Many Syrian refugees have found a place of safety in Germany. But escaping from trauma, anxiety and guilt can still be a long and difficult journey, as psychotherapist Maria Prochazkova explains.
Since the start of the conflict in Syria, thousands of refugees have fled to Europe, with a large number finding sanctuary in Germany. Against huge odds, many of them have been able to learn the language and become settled within just a few years.
But arriving in a new country like Germany is not the end of the story, nor the problems, for the majority of Syrian refugees. Many suffer from mental health problems as a result of past trauma and memories which continue to haunt them.
Maria Prochazkova, a Berlin-based psychotherapist who specializes in work with survivors of torture and war, spoke with InfoMigrants about trying to help with the hard journey to recovery.
InfoMigrants: What is the most common cause of mental health problems for Syrian refugees in Germany?
Maria Prochazkova: People react very individually to situations, and the stresses change over time once they arrive in Germany. For example, at first the lack of privacy in the place they live, and being overwhelmed by the bureaucratic requirements are major hurdles. Learning the language is often slow because it is hard for them to concentrate. That makes integration more difficult and their self-esteem suffers. It is rare that they achieve the feeling of security that they have waited for so long. Instead the sudden calm after their escape from Syria leads to a flood of horrible memories. What some refugees from Syria have experienced is unimaginable. Experiences of racism in everyday life can be another stressor.
What are the psychological effects of the separation from family and loved ones, the conflict in Syria and the constant disturbing news and pictures?
The effects can be very different. Worries, tension, detachment, shame and guilt, helplessness or sadness are very understandable reactions to this situation. The family is an important resource. It is where worries and reponsibilities are shared. But if someone in Germany is living all alone, or if they are lucky with their immediate family, an important element of support is missing. In addition, the uncertainty about the security of loved ones in the war-affected country of origin can be so paralyzing that one's own well-being or even progress in Germany becomes a secondary concern.
Who is worst affected? Is it mothers, or young men, or those who are unemployed?
All groups are faced with different kinds of stress. Arriving in Germany often goes hand in hand with a complete role change. Children often learn the new language more quickly than adults and often take on some of the roles of adults. This is called "parentification," and it is a burden for everyone involved. While the children are deprived of their own childhood, the parents suffer from guilt and shame. Men understandably suffer more often from a loss of status, especially if they can no longer work. Mothers lack the usual network of helpers so caring for the children leaves hardly any room for their own personal development. Unemployment goes hand in hand with a loss of daily structure and has a negative effect on the self-esteem of those affected.
What coping strategies do refugees use to deal with these problems themselves?
In psychotherapy we talk about "functional" and "disfunctional" coping strategies. Both are helpful, but the consequences of the disfunctional strategies have negative long-term effects. Most people cope with their problems themselves, they take good care of themselves and their loved ones, they study, work, pursue various interests. However, it can happen that a strategy that was helpful in the past is applied in a new situation and turns out to be a disadvantage. For example, distrust of others is a vital strategy when you are being persecuted by a regime. But in a new country, a deep distrust of other people leads to isolation and loneliness.
Is there a stigma associated with going to a counselor or psychotherapist, or other obstacles like lack of time, depression, or not being able to access help?
It is an important part of our work to get across to people that the decision to seek psychotherapy is also a sign of healthy self-care. Going through psychotherapy is a very important life-affirming decision. Of course it goes without saying that a sense of hopelessness, a lack of self-esteem or lack of drive that are typical of depression stop people from seeking help. There are also hurdles in the search for available psychotherapy appointments which are rarely available in the appropriate language and at a suitable time.
What impact do psychosocial problems have on people's ability to settle, accept and be accepted in their new community?
The psychosocial problems could be easily dealt with if they were short-term, if the support system was adequate, and if people had more resources and fewer problems. The opposite can unleash a "spiral of depression": A sleep disorder makes people exhausted and vulnerable during the day. This leads to a tendency to withdraw and feel ashamed about getting hardly anything done. When a person withdraws and has no contact with other people they then have time to worry and ruminate, to feel lonely and inadequate, to think others don’t like or don't need them. Everything becomes so exhausting that they don’t dare or don’t have the strength to tackle small things, to get back on track that way and to get out of the depression spiral. Depression is an extremely bad basis for trying to make a new beginning and to gain acceptance in the community. With depression, people feel alone and separated from their social environment.
Maria Prochazkova is a Berlin-based psychotherapist with Zentrum ÜBERLEBEN (SURVIVAL Center; former Behandlungszentrum für Folteropfer bzfo) who specializes in work with traumatized survivors of torture and war.