Stress and Burnout: Western concepts?

In a recent article for Open Democracy, I wrote that although increased awareness of mental health problems in the aid sector is encouraging, we have to be cautious that such problems aren’t confined solely to the white aid worker’s experience. I would like to build on that article by offering a few more examples from my doctoral research, to highlight the complexities of stress and wellbeing in the sector.

“I think they also don’t necessarily understand what it is, a lot of them. […] The first person I officially told was [my Congolese colleague]. […] I just basically in that conversation said I’m having a burnout, and he was like, ‘a what’? And I was like, ‘a burnout’ and he was like, ‘I have never heard of that, like what is that, I’ve never heard about it.”

This quote comes from a European woman who was suffering from a range of mental and physical health problems when I conducted my doctoral research in Kenya in 2015/16. After months of seeking help from different clinicians and therapists, she was told by one psychotherapist in Nairobi, also European, that her symptoms had the hallmarks of a ‘burnout’. This enabled her to negotiate extended sick leave with her employers at an international NGO with a regional office in Nairobi that covered multiple countries, including the one within her remit – the Democratic Republic of Congo.

Her Congolese colleague did not appear to have heard of this term, ‘burnout.’ I found this interesting as it resonated to some extent with what other aid workers from African countries had suggested to me: that stress, or stress-related conditions, weren’t really ‘a thing’ for them, in their societies. One Somali woman who was a diplomatic official said to me, when I told her about my research at a barbecue in Nairobi, “We don’t get stress in Africa. Stress is a western concept.” This was echoed by two Kenyan men working for a refugee organisation in Kakuma in northern Kenya, who told me that discussing stress, or seeking counselling for it, was “not so African,” with one of them admitting:

“To me it is a foreign concept. Not foreign but, er…it is not a concept instilled in me. As in at no one point can I tell someone ‘I’m stressed’ because I don’t really understand what stress means.”

Should we assume then that many aid workers in Africa don’t actually get stressed? This of course would not only be a sweeping generalisation, but also overlooks something more complex: how our social conditioning contributes to the way we conceptualise and respond to problems in our lives. In my thesis I argue that part of the reason why so many aid workers from western countries talk about, and claim, mental health problems is because we are used to pathologising our experiences in these societies: in seeking clinical explanations, and solutions, for our problems. Yet this pathologising does not occur all contexts, particularly when living in situations of acute impoverishment or conflict, where access to medical services is often limited.

Further examples from my research highlight this point. A group of aid workers I met from Somalia at a stress management workshop I facilitated in Nairobi told me about how they approached the everyday situations of violence and armed attacks in their neighbourhoods. They would often joke when they heard shootings or a bombing outside their office, that the popcorn was going off again. And one woman told me that she found it amusing how when these incidents occurred, her international colleagues visiting from Nairobi would often be on the first flight home; yet she is exposed to the risks of these attacks every day when she travels to work, and had family members who had lost limbs as a result of such incidents.

Referring to the regularity of armed attacks in Somalia, an Ethiopian aid worker who had lived and worked there for long periods, told me:

When that becomes every day a part of their life, if that happens every day, and the day after, for the last 25 years, at the end it becomes just a joke. The children in Mogadishu can tell you the sound of the gun, what gun that sound is… Is it from AK47? Is it from M16? Is it from Russian gun? Is it from American or Chinese gun? They can tell you the truth! So sometimes the concept of our western and…sort of, people who are not part of this mess, of stress and trauma and depression and that…is absolutely different when you talk to these guys who had that mess as part of their lives. I’m talking about the local aid workers as well…”

These remarks show us that stress may well be the part of everyday experience for some aid workers, in a way that doesn’t lead to pathologising but instead to finding ways to endure and carry on with life. National staff in particular do not have the same options to leave when the going gets tough, so they find ways of putting up with, and even making sense of, very challenging experiences. Religious faith played a big part in the lives of many of the Somali and Kenyan aid workers I met; it was the lens through which they made choices and took action in their lives, and through which they found meaning from suffering. As one Kenyan woman working for a development NGO told me:

My faith is more important now than anything else. Mostly because my faith helps me affirm my beliefs of who I am and what I’m capable of doing. Such that, as I step out, whether I’m stepping out or not, or as I face this matter, I face it with confidence.

There are two final, related, points to raise here. One is to acknowledge that these examples remain fairly general in their conceptualisations of stress; they are largely individualised, and don’t include the role of societal and organisational structures in framing human experience. That comes later in my thesis, where I discuss more how the expectations of one’s local community, and of one’s employers, result in the emotional lives of aid workers often being silenced or suppressed; and how a person’s gender, race or nationality all feed into how they experience their job and how they are treated in the workplace. (Other factors are of course also at play, such as social class and sexual orientation – but these issues did not arise so clearly in my research data.)

Secondly, recognising that some staff have their own ways of managing their hardships – for instance through their religious faith – does not let organisations off the hook. It is a problem within the aid sector, and more broadly within neoliberal societies, that self-care – whether it be prayer, breathing exercises or fitness classes – is seen as the panacea for all societal ills. When this attitude is taken, and when staff are encouraged to engage more with self-care practices, the structural and systemic problems within the aid sector remain intact, and it is simply business as usual. Stress, burnout, trauma – whatever we want to call these conditions – are structural, not just individual, problems requiring a collective response. I’ll end here with a passage from a manual I highly recommend for organisations seeking to understand what we mean by ‘trauma’ in African societies. In it, a Ugandan woman managing a women’s organisation, provides this insight:

I asked women in Samia, my own language: “what is trauma?” They described it as obuchuuni – a word you could translate as ‘pain’. In their explanation, pain meant discrimination, marginalization, denial of belonging, illness. All this caused them this invisible pain that affected their minds and body. That enabled me to start seeing how we could respond as an organization and start to deal with pain in their bodies, minds and spirits.

From: (Re)Conceptualizing Trauma: An AIR Convening (2014)

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