The Middle of Everywhere (34 page)

Psychologists ask, What does Gestalt theory or Jungian theory have to say about the Kurds or the Sudanese or the Vietnamese? These are the wrong questions. Better questions are, What models could we develop from our experience with refugees that would allow us to expand our knowledge of the human race? What are the universal components of healing? What are the aspects of resilience?

Sometimes psychologists have proselytized like missionaries. We have taught "Follow Sigmund Freud and Carl Rogers and you will be saved." We have said, "Our system is better than yours. Trust us to know you better than you know yourselves." But we have had an abysmal conversion rate. Our Western mental health system is dependent on verbal expressiveness, self-disclosure, and a belief in individualism. It splits the personal and the professional, the sacred and profane, and the mind and the body. Our system is also expensive, hard to schedule, and involves sitting in small rooms baring one's deepest secrets to perfect strangers.

Our ideas about how to deal with pain do not seem relevant to many newcomers. Catharsis and self-analysis are by no means universally respected as ways to heal. Not many refugees can be persuaded they will feel better if they talk about trauma. Psychologists have a metaphor for healing—a wound must be washed, cleaned to heal. It may be painful but it is necessary. The Vietnamese also employ the wound metaphor for healing. But they say, "A wound will only heal if it is left alone."

In his introductory psychology text, David G. Myers writes, "Most political dissidents who survive dozens of episodes of torture do not later exhibit post-traumatic stress disorder (Mineka and Zinbarg, 1996). And, although suffering some lingering stress symptoms, most American Jews who survived the Holocaust trauma, experiencing starvation, beatings, lost freedom, and the murders of loved ones, went on to live productive lives. In fact, compared to other American Jews of the same age, these survivors have been less likely to have seen a psychotherapist (18 percent vs. 31 percent) and more likely to have had stable marriages (83 percent vs. 62 percent). Moreover, virtually none has committed a criminal act."

These statistics suggest we should be extremely cautious about assuming that traumatized people are necessarily suffering clinical syndromes. Yet extreme situations induce extreme reactions. People who suffer terrible things have a time when they are sadder, angrier, more agitated, more withdrawn, and more passive. They are temporarily disorganized by grief and permanently changed by the tragic events.

One of the most common changes is a shifting of priorities. With tragedy, what is most and least important changes. Often people value family and friends more and care less about property and money. Spiritual concerns become more salient. Many Americans experience this change of priorities after a cancer scare or heart attack. They stop worrying about unfinished housework or job promotions. They spend more time with their grandchildren, travel, and watch sunsets.

Depression is certainly one of the most common reactions to trauma. Almost all the Afghani women I met were severely depressed. However, depression is a confusing word in this context. Who wouldn't be depressed after suffering these experiences? Depression implies pathology whereas reacting to trauma is normal, even healthy. Perhaps a better phrase for what we have called depression would be bone-deep sadness.

Avoidance is also common. A Kurdish woman could hardly bear to think of her past. And, most likely, her ability to push aside her memories was adaptive during her years on the run. Now, however, she had a therapy appointment once a week that she always forgot. After many weeks of no-shows, her kind therapist sent a car for her. Every Tuesday the Kurdish woman was shocked when the car pulled up. Her memory was generally excellent, but she'd blocked out her appointment. She wanted to avoid reliving those terrible years. Slowly, in her sessions, she talked about events that had once been too painful to recall.

Guilt is a big problem. Some of this guilt is survivor guilt, or the irrational feeling that one is somehow to blame for having stayed alive while loved ones died. Some guilt comes from situations in which people were forced to make terrible choices. Other people genuinely behaved badly. They took food from hungry people or killed others so that they might escape. Under abnormal conditions, normal people do very abnormal things. Human beings, afraid for their lives, don't always function at their best.

Anxiety and restlessness are common reactions to severe stress. People are startled at the smallest of events—a door slamming, a car backfiring, or a shadow on their floor. Many newcomers cannot fall asleep. Or, they wake easily, have nightmares and night sweats.

Paradoxically, torpor and lassitude are also common reactions. People just don't see any reason to get out of bed in the morning. They don't have the energy to cope with the complex new situations they are in. They don't have the energy to brush their teeth.

One common, and generally not very adaptive, way refugees deal with their pain and difficulties in America is to move. Moves are common among refugees as they find one town difficult and hear rumors that the grass is greener in other places. Generally these moves don't make things better; they are expensive, disruptive of the family's relationships with schools and community resources, and they don't solve the original problems. Still, it's understandable that geographical moves would appeal to refugees. After all, they have moved before to solve problems.

Refugees also are at risk to become hooked on drugs, alcohol, and nicotine as ways to cope with stress. They desperately want to forget reality and drugs help with that, at least in the short term. Many refugees come from places where they had limited access to alcohol and other mind-altering drags. They also come from places where there were no traditions for helping people learn to drink responsibly and where there was no education about drugs and nicotine. It is tragic to see a person who has endured terrible things and escaped from a dangerous place become enslaved by gin or heroin, surely as cruel a jailer as any in the old country.

