In September, when Steven C. Norton, PhD, began a yearlong assignment at the U.S. Embassy in Kabul, Afghanistan, he assumed he'd see some action, but he wasn't expecting it so quickly. Just five days into his job, insurgents attacked the embassy with rocket-propelled grenades. The blasts were part of a coordinated attack that targeted multiple sites in the city and killed several people, although none at the embassy were seriously hurt.
Norton immediately went to work with a social worker and embassy medical staff to help the 600 embassy workers cope with the trauma, educating them on psychological and physical reactions they may experience after such an event; advising them on self-care strategies; and letting them know that mental health care was available.
The first night after the attacks, a small minority of staff questioned whether their jobs were worth the risks. "That was a long, tough night for everyone," says Norton. But it's just part of the job for this psychologist, who is the first ever to work at the Afghanistan Embassy. The position was created in response to Secretary of State Hillary Clinton's call to bring more mental health services into war zones.
The State Department tapped Norton to apply for the job because of his experience working in conflict areas and with law enforcement agencies. Norton comes to the post with a specialty in forensic, criminal and law enforcement evaluations and interventions in his private practice in Rochester, Minn. He spent 11 years as a psychologist at the Federal Medical Center, a Bureau of Prisons facility in Rochester, and he has worked in the Nebraska Department of Corrections, the Olmstead County Adult Detention Center in Rochester, and other correctional facilities. In addition, he has done contract work with a Chicago-based organization called Mission Critical Psychological Services, where he assessed security and law enforcement personnel being considered for jobs overseas and debriefed workers in Iraq, Kuwait and other war zones following suicides and other traumatic events.
He is also an active member of APA Div. 18 (Psychologists in Public Service), serving as its president last year. The division's focus on sharing psychological expertise for the public good "very much fits with what I'm doing here," he says. "It is extremely rewarding to do my part to assist American staff working in a very challenging environment and to support the mission of the U.S. government to bring order and stability to this region."
Most of Norton's work takes place at the embassy itself, where he provides mental health services and seminars for embassy staff. When circumstances allow, Norton also provides counseling and training for civilian and military personnel in the field. Trips can get canceled at the last minute because of the threat level, and when he does go out, he dons a helmet and flak jacket and is escorted by military and/or security personnel. On a more limited basis, he consults with U.S. agencies working with Afghans to help modernize their prison system, and he consults with an agency at the embassy developing procedures for providing crisis mental health debriefings if American staff are taken hostage or held captive.
"Fortunately, that's a rare occurrence, but it's always a risk in active and chaotic war zones," he says.
Life in the compound
Given the dangers of living in a war zone, most of Norton's time is spent in the relatively small but highly fortified embassy compound in northern Kabul. The compound serves as a small city for the State Department personnel, who include diplomats, U.S. Agency for International Development staff and international law-enforcement personnel. About 300 Afghan citizens—who live outside the embassy and put themselves at some risk of terrorist threats and intimidation working these jobs—serve as administrative staff, secretaries, kitchen personnel and grounds crews.
"The essentials for life are available, but staff quickly develop a sense of what those essentials are," he says. There is no Starbucks, few TV choices, little green space to walk in, and at times, limited toilet paper. "Nobody gets in or out unless it's very clearly authorized, approved, checked and double-checked."
Norton sees American personnel as therapy clients and as co-workers with whom he shares information on stress management, insomnia and other topics. A day at the embassy often involves seeing two or three clients, attending general and health staff meetings, preparing presentations and getting a read on the collective mood.
Fortunately, most days aren't like the traumatic day in September. In general, workers face different kinds of problems, such as missing family and home, coping with a sense of confinement, and dealing with boredom—which many try to alleviate by working overtime. Norton urges them instead to develop hobbies, exercise and participate in social activities like Halloween and Christmas parties.
"I encourage folks to keep themselves strong and resilient before the really heavy things happen," he says.
Deeper concerns crop up regularly as well, especially among those doing humanitarian work, such as embassy personnel who are working to improve Afghan schools or educate local farmers. One recurring theme is whether they're doing any good in a country that remains unstable and chaotic.
In such cases, Norton encourages people to scale down their expectations and live more in the present. "I advise them to focus on the good they've done rather than what is left to be done," he says. "That shift in mindset can make a big difference."
In addition, he suggests finding a trusted confidante to vent with, and he helps people cope with insomnia by advising them to try progressive relaxation, journaling and other tactics to clear the mind.
He also tries to keep himself and others psychologically prepared for future attacks through proactive stress management—helping them recognize risk factors for stress, such as heavy workloads and sudden, unexpected changes to routine, for instance—and urging them to adopt healthy lifestyles by exercising, eating a healthy diet, relaxing and keeping in touch with family and friends.
In that sense, his work is extremely similar to his previous work with law enforcement personnel, Norton says. "You can also go from a quiet, almost boring day, and literally in a matter of seconds you're in this very intense, very dangerous situation," he says. "That change can create a lot of stress in and of itself."
Outside the walls
Norton's dealings with the Afghan people have been positive and informative, he adds. While the country has suffered decades of devastation, the people are incredibly resilient, and remarkably, retain a sense of national pride in spite of factionalism and instability.
"For the most part, they maintain an optimism," an attitude summarized by the Afghan word saber, says Norton. "It means patience, though it's a little more than that," he says. "It's really the notion that life will get better."
For his part, Norton has taken his own advice and figured out ways to cope in this tense and restricted environment. He's a member of the embassy's running club, for instance, and he's managed to stay connected via phone calls, email and Skype with the outside world—with his partner, Laura Thimijan, his four grown children, his mother, Thelma, and Div. 18 colleagues, for instance.
Despite the difficulties of the job, his psychology training and his work in the correctional and criminal justice systems have given him the resilience to stay sane and help others do so as well. And despite the job's challenges, he's found it extremely rewarding, he says.
Still, as he looked forward to returning to Minnesota for a break, he couldn't wait to see his family and friends—and familiar food as well. "I can't wait to go to Glynner's Bar and have a real hamburger and an American beer," he says.
Tori DeAngelis is a writer in Syracuse, N.Y.