Voies de « resubjectivation » chez les demandeurs d’asile victimes de torture
2018-10-4, Womersley, Gail, Kloetzer, Laure
Résumé Aux expériences traumatisantes multiples vécus tout au long du parcours migratoire, font écho des expériences d'exclusion ainsi que les difficultés et incertitudes liées aux trajectoires administratives – tous ces facteurs générant des effets désubjectivisants. Pour les victimes de torture en particulier, le trauma est extrême. Afin d’explorer des processus de resubjectivation, nous avons mené une étude longitudinale à Athènes, dans un centre pour demandeurs d’asile victimes de torture. Quelles activités et quelles ressources ces personnes en situation d’exil mobilisent-elles pour résister de manière créative aux processus de déshumanisation ? Les analyses dialogiques mettent en évidence le potentiel transformatif des « ressources créatives » mobilisées pour réinjecter de la vie et du lien là où prévaut le mortifère et la déliaison. Mots clés : traumatisme, resubjectivation, demandeurs d’asile, torture Pathways of “resubjectification” among victims of torture seeking asylum Résumé The multiple traumas experienced by migrants throughout the migratory journey echo experiences of exclusion as well as the difficulties and uncertainties related to administrative procedures in the host country - all of which risk “desubjectifying” the individual. For victims of torture in particular, the trauma is extreme. In order to explore processes of “resubjectification,” we conducted a longitudinal study in Athens, in a centre for victims of torture seeking asylum. What activities and resources do these individuals in exile mobilize creatively to resist processes of dehumanization? A dialogical analysis highlights the transformative potential of creative resources for the individual as a source of life and creativity. Key words: trauma, resubjectification, asylum seekers, torture
“My mind is not like before”: Psychosocial rehabilitation of victims of torture in Athens
2018-7-30, Womersley, Gail, Kloetzer, Laure, Van den Bergh, Rafael, Venables, Emilie, Severy, Nathalie, Gkionakis, Nikos, Popontopoulou, Christina, Kokkiniotis, Manolis, Zamatto, Federica
Abstract Introduction: The dual trauma of being a victim of torture as well as a refugee is related to a myriad of losses, human rights violations and other dimensions of suffering linked to torture experienced pre-migration, as well as different forms of violence experienced during and after migration. Method: To present three case studies to explore culturally-informed perspectives on trauma among victims of torture and track trajectories of psychosocial rehabilitation in relation to environmental factors. The case studies are part of a larger qualitative study of asylum seekers and refugees in a center for victims of torture in Athens, managed by Médecins Sans Frontières and Babel in collaboration with Greek Council for Refugees, which follows beneficiaries, their care providers and community representatives and leaders. Results: Key themes emerging include the substantial psychological impact of current material realities of migrant victims of torture as they adapt to their new environment and engage in rehabilitation. Delayed asylum trials, poor living conditions and unemployment have a substantial impact on posttraumatic symptoms that in turn influence psychosocial rehabilitation. Personal, social, and cultural resources emerged as having a mediating effect. Discussion: The results highlight the significant impact of the political, legal, and sociocultural environment on psychosocial rehabilitation. Practical implications for interventions are to ensure holistic, interdisciplinary, and culturally sensitive care which includes a focus on environmental factors affecting resilience; and with a dynamic focus on the totality of the individual over isolated pathologies.
Exploring culturally-informed representations of trauma among refugee victims of torture in Athens, Greece
2018-7-3, Womersley, Gail
The mental health impact of atrocities endured by refugees and asylum seekers is clear, with significantly high prevalence rates of post-traumatic stress disorder (PTSD) being reported among this population. Torture has emerged as a particular triggering factor. However, there have been significant concerns raised in the literature over the relevance and cross-cultural validity of this psychiatric diagnosis for refugee populations. Moreover, scholars globally have argued that the location of trauma at the level of the individual in the form of a PTSD diagnosis neglects the broader socio-political and cultural context within which trauma manifests. In order to explore culturally informed representations and perspectives on trauma among refugee victims of torture, we present the results of 12 months of research among asylum seekers and refugees in a center for victims of torture in Athens. This research includes 125 in-depth, qualitative interviews with beneficiaries (refugee victims of torture), health professionals, cultural mediators/interpreters, and leaders from refugee associations and communities across Athens. The results are illustrated using case studies. The majority of refugee victims of torture appear to contest the medicalised notion of « PTSD » with which they had been diagnosed. When referring to their subjective experiences of trauma, they draw upon a variety of diverse cultural representations of suffering (« explanatory models ») and idioms of distress to explain their subjective experiences of trauma. The research findings highlight the need for psychosocial interventions to incorporate a more culturally contextualised understanding of trauma.
