Case Study of PTSD in Ghana Armed Forces Personnel

Case Study of PTSD in Ghana Armed Forces Personnel CHAPTER ONE INTRODUCTION 1.1 Background to the Study According to The League of Nations was the first major organisation established after the First World War for conflict resolutions. Following the failure of the League of Nations to avert the Second World War, the United Nations Organisation (UNO) was established in 1945 to replace it. The United Nations (UN) is an international organisation, which among other things, aims to maintain international peace and security and to take collective and preventive measures to ensure global peace ( Rikhe, 1983). The need for peaceful co-existence and resolution of conflicts and wars necessitated the introduction of third party involvement in conflict resolution mechanisms in the nineteen century. The third party approach to settlement of conflicts and wars is practiced primarily by the UN, regional and sub-regional organisations through Peacekeeping Operations (PKO). Peacekeeping is defined as â€Å"the process of mediation, conciliation, negotiation and the management of conflict in a bid to bring peace in an area of conflict, violence or hostilities†. Peacekeeping involves the deployment of a neutral force (UN, Regional or Sub-regional body) in the field, with military, civil police and civilian personnel, in order to stabilize or dampen a conflict situation and provide viable opportunities for pacific resolution of conflicts. It entails peace-making and peace-building (Maj Agyemang-Bioh, 2000). In peace-making, an effort to settle the conflict through mediation, negotiation, concil iation and other forms of peaceful settlement is made using diplomatic action. Peace-building on the other hand, is â€Å"action-like†; it includes the identification and support of all measures and structures which will promote peace and build the needed trust and healthy interactions among former enemies; in order to avoid a relapse into conflict or recurrence of the hostilities. Thus peace-building is a social change through socio-economic development, rehabilitation and reconstruction; it actively seeks to eliminate the likelihood of direct or indirect violence in the conflict area, with the object of preventing further war and then to obviate any distress signal in the community (Ibid). The complex nature of modern conflicts and approaches to dealing with such conflicts gave birth to the term Peace Support Operations (PSO). Peace Support Operations are multifunctional operations in which impartial military activities are designed to create a secure environment and to facilitate the efforts of the civilian elements of the mission to create a self sustaining peace (Institute of Security Studies, 2000).  Ã‚   The concept of PSO refers to ‘the military, diplomatic, economic and humanitarian activities carried out in order to achieve long-term peace settlement and reinstate political and socio-economic stability to   a conflict or disaster situation (United Kingdom Joint Warfare Publication, 3-50). The terms Peacekeeping and Peace Support Operations are however, used interchangeably in this paper since both terminologies refer to the same concept. Additionally, the role of the peacekeeper has not changed significantly with the shift from PKO to PSO.   The first UN conflict resolution in Africa was in 1960 following the crisis in the Congo, now Democratic Republic of Congo (DRC).   Thereafter, the UN focused attention on all troubled spots in order to check crises before they escalated. It also encouraged the formation of regional and sub-regional bodies such as the Organisation of African Unity (OAU), now the African Union (AU), Economic Community of West African States (ECOWAS) and Southern African Development Community (SADC) to complement her efforts. This is in line with Article 53 of the UN Charter on regional organisations, which states that, ‘the Security Council should encourage associations or agencies that promote peace at regional level (Rikhe, 1983). Since its initial intervention in Congo in 1960, the Ghana Armed Forces has been involved in complex peacekeeping operations; from the civil wars in Rwanda, the Liberian and Sierra Leonean conflicts and the Ivorian conflicts, almost all commencing within the 1990s. All these conflicts were characterised by extreme cases of human rights violations and other violent crimes which have claimed so many lives and caused so much pain and suffering. In Liberia, Ghana was among the five leading member states of ECOWAS which deployed troops before the UN Security Council belatedly sanctioned it (Erskine (Lt Gen), (2000). Currently, the Ghana Armed Forces is providing contingents for United Nations peace support operations in Cote dIvoire, Liberia, the Democratic Republic of Congo, Sudan, and Lebanon.   