany who was working with another organization. Also helpful in this regard was the decision to restructure the work teams, with the art and physiotherapists transferred from Therapies to the Education and Medical Care teams respectively. In so doing, the therapists Gabriele Kramer
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were placed in a position where they could meet as a small group every week in a closed session, and discuss work-related problems, as well as other pertinent issues. Finally, it was also roughly at this time that I organized a
"self-experience" retreat for all staff members in a Tuzla area hotel. It proved to be a good experience for all of us. Not only did the change in venue make it easier for people to open up and be frank with one another and me, but the exercise helped to engender a new atmosphere of mutual respect and understanding.
Needless to say, it was largely this atmosphere that provided the basis for the project's success and growth over the first two years of its existence. Not only did the purchase of an ambulance substantially increase our capacity to serve the needs of refugee camp residents, but we started increasingly to plan and implement new initiatives, such as computer and language training for the women living at the Center and in the houses. However, at the very moment we were registering these successes, the political situation in the region was becoming inc,'Teasingly unstable, with the kidnapping of United Nations peace keepers, NATO air strikes against Bosnian Serb military targets, and, in July 1995, the capture of UN safe havens in Srebenica and Zepa by the Bosnian Serb militia. In all, 40,000 people were forced to ±1ee, of which a significant proportion ended up in the Tuzla area.
As the new refugees arrived, we began to make arrangements to accommodate additional residents at the Center. However, we were immediately struck by the fact that these women had substantially different psychological profiles than those who had ±1ed to Tuzla previously. Although many had emerged from their ordeals severely traumatized, having been subjected to rape and other forms of physical and psychological torture, the memories were so fresh in their minds that they had not had time to repress them. Given this finding, we launched into counseling as quickly as possible, and found that, for a significant number of women, a series of regular meetings for debriefing proved quite helpful, obviating the need for long-term therapy.
However, as horrible as the attacks upon Zepa and Srebenica undoubtedly were, the real turning point in the conflict was not until December 1995, when the Dayton peace agreement was ratified by the warring parties. Although the refugees and residents of Tuzla were happy that peace was at hand, the vast majority were exceedingly disappointed by the terms of the Dayton accord, most notably its willingness to recognize Serb sovereignty over the Srebenica region. In effect, this meant that the bulk of Tuzla's refugee population would never be able to return home again.
While the Center's social worker continued to devote much of her energies to the task of locating missing family members on behalf of residents, others'
husbands began slowly to trickle into the Tuzla area, many having not seen their wives for well over two years. Not surprisingly, this was often the 116
Assault on the Soul: Women in the Former Yugoslavia
source of considerable tension, since both wives and husbands had undergone significant traumatic experiences, and many women were loathe to give up the relative autonomy and independence they had enjoyed during the war years. In this way, spousal abuse rapidly became a serious problem within refugee families, as men sought to compensate for their low self-esteem by assaulting, raping and sometimes even killing their marital partners.
In the midst of these developments, we continued to carry out the mandate of the Center to the best of our abilities. Moreover, we were particularly gratified to learn that a German organization had agreed to provide specialized training to our therapists during the first half of 1996, as well as offering body therapy to Center residents. Finally, it was also at this time that we started to prepare for my own departure from Tuzla in February 1996. Having originally planned to stay for one year, which was subsequently extended to two, the time had come to step out of the way so that project staff could take charge themselves. However, we agreed that I would continue to serve in an advisory capacity from Germany, and would endeavor to ensure continued funding for the project until such time that it became wholly self-suft1cient.
THERAPY
When I first arrived in Tuzla, I was simply too busy with project logistics to spend much time thinking about the implications of undertaking therapy in an unstable environment in which traumatization was ongoing. Moreover, even when I did become sensitive to this issue, there seemed to be little that could be done. I was immersed in a cultural context with which I had little familiarity; my colleagues were for the most part inexperienced and not confident; and there was essentially no scope for bringing in outside experts so long as the town was under a state of siege. Thus, we had no choice but to attempt to find our own way of working with clients and overcoming the challenges inherent in the environment in which we found ourselves.
As one might imagine, these difficulties were themselves exacerbated by problems in adapting therapeutic approaches to the life contexts of clients.
