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The Mental Health of Refugees Ecological Approaches To Healing and Adaptation 1st Edition Unlimited Ebook Download

The book 'The Mental Health of Refugees: Ecological Approaches to Healing and Adaptation' explores the mental health challenges faced by refugees and internally displaced persons, emphasizing the need for culturally appropriate interventions. Edited by Kenneth E. Miller and Lisa M. Rasco, it presents various programs and strategies developed across different regions, highlighting the importance of community empowerment and ecological frameworks in addressing mental health needs. The contributors share innovative experiences that aim to support healing and adaptation for displaced communities affected by violence.

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432 views15 pages

The Mental Health of Refugees Ecological Approaches To Healing and Adaptation 1st Edition Unlimited Ebook Download

The book 'The Mental Health of Refugees: Ecological Approaches to Healing and Adaptation' explores the mental health challenges faced by refugees and internally displaced persons, emphasizing the need for culturally appropriate interventions. Edited by Kenneth E. Miller and Lisa M. Rasco, it presents various programs and strategies developed across different regions, highlighting the importance of community empowerment and ecological frameworks in addressing mental health needs. The contributors share innovative experiences that aim to support healing and adaptation for displaced communities affected by violence.

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mo.achhoang.kuangphach
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THE MENTAL HEALTH OF REFUGEES
Ecological Approaches
to Healing and Adaptation

Edited by

Kenneth E. Miller
San Francisco State University

Lisa M. Rasco
University of California, Berkeley

LAWRENCE ERLBAUM ASSOCIATES, PUBLISHERS


2004 Mahwah, New Jersey London
Camera ready copy for this book was provided by the editors.

Copyright © 2004 by Lawrence Erlbaum Associates, Inc.


All rights reserved. No part of this book may be reproduced in any form,
by photostat, microform, retrieval system, or any other means, with-
out prior written permission of the publisher.
Lawrence Erlbaum Associates, Inc., Publishers
10 Industrial Avenue
Mahwah, New Jersey 07430

Cover design by Kathryn Houghtaling Lacey

Library of Congress Cataloging-in-Publication Data


The mental health of refugees: ecological approaches to healing and
adaptation / edited by Kenneth E. Miller, Lisa M. Rasco.
p. cm.
Includes bibliographical references and index.
ISBN 0-8058-4172-5 (cloth : alk. paper)
ISBN 0-8058-4173-3 (pbk. : alk. paper)
1. Refugees—Mental health. 2. Refugees—Mental health services.
3. Cultural psychiatry. I. Miller, Kenneth E., 1963- II. Rasco,
Lisa M., 1970- .
RC451.4.R43F765 2004
362.2'086'914—dc22 2003064154
CIP
Books published by Lawrence Erlbaum Associates are printed on acid-
free paper, and their bindings are chosen for strength and durability.
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1
To Don Mateo, Dona Maria, Emilio, and Alonzo,
Who taught me about community and the meaning of resilience;
And to my parents: George Miller, a friend and colleague whose support
has been invaluable and without limit,
and Nina Miller, whose commitment to creating a more socially just world
Continues to be an inspiration for the work I do.

—Ken Miller

To Semir and Son/a,


Who opened my eyes to the incredible strength
And healing power of family amidst great loss and transition;
And to my own family: Mom, Dad, Laura, Darren, and Jamie;
Rema, Josh, Ray, and Trish;
Ben, Cara, and Niko—
You sustain me.

—Lisa Rasco
This page intentionally left blank
About the Editors ix

List of Contributors xi

Preface xiii

1 An Ecological Framework for Addressing the 1


Mental Health Needs of Refugee Communities
Kenneth E. Miller and Lisa M. Rasco

Part I: Programs in Africa and Asia

2 Internally Displaced Angolans: A Child-focused, 67


Community-based Intervention
Michael Wessells and Carlinda Monteiro

3 Sierra Leonean Refugees in Guinea: Addressing the 95


Mental Health Effects of Massive Community Violence
Jon Hubbard and Nancy Pearson

4 Internally Displaced Cambodians: Healing Trauma 133


in Communities
Willem A. C. M. van de Put and Maurice Eisenbruch

5 Internally Displaced Sri Lankan War Widows: 161


The Women's Empowerment Programme
Rachel Tribe and the Family Rehabilitation Centre Staff

6 Internally Displaced East Timorese: Challenges and 187


Lessons of Large-Scale Emergency Assistance
Kathleen Kostelny and Michael Wessells

Part II: Programs in South and North America

7 Internally Displaced Columbians: The Recovery of 229


Victims of Violence Within a Psychosocial Framework
Jorge Enrique Buitrago Cuellar

8 Bosnian and Kosovar Refugees in the United States: 263


Family Interventions in a Services Framework
Stevan Weine, Suzanne Feetham, Yasmina Kulauzovic, Sane/a
Besic, Alma Lezic, Aida Mujagic, Jasmina Muzurovic, Dzemila
Spahovic, Merita Zhubi, John Rolland, and Ivan Pavkovic

vn
9 Hmong Refugees in the United States: A Community- 295
Based Advocacy and Learning Intervention
Jessica Goodkind, Panfua Hang, and Mee Yang