A total of 3,250 troops are deployed for peace support operations in the five listed missions. As at 2008, Ghana was the sixth largest contributor of uniformed personnel to UN Peacekeeping (Un ited Nations Factsheet, 2008). Participation in these operations exposes military personnel to traumatic incidents. Since the twentieth century, a lot of changes have taken place in both the manner in which peacekeeping operations are executed and the circumstances to which the peacekeeping soldier is exposed to risk. Firstly, not only has peacekeeping operations increased in terms of frequency but they have also undergone a metamorphosis with regard to the manner in which they are conducted. It has been argued that previously peacekeeping soldiers were responsible for monitoring and observing cease-fire agreements between formally belligerent states (Liebenberg et al, 1997). Others contend that the 1990s witnessed conflicts where parties did not comply with peace agreements and/or disobeyed the rules of war (Olonisakin, 1998). He also refers to situations where peacekeeping soldiers themselves were viciously attacked. The nature of conflict also changed. In the pas,t conflict was characterised by being mainly inter-state, but today intra-state conflict is more prevalent (Nkiwane, 2000; Cilliers, 1999). Another indication of the changing nature of peacekeeping is illustrated in the roles that todays peacekeeping soldiers have to fulfill. The classic roles of the peacekeeping soldier to monitor the implementation of an honourable agreement between two or more parties in conflict; to act unarmed and guard a distinctly marked observation post, or to patrol a demilitarised cease-fire line, have become the exception rather than the rule (Potgieter, 1995). Thus, the evolving nature of peacekeeping duty in itself suggests that today peacekeeping soldiers are faced with new psychological challenges (Litz et al, 1997), and that it is no longer unusual for contemporary peacekeeping missions to include exposure to traditional war-zone experiences (Orsillo et al, 1998). The above conditions have the effect of increasing the stress levels of the peacekeeper. The ability to cope with stress is intrinsically related to psychological and material resources (Lazarus and Folkman, 1984), which are likely to be adversely affected by repeated traumatisation experienced during conflicts. Experience and appraisal of trauma tends to be related to both poverty (Muldoon, 2003) and social identity (Haslam et al, 2004). The most common psychological consequence of war and conflict is post-traumatic stress disorder (PTSD). The resulting stress has beenassociated with reduced cognitive, emotional, and behavioralperformance (Mitchell and Dyregov, 1993) and may negatively affect work performance (Paine, 1992).These findings have implications for both the career path ofthe worker and the efficiency and productivity of organizations. From the social identification perspective, the world may appear to be a frightening place and the trauma victim can feel powerless, helpless and incompetent. But in the interpersonal realm, the family is really affected. Post-t raumatic stress can cause the sufferer to become emotionally withdrawn and distant from family members. People affected can become overly needy and dependent, or outrageously demanding and impatient. Most of them can revert back to old habits like smoking or drinking, or become a newly hatched adolescent and engage in reckless, sometimes life threatening hobbies. PTSD is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened (Muldoon, (2003). Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat. These traumatic experiences could be caused by reasons such as near-death, serious physical injury, serious accident, violence, war, torture, any event that causes extreme fear, a horrifying event, or when one feels an extreme sense of helplessness (Ibid). PTSD can be categorized into four types depending on the length of time it takes for the disorder to appear and the amount of time it is present. These include; firstly, Acute Stress Disorder, symptoms of these occur within four weeks of the traumatic experience and lasts between two days and four weeks; secondly, Acute Post-Traumatic Stress Disorder, with symptoms lasting for more than four weeks; thirdly, Delayed Onset Post-Traumatic Stress Disorder, where symptoms appear years after the traumatic experience; and finally Chronic Post-Traumatic Stress Disorder where symptoms last for over three months with the symptoms disappearing for a few days and then reappearing. The major symptoms of PTSD include: exaggerated startle response, loss of memory (forgetfulness), sleep disorders (nightmares and waking up suddenly during the night), flashbacks or images of the traumatic incident that keeps coming back to haunt you, hyper vigilance (very similar to, but not paranoia), hypersensitivity, extreme irritability, anger over petty issues with violent outbursts, possessiveness, extreme nervousness and anxiety, muscle aches and pains for no apparent reason, unexplained fear, low self-esteem and lack of confidence (Mitchell and Dyregov, 1993). PTSD is categorized as Intrusion when the symptoms appear suddenly and happen when memories of a past traumatic incident keep coming back as flashbacks. These flashbacks could be induced by a variety of triggers such as smell, sight, or sound. Once the flashback is triggered, it is almost impossible to stop because the incident seems real with all the emotions involved. Nightmares are a good example of this. PTSD is categorized as Avoidance when a PTSD sufferer consciously or unconsciously tries to prevent remembering anything related to the traumatic experience. This may involve avoiding those close to you, or those you work with, causing misery to yourself and those close to you. PTSD is categorized as Hyper arousal when the symptoms are as a result of stimulated nerves and hormones. One could experience severe insomnia, and not remember the entire traumatic experience. During this phase one will have very poor concentration and will get irritated easily (Thompson and Gignac, 2000a ). PTSD can be treated. However, if left untreated, PTSD could remain lifelong, damaging ones relations with others and causing one several ailments, both physically and mentally (Solomon et al, 1996). 