The New Humanitarians Volume I - International Trauma Studies Program

Welcome to today's deep dive into the source material. We are really glad you could join us for this one because we're looking at something that completely flips a very conventional narrative on its head.

Yeah, it really does.

And I actually want to start by throwing a number at you just just to set the stage. In the late 1990s, how many torture survivors do you think were living in the United States?

I mean, it's a tough thing to guess.

Right.

Take a guess.

Yeah. Whatever number you have in your head right now, it is probably way too low. The sources estimate there were over 400,000 torture survivors in the US at that time.

Wow.

Yeah. And in the New York City area alone, there were between 70,000 and 90,000 survivors.

That is just a staggering figure. And what is perhaps even more striking about that is that most of these individuals had been living in the area for years, right? Living with their families, primarily in immigrant enclaves, without ever receiving specialized services for the long-term effects of that severe trauma.

Exactly. And that massive hidden crisis is exactly what we are exploring today. Our mission for this deep dive is to look at the groundbreaking work of the International Trauma Studies Program.

The ITSP?

Right, the ITSP. It was founded in 1998 by Dr. Jack Saul and Dr. Søren Bøas Jensen. We're going to uncover how the treatment of massive trauma, from political violence to natural disasters, shifted from a very Western, hospital-based psychiatric model to a much more community-driven, strengths-based approach.

Okay, let's unpack this because to really understand this shift, let's put ourselves in a traditional hospital waiting room.

Okay, I'm picturing it.

Picture the fluorescent lights buzzing overhead, the clipboards with endless intake forms, the clinicians in white coats.

Yeah, very sterile.

Exactly. This represents the traditional Western approach to mental health. Now, it is important to note that this clinical model exists for a reason. It is incredibly effective for acute individual pathologies.

Right, if you have a specific isolated issue.

Yes. But the core theme of our source material explores why this highly individualized approach, sometimes completely fails the people who need it the most, especially in the wake of mass atrocities.

Because it's too narrow.

Right. The ITSP recognized that true trauma healing on a mass scale requires a deep understanding of human rights, culture, and community context, rather than just isolated symptom management.

And the perfect example of that friction happened right at the Bellevue and NYU program for survivors of torture, which, uh, Dr. Jack Saul co-founded in 1995.

Right.

There's this incredible anecdote in the text about a group of Tibetan refugees who came to the clinic. Now, you would naturally assume they were there looking for Western psychotherapy.

A quiet room, a doctor asking about their feelings.

Exactly. Working through the trauma of their displacement. But they didn't want that at all. What they actually wanted was help setting up a nonprofit organization.

A nonprofit?

Yeah. They wanted to assist other Tibetan refugees with the practical, social, and economic challenges of adapting to life in New York.

But they hit a bureaucratic wall. The hospital's rules dictated that in order to receive assistance, these refugees had to be formally diagnosed.

Treated for a mental health disorder.

Right. In individual or group therapy. What's fascinating here is how clearly this illustrates a systemic mismatch.

Yeah, it really does.

The medical system required them to adopt the identity of a broken patient. They needed a specific pathology like post-traumatic stress disorder before the system would validate their need for for support.

But from the hospital's perspective, I mean, weren't they just following standard medical procedure? Why is it so difficult for large medical institutions to adapt to non-clinical requests, like setting up a community nonprofit?

It comes down to how these systems are architected and funded. A hospital is designed to treat disease. Its funding streams, its legal liabilities, its entire operational structure depend on diagnostic codes.

You need a code to bill the insurance.

Exactly. You cannot bill for community building. You bill for treating an illness. So the hospital is essentially saying, we can't help you build a community unless you admit you're mentally ill first. Wow.

And this is where the ITSP began to heavily advocate for a strengths-based approach. Instead of viewing survivors strictly through the lens of a PTSD diagnosis, focusing entirely on symptom reduction and isolation, they began to view them as individuals who possess immense natural resilience.

Right. Because the very fact that these refugees survived and were actively seeking to build community structures proved they had profound internal and cultural resources.

Resources that the medical model was completely ignoring.

Yeah. And that shift in perspective didn't just come out of nowhere either. It was heavily influenced by the global experiences of the co-founder, Dr. Søren Bys Jensen.

Right. His background is crucial here.

Before teaming up with Saul, Dr. Jensen was a psychiatrist from Denmark, who spent 3 years from 1994 to 1996 working with the World Health Organization during the war in the former Yugoslavia.

His work there is a masterclass in adapting to the realities of an active crisis. He was managing mental health services right in the middle of a war zone, and he didn't just fly in, hand out pamphlets, and fly out. No, not at all. He implemented regional trauma training programs for Bosnian, Croatian, Serbian, and Macedonian mental health practitioners. We are talking about training 30 to 32 professionals in a 1-year course in places like Mostar, Bosnia, under United Nations protection.

