Wading into chaos: PTSD and other threats you can’t see

Robert Macpherson has been a writer, aid worker, and career infantry officer in the U.S. Marines with service in Vietnam, Iraq, and Somalia. After retiring from the Marines, he joined the humanitarian organisation CARE, where he spent 15 years directing global risk mitigation for staff and vulnerable populations and led humanitarian response missions worldwide.

He’s published a book, Stewards of Humanity: Lighting the Darkness in Humanitarian Crises, telling the stories of the people who have courageously confronted evil and injustice from Somalia to Bosnia, Rwanda, Iraq and Afghanistan. Hit the Iron Bell asked Robert about these remarkable human beings, his calls for more support for the mental health of humanitarians and his thoughts on the future of aid work (Part 2 below).

Question: You talk in your book about what you called the ‘first world problem of self-absorption’, of people caught up in ‘the world of Monday night football’. But you also talked about the overwhelming support for your ‘Bears for Bosnia’ initiative, where people donated teddy bears to help children affected by that conflict in the mid-90s. How can we break through people’s complacency and motivate them to take action – however small – to stand up for people they will never meet, on the other side of the world? 

Robert Macpherson: Anything that kids are involved in, because most people at some point in their life have kids. You can always touch people’s hearts through kids.

The other thing I thought about was that you have to personalize it.

I remember on late night TV in the States, I would see these ads for smaller NGOs. They would have an actor or an actress on; they would be talking about kids and how much help they needed. And if you sent $19.95 or $29.95 a month you would take care of one kid for a long time. I thought that, okay, that does personalize it.

I’m just finishing a blog about a doctor I’ve known for 50 years. He’s a quiet man. If you’re sitting next to this guy on an airplane, you would have no idea what he’s done all over the world. And while in the States most doctors are pretty well off – I’m not going to say this guy’s lived hand-to-mouth – but he’s spent a lifetime working for the good of people. He’s a true, if you will, ‘humanitarian’.

How do we make it across that boundary to expand all our minds to work towards the common good of everybody, and not how you can get your hands on your next Big Mac? There’s got to be some way that we all feel accountable. I think they we’ve lost a lot of that. Hillary Clinton wrote a book titled, ‘It Takes a Village’. Well, it does. It takes a world.

That’s why I have a lot of faith in the UN. For Western nations, people have to understand what those institutions are about and what they do. And they also have to be engaged enough to know that when they start hearing some phony stuff from politicians about some of these institutions, that they know what’s straight and what’s just stupid.

But again, I don’t want to say I’m pessimistic about it and I’m not by nature. But I still think that we have a way to go to open this up. We will eventually get there. I’m not going to live to see it. But we will eventually break the code and get this thing right, because we’ve got to keep ‘it’ alive, don’t we? And I guess ‘it’ is this spirit of collectiveness, of humanitarianism, this spirit that I’m not just accountable for my family. If I want my family and grandchildren and grandchildren’s grandchildren to have a safer world, we need to pull together to make that happen.

Question: You had a great quote in your book about how one person will ‘wade into chaos to help while the other will put as much distance as possible between them and chaos’. What do you think is the essence of what drives aid workers? What it is that makes these people to do something that’s so outside of the norm, despite the risks, the personal cost and the frustrations? Have you noticed any common threads?

Robert Macpherson: You know what, I’m not sure they have a choice. First of all, when I talk about the people in the book, I didn’t want to go over the top by making them heroes because they they’re just regular people. Remember we talked earlier about how it’s not a profession, it’s not a job: it’s their way of life. I think in many cases they have to do it. In The Guardian I read that there are probably 450,000 aid workers on the planet.

Maybe it’s like being an artist. You know, we see on TV or in the movies where these artists are tortured if they’re not painting – let’s use that [as an example]. They know something’s wrong; they’re uncomfortable.

For a lot of Marines, it’s a job, for some it’s a profession, but maybe for 10% or 20% it really was a way of life. And I’m not talking about all the shooting and everything else. I’m just talking about the idealism of that organization. Well, flip that over to aid work. So, if you’re driven by something that you have to do, you’re going to stay at it, come hell or high water.

And I’ll go back again now to taking responsibility for your own wellbeing. Because if you keep this up, not only will you suffer, but if you get pulled out because you now have malaria or something, the organization will continue to work, but it’ll take a dip. And God forbid that that dip just happens to be at the moment where the people that you’re there to support need it the most.

Question: To build on that point about mental health, which is so central to your message, you make a rallying cry at the end of your book for NGOs, governments and other donors to be prioritising the mental health of aid workers. Are you seeing a shift in the right direction?

Robert Macpherson: Yes; not enough, but I’m pretty impatient with this. I won’t get into this too much, but I talk about somebody in that book who died by suicide after an event. And the terrible thing is, I can tell you the number who I didn’t write about who died by suicide, who completely burned out, failed marriages, substance abuse – everything that goes along with PTSD. And this is really the dilemma. We talked about staff safety and security and on that side, it’s pretty obvious, isn’t it? You’re in an insecure environment, there’s bombs going off and people being kidnapped, people being wounded.

Those are pretty physical things. Mental health is entirely different.

The individual who likes what they’re doing is going to be reluctant to voice, ‘Hey, I have a problem.’ So the organizations have to make it absolutely clear to everyone: if you have a problem, there’s going to be no prejudice or stigma here. We’re going to help you with that problem and it’s not going to affect your employment.

I think too often we talk in the aid world about great management. Management is moving things. Management is logistics. Management is human resources, making sure you’re in the right position. But leadership is instilling a common value throughout your organization of mutual respect, of staff feeling safe (and I’m not talking about physical safety, I’m saying that someone understands their environment and their job and they’re leading from upfront.) And with leaders, when you get a few bad apples or managers, they’ll get them out of your way.

