Family Therapy with Refugees and Political Exiles

Size: px

Start display at page:

Download "Family Therapy with Refugees and Political Exiles"

Dwayne Horn
5 years ago
Views:

1 Family Therapy with Refugees and Political Exiles Jeremy Woodcock Context, Reproduced with the kind permission of Context. This paper first appeared in Context, 20:37-41, Jeremy Woodcock is a Family Therapist at the Medical Foundation. The views expressed in this article are those of the author and do not necessarily reflect the policy of the Medical Foundation for the Care of Victims of Torture.

2 Family Therapy with Refugees and Political Exiles Jeremy Woodcock It is estimated that over 390,000 people sought political asylum in Europe in Centres which work with refugees found that more than 30% had suffered torture. Terror used to subjugate populations include atrocities, public execution, disappearances, torture and sexual violation; and those targetted are often those whose life and work symbolises shared values and resistance to subjugation; priests, community leaders, health workers, and teachers, political leaders and trade unionists. These strategies are frequently played out on the terrain of subsistence economies, and are devastatingly effective (Summerfield, 1992). What we frequently see at the Medical Foundation is that torture and violence get into people s psychic space: the father who cannot share with his seven-year-old son the terror that happened to him in prison, and yet day by day his son knows; the woman who guiltily realises that a space has opened up between herself and her partner, that the torturer has been inside her physically and psychologically in more intense and intimate ways than her partner ever has been; the Sri Lankan lad who is detained and tortured just for the accident of being between the age of fourteen and twenty-five who quite rightly asks the question Why me? ; the Iranian Shia woman who was driven three days across the desert into Iran at the outbreak of the Iran/Iraq war with three hundred of her community (one small group among thousands who went through the same terrifying ordeal), who witnessed an exhausted mother having to decide which one of her twins to lay down to leave beside the track to die, and which child to take with her, who quite rightly asks, Why us? Why me? We need to understand that torture and organised state violence does not only happen to magnificent brave people, although many are. It intervenes into ordinary life, and ordinary relationships, with all their inevitable difficulty, banality, and ambiguity. However, inevitably torture and organised violence are highly charged with political, and ethical dimensions. In my work with survivors, the thread that I attempt to follow in order to hold these dimensions together is a search for social justice and human rights: something that I believe should be at the heart of therapy in a direct and informative way that seeks to conform to the contours of the human experience and out of which meaning can be constructed. Europe as a Refuge for Asylum Seekers It is wise to be cautious when commenting upon refugee issues in the European context. All too easily Europe and North America can be constructed as the donor countries. What needs to be emphasised is that flows of refugees from the Third World into Europe are relatively recent phenomena. Until the mid-1970s there were fairly modest numbers seeking asylum in Europe from the Third World. There was a jump in the mid-1970s to an unprecedented new level. The main factor at play was the shift in the nature of Third World conflicts from colonial to far more deadly and complex post-colonial dynamics, and the relative increase in the number and size of those conflicts. The sponsorship of conflict by power blocs, the inadequacy of post-colonial economic partnership, and the massiveness of Medical Foundation Series Family Therapy with Refugees and Political Exiles 1

3 the world arms trade North to South have been underpinning factors. Current European Immigration Policies Towards Refugees In the UK decisions on asylum are made with discretion outside the immigration rules. There has been a growing trend since 1980 to award applicants B status or Exceptional Leave to Remain. This does not confer the same rights to permanent settlement or family reunion as full refugee status. A similar trend can be noted across Europe as a whole. This indicates political decisions to effect restrictive and deterrent policies in an effort to lower the numbers who seek asylum in the Europe. This trend is now so advanced that asylum lawyers and others in the field have coined the description fortress Europe, and in 1992, prompted ECRE (European Council on Refugees and Exiles), the umbrella group of non-governmental organisations working with refugees and exiles, to adopt the slogan, Europe: open for business, closed for refugees. The Schengen agreement which to date has been signed by eight of the twelve EC countries provides : 1. Control of external borders into Europe 2. A uniform visa policy, which has tended to impose visa controls on travellers from former colonial territories, who hitherto had free access to many European countries. 3. The creation of an information system which will include details of all foreign nationals entering the territory, which will be accessible to officials at all ports of entry, as well as within states. In June 1991 the Dublin convention was signed by all twelve. This so-called Asylum convention determines which state is responsible for deciding a claim of asylum applicants. It applies the one chance rule. Thus applicants can apply for asylum in only one member country. If the state to which they apply refuses, it is given that all the states have refused, even if the rules of determination in another state may have possibly ruled in the applicant s favour. However, it is not only the general harmonisation of procedures in Europe that is detrimental to the rights of asylum seekers. It is also the creation of measures to prevent asylum applicants even entering European territory. Under normal conditions in order to enter a state a traveller requires a visa which will only be granted for a legitimate reason for travel. Consulates will not issue visas in order to allow people to travel for the purposes of claiming asylum. Furthermore, while in flight from persecution an individual or family may find it very difficult even to obtain a passport from their national authorities. Escape from persecution is therefore extremely difficult. To add to those difficulties, European countries, led by the UK, have imposed the Carriers Liability Acts which fine airlines and shipping companies (in the UK 2,000) for each person they allow into the territory without proper documentation. The effect of this has been to force airline and shipping staff to impose stringent checks on passengers, thus creating a further barrier of immigration control and preventing asylum seekers even leaving the country where they are being persecuted. The stringency of these measures matches those imposed on labour immigration in most European states from the early 1970s. Having largely fulfilled their economic purpose, primary immigration was halted in the world recession of the 1970s. This immigration was often characterised by the need to fill low paid and low status jobs which members of the host community would not fill. In the summer of 1993 the UK brought into force its new asylum legislation. This imposed further restrictions on people seeking asylum and prevented asylum seekers being Medical Foundation Series Family Therapy with Refugees and Political Exiles 2

