The Storytelling Movement: A Trauma Recovery Intervention for War Affected Communities

 

One of the biggest challenges in developing trauma recovery interventions, both within post-conflict communities and those that continue to experience gross violations of human rights, is often they are resource poor settings. They have few, if any, mental health professionals, yet the number of individuals in need of psychological intervention comprises the majority of the community. In addition, it is rare for clinical psychologists to either be funded or able to remain within these communities voluntarily for a significant period of time that would allow them to provide evidence-based psychological treatments. Therefore, the disparity between those in need of psychological intervention and those with the skill set to intervene is substantial. The storytelling movement was pioneered to respond to this disparity by teaching communities to tell their stories. Pioneered and implemented in the Democratic Republic of Congo, the storytelling movement was seen to break the silence that can maintain and increases psychological distress.

 

What is the Storytelling Movement?

In its purest form, the storytelling movement is not necessarily a novel approach to treating the psychological wounds caused by traumatic events.  Theories of Posttraumatic Stress Disorder (PTSD) have well established that talking about the traumatic event(s) in detail results in significant reductions of PTSD symptoms. Successful interventions already utilise narration of the traumatic event(s) to good effect, for example Trauma Focused Cognitive Behavioural Therapy (Ehlers & Clark, 2000) and Narrative Exposure Therapy (Hensel-Dittmann, et al., 2011). Therefore, the storytelling movement does not claim to be a unique intervention, but rather represents how already existing treatment approaches are incorporated and adapted to respond to the challenge of providing psychological care to traumatised communities when limited resources and expert knowledge are available.

Why is it that so often communities remain silent? and what would happen if individuals or whole communities started telling their stories of war, torture and violence? This is what the storytelling movement represents. It aims to break the silence so often observed within grossly traumatised communities and support survivors to tell their story to bring freedom from traumatic experiences.

 

Why Storytelling?

The storytelling movement looked at research into the nature of trauma memories and evidence-based psychological treatments for PTSD to conceptualise how to tell stories in a way that starts the process of healing and coping with trauma, as well as building resilience to future traumatic events.

It is suggested that pathological responses to traumatic events occur when trauma memories have not been stored in the same way ordinary memories have (Brewin & Holmes, 2003). Unlike ordinary memories, trauma memories lack verbal coding in the brain and instead exist as a series of sensory representations (Brewin, 2001).

This is problematic because when the memory of a traumatic event is triggered, the individual experiences fragments of the event through vivid and intense sensory stimuli experienced at the time of the event. There is also a distortion in the sense of time, such that these sensory stimuli are experienced as happening in the present, rather than belonging to the past. Survivors often describe this re-experiencing as time travelling back to the event and reliving the horror of what happened without realising it is a memory. In the absence of verbal coding, communicating to others what happened can be difficult (Brewin, 2001).  

Therefore, an integral component of treating PTSD is supporting individuals to construct a coherent, detailed narrative of the traumatic event, in particular verbalising sensory representations. Research has well established that this process transforms pathological trauma memories into ordinary memory structures, directly reducing the frequency and severity of reliving symptoms (Bisson, et al., 2007). It also exposes individuals to the emotional impact of the traumatic event, cultivating a process of emotional habituation (Brewin, Dalgleish & Joseph, 1996)

 

The Process of Storytelling

The storytelling movement aims to teach communities to tell stories about their traumatic experiences in a coherent manner (i.e. with a clear beginning, middle and end) with rich descriptions about what they could see, hear, smell, touch, taste, what their body felt like, and what they were thinking and feeling at the time.  

This process happens at different levels within communities. The storytelling movement prioritises empowering communities to take responsibility for their own storytelling movement. This is achieved by providing workshops in the community on common psychological reactions to traumatic events and highlighting how storytelling can start a healing process. Space is then provided for the community to practice telling stories and the workshop ends with a collaborative discussion about how storytelling could organically be used in different settings within the community, for example: within families, places of worship and village meetings. 

At the next level the storytelling movement aims to provide further training to ‘barefoot psychologists’; either members of the local community and/or international staff/volunteers who are interested in using the storytelling movement in more structured settings.

 

Case Illustration

Democratic Republic of Congo

Since 1996, the Democratic Republic of Congo (DRC) has been the center of a complex array of intricate conflicts involving local, national, and international factions. These conflicts have claimed more than five million lives (IRC, 2008). Whole communities were targeted for massacre, mutilation, sexual violence, torture, child soldiering, house-to-house raids and the burning down of entire villages, leaving thousands displaced. Although the conflict has officially ended, much of the country remains desperately poor and the rebel-led violence continues to be widespread.