Yes.

The wild part about all this, these professionals were providing trauma services to victims while they themselves were enduring the exact same war. They were suffering from the exact same traumatic experiences.

That is a crucial detail because it dismantled the idea of the untouched expert treating the damaged victim. Right. In standard Western therapy, the therapist is supposed to be a blank slate, totally removed from the patient's trauma. But in a war zone, that's impossible. It forced a model where healing is collaborative.

You're healing alongside them.

Exactly. Practitioners must be trained not just in psychological theory, but in how to prevent their own burnout while doing profoundly demanding emotional work alongside their neighbors.

Yeah.

And Dr. Jensen's approach to this was also deeply inspired by his prior encounters with the Chilean human rights movement.

Yes, the work he did with Inger Ager regarding survivors of state terrorism during the Pinochet era in Chile. Looking at the source material's documentation of Pinochet's Chile, we can see how the political climate directly necessitated a new psychological framework.

Exactly. In Chile, they developed a framework referred to by the acronym DITE.

Right, DITE.

Documentation, Investigation, Therapy, and Evaluation. This is where the mental health and human rights perspectives merge in a really profound way. Let's break that down. Documentation and investigation weren't just legal steps; they became the mechanism for therapy.

And this is where the psychologists found something extraordinary in the text. The sources note that survivors who were giving testimonies to create documentary evidence for later war crimes trials actually had better mental health.

Yes.

Better mental health than those who hadn't yet given testimony and were still waiting in line.

Yeah.

I mean, how does reliving your trauma for a legal document actually make you feel better?

Because it restores agency.

Agency.

Giving their suffering a coherent, purposeful narrative was intrinsically healing. It provided a context for their pain that went beyond just, I am suffering.

Right. It became, my suffering is evidence.

My suffering is evidence that will hold my abusers accountable. The DIT framework advocated for something very unconventional in traditional psychology. Therapeutic non-neutrality.

Taking a side.

Yes. When working with victims of severe human rights violations, the therapist establishes an alliance with the victim in actively condemning the inhumane practices they suffered. You aren't just an impartial sounding board analyzing their coping mechanisms.

You are a witness.

You are a witness validating their reality and agreeing that a profound injustice occurred.

Which takes us right out of the clinical setting and into something entirely unexpected. From the clinic to the stage.

The theater project.

Yes. One of the most unique projects mentioned in the sources is the creation of a theater group called Theater Arts Against Political Violence. It actually started as a training exercise for U.S. Immigration and Naturalization Services asylum officers at Bellevue Hospital.

That's right. Asylum officers needed to learn how to sensitively interview severely traumatized applicants. So they hired a theater group and trained the actors to play traumatized refugees.

Okay.

The officers would roleplay the interviews, and they could freeze the action to discuss the dynamics in real time. It was a highly practical application of performance art.

But here's where it gets really interesting. What stands out as a massive paradigm shift is what happened after the training. The theater group wanted to create a broader play about human rights violations.

Right.

But the actors themselves hadn't experienced these horrors. So they invited real survivors, including a group of Chileans who had been living in the Bronx for over 15 years. To collaborate.

The real survivors?

Yeah. The actors would improvise scenes based on the survivors' stories, and then the survivors would critique them. And the critique the Chilean survivors gave was incredibly revealing. They told the actors, "You portrayed the pain effectively, but what we didn't see were the moments of humanity, warmth, and humor that was so important to us when we were in prison." That feedback completely shatters the monolithic view of trauma.

Often from the outside, We look at victims of atrocities and define them entirely by their suffering.

We just see the pain.

We reduce them to a single dimension of pain. We forget the resilience, the gallows humor, the deep interpersonal warmth that actually allows humans to survive unimaginable conditions.

Right.

The survivors were basically saying, we weren't just crying in the dark. We were still human beings. This theatrical collaboration opened up a totally different kind of public dialogue.

It was so impactful. That 2 months after the performance, that group of Chilean survivors took the raw, unedited video of the theater work back to Chile. It was their first visit in 15 years. They used it to share their experiences with other activists and theater groups. The art became a bridge for transnational communication.

This realization that healing requires culturally specific expressions of humanity and ritual is exactly what the ITSP had to apply a few years later in Kosovo.

Right.

This brings us to the year 2000 and the Kosovo Family Professional Education Collaborative, or KFPEC.

The sources detail a specific initiative by Albanian Kosovo mental health professionals who developed mobile teams to visit villages. And they visited this one small agricultural village called Slovia.

Right.

To give you the context from the text, in May 1999, Serbian military forces entered the village and massacred 58 people. The bodies were buried in mass graves, but days later, to hide the evidence, the forces returned, dug up the corpses, and took them away, leaving the graves empty.

Now think about the psychological impact of that.

