Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Book Forum: Trauma and Stress   |    
Broken Spirits: The Treatment of Traumatized Asylum Seekers, Refugees, and War and Torture Victims
Am J Psychiatry 2005;162:1768-1769. doi:10.1176/appi.ajp.162.9.1768
View Author and Article Information
Chevy Chase, Md.

Edited by John P. Wilson, Ph.D., and Boris Droždek, M.D., M.A. New York, Brunner-Routledge, 2004, 706 pp., $59.95.

text A A A

Wilson and Droždek have put together a superb collection of chapters by 44 contributors, nearly all of whom work outside the United States. We all need to become better informed about the tragic stories told in this book. Mental health professionals will benefit from this overview of effective treatment interventions that are specially adapted to victims of war, political oppression, and torture. We may sometimes turn a blind eye to these victims, partly because of our survivor guilt in relationship to fellow human beings who have suffered from unspeakable horrors. As van der Veer and van Waning recommend in their excellent chapter on "Creating a Safe Therapeutic Sanctuary," we instead need to have "a moral attitude…accompanied by a feeling of responsibility for the global community in which the conflicts occur from which refugees try to escape, and responsibility for the new community for the refugee" (p. 212).

A chapter by Volkan begins the book. With his typical clarity, he shares his deep understanding of the psychology of large groups that underlies both the suffering as well as the treatments described in the book. For example, he notes that many refugees get emotionally stuck by becoming "perennial mourners," who "behave as if lost objects have a future" in their lives (p. 10).

Silove then describes the clash between the burgeoning numbers of refugees worldwide and the erosion of governmental protections for asylum seekers, especially in the wake of Sept. 11, 2001. In previous decades, collective shame about the Holocaust spawned enlightened refugee policies throughout the world. Silove notes that a paradigmatic retreat in these attitudes occurred with the "refugee fatigue" toward Indochinese refugees in the 1970s. Successive waves of Vietnamese refugees went from receiving warm welcomes in countries such as the United States to spending long periods in refugee camps, which then became prison-like detention centers. During the past two decades, the number of refugees worldwide has tripled, further straining resources and goodwill. Tragically, "In the public mind, the war against terrorism has become confused with the challenge posed by asylum seekers, a blurring of issues seemingly fostered by political rhetoric" (p. 17).

Several other themes recur throughout the book. It is reassuring to see that all authors emphasize the initial and essential goal of establishing safety for survivors of trauma. Cultural variables receive the attention they deserve. Refugees experience cultural dislocation. So, as Aroche and Coello observe, "culture is both the cause of this pain as well as the pathway to recovery" (p. 55). All of the authors seem to be from Western countries, often treating clients who are fleeing non-Western countries. In the West, we tend to follow the maxim of de mortuis nihil nisi bonum, or Don’t speak ill of the dead. However, in some cultures, anger at those who have just died is permitted. One widow sarcastically asked her children to put four replicas of female genitalia in her late husband’s coffin, "so that he could enjoy adultery in afterlife as he sometimes did [while] alive" (p. 170).

Nonverbal expressive therapies have an important place in treating victims of trauma, since they are especially designed to engage with implicit consciousness and implicit memories. Art, music, and movement therapies have added advantages when therapist and patient do not share a common spoken language. Four chapters effectively describe clinical aspects of expressive treatment. We were disappointed that the authors did not link their treatments with relevant advances in the neuroscience of posttraumatic disorders.

Wilson and Dro%zdek deserve our deep thanks for putting this outstanding book together. Unfortunately, Wilson’s own chapters get entangled in overly intellectualized lists, diagrams, and theories. In addition, he sprinkles his chapters with quotations of some of his own most treacly past writing (e.g., "Weary souls displaced from their natural roots. Quietly desperate in a vacuum of loneliness. Their cries are silent. Existence in an abyss of pain and dark uncertainty" [p. 109]). The unadorned facts about these survivors are eloquent enough.

A recurrent theme is treaters’ and patients’ relationships with administrative and political policies that deeply affect refugees’ lives. Realistic anger and frustration with inhumane policies are widespread. A few authors acknowledge that "projecting guilt only on ‘the system’ can hamper seeking adequate active [solutions] to problems.…Rather than go through the work of mourning…they might prefer to attribute problems to their surroundings" (pp. 493–494). Such projection of all blame onto "the system" is surely a temptation for overwhelmed and vicariously traumatized treaters.

The book’s final two chapters address legal and political issues. This perspective is highly germane to the clinical issues with this patient population. Herlihy, Ferstman, and Turner highlight the labyrinthine complexities of legal systems that asylum seekers must navigate. Relevant international laws and treaties offer some protection for displaced persons, but draconian policies and unresponsive bureaucracies all too often interfere with effective and compassionate approaches to traumatized refugees. The book demonstrates that there is a clear need for further bridge-building work at the interface between clinicians and human rights advocates.

This book is an excellent compendium for clinicians in this field, and it helps point the way toward the further work necessary to fulfill our moral obligations to the victims of humanity’s darkest side.




CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 45.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 34.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 34.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 45.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 34.  >
Topic Collections
Psychiatric News