The lightning flashed and lit up the coffee cup sitting on the arm of my Adirondack chair as I sat in my front yard watching the early spring storm blow in from the west. I have been mesmerized by thunderstorms ever since I was a boy, despite the anxiety-riddled warnings of my Mom to stay away from windows and turn off appliances. Oh I listened to my Mom and adapted her warnings (minus the anxiety) to stay away from trees, and umbrellas and to get off the golf course when the siren sounds. But despite my mother’s admonitions I still enjoyed the power and the beauty of thunderstorms back then and on this night.
At the clinic the next morning, I was preparing for my first client of the day, an Iraqi wife and mother. I work with many Iraqi immigrants refugees. They make up about 60% of the clients I see each day. My mind was still replaying the power of the night’s storm in front of my eyes as I greeted this woman in tears, which was unusual for her. She chose to practice her English rather than use a phone interpreter, as if her intense emotions that morning gave her the impetus to risk trying more of her new second language.
I was quickly thrust into Psychologist mode as I listened to this woman’s report of her frightening sleepless night as the horrors of the Iraq war came to the front of her brain with the painful vengeance that is PTSD (post traumatic stress disorder). The deaths of family and friends, the sight of dead bodies piled up near her daughter’s school, the stray dogs wandering streets with human body parts in their mouths, the smell of benzene after an explosion, the rogue militia knocking on doors and bursting into homes to beat, kill or kidnap family members had all re-surfaced in this woman’s mind the night before, triggered by the very same thunder and lightning storm I had thought was so beautiful.
The Post Traumatic Stress of returning war vets and Iraqi immigrant refugees are significantly different if you look beyond the commonalities of symptoms they share: depression, anxiety, insomnia often with nightmares, hypervigilance and a damaged memory.
Immigrant refugees who experience PTSD are trauma victims in their home country then forced to leave behind all they knew and loved as they try to recreate a life in foreign country. This experience may make their trauma more stubborn and longer lasting.
Today, the war continues in Iraq despite the American military withdrawal. It has changed since the invasion in 2003 to the point where there are many enemies and many more victims on a daily basis. So even the first step in the treatment of PTSD of refugees – helping the client feel safe – is difficult because their family or friends in Iraq may be unsafe. Some Iraqis who have successfully immigrated to the U.S. still fear that what they share here, even in therapy, might get back to the enemy in Iraq and jeopardize the safety of family and friends there. I don’t dismiss this notion too quickly.
The hypervigilance component of the Iraqi immigrants is extreme. I had an Iraqi woman client become anxious about another Iraqi woman killed in San Diego. Therapy might be focused on why a woman killed 3000 miles away upset her. Her anxiety was resistant to the best of treatment plans however, because the murder victim was specifically an ‘Iraqi woman’ (like my client) and because many Iraqis believe that “bad people” have also arrived in the U.S. as immigrants and may lurk in many Iraqi communities across the country.
And while this lovely woman, frightened by a murder across the country, worked hard in therapy, an element of skepticism and vigilance kept her barricading her apartment door before she went to bed. She was also barricading herself against treatment until she better understood and felt safe here in the U.S., her new home.
I have discovered that the stubbornness of Iraqi PTSD can be penetrated, but it takes my patience, my better understanding of the Iraqi culture, my best listening skills and most importantly, my belief in the power of the extraordinary horrors reported. It also requires a lengthening of treatment goal timelines. I have found the most successful first step for anyone working with Iraqi families is to support them unconditionally. Offering trust, and cultural and human respect, over a period of time is key.
When I acknowledge their courage and conviction to leave home and their extended families, move to this strange country to be safe and free, and build a future for themselves and their families; when I basically call them heroes, it most often brings tears to their eyes; I think because no one has allowed them feel like heroes.
Imagine a crack of thunder echoing across the sky bringing us together. Bringing on a sense of wonder for me. Triggering war horrors for others.
The US House of Representatives proclaimed July as National Minority Mental Health Awareness Month in 2008 to improve access to mental health treatment and services for multicultural communities through increased public awareness. I have become aware the important nuances minorities bring to mental health treatment and my work is richer because of it.
Judson D. Smith, Ed.D. | Psychologist