I can't even imagine.

The grief of losing up to 5 family members at once was unimaginably compounded by the cultural devastation of not having the bodies. According to Muslim tradition, they couldn't perform the proper funeral rites, right? The normal pathways for communal grieving, the rituals that help a society process loss, were completely blocked.

So how do you treat that with a Western individual therapy model? You really can't. You can't just give someone a coping worksheet when their entire cultural mechanism for grief has been stolen.

Exactly.

The Kosovar professionals recognized that the entire family dynamic had to shift to survive this. Because the younger, stronger men had been killed, the elders, often the older women, had to step up. They had to take an active role in leading their massive extended families of widows and children.

And rather than just swooping in to diagnose everyone with trauma disorders, The Albanian Kosovar professionals actively explored these precise sources of newly formed strength. Yeah, they focused on enhancing family and community resilience, drawing on the existing resources within the Albanian Kosovar family structure to promote recovery. They supported these older women in their new leadership roles, which is brilliant. It's a fundamental pivot from asking what is broken to asking what is keeping you strong and how can we support that?

But that pivot from expert outsider to supporting the local community became incredibly personal for the ITSP shortly after. Because in September 2001, the international trauma expert suddenly became the local victim.

We are talking, of course, about the events of 9/11 in New York City. Dr. Jack Saul lived in downtown Manhattan, just 2 blocks from the World Trade Center site. His children were 5 and 8 years old at the time. They attended a public school right there in the neighborhood.

The text describes this surreal reversal. Suddenly, Saul is experiencing exactly what his international colleagues had warned him about in post-disaster situations. Downtown Manhattan turned into what the sources call a therapeutic supermarket.

If we connect this to the bigger picture, this is a classic pattern in disaster response. Journalists flood the area chasing the story, international relief organizations arrive, and importantly, there is a massive influx of outside trauma counselors and outside researchers.

Right.

Sahl offers a sharp critique here: "An enormous amount of funding was immediately directed toward training mental health professionals to screen for and treat post-traumatic stress disorder using Western clinical models." Wait, isn't an influx of trained professionals exactly what you want after a disaster?

Why is screening people for PTSD a bad thing in this context?

Because it pathologizes a normal reaction to an abnormal event. When an entire community goes through a collective trauma, feeling anxious, sleepless, or hypervigilant isn't necessarily a psychiatric disorder. It's a natural human response.

Oh, I see.

By immediately rushing in with clinical screening tools, the outside experts were essentially ignoring the local population: the parents, the teachers, the local organizations who had been there all along.

Who were already helping each other.

Exactly. These local groups were already engaged in grassroots efforts to cope and assist each other, but those organic efforts were largely undervalued and received almost no direct financial support.

In response to that disconnect, Saul and a group of parents and mental health professionals pushed back. They formed family support committees in the downtown elementary schools. They realized that while the city was focusing on screening children for PTSD, no one was asking the parents or teachers for input, right? And there was no place for the adults to discuss their own concerns as a community.

So they created the Downtown Community Resource Center. And what is brilliant about this is that they didn't just set up therapy couches, they focused on community engagement.

Yeah.

They created a community video narrative archive so people could hear each other's stories and record their own. They built a community website and pulling from their past experience, they created a dynamic theater piece based on oral histories.

The title of that theater piece is wonderfully ironic. Everything's Back to Normal in New York City: Below Canal. A work in progress.

A work in progress, which was literally true.

Yes.

During each performance, the actors would incorporate the audience's reactions from the previous show. The play shifted and changed as the experience of the people living in Lower Manhattan shifted and changed. It was a live, breathing catalyst for community conversation.

And the sources highlight how this period completely reversed the traditional flow of global knowledge.

Yeah.

Usually, Western experts export their models to the developing world, but here, The ITSP imported international wisdom to help New Yorkers heal. They brought in Dr. Nancy Barron, who ran a workshop presenting comprehensive community-based psychosocial interventions that had been developed in Uganda, Sudan, and Burundi.

And we should take a moment to understand what those African models actually look like in practice. In many traditional African societies, healing is not a one-on-one private chat behind a closed door. Right. It is deeply communal. When a crisis occurs, the response involves communal rituals, collective storytelling, and drawing upon the wisdom of community elders to solve psychosocial concerns as a group.

It's all connected.

It's about restoring the social fabric, not just repairing the individual mind. They brought those exact communal principles to New York City to help people cope with 9/11. Talk about flipping the script.

It proves that resilience is a universal human capacity, but the mechanisms to unlock it are deeply communal. And this understanding directly fueled the next major phase of the ITSP's work. From 2004 to 2007, which focused heavily on empowering grassroots leaders.

Bringing us to Staten Island.

Yes. Specifically, the Park Hill neighborhood, which was home to over 4,000 Liberian and Sierra Leonean refugees. The ITSP partnered with leaders of the West African community there to create a project called African Refuge.

