Many refugees have been victims of severe violence that has profoundly affected their physical, psychological, and spiritual lives. Take home points here.
Many refugees have been victims of severe violence that has profoundly affected their physical, psychological, and spiritual lives. Individuals and families have sustained multiple losses, including family, country, social position, social network, language, and status. Many have been confined in refugee camps for long periods-in some cases as long as 15 years. Ultimately, if they find themselves living in the United States, these patients bear the emotional toll of the violence they have experienced and of their refugee status.
Work with an empathetic interpreter who can accurately translate verbal and nonverbal communication and who is emotionally in tune with patients. The ability of refugees to adjust to American life is, in large part, a function of their educational level before the trauma and disruption. The interpreter also serves as a “cultural broker” when the patient and the psychiatrist have different concepts of psychiatric treatment.
Take the time to learn the full scope of the patient’s life experiences. Working with refugees who have survived violence and torture is complicated and not formulaic. Therapy must address the interface of psychiatric disorders related to trauma with an understanding of cross-cultural needs.
Take a trauma history, noting its effect on the patient-psychological, medical, and social. Cultural sensitivity and awareness of the effects of massive trauma are crucial. Listen to the patient’s story and stay with the patient through the difficult process of coming to terms with the trauma and adjusting to life in their new reality.
Actively treat depression, sleep disorders, and nightmares with appropriate medications. Therapy generally affords a rapid reduction in the most obvious symptoms (such as nightmares and startle reaction); nevertheless, patients remain highly vulnerable to stress.
Be prepared for chronic course of mental disability, with remissions and exacerbations. The clinical symptoms displayed by refugees who are victims of violence are quite similar-regardless of their cultural background. PTSD is almost always the result of torture and trauma, and MDD is often associated with the losses that the refugees have endured. Symptoms of psychosis may be present, as well as chronic brain damage from head trauma.
Provide a save, confidential, trusting relationship with a mental health professional-the most helpful aspect of the therapeutic encounter. Stress reduction is also essential and is achieved by ensuring that patients have housing, a social network, and adequate food, and by providing continuity of care in the community and alleviating symptoms with medication.
For more on this topic, see A Model for Treating Refugees Traumatized by Violence, by J. David Kinzie, MD, on which this slideshow is based.