Reactions to trauma depend on many things. In general, one discrete traumatic incident is more easily handled than years of chronic stress. The Kakuma refugees and Bintu and Mohamed, who had long periods of great stress, had more trouble healing than refugees who had one terrible experience.

Whether a person is singled out for victimization is also important. It is easier to deal with abuse that is random or the result of membership in a group than with abuse that feels personal. Torture is a great injury to the human spirit. No matter how serious the physical wounds, the spiritual wounds are worse.

Psychology has documented with great precision all human inadequacies. We have the
Diagnostic and Statistical Manual
to catalog our problems, but we have no equivalent inventory of human strengths. Writing this book, I discovered certain qualities in resilient people from all over the world, and I labeled them the attributes of resilience. Few refugees had all the attributes, but the ones who were successful at adapting to America had many of them. Those refugees with few or none of the attributes were in a great deal of trouble in America.

All of us can benefit from the attributes of resilience. As we cope with loss or adjust to new situations, we will do better if we have a sense of humor, if we are hardworking and honest, and if we know how to stay calm. On airplanes, we hear, "If needed, an oxygen mask will appear automatically." In times of crisis, these attributes are our oxygen masks. This list of attributes of resilience, while neither perfect nor exhaustive, summarizes what it takes to adjust to new and difficult environments.

Attributes of Resilience

1. Future Orientation
   Future orientation is about letting go and moving on. It is about newcomer zest. All refugees must put their hearts into America if they are to succeed in our country. Bintu is a good example of someone who has experienced great sorrow, but who looks toward the future. She began computer classes right away and made plans for bringing her "kids" from Ghana over to America.
   Having a future orientation doesn't mean repression of memory or silence about the past. On the contrary, dealing honestly with pain often allows refugees to leave the past behind. Nor does it mean leaving loved ones behind. Many of the most successful refugees are deeply tied to their homeland, and often much of their motivation to succeed is because they want to help people in their old country. However, having a future orientation does mean that refugees have plans and purpose. They do not live only in the past; they can envision a better future.
   
2. Energy and Good Health
   Adjusting to America and recovering from loss requires an enormous amount of energy. Just facing each day, with difficult jobs and coworkers who are hard to understand, is exhausting. Life is hard enough for the healthiest refugees, but it is almost impossible for refugees who are in chronic pain from injuries, who cannot work because of disabilities, or who have previous histories of mental illness. The children at Sycamore School, filled with life and wriggly with energy, exemplify energy and good health. I think of Khoa and Ly, so lively they could barely sit in their chairs. Youth is a great advantage in a new culture.
   
3. The Ability to Pay Attention
   Paying attention means being aware of subtle cues, knowing whom to trust, and accurately sensing danger. It means catching on to patterns and rules, picking up on how things work, and not repeating mistakes. Paying attention includes being empathic, remembering, and detecting small changes in tone and nuance.
   The Kurdish sisters had survived by paying attention. All of them could expertly read other people and respond quickly and sensitively to the slightest needs in others. I was struck by how rapidly they responded to changes in my face or mood. The Kurdish sisters didn't miss anything and they learned things the first time. We joked that they remembered my life better than I did. I said, "Don't move away or I won't know who to ask what I did last year."
   
4. Ambition and Initiative
   Being a hard worker requires motivation and stamina. It requires time-management skills, the ability to work with others, and the ability to do what one is told and more.
   Mohamed exemplifies these attributes. Within a few weeks of his arrival, he'd signed up for GED classes and was going to a mosque, working two jobs, and sending money to Africa. His employers respected him because he always offered to do more than his share of work. He was on time and never called in sick. He was taking driving lessons and computer classes in his spare time.
   
5. Verbal Expressiveness
   One of the most important attributes is simply being able to express one's needs clearly and appropriately. Being able to
   communicate thoughts and feelings, to ask good questions, and to articulate problems are all aspects of this attribute.
   Walat at Sycamore School was able to communicate clearly. He knew what he knew and what he didn't know. He asked for help when he needed it. In contrast, Trinh and Abdul were silent about their needs and feelings and hence were much harder to help. Knowing one needs information and knowing how to ask for it are critical survival skills.
   
6. Positive Mental Health
   Many people have "a talent for happiness." Long ago La Rochefoucauld seemed to know this when he wrote, "Happiness and misery depend as much on temperament as on fortune." Positive mental health requires an optimistic nature, a sense of humor, and the ability to appreciate and enjoy what one can in the midst of sorrow.
   Bintu is a good example of this. In spite of all her misfortune she is a joker and a seeker of fun. The Even Start mothers also exemplify this attribute. They worked all day in factories, then cared for their families and came to class. Many had lost children, husbands, and homes. However, I have rarely been with a happier group of women, all jokes, smiles, and high hopes and kindness to the teacher and one another.
   
