#26 Wie kleine Taten die mentale Gesundheit fördern
25.05.2026 23 min
Zusammenfassung & Show Notes
In dieser Folge von Traces of Light spricht Elsbeth Horbaty mit Paul Bolton, Arzt, Mental-Health-Experte und ehemaliger erster Mental Health Coordinator von USAID. Paul hat in vielen Krisen- und Kriegsgebieten gearbeitet, unter anderem an der thailändisch-kambodschanischen Grenze und während des Bosnienkriegs. Später widmete er sich der Frage, wie mentale Gesundheit in Entwicklungs- und Hilfsprogrammen stärker berücksichtigt werden kann.
Im Gespräch geht es um Trauma, Solidarität und die Bedeutung psychischer Gesundheit in unsicheren Zeiten. Paul erklärt, warum mentale Gesundheit kein Luxus ist, sondern oft die Grundlage dafür, dass Heilung, Entwicklung und Gemeinschaft überhaupt möglich werden. Dabei betont er, dass Hilfe nicht immer kompliziert oder teuer sein muss: Oft beginnt sie mit Zuhören, Beziehung und Menschen, die füreinander da sind.
Ein zentrales Bild dieser Folge ist Pauls Selbstbeschreibung als „Happy Warrior“ – als jemand, der sich engagiert, nicht weil alles leicht ist, sondern weil es sich lohnt, für Menschlichkeit, Hilfe und Dialog einzustehen. Für ihn entsteht Hoffnung nicht durch Wegschauen oder bloßen Optimismus, sondern durch konkretes Handeln.
Auch der drastische Rückbau von USAID und internationaler Hilfe wird Thema. Paul spricht über die Folgen für Menschen in Ländern mit niedrigem und mittlerem Einkommen, über das Ende wichtiger Programme und über die Frage, wie Vertrauen, Verantwortung und internationale Solidarität wieder aufgebaut werden können.
Diese Folge ist ein Gespräch über Krise und Hoffnung, über mentale Gesundheit als Menschenrecht und über den Mut, in schwierigen Zeiten nicht zu verstummen.
Themen dieser Folge:
- Warum mentale Gesundheit in Krisengebieten überlebenswichtig ist
- Wie Trauma ganze Gesellschaften prägen kann
- Was einfache, menschliche Unterstützung bewirken kann
- Warum Handeln gesünder sein kann als Angst und Ohnmacht
- Welche Folgen der Rückbau internationaler Hilfe hat
- Wie Hoffnung entsteht, wenn Menschen Verantwortung übernehmen
Über Traces of Light
In Traces of Light sucht Elsbeth Horbaty nach Menschen und Gemeinschaften, die in schwierigen Zeiten Mut, Klarheit und Menschlichkeit bewahren. Jede Folge erzählt von Erfahrungen, die Lichtspuren hinterlassen – im persönlichen Leben, in der Gesellschaft und in der Welt.
Transkript
Anmoderation: Willkommen bei Traces of Light. Elspeth Hobart macht sich auf die Suche nach Menschen und Gemeinschaften, die in schwierigen Zeiten Mut machen.
Anmoderation: In Zeiten rascher Veränderungen gibt es immer wieder Menschen, die eine besondere Ruhe in sich tragen. Nicht, weil sie die Schwierigkeiten der Welt nicht sehen, sondern weil sie gelernt haben, klar hinzuschauen, wenn vieles ins Wanken gerät.
Anmoderation: Mein heutiger Gast hat einen großen Teil seines Lebens in Krisengebieten und schwierigen Kontexten verbracht: zuerst als Arzt in Australien und Großbritannien, später an der thailändisch-kambodschanischen Grenze, während des Krieges in Bosnien und viele Jahre danach in internationalen Projekten zur psychischen Gesundheit. In unserem Gespräch auf Englisch spricht er über Trauma, Solidarität und mentale Gesundheit in unsicheren Zeiten - und darüber, wie er versucht, in der zunehmend gespaltenen Gesellschaft der USA Dialog zu fördern. Ein wichtiges Gespräch für Traces of Light.
