Refuge and Resilience: Promoting Resilience and Mental Health among Resettled Refugees and Forced Migrants PDF
Preview Refuge and Resilience: Promoting Resilience and Mental Health among Resettled Refugees and Forced Migrants
Refuge and Resilience The series publishes original scholarly books that advance our understanding of internationalmigrationandimmigrantintegration.Writtenbyacademicexpertsand policy specialists, each volume addresses a clearly defined research question or theme,employscriticalanalysisanddevelopsevidence-basedscholarship.Theseries includessingle-ormulti-authoredmonographs,volumesandeditedcollections. The scope of the series is international migration and integration research. Topics includebutarenotlimitedtothematicandcurrentissuesanddebates;comparative research of a regional, national or international nature; the changing character of urbanareasinwhichmigrantsorrefugeessettle;thereciprocalinfluenceofmigrants/ refugeesandhostcommunities;issuesofintegrationandsocialinequalityaswellas policyanalysisinmigrationresearch. SeriesEditors: PeterLiandBaha-Abu-Laban Forfurthervolumes: http://www.springer.com/series/8811 Laura Simich • Lisa Andermann Editors Refuge and Resilience Promoting Resilience and Mental Health among Resettled Refugees and Forced Migrants 2123 Editors LauraSimich LisaAndermann CenteronImmigrationandJustice DepartmentofPsychiatryEquity,Gender VeraInstituteofJustice andPopulationsDivision NewYork UniversityofTorontoandMountSinai NewYork Hospital USA Toronto Ontario Canada Thefindings,interpretations,andconclusionsexpressedhereinarethoseoftheauthoranddo notnecessarilyreflecttheviewsoftheVeraInstituteofJustice. ISSN2214-9805 ISSN2214-9813(electronic) ISBN978-94-007-7922-8 ISBN978-94-007-7923-5(eBook) DOI10.1007/978-94-007-7923-5 SpringerDordrechtHeidelbergNewYorkLondon LibraryofCongressControlNumber:2014930347 © SpringerScience+BusinessMediaB.V.2014 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher, whetherthewholeorpart of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionor informationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar methodologynowknownorhereafterdeveloped.Exemptedfromthislegalreservationarebriefexcerpts inconnectionwithreviewsorscholarlyanalysisormaterialsuppliedspecificallyforthepurposeofbeing enteredandexecutedonacomputersystem,forexclusiveusebythepurchaserofthework.Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of thePublisher’slocation, initscurrentversion, andpermissionforusemustalwaysbeobtainedfrom Springer.PermissionsforusemaybeobtainedthroughRightsLinkattheCopyrightClearanceCenter. ViolationsareliabletoprosecutionundertherespectiveCopyrightLaw. Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthispublication doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromtherelevant protectivelawsandregulationsandthereforefreeforgeneraluse. While the advice and information in this book are believed to be true and accurate at the date of publication,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityfor anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with respecttothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) To my parents and grandparents, who were once refugees and New Canadians; To my wonderful husband and children; And to all therefugeeswhohavesharedtheirstorieswith me. L.A. Topeaceandsanity. L.S. Foreword Therefugeeexperienceconfrontsuswithhumanityatitsmostchallenged—forcibly uprootedandinflightfromviolence,caughtbetweencountries,facinganuncertain future—butitalsoprovidessomeofthemoststrikingexamplesofhumanresilience. Thisinnovativeandimportantbookexploresthatresilienceanditsimplicationsfor resettlementandmentalhealthservices,policyandpractice.Thecontributorshavea wealthofresearch,clinicalandcommunityexperienceandhavebeenattheforefront ofinterdisciplinarystudiesthatadvanceourunderstandingofrefugeementalhealth and adaptation. They approach the person seeking refuge and resettling in a new countrynotasaclinical,socialorpoliticalproblembutastheactiveagentoftheir ownsurvival.Insodoing,theyencourageustomovefromdiagnosingandtreating traumatic wounds and losses to fostering individual and collective adaptation and flourishing. They