Psychological aspects of peacekeeping operations

Abstract

Peacekeeping operations are but one aspect of the systems of peace that have evolved over the past seven decades in a world that is riven with violence of all kinds. With the end of cold war in the late eighties of the last century we have come to see much intrastate violence, in addition to usual interstate hostilities and war, arising out of religious, political, ethnic and economic differences between people. In the changed scenario peacekeeping operations have become complex politico-military-humanitarian efforts. A soldier, trained for conventional military operations, is obliged to participate in the unconventional operations of waging peace in alien lands often in volatile and violent situations and in the process he stands to get exposed to widely variable demands for adjustment that have the potential to bring to the fore many maladaptive responses. Peacekeeping operations also have the potential to offer opportunities for growth and resilience. India is a major player in peacekeeping activities for well over sixty years all over the world. It is necessary for the commanders and mental health professionals to understand the multifarious factors that impinge on the peacekeeping soldier's mind and the emerging patterns of responses thereof for effective management trained manpower and fulfillment of mission objectives

“Peacekeeping is not a soldier's job, but only a soldier can do it.” - Dag Hammarskjold, former UN secretary general

War is a form of political violence carried out by states and nonstate actors to resolve issues perceived by them as unsolvable by any other means. In certain cases, war is the result of sheer arrogance and hubris of an individual. The approximate 14,500 wars that were waged since the rise of organized state 3,500 years ago have accounted for an estimated 3.5 billion deaths. During this period of recorded history, only 300 years were apparently free from wars![1] It is no wonder that peace has come to be defined and described often as absence of war or freedom from violence. Perhaps because of the rarity of peace and ubiquity of war peace is invoked in all faiths, at all gatherings of the faithful though invariably war is put at the service of peace, which is summed up so succinctly by the US General Ulysses Grant when he said, “Although a soldier by profession, I never felt any sort of fondness for war and never advocated it, except as a means of peace.”

Field Marshal Martin Saxe quoted to have said that a soldier is at peace in war which sounds fair enough as soldiers are trained to intimidate and prevail over the enemies of their states by the force of arms: It is not their job to make or keep peace yet it is said that they are best suited for the job. In this rather unconventional and unaccustomed role of a peacekeeper that a soldier of today is increasingly being drawn into ever since the last post was sounded for the “cold war” just over two decades ago.

SPECTRUM OF PEACE ACTIVITIES

Peacekeeping is one of the many activities undertaken by the UN and other international actors to maintain peace in the world. “Conflict prevention” involves taking measures to prevent inter-state and intra-state disputes and tensions escalating into violent conflicts while “peacemaking” includes measures to bring the bellicose parties to the negotiating table when the hostilities are in progress. Peacekeeping operations (PKOs) are designed to preserve peace after the halting of hostilities. Robust Peace involves use of force at the tactical level with the consent of the main parties of the conflict and the Security Council in the case of UN-mandated PKO. “Peace enforcement” involves the use of a range of coercive measures, including military force, at the strategic or international level and does not involve the consent of the main parties to the conflict. It can be seen that all of the above are addressed to mitigate direct violence. On the other hand, peace building includes all those activities that are designed to reduce structural violence which is said to occur when people are deprived of their basic rights and minimum needs. Structural violence kills indirectly and insidiously. Fundamentally peace building is concerned with social justice.[2,3] Structural violence and direct violence feed into each other to set up a “system of violence” so in effect individual components of the spectrum of peace activities cannot be seen in isolation.[3] Commanders and mental health professionals need to acquire some knowledge of systems of peace and the systems of violence to develop an appropriate attitude and be prepared for the operations of the peace kind.

