News Insight by Inge Missmahl*
BERLIN (IDN) - One dark night in Aleppo, Alima decided to flee. For months, she had been worrying about her two children being wounded, raped, or killed. This was not home anymore, there was only destruction around her, and she had to protect that space within herself, which was still alive and gave her meaning: to be a mother and enable a future for her children.
Alima saw no other option than leaving behind everything she had ever known to seek safety from the bombs and the violence around her – in another country where she was determined to build a new life.
Alima arrived in a new country, which was surprisingly different from the one she had imagined – from the color of the sky to the smell of food. Furthermore, she found herself suddenly living together with many other strangers, squeezed into a tight facility where opportunities for privacy were basically non-existing. This was especially unsettling for someone coming from a culture that strictly separates private and public life.
All of a sudden her determination and strength to provide her children a better future evaporated. She was confused, isolated, and all strength and bravery that had carried her to Germany was used up. She felt she could not get up again, could not care for her children, neither felt her children nor herself, and showed all signs of depression. She asked herself: “Who am I in this world, as a Syrian woman, a mother, a teacher, in a refugee camp in Berlin-Kreuzberg in bed No 189.”
Alima is not the only one asking herself this question.
As many as half of the refugees in Germany are suffering from psychological issues, according to a study released by Germany’s chamber of psychotherapists. Refugees arriving here are experiencing stress, depression, and consequences of traumatic experiences. Forty percent have already had suicidal thoughts or have even attempted to kill themselves. Only 4 percent of refugees in centres are currently receiving mental health support, so the study says.
After risking their lives to come here, many refugees in Germany and Europe share the same experience: a loss of identity, a loss of sense of purpose, and absolutely no emotional resources left to cope with their new lives. They become strangers to themselves.
We are facing a massive mental health crisis among refugees here in Europe, and it is a critical barrier to successfully welcoming and integrating them into our societies.
But treating refugees as mental health patients is not enough. If we want one million newly arrived people to become active members of our societies, we must empower them to become agents of their own integration.
I am a psychoanalyst from Germany. And I am here with a backpack full of insights and lessons learned from Afghanistan where over the past 12 years together with my team we have built an organization that created an alternative way of addressing mental health issues. We use a so-called psychosocial counselling approach and train Afghans to be counselors to help their fellow Afghans.
In Afghanistan, 66% of the patients coming to public health clinics showed symptoms of depression. I learned quickly, however, that people with mental health issues caused by social and political stress are not being helped if they are simply diagnosed as depressed. We had to understand the meaning of these symptoms.
The experiences of violence, loss of loved ones, land and house, loss of trust, and a high level of stress and insecurity in everyday life, the rapid change of a known world with clear rules and values into a modern world fueled by digital globalization. All that left people feeling powerless and victimized. And they could not even express what they felt; often they just felt ashamed.
We wanted to change that. So we developed a custom psychosocial counselling approach.
We wanted to empower people to help themselves, with the support of a psychosocial counsellor who was one of them. Afghans helping Afghans.
So, during the last 12 years with the help of Caritas international, the German Foreign Office, and the European Union, we trained 350 psychosocial counsellors in Afghanistan, each over the course of one year. We supported the public health system by placing the counsellors in health clinics all over the country in all 34 provinces. In the past 2 years alone, our counselors helped more than 110,000 people in individual talks.
We took the next step and launched an video-online counselling platform to provide access for all Afghans who need help. This was especially important for those who live far away or did not want to risk their anonymity – or even their lives – by going to a crowded health facility. And for those for whom an in-person appointment was too much of a social barrier. The online service helped break isolation and overcome shame and stigmatization.
So, to sum it up, here are the three things I learned from our work in Afghanistan:
- First, people who receive even just a basic one-year psychosocial training and who are motivated to work as counselor, can have a significant impact on improving the well-being of others.
- Second, it has proven to be very effective when counsellors share the same cultural background as the people they help.
- Third, we had developed a nimble, low-tech solution that can scale quickly. We have established some internet facilities and people have access through an App on their smartphone.
Can you see how this will work in Germany? Think of Alima.
What she needs now is quick, low-barrier access to care, to someone who can feel her and truly understands her, her culture and her values.
Our solution provides her with a qualified counsellor, who has gone through a training in which she or he learned to meet the other person with unconditional regard, authentic interest, a non-judgemental attitude, empathy, and clear analytical skills to examine the personal situation from all sides. Our counsellors are courageous and strong, they are supported through a group of trainers and supervisors.
Again and again we receive the same Feedback from people like Alima: "Because you have felt me I can feel myself again.“
This reconnection to oneself with the help of the counsellor is the first step to overcome this constant feeling of being powerless. Then, looking at one’s own situation and understanding this situation opens up the inner space to regain influence and have access to ones own resources.
Empathy and consciousness – it needs both.
And another person, a trained psychosocial counsellor.
And then imagine bringing this kind of care not only to Alima but to hundred thousands of refugees, who are struggling to cope. Imagine deliver it in-person and via our online platform.
I believe what we have established in Afghanistan can now work here.
Moreover, by training them as counsellors, we also create jobs for refugees. We are taking advantage of what economists might call an “excess capacity.” There are almost a million refugees in Germany. And they seek work that gives them a sense of belonging and makes them feel like a valued member of society.
In Afghanistan, we enabled Afghans to help fellow Afghans. In Germany, we’re going to enable refugees to help other refugees.
But don’t we all sometimes feel a loss of self and purpose in life, a loss of access to our emotional resources? At work, in our relationships, with our children. Our solution does not just help refugees – it can help all of us – to regain confidence and agency over our lives, to be in the driver’s seat again.
Our solution uses technology to utilize the most powerful resource we have: the human being. We are creating a safe space to foster intimate, human connections, and build empathy for all those who are strangers in a strange land. A new marketplace that connects those who care with those who seek care. An empathy engine at scale.
Sometimes you have to go far away to discover and feel something that is very close to your heart. I had to travel from Germany to Afghanistan to find out a very simple truth: big problems often have small solutions. Feeling the other – empathy combined with the desire and possibility to help – is at the heart of civilization. In a time where we are confronted with extremism and uncertainty, it is the smallest and for that very reason the most powerful unit of peace. [INPS – 22 March 2016]
*Note: This is a slightly abridged version of the TED Talk the writer gave on March 19, 2016.
Photo: Counsellors of the International Psychosocial Organisation (IPSO), a network of experts dedicated to developing and implementing psychosocial programs in various contexts. Credit: Inge Missmahl