“Crying makes your story more believable”: The use of PTSD by asylum seekers and health professionals within the asylum process
2018-10-26, Womersley, Gail
Asylum seekers entering into Europe are often obliged to tell their story to multiple actors (often with a focus on the ‘trauma narrative’) in order to be legally recognized as refugees. Lacking alternative evidence, many attempt to prove their ‘well-founded fear’ and the violence to which they have been exposed through a diagnosis of post-traumatic stress disorder (PTSD). However, the literature highlights the risk of PTSD becoming a ‘pre-requisite’ for validating the experiences of asylum seekers, reifying and reducing these experiences to a diagnosis in order to render accounts believable. To categorize an asylum seeker with PTSD is therefore ‘an act of meaning making,’ entrenched in the habits and discursive practices of medical and legal institutions with very concrete social, material and legal consequences. To explore this, we present the results of a yearlong research projects among asylum seekers diagnosed with PTSD as well as their treating health professionals (including doctors, psychologists and psychiatrists) in a center for victims of torture in Athens, Greece. We analyze the use of the category of PTSD by various actors, notably as factor influencing the decision-making process and the exercise of discretion during the refugee status determination process. The analysis reveals the multiple contradictions in how the various actors involved (including lawyers, bureaucrats, health professionals and the asylum seekers themselves) use this diagnostic construct. We highlight the substantial differences in understanding the diagnosis reflecting existing power imbalances, the way in which narratives of trauma may be purposefully ‘rehearsed’ for the tribunal, and the tensions surrounding the sharing of the trauma narrative within this activity-system.
Manifestations of shame in psychotherapeutic dialogues with politically silenced rape survivors in Cape Town, South Africa
2011-5-13, Womersley, Gail, Maw, Anastasia, Swartz, Sally
Shame is pervasive, and contagious. Shame is ashamed of itself. Shame activates shame. The mystifying dualism of shame is that it is at once an isolating, intimately intra-psychic phenomenon seeking concealment, yet remains deeply embedded in a visual and public interpersonal space where the self is violently and unexpectedly exposed to the critical gaze of the Other. The source of shame can therefore never be completely in the self or in the Other, but is a rupture of what Kaufman (1989, p. 22) calls the “interpersonal bridge” binding the two. The pervasive and potentially paralysing nature of shame and its particular relevance to a South African research context became no more apparent to me than in the course of interviews that I, as a researcher (white , middle-class) have had with rape survivors (coloured, working-class). This research had as its original aim to delineate the network of discourses in which the rape of women is embedded. However, I have come to understand that our co-constructed shame which permeated the research significantly affected my emotional and intellectual investments, and contoured my interpretations of the narrative which unfolded between myself and the research participants. Such recognition of this noxious affect is especially pertinent in the South African context, marked by a myriad of class, gender and race differentials between researcher and researched. Here, skewed power dynamics continue to mark intellectual relations between researcher and researched (Bennett, 2000) and “deeply entrenched and racialised divisions between communities continue to shape the negotiation of power” (Swartz, 2007, p. 177). Within this context (significantly determined by class formations developed through the formal structures of colonialism and apartheid) shame is inherently linked to the politics of knowledge production and the limitations of our own positionings within such unequal power structures. I attempt not only to understand the role of shame in the research relationship which unfolded, but to consider the way in which it was intrinsically linked to the representations of our multiple and constantly shifting identities within this space, as overtly marked by the “intersectionality” of class, race and gender (Burman, 2006).