I finally had to admit I had a problem and I suspected it was PTSD, but I didn’t know. I live in America, I’m a retired US Marine. And where do I go? I walk into the Veterans Administration (VA) and within 48 hours, I was in treatment with a team. They get a bad rap on many things – and on many things they deserve it. But, if you think from the Vietnam War in America, this VA has been working with PTSD for a long time.

Too many times I’ve seen aid workers, myself included, say, ‘I’m just going to keep my nose to the grindstone here because if I go, it’s all going to fall apart.’ No, it’s not. And if you walk out for five days for some…rest, you’re going to come back and start doing a much better job.

Here’s the dilemma: say when you were 27-years-old, you just got your Master’s in International Relations from George Washington University in Washington, D.C. You’ve always wanted to be an aid worker. You can’t get into one of the larger organizations but there’s a lot of smaller ones; you get hired, your life’s looking good, your career’s starting. And we send you off to Somalia to Dadaab Camp. So, you work there for six, seven, 12 months. And at the end of that contract, whether you’re male or female, you decide to get married or for some reason you move away from that organization.

And all of a sudden, you’ve got a problem. What happens? I walk into the VA and they turn the world upside down to help me. But for that other person it’s probably just going to get worse and worse, and they have no place to turn. [Organisations need to] be able to follow up with all staff when they come out of complex environments and not just let them disappear.

I have a service dog here, Blue, and every year someone from Southeastern Guide Dogs comes to this house to check on his wellbeing. Every year I have to turn in a physical for him from the vet. He’s only on loan to me until he’s ten-years-old when he ‘retires’. If there’s anything I do that they don’t approve of, they’ve a right to take him away.

Think about the aid workers who we send home. Do we have any kind of follow-up with them?

It’s very personal to me, not so much because of my own problem – and I’ll never get over it, but we’ve got it well mitigated – but boy, when I wrote that book, in the beginning I have the ‘stewards’ [of humanity] and I list about a hundred and some names. I know what happened to most of those people and some of it is not good.

Question: The United Nations talks about a ‘new era of conflict and violence’ in the years ahead, driven by climate change and other factors. And you talk in your book about the devastating and deadly effects of foreign government action, or inaction, in different countries. Over your many decades of experience both as a Marine and then a humanitarian, have you seen signs that governments are learning the hard lessons about when and how to intervene in foreign conflicts?

Robert Macpherson: No. In fact, in the book I tried to stay away from what I felt were the failed actions of a couple of Western governments, because the book was about the people I was writing about and not my opinions about those things. But let’s pull that question apart.

First of all, I think of water. In the western part of the United States, in the next 25 years, 20 years, even 15 years, there’s going to be a time when places like L.A. or San Diego – imagine this – run of water.

Think about that happening all over the world, in cities where people are crowded together. Think about India, where tens of millions are crowded into these cities, and all of a sudden you can’t get a simple natural resource like water.

And as much as I would like to see these discussions coming up on climate [this interview took place just before COP26] move in a direction where we’re now addressing this issue properly, I’m afraid we’re not going to be there in time. So, then we have a problem. And that problem is going to cause a greater requirement for aid work across the planet.

So, I think that even Western nations like my own, or Canada, that have been blessed for all these millenniums of having these resources and not having to worry about something like water – they’re going to become much more centric. It’s going to be looking in rather than out.

I mean, I’m not going to get into politics, but the world certainly saw a shift in American attitude towards aid and development in the four years under the Trump Administration. So, I think that may be more and more the norm where it’s, ‘Let’s take care of ourselves and forget the rest of these people.’

I think that we haven’t even begun to see some of the levels of violence. I know this sounds grim and I’m sorry, but this is how I see it.

You know, in Somalia, as a Marine, I came face-to-face with starvation. Most of us in aid work have seen hungry people. Seldom do we see the level of starvation that I saw in Somalia. Obviously, there was a drought, but the reason it was so bad was because the warlords were using food as a weapon of war. So, you could starve the people in one clan and that allowed them to get greater power.

Well, I think there’s going to be much more conflict over natural resources. And I think with that conflict, you’ve got ideologies going on. Right now, it’s Islamic, and who knows where that radical fundamentalism will go. And I’m not saying it’ll always be with Islam. But you’re going to have that developing along with it. So, it’s going to get grim.

And then there’s always the politics. You know, Bill Clinton went to Rwanda and got all teary saying he was sorry he didn’t intervene when 800,000, or a million, people were killed in four months. So, there’s that side of: how much do we really want to involve our armed forces and expend treasure and people? We’ve just gone through 20 years of that in the United States and Afghanistan. I don’t think Americans want to see their troops launch off to any place for a long time.

Question: You talked about your friend, Mike McDonough. You said he proved to you that one person really can make a difference. So, I wanted to finish by asking you, do you still believe this, and why?

Robert Macpherson: I think the first thing he had going for him was he was Irish! Seriously, who doesn’t love the Irish? And I used this analogy in the Marines. If you line up 100 people and you say, these are the hundred finest leaders I’ve ever seen: 98 per cent of them learn leadership, which is a good thing, but for two per cent of them, it’s just natural. They’re just born with it. Well, McDonough was born with it.

But here we go back to [aid work] being a calling, a way of life. Mike loved what he does. And he was willing to step outside every boundary known to people who say, ‘We can’t, we shouldn’t.’ In the midst of the worst things, Mike was positive and he inspired people. And I’m not even sure you have to be a leader to inspire people; I’ve known brave people who aren’t leaders. But he inspired people.

If I want my family and grandchildren and grandchildren’s grandchildren to have a safer world, we need to pull together to make that happen