Trauma and Migration (eBook)

Foreword 6
Contents 8
Part I: Trauma and Migration: Epidemiological and Conceptual Issues 10
1: Introduction: The Relevance of Trauma Among Immigrants 11
References 14
2: Rethinking Trauma as a Global Challenge 17
Introduction 17
The Genealogy of Trauma as a Mental Injury 18
Trauma and PTSD 20
Re-examining the Impact of Organised Violence, Armed Conflict and War on Population Health 25
The Global Impact of War and Violence 27
Contemporary Wars and the Emergence of New Forms of Warfare 30
Refugees and Internally Displaced Populations (IDPs) 31
Humanitarian Interventions Aimed at Civilian Populations in War-Torn Countries and Conflict Zones 32
Concluding Remarks 34
References 35
3: The Epidemiology of Post-traumatic Stress Disorder: A Focus on Refugee and Immigrant Populations 40
Background 40
Prevalence of PTSD and Traumatic Events 41
Prevalence of PTSD in Refugee Populations 41
Risk Factors Associated with PTSD 42
References 43
4: Cross-Cultural Communication with Traumatised Immigrants 45
Introduction 45
Cross-Cultural Communication 46
Language 47
Health Literacy 48
Idioms of Distress 48
Communicative Style and Discourse Systems 49
Culture, Trauma, Emotional Reactions 50
Cross-Cultural Communication Barriers 51
Bridging Barriers in Cross-Cultural Communication 52
The Narrative 52
Interpreters 53
Cultural Brokers 54
Self-Reflection and Supervision 54
Assessment and the Cultural Formulation Interview 54
Diagnostic Categories and Sense of Coherence 55
Building Trust and a Therapeutic Alliance 55
Case, Soran 56
Summary of Key Points for a Successful Intercultural Communication with Traumatised Immigrants 58
References 59
5: Trauma and Migration: The Role of Stigma 62
The Issue of ‘the Other’ 63
Migration and Mental Health 66
Trauma and Mental Health 67
Stigma and Stigmatisation 68
Responses to Stigma 69
The Issue of ‘Roots’ 70
Conclusions 71
References 72
Some of the Relevant United Nations Documents 73
6: Migration, Trauma and Resilience 74
Introduction 74
Definitions 75
Trauma 75
Resilience 75
Types of Migration 75
Cultural Bereavement 76
Culture Conflict 77
Culture Shock 77
Racism and Ethnic Identity 78
Resilience 82
Conclusions 83
References 83
Part II: Trauma and Migration: Diagnostic Issues 85
7: Clinical Diagnosis of Traumatised Immigrants 86
Migratory Phenomena Affecting Mental Health 86
Differences in Socialisation 87
Parenting and Family Structure 87
Tradition 88
Sense of Shame 89
Concepts of Illness 89
Somatisation 90
Expectations Towards the Professional 90
Interaction with the Sick 91
Refugees: Relevance of Trauma and Legal Issues 91
Problems Related to Reduced Language Proficiency 92
Use of Psychometric Measures 93
What Do Professionals Need? A Critical View of the Term “Intercultural Competence” 94
References 94
8: Special Problems in the Assessment of Psychological Sequelae of Torture and Incarceration 97
Introduction 97
Symptom-Related Characteristics in the Assessment of Psychologically Reactive Sequelae of Trauma 98
Dissociative Symptoms of Complex PTSD 102
Trauma-Specific Aspects of Transference and Countertransference 104
Distinction from Other Psychiatric Disorders 105
Right to Asylum and Residence 106
Special Problems in Residence Legal Procedures Determined by Linguistic and Cultural Differences 107
Conclusion 107
References 108
9: Gender and Trauma 110
Sex and Gender 110
Gender and Health 113
Gender, Mental Health and Trauma 113
Gender and Mass Traumas 121
Armed Conflicts, Wars and Trauma 122
Disasters, Trauma and Gender 125
Gender and Perceiving Benefits in Adversity 129
Concluding Remarks 134
References 135
10: Exposure to Trauma and Forced Migration: Mental Health and Acculturation Patterns Among Asylum Seekers in Israel 140
Forced Migration to Israel 140
Forced Migration and Mental Health 142
