Athena Madan: How to build resilience among individuals who experienced political violence

In brief

Athena Madan saw the psychological effects of political violence while working with refugees from the Algerian conflict in France and through her field experience in the Democratic Republic of Congo (DRC). For her PhD research project, Athena decided to interview individuals who had experienced state-sanctioned violence, and find out how the mental health system can better serve them.

She found that participants view the traumatic events they lived through in spiritual and relative terms, and in some cases, injuries felt political more than traumatic. Athena feels that trauma as a mental health diagnosis may not in fact be helpful, producing victims instead of enabling resilience. She also thinks that service providers and others working in the health and social services system need to have a better understanding of political and structural inequities specific to the DRC.

Athena Madan

In our latest Student Spotlight, EENet profiles Athena’s research.

Read about her story below or access the PDF.

Student Spotlights are brief profiles of up-and-coming student researchers.

What you need to know

For her PhD research project, Athena Madan interviewed refugees from the Democratic Republic of Congo (DRC) living now in Canada, supplemented by individuals and former colleagues living there. Her goal was to find out how the mental health system can better serve people affected by state-sanctioned violence, and how the mental health education system conceptualises trauma in the treatment of post-traumatic stress.  She found that participants view the traumatic events they lived through in spiritual and relative terms, and in some cases, injuries felt political more than traumatic.

Athena feels that trauma as a mental health diagnosis may not in fact be helpful, producing victims instead of enabling resilience. She also thinks that service providers and others working in the health and social services system need to have a better understanding of political and structural inequities specific to the DRC. 

About Athena

In Spring 2014, Athena Madan successfully defended her PhD in Sociology and Equity Studies at the University of Toronto. Her research interests include global mental health, photojournalism, and humanitarian and emergency medicine. Her past experience includes psychosocial research, practise, and humanitarian relief in Afghanistan, Bangladesh, the Democratic Republic of Congo (DRCongo), India, and South Africa. She has also taught in England, France, and the United States. Athena is half Filipino and half Indian, and enjoys taking photos, playing bike polo, and running half-marathons. 

What is Athena’s research about?

Some back story

Athena Madan saw the psychological effects of political violence while working with refugees from the Algerian conflict in France. She also undertook field experience in the DRC in 2011. While working with refugees in Canada, she came to see that medical residents here are poorly prepared to fully understand the complex psychological needs of individuals who have been traumatized by political violence. She also had a case experience that touched her both personally and professionally, and which she says motivated her research project. 

While working in a Montreal health clinic, Athena provided psychological support to a Congolese refugee, named Nteza, who had become pregnant as a result of rape while her husband was a political prisoner. Nteza had been diagnosed with post-traumatic stress disorder, and after the birth, her case worker, a colleague of Athena’s, reported that during a home visit, Nteza looked unresponsive and unhappy. The case worker interpreted something Nteza said as demonstrating that she wanted to take her life at a place not far from her home, so she decided that Nteza should be admitted to the hospital emergency room for a psychiatric assessment. Nteza was resistant and did not want to be separated from her children, and said that she was not in fact depressed. 

Athena tried to explain to the case worker that Nteza did not mean that she wanted to take her own life, but rather that her expression was metaphorical; the place was tranquil / “uncluttered from troubles” to Nteza and symbolised a place where she could feel at peace. The misunderstanding, Athena felt, was due to a poor understanding of not only Nteza’s culture and language, but her lived history, and the DRC’s historical circumstances.

Nteza was taken to hospital, where she was placed on suicide watch. Athena tried to convince child services that the children be placed with the pastor who had provided a home in Canada for Nteza and her children, as Nteza and the pastor had requested, but the children were placed in foster care instead. 

Nteza was released 17 hours later with a diagnosis of post-partum depression and one sample of antidepressant medication. She was reunited with her children, though child protection services continued to monitor her regularly. Nteza never returned for services, either to Athena’s clinic or the hospital. 

This experience marked Athena at a personal and professional level. She felt that the social services system did not meet Nteza’s needs or understand her complex circumstances – the system did not understand the dimensions of state-sanctioned violence or the way individuals like Nteza perceive their history.  She hopes that her research will help improve services for DRCongolese people seeking care, improve preparedness for individual clinicians, and provide advocacy as well as a rationale for more comprehensive treatment options. 

About the project

How to better assist people who survived political violence 

Athena’s goal was to answer several questions:

  • How can mental health interventions better assist people who survived political violence?
  • How can their stories inform and improve traditional approaches to mental health treatment, specifically how trauma is viewed within mental health education and discussions about resilience in the face of traumatic stress?
  • Are there approaches to treatment or alternate pathways to care that might avert traumatic stress for people who lived through political violence?

For her study, she conducted qualitative and exploratory interviews with seven individuals who had migrated to Canada from DRC in the past 15 years. To recruit subjects Athena used snowball sampling, a technique where existing study subjects recruit future subjects from among their acquaintances. These individuals lived in Toronto, Hamilton, and the Niagara region, with some also in Montreal. She also conducted three phone interviews with individuals and former colleagues living in Kinshasa and Kivu.

What she found

Political and structural inequities

Athena found that recovery has implications at the individual, group, and geopolitical levels. 

Individual levels of treatment. Individuals Athena interviewed had a different understanding of trauma as a concept compared to how it is taught in the mental health system. Study participants saw the violent events they experienced through a spiritual and relative lens, and some injuries as being political rather than traumatic.

Group and systems levels: The symptoms they discussed were not self-reported; they had been identified during assessments by various workers throughout the immigration process. Athena feels that diagnoses such as post-traumatic stress disorder or depression may in fact lead to producing victims instead of building resilience. The type of care that participants said they need in order to heal has similarities with recovery-oriented, community-based, and rights-based models of care.

Geopolitical levels: Participants mentioned three specific ways in which geographic/ political forces affect their wellbeing: 

  • The psychic, spiritual, and social legacies of Belgian colonisation in countries like DRC have resulted in individuals “feeling perpetually second-rate”; 
  • The mining industry (coltan and diamonds) perpetuates regional conflict and conflict involving children; and 
  • Foreign aid and international attention, abundant after the Rwandan genocide, are largely absent for DRC, although the genocide/war there has sustained more brutal and horrific losses.

Athena says that individuals who have experienced political violence would be better served and may achieve better outcomes if service providers and others in the health and social services system have a better understanding of political and structural inequities. When making a diagnosis and treatment decisions, service providers should also try to better understand how the individual perceives their own experience of violence.  

What’s next for Athena?

This fall, Athena will begin a postdoctoral fellowship at the Canadian Institute for Health Research Social Aetiology of Mental Illness Training Programme at CAMH, where her work will focus on child soldiers in Afghanistan. She will also be doing some consultancy work for Médecins sans frontières. 

For more information contact Athena at athena [dot] madan [at] camh [dot] ca.

Project Title: State-sanctioned violence and mental health: Implications for learning and treatment 
Project Supervisors: Kwame McKenzie, MD, FRCPsych, the Centre for Addiction and Mental Health (CAMH) 
Funding source/budget: Ontario Graduate Scholarship; Doctoral Completion Award from the School of Graduate Studies at University of Toronto 
Author: Rossana Coriandoli
Date: July 7, 2014

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