Using cultural-historical theory to explore trauma among refugee populations in Europe
2017-8-31, Womersley, Gail, Kloetzer, Laure
Europe is living through a refugee crisis of historic proportions which has now become one of the continent’s defining challenges of the early 21st century. Not least among the difficulties are the public health challenges of the multiple traumas faced by this population which constitute severe threats to human, social, cultural, and community development. The psychological impact of atrocities endured by refugees and asylum seekers populations is clear, with the literature reporting significantly high prevalence rates of post-traumatic stress disorder (PTSD) among this population (de Arellano & Danielson, 2008; Kirmayer, Kienzler, Afana, & Pedersen, 2010; Lambert & Alhassoon, 2015; Schweitzer, R., Melville, Steel, & Lacherez, 2006; Steel et al., 2009; Sturm, Baubet, & Moro, 2010; Van Ommeren et al., 2001; Weine, Kuc, Eldin, Razzano, & Pavkovic, 2001). However, there have been significant concerns raised in the literature over the relevance and cross-cultural validity of PTSD as a diagnostic construct (P. Bracken, 2002; P. J. Bracken, 2001; Fisher, 2014; Hinton & Lewis‐Fernández, 2011; Janoff-Bulman, 1985; Kirmayer et al., 2010; Marsella, 2010; Staeuble, 2004; Summerfield, 2001; Tummala-Narra, 2007; Wasco, 2003; Young, 1995). As noted by Roth and Lee (Roth & Lee, 2007), the analytic challenges raised by Vygotsky regarding the “atomistic and functional modes of analysis … [that] treated psychic processes in isolation” (p.1, as cited by Roth and Lee, 2007) remain unresolved. Indeed, one of the principal contributions of the Vygotsky-Luria project is the establishment of a "new psychology" – a ‘decolonized’ way of understanding human thought and activity which takes into consideration the inseparable unity of mind, brain and culture in concrete socio-historical settings (Toomela, 2014). Therefore, consistent with major Vygotskian principles of interactive individual–societal development via the creation of meaning in everyday activities (Daiute & Lucić, 2010), this paper presents the results of a qualitative investigation into experiences of trauma among refugees and asylum seekers. The study incorporates various units of analyses including historicity and context as well as social and material environments in an attempt to go beyond an ‘atomistic’ or individualised framing of psychological difficulties – a particularly relevant consideration for understanding trauma among refugees and asylum seekers in light of the multiple and arguably ongoing environmental stressors with which they are faced as they negotiate material ecologies which both enable and constrain their human activity. It thus offers a subjective analysis of trauma among migrants which takes into account historicity, context, and various levels of analytic scale from within a socio-cultural and historical perspective. Outside of a standardised clinical understanding of trauma, there is a plethora of research indicating that sociocultural and linguistic heritage influences what experiences are interpreted as ‘traumatic,’ the manifestations and expressions of post-traumatic symptomatology, the interpretation of symptoms, narratives of distress as well as culturally-informed healing models (Janoff-Bulman, 1985; Kirmayer et al., 2010; Kleinman & Good, 2004; Luno, Beck, & Louwerse, 2013; Marsella, 2010). As a diagnostic construct developed for use in Western contexts, PTSD has been criticized for ignoring significant variability among symptoms evident in different cultural settings across the world (Hinton & Lewis‐Fernández, 2011; Steel et al., 2009). One example of this variability which continues to attract considerable debate is the prevalence of psychosomatic symptoms found among some cultures and not others (Eagle, 2014). Further criticism is based on the fact that one cannot always link post-traumatic symptoms directly and uncritically to a single event in the life of an individual – a pre-requisite of a PTSD diagnosis by its very definition. Moreover, scholars globally have argued that the location of trauma at the level of the individual in the form of a PTSD diagnosis neglects the broader socio-political and cultural context within which it occurs (Marsella, 2010; Summerfield, 2001; Young, 1995). Such a reductionist discourse potentially individualizes and medicalizes an issue by focusing attention on therapeutic outcomes rather than a political response to the structural issues that led to trauma (Pratt, Johnston, & Banta, 2015). The medicalisation of trauma on an individual level through a psychiatric diagnosis, linked to fixed ‘traumatic’ events in the past, risks rendering us blind to other ongoing aspects of interpersonal, political and social violence on a more global scale, including