1.2 Statement of the Problem Post Traumatic Stress Disorder (PTSD) is common among people who have served in the military or any of the security or law enforcement agencies. The involvement and exposure of military personnel to combat and combat related situations expose them to risks which tend to affect them physically, mentally and emotionally. Some military occupations are more likely to witness traumatic events than others and thus be at greater risk. These occupations include frontline combat unit, combat engineers and medical personnel. It is often these same professionals or trades that are tasked repeatedly for peace support operations (Gignac, 2000). The fundamental components of combat power of the Armed Forces include the equipment and the personnel who carry out the combat roles. Therefore, it is important that all armed forces maintain a high state of personnel readiness (United Kingdom Doctrine for Joint and Multinational Operations-JWP 0-10). However, participation in combat and combat related activities exposes the military to stressful conditions. Over the years, the Ghana Armed Forces (GAF) have been exposed to battlefield hazards through their participation in peace support operations including the   Economic Community of West African States Monitoring Group (ECOMOG) operations in Liberia, The United Nations Mission in Sierra Leone (UNAMSIL), the United Nations Interim Force in Lebanon (UNIFIL), the United Nations Mission in Liberia (UNMIL), the United Nations Mission in the Democratic Republic of Congo (MONUC), the United Nations Mission in La Cote IVoire (UNOCI), and until recently, the United Nations Mission in Chad (MINURCAT). Exposure to such hazards of war in most cases result in mental and emotional tensions, injuries and death.   These situations usually result in what is referred to as stress on the part of the service personnel. It is therefore necessary that serious attention is paid to the problem of stress among participants of peace support operations. This research will therefore investigate and examine so cial identification and post-traumatic stress symptoms among participants of peace support operation, with the GAF as a case study. 1.3 Justification of the Study The military plays an important role in a nations development. They provide a congenial atmosphere for the overall development of a nation. Military personnel as a core element of the security services therefore need sound mind and body to be able to perform their duties effectively and efficiently. It is therefore important that attention is paid to the psychological and emotional needs of the military. Effective handling of post-traumatic stress related problems among personnel of the GAF will enhance their efficiency and productivity both at home and during peace support operations outside the country.The study will help come out with relevant information and recommendations that will help in assisting personnel who are affected by post-traumatic stress in the course of discharging their duties. It will also help reduce the incidence of PTSD among peacekeepers. This will help boost the morale of the personnel of the GAF both at home and on international peace support operations. 1.4 Research Questions The study will attempt to find answers to the following questions: What are the symptoms of post-traumatic stress disorders among personnel of the GAF? What are the effects of peace support operations on post-traumatic stress disorder and social identification? Which are the populations that are affected by post-traumatic stress disorders in the GAF? Is there a relationship between post-traumatic stress and the strength of social identification? 1.5.Methodology This research which is a case study of Social Identification and Post-Traumatic Stress Symptoms among personnel of the Ghana Armed Forces is a   qualitative research project hence the researcher largely employs the use of qualitative research design to include both primary and secondary data. Qualitative research is exploratory in nature and encompasses a range of philosophies, research designs and specific techniques including in-depth qualitative interviews; participant and non-participant observation; focus groups; document analyses; and a number of other methods of data collection (Pope and Mays, 2006). The primary data was collected from live interviews, focus group discussions and questionnaire administration. A total sample size of two hundred (200) was used for the study.   