Healing Trauma after the war
“We are all brothers and sisters and have to take responsibility for our communities and the world we live in.” The Dalai Lama
I have recently travelled to Sri Lanka, as through my work in the asylum seeker and refugee sector, I have met many Tamil refugees and have been enticed by the beauty of this country and its people. The friendliness, positive attitude and mostly the generosity that I have encountered with this population has really touched my heart and has led me to do a research project on cross-cultural healing approaches in Australia. As I continue working with asylum seekers and refugees and would like to create more opportunities for healing and integration, I belief an understanding of the challenges and difficulties war survivors are faced with, helps building communities that embrace refugees. It encourages everyone to feel into their own hearts and find the love and compassion to take responsibility for a shared world we live in. In this context, I would like to give a summary of my findings:
Current trauma research has revealed that a holistic approach to health and healing has shown to be most effective with trauma clients. In particular in relation to the trauma of asylum seekers and refugees, recent trauma experts stress the importance of a multi-level approach to trauma healing. This requires moving away from the limited Post-Traumatic Stress Diagnosis (PTSD) of a biopsychomedical model of service delivery aiming for symptom reduction and functionally, to a model of social healing that includes socio-economic, political, social and religious factors. A social model of healing is a holistic approach to mental health that offers culturally appropriate interventions, recognizes community as a strong influencing healing factor and encourages the active engagement of the people in their own healing process. Social anthropologists and mental health experts working in collaboration have highlighted that culture forms the way people think and experience trauma. If people accept “traumatic” experiences as part of their life, the attitude and response to those experiences allows easier integration compared to the medicalization and possible victimisation with a post-traumatic stress diagnosis (PTSD). Religious understanding of traumatic experiences and ways to deal with them, have also shown to be major factors contributing to integration and healing.
Trauma responses after disasters and wars range from adaptive and constructive coping responses to a number of psychiatric disorders such as acute stress reaction, post traumatic stress disorder, depression, anxiety, somatoform disorders, alcohol and drug abuse or personality changes. Refugees often present with issues of unresolved grief, suicides, alcoholism, child abuse and domestic violence, poverty and unemployment, physical injuries and handicap, distrust, hopelessness and powerlessness. Some of these issues are secondary and get enforced by the environment refugees live in.
Individuals from collectivistic cultures, such as Tamils from Sri Lanka, are socialized in different ways to individuals from individualistic cultures. Collectivistic cultures focus their attention on social relationships and on the maintenance of social harmony between the involved parties. In particular the family is seen as a major source of support and acts as a buffer for stressful events. In Sri Lanka it has been recognized that purely psychiatric treatments for war survivors did not work, and that community based programs to rebuild damaged family units and social structures, resources and relationships, encouraging traditional healing rituals and group meetings were more effective. A comprehensive research on Tamil war-survivors in Sri Lanka has illustrated that a holistic community approach to trauma healing has shown significant recovery for mental health of the affected population. It has demonstrated that effective practices for mental health interventions incorporate community development approaches such as encouraging traditional healing practices (massage, breathing practices, yoga and meditation), spiritual rituals (chanting and prayers) and rebuilding a social network for support and a sense of belonging.
Similarly in Australia, research has shown that for people with cultural backgrounds that are more community oriented, a social model of healing can be more effective than a service delivery approach to mental health. It has become evident that working in collaboration with refugee’s needs is essential and will promote empowerment and healing. Emerging paradigms in mental health for refugees recognize that a holistic approach that fosters strength, capacity and resilience can enhance trauma healing, integration and resettlement of refugees.
This supports other current research in the field of trauma, valuing the interrelationship of body and mind and the importance of including the body in the healing process. In this context, the understanding of neuroscience has also been an influencing factor for trauma recovery.
Recent studies in neuroscience have demonstrated that neuroplasticity significantly contributes to trauma responses and integration. If the way we perceive a traumatic event determines how we integrate it, we can change the way we look at it through internal processes and hence influence the neurological firing in our brain, which will affect the way we integrate the trauma. This approach gives us two options of understanding how people integrate trauma: a) Culture and socialisation determine how we perceive trauma and b) this creates certain neuropathic networks which then influence our trauma responses. As we can influence our neuropathic networks, we can adapt different ways of thinking and feeling, which then can create new responses to traumatic experiences and facilitate integration. Studies on mindfulness and meditation, for example, have explained how brain waves change with regular meditation practice and how mindfulness practice allows people to see their problems in a different way and gives them tools to regulate their nervous systems and brain stem reactions.
Asylum seekers are amongst one of the most vulnerable groups in Australia, mostly living in a state of poverty and at risk of mental ill health. As a society with a social justice framework, we have an ethical responsibility to take care of disadvantaged and vulnerable minorities, ensuring their well-being and mental and physical health. Studies indicate that people who have fled conflict and have experienced post migration stress are at increased risk for PTSD and mental health disorders. It becomes evident that for positive resettlement governments need to write polices that support the acculturation process and psychosocial adjustment of refugees, as such policies have serious implications for mental health professionals that are attempting to provide culturally responsive services. A holistic approach values cultural systems and does not pathologize them. A review on refugee mental health interventions in Australia shows that recently the emphasis has been placed on psychosocial models, with interventions (e.g. group work, life skills workshops, social gatherings or religious celebrations) that aim to develop stability, safety and trust and a sense of control over life. This promotes a focus on growth and change in response to adversity and moves away from the medicalization of the refugee experience.
Conclusion: Australia predominately has followed a biomedical mental health model with a therapeutic service delivery. As research shows this might not be the most effective model in the field of trauma recovery and mental health of refugees. It neglects the socio-economic, social and religious dimensions of the issue and does not include culturally developed cognition, implicit models and procedural knowledge that are embedded in the body. Models that have used a combination of narrative therapy, cognitive-behaviour therapy, mindfulness approaches and body oriented practices, and including political or socio-economic engagement, have shown great results with integration and healing of trauma. With a social concept of healing, community planning is linked to a sense of belonging, which supports a shift from linear processes of planning and service provision to planning in context of systems. Transforming our close communities holds the promise for transforming the society we belong to. Defining trauma as part of our lives (instead of a medical symptom or dis-ease) brings it closer to our hearts allowing compassion to rise for others. Research shows that trauma is integrated and healed largely in the presence of others, in positive social interactions, which establish trust and new experiences of love and holding. In particular with people who come from communal rather than individualistic cultures, a sense of social holding and contributing to the community is crucial for their healing.
Hence, for positive outcomes in mental health and effective treatment of trauma, mental health providers need to move away from a passive individualistic service model to work together with community developers, with the goal of empowering individuals and communities to take charge of their own healing processes.
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