significant post migration factors which may be deemed equally traumatic by refugees, including current social, political and economic realities and lived daily experiences in host countries (Maier & Straub, 2011; D. Silove, Steel, McGorry, & Mohan, 1998; Derrick Silove, Steel, & Watters, 2000). These criticisms of PTSD therefore highlight the need for a more nuanced, contextualised and ‘decolonized’ understanding of trauma as being significantly determined by larger cultural systems and historic contexts (Carlson, 2005; Dauite, In Press; Kirmayer et al., 2010; Marsella, 2010; Marsella, Friedman, & Spain, 1996; Mattar, 2011; Rousseau, Drapeau, & Corin, 1997; Tummala-Narra, 2007; Wilson, Wilson, & Drozdek, 2004; T. Zittoun, 2014; T. Zittoun, & Sato In press). We will present the results of a 2 month research intervention with NGOs addressing the refugee crisis in Athens, Greece - which included both participant observation and qualitative, in-depth interviews among staff and beneficiaries. Based on principles of ‘action research’ (Reason & Torbert, 2001), the methodology was designed both with regards to the collection of data for research as well as for its potential for transformative action for participants. As such, the design allowed for collaboration with team members of the involved NGOs, local refugee communities and individual beneficiaries, including those diagnosed with PTSD, in order to forge a more direct link between intellectual knowledge and moment-to-moment personal and social action (Reason, 2006; Reason & Torbert, 2001) as well as for an analysis of institutional frameworks. This methodology was similarly inspired by the call of Loizos (Loizos, 2002) for us to invite participants to ‘tell stories’ about themselves at their own speed… [allowing] the suffering persons to represent their ‘illness’ to themselves, perceiving the illness within their own ideas, according to their culture’ (p. 227). Individual participants interviewed were all victims of torture in their respective countries of origin who subsequently sought psychological and medical attention from NGO clinics in Athens, Greece. The 20 refugee community leaders were interviewed in order to broaden our exploration into the multiple traumas to which refugee communities are exposed, and some subjective understandings of ‘PTSD’ as a diagnosis among this population (Schick et al., 2016). By interviewing both individuals as well as community leaders, we attempt to gain a deeper understanding of life trajectories, dynamic processes, interactions and the continual development and change in psychological symptoms; an exploration which equally incorporates a focus on the ever-changing cultural and social systems which determine the various forms of individual subjective experience of psychological difficulties (Ratcliff & Rossi, 2015) The results of these interviews will be presented and open to the audience for discussion. They have been analysed through the lens of activity theory, recently defined by O’Connor as ‘a family of approaches to understanding human mental functioning and action that focuses on how culture, history and social interactions shape individual consciousness’ (p. 1). He examines the various levels in which to make sense of human mental functioning, notably phylogeny (the history of the species), the cultural history of the social group, ontogenesis (the personal history of the individual), and micro-genesis (a microhistory of specific events in the life of the individual, including traumatic events). He draws on Vygotskian theory to illustrate that before a process has landed on a psychological plane, it has to arrive on the social plane. Thus, in examining trauma among refugees, the focus is on ever-changing cultural and social systems which are in continual interaction with the various forms of an individual subjective experience of mental illness. Furthermore, the individuals interviewed are seen as being deeply embedded in complex and dynamic activity systems in which resources are exchanged - wherein individuals are both capable of negotiating and influencing this system as well as being influenced themselves by the system. We will also explore the dynamics of multiple tensions and internal conflicts faced by these individuals in this particular developmental phase of their life trajectories. As such, this presentation aims to draw on a socio-cultural framework which focuses on the intersubjective, mediational space between the individual and culture-society-interaction (O'Connor, 2015); going beyond reductionist labels such as ‘refugee’ or ‘PTSD’ in order to try account for the experience of humans in time and in particular social and cultural environments (T. Zittoun, 2012). Such an approach presupposes human beings inhabit shared forms of life, and utilize semiotic resources (meaning-making