I arrived in Nablus in 2008, amid the human and emotional devastation that followed the Second Intifada. As a psychologist with an international NGO, I came to the West Bank to provide therapeutic support to Palestinians who carried the wounds of the ongoing conflict and military occupation: I worked with former prisoners, mothers who had lost their sons in armed operations, families whose livelihood was constantly threatened by expansion of Israeli settlements.
Like most newcomers to the field my idea of humanitarian work had been influenced by the image conveyed by the media: men and women flying off to remote locations to help survivors of natural catastrophes and tragic wars. Needless to say the Palestinians quickly taught me the lesson I needed to learn: at best humanitarian professionals are “selfish altruists” whose desire to help “distant strangers” is a way to fulfil our own need for meaning and purpose. There is still a sort of mythical rhetoric around humanitarian work that prevents us from recognising “that our personal motives are likely to combine psychologically healthy moral drivers with some fairly dysfunctional motivations too” (Slim, 2015: p. 233). This often goes hand-in-hand with an incapacity to see the humanity and vulnerability that accompanies those who take up humanitarian work. If the principle of humanity is about addressing suffering wherever it is found, and the purpose of humanitarian action is to protect life and ensure respect for human beings, then humanitarian agencies have the moral duty to apply this very principle to the humanitarian individual as well.
This reflection accompanied me as I became aware of how in an attempt to care for others, the first casualty could be my very own mental health. I soon learned that the biggest stressor for all of us in the team were not military checkpoints, but strained relations with managers, team conflicts or what in hindsight seem petty discussions over washing up or curfew. Threats to our well-being came from within, not just from the volatile political environment. This meant that I was much more at risk of burnout, or physical, mental and emotional exhaustion due to a combination of my own “saviour complex” and organisational dysfunctions, than of post-traumatic stress disorder (PTSD) caused by living and working in a conflict-zone. More and more I started to turn the psychological mirror towards myself and my own people, humanitarian professionals. My initial question was: how could we be best equipped to work with people who are suffering due to political violence? This is where mindfulness began to play a role in my humanitarian work leading me to a sequel of questions and dilemmas that I continue to research today several years after working in Nablus. What kind of individuals choose a humanitarian career? What motivating factors make one decide on such a potentially dangerous profession? What are the main causes of stress and suffering for aid workers? How do they respond psychologically? How do humanitarian agencies support their staff? And most importantly how does the mental and emotional health of aid workers affect their work in the field? My primary interest lies at the intersection between individuals’ mental health, organisational culture and humanitarian action: can our own well-being and the culture that we breathe in our agencies be a catalyst for effective and humane action? And when do they become an obstacle?
In an attempt to shed light on these questions I decided to share with aid workers the self-care practice that I had found helpful as a field psychologist. In 2011 I set out to teach mindfulness for stress reduction and burnout prevention to humanitarians in Palestine. Mindfulness is a practice based on ancient Buddhist meditation and even in its secular western form it can be beneficial at different levels: 1) as a self-care approach, an 2) as an ethical reflective practice. As a self-care approach mindfulness entails that we intentionally sit quietly, breathe and be aware of body sensations, emotions, thoughts racing through the mind. Making space for stillness and silence is essential for aid workers who are engaged in frantic and demanding activities that can wear them down physically, emotionally and mentally. Taking stock and bringing attention to what goes on within us can help us relax and prevent the spiralling of suffering. As an ethical reflective practice, mindfulness can be defined as the capacity to make wise decisions in the face of uncertainties and/or adversities, while maintaining a compassionate attitude towards oneself and others. A such the practice can help humanitarians to be more aware of a whole range of issues that sit in the shadow of aid work such as power dynamics, or inappropriate behaviours that contribute to the decaying image that humanitarians have in the field. In this way it can open a space to reflect on the ethical implications of our actions. Like a bird, mindfulness has two wings: compassion, which includes self-care, and wisdom which encompasses reflection on the self and its interaction with the world. Both qualities of mindfulness are important for the humanitarian individual: self-care without reflection can make us self-indulgent, reflection without self-care can make us cynical, self-righteous and cold. Today we see much of the mainstream practice of mindfulness stripped of its ethical dimension and turned into a self-care commodity alongside yoga, massage therapy or a spa treatment. But ethics is an essential component of mindfulness, as it is of humanitarian work. As Hugo Slim writes in his new book Humanitarian Ethics (2015, p. 231): “The way each person in every agency decides to be humanitarian when he or she gets up in the morning sets the tone of humanitarian ethics around the world. If most of us choose to be principled, practical, daring, courageous and thoughtful, and keep struggling to stay close to affected communities and create solutions with them, then humanitarian action stands a good chance of being relevant, effective and respected. If too many of us become cynical, cautious, bureaucratic, self-interested, inefficient and prefer to sit with our laptops rather than with people suffering around us, then our agencies and the humanitarian system will reflect these attitudes and attract resentment rather than admiration.” In mindfulness as well as in humanitarian practice we cultivate ethics, not as some abstract speculation, but in the lived everyday experience, with its nagging problems, strained relationships with HQ, and difficulties with managers and colleagues. The idea of alleviating the suffering of others without cultivating humanity and respect towards oneself, and towards one’s most immediate peers – that is within our own organisations – is a flawed enterprise.
Aid agencies still carry a “macho culture” where the psychological health of field staff is generally ignored, unless some critical incident occurs. But being a humanitarian and not being touched by the suffering witnessed, is as dangerous as crying at the sight of every person in distress, because by numbing out we lose our empathy and humanity. In a sector where job instability runs high, and mental health is still stigmatised, aid workers are known to hide their own suffering for fear of not being seen fit for the job. What if humanitarian agencies cultivated from within the very humanity that they purport to have for “distant strangers”? In their strive to alleviate the suffering of others, some agencies may have forgotten that the well-being of their most valuable asset, that is their own staff, matters. If humanitarian agencies want to fulfil their duty of care to prevent and address potential traumatic events, not only do they have to be mindful of external threats such as abductions, and other forms of violence against aid workers. They also need to look within for “internal vulnerabilities” (Fast, 2014), foster peer support, cultivate soft-skills, and instil empathy, respect and care within their own culture. Mindfulness is no panacea and I am afraid that its deeper value, which is its ethical stance of wisdom and compassion, has been hampered by a supermarket of self-help gurus. Yet, if we remain true to the spirit of meditation, with its combination of ethical self-care and reflection, it remains a valid and inspiring approach that can help aid professionals to cultivate humanity and develop moral courage, while remembering that care and respect for others start from within ourselves and within our organisations.
Fast, L. (2014) Aid in Danger: The Perils and Promise of Humanitarianism, University of Pennsylvania Press: Philadelphia
Slim, H. (2015) Humanitarian Ethics: A Guide to the Morality of Aid in War and Disaster, Hurst Publishers: London
Alessandra Pigni is a clinical psychologist, she has worked for MSF and other local and international NGOs in Israel/Palestine. She is currently visiting research fellow at the Institute for Ethics, Law and Armed Conflict at the University of Oxford. She runs the blog mindfulnext.org to support humanitarians and reflect on the psychology of aid.