The UNHCR’s Dr Gail Theisen-Womersley on ‘trauma and resilience among displaced populations: a sociocultural exploration.’
Dr Theisen-Womersley asked one central question: how are refugee experiences of potentially traumatic events historically rooted, socially constructed and culturally shaped? Displaced populations are widely studied, yet enormously heterogenous, indeed published reported rates of PTSD vary from 0-99% depending on individual studies. Many cultural settings lack the words for ‘trauma’ and ‘PTSD’ or do so in different way. Therefore, our own prevailing conceptualisation risks obscuring the socio-political causes of emotional distress and narrows the framing of the event and its consequences to an individual mental disorder.
Dr Gail Theisen-Womersley is an academic and clinical psychologist who currently works as a Senior Staff Counsellor with UNHCR in Geneva. She has worked for over 15 years as a clinical psychologist and researcher for humanitarian organisations in the context of forced migration. She has worked in emergency contexts with displaced populations in countries across the world including in diverse, insecure, and resource-constrained environments such as the Central African Republic, the Democratic Republic of Congo, Iraq, Israel, the Philippines, South Africa, South Sudan, Ukraine and Zimbabwe. Her recent publication, Trauma Without Borders: Working with Adversity and Resilience Among Displaced Populations (Springer, 2021), provides an understanding of historical, collective, cultural, and identity-related trauma, emphasising the social and political location of human subjects. It explores a socio-ecological perspective on refugee trauma, rather than viewing displaced individuals as traumatised ‘passive victims’.
“Trauma is… a relational and subjective experience, embedded in geo-political and sociocultural systems mediated by human language.”
– Dr Gail Theisen-Womersley
Drawing on her own professional experience and Drožđek’s (2015) model, Dr Theisen-Womersley took the audience through the presentation of trauma in populations who have lived with constant conflict and the necessity to emphasise the social, cultural and historical contexts of trauma, the need to view trauma through a cultural lens and its relationship to identity and the social collective, not just the individual.
“PTSD is being used strategically as a cultural tool by various actors within systems to address the influx of refugees across Europe,” she stated. “This can result in a multitude of ways in which refugees may exert a power to act as active agents, despite the obvious power balances within these systems”. She recounted how, for refugees their response to past trauma(s) cannot and should not be separated from the ongoing (potential) trauma of going through the asylum application procedures. Whilst some asylum seekers did not seem to understand the idea of a traumatic illness or disorder according to an assessing medical professional, a “performance of trauma” was necessary from them. As a result, “some asylum seekers deliberately drew on Westernised narratives of trauma to present their case,” she said. In this context, demonstrating lasting traumatic impact was linked to being defined as a refugee which is turn was necessary to claim asylum. However, by constraining the individual to a narrow operationalised view of what trauma and a traumatic response is and should be, the true nature and impact of the trauma is ignored. In doing so, the refuges’ personal stories of traumatic experience and the consequences are silenced, and appropriate support cannot be accessed.
“As a clinician, I am not disputing PTSD as a medical disorder. What I am saying is it is ‘yes’ but also ‘and…and…and’,” she said. Accordingly it is important to consider how do we define traumatic events and the need to consider the sense-making of both the traumatic event itself as well as the consequences and response to that event. A truly socio-cultural definition of PTSD, Dr Theisen-Wormsley stated, emphasises the role of narrative. For mental health programmes delivered within a humanitarian context this may mean considering a community-based, culturally relevant approach to both trauma expression and response. For example, acknowledging, fostering and working within group-based religious contexts where singing, movement, and the coming together as a collective may help process trauma, particularly when individual intervention is not always appropriate.
“Trauma is that which cannot be elaborated through semiotic means. It is a relational and subjective experience, embedded in geo-political and sociocultural systems mediated by human language,” Dr Theisen-Womersley said. “It is a ‘crisis’ which is situated, negotiated and mended in relationships and is non-linear and non-dose dependent”. By understanding and embracing this, and unpacking what we understand through our own systemic conceptualisations of trauma, we can help ensure those in need can access the support and healing they deserve.
UKPTS Bites is a series of short, free, online lunchtime sessions on topics related to PTSD, trauma and beyond. It is hosted in partnership with the ESTSS. More details on upcoming sessions can be found on our events page.
