Middle of Everywhere - Mary Bray Pipher [118]
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 People who suffer terrible things have a time when they are sadder, angrier, more agitated, more withdrawn, and more passive.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