Trauma advocacy, veteran politics, and the Croatian therapeutic state.

Author:Pupavac, Mladen
Position:Report
 
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Abstract

This article considers international trauma advocacy and Croatian veteran politics. The article begins by discussing international trauma advocacy and therapeutic state legitimation. International trauma advocacy seeks to promote peace, however unwittingly it has legitimized veteran politics antithetical to its ideals. The second half of the article goes on to consider Croatian state legitimation and privileged veteran pensions. The article suggests that Croatia is developing therapeutic forms of state legitimation. The article highlights the problems of Croatia as a therapeutic state and its recognition of extensive veteran privileges. The article concludes that the veteran privileges represent a political, social, and economic burden which is hindering Croatia's postconflict development.

Keywords

trauma, advocacy, therapeutic state, legitimation, Croatia

"We were together in the war, let us be together in peace," the Croatian Ministry of Families, Veterans, and Intergenerational Solidarity declared in newspaper adverts on August 5, 2011. (1) The date of the military Operation Storm and fall of Republika Srpska Krajina is officially celebrated as Croatian Victory Day, Homeland Thanksgiving Day, and Croatian Veterans Day. During the annual celebrations in 2011, the then Prime Minister and former Veterans Minister Jadranka Kosor renewed her promise to veterans that she would protect their interests. For Kosor, the veterans' position in society transcends politics. "Let us not squabble over the veterans' back, we have a commitment to them and they are above politics," Kosor declared in earlier Victory and Homeland Thanksgiving Day celebrations. (2) The new Croatian government has not yet declared a firm position on Croatian veterans, nor has the European Union following Croatia's EU accession treaty signed in December 2011 and ratified in March 2012. But apprehension has been growing among veterans that their position in society is under threat.

This article considers international trauma advocacy and Croatian veteran politics. Croatia is interesting as a case study of international trauma advocacy as it was the first country where international trauma programs took off in the early 1990s. The origins of posttraumatic stress disorder (PTSD) are linked to the US antiwar movement and human rights advocacy. International human rights advocacy in the 1990s sought to assert individuals' rights against national sovereignty, but ironically legitimized state claims and power politics. (3) Similarly international victim trauma advocacy sought to assert individuals' interests against nationalist politics, but ironically in Croatia legitimized sectional nationalist interests. Specifically, international victim trauma advocacy helped legitimize Croatian veteran politics and their privileged position in Croatian society. The article begins by discussing international trauma advocacy in Croatia and its legitimization of privileged veteran pensions. The article then goes on to discuss therapeutic state legitimation and international therapeutic governance. The second half of the article considers Croatian state legitimation in the context of the need for international and national recognition. We suggest that Croatia is developing therapeutic forms of state legitimation. Croatia may be conceptualized as what the sociologist James Nolan has termed a "therapeutic state," where the state relates to key sections of society through therapeutic governance. (4) We conclude that the Croatian therapeutic state is characterized by parasitical therapeutic relations and social stasis.

In our criticisms of expanding therapeutic governance, we are not disputing that people are marked by their experiences or the presence of psychological distress. However, we are contesting how the prevailing paradigms have constructed war trauma and legitimized particular political relations. There has been strikingly little understanding or follow-up in the international trauma advocacy field of how their ideas became absorbed into the recipient societies and adapted to local political interests. International trauma advocacy and therapeutic governance have actually complicated postconflict national politics and development in Croatia.

International Trauma Advocacy in Croatia

There was a veritable explosion of international trauma programs first in Croatia and then in Bosnia. This new field was expressed in United Nations High Commissioner for Refugees's (UNHCR) revised 1990s' guidance on refugees, which began to recommend counseling services for refugees and war-affected populations. (5) A 1994 report documented a total of 185 psychosocial programs in Bosnia and Croatia. (6) Interventions are not simply about alleviating individual psychological distress. Therapeutic governance of war-affected societies seeks to break perceived cycles of trawna and violence and views untreated war trauma as a trigger of future war. The US Common Bond Institute (CBI), among the western organizations promoting a psychosocial war paradigm, contends that "unresolved communal psychological wounds, often inherited from one generation to the other, are one of the most powerful fuels of war and violent conflicts." (7) Without psychosocial intervention, it is feared, "the cycle of violence and the cycle of trauma directly contribute to each other. The pervasive presence of such a large segment of traumatized members in all areas of these societies poses perhaps the most (8) formidable barrier to peace." (9)