 

Justice Rising in the DRC

Justice Rising is a non-profit organisation partnering and living within conflict-affected communities. The vision is to build mutual relationships with nationals, empowering these individual’s with the resources and skills they need to carry self-sustaining projects. I was asked to partner with Justice Rising in late 2013 to think about what projects could be developed to respond to whole communities affected by years of relentless violence in the DRC. 

The idea of a storytelling movement was developed to respond to the challenge that my time living in the communities was limited (5 weeks), the majority of individuals lacked basic education, and there would be limited opportunities to provide frequent and on-going supervision and support for any projects implemented.

 

A Storytelling Movement

I worked with a community in North Kivu, DRC that has experienced relentless violations of human rights and repeatedly experience village raids and massacres. Poverty is rife and access to healthcare is limited. The storytelling movement was introduced via workshops in the following format:

1)  Education on what traumatic events are and common psychological reactions to these events,

2) Education on why storytelling can start a process of healing from, and coping with, the psychological impact of traumatic events,

3)  Training on how to tell stories in a helpful way and,

4)  Space to practice storytelling.

The culture in the DRC is such that the village elders, chiefs and pastors must be addressed first. Therefore, the first workshop comprised these individuals, in the hope that they would champion the storytelling movement.  At the end of this workshop, the feedback seemed generally positive, however, when I returned to the village a week later, this had changed.  I was told that in the DRC talking about what happened during the war is completely counter-cultural and believed to perpetuate violence by evoking feelings of anger and revenge and prolong [psychological] suffering. Therefore, the overall feedback was that they were not interested in starting a storytelling movement.

In the same village, Justice Rising has pioneered a Leadership League: a soccer team comprised of 40 boys and young men, who choose to play soccer and receive discipleship, rather than join rebel armies. I delivered the same workshop to them. The Leadership League offered further explanations about why the community do not talk about traumatic events explaining that everyone has experienced and witnessed the same events, thus it was unnecessary to talk about it. They also explained that even if they wanted to talk, there was no one in their community “free from pain” whom they could “burden” with their own suffering, and it didn’t make sense to talk about events they are trying to forget.

Despite these beliefs, one member of the Leadership League decided to share his story. He communicated to the group his urge to talk about what he had experienced, yet he never knew who would listen. He described the day his family ran for their lives during a village raid and how he witnessed a bullet go through his sister’s back and out through her chest, before she fell to the ground and died. He was too scared to stop and retrieve her body in fear of being killed. He said he had never shared this story in fear of upsetting others or his peers laughing (a common coping response in the Congolese culture). At the end of his story, one of his peers spoke out and said, “I am sorry that happened to you”. Three others shared a story that day.

The feedback from the Leadership League was more encouraging, for example: “When I talk, I feel sad, but I also feel stronger”, “When we hear other people’s stories, it gives us the opportunity to say sorry to them for what happened”, and “If we share our stories we can be free of pain and from the past”. 

The workshop with the Leadership League encouraged me to run a longer workshop with the village elders, chiefs and pastors, but this time I invited older members of the Leadership League. Reflecting on feedback from the previous workshops, more time was dedicated to explaining how storytelling can start a process of recovery from traumatic events. In addition, a space was given to the Leadership League attendees to share their experiences of storytelling, giving others the opportunity to make comments and ask them questions. This was a significant process that developed into a debate between the group about what is helpful and unhelpful about storytelling. As an observer it was clear that a member(s) of the community advocating for a storytelling movement because of their own positive experience had more influence than an outside ‘expert’.   As the debate came to an end, the group split into twos and shared stories. Looking around the room, I was struck by the observable eagerness to be heard and understood and also the ability of the other to convey empathy as they listened.

To summarise the effect that this workshop had on this particular group of people, I am reminded of two comments: one from a pastor who said: “The first stone has been laid. We must build upon it. This is a medicine that costs no money. We must start talking”, and the second from a village elder “There is a group of people here who want to talk. What shall we do?

As a group we discussed how the storytelling movement could continue. We recognised that their family and friends had yet to learn about storytelling, so it would be helpful to share what they had learnt and then practice sharing with each other. It was encouraging to hear their dreams for groups to emerge where people could regularly get together to talk and support one another. 

This was nearly six months ago and the storytelling movement is growing. The staff on the ground have been overwhelmed by the feedback. The village elders, chiefs and pastors have been sharing the storytelling movement with their families. Their testimonies demonstrate how the storytelling movement is bringing families closer together: “As I have been talking to my wife, I am discovering things she has experienced that I did not know of before” and “My daughter has been telling me the hurts she has experienced because of her husband”. These leaders are taking responsibility for their own storytelling movement and are discussing how to set up listening rooms for the whole community. Some members of the Leadership League meet weekly to share their stories and have asked for further training so they can support the rest of the league.  Justice Rising is observing that in this community the silence is breaking. Families, friends and neighbours are engaging in difficult conversations, providing opportunities for individuals to have their experiences validated and to be supported. The village chief has highlighted the empowering nature of the storytelling movement as he reflected: “We don’t need to wait for outsiders to come, we can start healing ourselves.” 

