Missing loved ones: helping families cope with the uncertainty
When a loved one goes missing, the psychological impact on those left behind can be overwhelming. Laurence de Barros-Duchene is in charge of the ICRC's mental health programmes for victims of armed conflict and other forms of violence. Recently returned from Georgia/Abkhazia, where she helped train specialists and staff of non-governmental organizations (NGOs) in supporting the families of missing persons, she explains how the psychological distress caused by the disappearance is compounded by its legal, economic and social consequences.
What was the aim of the recent ICRC-led training sessions in Tbilissi and Sukhumi?
The aim was to train local partners in supporting the families of the missing. The ICRC has spent the last four years developing a support network in this way, encouraging solidarity on the part of local actors, both specialist and non-specialist. The aim is to be able to meet the needs of these families on every level – legal, financial, social and psychological.
With this in mind, we invited a broad selection of people to participate, including representatives from affected families, experts in forensic medicine, lawyers, psychologists, psychiatrists, doctors and heads of family associations set up post-war in the 1990s.
Our goal was to mobilize as many people as possible to address the families'needs and to establish how each could contribute to the effort. The training sessions were also an opportunity for the relatives of the missing to speak of their struggles, and for specialists to understand the psychological torment the disappearance of a loved one can cause.
The training content was largely founded on the ICRC's experiences, which also served as the basis of a practical guide to supporting families of the missing, including tips on how to organize helpful activities. We realized that this training was useful for specialists and non-specialists alike. Indeed, few know what these families have to endure, and even fewer are " equipped " to attend to the psychological aspect of their suffering. Though not considered pathological, the distress relatives suffer can seriously affect their health over time. Specialist attention is sometimes necessary, but even this is not enough on its own – especially if the families receive no news of their loved one.
What particular needs arise if the disappearance is conflict-related?
The family's needs are many and interlinked. More than anything, they want to know what has happened to their loved one. It becomes an obsession and a constant source of great anguish. While the ICRC is not mandated to respond to this need directly, it can encourage and assist the relevant authorities to do so. The ICRC has, for example, developed a model law to guide governments in establishing tracing mechanisms and creating a legal framework that accommodates the families'difficulties and addres ses the issue of disappearances in general.
Men are more likely to go missing than women, whether as soldiers or civilians. As the man is often a family's only breadwinner, his disappearance can cause major financial difficulties for those left behind. The problem is compounded when the family spend what little money they do have on fortune-tellers, informants and costly administrative steps to try and find out the fate of their loved one.
During armed conflict, there is the additional problem of a lack of community and government support, meaning families have to cope alone with their anguish and the daily struggle to survive.
Their distress can last for years, especially when they have no idea what happened. Some may have to wait a whole generation before hearing any news or locating the body of their loved one. We now understand that their pain does not fade over time; instead it lingers on, sometimes in silence, ready to resurface at any moment. With such uncertainty, they are not able to begin the mourning process.
How can we really tackle the psychological effects of a disappearance?
Ensuring that families of the missing receive psychological and community support is a fundamental part of the ICRC's global response to disappearances resulting from armed conflict and internal violence.
The wars in the Balkans and the Caucasus in the 1990s were what initially spurred the ICRC to adopt such an approach. The 2003 International Conference on the Missing, held in Geneva, was an opportunity for the ICRC to set objectives in dealing with the issue. In addition to working alongside the authorities to trace the missing, the ICRC expressed its wish to support the affected families directly. Specialists were subsequently posted to various countries in the Northern and Southern Caucasus to set up support programmes. Their work in Georgia has been a particular success.
First of all, by taking simple steps that family associations may not have previously considered. For example, by organizing activities that bring affected families together to share experiences and exchange information. This encourages them to break out of their isolation and join forces to find solutions to their problems. Guided activities of this kind can have an extremely positive effect on the families and their approach to dealing with the consequences of their loss.