That is to say, whereas the therapies had been designed for work with individuals who were well-educated and lived in a Western industrialized country, the women involved in the project had little formal education and emerged from a cultural background that was at once highly traditional and patriarchal in its orientation. Sensitive to these differences, the challenge we faced was one of making contact with the women while at the same time resisting the urge to force our theories, structures and techniques upon them.
Given my own background as a German woman who had no previous work experience in the Former Yugoslavia, I found this to be particularly dift1cult. In short, not only was I forced to modify many of my expectations Gabriele Kramer
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and assumptions, but it also became clear to me that I would have to have the courage to leave the "normal" structure of therapy if I was to reach the women with whom I was working. This latter point was brought home to me in particularly stark terms in August 1994, when the husband of one of the residents returned to Tuzla, having managed to escape from a Serb-run concentration camp. His description of the atrocities committed there left all of the other women in a deep state of depression (as many had relatives who were being held in the same camp), and there seemed to be no way of making contact with them. At wit's end, I decided spontaneously that I would organize a special evening of music and dancing, having noticed previously how much the women appeared to enjoy singing and listening to the old traditional songs. The evening proved to be a remarkable success, with everyone-even those who had until that point been entirely non-communicative and apathetic-taking part in the festivities. For me, the night also brought understanding, highlighting as it did the extent to which something as seemingly mundane as music could bring the women back to their roots, and give them the sense of being on common ground.
After this evening I began to notice myself interacting with the residents in a ditierent way, as I placed more and more emphasis upon uncovering their feelings, relationships, and ways of understanding the world around them.
For example, in the sessions I held with women living in one of the Center's houses, I suggested that we rearrange the meeting room, replacing the tables and chairs with pillows on the floor in traditional Bosnian fashion. Having done so, everyone felt more at ease, and increasingly willing to talk about their lives prior to the war, whether their childhood, their family, or their first contact with men. Like the music and dancing, storytelling offered the women a means of regaining a lost sense of identity and stability.
Still, this is not to suggest that the latter was the only therapeutic technique used in the sessions. On the one hand, we engaged in a number of exercises involving imagination and dreams, though I was always careful to avoid references to images (such as forests) that might bring back unpleasant memories of the war. To the extent that I was successful in doing so, participants found the exercises to be quite helpful, particularly those involving the sea-side and inner helpers (e.g., wise women). On the other hand, I also made ample use of drawing and painting as a way of helping the women to come to terms with their pain and shame, feelings that had led many of them to abuse or mistreat their children. Needless to say, this latter behavior was especially disturbing in light of the fact that the children were often severely traumatized themselves, forcing us to devote considerable energy to the task of working through this issue with both parties.
However, regardless of the therapy used, it quickly became apparent to us that the degree of traumatization, among both women and children, was 118 Assault on the Soul: Women in"the Former Yugoslavia immense by any standard. Indeed, many could only make sense of their suffering by placing it within the context of a plot designed specifically to punish them, at a personal level, for misdeeds which they had committed in the past. In other words, they were incapable of grounding their trauma in the wider political and social structures of which they were part Thus, our aim in working with the women was to help them overcome their sense of helplessness and guilt. However, as strenuously as we tried to empower and reenergize them, we were often unsuccessfuL In these cases, we simply attempted to provide the women with a set of structures around which they could organize their lives, and support them step-by-step in their journey towards independence and autonomy.
Of course, an important element in this regard was the fact that we were there to bear witness for them, and to affirm them in naming those who were responsible for their suffering. This was neither the time nor the place for neutrality; the crimes were too horrible, and the women were simply too much in need of someone who would be there for them and believe in the stories they told. However, this is not to suggest that the therapists were unaware of the dangers of transference and counter-transference, leading them to pay particular attention to boundary issues in the sessions they held with the women. While it was vital that staff members protect themselves from the effects of secondary traumatization and burnout, it was also important that they assist the clients in recovering a sense of control over their everyday lives, for example, by showing them how to manage traumatic memories in a constructive fashion.
Reference has already been made to the problems inherent in attempting to provide therapy in a context where one's clients are being re-traumatized on a daily basis. Almost all of the women taking part in the project had been forced to flee their homes, taking only what they could carry with them, and most had missing family members as well. Needless to say, this made it very difficult for them to acquire a sense of closure, and all the more so because their lives continued to be circumscribed by the violence around them. Obviously, this presented us with a serious challenge, made that much worse by the fact that many of the women were not willing to accept closure in any case, since this would entail admitting to themselves that there was no hope of returning to their old homes or old ways of life.