7. The Ability to Calm Down
   These skills, which include deep breathing, putting things into perspective, and optimistic thinking, allow people to stay calm and positive, to forgive themselves and others, to sleep nights, to avoid addictions or impulsive behaviors, and to control feelings in the face of great sadness and trauma. These are the skills Martin Seligman teaches in his work on "learned optimism" and Daniel Goleman teaches as "emotional intelligence," a concept pioneered by Peter Salovey and John Mayer.
   Many people get into trouble because they cannot tolerate pain. They run from it, try to drink it away, or inflict their pain on others. Stoicism, or being able to endure pain, is an important attribute of resilience. Wendy Kaminer defined stoicism as "the strength to tolerate sorrow."
   Because refugees have experienced pain and chaos, many of them have had a chance to develop good coping skills. Tharaya and Velida could tolerate the pain of their pasts. Velida even coped with her brain tumor in a stoic and heroic way. Even as the Afghani women struggled with great sadness, they did what they needed to do to take good care of their children.
   Nithal was a high school student from the Nuba Mountains in Sudan. She helped her mother with many younger siblings, made A's at high school in her fourth language, and gave talks about her people to raise money for supplies. Nithal was shy, but she spoke clearly as she told of the tragedy of war in her country. One quarter million of her people had died and the attacks on them continued. Nithal's father was Yousif Kowa, leader of the Nuba people. He stayed in the Nuba Mountains to fight for his people, but he sent his family to America to be safe. "While I wrote this book, Yousif died. Nithal said of her father's death, "He has been gone so much. It's easy to think of him as on a journey. I like to think that this trip is a safe one. "We will be together when it is over."
   
8. Flexibility
   Flexibility means simply that one can behave differently in new situations. One can assess the situation and act accordingly. It's being adept at cultural switching. Flexibility also involves understanding the concept of point of view, that is, knowing that different people have different perspectives and that all behavior is contextual.
   The high school students come to mind as moving between worlds, being traditional at home and American at school. Liem is an example of someone adept at cultural switching. He adopted Vietnamese ways at home and mostly American behaviors at school. He managed to stay out of trouble and work toward his goals in a very complicated environment.
   Anton was having more trouble. He was in a safe place now, but his behavior remained that of a person in a war zone. His mother also had trouble being flexible. She and Anton would have had an easier time if they had been able to change a little and trust others in a new, more trustworthy place.
   
9. Intentionality, or Being Thoughtful about Choices
   In the United States, where there are so many choices, it's imperative to make careful decisions, to choose wisely what to do and not do. It's also important to be able to pick wholesome friends who will help with adjustment and to make good choices about work, housing, schools, time, and money. It's necessary to rapidly develop consumer skills and some sophistication about media and advertising. One of the most useful skills is knowing the difference between what one wants and what one needs.
   Mohamed was an intentional person. He realized cars were expensive and decided to bike as long as he could, at least until his first Nebraska winter. He knew to stay away from credit cards, nicotine, alcohol, and useless products. He was a good judge of people and soon had solid, intelligent friends around him.
   
10. Lovability
    Lovability is a complex attribute that includes many qualities from other attributes. Certainly energy, verbal expressiveness, empathy, and good character are all part of being lovable. It's an elusive quality, but we all know it when we see it. Lovable people make us feel good. We want to be with them and we want to make them happy.
    There were no refugees more lovable then the Kurdish sisters. With their bright eyes and hearty laughter, their jokes and eager curiosity about the world, and their enthusiasm for parties, for dressing up, for camping trips and adventures, they were easy to love. I never was with them without enjoying myself, without feeling cared for and appreciated, and without learning something new about the world.
    
11. The Ability to Love New People
    Originally I thought lovability might be the most important attribute of resilience. People who are loved are granted favors, given advice and privileges. They are invited to events and awarded scholarships. But I now realize that even more important than being loved is being able to love.
    Caring for others is what motivates humans to get out of bed in the morning. It gives life purpose and meaning. Especially if one has had great losses, the best cure is to find new people to love. Zahra, the bereft Afghani grandmother, was saved when she became interested in Ritu's children. Bintu befriended needy refugee families here and worked for the children in her refugee camp in Ghana. With all that had happened to Bintu, if she did not have this skill, she could not have survived psychically. She cared for herself by caring for others. And there was Ly, the Vietnamese schoolgirl who thought I, a very ordinary fifty-four-year-old woman, was beautiful.
    A man in our town lost his wife in the same time period that one of his daughters had triplets and the other had twins. He alternated nights at his daughters' homes, getting up to help feed and change the babies. Mercifully, he had five new people to love as he dealt with the loss of his wife.
    A friend of mine lost her daughter to cancer. Shortly after this untimely death, her first grandchild was born. This new baby came into her life at a time of great need and gave my friend a reason to keep on living. My friend said, "I can see my daughter's smile in the baby's smile, my daughter's eyes in her eyes." When we lose people, as we all do, we must be able to find new people to love. They cannot replace those who were lost, but they can give us joy, hope, and a sense of purpose.
    
12. Good Moral Character
    Good character is vital to success. Honesty, responsibility, and loyalty all help newcomers succeed. One of the joys of writing this book was that I met many heroes. Joseph worked to support his siblings and studied bleary-eyed for his GED. Often I could hear his stomach rumbling with hunger. Leda commuted hours to a job that made her cry, then on weekends she cooked meals of nourishing Iraqi food and cleaned the house. Deena from Sycamore School helped her overwhelmed family cope with their first year in America. She found time to pull Trinh, a withdrawn Vietnamese girl, into the life of the school.