EVOLUTION OF UNITED NATIONS PEACE KEEPING OPERATIONS

The UN was established just when the last Great War was about to end, precisely on 26 June 1945, with the lofty aim of saving the succeeding generations from the scourge of war but Peacekeeping per se was never mentioned in the UN charter. Peacekeeping provisions are implicit in Chapters VI and VII of the Charter and based on the concept of impartial soldiers from neutral nations applying the techniques of conflict resolution to contain and limit violence.[3] Since the inception of PKO in 1948, the UN has undertaken 68 missions out of which only 8 were in the precold war era.[4] For the cause of peace 3,120 troops laid down their lives under the UN flag[4] which underscores the fact that peace operations are not exactly peaceful! Unfortunately, the basic aim of the UN has turned out to be a continuous process rather than an endpoint as the small world of our times is becoming more volatile, violent, and chaotic.

Traditional peacekeeping

During the cold war, period unarmed or lightly armed military personnel from member countries acted as buffers between warring factions after a peace treaty was negotiated, agreed upon and signed.

Multi-dimensional peace keeping

After the collapse of cold war in the late 1980s, intra-state ethnic, cultural, tribal, and political conflicts came to the fore all over the world as a result of which not only PKOs have grown in size but also have become more complex to include such activities as facilitating political process through dialog and reconciliation; protecting civilians in the conflict areas; assisting disarming, demobilization and reintegration of combatants; electoral support, law and order maintenance; economic and social support, humanitarian aid and so on as a result of which nonmilitary elements also became substantial. A department of peacekeeping operations was formed in 1992 at the UN. Now there is a new willingness for the use of force by the UN if the situation so warranted.[5] Peacekeeping is not seen now as a standalone operation in isolation from peacemaking and peacebuilding.[2]

Non-UN peacekeeping

In special circumstances, UN may authorize organizations like NATO, ECWAS or other coalitions to implement peacekeeping functions. Some countries and organizations may conduct PKOs independent of UN with the consent of host nation or the concerned parties; Indian peacekeeping force in Sri Lanka is an example of such independent initiative.

Role of India in peacekeeping

India deployed its troops for the first time in Korea as a part of UN peacekeeping mission in 1950 and has been the largest contributor to UN PKOs ever since. More than 160,000 troops participated in 43 PKOs so far. 160 soldiers (largest number among other nations) made the supreme sacrifice for the cause of peace. The military nature of PKOs can be discerned from the fact that 74 gallantry awards including one Param Vir Chakra (highest gallantry award in India) and 6 Maha Vir Chakras were awarded to officers and men of these missions.[6] India conducted peacekeeping operations in Sri Lanka independently (1987–1990) at the invitation of the host nation to facilitate bringing the internal strife in that country to an acceptable end point. More than 1000 Indian soldiers died unsung in this operation.[7] One can perhaps say with apologies to Milton that “peace hath its casualties no less renowned than war”!

DIMENSIONS OF STRESSORS IN PEACE KEEPING OPERATIONS

The postcold-war PKOs have become multi-dimensional in nature with the result that their members are subject to stressors in multiple dimensions. A substantial war-like atmosphere prevailed in many PKOs so far, and the emerging scenarios are likely to be no different. Peacekeepers will continue to be subject to combat stressors, but their cognitive processing could be different as the explicitly stated intentions of PKOs are sustainable peace, humanitarian help and restoration of democratic institutions. Second, and perhaps more importantly, 30% of the members are civilians who are unlikely to have had any exposure to the gore, grime, and din of combat. Third, the present day PKOs have a significant number of women in their ranks; in fact India had sent a full contingent of women CRPF personnel to Liberia in 2007.[6] The possibility that women might face qualitatively different stressors in military and nonmilitary settings also cannot be overlooked.