and signifying) with reference to social structures and institutions. Meaning is continually negotiated within the social sphere and ‘cultural products, like language and other symbolic systems, mediate thought and place their stamp on our representations of reality’ (Bruner, 1991) (p. 3). This perspective therefore involves a focus on the thread of language and related underlying semiotic systems (T. Zittoun, 2014). It likewise includes a recognition that all languages are composed of different social languages (Bakhtin, 1981; Gee, 2014). Within this framework, we aim to explore, together with the audience, how an individual’s experience of trauma necessarily is influenced by and reflected through language and culture – with culture being considered both as a set of practices physically executed in a tangible and observable sense by the group, as well as integral to belief systems lying internally within individual members (Brewin, Dalgleish, & Joseph, 1996; Drozdek & Wilson, 2007; Sturm, Baubet, & Moro, 2007; Sturm et al., 2010). Such a constructivist approach acknowledges that current concepts of mental health, notably a diagnosis of PTSD, are to some extent socially constructed objects produced within a specific historical period (Ratcliff & Rossi, 2015). The perception of trauma then is mediated through collective memory and the inter-generationally transmitted historic experiences, myths or stories from the past shaping worldviews (Drozdek & Wilson, 2007). Here, elements of temporality will be considered, as well as the continual interaction of the person with their environment in a given social and historical context. The results demonstrate that not only do reactions to trauma differ according to cultural norms, but the very making sense of what is or what is not traumatic may similarly be informed by socio-cultural context (Dauite, In Press; T. Zittoun, 2014; T. Zittoun, & Sato In press). This critical approach goes beyond a reductionist focus on ‘cultural differences’ wherein ‘culture’ is perceived a reified, crystallised concept and viewed as a potential barrier to be overcome in a process of psychiatric classification (Watters, 2001). We thus draw on a Vygotskian view noted by Dauite and Lucic (2010) wherein “ ‘culture’ is not presumed to exist in values or beliefs of ethnicity, gender, or other categories but in the creation of meaning through symbolic thought in situations on the ground. As the primary location of development, social interaction, according to this theory, is not only an influence but the basis for human processes of knowing” (p. 616). The results aim to highlight the heterogeneous, fluid and dynamic nature of individual subjectivities and the multitude of socio-culturally determined discourses which may be drawn upon to make sense of life experiences (Gee, 2014; Squire, 2008), bringing ‘profoundly into question not only the universality of knowledge from one domain to another, but the universal translatability of knowledge from one culture to another (Bruner, 1991)(p. 2). In engaging in such an exploration together with the audience, we aim to contribute to practices of ISCAR by enriching understandings of ‘historical trauma’ (Gone, 2013) or collective, cultural, and identity-related trauma among refugee and asylum seeking populations, with an emphasis on the social location of human subjects and a recognition that trauma responses may carry a sense of group burden and collective suffering beyond symptomatic individuals (Eagle, 2014; T. Zittoun, 2014). Learning about the impact of dislocation, trauma and loss, of political persecution and human malevolence, and social systems involving abuse, neglect, and ethnic and cultural rejection is crucial to understanding the social and historical perspectives of trauma (Wilson et al., 2004).
Post-traumatic Stress responses among refugees following xenophobic attacks in Durban, South Africa
2016-4-30, Womersley, Gail, Shroufi, Amir, Severy, Nathalie, Van Cutsem, Gilles
Following a recent spate of xenophobic attacks against foreign nationals in Durban, South Africa, displacement camps were set up to shelter predominantly Congolese and Burundian refugees. Embedded within the emergency program a prevalence study of symptoms of posttraumatic stress disorder (PTSD) was conducted among a convenience sample of this population. Participants included men and women who were screened for symptoms using the Harvard Trauma Questionnaire (HTQ). Results indicate a prevalence rate of 85% among this population. Limitations include the small sample size and potential self-reporting. The high prevalence rate of people who meet diagnostic criteria for PTSD has profound implications for psychosocial interventions and access to mental health services for this community – as well as significant broader legal and social justice implications.
