Table Of ContentGail Theisen-Womersley
Trauma and
Resilience
Among Displaced
Populations
A Sociocultural Exploration
Trauma and Resilience Among Displaced
Populations
Gail Theisen-Womersley
Trauma and Resilience
Among Displaced
Populations
A Sociocultural Exploration
GailTheisen-Womersley
InstitutdePsychologieetEducation
UniversityofNeuchâtel
Neuchâtel,Switzerland
ISBN978-3-030-67711-4 ISBN978-3-030-67712-1 (eBook)
https://doi.org/10.1007/978-3-030-67712-1
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Contents
1 Introduction .................................................. 1
MentalHealthofRefugeePopulations ............................ 2
TheProblemwithPTSD ........................................ 3
CallsforaMoreContextualisedUnderstandingofTrauma ........... 7
AdaptingClinicalPractice ....................................... 8
AddressingtheGapintheLiterature—ImplicationsforResearch ...... 9
TheContextoftheResearch ..................................... 11
WhyReadThisBook ........................................... 11
TheoreticalFramework ....................................... 12
Conceptualising Experiences of Trauma and Migration
fromaCollective,SocioculturalPerspective ..................... 15
ApplicationsforProfessionals ................................. 17
Conclusion ................................................. 21
References .................................................... 21
2 TraumaandMigration ........................................ 29
Pre-migration .................................................. 30
Torture ..................................................... 31
Migration ..................................................... 33
RequestingAsylum .......................................... 34
ProlongedDetention ......................................... 36
CourtProceedings ........................................... 37
BeingDeniedAsylum ........................................ 38
Post-migration ................................................. 38
ReceptionintheHostCountry ................................. 39
MultipleLossesandSocialIsolation ........................... 40
ContinualExposuretoTrauma ................................ 41
Unemployment .............................................. 41
Race-RelatedTrauma ........................................ 42
LanguageProficiency ........................................ 43
v
vi Contents
Gender ..................................................... 44
DailyStressors .............................................. 44
ConsideringtheInterrelationofFactors ........................... 45
CaseStudyOne:TraumaAmongDisplacedVictimsofTorture
inAthens,Greece .............................................. 48
CasePresentation ............................................ 48
FirstFeedbackLoop:BreakdownofInterpersonalRelations ....... 51
SecondFeedbackLoop:DelayedAsylumProcedure .............. 51
ThirdFeedbackLoop:LivingConditions ....................... 52
Fourth Feedback Loop: Hospitalisation and Interpersonal
EncountersinMedicalConsultations ........................... 52
CaseStudyTwo:Self-immolationAmonganAsylumSeeker
inSwitzerland ................................................. 53
TheSelf-immolationofArmin ................................ 53
Analysis .................................................... 55
ConcludingRemarks ......................................... 57
References .................................................... 59
3 PrevalenceofPTSDAmongDisplacedPopulations—Three
CaseStudies .................................................. 67
CaseStudyOne:Durban,SouthAfrica ............................ 68
Method .................................................... 69
Results ..................................................... 69
CaseStudyTwo:YezidisinIraq .................................. 70
Method .................................................... 72
Results:ToplineFindings ..................................... 72
WHO-5 .................................................... 73
HarvardTraumaQuestionnaire ................................ 73
CaseStudyThree:Marawi,Philippines ............................ 76
Method .................................................... 76
Results ..................................................... 77
Conclusion .................................................... 78
References .................................................... 80
4 BeyondPTSD ................................................. 83
ModelsofTrauma:ConflictingTheoreticalTraditions ............... 84
WhatIs“Trauma”? ............................................. 87
ConflictingConceptsofTrauma .................................. 90
TheProblemofPathologization .................................. 92
CriticismoftheUseofPTSDasaDiagnosisAmongRefugee
Communities .................................................. 94
TheInstrumentalisationoftheDiagnosisAmongAsylumSeekers ..... 97
Conclusion .................................................... 100
CaseStudy .................................................... 101
RepresentationsofTraumaAmongRefugeeVictimsofTorture
inAthens ..................................................... 102
Contents vii
RepresentationsofTraumaAmongMedicalProfessionalsAcross
Europe ....................................................... 103
References .................................................... 105
5 CulturallyInformedManifestationsofTrauma .................. 113
DefiningCulturefromaSocioculturalPerspective .................. 114
Culturally-Informed Narratives of Trauma: Perspectives
ofDiverseTheoreticalTraditions ................................. 115
TheImpactofTrauma .......................................... 118
TheInterplayofFactors ......................................... 120
Culturally-InformedResponsestoTrauma:AttributingMeaning
totheExperience ............................................... 122
PathwaystoHealing ............................................ 125
CaseStudy 1:MassFainting Spells Among theMurleTribe
ofSouthSudan ................................................ 130
IntroductiontotheContext .................................... 130
ACaseof“MassHysteria”? ................................... 131
Reflections ................................................. 132
CaseStudy2:PsychotherapywithaGuineanRefugeeVictim
ofTortureinAthens ............................................ 133
Conclusion:IntroducingaCollective,SocioculturalApproach
toUnderstandingTraumaandRecovery ........................... 135
References .................................................... 139
6 CollectiveTrauma,CollectiveHealing ........................... 147
Lossof“Home”asContainer .................................... 149
CollectiveResponsestoTrauma ............................... 150
Collective,Culturally-BasedInterventions ...................... 151
CaseStudyOne:TheDisplacedYezidiCommunityofNorthern
Iraq .......................................................... 152