The nature of stressors also differs from mission to mission, length of each mission, amount of chaos in the ground situation, support of the local populace, degree of peace enforcement element, and attacks from splinter groups. Hence, stressors need to be viewed in the subjective-objective, traumatic-nontraumatic and common-uncommon dimensions. Many aspects of the stressors, adjustment and maladjustment thereof have been studied and reviewed by many investigators.[8,9,10,11,12,13,14,15,16,17,18,19]

Absence of any studies in this regard on Indian peacekeepers in spite of the long tradition of participating in PKOs with large contingents is glaring and rather unfortunate. Quite surprisingly, the author came across a Chinese study on the peacekeepers of the Indian subcontinent.[20] There is a recent study from Pakistan.[21]

COMMON STRESSORS

The UN pamphlet categorizes them into basic, cumulative, and critical traumatic stressors. All of them can be experienced in varying degrees before, during, and after deployment in PKOs. Basic stressors are those arising out of daily hassles, discomfort, homesickness, and fatigue. They are generally manageable. Cumulative stressors arise when basic stressors remain unresolved or when stressors are repetitive and overwhelm the individual. Critical traumatic stressors are out of the ordinary overwhelming stressors.[8,13]

Predeployment stressors

Uncertainty of the date of departure, duration of engagement, time pressure to solve personal life issues and issues related to family, prospect of exposure to alien culture and language, anticipation of difficulties in communication to home, doubts about adequacy of preparation for the unaccustomed operations, the possibility of combat, and the excitement of venturing abroad can place demands for adjustment.

Deployment stressors

Deployment in an alien terrain and environment in a role that is fundamentally different from that of soldiering can be quite stressful for the soldiers trained for conventional war. Isolation, ambiguity, exposure to atrocities, danger, boredom, alien culture, perceived incompetent leadership, fluid command, pent up aggression, doubts, vicarious suffering, and home front worries can adversely affect the adjustment of a soldier.

Isolation

In PKOs, isolation is physical and psychological as members are often deployed in remote areas from where they find it difficult to communicate with their families. Lack of media attention also may make them feel that they are forgotten.

Ambiguity

Soldiers are trained for war. In PKOs, they are required to maintain peace under strict rules of engagement (ROE). There are no enemies to vanquish; exhilaration of victory cannot be experienced. Role conflict is intrinsic to all peacekeeping operations

Danger

Only the main conflicting parties are parties to the consent agreement for PKOs. Attacks from renegade or hostile elements and hostile locals; land mines, endemic diseases, and exposure to noxious agents may put the life and limb of soldiers to serious risk. The prospect of exposure to such can add a cognitive dimension to the demands for adjustment.

Boredom

soldiers may suffer from the stress of ennui because of simple, repetitive, and monotonous routines and lack of entertainment and lack of professionally meaningful work. Boredom, when interspersed with intense humanitarian or combat activity, can be extremely demanding.

Witnessing atrocities and human remains

Peacekeeping operation soldiers are obliged to maintain impartiality dictated by the ROE. So they may remain as bystanders and witness gross atrocities. In Rwanda, thousands were massacred with clubs and machetes in broad daylight under the very eyes of UN while in Srebrenica, in former Yugoslavia, UN troops watched the rape and killings of hundreds of unarmed people by the Serbs. Helplessly witnessing helpless people is called “double helplessness.” Witnessing mutilated bodies and mass graves and retrieving dead bodies can be extremely unpleasant and stressful.

Powerlessness

Inability to retaliate in kind in the face of hostile mobs, frustrating negotiations at checkpoints, passing through destruction may make peacekeepers feel powerless. There will be plenty of opportunities to accumulate and less opportunities for discharge of aggressive urges.

Doubts

Peacekeepers may experience doubts about their ability to meet the needs of the local population. They may also vicariously experience the powerlessness, rage, and despair of the locals.

Homesickness

Soldiers the world over are known to carry their homes to their workplace. From the distance of foreign land issues of home can get magnified. Even effective communications sometimes may create problems if family members are not discrete enough in conveying unpleasant news.

Heterogeneity and fluid command structure

In a given mission elements of more than a dozen nations may participate making the working milieu somewhat fuzzy. For instance, in Cambodia, 34 countries participated.[14] Each element belonging diverse nationalities may have its own agenda even each element within a contingent may have different work ethos creating stressors in the interface.[13] Doing business in a fluid environment may add to the stress. Peacekeepers may also have to contend with private military companies, military support companies, and unarmed civilians in operational areas.