emphasize the importance of the larger community that receives thoseseekingasylumandcallustoamorehumaneandeffectiveresponse. Migrationhasbeenaconstantinhumanevolutionandtheabilitytoadapttorad- icallynewenvironmentsisintrinsictoourpsychology.Themigrationsofprehistory broughtusintodifferentecologicalenvironmentsthatgaverisetodiversecultures, withdifferentwaysoflifethatincludedchangesinmodesofsubsistence,worldviews, systemsofvaluesandaspirations.Therootsofhumanresilienceareinself-regulating andself-rightingadaptivesystemsthatincludeourcapacitytoacquirenewstrategies for survival and to reorganize our ways of life to fit new contexts. Resilience then is part of ‘human nature’built into our multiple systems of learning, grounded in neuroplasticity,psychologicalinventiveness,andculturalcreativity,whichallowus toembraceandadoptnew, hybrididentities.Atthesametime, continuityofiden- tity,relationshipsandcommunityarecentraltomanyindividuals’strength,senseof coherence,andself-efficacy. Muchofthescientificresearchonresiliencehasfocusedonindividualcharacter- istics,butresilienceisnotonlytheoutcomeofpsychologicalprocessesbutalsoof socialprocessthatresideinrelationshipsamongpeople,systemsandinstitutionsat theleveloffamilies,neighborhoods,communities,andorganizations,governments andtransnationalnetworks.Recognizingthesocialdimensionsofrefugeeresilience meanswemustlookbeyondtheindividualtounderstandthelargercontextsinwhich theyareembedded.Resettlementpoliciescansupporttherefugee’seffortstobuild vii viii Foreword anewlifeorunderminethem,leavingindividualsorwholegroupsstrandedwithout connection. International conventions on refugees and asylum emerged in the wake of the SecondWorldWarduringwhichcountlessnumbersofpeopleseekingsafetywere turned away by Canada and other countries that could have easily received them. EarliergenerationsofmigrantsfromEuropeandotherwartornareasdidnothave the formal category of refugee to frame their identity but faced many of the same challengesinescapingdanger,bringingtheirfamiliesandlovedonestosafety,and buildinganewlifeinanewland.Thecategoriesofasylum-seeker,refugeeandimmi- grantimplyacleardistinctionbetweenthosewhomigratevoluntarilyforeconomic or other personal advancement and those who are forced to by threat of political violence.Infact,thisdistinctionisoftenhardtomakeanddoesnotfitthecomplex realitiesofindividualstruggles. Afterachievingtheirescapefromharm’sway,refugeesseeknotjustbaresurvival but a better life for themselves and their families. Those who are able to focus on a hopeful future, find meaningful work and relationships, and invest in the next generation,arelikelytofarewell.Thosecaughtinaconsumingnostalgiaforwhat they have lost, may find it difficult to invest in the future or find the energy and flexibilityneededtofaceallthemanydemandsoftheirnewenvironment. Formostrefugees,thelong-termoutcomeofmigrationwillbepositive.Butthis outcome depends on many factors involving the individual’s history, the kinds of violence and losses they have endured, their migration trajectory, and especially, theirreceptioninthecountrywheretheyfindanewhome.Amajorlessonfromthe researchonlong-termadaptationcollectedinthisvolumeisthatthequalityofthehost countryreceptionofnewcomersisamajordeterminantoftheirhealth, well-being andsocialintegration.Thisisgoodnewsbecausethisreceptionissomethingthatcan beimprovedthroughpublicpolicy.Thedilemmaisthatinthecurrentenvironment of international insecurity, there is a risk of forgetting our recent history, reneging onourcommitments,andclosingthedoorstothoseseekingasylumandmakingit harderforthoseacceptedtobuildtheirnewlives. Our experience with refugees and asylum seekers at the Cultural Consultation ServiceinMontrealunderscorestheirresilienceaswellasthemajorchallengesthey face.Manyofthesechallengesstemnotfromhavingtonavigateanewculturalenvi- ronment,butfromdifficultiesnegotiatingbureaucraticinstitutionsthataredivorced fromthehumanrealitiesofforcedmigration.Forexample,weknowthatdetention canbeextraordinarilyharmful,thatlongdelaysindecidingoutcomesarecorrosive to well-being and confidence, that taking meaningful work and choice away from people renders them helpless, and that ensuring the safety