Host: I'm here with Paul Bolton. He's calling in from?
Paul Bolton: Scituate, Massachusetts, USA.
Host: Massachusetts, USA. And we'll be talking a bit about how, in these difficult times, you can still give some light to your colleagues, your family, and the world. Thank you very much for joining me, Paul. To start with, maybe you can give me a bit of background: who you are and where you've been working.
Paul Bolton: Okay, sure. I'm happy to be here and happy to talk to you. My background is that I grew up in Australia. I qualified as a physician in Australia, working in teaching hospitals there.
Paul Bolton: Then I left and went to the United Kingdom, where I also worked as a physician. In Australia and the UK I had a variety of jobs: I worked as a flying doctor, as a ship's doctor, and as a doctor in small country towns. After the United Kingdom I went to Thailand, to the Thai-Cambodian border, where I worked as the director of a medical program during the war between Thailand, Cambodia and Vietnam. I was there for a few years. Later on I worked as the director of a medical program in the Bosnia war.
Paul Bolton: Then I switched careers and started to focus on mental health, because I realized that one of the problems with all of our health and development programs was that we weren't addressing mental health at all. That was actually making our programs less successful. Our infectious disease programs, chronic disease programs, and even seed and agriculture programs were all affected by the lack of mental health programming.
Paul Bolton: So then I started to work on the development of, and research into, effective mental health programs in low- and middle-income countries.
Paul Bolton: That was around the turn of the century, and I did that for about 20 years, working in about 35 different countries with colleagues to figure out what is most effective and helpful, and then integrating that into other programs.
Paul Bolton: More recently, I was USAID's first mental health coordinator from 2020 to 2023. So I left about a year before the agency was effectively shut down. Since that time, I have worked in advocacy. I've been advocating for the return of foreign assistance in an improved form. Sadly, since the great reduction in foreign assistance, one of the casualties has been mental health programming. The US government, the various NGOs it supports, and the government programs in other countries that it supports have all drawn back from supporting mental health.
Paul Bolton: So that's no longer a focus. Any programs that assist with mental health at the moment are privately funded and much smaller than the programs used to be. For me, I advocate for the return of foreign assistance because, without that return, we're not going to have mental health programming at anything like the size we actually need, including programming for former aid workers.
Host: The people who used to work for USAID were told, about a year ago, to go back home. As I understand it, that was almost about 10,000 people.
Paul Bolton: Yes, that's exactly right. 10,000 people across the USA and around the world.
Host: So my question is: are you supporting them, or are other people supporting them?
Host: Are there some people supporting them?
Paul Bolton: I know of no efforts to do that. Everyone is pretty much on their own. So if people are getting mental health assistance, they're getting it through their own local mental health services, if they have them, and through their own health insurance, if it covers it. But I don't know of anything organized for former workers to assist with their mental health.
Paul Bolton: I feel this for my fellow workers, but I feel it even more for the populations and people that we used to assist overseas - to have programs shut down when, frankly, they were highly effective and people were in a lot of need. Seventy-five percent of all mental health problems in the world are in low- and middle-income countries. That's partly due to population, but it's also largely due to the fact that that's where a lot of the trauma and loss is.
Host: You're right. I lived for many years in Nicaragua, Latin America and Mexico. After I worked there, I decided to study trauma issues, because you start to realize the effects that all the politics have had on these countries: the traumatization of a whole population.
Paul Bolton: And people need abilities to deal with that. One of the wonderful things about mental health is that we found about 80% of the people who came to our programs could be assisted purely with counseling therapy. In other words, most people - the vast majority - don't need drugs or special equipment. What they need is trained counselors. And one thing we have a plentiful supply of around the world, regardless of whether it's a high-, low- or middle-income country, is people. So we would train local people to provide those counseling skills. As I mentioned, about 80% of people would get better just with that.