Part III: Critical Issues

10 Evaluating Ecological Mental Health Interventions in 337


Refugee Communities
Jon Hubbard and Kenneth E. Miller

11 Innovations, Challenges, and Critical Issues in the 375


Development of Ecological Mental Health Interventions
With Refugees
Lisa M. Rasco and Kenneth E. Miller

Author Index 415

Subject Index 425


About the Editors

Kenneth E. Miller is an assistant professor of psychology at San


Francisco State University. He received a doctorate in clinical psycho-
logy from the University of Michigan, and completed two years of
postdoctoral training in community and prevention research at Arizona
State University and the University of Illinois at Chicago. His research
is focused on the impact of war experiences and exile-related stressors on
refugee wellbeing, and on the effectiveness of ecological mental health
interventions with refugee communities. He has worked with and
studied Guatemalan refugee families in southern Mexico, Bosnian
refugees in Chicago and the San Francisco Bay Area, and most recently
Afghan refugees in the San Francisco Bay Area.

Lisa M. Rasco is a doctoral candidate in clinical psychology and fellow


of the Center for the Development of Peace and Well-being at the
University of California, Berkeley. Her research has focused on the
psychophysiological effects of war-related trauma and currently concerns
the impact of trauma and stress on family functioning and the
socioemotional development of children. She has consulted on the
design of a Bosnian community center and, with Ken Miller, on the
development of an ecological mental health intervention for Afghan
refugees that integrates mental health concepts and practices into the
English as a Second Language classroom.

IX
This page intentionally left blank
List of Contributors

Sanela Besic, Department of Psychiatry, University of Illinois at


Chicago, Chicago, IL, USA
Jorge Enrique Buitrago Cuellar, Corporacion AVRE, Bogota, Colombia
Maurice Eisenbruch, University of New South Wales, New South
Wales, Australia
The Family Rehabilitation Centre Staff, Sri Lanka
Suzanne Feetham, Department of Psychiatry, University of Illinois at
Chicago, Chicago, IL, USA
Jessica Goodkind, California State University Hayward, Hayward, CA,
USA
Panfua Hang, Michigan State University, East Lansing, Ml, USA
Jon Hubbard, Center for Victims of Torture, Minneapolis, MN, USA
Kathleen Kostelny, Erikson Institute, Chicago, IL, USA, and Christian
Children's Fund, Richmond, VA, USA
Yasmina Kulauzovic, Department of Psychiatry, University of Illinois at
Chicago, Chicago, IL, USA
Alma Lezic, Department of Psychiatry, University of Illinois at Chicago,
Chicago, IL, USA
Kenneth E. Miller, San Francisco State University, San Francisco, CA,
USA
Carlinda Monteiro, Christian Children's Fund, Luanda, Angola
Aida Mujagic, Department of Psychiatry, University of Illinois at Chicago,
Chicago, IL, USA
Jasmina Muzurovic, Department of Psychiatry, University of Illinois at
Chicago, Chicago, IL, USA
Ivan Pavkovic, Department of Psychiatry, University of Illinois at
Chicago, Chicago, IL, USA
Nancy Pearson, Center for Victims of Torture, Minneapolis, MN, USA

XI
xii Contributors

Lisa M. Rasco, University of California Berkeley, Berkeley, CA, USA


John Rolland, Department of Psychiatry, University of Illinois at
Chicago, Chicago, IL, USA
Dzemila Spahovic, Department of Psychiatry, University of Illinois at
Chicago, Chicago, IL, USA
Rachel Tribe, University of East London, London, England
Willem A. C. M. van de Put, HealthNet International, Amsterdam, The
Netherlands
Stevan M. Weine, Department of Psychiatry, University of Illinois at
Chicaco, Chicago, IL USA
Michael Wessells, Christian Children's Fund, Richmond, VA, USA, and
Randolph Macon College, Ashland, VA USA
Mee Yang, Michigan State University, East Lansing, Ml, USA
Merita Zhubi, Department of Psychiatry, University of Illinois at Chicaco,
Chicago, IL USA
PREFACE

