A Threatened Identity: The Mental Health Status of Syrian Refugees in Egypt and Its Etiology

This study utilized the development-based trauma framework on identity traumas to study the cumulative effects of trauma on the identities of Syrian refugees. Participants included 196 Syrian refugees residing in Cairo, Egypt (Mean age = 35.99, SD = 11.05). The rate of post-traumatic stress disorder was 33.5%, and the rate of depression was around 30%; the level of comorbidity was high with a high rate of suicidal plans or attempts (13.7%). Analyses indicated that existential annihilation anxieties, moderated by identity salience, mediated the effects of cumulative trauma on mental health. The results confirmed the utility and validity of the identity trauma model and provided evidence of the dire mental health needs of Syrian refugees.     

“You cannot forgive and you cannot forget”: The Serbian refugee settlement experience in Australia

Currently, there is limited research on the settlement experiences of refugees from the Balkan regions and in particular Serbia. There is also a need to provide a contextual understanding of the refugee settlement experience. The current study explored the refugee experience of 12 male Serbian refugees (aged 30 to 65), who migrated to Australia following the Yugoslav Civil War (1991–2001). A qualitative, phenomenological methodology explored the experiences of the refugees from their own perspective. Thematic coding of the interview data revealed the two major themes of settlement and traumatic experiences, as central to the experiences of this group of refugees. Language difficulties, discrimination, stigmatization of Serbian identity, multiple losses and grief, and failing of the justice system to establish accountability and provide reparation to the victims were all significant obstacles to successful settlement. Most salient, however, were the experiences of torture and trauma. Participants were still trying to negotiate these memories years after the events. Nevertheless, some participants showed strong resilience and the belief that they became stronger as a consequence of their experiences. We encourage those working with Serbian refugees to help them search for meaning in their stories of trauma.     

Neuropsychological Issues in the Assessment of Refugees and Victims of Mass Violence

Brain injury, stressor severity, depression, premorbid vulnerabilities, and PTSD are frequently intertwined in trauma populations. This interaction is further complicated when the neuropsychologist evaluates refugees from other cultures. In addition, the observed psychiatric symptoms reported in refugees and victims of mass violence may in fact not be the primary features of PTSD and depression but psychiatric symptoms secondary to the effects of traumatic brain injury. This paper reviews the occurrence of starvation, torture, beatings, imprisonment, and other head injury experiences in refugee and POW populations to alert treators to the presence of chronic and persistent neuropsychiatric morbidity, with implications for psychosocial adjustment. The concept of fixed neural loss may also interact with environmental and emotional stresses, and a model of neuropsychological abnormalities triggered by traumatic events and influenced by subsequent stress will also be considered. Neuropsychologists working with refugees play an important role in assessing the possibility of traumatic brain injury with tools that are relatively culture-fair.     

Traumatic Experiences and PTSD Among Adolescent Congolese Refugees in Uganda: A Preliminary Study

The study examined experienced traumatic events and the related Post-Traumatic Stress Disorder (PTSD) amongst a sample of 89 adolescent Congolese refugees (56 females and 33 males) at a refugee camp in Uganda. Data was collected using a questionnaire, and analyzed for trauma moderation by demographics and mediation by PTSD symptom scores. Findings indicate a prevalence of PTSD of 49.4% overall, with 75% of the female refugees meeting the PTSD criteria. The refugees with PTSD had high intrusive, avoidance and arousal scores, in addition to moderate to severe PTSD symptom severity scores. Trauma load was a significant predictor of PTSD among adolescent refugees. Our findings point to the high prevalence of PTSD resulting from an increased trauma load and being a female.     

Our Relations to Refugees: Between Compassion and Dehumanization*

After the so-called refugee crisis of 2015–2016 European reactions to foreigners had come to the fore and we are seeing xenophobic political and populist movements become increasingly mainstream. The massive rejection of refugees/asylum seekers taking place has made their conditions before, during and after flight, increasingly difficult and dangerous. This paper relates current xenophobia to historical attitudinal trends in Europe regarding Islam, and claims that a much more basic conflict is at work: the one between anti-modernism/traditionalism and modernism/globalization. Narratives on refugees often relate them to both the foreign (Islam) and to “trauma”. In an environment of insecurity and collective anxiety, refugees may represent something alien and frightening but also fascinating. I will argue that current concepts and theories about “trauma” or “the person with trauma” are insufficient to understand the complexity of the refugee predicament. Due to individual and collective countertransference reactions, the word “trauma” tends to lose its theoretical anchoring and becomes an object of projection for un-nameable anxieties. This disturbs relations to refugees at both societal and clinical levels and lays the groundwork for the poor conditions that they are currently experiencing. Historically, attitudes towards refugees fall somewhere along a continuum between compassion and rejection/dehumanization. At the moment, they seem much closer to the latter. I would argue that today’s xenophobia and/or xeno-racism reflect the fact that, both for individuals and for society, refugees have come to represent the Freudian Uncanny/das Unheimliche.     

