Refugee Trauma

Version	Summary	Created by	Modification	Content Size	Created at	Operation
1		Małgorzata Różańska-Mglej	--	1148	2023-05-22 11:46:57	\|
2	format correct	Conner Chen	Meta information modification	1148	2023-05-23 07:15:18	\| \|
3	format correct	Conner Chen	Meta information modification	1148	2023-05-24 08:30:38	\| \|
4	2 references were added	Małgorzata Różańska-Mglej	-1 word(s)	1147	2023-05-29 19:51:15	\|

This entry is adapted from the peer-reviewed paper 10.3390/ijerph20095694

The first comprehensive definition of trauma appeared in the Diagnostic and Statistical Manual of Mental Disorders and specified that trauma occurs when a person has to confront a potential threat to life or a dangerous event beyond their everyday life.

refugees artists mental health

1. Introduction

The aim of these contents is to address the mental health challenges of refugee artists who are grantees of ICORN—the International Cities of Refuge Network—from the perspective of the extended conceptual ADAPT model. This issue will be discussed based on the results of a qualitative study conducted with ICORN refugee artists between 2017 and 2022 in Poland, Norway, and Sweden. The main research question primarily encompasses factors that influence the acculturation process of the respondents once they reach a place of safe residence. Moreover, it also involves crucial elements of this process and the impact of these factors on the mental health of refugee artists from the perspective of the ADAPT model. It is a model developed by the Australian researcher Derek Silove and it focuses on demonstrating a wide range of dynamic psychosocial factors that can affect the mental health of populations experiencing mass conflict and displacement, including refugee populations ^{^[1]}. ADAPT identifies five key psychosocial pillars seen as crucial to mental health and post-trauma recovery: (1) Security; (2) Bonds and Networks; (3) Justice; (4) Roles and Identities; and (5) Existential Meaning ^{^[2]}.

The respondents are grantees of the International Cities of Refuge Network, ICORN, which was launched in 2005 and now connects more than 75 cities around the world. The aim of the network is to provide long-term refuge for persecuted artists who often become targets of politically motivated harassment and attacks. The ICORN cities invite one persecuted artist at a time (alone or with family) and, in the form of a stipend, provide him/her with a place of safe residence and an opportunity to continue his/her work for a period of several years or longer. As of 2023, the network has hosted over 200 persecuted poets, novelists, playwrights, screenwriters, translators, bloggers, comic book writers, musicians, actors, publishers, and others ^[3].

All ICORN artists meet the refugee criteria as detailed in the Geneva Convention ^[4]; however, not all of them have legal refugee status. In host cities in Norway, for instance, artists automatically obtain refugee status and, consequently, are required to participate in a full integration programme. In contrast, artists residing in Sweden or Poland are only granted temporary residency.

2. Refugee Trauma

The first comprehensive definition of trauma appeared in the Diagnostic and Statistical Manual of Mental Disorders ^[5] (p. 236) and specified that trauma occurs when a person has to confront a potential threat to life or a dangerous event beyond their everyday life:

The stressor producing this syndrome would evoke significant symptoms of distress in most people, and is generally outside such common experiences as bereavement, chronic illness, business losses, or martial conflict. The trauma may be experienced alone (rape or assault) or in the company of groups of people (military combat). Stressors producing this disorder include natural disasters (floods, earthquakes), accidental man-made disasters (car accidents with serious physical injury, airplane crushes, large fires), or deliberate man-made disasters (bombing, torture, death camps.)

Over the years, this definition has been significantly modified by, among other things, the results of epidemiological studies on the frequency of exposure to trauma ^[6]. The subsequent definition of trauma provided in the Diagnostic and Statistical Manual of Mental Disorders from the year 2000 ^[7] was expanded to include the component of witnessing a traumatic event that befalls someone else and the subjective perception of the event in question as something overwhelming, causing fear, feelings of helplessness and terror. This means that an event can be traumatic for one person but not necessarily for another. The most recent definition of trauma can be found in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders from the year 2013 ^[8]. Although this definition retains the previously introduced condition of witnessing a traumatic event that affects someone else, it no longer includes a subjective perception component, as research has shown that an experience can be traumatic despite the lack of manifestation of emotions such as helplessness, fear, or terror ^[9].

Mention should also be made of the neurobiological determinants of trauma, which are, especially since 2000, an important area of research. Researchers have identified two distinct ways of coping with trauma: adaptive and non-adaptive ^[10]. The adaptive way assumes the individual’s ability to maintain healthy psychological and physical functioning while experiencing traumatic events ^[11]. The non-adaptive way of coping with trauma, on the other hand, assumes that trauma is located behind a wall that provides mental and emotional relief to the individual experiencing it ^[12]. The non-adaptive way of coping with trauma is particularly common among refugees, as migration forces them to adapt to life in a new country, redefine their family responsibilities, and focus on psychological strength. As a result, these refugees need to maintain the defence mechanisms that make this possible. However, if a non-adaptive way of coping with trauma persists, it can lead to chronic pathological reactions such as illness or criminal behaviour ^[13]. In the case of the non-adaptive way of coping with trauma, isolated memories of trauma persist and are constantly active causing a state of hyperactivity called ‘somatic memory’, which is one of the symptoms of post-traumatic stress. This state can persist as long as the traumatic memories have not been transformed and integrated ^[14].

Refugees who have fled their countries of origin for fear of persecution have often experienced or witnessed life-threatening situations, multiple losses, torture, murder, long-term stays in overcrowded camps, powerlessness, and suffering before or even during their journey ^[15]. Subsequently, they not only experience the stress of cultural adaptation in their new place of residence but also often feel treated as criminals ^[16]. Lengthy and complicated asylum procedures and continued uncertainty about their final legal status can further increase their stress levels ^[17].