At the dawn of the 21st century, we are living in a time of remarkable


technological achievement, of extraordinary advancements in our ability
to treat and prevent an ever-widening range of disease, and of an ex-
panding global economy that links together the most geographically dis-
tant communities. Against this backdrop of impressive development, it is
disheartening to observe how little distance we have traveled toward the
creation of a more socially, economically, and environmentally just world
community. Repressive regimes flourish, often with the covert aid of in-
dustrialized nations who profess a deep commitment to democratic ide-
als. The disparity in wealth between nations of the southern and northern
hemispheres continues to worsen, with hundreds of millions of people in
developing countries living on the equivalent of a dollar a day, and mil-
lions dying of preventable and treatable diseases. Multinational corporate
profit is frequently prioritized over the basic human and civil rights of im-
poverished communities that provide inexpensive labor under conditions
of exploitation and stark repression; and extreme ethnic violence, at
times reaching the level of genocide, is allowed to proceed essentially
unopposed while politicians offer moving speeches honoring the victims
of the Nazi Holocaust and promise that such horrors will never again be
allowed to occur.
Violent conflict, ethnic and political persecution, and state sanctioned
repression continue to drive millions of people into exile or internal dis-
placement, forcing them to leave behind their homes, their communities,
and for many, their homelands. Many are forced to flee with little time to
prepare for the journey of exile, and carry with them only their most es-
sential and portable possessions. They leave behind houses, plots of
land passed down through generations, family members and friends un-
able or unwilling to go into exile; proximity to the graves of ancestors;
and the sense of belonging that comes with living in one's own culture,
as a member of one's own community, a citizen of one's own country.
They flee after having witnessed the death of loved ones, the destruction
of their property, and the humiliation of family members, friends, and
neighbors at the hands of sadistic armed combatants; and they flee after
enduring their own experiences of physical and sexual violence, arbitrary
detention, and prolonged fear and vulnerability. They leave not in search
of a better life, but simply to survive, because survival in their own homes
and communities has become tenuous if not altogether impossible. They
seek safe haven, and many hold tightly to the dream of an eventual re-
turn home. History has demonstrated repeatedly, however, that the

XIII
xiv Preface
dreamt of return is often elusive, due to prolonged conflict that makes a
safe repatriation impossible.
Psychologists, psychiatrists, and other mental health professionals
have begun to recognize and document the high levels of psychological
distress experienced by refugees and displaced persons worldwide.
There is a rapidly growing body of research documenting patterns of
widespread psychological trauma and depression within these communi-
ties, a pattern that holds across diverse methodologies and samples.
Paralleling this emphasis on research, mental health professionals have
begun offering clinical services such as psychotherapy and psychiatric
medication to refugees, with the goal of alleviating symptoms of distress
and facilitating adjustment to life in exile. Refugee mental health clinics
have been established in major cities throughout the industrialized (i.e.,
"developed") world, as well as in some of the developing countries where
the majority of the world's refugees and displaced people reside. The
response of the mental health community has been well intentioned, and
although empirical data are lacking, it seems reasonable to suggest that
clinic-based services have provided much needed assistance to those
refugees who have had access to and were willing to utilize them.
This book, which brings together the writings of leading experts in
the field of refugee mental health, reflects a growing concern that clinic-
based psychological and psychiatric services developed primarily in
Western Europe and the United States may be limited in some very fun-
damental ways in their capacity to address the mental health needs of
refugee communities. Rooted in Western conceptions of wellness, dis-
tress, and healing, such services are culturally alien to most refugees,
who generally come from non-Western societies with very different mod-
els of mental health and the mechanisms by which distress should be
alleviated. Such services are also limited because they are largely inac-
cessible to the majority of the world's displaced people, who live in de-
veloping countries where Western mental health services are often
scarce or non-existent; and they are limited because they are poorly
suited to addressing the diverse range of psychosocial stressors that
affect refugees on a daily basis (e.g., the loss social support networks,
the loss of social roles and of meaningful role-related activity, a lack of
access to key resources, difficulties navigating the new setting).
In short, there is a gradual recognition occurring among mental
health professionals who work with refugees and internally displaced
people that the old paradigm of clinical intervention, though certainly use-
ful, cannot be the cornerstone of our response to the mental health
needs of these communities. The authors in this book share a common
vision, a commitment to an alternative conceptual framework within
which culturally appropriate refugee mental health programs can be de-
Preface xv
veloped. As the various chapters illustrate, such programs empower
communities to take greater control over their own mental health and the
conditions that affect it. Guided by an ecological model that combines
elements of public health, empowerment theory, community psychology,
clinical psychology, psychiatry, and anthropology, ecological mental
health programs have been developed for refugees in highly diverse set-
tings, from Sierra Leonean refugees in Guinean refugee camps, to inter-
nally displaced women widowed by the civil war in Sri Lanka, to Bosnian
refugees in a large urban center the United States. While the programs
differ in their populations, foci, and specific methods, they share a guid-
ing framework that recognizes the inherent strengths and sources of re-
silience that all refugee communities possess. The diverse projects de-
scribed in this book are innovative, empowering, and far-reaching in their
impact.
Importantly, the contributing authors have not been asked to present
models of fully polished, flawless intervention strategies. Instead, the
goal has been for this group of creative, resourceful individuals to share
a wealth of innovative and impactful intervention experiences that illus-
trate a new way of thinking about how we can best support the healing
and adaptation of communities displaced by violence—communities that
are struggling to heal from the wounds of the past, to adapt successfully
to the challenges of the present, and to create futures that hold the prom-
ise of new life projects, new social roles, and new social networks that
provide meaning and value to life.
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