Human suffering

Peacekeeping operations are undertaken in chaotic conditions. Witnessing the suffering due to starvation (Somalia, Darfur) and disease on a massive scale among internally displaced persons and refugees can be quite traumatic. There was a huge movement of refugees amid raging conflict in Rwanda and Croatia.[14]

Post deployment stressors

Homecoming may turn out to be stressful due to several factors. Subsumed under the term “transition stress,”[12] these may include yearning for comrades and recently experienced closeness of work with them, issues related to guilt, mismatch between fantasies of homecoming and reality, reworking relationships, picking up the threads of old routines in the regiments and garrisons, changes in emotionality (brought about by exposure to stress), and indifferent public attitude. Rapid reintegration may add to the problems further by not giving the soldier adequate time and opportunity to develop a perspective and effect closure.[8,15,46]

ADAPTING TO STRESS

Soldiers with the disposition of psychological hardiness were noted to do well in PKO atmosphere.[22] Hardy people see life experiences as interesting opportunities to grow. In a Dutch study, it was found that those with personality traits of negativism (psycho-neuroticism) were vulnerable for stress reactions.[23] Lower rank,[24,25,26] staff duties,[25] bachelorhood, childhood adversity, lower education,[27] female gender,[25] past psychiatric history,[27] first time exposure to combat, western culture[10,24] were noted to be some of the other vulnerability factors. Peacekeepers are noted to cope with stress in five main ways: Seeking safety (gravitating toward base areas which are guarded); diversion through stimuli (alcohol, cigarettes); seeking change of scene (wearing “civies,” partying with locals); diversion by thinking about other things; and seeking social support (talking to a comrade).[19]

STRESS RESPONSES

Peacekeeping operation personnel respond to stressors in both positive and negative ways. In some ways, PKOs are like low-intensity conflicts (LIC) the only difference being in LIC security personnel operate against identified groups who indulge in aggression against legitimate state. To a certain extent, PKOs are also like working in manmade disaster situations with large-scale human misery and humanitarian effort, but in PKOs, humanitarian effort is but one aspect of multi-dimensional operations. Keeping with the unique nature of stressors, several psychiatric syndromes were described.[8,9,15,17,18,28,29]

Acute stress syndromes

Battle fatigue

In combat scenarios of PKOs, soldiers may suffer from this condition which could be of mild, moderate or severe in nature. Mild conditions generally manifest in the form heightened arousal symptoms. Increased or decreased motor activity will be additional features in moderate conditions while severe conditions present with transient psychotic features.

Flame out

This is an analogy to sudden failure of combustion of the jet engine due to bird hit or fuel loss. A burnout like a condition developing rapidly in disaster, trauma or PKO is called flame out.

Peacekeepers acute stress syndrome

Peacekeepers develop this syndrome when they find themselves unable to respond to atrocities and violence due to strict ROE. This syndrome is characterized by rage, delusions, frustration, feelings of impotence, and helplessness.

Survivor guilt syndrome

Survivors of combat or other serious traumatic situations blame themselves inappropriately for the death of others in the same situation.

Chronic stress syndromes

Burnout

This is an analogy to a rocket with spent fuel circling the earth mechanically. The syndrome arises out of chronic workplace tedium and characterized by diminished interest in the work, physical and mental exhaustion and neglect of personal needs for food, rest, friends and family.

Compassion fatigue

Compassion fatigue occurs in trauma care workers who help people over long periods. It is characterized by gradual lessening of compassion and resistance to help others. Sufferers exhibit negative attitudes, anhedonia, anxiety, feelings of incompetency, self-doubt, and nightmares (to be contrasted with burnout which occurs due to routine workplace tedium).

