Womersley, Gail

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.

2018-6-19, Womersley, Gail, Kloetzer, Laure

The psychological impact of atrocities endured by refugee populations is clear, with the literature reporting significantly high prevalence rates of post-traumatic stress disorder (PTSD). Given the numerous criticisms surrounding the use of PTSD, we argue that cultural-historical psychology allows for a unique perspective in which to examine trauma among this population. Notably, we aim to bring a critical regard towards ‘psychiatrisation,’ arguing instead for a non-reductionist ontological vision of human nature and development as being rooted in cultural-historical context as well as material social practices. The results of a yearlong intervention in a center for refugee victims of torture in Athens is presented, which included 3 months of participant observation and 125 interviews with health professionals, refugee community leaders and individual victims of torture. A qualitative case study is presented to emphasise the social, cultural, and historical location of trauma. The paper highlights the need to focus on the current material ecologies of refugees entering Europe – their developmental activities in interaction with their environment.

2020, Womersley, Gail

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. The mental health impact of atrocities endured by refugee populations (1) is clear, with the literature reporting significantly high prevalence rates of post-traumatic stress disorder (P.T.S.D.) among this population. However, there have been significant concerns raised over the relevance and cross-cultural validity of P.T.S.D. as a diagnostic construct. Furthermore, we cannot ignore the impact of the current economic, political, and sociocultural reality facing refugees on their mental health. We need to locate trauma experiences within sociocultural context. The thesis aims to do so by addressing the following questions: • Which narratives of trauma circulate among the diverse actors working with refugees within various legal and medical activity systems? How is the diagnostic construct of P.T.S.D. used as a tool within these activity systems? • How do the individual trajectories of individual refugees, diagnosed with P.T.S.D., unfold over time within this sociocultural context? • How is trauma understood and made sense of by individual refugees? How is a diagnosis of P.T.S.D. accepted and understood (or not) by asylum seekers and refugees from culturally diverse populations? The research is centred on a yearlong follow-up of 10 beneficiaries of the M.S.F. Victims of Torture (V.O.T.) Project in Athens and their partner organization, Babel. An average of five open-ended interviews were conducted with these individual participants. Further data was also gained through complementary sources in order to locate these individual narratives within a socio-cultural context. This included 43 semi-structured interviews with “key informants” - professionals working with this population (doctors, psychologists, psychiatrists, social workers etc.), 21 semi-structured interviews with community leaders of various refugee communities across Athens, and four months of participant observation in the project The results, presented in the form of eight publications, highlight: i) the way in which a P.T.S.D. diagnosis is being used strategically as a cultural tool by various actors within medical and legal activity systems put in place to address the large influx of refugees arriving in Europe ii) the substantial impact of the current (sociocultural, legal, economic, and political) environment on refugee trauma trajectories iii) the culturally diverse narratives of trauma informing refugee mental health, which may compete, contradict, or conform to the narrative of trauma inherent to a diagnosis of P.T.S.D. iv)the multitude of ways in which refugees may exert a power to act as active agents,despite obvious power imbalances characterizing the medical and legal systems within which they manoeuvre. (1)Throughout the thesis, the term “refugee” as defined by the Geneva Convention of 1951 is used to include both refugees legally recognised in a host country as well as asylum-seekers. Résumé: La migration est devenue l’un des sujets majeurs pour le continent européen en ce début de XXIe siècle. Les besoins en accompagnement psychologique des populations de réfugiés sont reconnus, la littérature faisant notamment état d’un taux de prévalence significativement élevé du syndrome de stress post-traumatique (SSPT) au sein de cette population. Toutefois, la pertinence et la validité interculturelle du SSPT en tant que construction diagnostique fait l’objet de critiques et d’interrogations. En outre, nous ne pouvons figer les besoins de réfugiés à leur situation pré-migratoire et ignorer l'impact des réalités économiques, politiques et socioculturelles auxquelles ils sont confrontés tout au long de leur parcours migratoire, au sein des pays d’accueil et de destination, sur leur santé mentale. Nous devons situer les expériences traumatisantes dans leur contexte socioculturel. La présente thèse vise à le faire en abordant les questions ci-après : • Quels récits du traumatisme circulent parmi les divers acteurs travaillant avec les réfugiés dans le cadre des systèmes d'accompagnement et de prise en charge juridiques, sociaux et médicaux ? • Comment la construction diagnostique du SSPT est-elle utilisée comme outil par et au sein de ces systèmes ? • Comment les trajectoires individuelles de chaque réfugié diagnostiqué avec un SSPT se déroulent-elles dans le temps dans leur contexte socioculturel ? • Comment le traumatisme est-il perçu par chaque réfugié ? • Comment un diagnostic de SSPT est-il accepté et compris (ou non) par les réfugiés issus de populations culturellement diverses ? Cette recherche est centrée sur un suivi d’une durée d’un an de dix bénéficiaires pris en charge au sein du projet de Médecins sans Frontières pour les Victimes de Torture à Athènes et par une organisation partenaire, Babel. En moyenne, cinq entretiens ouverts et individuels ont été menés avec chaque participant. Des sources complémentaires ont également été consultées, afin de situer ces récits individuels dans leur contexte socioculturel. Ces dernières comprennent 43 entretiens semi-structurés avec des « informateurs clés » - des professionnels travaillant avec cette population (médecins, psychologues, psychiatres, travailleurs sociaux, etc.), 21 entretiens semi-structurés avec des responsables de diverses communautés de réfugiés à Athènes, et quatre mois d'observation des participants au projet. Les résultats, présentés sous forme de huit publications, mettent en évidence : v) la manière dont un diagnostic de SSPT est utilisé stratégiquement comme outil culturel par divers acteurs au sein des systèmes d’accompagnement et de prise en charge sociale, médicale et juridique ; vi) l'impact considérable de leur environnement actuel (socioculturel, juridique, économique et politique) sur les trajectoires de traumatisme des réfugiés ; vii)les récits culturellement divers du traumatisme informant la santé mentale des réfugiés, parfois en concurrence, contradiction ou conformité avec le récit du traumatisme tel que porté par un diagnostic de SSPT ; viii)les multiples manières dont les réfugiés peuvent exercer leur pouvoir d'action,malgré les déséquilibres de pouvoir évidents caractérisant les systèmes d’accompagnement et de prise en charge sociaux, médicaux et juridiques au sein desquels ils évoluent.

2018, Womersley, Gail, Shroufi, Amir, Severy, Nathalie, van Cutsem, Gilles

Following a 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. Twenty-seven 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.

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.

2017, Womersley, Gail, Kloetzer, Laure, Goguikian Ratcliff, Betty

Events that took place before migration have an influence on the mental health of asylum seekers and refugees. But research findings show that the majority of stress factors are directly related to post-migration living conditions and restrictions. Prolonged legal insecurity, the obligation to move from one center to another, and isolation among other factors contribute to the deterioration of refugees’ mental health. Implications reach far beyond the individual: it is a question of social and economic significance for Switzerland as well.