Taking lead from the community, the next step for the storytelling movement, in this community is to support them to think about what groups they would like to develop, what a listening room might look like an who would be best to facilitate and sustain these projects. Then further training on using storytelling in a more structured setting would be offered.

 

Concluding Remarks

The storytelling movement was pioneered in response to the challenge of providing psychological intervention when whole communities are traumatised and mental health resources are either low or non-existent. Drawing on previous research and successful psychological interventions for PTSD, the storytelling movements is a tool that can start a process of healing from, and coping with, traumatic events, yet requires relatively low involvement from mental health professionals. As demonstrated in the DRC, following the storytelling movement workshops, the movement itself is self-sustainable, if the community choose to use it. This is because telling stories is not a complex process, but rather utilises natural forms of human behaviour and communication that are known to organically contribute to the process of recovering from traumatic events.   

While no formal research has yet to determine if the storytelling movement reduces the severity or occurrence of PTSD, verbal reports indicate that it can help communities break the silence that so often maintains and increases psychological distress, providing substantial relief to individuals. It also seems to enrich social bonds and bolster social support, which is known to buffer against the psychological impact of trauma (Brewin, et al., 2000). Therefore, it has been observed as an effective method to respond to the mental health needs of traumatised communities when more traditional approaches, that rely on one-to-one interventions, between professional and survivor, are unavailable.

 

Personal Reflections

The more I sit with survivors of repetitive and on-going war-related trauma, my expectations, or rather, understanding of what ‘recovery’ is within this context is vastly changing. It is not that I should cease striving to see whole communities free from PTSD, but the reality of what I can do with the resources I have hits me. Therefore, what I value about the storytelling movement is that it is not just a tool that focuses exclusively on recovery from post-traumatic symptoms, but I think it symbolises to the survivor that ‘your story is important’, which I hope restores their human dignity which is so often robbed within war-related trauma. My hope is that through storytelling, survivors can find meaning in their suffering because their suffering should not be in vein. I have seen survivors who, through storytelling, have recovered their dignity and found meaning in their suffering become more determined than ever to continuing living and surviving. In some ways, if recovery looks like that, rather than significantly reducing symptoms of PTSD, I hope more war-effected communities are given the opportunity to tell their stories.

 

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We are overwhelmed by the momentum of the Storytelling Movement. Dr. Sarah W.H. pioneered the movement in 2014 as a tool for communities affected by war and related events to break the silence that so often increase suffering by supporting survivors to tell their stories (in the featured publication below, you can read more about the Storytelling Movement, including the psychological and cultural mechanisms that contribute to it’s success). 

Since 2014 the Storytelling Movement has organically evolved and our communities have asked to take the movement further. Our local leaders have asked for more training and formal ‘listening rooms’ to provide more mental health support to their families and neighbours. In July, Sarah will be back in the DRC providing more in-depth education and training and working closely with the local communities to support them in developing the Storytelling Movement. 

 

 

References

 

Bisson, J., Ehlers, A., Matthews, R., Pilling, S., Richards, D. & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis. British Journal of Psychology, 190, 97-104.

Brewin, C. R. (2001). A cognitive neuroscience account of posttraumatic stress disorder and its treatment. Behaviour Research and Therapy, 39, 373–393.

Brewin, C.R., Dalgleish, T., & Joseph, S. (1996). Dual representation theory of posttraumatic stress disorder. Archives of General Psychiatry, 50, 294-305.

Brewin, C. R. & Holmes, E. A. (2003). Psychological theories of posttraumatic stress disorder. Clinical Psychology Review, 23, 339-376.

Ehlers, A. & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345.

Ehlers, A., Clark, D. M., Hackmann, A., McManuc, F. & Fennell, M. (2005). Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research and Therapy, 43, 413-431. 

Foa, E. B. & Kozak, M. J. (1986). Emotional Processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20-35.

Hensel-Dittmann, D., Schauer, M., Catani, C., Odenwald, M., Elbert, T. & Neuner, F. (2011). Treatment of traumatized victims of war and torture: A randomized controlled comparison of narrative exposure therapy and stress inoculation training. Psychotherapy and Psychosmatics, 80, 345-352.

International Rescue Committee, Mortality in the Democratic Republic in Congo: an ongoing crisis. International Rescue Committee Web site. http://www.theirc.org/resources/2007/2006-7_congomortalitysurvey.pdf. Published 2008. Accessed April 4, 2008. 

 

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