Posttraumatic stress disorder

Prevalence figures ranging from 2% to 15% have been reported. This wide variance was attributed mainly to the degree of combat exposure and the subjective experience of the actual trauma. Complex posttraumatic stress disorder (PTSD) is a variant which occurs in those who are exposed to prolonged or extreme repeated stress and characterized by affect dysregulation, altered ability to form interpersonal relations, enduring feelings of revenge, preoccupation with perpetrators and self-destructive behavior.

Counter disaster syndrome

This syndrome is characterized by inappropriate over-involvement, excitement, and a sense of omnipotence. The high of this condition may border on hypomania.

Peacekeepers stress syndrome

It is a syndrome of role identity conflict in PKO soldiers compounded by long-term frustration, outrage, guilt, and mortal fear. Fear of losing control over own aggression predominates the picture.

Culture change syndrome

This is a permanent change in personality after combat experience and characterized by alienation from society. They find homecoming stressful and establish countercultural lifestyles (e.g. Vietnam veteran biker groups).

Stockholm syndrome

This occurs in a hostage situation. Hostages may express sympathy, empathy, and positive feelings toward their captors.

Miscellaneous or hidden effects

In addition to the named conditions above, high levels of stress over sustained periods may cause impairments of concentration and memory leading to impaired decision making; disruptions in cohesion and breach of discipline leading to misconducts and clumsiness and recklessness leading to equipment loss and friendly fires (“blues against blues”).[9]

GENERAL PSYCHIATRIC PROBLEMS

In some soldiers, general psychiatric conditions may get precipitated, or it might so happen that some soldiers may enter into PKOs while still undergoing psychiatric treatment through extra-service sources. High morbidity ranging from 15% to 30% has been reported in several studies.[11,16,27,30,38] Increased Incidence of anxiety, depression,[30] suicides,[28] increased alcohol use,[11,19,31] violent deaths,[28,30] and accident proneness[11] have been reported. In one study, though 23.2% perceived the need for mental health care, they did not use mental health services due to structural and attitudinal barriers.[16] Gross misconduct behaviors such as sexual abuse and murder by peacekeeping soldiers have also been reported.[32,33,34] The nature and quantum of psychiatric problems in Indian peacekeepers are not known, but the absence of evidence of morbidity need not be construed as evidence of its absence. If one draws a parallel to the psychiatric morbidity in LIC operations[39,40,41] the morbidity in PKOs could, in fact, be quite significant.

FAMILIES

For families, as for the peacekeepers, peacekeeping brings a mixed bag of problems and positives. Two-thirds of the families reported feeling better than expected.[48] Families may experience anticipatory anxiety during the predeployment period; may feel helpless on hearing untoward incidents in the media during the deployment period. Some felt bored, depressed, and loss of support.[8,47,48] Secondary traumatization[49] and Reunion stress[49] could put a big demand for adjustment in the postdeployment period.

Secondary traumatization

It is a natural emotional reaction to the traumatic experience of a significant other and manifests in the form of a variety of cognitive, emotional, and physical symptoms.

Reunion stress

It refers to physical and emotional demands experienced by all family members around the time of homecoming of a soldier. Families require about 3 months to feel comfortable with each other again.

POSITIVE ASPECTS OF PEACEKEEPING MISSIONS

Most PKO personnel (60–90%) report positive benefits. A sense of fulfillment in helping other people in need, contributing to the good of other nations, experience of working with militaries of other nations, exposure to new equipment, experiencing a sense of effectiveness in working in alien culture and so on may bring feeling of competence and confidence leading to a new perspective of life and one's role as a military person.[15,16,35,36,37] Financial benefit[21] and appreciation of things back home[45] are some of the other positives reported.

MANAGING THE STRESS OF PEACEKEEPING

The UN PKOs can be quite different from each other as far as the demand for adjustments are concerned; for example in Somalia UN forces were subjected to violent attacks while in Cambodia civilian members outnumbered the military personnel as the focus was on peace building. As each country will have its own culture, it will be quite difficult to set guidelines that could be universally applicable.[15] In 1994, the UN Peacekeeping Training Unit was formed out of the need for better training and managing human resources to make PKOs more effective. The UN Mission Readiness and Stress Management booklet[42] and the UN Stress Management Booklet[8] give simple guidelines for psychologically preparing the civilian and military peacekeepers for PKO missions and managing varying stresses of predeployment, deployment and postdeployment stages. Though the UN supports it, the onus of training PKO personnel rests with the parent country.

