ASPECT ONE – THE STATES OF BEING

At some time in life, most anyone goes through the feelings, thoughts and experiences that can lead to a radically changed state of being. For example, almost everyone – at one time or another – has experienced the feeling of the stranger or the outsider (Josephson and Josephson, 1962). We have all had feelings of loneliness, of missing a loved one or a place. We may have had feelings of inferiority, or not had the words to express something we want to say or feel or believe, and felt stupid and inferior, humiliated or degraded. We may have felt at times suspicious or prejudiced, even against our will, or felt that someone has been discriminating or is prejudiced against us. Perhaps we may have, at one time or another felt that we were a scapegoat for another person, in a group or institution or out in society.

However, when someone’s existence becomes dominated by one or several of these states on a conscious and/or unconscious level – to an extent that it dominates his/her inner and outer world – the person is in a state of being. The individual experiences life as controlled by the state of being. For example, the feeling of being a stranger grows – finally to form the state of being, the stranger (Wilson, 1956). Such states of being are experienced regardless of homeland, age, sex, culture, religion, color, racial or ethnic origin; language or socioeconomic, educational, vocational or political background; or for whatever reason or however long ago the individual came to the country.

Each state of being may:

· be conscious or unconscious;

· be based on reality, or the exaggerated experience of reality or fantasy;

· cause, influence or complicate current symptoms or inner and outer difficulties;

· be more apparent during emotional and/or existential questioning, conflicts or a life crisis or life change;

· affect current symptoms and difficulties and how these are endured, depending on the refugee/immigrant situation, and also other aspects in the framework;

· be experienced at the same time as other state(s) of being;

· cause different degrees of suffering – from confusion and inner and outer conflicts, through neurotic and psychotic feelings, to neurosis and psychosis;

· represent a fusion between current symptoms and difficulties, the state(s) of being and aspects of the framework making these difficult to differentiate and diagnose and treat;

· be caused and further complicated by other factors, such as – in the refugee:

· past home experiences of oppression, war and its atrocities, torture, natural and man-made catastrophes;

· traumatic experiences in relation to the above;

· inability to visit or return to live in the homeland;

in the immigrant:

· past homeland experiences – personal, socioeconomic, or due to natural and man-made catastrophes;

· traumatic experiences in relation to the above;

· ability to return at any time to the homeland;

in the child:

· identification with the state(s) of being of parents and siblings, and going-through these in similar ways.

Each state of being is explained separately, and depicted by three cases selected from the total refugee/immigrant population so as best to illustrate the particular state of being.

STATE OF BEING: THE STRANGER

The refugee and the immigrant and their children are “strangers”

when they arrive in the new country. At first, based on reality, almost everything and everyone is unknown and different. Often the individual/family must learn anew much of what was taken for granted in the homeland, from the simple to the complicated: basic tasks, habits, the language, the physical environment – the outer conditions of the new country. It can be even more difficult to learn the inner characteristics of the new country, such as psychological and sociocultural attitudes, rights and wrongs, the way of life. The refugee and immigrant is, in reality, a stranger or outsider. Everyday, he/she is reminded of it – from small unimportant happenings to larger events that affect his/her future in the new country.

Feeling like a stranger was reported to come on either suddenly or gradually, and last a few seconds, minutes or longer periods of time –

depending on what the refugee or immigrant is going through in his/her present life. Its onset has widely varying outer reasons – from the seemingly banal to the serious – such as a switchboard operator who may not understand his/her accent, or not getting a job he/she is qualified for.

These are reminders that may be constant over the first months and years, or at certain specific times in life, or for the rest of life – according to how the person has adapted to the new country. Whether he/she remains a stranger and these feelings become the state of being does not appear to be based on how long the person is in the new country, but on how he/she encounters (and is encountered by) the new country. Is the person isolated? Does he/she have contact with the inhabitants of the new country? Has he/she learned the language, the customs, the life style of the new country? Many refugees and immigrants spend years in the new country, and still have only stereotyped ideas about the majority population. This may lead to remaining the stranger. The outward situation is reflected inwardly; he/she feels like a stranger and becomes encompassed by it. It becomes part of the individual and a permanent state of being. He/she is the stranger, the outsider.

