Sarah, an African refugee, entered into an arranged marriage as a teen and was abused. During the Somali war of 1991, her entire family was robbed and she was beaten on the head. Her father protested her treatment and he was killed immediately in front of her. In 1994 both Sarah and her son suffered bullet wounds that were not lethal. In 1997 she was running away with her eight-year-old daughter, who was then hit by bullets. She looked back and saw that her son was locked in her house, which was set on fire, and he burned to death. Her husband wandered away totally unable to function. She was attacked by the rebels again and threatened with rape. Her oldest son was taken away by the rebels and was never seen again. She and her daughter became refugees in Egypt before coming to the Unites States. In the clinic where I work, the Intercultural Psychiatric Program in Oregon, she was diagnosed with severe post-traumatic stress disorder (PTSD) and major depressive disorder. Her husband was in Egypt and unable to come to the United States. She then was involved in a car accident, which only increased her symptoms. Over time her symptoms improved, but following the terrorist attacks on 9/11, they markedly increased. Eventually her husband joined the family, but he was totally unable to function, probably suffering from chronic psychosis.
Sarah (a fictitious name provided for confidentiality purposes) represents one of millions of refugees who come from conflict and war-torn areas, often suffering from severe trauma. There are approximately 20 million refugees in the world today, and many of them—approximately 70,000 each year—come to the United States. In addition, there are asylum seekers: people facing persecution or torture in their own countries who come to the United States, some illegally, some seeking the legal protection of asylum.
Since 1977 the Intercultural Psychiatric Program in Oregon has treated refugees and asylum seekers. Currently, its clinic treats about 1,200 patients. Patients are treated by counselors from their own culture and a psychiatrist associated with the Department of Psychiatry at the Oregon Health and Sciences University. The clinic now accommodates 18 different languages, including Amharic, Arabic, Bosnian, Cantonese, Mandarin, Oromo, Russian, Somalia, Spanish, Swahili, and many languages from Asia.
The stories of the refugees and asylum seekers are indeed tragic and sometimes overwhelming. They require a great deal of clinical experience and empathy to maintain appropriate therapeutic intervention.