The Middle of Everywhere (35 page)

Freya Stark wrote that "People who have gone through sorrow are more sympathetic, not so much because of what they know about sorrow but because they know more about happiness—they appreciate its value and fragility and welcome it wherever it may be."

Laughter, music, prayer, touch, truth telling, and forgiveness are universal methods of healing. Talking to friends, sharing food, enjoying children, and watching the stars have soothed us humans for thousands of years. Many cultures have healing ceremonies, purification and forgiveness rituals, often with a spiritual component. Karl Marx called religion the opium of the people. Described more kindly, religion is the healing balm for all people. Faith is an important aspect of healing, faith that one's suffering has not been in vain and that the future will be better.

Traditional healers and customs work because they are believed to work. Almost all mental health cures are about placebo effects. Placebo effects aren't negligible. They are about hope and faith. Langston Hughes wrote, "Hold on to dreams for when dreams go / Life is a barren field frozen with snow."

In the Middle East, troubled people often visit "saint's houses." Usually these are peaceful retreats with kind people to assist the travelers. The guests visit with food to share. They pray, cry, talk to others, and rest. Most return home feeling much better.

Buddhism has an ancient and sophisticated set of practices for calming and healing. Breathing properly, meditating, and focusing on the impermanence of all things are healing activities. In fact, some of our most successful psychotherapy incorporates aspects of Buddhism.

Praying works whether or not people believe in God. Prayer is a more active, trusting process than worrying. It is more calming and hopeful. Talking to God is generally more satisfying to people than talking to Freud. Also, with prayer, there is no need for diagnosis, treatment, or authorization from managed-care representatives.

Rituals are often part of healing. They vary in their depth and intensity. Sometimes they reflect deep cultural values, sometimes they merely allow people to go on with their lives. They mark transitions and allow the next step. They acknowledge that something has happened and allow people to say what needs to be said. The flower ceremony at Sycamore School was a simple ritual that helped the children heal from loss.

Art is also a great connector. Art and music don't require a common language, they are a language. They allow people to express pain they may not be able to communicate in any other way. Sometimes art allows people to transcend pain, to turn pain into meaning and beauty.

Refugees seem to understand the value of positive emotions and joyful events. There is an Iraqi saying, Three things are calming—the color of grass, water, and the face of a beautiful woman. Latinos have all-night fiestas. The Vietnamese are masters of potlucks. All cultures like food, dance, music, and parties. The Africans came from places where whole villages of people had been slaughtered and children had been stolen from their parents. We offered them therapy and doctors, but the first thing they wanted was to get all their people together and have a celebration. And they wanted a community center so that they could be together and plan more festivals. They knew that before housing, jobs, medical care, or money, community is what heals. It is good to share pain, but what is really healing is to share joy.

Social activism provides meaning and assuages survivor guilt. Documenting the abuses of an authoritarian regime or working for human rights is what saves many victims of a repressive government. Bringing family over from the old country is profoundly healing. Toni Morrison put it well when she said, "The purpose of freedom is to free someone else."

Refugees are great role models for resilience. They don't fit our theories. With all their stress and sadness they should be the most miserable of people. Still, for most, healing occurs with the tincture of time. Slowly most people learn to relax and trust again. And after trauma, instead of being bitter, many people become more loving and more appreciative of life. They often describe their characters as greatly improved by their experiences. They see the world in a more layered, complex, and empathic way.

After a few years, refugees find themselves humming as they walk to work or smiling as they hang clothes on a spring morning. They have babies, learn how to e-mail their friends, and form neighborhood support systems. In fact, refugee communities are often our most vibrant, bustling, and hopeful communities, filled with people who believe in the American dream.

Sara Alexander, a psychologist from Boston, talked about her collaborative work with refugees to create "healing packages." She helped refugees design healing packages from a smorgasbord of activities that included reading to children, exercising, finding a mosque, taking a class in English, looking for a better job, or going out to eat. Healing packages were about joy, contentment, recreation, physical pleasure, rest, and social connection. Not all refugees included psychotherapy in their healing packages.

This lack of interest in therapy is quite consistent with the findings from Thrive. Refugees chose circuses and dances, GED classes and job fairs, over opportunities to talk to mental health professionals. Thrive mentors demonstrated that refugees could only be helped when they were seen as whole people with physical, spiritual, social, intellectual, and vocational needs. They also showed us the importance of love, work, fun, and community in healing.

However, therapists can be part of healing packages, especially if we take a problem-solving or psycho-educational approach. An educational approach involves sharing information or teaching skills such as stress management, assertiveness, or relaxation techniques. Many newcomers resist psychotherapy, but most people like to learn. Education carries no stigma, no shame, and no hierarchy.

Psycho-education can help people look at the circumstances at the time of their trauma and understand that they were powerless to stop certain events. Just because they felt vulnerable and frightened doesn't mean they were weak. A mother whose baby starved needs to hear, "You did all you could. There was nothing to eat." A father whose son washed away in a river needs to hear, "You could not help how swiftly the current flowed."

Therapists' best work emphasizes empowerment and control. Identifying strengths and celebrating victories build trust and pride. It is good to ask, "How did you survive all this? What helped you stay sane?" Or, "Are there things you did that you feel proud of?" It's good to find out what people do well and encourage them to do more.

Therapists will be more useful to refugees if we broaden our roles and become cultural brokers, college advisers, drivers, teachers, case managers, advocates, or cooks. We can help with life planning, mediation, money and time management, and strength building. We can ask people to elaborate on their strengths, although this can be overdone. I complimented one man on not going crazy and he asked me, "How do you know I am not crazy?" Our specialty areas can be dealing with emotions and resolving conflicts. We can empower with information. If what we offer is useful, newcomers will want to come see us. They won't need to be coaxed, they'll beat down our doors.