Past experiences, such as war and its atrocities, torture and oppression, seem to cause severe feelings of alienation and suspicion toward people and, at times, life itself (Fanon, 1967; Miserez, 1987). Due to experiences in the homeland, the traumatized and/or tortured refugee seems to suffer more deeply because of the feeling of, or the state of being, the stranger.

Cases – state of being: the stranger

This first case exemplifies the state of being: the stranger when it is triggered off by a concrete or real happening or event.

Case 5.1

A female refugee, age 50, 20 years in Sweden, a saleswoman (an accountant in her native country), divorced; she has 2 children, 15 and 18 years old. Reason for treatment: severe depression. Form of treatment: psychotherapy, once a week. Duration: 1 year.

Case excerpt (from session 3, after 3 weeks of treatment):

She describes herself as feeling like a stranger in society. She has had this feeling for many years, she explained, but it was revived by a form she received in the mail which she could not understand. It was written in difficult, bureaucratic Swedish. She had to ask her teenage daughter, born in Sweden, to help her decipher it, which she did willingly. Shortly afterwards, she went into a severe depression. She could not work or take

care of her children, and found life without meaning. She then started psychotherapy.

By eventually becoming aware of her feelings of being the stranger and how they started, but realizing that she did in fact belong to society, with her family and friends, the depression began to lift. The actual inner difficulty was then revealed, a life crisis (menopause). She could look at, gain insight into and understand her feelings of being the stranger in Swedish society, along with her ambivalent feelings towards her “more Swedish than homeland” teenager (as she expressed it). Finally, she could come to terms with the temporary dependency on her daughter she had shown (even though this, she felt, was against both the cultural attitudes of her homeland and Sweden) and free herself from her feelings of guilt and envy towards her daughter. Her depression lifted when she could distinguish the state of being: the stranger, from the current psychological difficulties she was going through plus the life crisis, for which we could then continue psychotherapy.

The following case describes the state of being: the stranger when it is based on an exaggeration of reality of the person’s life in the new country.

Case 5.2

Amale immigrant, age 25, 6 years in Sweden, he came to the country to find work; currently unemployed. Reason for treatment: hashish abuse.

Form of treatment: motivation support work with a social worker, twice monthly. Duration: 2 months.

Case summary (after termination):

He was 19 when he came to Stockholm, from a poor rural background.

He worked at odd jobs for a while, but is now unemployed and lives in a rented room. He has a poor knowledge of the Swedish language. He started smoking hashish with some acquaintances from his own country when he first came. He continued to do so alone “to forget the loneliness”. He now sits in his room smoking hashish all day. He has lived outside the new society since he came. He describes himself as “strange” and “alien” to everything and everyone in Sweden. He hates the people and the way of life, but now that he is on hashish, he can’t go home, he says. He won’t talk about his situation and refuses help for treatment of his abuse.

Feelings of alienation may not always be based on concrete reality, and can be painful and difficult for the person and others to comprehend.

These feelings may be the result of something repressed in the past.

Case 5.3 provides an example of the state of being: the stranger when not based on reality.

Case 5.3

A tortured refugee, age 36, 13 years in Sweden, a social worker, married; he has 2 children, 8 and 12 years old. Homeland trauma: at 20 years of age he was imprisoned and tortured for 6 months. Reason for

treatment: severe feelings of alienation. Form of treatment: supportive psychological conversations, once a week. Duration: 6 months.

Case summary:

A university student when he came to Sweden, now a social worker working with teenagers from his homeland who have serious asocial behaviors. He seeks professional help for feelings of alienation, for feeling like an outsider. He doesn’t want to tell his friends or family, as they would worry. He has no real reason to feel this way, he explains. He has a family he loves and work he is satisfied with. The feelings of alienation have been with him several months. He cannot sleep and has nightmares when he does. He is intellectual and astute with words, but after a few sessions, it is evident that he has very few words for his feelings, nor does he take his feelings seriously. The psychologist tries to cut through the barrier of intellectuality. He is provoked and refuses to come to 2 sessions.