Migration and Mental Health in Adults 142
Migrant Adolescents and Mental Health 143
Acculturation and Mental Health 145
Studies Related to Forced Migration in Israel 146
Exposure to Trauma During the Journey to Israel Among Asylum Seekers 146
Studies of Acculturation Among Asylum Seekers in Israel 147
Acculturation Among Adult Asylum Seekers 148
Acculturation Among Adolescents 149
Discussion 150
References 153
Part III: Trauma and Migration: Treatment Issues 158
11: Cultural Competence in Trauma 159
Introduction 159
Culturalist 160
Race Based 161
Experience 161
Expression 162
Explanation 163
Expectations 164
Knowledge 164
Attitudes 165
Skills 166
Trauma as a Sociocultural Construct 167
Trauma in Context 169
Conclusions 172
References 173
12: Intercultural Trauma-Centred Psychotherapy and the Application of the EMDR Method 176
Introduction 176
Epidemiology 177
Trauma and Migration 178
Diagnosis of Post-traumatic Stress Disorder 178
Special Aspects in Intercultural Treatment Processes 179
Working with Interpreters (Linguistic and Cultural Mediators) 180
Intercultural Trauma-Centred Psychotherapy 181
EMDR 182
Final Considerations 184
References 185
13: Resilience-Oriented Treatment of Traumatised Asylum Seekers and Refugees 190
Introduction 190
Trauma-Focused and Resilience-Focused Interventions 191
The ROTS Model 192
Resources of Resilience 194
Biological Resources 194
Understanding the Body 194
Physical Exercise 194
Stress Management/Relaxation 195
Medication 196
Treatment of Nonpsychiatric Illnesses 196
Psychological Resources 196
Positive Emotions and Humour 196
Cognitive Flexibility 197
Empowering Self-Esteem 198
Coping 198
Social Resources 199
Social Relatedness/Connectedness to the Family 199
Social Support 200
Meaningful Activities 200
Religious/Spiritual Resources 201
Cultural Resources 202
Conclusion 203
References 203
14: Traumatised Immigrants in an Outpatient Clinic: An Experience-Based Report 208
Introduction 208
The Concept of the Psychiatric Outpatient Clinic (PIA) 209
Patients with a Migration Background in Psychiatric Outpatient Institutions 209
Therapeutic Approach to Treating Traumatised Refugees and Asylum Seekers in Our PIA 210
Special Group Concept 212
Working with Interpreters 214
Interpretation Costs 218
Conclusion 219
References 219
15: Psychotherapy with Immigrants and Refugees from Crisis Zones 221
Introduction 221
Mentally Ill Refugees and the Health System 222
Mental and Psychosomatic Disorders in Migrants from Crisis Zones 223
Diagnostic Approaches with Patients with a History of Displacement 226
Specifics in Psychotherapeutic Work with Refugees 227
Psychotherapy with Interpreters 230
Clinical Certificates and Statements in Psychotherapy with Refugees 231
Why Do Clinical Certificates Play an Important Role in Asylum and Immigration Law Procedures? 231
Mandatory Conditions for Clinical Professionals 233
Standards for Expert Assessment and Examination According to the Istanbul Protocol 235
References 236
16: A Therapy Model for Traumatised Refugees in Denmark 240
Resume 240
Introduction 240
Historical Aspects 241
The Initiation of Therapeutic Interventions 242
Statistical and Brief History of Immigration in DK 243
Outline of Health Services in Denmark (With Focus to Treatment of Trauma) 244
Public and Private Institutions, Organisations and Units Offering Specialised Treatment to Traumatised Refugees in Denmark 244
Institutions in Denmark Focusing on Traumatised Refugees 245
Medical Technology Assessment 247
An Overview of the Different Therapies for Traumatised Refugees Used in Denmark 248
The Competence Centre for Transcultural Psychiatry (CTP) (www.psykiatri regionh.dk) 248
Future Perspectives for Treatment of Traumatised Refugees in Denmark 251
Concerns 252
International Collaboration and Networking 253
References 254