4 housed by local authorities. In 1992 when the UK signed the United Nations Convention on the Rights of the Child it entered a reservation on immigration matters which allows it to disregard the right of refugee children to family reunion. In Copenhagen in June 1993, under the provisions of Maastricht and other European instruments, European heads of state agreed to impose stringent restrictions on the reunification of refugee families. Health and Social Provision for Refugees European governments have expected non-governmental organisations (NGOs) to meet the psycho-social and health needs of refugees. There are initiatives created by interested clinicians working in hospitals who have managed to organise their departments to meet some of the needs of refugees. Additionally, there are small voluntarily funded specialist centres which tend to offer a multi-disciplinary service of psychologists, social workers, family therapists, psychotherapists, doctors, alternative practitioners and so on; like the Medical Foundation for the Care of Victims of Torture, in which I work. These centres have come into existence within the past five to ten years, often drawing together groups of committed practitioners already active in the field. Commonly, they are organised politically in critical relation to the construction of human rights in the European context as I have previously outlined. These centres act as filters, offering treatment where available and referring patients who sometimes need more complex hospital treatment. However, while playing an important strategic role there is little doubt that they cannot come close to meeting the health care needs of the real numbers of asylum seekers entering Europe year by year. For instance, in 1986 when the Medical Foundation was first set up with two members of staff drawing on a small network of health professionals, it treated 75 people. In 1991 it had grown considerably. It employed 25 clinical and administrative staff and drew on a network of about 40 volunteer practitioners, and saw an almost unmanageable peak of about 2,000 new patients that year. However, during 1986 there were 5,000 asylum applicants in the UK and in 1991 this had risen to 25,000. Dedicated provision for refugees is therefore very thinly spread. Furthermore, the gap between the number seeking help and absolute numbers of asylum seekers is so great that we cannot harbour the illusion that all families and individuals who would benefit from help will receive it. Therefore, practitioners in all fields of health and social care need to be aware that when an individual or family presents for help from a national group which has produced refugee flows, their needs may be rooted in that experience. Post-Traumatic Stress Disorder Post-traumatic stress disorder (PTSD) has gained great prominence, and for a period shaped a great deal of clinical thinking regarding the treatment of asylum seekers and refugees. The ranking of symptoms within PTSD, including avoidance, intrusive recollections, anxiety, organised under the rubric that the sufferer must have been subjected to an experience of overwhelming proportion, beyond the normal scope of human experience, seems to match the facts of torture and organised violence particularly well. However, undue concentration on the symptomatic presentation must not lead us to overlook the existential changes shaped by the torture experience, which appear to be far more significant in terms of a patient s attitudes toward life, and hopes for the future, and recovery. Current research at the Medical Foundation suggests that individuals and, from my clinical knowledge, families are far more organised around changes in the meanings of Medical Foundation Series Family Therapy with Refugees and Political Exiles 3

