Refuge and Resilience: Promoting Resilience and Mental Health among Resettled Refugees and Forced Migrants

238 Pages·2014·1.77 MB·English

by  Laura Simich

Refuge and Resilience
The series publishes original scholarly books that advance our understanding of
internationalmigrationandimmigrantintegration.Writtenbyacademicexpertsand
policy specialists, each volume addresses a clearly defined research question or
theme,employscriticalanalysisanddevelopsevidence-basedscholarship.Theseries
includessingle-ormulti-authoredmonographs,volumesandeditedcollections.
The scope of the series is international migration and integration research. Topics
includebutarenotlimitedtothematicandcurrentissuesanddebates;comparative
research of a regional, national or international nature; the changing character of
urbanareasinwhichmigrantsorrefugeessettle;thereciprocalinfluenceofmigrants/
refugeesandhostcommunities;issuesofintegrationandsocialinequalityaswellas
policyanalysisinmigrationresearch.
SeriesEditors:
PeterLiandBaha-Abu-Laban
Forfurthervolumes:
http://www.springer.com/series/8811
Laura Simich • Lisa Andermann
Editors
Refuge and Resilience
Promoting Resilience and Mental Health
among Resettled Refugees and Forced
Migrants
2123
Editors
LauraSimich LisaAndermann
CenteronImmigrationandJustice DepartmentofPsychiatryEquity,Gender
VeraInstituteofJustice andPopulationsDivision
NewYork UniversityofTorontoandMountSinai
NewYork Hospital
USA Toronto
Ontario
Canada
Thefindings,interpretations,andconclusionsexpressedhereinarethoseoftheauthoranddo
notnecessarilyreflecttheviewsoftheVeraInstituteofJustice.
ISSN2214-9805 ISSN2214-9813(electronic)
ISBN978-94-007-7922-8 ISBN978-94-007-7923-5(eBook)
DOI10.1007/978-94-007-7923-5
SpringerDordrechtHeidelbergNewYorkLondon
LibraryofCongressControlNumber:2014930347
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To my parents and grandparents, who were
once refugees and New Canadians; To my
wonderful husband and children; And to all
therefugeeswhohavesharedtheirstorieswith
me.
L.A.
Topeaceandsanity.
L.S.
Foreword
Therefugeeexperienceconfrontsuswithhumanityatitsmostchallenged—forcibly
uprootedandinflightfromviolence,caughtbetweencountries,facinganuncertain
future—butitalsoprovidessomeofthemoststrikingexamplesofhumanresilience.
Thisinnovativeandimportantbookexploresthatresilienceanditsimplicationsfor
resettlementandmentalhealthservices,policyandpractice.Thecontributorshavea
wealthofresearch,clinicalandcommunityexperienceandhavebeenattheforefront
ofinterdisciplinarystudiesthatadvanceourunderstandingofrefugeementalhealth
and adaptation. They approach the person seeking refuge and resettling in a new
countrynotasaclinical,socialorpoliticalproblembutastheactiveagentoftheir
ownsurvival.Insodoing,theyencourageustomovefromdiagnosingandtreating
traumatic wounds and losses to fostering individual and collective adaptation and
flourishing. They emphasize the importance of the larger community that receives
thoseseekingasylumandcallustoamorehumaneandeffectiveresponse.
Migrationhasbeenaconstantinhumanevolutionandtheabilitytoadapttorad-
icallynewenvironmentsisintrinsictoourpsychology.Themigrationsofprehistory
broughtusintodifferentecologicalenvironmentsthatgaverisetodiversecultures,
withdifferentwaysoflifethatincludedchangesinmodesofsubsistence,worldviews,
systemsofvaluesandaspirations.Therootsofhumanresilienceareinself-regulating
andself-rightingadaptivesystemsthatincludeourcapacitytoacquirenewstrategies
for survival and to reorganize our ways of life to fit new contexts. Resilience then
is part of ‘human nature’built into our multiple systems of learning, grounded in
neuroplasticity,psychologicalinventiveness,andculturalcreativity,whichallowus
toembraceandadoptnew, hybrididentities.Atthesametime, continuityofiden-
tity,relationshipsandcommunityarecentraltomanyindividuals’strength,senseof
coherence,andself-efficacy.