The Harvard Program in Refugee Trauma has been influential in its efforts to build a "new paradigm for the prevention of war and the healing and recovery of survivors of violence." It seeks to place "human and mental health issues at the center of global approaches to world peace and development." Bosnia and Croatia were a key focus on its work in the 1990s. The Harvard Program describes how since 1995, it has "trained over 200 practitioners in Bosnia and Croatia in caring for survivors of mass violence, through a model that is being replicated throughout Bosnia and has been accepted by the region's Stability Pact. Our work in Bosnia has been supported by the World Bank, the Open Society Institute, and USAID." (10)

Intergovernmental and nongovernmental organizations adopted these psychosocial approaches, as the Harvard program indicates. The World Health Organization (WHO)'s Consultation on Health as a Bridge to Peace warns untreated trauma "may contribute to demoralization and lack of initiative, as well as to rigid patterns of thinking that perpetuate war and make it chronic." (11)

As part of its endeavor, the Harvard Program adapted its Trauma Questionnaire (HTQ), symptoms checklist, and trauma manual to the country context, including a specific version for Croatian veterans, available in English and Croatian. (12) Other US diagnostic tests have also been applied in Croatia. (13) International trauma models have therefore been integral to the screening and legitimizing of veteran trauma claims.

Western psychosocial interventions have been attacked by critics as foreign impositions, marginalizing alternative cultural meanings, delegitimizing, and undermining local understandings and coping mechanisms. (14) Western checklists have been problematized as pathologizing normal responses, overlooking the social meaning of symptoms and inflating the numbers deemed to be dysfunctional and in need of psychosocial interventions. Overall trauma programs have been criticized for emphasizing vulnerability and neglecting resilience. (15) Controversies over the assumptions and quality of many international psychosocial programs subsequently led the WHO to modify its guide-lines on trauma interventions. (16) Nevertheless the WHO accepted the premise of the field that psychosocial interventions were needed to support war-affected populations.

Croatian Veteran Pensions

Croatian society, seeking international recognition and EU membership, has been very receptive to external ideas and initiatives. Professionals, pleased to develop international links, readily allowed responses to war-affected individuals to be shaped by the western PTSD framework through international counseling or training programs which mushroomed in the war. (17) Croatian medical literature and pension policies have overwhelmingly endorsed PTSD models and the medicalization of veterans. International trauma assumptions of mass psychological dysfunction in war, supported by authoritative diagnostic checklists, have legitimized large-scale veteran claims to PTSD diagnosis, institutionalizing veteran rights and veterans' privileged social position. A key ministry adviser on the law was Herman VukusSia, President of the Society of Medical Stress in Zagreb. In an earlier coauthored ministry study, he suggested:

PTSD incidence in Croatian war veterans suggest that at this moment at least 14-16% of population participating in the Croatian Homeland Defence War suffer from post-traumatic stress disorder. This figure is very probably the lower limit of incidence, whereas the upper limit could be inferred ranging from 25 up to over 40%. (18) Given this evaluation, the study recommended veterans' need for intensive psychosocial assistance and the community's social responsibility toward them. The attractiveness of PTSD is very apparent with thousands of veterans making trauma pension claims supported by international trauma models presuming long-term traumatic dysfunction. (19)

Notwithstanding Croatia's cultural receptiveness, international trauma advocacy literature has not adequately reflected on how its ideas became intertwined in Croatian politics and sectional interests. Ironically international trauma advocacy has helped legitimize a therapeutic veteran frame-work, actually institutionalizing "chronic" conditions and "demoralization and lack of initiative, as well as to rigid patterns of thinking" which...

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