The trauma of being a refugee

This article attempts to convey a human 'feel' for the refugee and the helper, without being oppressively expert or conveying pity. It explores differences and similarities between post-traumatic stress disorder and surviving and coping capacities, leading to an argument against biased use of western forms of psychological help and a plea for fitting in with local cultural patterns for coping with disaster. The difference between 'victim' and 'survivor' is emphasized and the problems of gratitude and envy in both helped and helper considered. In FYR Macedonia deskilled professionals became their own 'experts' as they responded imaginatively to the refugees on their doorstep. They wanted professional support, literature, supervision, consultancy and friendship, but not to be told 'how to do it'. The concept of 'resilience' is examined. Some children survive the disaster others do not. The latter suffer as refugees, whilst those initially terrified benefit from the security and predictability of camp life. An attempt is made to acknowledge normal coping capacities and allow for cultural differences in ways of coping, and so to emphasize survival rather than collapse or victimisation, while not denying the pain, terror, boredom, and frustration of being a refugee. This may lead to mental breakdown, PTSD, pathological grieving, but it does not automatically do so. There is no panacea of 'treatment', but it is essential to support and enable survivors.