Muchofthescientificresearchonresiliencehasfocusedonindividualcharacter-
istics,butresilienceisnotonlytheoutcomeofpsychologicalprocessesbutalsoof
socialprocessthatresideinrelationshipsamongpeople,systemsandinstitutionsat
theleveloffamilies,neighborhoods,communities,andorganizations,governments
andtransnationalnetworks.Recognizingthesocialdimensionsofrefugeeresilience
meanswemustlookbeyondtheindividualtounderstandthelargercontextsinwhich
theyareembedded.Resettlementpoliciescansupporttherefugee’seffortstobuild
vii
viii Foreword
anewlifeorunderminethem,leavingindividualsorwholegroupsstrandedwithout
connection.
International conventions on refugees and asylum emerged in the wake of the
SecondWorldWarduringwhichcountlessnumbersofpeopleseekingsafetywere
turned away by Canada and other countries that could have easily received them.
EarliergenerationsofmigrantsfromEuropeandotherwartornareasdidnothave
the formal category of refugee to frame their identity but faced many of the same
challengesinescapingdanger,bringingtheirfamiliesandlovedonestosafety,and
buildinganewlifeinanewland.Thecategoriesofasylum-seeker,refugeeandimmi-
grantimplyacleardistinctionbetweenthosewhomigratevoluntarilyforeconomic
or other personal advancement and those who are forced to by threat of political
violence.Infact,thisdistinctionisoftenhardtomakeanddoesnotfitthecomplex
realitiesofindividualstruggles.
Afterachievingtheirescapefromharm’sway,refugeesseeknotjustbaresurvival
but a better life for themselves and their families. Those who are able to focus on
a hopeful future, find meaningful work and relationships, and invest in the next
generation,arelikelytofarewell.Thosecaughtinaconsumingnostalgiaforwhat
they have lost, may find it difficult to invest in the future or find the energy and
flexibilityneededtofaceallthemanydemandsoftheirnewenvironment.
Formostrefugees,thelong-termoutcomeofmigrationwillbepositive.Butthis
outcome depends on many factors involving the individual’s history, the kinds of
violence and losses they have endured, their migration trajectory, and especially,
theirreceptioninthecountrywheretheyfindanewhome.Amajorlessonfromthe
researchonlong-termadaptationcollectedinthisvolumeisthatthequalityofthehost
countryreceptionofnewcomersisamajordeterminantoftheirhealth, well-being
andsocialintegration.Thisisgoodnewsbecausethisreceptionissomethingthatcan
beimprovedthroughpublicpolicy.Thedilemmaisthatinthecurrentenvironment
of international insecurity, there is a risk of forgetting our recent history, reneging
onourcommitments,andclosingthedoorstothoseseekingasylumandmakingit
harderforthoseacceptedtobuildtheirnewlives.
Our experience with refugees and asylum seekers at the Cultural Consultation
ServiceinMontrealunderscorestheirresilienceaswellasthemajorchallengesthey
face.Manyofthesechallengesstemnotfromhavingtonavigateanewculturalenvi-
ronment,butfromdifficultiesnegotiatingbureaucraticinstitutionsthataredivorced
fromthehumanrealitiesofforcedmigration.Forexample,weknowthatdetention
canbeextraordinarilyharmful,thatlongdelaysindecidingoutcomesarecorrosive
to well-being and confidence, that taking meaningful work and choice away from
people renders them helpless, and that ensuring the safety of loved ones left be-
hindandreunitingwithone’sfamilyareallpowerfuldeterminantsofmentalhealth.
Yet politically motivated policies and institutional practices strew obstacles in the
refugee’spath.