(Un)imagination and (im)mobility: Exploring the past and constructing possible futures among refugee victims of torture in Greece
2020-1-7, Womersley, Gail
Greece represents a unique context in which to explore the imagination-(im)mobility nexus: both a transit country and final destination for refugees. This article explores the imagination of refugee victims of torture in Athens as they weave together images of the past, present and future to confer meaning to their current situation and imagine new possible futures. In the context of a growing interest in emotions and temporalities linked to migration, the aim of this paper is thus to explore the complex interplay between the imagination of migrants and the trauma from the theoretical standpoint of sociocultural psychology. The paradoxes are multiple: (i) Migration is inherently imaginative, in the sense that the actualisation of migration begins with individuals imagining their destination; (ii) however, trauma related to forced migration experiences in particular may impede imagination. To further add to the complexity: it may be imagination itself which acts as an essential component to healing from trauma. The article explores forced migrants’ mobility choices and individual migration trajectories to provide insight into how the emotionality of subjective experiences, as well as the sociocultural context, are fundamentally involved in people’s plans to migrate and the development of their ever-changing imagination of a better future elsewhere. The results similarly illustrate imagination as being significantly shaped by the collective imaginings of entire communities.
Contextualising the experience of South African women in the immediate aftermath of rape
2009-1-1, Womersley, Gail, Maw, Anastasia
The psychological impact of rape is most commonly described by drawing on a medical/ psychiatric framework, which feminists have argued fails to factor in the broader contexts of patriarchy and female oppression. Internationally, and in South Africa, feminist researchers have called for more research on rape trauma which seeks to understand the impact of rape in light of the marginalised and oppressive contexts within which particular groups of women live. In response to this need, this article presents a feminist discourse analysis of conversations with nine women living in a low-income area of Cape Town interviewed within 72 hours of being raped. The analysis revealed that the women's narratives of rape were informed by patriarchal discourses which operated to reinforce gendered relations of power. The discourses discussed in the paper are identified as discourses of damage, ostracism, resistance and survival, confessional discourses and discourses of masculinity and femininity. A multitude of cultural scripts informed the discourses drawn upon by the participants, highlighting the heterogeneous, fluid and dynamic nature of the participants' subjectivities and indicating that their relation to such discourses are far from being fixed, stable and unambiguous. Furthermore, the dominant discourses highlighted in the findings are understood to play a binding role in maintaining social structures of power.
A sociocultural exploration of shame and trauma among refugees
2018-7-2, Womersley, Gail
Shame profoundly colours the experiences of the thousands of refugees entering Europe. Not only does the literature attest to the high levels of trauma among this population, research in the past decade has increasingly revealed the hidden yet pervasive role that shame may play in posttraumatic symptomatology. Shame may emerge as a result of the many forms of torture, sexual violence and other atrocities experienced in the country of origin, yet is equally exacerbated by degrading and humiliating asylum procedures, having to accept a new and often devalued social identity of being an asylum seeker, and the embarrassment of not meeting culturally-informed expectations to financially support the family back home. Shame is a complex process affecting core dimensions of the self, identity, ego processes, and personality – and is thus inextricably shaped by culture. It has a detrimental impact on health-seeking behavior, yet its masked manifestations often remain unnoticed by practitioners. This is a critical consideration for clinicians and researchers working with refugee populations, where the relation is typically marked by power differentials across a matrix of identities informing not only the shame of the refugee but of the clinicians or researchers themselves. As both a researcher and clinical psychologist working with refugee populations, I explore the myriad dimensions of shame within this context based on personal reflections of my time “in the field” as well as the burgeoning literature on this topic. Understanding shame as a health resource for refugee populations will be discussed.