Uprooting, trauma, and confinement: psychiatry in refugee camps, 1945 -1993

This thesis is a history of psychiatry through the lens of refugees, and a history of refugees through the lens of psychiatry. It explores the history of psychiatry in medical humanitarianism and refugee relief from the end of the Second World War to the end of the Cold War. My research shows that throughout the period under study, psychiatrists have approached refugees through three perspectives: as uprooted and homeless people, as people confined in a camp and dependent on humanitarian assistance, and as traumatized victims who have been through horrific experiences. I trace how the notion of ‘trauma’ came to occupy a central place in discourses on refugee mental health. The centrality of the trauma of the Holocaust to the psychological legacy of World War II did not figure prominently in the minds of humanitarians, doctors, and policy makers in the immediate aftermath of the war. Europe’s refugee problem was seen in terms of population displacement and not the aftermath of genocide. At the time psychiatrists pointed not to the horrors of Nazi persecution, but to the event of ‘uprooting’ from the homeland as the major cause of psychic suffering in refugees. Despite a flurry of activity on the mental health aspects of camp containment, repatriation, and resettlement in the 1940s and 1950s, much of this work was forgotten by the 1960s when refugees became a Third World phenomenon. Throughout the 1960s and 1970s, very little attention was paid to mental health in humanitarian crises. The limited engagement with mental health issues in refugees in postcolonial independent African states happened in the context of modernisation and nation building rather than humanitarian relief. This trend was reversed in the 1980s, when a new generation of Western humanitarians brought their own historical baggage emanating from the legacy of the Holocaust to refugee camps on the Thai-Cambodian border. The notion that Cambodians were uniquely traumatized was a popular one, and it was here that the idea of trauma and the now ubiquitous diagnosis of post-traumatic stress disorder were first applied in a humanitarian crisis. In this PhD, an interdisciplinary project encompassing history of medicine and refugee studies, I seek to historicize what Liisa Malkki has called the ‘psychologizing modes of knowledge and therapeutic forms of relationship’ that refugees are often subjected to by those who study them