Theemphasisonstrengthandresilienceisawelcomeshiftfromtheemphasisin
mentalhealthresearchonvulnerabilityandpathology.Infocusingonstrengthsand
resilience,however,thereisariskthatthosewhohaveahardertimewillbefurther
stigmatizedas‘lackingresilience’.Thisisespeciallyegregiouswhenthebarriersto
Foreword ix
adaptationclearlyreflectsocialobstaclesandadversity.Itisimportantthatresilience
beunderstoodnotastheinevitableoutcomeofsomeinherentqualityorcapacityof
theindividualbutasadynamicprocessofinteractionsbetweenindividualsandthe
circumstancesinwhichtheyfindthemselves.Whatisadaptiveinonesituationmaybe
problematicinothersandnewstrengthsmayemergewhentheindividualisafforded
new opportunities. The resilience perspective is an invitation to clinicians, policy
makersandotherstothinkintermsofstrengthsandsolutionsratherthandeficitsand
to ensure that our welcoming and hospitality to those most in need provides them
withthebasicstructuresandresourcestheyneedtorebuildtheirlivesand,ultimately
tocontributetothevariegatedtapestryofourcommunities.
Thecreationofrefugeestatusandthemoralandlegalobligationtoprovideasylum
reflectanemergingglobalethicessentialforourcollectivesurvival.Indeed,climate
changeandtheresultanteconomicandpoliticinstabilitiesarelikelytodramatically
increasetheneedforaninternationalhumanrightsregimeintheyearstocome.Inthe
wakeofpastfailures,Canadabecameamodelofprogressivepracticesintheareaof
refugeeresettlement.Unfortunately,recentlyenactedrestrictivepoliciestightening
therefugeedeterminationprocessandreducingbasiccoverageofmedicalcarefor
refugees(ontheabsurdargumentthattheyarebettertreatedthantheaverageCana-
diancitizen)haveunderminedthiscommitment.Theseshort-sightedpolicieshave
beenwidelydenouncedbymanysectorsofsocietyincludingphysiciansandthose
mostknowledgeableabouttherefugeeexperience.Hopefully,theseregressivesteps
willsoongivewaytoamoresociallyresponsiveviewconsonantwithlong-standing
Canadian values so that we can once again contribute to advancing international
humanrights.
Inadditiontoadvocatingforchangeatthelevelofpolicy,andhealthandsocialser-
vicesprofessionalsandresearcherscancontributeinmanywaystothewell-beingand
socialintegrationofrefugees.Intheclinicalencounter,wecanworktounderstand
refugees’stories,learningmoreabouttheiruniquepredicamentsanddevelopingthe
skillsneededtorespondeffectively.Wecansupportothersinthecommunityintheir
effortstoprovideawelcomingspaceandpathwaystowardintegrationandreunifica-
tionforrefugeesandtheirfamilies.Asthecontributorstothisvolumeshow,through
research, advocacy and clinical engagement, we can contribute to building a civil
societyfoundedonthevaluesofdignityanddiversity.
Montreal, August2013 LaurenceJ.Kirmayer
Contents
1 Editor’sIntroduction........................................... 1
LauraSimich
2 WhatIsResilienceandHowDoesItRelatetotheRefugee
Experience?HistoricalandTheoreticalPerspectives ............... 7
WadeE.Pickren
3 SocialDeterminantsofRefugeeMentalHealth .................... 27
FarahN.Mawani
4 TheDebateAboutTraumaandPsychosocialTreatmentforRefugees 51
ClarePain,PushpaKanagaratnamandDonaldPayne
5 ReflectionsonUsingaCulturalPsychiatryApproachtoAssessing
andFortifyingRefugeeResilienceinCanada...................... 61
LisaAndermann
6 PersonalandSocialFormsofResilience:ResearchwithSoutheast
AsianandSriLankanTamilRefugeesinCanada .................. 73
MortonBeiser
7 SocialSupportinRefugeeResettlement .......................... 91
MiriamJ.Stewart
8 NewcomerYouthSelf-Esteem:ACommunity-BasedMixedMethods
StudyofAfghan, Columbian, SudaneseandTamilYouthinToronto,
Canada ....................................................... 109
NazillaKhanlou,YogendraB.Shakya,FarahIslamandEmmaOudeh
9 Newcomer RefugeeYouth as ‘Resettlement Champions’for their
Families:Vulnerability,ResilienceandEmpowerment.............. 131
YogendraB.Shakya,SepaliGuruge,MichaelaHynie,SheilaHtoo,
ArzoAkbari,Barinder(Binny)Jandu,RabeaMurtaza,MeganSpasevski,
NahomBerhaneand JessicaForster
xi