Therapy can happen anywhere—in homes, schools, community centers, churches, cars, parks, and cafés. I'm reminded of a story about Willie Sutton, the famous bank robber. He was asked, "Why do you rob banks?" Sutton answered, "That's where the money is." If the question is "Where should therapists do therapy?" The answer is, "Where refugees are."

Not too long ago, I listened to a roomful of professionals discuss how to help traumatized people. People suggested various forms of therapy, all of which involved facing pain. Fair enough. In many cases, pain needs to be faced, but no one in the room suggested anything pleasant such as music, art, parties, pets, or walks in the countryside. This serious discussion seemed a metaphor for our blind spots as a field. We have focused on narrow, and not necessarily the most palatable, of treatments. We have ignored some of the oldest, most useful, and most universal healing procedures.

After thirty years of being a therapist and several years of working with refugees, I have found certain constants in the healing experience, certain experiences that help people in all times and places. These constants include some things we've seen with the Thrive mentors—fun, useful work, the support of community and family, and religious beliefs. And the constants include some of the essential elements in psychotherapy—safe, calm places; caring relationships; finding hope and meaning in painfiil events. In the future, good therapists will use elements from healing from all over the world.

Calmness is a language that the deaf can hear and the blind can read.

—M
ARK
T
WAIN

A calm, safe environment begins the healing process. The best treatment facilities for refugees know this. The Center for Victims of Torture is housed in an old home near the University of Minnesota. There is a fountain in the lobby that makes splashy, soothing water sounds. The house has lots of skylights and windows and no small rectangular rooms. Artifacts from many cultures remind visitors of their homelands. The Universal Declaration of Human Rights is translated into many languages and framed on the walls. Offices are homey and noninstitutional, with easy chairs, couches, and soft light. Classical music plays, flowers decorate desks and tables, and outside a garden flourishes.

The best treatment programs for refugees are user-friendly systems. Paperwork is kept to a minimum. Greeters and gifts, such as pizza and free TB tests, draw people in. The best treatment is holistic and incorporates school, family, and community resources. Dr. Keller at the Bellevue/NYU Program for Survivors of Torture put it this way, "Whatever problem a person has, we try to find the nicest person we can to solve it."

Therapy is very much about die construction of a space for people to think, talk, and work out their problems. But the ideas about a quiet space are much older than psychology. Almost all of the great religious leaders found enlightenment when they were alone in the wilderness. Many tribes encourage their members to go away from the community and be alone to seek knowledge and to heal. Healing rituals from all over the world involve isolating people from others and decreasing the amount of stimulation they receive so that they can calm down and think.

Time alone outdoors is an ancient and a modern remedy. Some of our most cutting-edge therapy recommends wilderness experience. A local social worker, who was one of the wisest people I knew, walked on our prairie for hours every day to heal from the death of her husband.

The first casualty of trauma is trust. After being tortured or witnessing murders, people lose their protective shields of invulnerability. They have no illusions that they are safe. They know what humans will do to each other. This puts them in a difficult bind. They cannot heal without relationships, but relationships seem dangerous.

Earlier we discussed the importance of family, friends, and community in the healing process. Just knowing that someone cares is therapeutic. Healing occurs when a real person connects to another real person, that is, when people are comfortable enough with each other to be who they truly are.

People who have been betrayed by the human race most need a person who asks, "What is your experience?" then listens closely to their answers. This person can be a family member, a friend, a cultural broker, or a religious leader. It can be a shaman, a curandero, or a therapist. The important thing isn't the label, but the relationship, which is nurturing, consistent, and respectful.

This healing relationship often relies on what psychologist Celia Jaes Falicov calls "the power of small gestures." When I visit Bintu, I take her flowers. In fact, whenever I visit people who have suffered, I try to take a small gift. When grief-stricken people visited my aunt Grace, she offered them pie. Sometimes what heals is as simple as a touch of the hand, a smile, or the expression of sympathy.

Relationships reintroduce people who have suffered to the community of love. If they have been dehumanized, caring can rehumanize them. Warmth and respect can rebuild a person who has been systematically humiliated and degraded by torturers. Many people have been pulled back from the precipice of despair by one person who let them know they mattered.

Linda Simon wrote of William James, one of our best psychologists, "He was a birthright member of the great society of encouragers." We can all be in that great society of encouragers.
We can ask people about their feelings and allow them to cry and rage. And we can be what Donald Meichenbaum called "purveyors of hope."

Love and hope are necessary to keep people's heads above water when they are in dire straits. A truly good listener manages to convey, "You have lost a lot, but you have not lost everything." In the end, healing relationships are about finding dignity adequate to the sorrow. I think of the three Iraqi men from the prison camp in Saudi Arabia. The most important thing for them was to find meaning in their experiences, to understand what happened to them in a way that allowed them to see themselves as men, worthy of respect.

All sorrows can be borne if they can be put into a story.

—I
SAK
D
INESEN

People survive because they partake of the alchemy of healing. They turn their pain into a deeper understanding of themselves and of what it means to be human. As Pico Iyer wrote, "The final destination of any journey is not after all the last item on the agenda but rather some understanding, however simple and provisional, of what one has seen."

To say that people can grow and learn from any experience is not to justify their experience or even to say that they couldn't have learned from an easier life, but it is to say that healthy people learn and grow from everything, even trauma.