5 their lives, than they are around symptoms (Turner & Gorst-Unsworth, 1993). It is when these deeply altered meanings are woven into a meaningful matrix that recovery takes place. Nevertheless, symptoms of PTSD are often extremely troubling. Furthermore, they are often part of a more complex clinical picture involving complicated grief. Recent research appears to show that the intrusive material of PTSD and the avoidant response of the sufferer can result in a significant block to the work of grieving essential to emotional recovery from organised violence. This can put the practitioner in a bind. What can happen is that in attempting to work through the material of grief with the survivor, the practitioner may evoke terrifying PTSD material which acts as a significant deterrent to working on recollections essential to effectively grieve. On such occasions the practitioner may be terrified of persevering for fear of further harming the survivor. In these circumstances a flexible clinical approach is required. Naturally a relationship of trust is necessary with the survivor, in which conversation about events and their meaning can be ventured with permission and skill, into and through extremely troubling areas of experience. Experience shows that one needs to use a variety of strategies depending on the needs and presentation of the survivor. These may include cognitive behavioural elements in conjunction with symbolic working through of material framed within the culture and experience of the survivor. The appropriateness of a transcultural understanding of how survivors respond to organised violence and exile cannot be over emphasised and the importance of indigenous religious and cultural ceremonies as healing must be borne in mind. Family Therapy and Anthropology One of the most fruitful collaborations that is happening is between anthropologists, specifically studying the communal effects of trauma, migration and exile, and health workers, and specifically family therapists, who I think are in a prime position to benefit because of the relative similarity between the epistemological structures and histories of anthropology and family therapy. Eastmond (1991) argues the following needs in treating cultural trauma: 1. Understanding and assistance in cultural bereavement must be grounded in refugees own cultural, religious, cosmological, political and ideological meaning systems. 2. Collective forms of expression must be made possible. 3. The need for mourning the losses inherent in the refugee situation must be addressed. Collective expressions and paradigms are especially important here in providing meaning and affirming identity and continuity of survivors. 4. The transformative and healing potential of ritual and other collective, formalised and dramatic/symbolic enactments should be understood. 5. Models in western institutions need to incorporate refugees experience and meaning systems as a resource. Family Culture and Family Therapy In my work at the Medical Foundation I developed ways in which family therapy with survivors can incorporate these aims. Every society has a rich set of rituals to mark seasonal and life cycle changes. Refugees often find it difficult to practise rituals in the host society outside of the context of homeland. This represents the double loss exile, not only of homeland but also of forms of living which bring homeland back to life. The Medical Foundation Series Family Therapy with Refugees and Political Exiles 4

6 consequences of the loss of ritual which mark changes and incorporate meaning into events is most poignantly felt over the death of a loved one in exile. It summarises all the personal and communal disruptions of exile and resonates with losses of homeland, health, family loved ones, political and communal vitality, in a way that can be devastating. Family rites can be worked out which bring into play the richness of cultural forms, through which death can be effectively mourned. Death, instead of amplifying other losses can be used in family and communal rituals to reawaken the use of ritual behaviour and to mobilise patterns of resilience. Experience with survivors shows that the effect of exile is at least as devastating as organised violence. In exile, life cycle transitions pass without being marked and a common effect is that exiles feel lost in time, stripped of elements of their identity and role which formerly structured time for them. I always set out to note passing time with families in exile using any relevant markers of change. Passing seasons and how they contrast with home makes one vital connection; the children s progress at school and so on make others. Attention to these details, linking the experience of how role and identity are experienced here in relation to time, and how this contrasts with their former life in their homeland can start shifting a family that has been immobilised by the disruptions of exile forward into progressive thinking about the tasks and changes of adaptation. Children of the family at school will need to cope with a peer group, and teachers who have probably never seen, or really understand, anything of the horror and losses which these children have experienced and witnessed. Frequently, the children learn the host language much more rapidly than their parents and often have to act as the interpreters of language and culture. If the parents cope poorly because of their own personal difficulties this can lead to children experiencing their parents as shadows of their former selves, emotionally absent, ill-tempered, and even violent. Younger children who have less ability to distinguish the effects of changes in their social world from their inner world may blame themselves for the change in their parents (Melzack,1992).To add to the tensions, adolescent children may conform to host society peer group pressure and adapt in ways their parents find challenging. Meanwhile the parents often find themselves adopting customs and attitudes which reflect more conservative aspects of their culture in an attempt to cope with what is happening to them. They may believe that they are likely to lose their children to the host society, and codes of discipline may be imposed more rigidly than is likely to be successful. In this scenario it is rarely helpful to be critical of such reactions. If the parents experience therapy as supportive and respectful of their beliefs and culture they are far more likely to open up to discussion about the dilemmas it presents them in exile and to consider an array of possible solutions. The Social World of the Refugee The massive changes refugees experience as a result of exile require particular account to be given to their social world. Themes of continuity and change need to be brought into therapy by the therapist. Common core dilemmas confront refugees and these can be discussed to compare and contrast with homeland. Changes such as school and peer group; the dramatic downward shifts in family status and material means; the lack of empowerment for refugees; the experience of racism, which is frequently a shocking and puzzling experience to newly arrived refugees - all need to be actively brought into therapy, as well as legal issues and anxieties of getting refugee status and the fate of separated family members and so forth. Medical Foundation Series Family Therapy with Refugees and Political Exiles 5