Case excerpt (from session 5, after 5 weeks of treatment):

He comes into the office with a threatening and aggressive attitude.

P: “I’m reminded of prison.” T: “Prison? You’ve been in prison?”

P: “Six months of hard mental and physical torture. I was 20 years old.”

He went back to that period describing the inhuman conditions he was faced with and the mental and physical torture he endured. We worked through this verbally in session after session. Finally, tears and gut feelings came out, as if they would never stop. Then, one day he came in and said that “they” didn’t understand.

T: “Who?” P: “My own children, and the kids I work with. They don’t know why they are in Sweden. Why their parents are forced to live in exile.

I wasn’t much older than the kids I work with when I was tortured. I was about 12 years old, my son’s age, when I started working politically. All my son does is listen to his stereo.” T: “Do they know that you have been imprisoned and tortured for your political views?” P: “No!” T: “Why not?”

P: “I wanted to forget.” T: “But you couldn’t…And now you are here…”

P: “You mean I should tell them about it?” T: “It is an important part of who you are. Why do you have to deny it? Why do you have to hide it?”

A few sessions later, he didn’t need my help any longer, he said. He slept now, without nightmares and he didn’t feel alienated.

P: “I told it all to the kids I work with. One of them said I knew. You are so tough on yourself and on us, he said. Then I told my own children.

My 8 year old daughter said, ‘Daddy, I can kiss the pain away’. My son wanted me to help him to read my books in our language on the political history of our country.”

STATE OF BEING: LONELINESS

The refugee and the immigrant may feel a sense of great loneliness during different periods of life in the new country, based on all that is not there (Deutsch and Won, 1956). Such feelings can overwhelm the individual,

and finally lead to the state of being: loneliness. Loneliness may be based on the concrete reality of life in the new country (Feldstein and Costello, 1974; Malzberg and Lee, 1956). The refugee or immigrant lives in the isolated world of the family, if they have one, or alone. This can become more serious as time passes. He/she may become even more isolated to avoid being reminded of the loneliness.

With the traumatized and/or tortured refugee, the feelings and the state of being can be caused or further deepened by trauma. He/she may have been forced to flee the homeland suddenly or under difficult circumstances. He/she has usually had past homeland experiences of sudden and violent separation and loss of close relationships. The state of being seems to be more severe when the person experiences it combined with the trauma, as described below in Case 5.4.

Cases – state of being: loneliness

The following case illustrates the state of being: loneliness based on the reality of the individual’s life situation.

Case 5.4

A traumatized female refugee, age 59, 39 years in Sweden, a librarian, unmarried. Homeland trauma: World War II concentration camp survivor. She came to Sweden alone when she was 20 years old. Her family had perished in German concentration camps. Reason for treatment: severe depression. Form of treatment: medication; support work, once a week. Duration: 7 weeks.

Case summary:

The woman had worked at the same library for l5 years. She spoke with a heavy accent. She was polite and worked well, but kept to herself and bothered no one. Only one person there had asked why she had come to Sweden. She lived in a one-room apartment in an old area of a large city. She had no friends or social life. While in treatment, she committed suicide by hanging herself. She had been dead for 3 days when she was found. Someone she worked with wondered why she had not come to the office or called. It was so unlike her, she said.

Even if there is a network of family and friends, the refugee/immigrant can sometimes feel a sense of great loneliness. Such loneliness can be a consequence of the refugee/immigrant situation – all that is not, or does not seem to be there. Case 5.5 illustrates the state of being: loneliness based on exaggerated feelings of reality.

Case 5.5

A male refugee, age 57, 37 years in Sweden, a businessman, married with 3 adult children, 1 son and 2 daughters, 27, 25 and 22 years old.

Reason for treatment: severe depression, unable to work for over 2 months. Form of treatment: psychotherapy, once a week. Duration: 8 months.