Fundamentally, the guidelines envisage peer support and self-help for basic and cumulative stress and professional help for critical event stress and major psychiatric disorders.[43] However, as specialist psychiatric services may be available only at level 3 hospitals of UNPKOs, local facilities may have to be utilized before evacuation of the serious patients back home. In the Predeployment phase the focus is on imparting knowledge about various aspects of the mission: Terrain, culture, nature of mission, likely duration, health risks, risk for life, potential for combat, and so on. Each individual completes a checklist of Dos regarding his/her personnel and domestic matters like family events, finances, insurance, emergency contact information, family support in his/her absence. Members are put through individual and group stress management skill drills which may include deep breathing, muscular relaxation, positive imagery, positive self-talk and meditation; group activities may consist of peer sharing, practicing humor, psychological first aid (PFA), recreation, critical incident stress debriefing (CISD), and critical event stress management (CISM).[44]

During deployment competent command ensures unit cohesion and esprit de corps which are essential bulwarks against breakdown of discipline and stress. Leadership like Caesar's wife should not only be good but also to be seen as good. PFA, CISD and CISM, counseling and psychotherapy form the main ingredients of managing stress and reducing persisting morbidity in the form of PTSD. Pearn gives information in a nutshell about the methods of management of specific stress syndromes.[17,18] Though there have been some negative reports[15,51] by and large CISD and CISM are found to be useful.[51,53] The reported effectiveness of tiagabine, sertraline, and fluoxetine in enhancing resiliency[54] and propranolol, clonidine and prazosin for preventing PTSD[55] need to be replicated in PKO setting.

Postdeployment debriefing is given in the so-called “cooling down camps”[13] to prepare the soldiers for reintegration into routine family and regimental life. Ideally, further progress of the members need to be followed-up to identify delayed emergence of PTSD and persisting postdeployment syndrome symptoms and other sequelae. Psychological support should be extended continuously the families to identify secondary traumatization and suffering. Mechanisms for service delivery have to be put in place to ensure continuity of care.

CONCLUSION

Peacekeeping operations, by the very nature of their complex politico-military-humanitarian responsibilities, have redefined the role of modern armed forces.[13] A soldier is required to put to use his fundamental attributes of discipline, loyalty, purposive action, and camaraderie in increasingly complex and chaotic conditions. Sceptics might voice concern of this march towards peace as “militarization of human security”[13] or “civilianization of army”[14] but as far as one can see now, multi-dimensional peacekeeping missions have come to stay. Soldier members of PKOs will continue to be subjected to novel stressors which could be even more demanding than those of conventional combat.[13] It is, therefore, an onerous task for the commanders and mental health professionals to nurture the positives and manage the negative mental health consequences effectively to achieve the mission objectives of their nations.

As a concept, peacekeeping has evolved over time and will continue to evolve with changing geopolitical scenario. PKOs will need to keep in step with changing times and resulting changes in the patterns of stress. Military psychiatrists and psychologists have an obligation to study the psychological factors of PKO systematically so that actionable information is available to the commanders and the policy makers at various levels. The burgeoning research interest in the mental health issues of PKOs is a relatively recent phenomenon; going by the trend and trajectory one can visualize more vigorous and sustained expeditions into this area. Sadly, Indian research in this field is appallingly conspicuous by its absence. Our penchant for, what the great soldier Field Marshal Manekshaw said while referring to military's relationship with media, “stupid secretiveness”[56] is perhaps thwarting the enthusiasm of some of our energetic medical officers to look back on their tenure as peacekeepers, think and write.