7 Gender Issues We often find that women are more adaptive to exile. It seems that the elements of their identity tied up with relationships and home-making skills, which in themselves demand a variable and adaptive set of skills, and which continue to be demanded of them in exile, act as protective factors. Meanwhile, men and those women who have identities rooted in work and political action, find their worlds dramatically diminished, and struggle to establish continuity between their past life and the culturally impoverished present. For both women and men, enforced helplessness will emphasise poor coping brought about by psychic wounds. Disruptions to family structure are common in this scenario. Therapy needs to attend to the renegotiation of gender roles which both take account of cultural expectations and the demands of exile. The Relevance of Family Therapy Confrontation with the subject matter of political exile is at first a dramatically deskilling experience. This isn t because family therapy skills aren t appropriate. It is because in the face of what has to be acknowledged, overwhelming and profoundly terrifying experiences, any professional needs to re-examine their own defences and forms of discourse. What distinguishes systemic family therapy from other forms of therapy and makes it particularly suitable for this work, is that it acknowledges not only the mind and emotions of its clients, but also engages with the social, cultural, and political matrix of families. It also gives primary recognition to the belief that reality is socially and politically constructed, and thus adopts a posture of curiosity and empowerment toward families, their cultures, and their difficulties. It follows from this that it tends not to prescribe ways in which families should behave but rather promotes situations in which families can find their own solutions (Woodcock, 1991). As I have shown above, these modes of work are particularly suited to families in exile. Postscript Exile forces the examination of the heart of culture as it is played out in family relation. At its simplest, therapy should merely seek to enable that examination with a sense of unflinching honesty. In doing so one must not be led merely to the binding up of psychic wounds. This task involves bringing into play both yours and the family s culture, which includes a set of social and political realities binding your political and aesthetic sensibility to theirs in a set of critical relations. To embark on therapy is to connect at some level in ways that are fundamentally challenging to the political and aesthetic assumptions of this host society. Who makes the immigration rules that is preventing this family from being reunited? Who manufactured and exported the weaponry that was used against them? Which power bloc frames the sets of political relations which sponsor conflict in that part of the world? Who decides which forms of cultural expression are marginalised? To converse with families who have survived is therefore to hold up a mirror to oneself. References Eastmond, M. The Dilemmas of Exile: Chilean Refugees in the USA. PhD. Thesis. Dept. of Social Anthropology,Gothenburg University, Sweden, Eisenbruch, M. From Post-Traumatic Stress Disorder to Cultural Bereavement : Medical Foundation Series Family Therapy with Refugees and Political Exiles 6

8 Diagnosis of Southeast Asian Refugees. Social Science and Medicine, 33 (6): , Melzak, S. You can t always see your reflection when the water is full of soap suds. In Willegen,L.van (ed.) Health Hazards of Organized Violence in Children. Pharos Foundation, Utrecht, Richman, N. Annotation: Children in Situations of Political Violence. Journal of Child Psychology and Psychiatry.34: , Summerfield, D. Addressing Human Response to War and Atrocity: Major themes for Health Workers. Paper given to World Conference of the International Society for Traumatic Stress Studies. Amsterdam, June Turner, S.W.& Gorst-Unsworth, C. Psychological Sequelae of Torture. In Wilson J.P. & Raphael B. (eds.) International Handbook of Traumatic Stress Syndromes. Plenum Press, New York, Woodcock, J. Healing Rituals with Families in Exile. Paper presented to 3rd International Conference of Centres, Institutions and Individuals Concerned with the Care for Victims of Organised Violence, Political Repression and Human Rights. Santiago, Chile, November Medical Foundation Series Family Therapy with Refugees and Political Exiles 7

No Safe Place : Children of Mothers Fleeing Torture and Sexual Violence. North East Conference on Sexual Violence November 2010

No Safe Place : Children of Mothers Fleeing Torture and Sexual Violence North East Conference on Sexual Violence November 2010 Medical Foundation North East Margaret Bird Counsellor/Caseworker What do