Indeed, from this perspective it must be acknowledged that much of our work in Tuzla was focused upon crisis intervention and supporting women as they struggled to regain their will to live. As such, we encountered many individuals who were suffering from symptoms akin to dissociation or psy-chosis, as well as many others who had adopted highly destructive coping mechanisms. For example, it was not uncommon for survivors to engage in a form of projective identification with the perpetrators, seeing them as essen-Gabriele Kramer
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tially good people who were merely punishing them for evil acts they themselves had committed. To cite one particularly disturbing case, a woman who was suffering from profound guilt and shame from a previous rape experience was attacked once again by the same group of men. However, on this occasion she had her period, and they told her that she was so dirty and worthless that they would not even bother to rape her. Afterwards, she was so traumatized that it almost came as a relief when she started to articulate her hate and rage by means of self-injury. Although her anger was directed towards the inner enemy rather than the outer and real one, it provided an opening through which she could vent her pain and, in so doing, avoid going insane.
CONCLUSION
As I have endeavored to make clear in the discussion above, the overwhelming majority of female refugees whom we met during the course of our work in the Tuzla area had been subjected to extreme victimization at the hands of militia forces and others. Moreover, as a therapist myself, I could see how their suffering, along with the stress of living in a war zone more generally, was having an effect upon my own well-being. Although I tended not to experience any ill-effects while I was in Bosnia, as soon as I returned to Germany for a holiday I would immediately become physically ill, all the while suffering from nightmares, insomnia and a deep malaise. Needless to say, these symptoms were warning signs from my body, informing me of the dangers of working in an environment where relaxation was at a premium and constant vigilance a necessity.
In the event, I left Tuzla in February 1996. Upon my return to Germany, I devoted several months to the task of finding new sources of financial support for the project, since the organization with which we were originally involved was in the process of winding down its commitment to the Center.
Although it was clear by July that sufficient funding would be available to ensure that the project could continue to operate for at least another year, I remained actively involved in the Center's work until early 1997. At this time, I decided that it would be in everyone's best interest if I stepped back and let others take my place.
However, this is not to say that I have become disengaged from the vision that drove me to Bosnia in the first place. I continue to work with refugees, many of whom are from the Former Yugoslavia, and many of whom bear scars remarkably similar to those which I encountered so often in Tuzla. I also continue to get angry, angry at the individuals who inflicted such suffering upon my clients, angry at the ritual of humiliation which asylum seekers must endure before they are allowed to stay in this country, angry at the War 120
Assault on the Soul: Women in the Former Yugoslavia
KEYWORDS. Woman-centered training, trauma counseHng, training witnesses and their families. It was precisely this same anger that drove me, along with two other women, to take action in 1993 in the face of the unimaginable atrocities being committed in the name of ethnic nationalism in the Former Yugoslavia. That had not changed.
War, Life Crisis and Trauma: Assessing the
Impact of a Woman-Centered Training
Program in Bosnia
Sabine Scheffler
Agnes Miichele
SUMMARY. This article presents a woman-centered approach to healing that is necessitated by trauma inflicted by armed conflict. The authors present a historical context within which they depict many of the daily consequences that citizens experienced. A training program was developed during a trip to Bosnia in which sixteen women, among whom were social workers, psychologists, physicians, teachers and one Islamic theologian, participated. This program was comprised of five training modules: introduction to basic concepts and issues, the social psychology of war, the counseling process and techniques, social work in a wartime environment, and termination. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com]
Sabine Scheffler, PhD, is Professor of Social Psychology, College for Applied Sciences and Co-Director of the Zentrum fUr Angewandte Psychologic und Frauenforschung (Center of Applied Psychology and Women's Research) in Cologne, Germany. Agnes Miichele, PhD, is Co-Director of the Zentrums fiir Angewandte Psychologic und Frauenforschung (Center of Applied Psychology and Women's Research) in Cologne, Germany.
Address correspondence to: Dr. Sabine Scheffler, Zentrum fiir Angewandte Psychologic und Frauenforschung (Center of Applied Psychology and