My Education in Mental Health

One of the unique opportunities this year at my site is that the Kovler Center has hired two therapist intern. With their hiring comes about 10 orientation sessions to help them learn more about counseling torture victims. One of my supervisors asked Phil (the other Amate volunteer) and me to join. We have and have learned a lot! I am going to summarize a bit from my sessions.

1. Working with Interpreters

One of the difficulties about therapy in this line of work is significant language barriers. Any professional that works with clients opens up a dangerous possibility of misinterpretation. Lawyers talk through interpreters when building an immigration case; doctors talk through interpreters when attempting to diagnose (which makes tests such as Alzheimer's exams nearly impossible); therapists talk through interpreters to help clients suffering from Post-Traumatic Stress Disorder (PTSD).

When watching a movie on the asylum process, a big component of that movie was showing the danger of poor interpreters. Immigration cases hinge on details and a sloppy or an untrained interpreter can ruin an entire case.

Dates and details can be essential. For example (this story isn't really about interpreting exactly, but it will help paint a bigger picture), one woman from Eastern Europe immigrated to the United States and applied for asylum. She claimed she was persecuted because she was an Anglican. The Asylum Officer (AO) asked her who the head of the Anglican Church was. She responded Bishop George. The AO deferred her appeal for asylum to an immigration judge (essentially a "no" that gets appealed). The AO said in the video that any Anglican would know the Archbishop of Canterbury is the head of the Anglican Church. In fact, Bishop George was the head of the Anglican Church in Eastern Europe. She was delayed several years due to a misunderstanding.

Interpreting is extremely difficult because it's very subjective. When people ask for language skills, people with a basic proficiency will often claim fluency and volunteer to interpret. However, the amount of skill required by interpreting is way beyond mere proficiency. The subtleties of languages are immense and diagnosing PTSD relies on those nuances. (For example, a common question is whether the patient experiences feelings of nervousness. In French, a common translation of nervous is "nerveuse" when in reality "inquiet" would be more accurate. Nerveuse could best be translated as "highly strung" which is not what we understand nervousness to be. Nervousness is more correctly thought of as a discomfort instead of a severe anxiety. Sorry, long diatribe.) A professional in this line of work needs to be frank with interpreters and be aware. Obvious omissions or false interpretations should be confronted A lot is at stake.

2. Immigration Law

Depaul Law School invited us to attend an immigration class. If you bore easily, feel free to skip this section.

I forget whether I described this path earlier but a typical torture survivor flees his (or her, I'm going to just say his for ease) country illegally because the gov't would forbid them from leaving.

Typically, smuggling a human costs anywhere up to $10,000. Upon entering illegally, if they are detained but they present a "credible fear" of returning to home country the US will ask if they would like to seek asylum. They apply usually with a pro bono lawyer. The client needs to show an immigration judge that his life would be at risk by returning. When building a case, the lawyer needs an affidavit. If it becomes apparent to the lawyer that tortured occurred, the client will be referred to us.
The basic guide for a successful asylum case is ensuring that evidence of persecution or future persecution is presented and there is a cohesive story. To provide evidence of trauma, professionals collect physiological and/or medical forensic evidence. If the lawyer can show a "well-founded fear" of returning, the judge will grant the client asylum, and he will be on the path to citizenship.


3. Cross Cultural Boundaries

One of the difficulties with therapy is that it mimics interrogation. Picture the two scenarios, both involve the client facing an authoritative figure who asks probing questions. Therefore, it is essential that therapists let clients control the meeting. Where do you meet, sit, etc. Control needs to be in the clients hands.

4. Occupational Therapy

Surprisingly one of the best sessions was on occupational therapy. I had never heard of occupational therapy before, but I learned that it's about more than jobs. One of the hardest things for immigrants in general is returning to a sense of "normalcy." I shall say this story as an example.

In the early stages of the Kovler Center, the therapists encountered a large scale problem. Some Latino immigrants were unable to raise their kids effectively due to their trauma. They were so afraid of burdening their kids they kept their distance.

(As a side note, a really difficult aspect of immigration is kids learn languages much faster. As a result, it is common to see a role reversal in parenthood. Kids often are taking their parents to appointments and translating. It creates a very difficult dynamic because rather having the kids grow, they need to provide and essentially parent their parents. It's difficult to see).

So back to the Latino family: as a result of the parents coping with their own trauma, the children were falling into bad habits. There days were spent either in front of the TV or roaming the streets with unsavory characters. During therapy sessions, the parents confessed their anguish over the very likely possibility that their children would soon join gangs. The therapists turned to an occupational therapist.

After severe shifts such as immigration, torture (or even graduating from college for that matter) it requires observing oneself to establish how to spend one's time. To all my fellow grads, I think we could really learn a lot from an occupational therapist. So many of my weekends in college were spent clustering with friends, homework, or regular extracurricular activities. When you lose the regularity of school and band practices you lose your identity in a sense. Weekends here are occasionally aimlessly spent waiting for the week to start. Occupational therapists work to help clients realize their own power of situations. Children don't have to resort to TV just because they are no longer in their own country. The therapist worked with the children and helped them recreate their childhood in a new location. They began to play sports and celebrate festivals. By realizing that they can control their environment, the children could build their life back.

5. Psychological effects of torture

I will write on this subject tomorrow. There's a lot to it!