Picture a busy, vibrant community drop-in center right in the middle of a housing project. This space was run under the leadership of Jacob Massacoy. He was himself a torture survivor who had escaped the civil wars in Liberia and gained political asylum.

Right.

Now remember the Tibetan refugees at Bellevue who were forced into a mental health diagnosis before getting help?

The systemic failure we talked about earlier.

Exactly. African Refuge took the exact opposite approach. They were dealing with a highly suspicious population living in a neighborhood facing extreme poverty and high crime rates.

Yeah.

If they had opened their doors and said, "Come in for trauma therapy," absolutely no one would have shown up. The stigma would have been too high, and the immediate daily survival needs were too pressing.

So instead, they offered what the community actually asked for. They offered immigration assistance. They set up computers and taught people how to use them. They helped people get access to health insurance and job counseling.

Practical needs.

They built trust first, offering incredibly practical services with minimal intrusive questions asked.

And once that trust was established, the true scope of the trauma became visible. A survey of the adults attending the center revealed that over 80% had experienced the recent wars, and nearly 50% reported personal experiences of torture.

50%. That is just heartbreaking.

It is.

But because they had a safe, trusted space, they could begin to heal. And once again, art played a massive role in that connection. They launched an initiative called the Coming Home Project. 8 diaspora elders living in Staten Island came together to create photo and video messages for their friends and family back back in Liberia.

A project coordinator, Serena Chaudhry, actually traveled to Liberia, delivered these messages, filmed the responses from their loved ones, and brought those films back to the Staten Island community. It culminated in a multimedia exhibit. Now think about the therapeutic value of this. It wasn't clinical therapy. It was the physical restoration of severed social connections across an ocean. It bridged the gap of exile.

Which is so beautiful.

Yeah.

But it leads to a really frustrating reality that the source material points out about how these projects survive, or rather, how they struggle to survive.

Yes. This raises an important question, and it highlights a massive structural challenge in the world of humanitarian aid: the funding paradox.

The funding paradox.

The text outlines this very clearly. When massive funding is released for refugee services or trauma response, it almost always goes to massive, large-scale organizations.

The big names. The ones with the polished grant writers and the massive administrative overhead.

Exactly. But those large organizations are outside the community. They have the financial resources, but they have absolutely no access to or trust from the local population.

Right.

On the flip side, you have grassroots community-based organizations like African Refuge. They are deeply embedded. They have the access, they have the cultural fluency, and they have the trust of the people who actually need the help, but they have virtually no money.

So what ends up happening? The large organizations with all the funding go to the small community groups and say, hey, can you refer clients to us?

Yes.

The small groups do the exhausting, time-consuming outreach work, navigating the cultural nuances, building the trust over months or years because they care about their community, but they don't get reimbursed for that labor.

No, they don't.

So the grassroots leaders end up depleting their own meager resources to help the large organizations hit their client quotas. It is completely backwards.

It is an exploitative dynamic that actively undermines local capacity. And it's exactly why the ITSP had to constantly advocate for these community organizations, insisting that funding and power be directed to the grassroots level where the actual trust resides, rather than forcing the grassroots to subsidize the large NGOs.

So what does this all mean for you listening? We've covered a lot of ground today, from Tibetan refugees in New York to testimonies in Chile, mobile teams in Kosovo, the aftermath of 9/11, and the African refuge in Staten Island.

We really have.

The core takeaway from all of this source material is that healing from massive trauma is not just about a private therapist reducing symptoms in an isolated office. Yeah. True healing requires a systemic approach.

Yes.

It requires human rights advocacy, acknowledging and respecting cultural traditions, utilizing the arts to share and reclaim testimonies, and crucially, trusting and funding local grassroots community leaders.

The ITSP's findings align perfectly with the guidelines published by the Interagency Standing Committee, or IASC, regarding mental health in emergency settings. The mandates are clear: do no harm, maximize local participation, and avoid the arrogance of imposing external standardized Western solutions on unique localized suffering.

Right.

You must build on the resources and capacities that the community already possesses.

It completely reframes how we think about recovery. And I want to leave you with a thought to mull over as you go about the rest of your day. We've been talking about catastrophic, massive trauma. But think about the everyday stressors, the personal crises, or the burnout in your own life.

That's a great point.

If the most profound healing from catastrophic trauma comes not from clinical isolation, but from reclaiming our stories and reconnecting with our community, How might that change the way you look at your own struggles? Are we constantly trying to treat ourselves in isolation when what we really just need is to connect with others?

A vital question to consider. Human resilience is vast, but it is rarely a solo endeavor.

Beautifully said. Thank you so much for joining us on this deep dive into the source material. Keep questioning, keep learning, and we will see you on the next exploration.