of loved ones left be- hindandreunitingwithone’sfamilyareallpowerfuldeterminantsofmentalhealth. Yet politically motivated policies and institutional practices strew obstacles in the refugee’spath. Theemphasisonstrengthandresilienceisawelcomeshiftfromtheemphasisin mentalhealthresearchonvulnerabilityandpathology.Infocusingonstrengthsand resilience,however,thereisariskthatthosewhohaveahardertimewillbefurther stigmatizedas‘lackingresilience’.Thisisespeciallyegregiouswhenthebarriersto Foreword ix adaptationclearlyreflectsocialobstaclesandadversity.Itisimportantthatresilience beunderstoodnotastheinevitableoutcomeofsomeinherentqualityorcapacityof theindividualbutasadynamicprocessofinteractionsbetweenindividualsandthe circumstancesinwhichtheyfindthemselves.Whatisadaptiveinonesituationmaybe problematicinothersandnewstrengthsmayemergewhentheindividualisafforded new opportunities. The resilience perspective is an invitation to clinicians, policy makersandotherstothinkintermsofstrengthsandsolutionsratherthandeficitsand to ensure that our welcoming and hospitality to those most in need provides them withthebasicstructuresandresourcestheyneedtorebuildtheirlivesand,ultimately tocontributetothevariegatedtapestryofourcommunities. Thecreationofrefugeestatusandthemoralandlegalobligationtoprovideasylum reflectanemergingglobalethicessentialforourcollectivesurvival.Indeed,climate changeandtheresultanteconomicandpoliticinstabilitiesarelikelytodramatically increasetheneedforaninternationalhumanrightsregimeintheyearstocome.Inthe wakeofpastfailures,Canadabecameamodelofprogressivepracticesintheareaof refugeeresettlement.Unfortunately,recentlyenactedrestrictivepoliciestightening therefugeedeterminationprocessandreducingbasiccoverageofmedicalcarefor refugees(ontheabsurdargumentthattheyarebettertreatedthantheaverageCana- diancitizen)haveunderminedthiscommitment.Theseshort-sightedpolicieshave beenwidelydenouncedbymanysectorsofsocietyincludingphysiciansandthose mostknowledgeableabouttherefugeeexperience.Hopefully,theseregressivesteps willsoongivewaytoamoresociallyresponsiveviewconsonantwithlong-standing Canadian values so that we can once again contribute to advancing international humanrights. Inadditiontoadvocatingforchangeatthelevelofpolicy,andhealthandsocialser- vicesprofessionalsandresearcherscancontributeinmanywaystothewell-beingand socialintegrationofrefugees.Intheclinicalencounter,wecanworktounderstand refugees’stories,learningmoreabouttheiruniquepredicamentsanddevelopingthe skillsneededtorespondeffectively.Wecansupportothersinthecommunityintheir effortstoprovideawelcomingspaceandpathwaystowardintegrationandreunifica- tionforrefugeesandtheirfamilies.Asthecontributorstothisvolumeshow,through research, advocacy and clinical engagement, we can contribute to building a civil societyfoundedonthevaluesofdignityanddiversity. Montreal, August2013 LaurenceJ.Kirmayer Contents 1 Editor’sIntroduction........................................... 1 LauraSimich 2 WhatIsResilienceandHowDoesItRelatetotheRefugee Experience?HistoricalandTheoreticalPerspectives ............... 7 WadeE.Pickren 3 SocialDeterminantsofRefugeeMentalHealth .................... 27 FarahN.Mawani 4 TheDebateAboutTraumaandPsychosocialTreatmentforRefugees 51 ClarePain,PushpaKanagaratnamandDonaldPayne 5 ReflectionsonUsingaCulturalPsychiatryApproachtoAssessing andFortifyingRefugeeResilienceinCanada...................... 61 LisaAndermann 6 PersonalandSocialFormsofResilience:ResearchwithSoutheast AsianandSriLankanTamilRefugeesinCanada .................. 73 MortonBeiser 7 SocialSupportinRefugeeResettlement .......................... 91 MiriamJ.Stewart 8 NewcomerYouthSelf-Esteem:ACommunity-BasedMixedMethods StudyofAfghan, Columbian, SudaneseandTamilYouthinToronto, Canada ....................................................... 109 NazillaKhanlou,YogendraB.Shakya,FarahIslamandEmmaOudeh 9 Newcomer RefugeeYouth as ‘Resettlement Champions’for their Families:Vulnerability,ResilienceandEmpowerment.............. 131 YogendraB.Shakya,SepaliGuruge,MichaelaHynie,SheilaHtoo, ArzoAkbari,Barinder(Binny)Jandu,RabeaMurtaza,MeganSpasevski, NahomBerhaneand JessicaForster xi
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