Zwischenmoderation: Was mich an diesem Gespräch besonders berührt, ist seine Erfahrung aus vielen Krisengebieten: Psychische Gesundheit ist kein Luxus, sondern oft die Grundlage dafür, dass Heilung, Entwicklung und Gemeinschaft überhaupt möglich werden. Paul Bolton zeigt, dass diese Hilfe nicht immer kompliziert oder teuer sein muss. Oft beginnt sie mit etwas zutiefst Menschlichem: mit Zuhören, Beziehung und Menschen, die füreinander da sind.
Host: That brings me to a maybe funny question: what do you do to stay healthy in this very demanding world?
Paul Bolton: You know, it's funny. I don't know if you've heard the term in English: happy warrior. Have you heard that term, a happy warrior?
Host: No, I haven't.
Paul Bolton: A happy warrior is somebody who's in a fight that they enjoy. I feel like I'm in a fight and it's a good fight - a fight worth having. So how I maintain my own mental health in this environment - I assume you mean the US political environment - is by doing things that I think make a difference.
Host: Yes.
Paul Bolton: If I were to just sit and vent with my friends and neighbors, complaining, that would make my mental health worse. When people just vent about how bad things are, as a group they tend to dig themselves into a hole and make their mental state worse.
Paul Bolton: But when you're involved in activities where you feel you're actually having some impact, for me anyway, that makes me feel good. It's a continuation of what I said to you: I was in a war zone in Southeast Asia, I was in a war zone in Bosnia. To me, this is another war zone - a different kind of war, but still the same thing: the opportunity to make a difference, the opportunity to change things.
Paul Bolton: So my mental health is very good.
Host: I think I'll join your group, because I do the same thing. What we do today with my podcast and with my coaching side - I find I'm doing something in this world to keep us healthy. As you say, this is mentally so much better than complaining or worrying. I think the worst part is worrying and anxiety, because then people can start to manipulate you when you're afraid, no?
Paul Bolton: Right.
Paul Bolton: And I also think about the future. This dark period is going to pass, right? What do we want to say about ourselves when it does pass? That we did nothing, or that we did something? I fear being in a situation where, in the future, I'd have to say to myself: there was this time when we really needed people to speak up and work, and I didn't do anything effective. So it's almost like an investment in my future mental health.
Host: Exactly, exactly. You say very great words.
Zwischenmoderation: Er beschreibt sich selbst als einen "happy warrior" - als jemanden, der sich trotz schwieriger Zeiten engagiert, weil ihm menschliche und gesellschaftliche Entwicklung nicht gleichgültig sind. Er erzählt auch, warum Hoffnung, Dialog und konkretes Handeln für ihn wichtiger sind als je zuvor.
Zwischenmoderation: Paul beschreibt Hoffnung nicht als bloßen Optimismus oder als Überzeugung, dass alles gut wird, sondern als etwas Aktives. Er sagt: Wenn wir nur zusammensitzen und in Angst übereinander sprechen, werden wir eher kränker. Wenn wir aber das Gefühl haben, dass unser Handeln einen Unterschied macht - und sei er noch so klein -, dann verändert das auch unsere psychische Gesundheit.
Zwischenmoderation: Vielleicht ist genau das dieser eine Lichtstrahl.
Host: What did we lose when we lost USAID?
Paul Bolton: That is what you do?
Host: Yes, that's what I do.
Host: Great. And what do you think is the main thing we lost by losing an organization like that?
Paul Bolton: For me, being inside the organization, I deeply feel the loss of programs that I think helped people and really made a difference. The way in which we shut those programs down, frankly, led to a lot of indirect deaths because people had no other arrangements. You probably heard that, with HIV, people suddenly had their HIV medicine stopped. Or in malaria programs or TB programs, people suddenly had those medications stopped.
Paul Bolton: Because it was done so suddenly, there was no plan for how these people were going to replace the medication - no ability to make arrangements by governments, NGOs or other groups to try to fill the gap. It was just suddenly lost. So I feel that very much.