Trauma in Resettled Iraqi Refugees: Differences between Those Seeking Psychological Treatment and Those Not Seeking Psychological Treatment

Psychological distress experienced by resettling refugees has been well documented, with posttraumatic stress disorder (PTSD) and depression being prevalent outcomes. This study examined psychological and physiological measures of trauma exposure in 2 groups of Iraqi refugees resettled in Australia, those seeking psychological treatment (n = 25) versus those not seeking treatment (n = 22). Data from a group of healthy sex- and age-matched controls (n = 32) were collected to facilitate norm comparisons for physiological arousal. Continuous recording of electrocardiogram data examined resting heart rate (HR). Refugees seeking treatment had significantly higher levels of PTSD symptomology and depression levels compared to non-treatment-seeking refugees; however, there was no difference in the number of trauma events endorsed. Finally, resting HR was significantly higher in both refugee groups compared with healthy controls; however, there was no difference between the refugee groups. Clinical consideration of this excessive trauma exposure and elevated autonomic arousal is warranted.     

Posttraumatic symptoms and growth of Kosovar war refugees: The influence of hope and cognitive coping

Research on war trauma has been dominated by a pathological focus for decades. Researchers have now counterbalanced studies of trauma with a new focus, positive changes following crisis. This prospective study examines how specific psychological factors might influence post-war adaptive outcomes (the coexistence of posttraumatic growth [PTG] and posttraumatic stress disorder [PTSD] symptoms) in a sample of 50 Kosovar war refugees. Individual differences in positive attitude and coping strategies were explored. Hope assessed during resettlement, and cognitive coping strategies, employed between resettlement and follow-up, were associated with PTG, controlling for war-related trauma and baseline symptoms. PTG and symptoms were unrelated. No predictors for present symptoms were identified. Future mental health practice with refugees should address both positive and negative aspects.     

The Visibility and Invisibility of Arab Americans and Implications for Psychological Treatment: A Comment on Cho

The following is a commentary on “Ethical Considerations for Psychologists Providing Treatment for Arab Americans” (Cho, this issue). Cho (this issue) brings to light important issues on providing ethical treatment with the Arab American community. However, there is currently no formal mechanism to identify the number of Americans of Arab descent, thus impacting the ability of researchers to study psychological treatment with Arab Americans. In addition, many Arab Americans are refugees with exposure to trauma, highlighting the need for understanding the role of culture in trauma when working with this community. Implications of these issues pertinent to the Arab American community and the need for psychologists to act in advocacy roles are discussed.     

Testimony work with Bosnian refugees: living in legal limbo

Mental health professionals working with refugees are often confronted with traumatised survivors who are living in legal limbo. Complicated asylum procedures or provisions of only 'temporary' protection trigger existential fears, reexperiencing of trauma and feelings of hopelessness and deep despair and can actively contribute to further destabilise survivors. Mental health centres have to reconceptualise their provided services for these clients. The paper introduces a testimony project for traumatised Bosnian refugees in Frankfurt, Germany, who were living in legal limbo for many years. The testimony method was used in combination with supportive therapy and informed advocacy to try to reduce the survivors' feelings of humiliation and demoralisation which for them were at the centre of their survival. By giving testimony, survivors benefited psychologically and became better able to cope with the difficult present. Feelings of self-worth and dignity could be regained and a trusting relationship between the survivor and the listener facilitated the therapeutic process. The testimony material documented human rights abuses both in the country of origin and in exile, helped us to perform informed advocacy for this group and informed a larger public on the psychological costs of refugee resettlement policies.     

Witnesses to Reality: Working Psychodynamically With Survivors of Terror 1

As generations of young men and women return from combat scarred not only physically but also psychologically by their experiences, as civil wars and genocide proliferate and refugees seek sanctuary in America from persecution in their native countries, even while others are held in violation of their international human rights by the United States government, this paper asks what role psychoanalysts can play in working with those who have survived violence and terror as adults. Offering a relational formulation of adult onset trauma, the author reviews some of the difficulties inherent in being called upon to bear witness to destructive social forces. The paper concludes with the case of a man who has been detained in Guantanamo Bay for the last 6 years.     

Art Speaks in Healing Survivors of War

Abstract

Mental health clinics can use creative art therapies as a means of reaching out to war refugees in their communities who may not respond to traditional talk therapy. In this case, the use of quilting and other artwork was utilized by the staff at Chicago Health Outreach to assist displaced Bosnians to cope with their war-related trauma and integration into their new environment in the United States. It can be difficult to reach refugee populations within a community whose culture and language are different from the majority, but finding other means of communicating can make a real difference for these individuals as they find safety and understanding by working on and sharing special creative projects.     

Career and Employment Counseling With Soviet Jewish Immigrants: Issues and Recommendations

This article addresses issues faced by career and employment counselors working with Soviet Jewish refugees and provides recommendations for working effectively with this population.     

