SURVIVING KOSOVO'S WAR WAS HARD. SO IS THE PEACE
By James S. Gordon

February 22, 2004 – (Washington Post) The tiny house in the Drenica region of Kosovo was colder and darker than the gray midwinter street outside. The windows were small and smudged, and there was no electricity. There was a single chair at a table on which sat a used dish and glass. I stood there in December, shivering in my warm parka, while a man who is 50 but looked 65 gestured at the picture of his son. The young man was a student when it was taken, later a soldier with the Kosovo Liberation Army. At 21, he killed himself in this small house, in a region where suicide has become all too common.

It was my 15th trip to work with ethnic Albanians in Kosovo since 1998. Then as now, my colleagues and I were teaching health and mental health professionals, teachers and mothers to use mind-body medicine (meditation, guided imagery, breathing), self-expression (through words, drawings and movement) and group support to deal with their own psychological trauma and in turn to help others.

When I first arrived in Drenica more than five years ago, there was war. In that poor but beautiful mountainous region, where the Kosovo Albanian armed struggle against the Serbs began, thousands of Albanian homes were being burned or bombed, and massacres -- of 10, 20 or 50 men, women and children in or in front of their homes -- were frequent. Fields, littered with the carcasses of slaughtered cattle, lay fallow. In the mountains where the populace had fled, old people and infants were dying of infections and exposure; mothers were frantic with worry about missing sons and husbands; fear filled their children's nights and the drawings that they did with us. Even in 1999, after the NATO bombing that
expelled Serbian troops, sorrow at the devastating loss of family and friends mixed with joy and pride in liberation.

For the last two years my colleagues in Drenica and I have had a different concern. This region, which is the geographic center of Kosovo as well as the cradle of its revolution, has become the center of a Kosovo-wide escalation of suicides. According to police statistics, which can't be considered completely reliable, there was only one suicide in Drenica between 1950 and 1999. In the four and half years since the end of the NATO bombing, 40 have been recorded among the region's roughly 150,000 people.

The exponential increase in self-destruction can also be seen in the southern rural region of Suhareka, where the war raged for 15 months and 90 percent of all houses were burned, according to the United Nations. There, the number of suicides has climbed from one every year or two in the decades before the war to seven in 2003 alone, local police say. In nearby Prizren, a region of 220,000, police figures for 2003 note 13 suicides.
The suicide rate for Kosovo overall may not seem high to Americans, as we lose 11 people to suicide per 100,000 each year. But in a place where close families and Islamic tradition once sustained those who were vulnerable to despair, and restrained those who might have acted on suicidal urges, an increase from one per 100,000 to the current rate of 10 or 11 or 13 is stunning.

The "psychological autopsy" of suicide is rarely easy. Still, some patterns emerge. There are, to be sure, individual psychological issues: Many of those who killed themselves are described by family members as lifelong "introverts;" a few had a history of childhood sadness, perhaps depression, and sudden rages. But beyond individual factors is the experience of war, and the poverty and social and emotional dislocation that have come in its wake. They saturate the lives of the despairing, and of their families, like dark water in a swamp.

More than15,000 and perhaps as many as 18,000 people were killed in the 1998-99 war in Kosovo. The vast majority were civilians, many of them women and children. The web of extended families and close community that has helped to sustain the living in their grief also ensured that nearly everyone lost someone they knew well. The years since then have been a disappointment. Kosovo's ethnic Albanians are now largely free of Serbian rule, but their hopes for economic recovery have dimmed. The unemployment rate in Kosovo is more than 60 percent, according to the government there, and those who can find work often must hold two or three jobs to feed their families. Only the region around Ferizaj, where 5,000 people still work for the U.S. Army, seems prosperous.

In poor rural areas, which almost certainly sent the largest proportion of young people to fight and which paid the heaviest penalty in loss of lives and property, freedom today feels like a prison of poverty. With little or no way to shape their own, or their country's future, young men, among them many veterans, feel isolated and paralyzed. Sitting idle for too many hours each day, they are overwhelmed by memories of damage and loss. Levels of post-traumatic stress disorder -- extreme agitation, emotional withdrawal, flashbacks and nightmares -- seem to be as high in Drenica and Suhareka, four years later, as they were in the months just after the war.