Paul Bolton: For the United States, honestly, I feel the country has been dishonored. I talk to colleagues overseas. The United States is not viewed nearly as positively as it was before. Some people in other countries, particularly prominent people and politicians, are not willing to speak publicly about this because they're trying not to make the situation worse. But privately, there's a lot of anger against the United States about how this was done.
Paul Bolton: The main criticism of the United States is not that we withdrew aid; it's how we did it. It was an obviously uncaring, cruel way of going about it. And now that's our brand around the world: the US government is cruel and uncaring.
Host: So why do you think they decided to just pull out and close down?
Host: Anything you know about the US?
Paul Bolton: Well, it was a surprise to us. I could talk about why I think they could do it. One reason is that many Americans had never heard of USAID or how aid was done. We were actively discouraged from reaching out to the American public and informing them about what we did. I always drew the comparison with NASA. NASA was the complete opposite. NASA's mission statement was actually to inform the American public about what they do.
Host: Exactly. Everybody knows them.
Paul Bolton: Yes, everyone knows them. They actually encouraged and supported their staff to go out and talk to high schools, colleges - whoever was interested. We were not.
Paul Bolton: So if we get back to foreign assistance, and if we have an independent agency again, I think that agency really has to make that part of its mission. You asked me why they did it. My view, based on the evidence, is that there are a lot of things wealthy people in the United States don't want to pay for, and there are many reasons why they want to pay less taxes. Shuttering USAID is one part of saving money so that they can provide tax cuts to wealthy people. That's my observation, because I see what the government is doing.
Paul Bolton: They have tried to cut back on Medicare and Medicaid, which are our government health insurance programs. They have cut back on services for veterans. They are pretty much cutting back on everything they can that serves the public in order to fund these tax cuts.
Host: Thank you very much, Paul. Before we end, you said at the beginning that this is just a phase we're going through. Where is the end of the tunnel, Paul?
Paul Bolton: I think it's a phase because the vast majority of the American public, in surveys, supports foreign assistance.
Paul Bolton: The current administration didn't go after foreign assistance in general as much as it went after the agency. In some ways, I agreed with some of what they said: the agency needed some reforms. So I see foreign assistance coming back as a politically popular thing eventually, after this current administration has left. Then we have an opportunity to build a better version of foreign assistance than we had before. So I feel quite hopeful about foreign assistance in general, that this is a temporary pullback.
Paul Bolton: I used to work in humanitarian aid, and one of the things we would say there was: the more something is destroyed, the more fundamentally you can rebuild it. I feel that with this, we have an opportunity to fundamentally rebuild foreign assistance and make it better.
Host: Thank you very much. Any word that brings you through these difficult times?
Paul Bolton: I look at the polls. We have a midterm election coming up. I think the people who support the current administration are going to do badly in those elections, and I think the mood of the country has changed and will be reflected in the election. I think we're going to turn the corner.
Paul Bolton: In some ways, I think the reputation of the United States is permanently damaged. I don't think that it's retrievable. But in terms of what the United States does in the future, I think we can get much closer back to where we were, and in a better way of supporting our citizens and being a good neighbor in the world. But that kind of trust and reputation is going to take a lot longer before people trust us again.
Host: Thank you very, very much, Paul. I truly appreciate you taking your time and giving us some words of hope, which are getting fewer and fewer. I really appreciate you staying in touch, and maybe we'll talk to each other some other day without recording, just to hear a bit more of what you do. Thank you very much, Paul.
Paul Bolton: You're welcome, Elspeth. It's great to talk to you.
Abmoderation: Paul spricht davon, sich einzubringen. Für ihn bedeutet das, etwas zu tun, das größer ist als Angst oder Zynismus.
Abmoderation: Vielleicht heißt Hoffnung nicht, sich seiner Sache immer sicher zu sein. Vielleicht heißt Hoffnung, weiterzugehen und füreinander da zu sein. Danke fürs Zuhören.