Our Immigration and Human Rights Work Group in Action: Psychoanalysts Evaluating Asylum Seekers,Trauma and Family Devastation

ABSTRACT

This paper presents the story of a family of four refugees from Central America seeking asylum in the United States, and of the experience of a group of psychoanalysts, members of the New York University Postdoctoral Program Immigration and Human Rights Work Group, who evaluated each member of the family and wrote affidavits in support of their applications for asylum. The work described provides an example of how clinicians can apply their skills and understandings outside the consulting room to address the dire needs of refugees who have fled from their homes. We discuss the process of refugees seeking asylum and the role of a psychological evaluation in the asylum process. We elaborate on the content and process of the evaluations of each member of the family with a focus on the trauma suffered and its sequelae on two school-aged children, their adolescent aunt, and their courageous and protective mother. We also address the analysts’ experience of doing psychological evaluations and writing affidavits for asylum seekers who have experienced trauma.     

The Relationship between Trauma and Financial and Physical Well-Being Among Cambodians in the United States

This study focused on the relationship between trauma and financial and physical well-being of Cambodian refugees in the United Sates. Trauma was defined by three variables: whether or not trauma had been experienced in Cambodia, the number of traumas experienced, and the number of years spent in refugee camps. It was hypothesized that these trauma variables would predict financial and physical health among Cambodians in the United States. A discriminant analysis showed significant relationships between the trauma variables and current employment status, and multiple regression analyses showed that trauma predicted income and physical health.     

The relationship between trauma and financial and physical well-being among Cambodians in the United States.

This study focused on the relationship between trauma and financial and physical well-being of Cambodian refugees in the United States. Trauma was defined by three variables: whether or not trauma had been experienced in Cambodia, the number of traumas experienced, and the number of years spent in refugee camps. It was hypothesized that these trauma variables would predict financial and physical health among Cambodians in the United States. A discriminant analysis showed significant relationships between the trauma variables and current employment status, and multiple regression analyses showed that trauma predicted income and physical health.     

A peocess model of ethnocultural counselling for African survivors of organized violence

By analysing some 500 counselling and psychotherapy cases of survivors of organized violence as a therapist and supervisor over ten years the author developed a heuristic framework for a process model of ethnocultural counselling considering: (1) African counsellor's indigenous concepts, (2) a WHO-UNHCR approach, (3) a heuristic approach to psychotherapy, (4) a constructive narrative perspective, (5) an ethnopsychotherapeutic approach, and (6) a counselling approach for lay counsellors. The counselling process model comprises the following components: (1) Establishing a counselling relationship and motivation for change; (2) defining the problem, explanatory models, goals, and finding interventional means; (3) social comparison, cognitive undoing, metaphors, shared experiences and relaxation techniques; (4) working through the trauma, testimony approach; (5) ritualistic, cognitive and supportive approaches; (6) principle of education and advice; (7) evaluating and revizing treatment and stabilizing behaviour. These seven counselling components are described and counselling case examples are provided from Sudanese refugees in a large camp in Uganda and Malawian torture survivors in Malawi.     

Scholastic achievement of adolescent refugees from Cambodia and Central America

This study investigated the relationship of emotional disturbance and pre- and postmigration environment to the scholastic achievement of adolescent refugees of very different cultural backgrounds. One hundred fifty-two Central American and Cambodian students in six Canadian high schools, as well as their parents, were interviewed to assess the students' emotional problems (using the Youth Self-Report and Child Behavior Checklist) and to determine the pre- and postmigration family environment. The findings indicated that the relationship between the emotional problems and scholastic achievement of teenaged refugees was tenuous. It was concluded that a connection between young refugees' symptomatology and their functional capacity should not be assumed. Nonetheless, certain pre- and postmigration variables, particularly trauma experienced in the homeland, seem to be associated with the academic achievement of some refugees.     

Correlates of Vocational Success in Refugee Work Adaptation1

Past research on Indochinese refugees has shown that status inconsistency (loss of socioeconomic status from their last job in Indochina to their most recent job in the United States) has a strong negative effect on acculturation. This study examines refugee adaptation to working in America and the effect of status inconsistency on work performance. After three years in the U.S., there was great improvement in job performance. We had predicted that greater status inconsistency would be associated with poorer vocational performance. The status inconsistency effect was found for those refugees who previously held high-prestige positions in their homeland, but only during the time before they had spent 3 years in America. Previous high-prestige refugees who had lived in the U.S. for less than three years did not stay on their jobs as long as former low-prestige refugees. After three years, however, the former high-prestige refugees outlasted the former low-prestige refugees.     

Symptom Presentation and Symptom Meaning Among Traumatized Cambodian Refugees: Relevance to a Somatically Focused Cognitive-Behavior Therapy

Among psychologically distressed Cambodian refugees, somatic complaints are particularly prominent. Cambodians interpret anxiety-related somatic sensations in terms of “Wind” (khyâl), an ethnophysiology that gives rise to multiple catastrophic interpretations; and they have prominent trauma-memory associations to anxiety-related somatic symptoms. In this article, we detail some of the common sensation-related dysphoric networks of Cambodian refugees, focusing on catastrophic cognitions and trauma associations. We argue that delineating symptom-related dysphoric networks is crucial to successfully adapt cognitive-behavioral interventions to treat panic disorder and posttraumatic stress disorder among Cambodian refugees, and that such an approach may be useful for the culturally sensitive adaptation of cognitive-behavior therapy for other traumatized non-Western groups.