International Society for Traumatic Stress Studies

A Student Perspective on Challenges and Responsibilities of Doing Global Work in Stress and Trauma

Posted 1 September 2008 in StressPoints by Anne Richards, MD, MPH

As a political activist, Noam Chomsky has advised his students to advocate to those who can make a difference. He also has urged his students not to consider national borders the limit of our political and moral responsibility (see Chomsky, 1967). Scholars of stress and trauma in industrialized, wealthy nations are appropriately poised to explore and advocate for addressing global health needs. With more access to funding and institutional support, such scholars can work to implement treatment interventions, increase local capacity, and advocate for change for those affected by violence, disaster and other potentially traumatic events worldwide.

My recent work in Colombia, evaluating mental distress and treatment needs in Colombians who were internally displaced by the violence between armed groups in the country, highlighted the importance and satisfaction of global work in stress and trauma. It also clarified some of its challenges.

One of the major challenges as a trainee just starting to develop a career in research is funding. I was fortunate to have funding through a University training grant at the University of California, San Francisco to conduct a small pilot project abroad. Many universities and training institutions, however, may not have the resources or interest to support research abroad. Therefore, if you are interested in doing research in global mental health and trauma, I would recommend assessing ahead of time what funding is available at the schools you are considering. Another option is to apply for grants, which can be few and far between when it comes to doing global health work. However, certain foundations and organizations geared towards working with specific populations or in certain regions of the world may be able to provide support for budding global health researchers.

Another major challenge in doing global work in stress and trauma is mentorship. Part of the reward of this work involves understanding mental health problems and mental health needs in cultures that differ from our own. The same terminology to express distress in one culture may not be used in another. For example, somatic symptoms may be more prevalent than psychological experiences in non-western cultures. Western-models of treatment, which currently dominate the field, may not entirely apply and may require some tweaking. Although there is evidence that survivors of trauma worldwide experience some of the same symptoms of posttraumatic stress disorder, the meaning of those symptoms and the ways they cope with them may be entirely different. To do research in such cultures, therefore, often requires a mixed-method approach- one which includes both quantitative and qualitative methods. At many institutions, it may be challenging to find a mentor with expertise in both stress and trauma research and mixed-method research approaches. For this reason, it is important to consider enlisting several mentors, who will have expertise in each of these areas.

The easiest way to address both the funding and mentorship challenges is to work with an already-established and funded investigator engaged in a project that you find, at least in some respects, interesting. It may not be the project of your dreams, but this is the best way to become well trained in research and to be productive, thereby increasing your likelihood of getting grants and fellowships in the future. Ideally, you’ll be able to develop a small protocol which can be appended to your principal investigator’s protocol that will guarantee you some first authorship papers in your area of interest.

Another area of challenge in doing global mental health work, and specifically with traumatized populations, is the instability of the population and the institutions that support them. Both I and another trainee at my institution experienced near collapse of our projects when our collaborating non-governmental organizations either backed down from the project or lost their contract to work with the population under study. For this reason, it is paramount to establish reliable ties with local or, preferably, national university researchers. These relationships ensure commitment and support within the country where you will work.

The instability of the population under study can also make maintaining scientific rigor challenging. It is difficult to remain bound to a protocol and to complete the work on time when clients cannot make it to follow-up or have to leave a focus group early because of childcare problems, lack of resources to pay for transport, or other basic needs that must be addressed. Planning for many unexpected delays and accepting a small degree of chaos is paramount to accomplishing one’s primary study or treatment goals- despite some of the limitations that will undoubtedly emerge.

Even with these challenges and resulting limitations research in global mental health, and in stress and trauma specifically, is definitely worthwhile. This work advances our understanding of the phenomenology, causes, mechanisms, and cures for posttraumatic stress disorder and other responses to trauma. We also hope it will be of direct benefit to populations in need. One of the most important issues to consider in engaging in global trauma work is the responsibility one takes on in engaging in the research. Conducting evaluations, needs assessments, and descriptive research are useful for edification and for dissertations and other student projects, but are only a first step in taking on responsibilities towards global neighbors suffering from the effects of traumatic stress. Such projects should also include a plan to create visibility, advocate for social and institutional change, build capacity, and/or develop interventions that will benefit the population under study.

Chomsky, N. (1967). The responsibility of intellectuals. The New York Review of Books, Feb 23.