Late last year, I listened as families described loved ones they had lost to suicide. One, a man from Suhareka, had been a solider in the Yugoslav army in Croatia in 1991. His job was to pick up the body parts of Croats blown or hacked to pieces. Eight years later, he volunteered to help free his own land from the Serbs. After that war ended in 1999, the images of body parts, the terrible smells and the memories of the cruelty he witnessed in Croatia returned -- "re-traumatization," we psychiatrists call it. Like fog, they filled days emptied by poverty and underemployment, and obscured his future. "Blood will not be forgotten," he told his father. Two years later, he ended his life with a pistol he had used in the war.
During the war in Kosovo, a teenage boy in a Drenica village watched playmates die and was beaten by Serbian soldiers. Afterward, he came to believe that French NATO troops, who searched angrily for weapons, might turn their fury on him. Last summer he used a pistol, too.

The son of the man in the tiny cold house could not stay comfortably with his family when they left Drenica for the South. Haunted by memories of killing, pained by a war wound, finding no work in the south, he returned over and over to the grim cottage to which his father now returns. He used a Kalashnikov.

Women are also killing themselves, although here, as in most countries , in many fewer numbers than men. Sometimes the act appears to be a direct consequence of war: Rape by Serbian soldiers steeps a woman in shame, isolates her from her family and friends, and forecloses marriage prospects; suicide seems the only way out.

More often, though, the effects of the war on women who commit suicide are indirect and compounded by changes in the postwar culture. The girls at a rural high school in Suhareka dress and act like their American counterparts. They stop at the Internet café and watch satellite TV. They are living in the 21st century, but in their poor homes, disillusioned and disheartened fathers insist on 19th-century behavior and values. An example: A man in Gjilan who lost a son in the war became depressed, aggressive and increasingly authoritarian. He arranged a marriage between his bright, lovely daughter and an older suitor. When the husband turned out to be physically abusive, the daughter begged to divorce. "You'll not come home," her father told her. "I'll kill myself," she said. And she did.

Suicide may be a solitary act, but it reverberates among those who are close to it. In Kosovo, where extended families are often huge and community ties, if fraying, are still strong, the tremors are seismic.

Before his son's suicide, the man in the cold, dark cottage, was, I am told, witty and resourceful, a successful store owner. Now he is morose, has trouble working and makes little money when he does. His wife yells at her remaining children, weeps when they are minutes late and scans the radio for bad news. "The best part of our life is in the grave," the man says.

Suicide does not, according to the few studies on the subject, automatically increase after a war. But when soldiers are wounded physically and emotionally, when their sacrifices feel devalued, the rates increase. There are also more suicides when social dislocation is pervasive and economic opportunity is stunted, as it is among those who live in postwar poverty in refugee camps and slums in Asia, Africa and the Middle East. When both devaluation and dislocation are present, as they are in Kosovo, the ground is well-prepared for self-destruction.

Ever since my most recent trip there, I keep thinking about how ignorant we in America are about war and its consequences. I want to take those who commit us to war to meet the broken, grieving families in Drenica and Suhareka to remind them that war does not end with combat, "major" or otherwise, and that "victory" brings almost as much suffering as defeat. I want Americans to feel that those dead young people are our children, too, and that casualties are not only "over there" or "among those people."

Like them, our dead and wounded soldiers from the wars in Afghanistan and Iraq will not disappear from the lives of their families and communities. My experiences in Kosovo tell me that what our soldiers are seeing and feeling and doing will continue to haunt them, particularly if they have doubts about what they are doing. The suicide rate among our troops in Iraq is up, as reported by this newspaper last Thursday, and I worry that the discontent, depression and anger among the wounded who return is just beginning.

Author's e-mail: JGordon@cmbm.org

James Gordon, a psychiatrist, is director of the Center for Mind-Body Medicine, a nonprofit group working in Kosovo (and soon to be working with Israelis and Palestinians) to address the psychological trauma caused by war.

From: http://www.washingtonpost.com/wp-dyn/articles/A59366-2004Feb20.html