Trauma Care

Problems of Trauma and Psychological Care

Considering the high degree of insecurity that refugees face, they have been shown to be at increased risk of various problems that affect their standard of living and often lead to sequential trauma. This occurs when one factor causing trauma is complemented or replaced with a new factor that increases the trauma and aggravates the psychological and mental condition of a refugee. In this case the mental condition of a refugee and the psychosocial problems are highly interconnected, yet they may be predominantly either social or psychological in nature. The social problems of refugees have already been highlighted above. When it comes to the problems of a predominantly psychological nature, these might include pre-existing problems (mental and health disorders) and emergency-induced problems (i.e. grief, non-pathological distress, depression and anxiety disorders, including post-traumatic stress disorder (PTSD)). Thus, emergencies tend to amplify pre-existing problems of social injustice and inequality and, combined with new stress experienced in the country of exile, lead to diverse forms of trauma that, in fact, encompass far more than PTSD.

All the professionals who work with refugees – either as therapists, lawyers, counselors, or as officials who make decisions on asylum procedures – work with or write about what trauma is. The generally accepted definition of trauma is reduced to its medical aspects (as determined in ICD 10 and DSMIV) and does not take into account complex psychodynamic and ethnological considerations. On the other hand, they are many theories of trauma that try to cover various aspects of this concept starting with purely scientific medical considerations and getting deeper into the field of the human psyche with all its multi-layered psycho-social dimensions. However, regardless of the thorough knowledge of trauma that exists, there is still no generally accepted view of this issue. Sequential trauma is generally acknowledged nowadays, but this concept does not always offer a clear definition of symptoms. On the other hand, the concept of PTSD is successful in describing symptoms of a traumatic situation, but it does not take the contextual and psychosocial context adequately into account. An exclusive focus on traumatic stress may lead to the neglect of many other key mental health and psychosocial issues.

We have to assume that there are different definitions of trauma that do not exclude each other, but rather focus on its various aspects. Traumata are not static objects that remain unchanged, they are constantly in action, changing and developing, and are affected by various groups of professionals observing and working with them. Socio-political trauma processes have so many dimensions that they probably cannot be understood from one point of view alone.

We can always call upon highly specialized knowledge and different techniques used to determine trauma-related disturbances. At the same time, we are unable to determine the effects that enormous suffering and emotional pain induced by trauma have on the psyche and the lives of refugees and victims of torture.
 
Although these people need specialized and long-term support, in the work with refugees and survivors of torture one should realize that these groups have their resources that support their psychosocial well-being. A common error in work with trauma is to ignore these resources and to focus solely on deficits – the weaknesses, suffering and pathology of the affected persons. The key task is to identify, mobilize and strengthen the skills and capacities of individuals and their families. Examples of potentially supportive resources include families, common activities with people from their community and other groups (i.e. social workers, teachers, and religious leaders), art and, of course, opportunities of integration into the society where the affected people now live.