Trauma & Dissociation in the News

World Refugee Day

Mary-Anne Kate, PhD

World Refugee Day, held every year on June 20th, commemorates the strength, courage and perseverance of millions of refugees, shows support for refugees, and requests that governments work together and do their fair share for refugees.

Who is a refugee?
A refugee is a person who has been forced to flee their country because of persecution, war or violence. Refugees by definition are traumatised individuals, with the legal criteria for refugee status requiring the person to have a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group and that, for these reasons, they are unable to return home or are afraid to do so. The right to seek asylum was enshrined in the 1951 Geneva Convention in the aftermath of World War II. War and ethnic, tribal and religious violence are leading causes of refugees fleeing their countries.

Parallels between the refugee experience and dissociation
Having worked in the refugee and migration field for over a decade and then completing a PhD about childhood trauma and dissociation, I find the similarity between the situation of refugees and individuals with Dissociative Disorders striking. Both have been traumatised by the actions (or inactions) of the very people who are responsible for protecting them, and this frequently results in the fragmentation of their identity. On one hand, refugees may find it difficult to continue to align themselves with their national, cultural, social or religious identities, as these are also aligned to those who persecuted them. On the other hand, they may continue to cling to these aspects, which forms a core part of their heritage and personal identity.

Furthermore, their new lives may be so discordant from their old, that they barely recognise themselves. This echoes the experiences of people who dissociate to cope with abusive and frightening caregivers, who they may continue to have love for, and loyalty to, even though their caregivers have harmed them in unspeakable ways. It is not surprising then that, like people who suffered chronic abuse at the hands of their caregivers, refugees have high rates of dissociation.

Refugees: a global perspective
There are 25 million refugees worldwide. Two-thirds of all refugees worldwide come from just five countries: Syria, Afghanistan, South Sudan, Myanmar and Somalia. In addition to refugees, there are 40 million Internally Displaced People (IDP) worldwide who have been forced to flee their home as a result of civil war, internal strife or natural disasters.

While many people in the West feel that their country is shouldering the burden of refugees this is far from the truth as 85% of refugees and IDPs reside in developing countries such as Uganda and Pakistan. Turkey alone hosts 3.5 million refugees. In comparison only 24,000 of these refugees were resettled in Europe in 2017. The most generous Western countries for refugee resettlement when the population of that country is taken into account, i.e. number of refugees resettled per thousand residents, are Monaco (.59), Norway (.53), Sweden (.34), and Luxembourg (.31), which is higher than the traditional refugee resettlement countries of Canada (.24) and Australia (.16) and the US (.08).

Seeking asylum in western countries
Only 1 in every 21 refugees residing in the country they fled to, who are in need of resettlement to a safe third country, will be given that opportunity due to the very limited number of resettlement places offered internationally. With scant opportunities for resettlement, it should not be surprising that many refugees and IDPs undertake a frequently perilous journey to seek asylum in a safe country. While we may have the impression of all asylum seekers heading to Western countries, this is incorrect as half seek asylum in developing countries. In 2017 over 3 million people were awaiting decisions on their asylum applications.

Memory, credibility, shame and disclosure
Research suggests that refugee status decision-makers typically have unrealistic expectations of what people can reasonably remember. They assume that the person should accurately recall dates, frequency, duration and sequence; and even peripheral information and verbatim wording of verbal exchanges. If the asylum-seeker cannot give a detailed account of events then their claim may be deemed not credible. These expectations about memory recall are too high for even normal events and do not take into consideration the neurobiology of traumatic memory or dissociative amnesia.

Having personally conducted several hundred refugee status determination interviews in North Africa, I often found the interviewees who could provide a detailed narrative of their experiences were the ones whose claims I found were not credible (which would become clear to me when I focused on their life generally outside the refugee claim and the two accounts would not match up).
I also noticed how shame, trauma, and a lack of trust and rapport also prevented genuine claims from being disclosed. Not unlike an initial therapy session for a dissociative client, there is little more than an hour to build rapport with a person that is fearful and distrustful of authority figures and to uncover the kernel of their story.

I recall interviewing a journalist who had been tortured for weeks and witnessed his cell mates killed in front of him. This man was physically and emotionally broken, could barely speak, and had no wish to recount his horrific and humiliating experiences. I interviewed three young women huddled together who were shaking in fear so intensely that I did not follow the normal protocol of separating them. I remember a woman telling me about being held captive by a ‘bad man’ and I strongly suspected she had been raped, but I knew she could not disclose that to me – rape is not only shameful, but a cultural stigma that can lead to a woman being outcast by her husband and her own family. However, if she had been able to tell me, it would have made her claim stronger. There is no way I could do justice to these people’s experience in the hour or so that I had with them. For the record, I did grant refugee or humanitarian status to these people who could then start a new life in Australia, but I knew that the outcome may have been different if the interviewer had been someone that was not as attuned to trauma as I was.

National asylum policies: a trauma-creating approach
Western countries are spending hundreds of billions of dollars on additional measures to stop asylum seekers reaching their soil. Many compete with each other in a race to the bottom to be the least desirable destination, sacrificing human rights in the process. For example, since 2001 the Australian government has prided itself on its initiatives to “stop the boats” to prevent the arrival of asylum-seekers in Australia, regardless of the strength of their refugee claims.