This comprised of interviews with thirty individuals, thirty persons in focus groups of six and one hundred and forty questionnaire which were administered to randomly selected personnel of the Ghana A rmed Forces. The secondary data were gathered from books, journals, articles, dissertations, and published and unpublished thesis.   1.6 Objectives of the Study The study has four-fold objectives. These are to: Identify and examine the symptoms of post-traumatic stress disorders among personnel of the GAF; Examine and analyze the effects of peace support operations on post-traumatic stress disorder and social identification; Examine and analyze the prevalent group of post-traumatic stress disorders in the Ghana Armed Forces; and Examine and analyze the relationship between post-traumatic stress and the strength of social identification. 1.6 Hypothesis The research hypotheses used in this study is tailored to suit a qualitative methodology that is interpretative rather than statistical. 1.6.1 Alternative Hypotheses There are symptoms of post-traumatic stress disorders among personnel of the GAF. Peace support operations have effect on post-traumatic stress and social identification. Post-traumatic stress disorders affect people of a particular group in the GAF. There is a relationship between post-traumatic stress and the strength of social identification. 1.6.2 Null Hypotheses There are no symptoms of post-traumatic stress disorders among personnel of the GAF. Peace support operations do not have effect on post-traumatic stress and social identification. Post-traumatic stress disorders affect every group in the GAF. There is no relationship between post-traumatic stress and the strength of social identification. 1.5 Limitations The research was limited in terms of data collection. Military personnel are generally sceptical about accepting their stress situations, largely due to the existing stigmatization associated with combat stress and PTSD. Nevertheless, the researchers status as a member of the GAF provided an insight into some of the issues relating to social identification and PTSD. The researcher further interacted with colleagues and other military personnel involved in post peace support operations to gain further insights into issues raised in the research. 1.6 Organization of Study The study is organized into five chapters. An introduction of the entire study is captured in Chapter one. Chapter two presents a review of the relevant literature. Chapter three outlines the methods of data collection while an analysis and interpretation of data and results is covered in chapter four. The fifth chapter is devoted to the summary of findings, conclusions and recommendations. CHAPTER TWO LITERATURE REVIEW 2.1Introduction This chapter provides the theoretical framework for the research.   It considers the views of some writers on Peace Support Operations and how they impact on social identity, stress and related concepts.   The study of these concepts will help in understanding the social identification and post-traumatic stress symptoms in post peace support operations among Ghanaian peacekeepers. 2.2 Social Identification and related Theories 2.2.1 Social Identification Social identification is the process by which an aspect of self- image is developed based on in-group preference or ethnocentrism and a perception of belonging to a social or cultural group. (APA, Thesaurus of Psychological Index Terms, 8th ed). 2.2.2 Theories of Social Identification Several theories have been formulated to explain how threats or stress affect social identification. Three of the well known theories are explained below: 2.2.2.1 The Integrated Threat Theory The theory of Integrated Threat was first identified by Walter and Cookie Stepan, when they attempted to explain how a groups prejudiceswere created by threats from other groups. These threats are said tobe present anytimeone groups actions, beliefs, or characteristics challenge the goal attainment or well being of another group (Riek, Mania, Gaertner, 2006).An individual group may feel threatened by another which is utilizing resources it needs to achieve its goals or to sustain its status as a group. These resources may be tangible, such as money or materials, or intangible, such as status, power or knowledge (Ibid). When resources are scarce, the group whichis threatened by the lack of resources finds itself motivated to compete for the resources in order to maintain its identity as a group or to achieve its goals (Ibid). This competitionpromotes negative attitudes towards those in the group utilizing the resources (Aberson Gaffney, 2008). The two groups in competition over resources can be described as the in-group and the out-group. The in-group can be described as the group of people with whom an individual categorizes himself/herself with. Members of an in-group feel a sense of commitment to the group and gain greater esteem from their sense of belonging to the group (Redmond, 2010). The out-group can be described as any group outside of an individuals in-group and a group that can be a potential rival/competitor for resources (Ibid). The in-group is the group which feels threatened, and the out-group is the group which is posing a threat to the in-group (Kendall, 1998). Intergroup threats contribute to conflict because they influence behaviors, perceptions, and emotions. An appraisal of threat can evoke strong negative emotions, including that of fear, rage, anger, resentment, frustration, contempt and insecurity. In addition, perceptions of threat reduce emotional empathy for members of the out-group. All of these negative emotions combined with the lack of empathy felt for the other group, can literally bring people to a breaking point. 