A major first step in refugees' adjustment to living in an unfamiliar country such as the United States is to learn English and secure employment. One study reported that individuals who are literate in their native language achieve literacy in English much faster (Raccine, 1984). Refugee women reported having less education and a lower degree of literacy in their native language compared to the men. This fact increased distress for women.
Not surprisingly these women reported significantly lower ESL (English as a second language) class attendance in their new country than men. This may be due to their lack of education and having little or no experience as students, which in turn may cause high levels of anxiety about the anticipated classroom experience. Without the context of formal education, women may find themselves not only having to learn new content areas such as English, but simultaneously "learning how to learn."
There may also be a relationship between refugees' past traumatic experiences and difficulty in learning English. Many refugees were tortured during the Vietnam war. The most common form of torture for Southeast Asian refugees was beatings to the head, oftentimes resulting in head injury, and impaired memory and concentration (Allden, 1997). Such beatings may interfere with educational potential as well as other facets of adaptation such as socialization skills, daily routine functioning, general intelligence and/or problem-solving abilities.
The pressure to learn English is great, because in traditional Southeast Asian cultures there are prescribed gender roles, with husbands functioning as providers and wives staying at home to care for the family. It is necessary for men to master the host language of a country in order to increase their chances of securing a job. Vietnamese refugee men have reported that the decision they made to leave their country was distressing, which suggests that men may feel guilty for subjecting their families to hardship and for being unable to provide or protect the family from economic and related psychological problems.
Unemployment or underemployment of refugee men has commonly forced refugee women to work in order to support their families. Ironically, whereas many men have experienced downward mobility, many women have experienced upward mobility due to increased occupational opportunities in the United States as compared to Southeast Asia. The resulting changes in gender roles have created conflicts between the values of the Southeastern Asian culture and those of the resettlement country. In turn, these shifts have placed severe pressure on traditional marriage and family relationships (Ito et al., 1997).Clinical Implications
The Chung et al. study (1998) strongly suggests that it is not only premigration trauma that contributes to gender differences in psychological distress among refugees but also a complex interaction of both pre- and postmigration factors. Given the large extent of family loss and degree of trauma, additional research focusing on coping strategies, resiliency and social support would be beneficial in treating the refugee population. In addition, investigations regarding traditional cultural healing methods and individual, group and family resiliency would expand the theoretical knowledge regarding effective and culturally responsive community and mental health programs.
The research previously discussed also has important implications for mental health practitioners working with refugee populations. For example, issues such as the role reversals of men and women may be critical to address in conjunction with premigration trauma. Furthermore, it is also important that mental health professionals be aware of gender differences in degrees of psychological distress. Nolen-Hoeksema (1990) has argued that the higher incidence of depression among women may be related to childhood habits of dwelling on depressive memories. Knowledge about gender role socialization within the cultural and historical context is essential for mental health practitioners to provide effective treatment.
Group psychotherapy may be important for Southeast Asian refugees. Studies have shown that women exhibit greater distress than men only when the stressors they experience affect their social relationships (Kessler, 1984). Thus social support networks of similar ethnic groups, especially for women, should be developed through group sessions that facilitate an exploration of deeper psychological issues regarding pre- and postmigration concerns. The concept of universality, a curative factor identified by Yalom (1995), would be important in fostering these crucial networks.
Changing U.S. policy regarding refugee assimilation raises serious mental health concerns for both men and women. The lack of continued welfare support while learn- ing English and prevocational skills as well as U.S. customs and culture may place refugees at risk for developing serious psychological problems. Shifts in traditional women's roles as family caregivers and men's roles as providers will further contribute to problems in adjusting to life in the United States.
Sufficient support provided to refugees would ensure adequate mastery of the English language, which in turn will lead to their economic self-sufficiency and a more successful adjustment.