Australia began processing asylum-seekers off-shore on small islands in the pacific to avoid its responsibility under the Geneva convention. The detention centre on Manus Island, Papua New Guinea, was found to be illegal and unconstitutional and the Australian government was forced to pay a settlement to nearly 2,000 refugees and asylum-seekers for illegally detaining them in horrific conditions. Amnesty International reports also found that asylum seekers in detention on the island nation of Nauru were subjected to humiliation, neglect, abuse and poor physical and mental health care.

In the US, President Trump signed executive orders affecting asylum-seekers and refugees, including the proposal for the wall to be built along the USA-Mexico border; allowing the forcible return of asylum-seekers to their home country; and the increased detention of asylum-seekers and their families; and children being forcibly separated from asylum-seeking parents. In dealing with vulnerable and traumatised populations a trauma-informed approach is needed, but a trauma-generating approach has been implemented as the asylum-seeking process becomes a traumatic experience in itself, making individuals more traumatised.

When the ‘safe’ country doesn’t feel safe
Like dissociative clients who have been abused by caregivers and develop a conceptual template that people and the world are unsafe, many refugees have a similar experience. To heal from trauma, one needs to feel safe. Most refugees have learned to be distrustful of authority, and too often the refugees are further traumatised, not only by their refugee journey, but by authority figures implementing the policies of the ‘safe’ countries to deter asylum-seekers. How then does a refugee feel safe in their host country?

Furthermore, a number of countries offer temporary, instead of permanent, protection which means that the refugee is living in limbo and not able to feel secure and settled given at any time they can be returned to their home country should the authorities deem it is safe to return.

Refugees and asylum seekers are our responsibility
“They have no business coming here” is a common phrase heard when the public are discussing asylum seekers whilst seemingly ignoring the right to do so that is enshrined in the Geneva convention.

The truth is that we are all responsible. International organizations, Western governments and their citizens all contribute to, or help to alleviate, the factors that create the conditions for refugees and IDPS. If people are living in a time of war or insurgency is military intervention protecting them from violent oppression, or creating greater dangers; and are there effective peacekeeping forces and diplomatic resolutions? If people are suffering as a result of war or natural disaster, is humanitarian assistance alleviating this? If people are living in abject poverty with little or no access to basic services such as water, health and education, is development assistance making their situation more tolerable? Are the goods and services produced for Western countries or the tourist market helping to provide locals with a basic income? Is the environmental inaction of Western countries (or our demand for products produced in that country) creating dangerous levels of pollution, or leading to desertification or coastal flooding in the area in which they live? Is their country struggling to cope with the ‘brain drain’ of professionals such as health care workers and engineers who are now working in our countries?

Hence, policies at the national and supranational level, and the decisions of individual consumers on what they buy and what charities they support contribute to strengthening or weakening push factors in the refugees’ countries of origin.

What would happen if these hundreds of billions spent on border security around the world were spent addressing the root causes of migration and refugee movements? Surely, if people had safety and reasonable future prospects they would not be desperate to flee their own countries in incredibly dangerous circumstances.

Community support
Refugees need a lot of support when they arrive in the host country. This may include assistance in finding suitable housing, tuition to learn the host country’s language, education and training, including getting recognition for qualifications and skills acquired in their home country, arranging schooling for children, and addressing unmet and ongoing health issues. When these needs are met, the person become more involved in the wider community (and their own cultural community) through employment, education, volunteering and civic engagement. It is through these wide range of experiences and interactions with the host society that a refugee may begin to feel safe in their new country. For refugee settlement to work well, there needs to be goodwill and practical support as well as protection from racism and other forms of discrimination.

Despite trauma being at the core of the refugee experience, mental health is rarely systematically addressed. Refugees may not seek mental health treatment as they are not aware of its benefits, are distrustful of it, lack access to it, or avoid it due to a cultural stigma surrounding mental health problems. Access to trauma-informed mental health care should be a priority for refugees, their families and their communities. Training and community education is equally important to ensure that services to refugees are delivered in a trauma-informed framework, including one that addresses dissociation.

Resources
Dissociation in refugees:
https://www.ncbi.nlm.nih.gov/pubmed/25415764
Refugee interviewing, credibility and memory:
https://academic.oup.com/ijrl/article-abstract/22/4/469/1520136
The responsibility of Western countries:
https://www.researchgate.net/publication/274007389_Kate_2011_’The_EU_migrants’_pathways_and_EU_policy_responses’_in_Ed_Novotny_Opening_the_door_Immigration_and_integration_in_the_European_Union_Centre_for_European_Studies_Brussels_ISBN_978-2-930632-11
Amnesty International:
https://www.amnesty.org/en/countries/
UNHCR statistics:
https://www.unhcr.org/en-au/figures-at-a-glance.html
https://www.unhcr.org/en-au/publications/fundraising/5a0c05027/unhcr-global-appeal-2018-2019-full-report.html
https://www.unhcr.org/en-au/protection/resettlement/5b28a7df4/projected-global-resettlement-needs-2019.html
https://www.unhcr.org/5b27be547.pdf

About Mary-Anne
Before specialising in Dissociative Disorders, Mary-Anne worked in the migration and refugee field for over a decade, including as a diplomat managing Australia’s refugee and migration programmes for North Africa; coordinating Australia’s National Integrated Settlement Strategy for migrants and refugees; and as a researcher and analyst for Europe’s most influential think-tank on migration and equality where she wrote policy for the European Commission. Mary-Anne completed her Master of Science at the University of Edinburgh and her dissertation on the inequity of protection for asylum seekers in Western countries was published by the United Nations High Commission for Refugees (UNHCR).