As a consequence of the challenges they have experienced, refugees can experience normative and non-normative behavioural, emotional, and social reactions. Normative reactions include anger at the injustice experienced, an adequate response to danger, ensuring one’s own safety as well as that of their loved ones, or culturally accepted mourning. However, these reactions can also develop into non-normative reactions such as paranoia, hypersensitivity to signs of danger, prolonged grief, or depression ^[18].

Studies of mental health among refugees indicate a high rate of psychological disorders in this population compared to the other residents in their host countries ^[19]^[20]. The multiple traumatic experiences that refugees have faced in their countries of origin, during forced migration, and in their new places of residence can lead some to exhibit symptoms of refugee trauma, which is sometimes referred to as post-traumatic stress syndrome ^[15]^[21]^[22]. There can be many different symptoms of refugee trauma, including both somatic and psychological aspects ^[15]. These symptoms can be diagnosed and treated as a range of disorders, including psychosis, PTSD, and depressive and anxiety disorders, which are prevalent in this population ^[23].

References

Tay, A.K.; Silove, D. The ADAPT model: Bridging the gap between psychosocial and individual responses to mass violence and refugee trauma. Epidemiol. Psychiatr. Sci. 2017, 26, 142–145. https://doi.org/10.1017/S2045796016000925 (accessed on 24 January 2023).
Silove, D. The ADAPT model: A conceptual framework for mental health and psychosocial programming in post conflict settings. Intervention 2013, 11/3, 237–248. https://doi.org/10.1097/WTF.0000000000000005 (accessed on 27 January 2023).
ICORN. Available online: http://www.icorn.org/ (accessed on 10 July 2022).
UN General Assembly. Convention Relating to the Status of Refugees. United Nations. Treaty Ser. 1951, 189, 137–220. Available online: https://www.refworld.org/docid/3be01b964.html (accessed on 25 January 2023).
Diagnostic and Statistical Manual of Mental Disorders, 3rd ed.; American Psychiatric Association: Washington, DC, USA, 1980.
O’Donnell, M.L.; Schaefer, I.; Varker, T.; Kartal, D.; Forbes, D.; Bryant, R.A.A.; Silove, D.; Creamer, M.; McFarlane, A.; Malhi, G.; et al. A systematic review of person-centered approaches to investigating patterns of trauma exposure. Clin. Psychol. Rev. 2017, 2017, 208–225.
Diagnostic and Statistical Manual of Mental Disorders, 4th ed.; American Psychiatric Association: Washington, DC, USA, 2000.
Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; American Psychiatric Association: Washington, DC, USA, 2013.
Friedman, M.J.; Resick, P.A.; Bryant, R.A.; Brewin, C.R. Considering PTSD for DSM-5. Depress. Anxiety 2011, 28, 750–769.
Greenwald, R. Child Trauma Handbook: A Guide for Helping Trauma-Exposed Children and Adolescents; The Haworth Reference Press: New York, NY, USA, 2005.
Bonanno, G.A. Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? Am. Psychol. 2004, 59, 20–28.
Rothschild, B. Trauma Essentials; W.W. Norton & Company: New York, NY, USA, 2011.
Koch, S.C.; Weidinger-von der Recke, B. Traumatised refugees: An integrated dance and verbal therapy approach. Arts Psychother. 2009, 36, 289–296.
Rothschild, B. The Body Remembers; W.W. Norton & Company: New York, NY, USA, 2000.
Nickerson, A.; Bryant, R.A.; Silove, D.; Steel, Z. A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clin. Psychol. Rev. 2011, 31, 399–417.
Phillimore, J. Refugees, acculturation strategies, stress and integration. J. Soc. Policy 2011, 40/03, 575–593.
Gleeson, C.; Frost, R.; Sherwood, L.; Shevlin, M.; Hyland, P.; Halpin, R.; Murphy, J.; Silove, D. Post-migration factors and mental health outcomes in asylum-seeking and refugee populations: A systematic review. Eur. J. Psychotraumatology 2020, 11, 1–13.
Silove, D. The ADAPT model: A conceptual framework for mental health and psychosocial programming in post conflict settings. Intervention 2013, 11/3, 237–248.
Fazel, M.; Wheeler, J.; Danesh, J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. Lancet 2005, 365, 1309–1314.
Steel, Z.; Silove, D.; Brooks, R.; Momartin, S.; Alzuhairi, B.; Susljik, I. Impact of immigration detention and temporary protection on the mental health of refugees. Br. J. Psychiatry 2006, 188, 58–64.
Potocky-Tripodi, M. Best Practice for Social Work with Refugees and Immigrants; Columbia University Press: New York, NY, USA, 2002.
Karam, E.G.; Friedman, M.J.; Hill, E.D.; Kessler, R.C.; McLaughlin, K.A.; Petukhova, M.; Sampson, L.; Shahly, V.; Angermeyer, M.C.; Bromet, E.J.; et al. Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) surveys. Depress. Anxiety 2014, 31, 130–142.
Duhig, M.; Patterson, S.; Connell, M.; Foley, S.; Capra, C.; Dark, F.; Gordon, A.; Singh, S.; Hides, L.; McGrath, J.J.; et al. The prevalence and correlates of childhood trauma in patients with early psychosis. Aust. N. Z. J. Psychiatry 2015, 49, 651–659.

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Małgorzata Różańska-Mglej

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1. Introduction

2. Refugee Trauma

References