TheImpactofEvents ........................................ 154
ManifestationsofTrauma ..................................... 155
CollectiveTrauma ........................................... 155
CulturallyInformedIdiomsofDistress ......................... 156
PerceptionsofMentalHealthServices .......................... 157
Case Study Two: Displaced Populations Affected by ISIS
inMarawi,Philippines .......................................... 157
OriginsandLayersofTrauma ................................. 158
IntergenerationalTransmission ................................ 159
EffectonAdultsandChildren ................................. 159
Self-awarenessofTrauma ..................................... 159
ThematicAnalysisofQualitativeData .......................... 159
SubjectiveExperiencesoftheMarawiSiege ..................... 161
IndividualTraumaNarratives—SpecificFocus ................... 162
PsychologicalAvoidance ..................................... 164
MultipleLevelsofLoss ...................................... 164
viii Contents
CommunityResponse ........................................ 165
ImpactonChildren .......................................... 166
ReligiousValuesandBeliefs .................................. 167
UncertaintyAbouttheFuture .................................. 168
Post-TraumaticGrowthandResilience .......................... 168
Conclusion .................................................... 169
References .................................................... 170
7 CollectiveResilienceandImagination ........................... 175
CollectiveResilienceAmongDisplacedPopulations ................ 175
Imagination,TraumaandMigration ............................... 177
ImaginationfromaSocioculturalPerspective ...................... 180
Case Study: Resilience and Imagination Among Victims
ofTortureinAthens,Greece ..................................... 182
TheCaseofJules ............................................ 183
Discussion .................................................. 188
Conclusion .................................................... 190
References .................................................... 191
8 CollectiveAspirations ......................................... 195
CaseStudy:CollectiveAspirationsofRefugeesinEurope ........... 198
Analysis ...................................................... 199
TheCaseofMrB .............................................. 199
Discussion .................................................... 204
Conclusion .................................................... 206
References .................................................... 206
9 WorkingwithShameandTrauma .............................. 209
MigrationandPost-traumaticShame .............................. 210
CulturalManifestationsofShameandImplicationsforClinicians ..... 211
CaseStudyOne:ResearchAmongDisplacedVictimsofTorture
inAthens,Greece .............................................. 212
AppliedApproachtoDealingwithShame:TheCaseofSylvain ....... 215
TheShameofDependence ...................................... 215
ImplicationsforTransformation .................................. 216
TheShameofSocialDiscrimination .............................. 216
ImplicationsforTransformation .................................. 217
TheShameofBeingUnemployed ................................ 217
ImplicationsforTransformation .................................. 218
CaseStudyTwo:FemaleSurvivorsofSexualViolenceinCape
Town,SouthAfrica ............................................. 219
Analysis ...................................................... 221
Conclusion .................................................... 228
References .................................................... 229
Contents ix
10 WorkingwithCulturalMediators .............................. 233
Case Study: Cultural Mediation Among Victims of Torture
inAthens ..................................................... 237
CulturalMediatorsasNegotiatingDifferentInterpretations
ofTrauma .................................................. 239
Translation:AccuracyVersusInterpretation ..................... 239
A Game of Alliances Between Refugees and Health
Professionals ................................................ 241
Working with Health Professionals Perceived as “Culturally
Inexperienced” ................................................. 243
Conclusion .................................................... 244
References .................................................... 245
11 WorkingwithPTSDintheAsylumProcedure ................... 249
PTSDAmongRefugeePopulations ............................... 250
TheImportanceofCorrectlyIdentifyingTraumaintheRefugee
DeterminationProcess .......................................... 251
PTSDandtheQuestionofLegalCausality ......................... 252
TheRefugeeDeterminationProcedureasaSystemofActivity ........ 254
CaseStudy .................................................... 256
AsylumSeekerPerspectives ................................... 257
DiscrepanciesinNarrativesofTrauma ............................ 258
AsymmetriesinTraumaNarratives,AsymmetriesofPower:
TheCaseofDilraj ........................................... 259
AdaptingtheTraumaNarrative:TheCaseofJules ................ 260
HealthProfessionals’Perspectives ............................. 262
ConflictingNarrativesAcrosstheActivitySystem ................ 265
Discussion: An Overview of the Various Critiques of PTSD
WithintheAsylumProcess ...................................... 266
Deconstructingthe“TraumatizedRefugee”Narrative ................ 267
Implications for Health Professionals Working with Asylum
Seekers ....................................................... 268
Conclusion .................................................... 269
References .................................................... 271
12 Conclusion ................................................... 277
TowardsaSocioculturalDefinitionofTrauma ...................... 282
ImplicationsforMentalHealthClinicians .......................... 285
TheRoleofNarrativeActivity ................................. 285
TheCollectiveCulturalFrame ................................. 286
Temporality ................................................. 287
ThePermeableSelf .......................................... 291
UniversalityofExperience .................................... 291
Implications for Mental Health and Psychosocial (MHPSS)
InterventionsinHumanitarianSettings ............................ 293
ACommunity-BasedResponse ................................ 294
x Contents
ACulturallyRelevantResponse ............................... 295
ALongitudinal,ContextuallySituatedResponse ................. 296
ADepathologizingResponse .................................. 296
AResiliency-Based,Forward-LookingResponse ................. 297
References .................................................... 300
