When Daniel Holland, a psychology professor at the University of Arkansas at Little Rock, set out to examine the role non-governmental organizations play in the health care infrastructure of post-communist societies, he was ready for some surprises. But, as someone who has devoted years of his life to learning, he didn’t expect the biggest surprise to be gaps he uncovered in his own knowledge.
Psychologists, he said, aren’t generally trained for international applications of their work. At the same time, however, many critical issues facing the profession – such as preventive health issues, international security, and population behavior – need an international focus.
Holland, who spent five months in the Slovak Republic last year, said the experience underscored how difficult it can be to conduct field work in another country. “The barriers weren’t huge,” he said, “but it was a good reminder that there are some things you can’t predict beforehand, and anything can happen.”
The Slovak Republic peacefully dissociated from the former Czechoslovakia in 1993 following the fall of communism in 1989, and the political infrastructure of the nation today is Byzantine. Many members of the current government adhere to democratic values, but there are also many who continue to support the values of the communist regime. In particular, the old guard believes that freestanding civil societies – such as community-based, citizen-driven health care organizations that help people with disabilities live independently – are anathema.
“Our society believes that these independent, non-governmental organizations are critical for a healthy democracy,” Holland said. “But if you believe in centralized government, then you don’t think the role any civil society organization plays should ever be divorced from the government. Many of those who hold to the old party line would like to see that whole sector just go away.”
Traveling on a Fulbright scholarship, Holland arrived in the remote town of Martin, home to about 40,000 residents of the Slovak Republic and Comenius University. He had known full well about that political schism, which exists through much of Eastern Europe, before he reported for work at the Jessenius Faculty of Medicine under the head of the department to which he was assigned. What he hadn’t known – and what came as the big surprise – was that the head of his department, in addition to being a member of Parliament, was vehemently opposed to the existence of the very organizations Holland had traveled across the globe to study.
“Politically, we were coming at this from two opposing positions,” Holland said. “It made for a very interesting experience. But it was a fantastic opportunity to learn about these forces, which are actually pretty well represented in that corner of the world right now.”
While disabilities are traditionally viewed as a problem with the psychological, physiological, or anatomical aspects of an individual – the so-called biomedical model – advocates of community health care and disability rights often argue that health is actually made up of biological, psychological, and social factors. That is, cultural forces have a great deal of influence on the definitions of both health
Holland spent months talking to people in the Slovak Republic who work with non-governmental organizations. These NGO’s are committed to meeting the needs of people with disabilities without warehousing them. But this is nothing new for Holland – he has explored models of noninstitutionalized care for people with disabilities during much of his career, a career that has been filled with community and alternative treatment from the very beginning.
Expanding Traditional Roles
Holland’s interest in community-based health treatment goes back to his days as an undergraduate. He was working on a degree in literature from Oberlin College, which he compared to “spending four years in a commune and then getting a bachelor’s degree at the end of it.” But he wound up in New York City for a semester at the Fountain House, a community-based recovery and rehabilitation center for people with mental illness. “I got a very early introduction to alternative models of treatment,” he said. That exposure inspired him to pursue a doctorate in clinical psychology from Southern Illinois University.
His undergraduate degree also influenced how Holland views his profession. “When you have a liberal arts background, one of the things drilled into you is an interdisciplinary approach to knowledge and life. The Fountain House showed me the value of social entrepreneurship, taking risks, being innovative. Sometimes we feel inhibited from doing things like that because of education, when it seems to be the more education we have, the more creative we should feel compelled to be.”
That’s the same message he delivers to his students at Little Rock. “Sometimes I think one of my jobs is to convince students to not pursue the traditional route in psychology,” he said with a laugh. “It’s not so much a matter of putting traditional folks out of business, but of finding alternative applications for what we have. For instance, I’m a college professor. In general, the tendency in an academic setting is to not forge creative links with social entrepreneurs and community-based organizations, which would result in more creative models in the halls of academe.”
Holland considers this mutual exclusion of academia and community a tragedy. “Most broad social problems don’t abide by disciplinary boundaries, but there’s this resistance to the interdisciplinary model. It can be frustrating. What many of us don’t realize is that we have far more relevance to far more settings than we’re currently pursuing.”
He points to Eastern Europe as an example. “There’s a great need for knowledge regarding behavior and health there,” he said. “People with a background in psychology really have something important to offer in that kind of environment. But there’s no kind of job description for that sort of thing that one would find listed under clinical psychology. Yet the knowledge base and skills we have can generalize quite easily to help resolve these very pressing problems facing a significant portion of the world’s population.”
Some behavioral health specialists agree. “What Dan is doing is critically important, both from a practical perspective and from a cross-cultural perspective,” said Arancha Garcia del Soto, Director of Refugee Initiatives at the University of Pennsylvania’s Solomon Asch Center for study of ethnopolitical conflict. “It’s very difficult to find committed American community psychologists doing work in foreign countries.”
While Garcia del Soto shares Holland’s interdisciplinary passions, she shares his concerns as well. “Instead of working in solitude, we need to learn how to better work as part of a team, bringing together people – psychologists, doctors, social workers, and volunteers – to address needs that aren’t currently being met,” she said. “We both agree on the need for regular citizens to become more aware of, and involved with, psychological work, and how that work is connected to other disciplines.”
Holland believes that psychologists need to do more to expand beyond traditional roles. “While I’m extremely dedicated to the profession, I can also be quite critical of it. Too often we feel we’ve reached a dead end, when that’s really just a failure of imagination. We need to be willing to take some risks, stick our necks out a little bit and find, through trial and error, some new niches where we have a great deal to offer.”
Applying New Knowledge Overseas
Holland’s research in the Slovak Republic showed that even where people are willing to try novel approaches, sometimes the infrastructure just won’t support them. While grassroots activists in the Slovak Republic have been successful at creating non-governmental organizations to assist people with disabilities, their survival is not assured.
“One of the things we take for granted in our society is a very strong for-profit sector,” Holland said. “That’s really what keeps our NGOs going.” In the West, when citizens see a need that the government won’t respond to, they solicit funds and set up their own shop to deal with the problem. That’s not usually an option in Eastern Europe.
So who grants NGOs in the Slovak Republic their funding? Ironically, it is almost exclusively the government. As the political winds change, those NGOs could face the possibility of having their funding eliminated. Over the years, NGOs in both the Czech Republic and the Slovak Republic have faced opposition to their continued existence.
Because of this dependence, the ability of NGOs to lobby the government for needed changes in the Slovak Republic’s health care system is strikingly limited. While Western NGOs acts as gadflies or agents of change, NGOs in Eastern Europe are almost entirely focused on providing care. Despite the long odds, the struggle seesaws as younger generations become more accustomed to a new freedom. Each time centralized governments are elected, dissidents convinced that such grassroots activities are vital have eventually taken back the reins of power. The result is that coalitions in these parliamentary-based political systems experience the wild swings of an electorate still getting used to the idea of open elections.
It is Holland’s belief that NGOs must eventually put more weight on their end of the scale. “[NGO] survival and growth will be critical for a population whose need for health care will only increase over the years,” he said. “These people have psychological needs that will have to be addressed. The NGOs are going to need international support by means of networking, information sharing, and grants.” It comes as no surprise that he is the one leading the charge to address these needs, but Holland admitted an overwhelming change will take many years and much collaboration.
“[The Eastern European NGOs] really don’t represent too much of a voice on government policies,” Holland said. “Right now, these non-government organizations don’t really represent an independent sector either, and it’s going to be a long time before they do.”