2.2.2.2 Social Identity Theory Social Identity Theory focuses on the relationship between self-concept and group behavior (Hogg and Terry, 2001). The social identity theory was proposed by Henri Tajfel as a result of work he was doing in the 1970s concerning categorization and social perception, intergroup behavior, and the pursuit of social psychological understanding of the causes of prejudice and intergroup conflict (Abrams and Hogg, 1999). He believed that there was discontinuity between how people behaved when they related to others on an intergroup basis as opposed to an interpersonal or individual basis and sought to explain the behavior of people in group situations (Abrams and Terry, 2001). Tajfel identified three components of social identity, self-conceptualization, group self-esteem, and commitment to the group, which when met, lead a person to feel connected to their in-group. As a result, all other groups become out-groups and are rivals for status and resources as well as a source for comparison. Th is can lead to discrimination in favour of the in-group or against other out-groups as well as stereotyping and prejudice when a perceived threat occurs (Redmond, 2009). According to the Social Identity Theory, social identity and intergroup behavior is guided by the pursuit of evaluative positive social identity through positive intergroup distinctiveness, which in turn is motivated by the need for positive self-esteem (Hogg Terry, 2001). In other words, a persons behavior will be affected by their positive association with their in-group, when their self-esteem and/or status are elevated by that association. Central to this theory are three components identified by Tajfel: self-categorization, group self-esteem, and group commitment. 2.2.2.2.1 Self-Categorization Self-categorization refers to a persons belief that he/she belongs to a group. A person must categorize or identify him or herself as a member of a group in order to have their self-esteem elevated through association with the group. According to this theory, categorization sharpens intergroup boundaries by producing group-distinctive stereotypical and normative perceptions and actions and assigns people, including self, to the contextually relevant category (Ibid). In addition, self-categorization can reduce uncertainty about themselves and others and about how they and others may or ought to behave in specific social contexts (Ibid). The core of an identity is the categorization of the self as the occupant of a role (Stets Burke, 2000). By assigning roles to individuals that are self-categorized as being part of a group, individuals can derive meanings and expectations associated with their roles, and as a result, are able to create values based standards that motivate and guide b ehavior. 2.2.2.2.2 Group Self-Esteem Group self-esteem refers to the positive self-esteem or self-identity gained through membership in a group. In order to categorize ones self as a member of a group, membership in the group must hold some value for the person such as improvement in their status or positive personal identity through the association with the group. The theory suggests that people have a need to see themselves in a positive light in relation to relevant others (Hogg and Terry, 2001) and that this can be achieved in a group context through making comparisons between in-group and relevant out-groups in ways that favour the in-group (Ibid). 2.2.2.2.3 Group Commitment Group commitment refers to the strength of the commitment a person feels to their in-group. This is important because if an individual believes they can move into a higher status group, this person will be unlikely to show much solidarity or engage in much direct intergroup competition and will instead attempt to disidentify and gain psychological entry to the dominant group (Ibid). When a person identifies him or herself with a group, gains a positive self-esteem through the group, and feels committed to the group, the person will be motivated to maintain the group and their memberships in the group (Redmond, 2009). There can also be adverse consequences, however, to an individual over-identifying with a group. When a person becomes too attached to a group, it can lead to stereotyping and the degradation of out-groups as well as overdependence, antisocial behavior, decreased creativity, and a decreased sense of self for the individual (Hogg Terry, 2001). As a result of being too attached, the lines that once separated the individual identity from that of the group may become blurred. If this loss of individuality takes place, it may result in a decreased ability to create an independent self concept apart from the group. 