The Psychology of a refugee

WAHA’s  Roula Michati, first female director of the psychiatric ward of the Aleppo hospital and a refugee herself, leads group therapy sessions with refugees stranded on the islands of Chios, Lesbos and Kos.

Stav Dimitropoulos

In late-March 2016, mainland Europe shut down its borders, leading to the entrapment of over 62,000 migrants and refugees in the “hot spots” of Greece, which, now in its seventh year of recession, has been burdened with processing 56,000 asylum applications (scoring the fourth place in the chart of the countries handling the highest numbers of asylum applications).

Under such grim circumstances, organizations like Women and Health Alliance International (WAHA) are trying to treat refugees and migrants who are suffering from physical or psychological ailments under less than ideal circumstances. Fleeing war makes you particularly prone to developing depression, post-traumatic-stress-disorder (PTSD) or generalized anxiety disorder (GAD).  WAHA’s  Roula Michati, first female director of the psychiatric ward of the Aleppo hospital and a refugee herself,  knows these all too well. On a weekly basis, she leads group therapy sessions with refugees stranded on the islands of Chios, Lesbos and Kos. An interview with Dr. Michati for Continnect follows:

Tell us some things about your past, your professional background.

I studied Medicine in Syria, but did my specialization in Adolescent Psychiatry in Canada. At the age of 33, in 2004, I became the first female director of the psychiatric ward of Aleppo hospital. I remained in this position until 2011, with the only difference that between 2007 and 2011 I spent big chunks of my time in France (I was doing a Psychopathology course in France at the time, but interrupted when the war started). Eight months after the onset of the war, one of my colleagues was kidnapped and killed. I decided to step down from my position as there was increased fear over my safety though I did remain in Syria for one and a half year after the war set off. Two months after my resignation, the rebels took control of the hospital.

How was your life before the Syrian Civil War?

I enjoyed immense respect because I had brought to Syria innovative ideas from abroad, and I often attended meetings with the Minister of Health in Damascus.  I am Christian, bud did not have any specific problems with my religion since in Syria the majority of Muslims are open-minded, and Christians and Muslims live together peacefully.

Now in Greece—on the Greek islands of Kos, Chios and Lesbos, in specific—what is your main responsibility as a psychiatrist?

My main responsibility is to battle the severe trauma of war, to protect refugees who escaped death and have been through hell from losing their sanity.

And how do you do that?

I lead weekly group therapy sessions with refugees. We invite six to ten people who are preferably of the same gender, speak the same language, and are aged between 18 and 50, to form a circle.  One of the targets of the intervention is to make them discover that this is a transitional period and that they can even draw empowerment out of it, and that they need to concentrate on the importance of not being in danger anymore.

Can you describe a typical group therapy session more analytically?

Sure. As I told, the refugees form a circle. We introduce ourselves and the purpose of this session, which carries a name, for example, “stress management session”. We then ask every participant to introduce themselves. Next, we start asking who would like to share with us how they arrived at this place and why. We encourage everyone to participate, but do not exert pressure if they are reluctant to do so. It is most often the case that one starts complaining about the situation at the camp, about the fact that the camp authorities don’t see them as human beings, and the conversation is kind of set on fire. One thing brings another, and in a few minutes you have people opening up about their real, internalized, emotional problems. In a way, they see group therapy as confessional conversation and not therapy. As a matter of fact, eighty per cent of them come back.

What are the most usual mental health problems you encounter during these therapies?

I see a lot of PTSD, major depression and GAD incidents. Many of the people have been trapped for over eight months at the camps, and are afraid of being deported back to Turkey, which gives them episodes of acute stress. Syrians are especially afflicted by PTSD and GAD since they have witnessed carnage and most of them feel helpless, that there is no tomorrow for them. You’ll find it hard to believe, but men may suffer more. They think they are more responsible than women to be protectors and this stresses them out much more. Women also tend to cry more, to reach out to other people more, it is a cultural thing.

Do you also prescribe medication?

Yes. Once I see that some refugees cannot/will not participate in the group therapy and appear severely withdrawn, I suggest individual sessions and give them antidepressants. I should also stress that I continue treating patients in Aleppo through Facebook and What’s App (she laughs). I mean that I check whether those patients of mine who are left behind in Aleppo and are suffering from GAD or acute stress continue taking their medication. I even use social media to check on how they feel six months after the relief of their symptoms.

You are a refugee yourself. How are you coping with all this

With many of my old patients and some relatives of mine still back in Syria, I think I myself suffer from separation disorder when I am not near my cell phone (she laughs again). The truth is that like all refugees I have been exposed to atrocity myself. While I was still in Syria, a few months after the war broke out, I remember seeing  graves in parks. People didn’t know where to bury their dead, and they buried them inside parks. Now, I am trying to focus on helping my patients and this helps me forget, but I miss my country, I miss my citadel, nothing will ever be the same.

Stav Dimitropoulos is a journalist and writer who has appeared on CBC, CBS Radio and FOX Channel, and has written for In The Fray, YourTango, Gadgette and many more. Facebook | Twitter: @TheyCallMeStav

The picture in the interview is of one of the patients at the Women and Health Alliance International (WAHA) organisation.

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