In some cases, this alone is not enough. The psychological burden on these families may be so great that specialist attention is required. The parents of the missing, for example, tend completely to neglect their own needs and those of the other members of the family; they focus all their energy and attention on searching for their missing children. With time, they may withdraw socially and emotionally from those around them, thus missing out on vital support from the outside. They need help in changing this compulsive behaviour so that they can slowly start to enjoy life again, without feeling guilty for doing so. For these people, stopping the search is like abandoning their children forever or " killing them all over again. "
It is extremely difficult to allevia te the guilt and anxiety that stem from uncertainty, and to contend with the fear that missing loved ones will be forgotten forever, leaving no trace they ever existed. The obsessive questioning " Who will remember them when I am gone? " is revelatory of the psychological pain these families are suffering – pain that cannot be relieved solely through specialist medical attention or support from the community. Public recognition of their plight and of the disappearance can also help, for example through a monument or register featuring the names of the missing. The important thing is that the missing are not forgotten and allowed to disappear forever.
Not being able to give a loved one a proper burial also causes distress and guilt, which is why it is so important to find the body and return it to the family. Though extremely painful, this final step can also bring a real sense of relief. In the best cases, receiving the body enables the family to begin the life-saving process of coming to terms with the loss.
What role do specialists play in supporting the families?
It is not easy to help families live with the uncertainty and emotional turmoil caused by the disappearance of a loved one. Goodwill alone does not suffice. Therapy is essential, though the aim is not to encourage the families to mourn, since this is impossible without them knowing the fate of their loved one or having found and honoured the body as their culture dictates. Rather, therapy can help them find a way of coping with the disappearance, without letting it affect their day-to-day lives or their social and emotional relationships.
We know from experience that their psychological distress persists for many years after the disappearance; families never forget their missing. The mental and physical exhaustion this brings about can occasionally lead to further c omplications and pathologies, such as depression or chronic illness.
Among all those involved, what is the place of family associations and what assistance do they receive from the ICRC?
Family associations are at the very heart of the activity. Since these associations were founded by parents of the missing, they are directly concerned by the issue of disappearances. This gives them the legitimacy and motivation to support families over the long term. They also have an intimate understanding of the problems that arise and maintain close contact with those they are helping. The associations, acting on behalf of the families, can therefore be instrumental in guiding and advising the authorities on this issue.
The role they play nevertheless has its limits. The members of these associations are themselves suffering emotional distress, and it is often impossible for them to maintain a healthy distance from the families they are helping. This is why we encourage them to work in partnership with other local actors.
The ICRC works with the associations on many levels. On a local level, it puts them in touch with specialists and NGOs, and offers them assistance in developing support activities and improving the way they run. On a more political level, the ICRC facilitates their relationship with the authorities and ensures their voice is heard. The ICRC may also occasionally act as their spokesperson, and equip the associations to enhance their visibility.
Do the needs of affected families differ from one culture to another?
The psychological torment does not change from country to country. When your child disappears, it does not matter if you are from Nepal, the Democratic Republic of the Congo or Chechnya – you still feel the same pain. The difference will be in the way this pain is expressed or relieved.
By the same token, time does not lessen the pain of a disappearance. Families we have met in Georgia, Guatemala, Nepal, Cyprus and Chechnya seem to be experiencing the same struggles, no matter how long they have been searching for their missing. All are battling with the same questions, entertaining the same hopes.
Families'needs can vary according to other factors, however, such as the length of time they have to cope with economic instability, or whether or not their government authorizes search and identification procedures.
A lot depends on the context and causes of a disappearance. When people go missing as a result of natural disasters, such as tsunamis or earthquakes, this does not have the same psychological impact on the family as disappearances that occur during armed conflict or political violence, where the victims are likely to have been targeted for their ethnic or political affiliation.
The reason for a disappearance influences the way the families are affected and how the community will react. If the disappearance is considered " suspect, " the family could well be stigmatized. Visiting the family may be interpreted as adhering to an ideology or affiliating oneself with a particular group. In Sri Lanka, for example, unexplained disappearances can be considered a sign of bad karma, which is passed through the generations along the female line. To visit the affected families would be to expose oneself to misfortune. These are just some of the cultural differences we come across. It is important that we recognize them in order to adapt our response accordingly.