2.2.2.3 Social Dominance Theory The Social Dominance Theory originated in an attempt to combine the more classical theories of social behaviour such as Marxism, and more contemporary theories such as Social Identity Theory into a unified behavioral model to explain bias in group behavior (Sidanius Pratto, 1999).The Social Dominance Theory is based on the idea that in virtually all societies, group-based hierarchies are formed in which both dominant and subordinate groups co-exist. As is naturally the case, the dominant group(s), referred to as having positive social value in the group structure; has access to rights and privileges that are denied to subordinate group(s) because their (negative) social value and ability to bring to bear power and resources are limited (Ibid). A principledistinction between Social Dominance Theory and similargroup-based social theories, such as Social Identity Theory, is that group members are not only motivated to protect the group to preserve their social status, but feel compelled to justify their group behavior (dominant or subordinate) through ahierarchicalsystem represented through the following omponents:Legitimizing Myths, Trimorphic Structure, and Social Dominance Orientation (Redmond, 2009). 2.2.2.3.1 Legitimizing Myths Dambrun, et al.(2009)upholds Sidanius and Prattos contention that both dominant and subordinate groups strive to sustain group-based hierarchies by the development of opposing ideologies that promote, or attenuate group inequality and domination; otherwise referred to as legitimizing myths. In other words, social groups play off each other through social policies to maintain the group hierarchy but are motivated to do so for different reasons. The differences between these reasons are referred to as behavioral asymmetry (Redmond, 2009). Asymmetry occurs when the dominant group wishes to maintain their positive social status, yet the subordinate group wishes to climb the proverbial ladder and participate in the myriad advantages of the dominant social group. As selfish as we are, social groups are not fully inclusive. These groups seek to maintain their social status by justifyingbehaviors through mitigating perceived gaps in social status. This is accomplished through legitimizing myths in the form of perceived negative stereotypes, values and beliefs against the opposing groups. â€Å"Legitimizing myths consist of attitudes, values, beliefs stereotypes, and ideologies that provide moral and intellectual justification for the social practices that distribute social value within the social system† (Sidanius and Pratto, 1999). Legitimizing myths can be broken down into two distinct groups: hierarchy-enhancing legitimizing myths (HELM) and hierarchy-attenuating legitimizing myths (HALM). HELMs not only organize individual, group, and institutional behavior in ways that sustain dominance, they often lead subordinates to collaborate with dominants in the maintenance of oppression (Pratto et al, 2006). 2.1.2.3.2. Trimorphic Structure of Group-Based Hierarchies Our predisposition to join groups is an essential element of Social Dominance Theory that assumes a trimorphic structure of group-based social hierarchy in which members are stratified into social groups based on characteristics related to the following three structures (Sidanius and Prato, 1999): Age A biologically-based system where adults are classified as socially higher (valued) than younger people. Gender Another biologically-based system in which males are classified as socially higher than women. Arbitrary set -Group-based hierarchies determineits orderbased on a virtually limitless set of factors including personal preferences, religion, beliefs, class, ethnicityor values.The age and gender systems are fixed in terms of their applicability to social groups. In other words, these stratification systems extend to all social systems as members invariably fall into a range of either group. The inclusion (or exclusion) of membership within the arbitrary set system however, is dependent upon the factor(s) applied to the group. For example, a social group based on ethnicity or religion will include a very specific subset of participants to the exclusion of all others. For these reasons, the arbitrary set system represents the most dynamic group-based social hierarchy. This system has the potential to be the most inclusive (and positive) in terms of being socially constructive, as well as the most exclusive, or socially destructive. 2.1.2.3.3.Social Dominance Orientation To better predict social group bias, Social Dominance Orientation (SDO) was developed to measure the extent to which individuals manifest discriminatory behaviors(Sidanius and Prato, 1999). SDO is defined as the degree to which individuals desire and support group-based hierarchy and the domination of inferior groups by superior groups (Ibid). 2.2. Concepts of Stress and Post Traumatic Stress Disorder 2.2.1. Combat/Traumatic Stress Stress is a word that is often used to cover a whole range of feelings and emotions. There are many varying definitions of stress. Some researchers distinguish between eustress (when something changes for the better) an