Case excerpt (from session 1):

He described the depression as a “feeling of loneliness that came over him”. He felt he could not cope with life any longer. He did not want to go out of his house, and felt indifferent to everything and everyone around him. His son had just christened his infant child and named him after his father according to the tradition of his country. It was an occasion of great joy for him and his family. There had been lots of celebrations, and a brother whom he had not seen for many years traveled from another country for the christening. It was soon after his brother’s departure that he became depressed, he explained. He had gone into a process of remembering, longing and feeling lonely. Remembering his dead parents and brothers, sisters and relatives, now scattered all over the world, and the war and poverty that had separated them. He was unconsciously longing for his family and his country, and therefore feeling lonely.

During this time of great joy for him, and on reunion with his brother, he went into an unconscious mourning process, which he had not been through in the past – being a busy and successful businessman. He had everything now, which produced more unconscious guilt and self-anger and finally led to a depression, even more difficult because he felt he had no right to be sad and depressed.

Case summary:

After several psychotherapy sessions he became aware of his longings and feelings of loneliness. He could finally accept without guilt that he could feel longing, feel lonely and depressed, things he had never allowed himself to do – and that these feelings could even be experienced in moments of joy. When he could accept that he could still, after 35 years in Sweden, long for his family and his country and feel pain because of being forced to separate from his relatives and country, his loneliness disappeared.

Feelings of loneliness and the state of being in the refugee and the immigrant can be complicated by commonly occurring feelings of existential loneliness – in part due to the inner and outer reality of the refugee/immigrant situation. Case 5.6 offers an illustration of the state of being: loneliness founded on feelings of existential loneliness.

Case 5.6

A female immigrant, age 24, 17 years in Sweden, a medical student;

her father, age 54, is a businessman; her mother, age 52, is a nurse; her brother, age 21, is a university student. She is engaged to a fellow medical student, age 25. Reason for treatment: She had been unhappy for several weeks, and has now stopped attending the last term of university leading up to taking her medical degree; she complains of constant feelings of

loneliness. Form of treatment: crisis therapy, twice weekly, followed by long-term psychotherapy, once a week. Duration: 2 years.

Case summary:

She is fluent in Swedish and her native language. She had a good family situation as a child with warm, loving, hard-working parents and a younger brother with all of whom she has good relationships. She has friends, is well liked, and active. There seemed to be nothing in her external situation to cause the unhappiness.

Case excerpts (from sessions 1 and 9):

Session 1:

She complains of feelings of loneliness. She cries often, she explains. She feels as if life has no meaning. We die anyway. We die alone. She came to Sweden when she was 7 years old, she explained. She started school without knowledge of the Swedish language, but learned it quickly and was a good student. She had not been bullied, but recalled those first months at school when she couldn’t communicate, having no Swedish and the loneliness she felt during that period of time. Had the approaching end of her school years and the start of her working life become a reminder of the beginning of her new life in Sweden, as a 7 year old, and the loneliness she felt then, combined with the existential loneliness many people can go through facing a life change? I asked myself, after our first meeting. The young woman started crisis psychotherapy, afraid that she would not finish her medical degree.

Session 9:

When she could remember her feelings of loneliness as a child and understand that they were the feelings of a lonely 7 year old immigrant child without language, and that those feelings were still a part of her – could acknowledge them, accept them, feel them, but see that her present reality was very different – the feelings of a child’s loneliness disappeared. The existential loneliness caused by the life change could then be worked through. She returned to her studies and decided to continue in long-term psychotherapy.

STATE OF BEING: MISSING

The refugee/immigrant, throughout his/her life, may miss – to different degrees – something, someone or some place from the homeland.

Feelings of missing are reported to be experienced to a lesser or greater extent during different periods of life in the new country. The immigrant may go back to visit or return to the homeland. The refugee cannot. Life in exile may be more difficult and complicated for the refugee who does not have the choice to visit, or finally return to the homeland. The traumas that he/she may have experienced also may influence feelings of missing.