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Using cultural-historical activity theory to explore trauma among refugee populations in Europe
Europe is living through a refugee crisis of historic proportions which has now become one of the continent’s defining challenges of the early 21st century. Not least among the difficulties are the public health challenges of the multiple traumas faced by this population which constitute severe threats to human, social, cultural, and community development. The psychological impact of atrocities endured by refugees and asylum seekers populations is clear, with the literature reporting significantly high prevalence rates of post-traumatic stress disorder (PTSD) among this population (Lambert & Alhassoon, 2015). However, there have been significant concerns raised in the literature over the relevance and cross-cultural validity of PTSD as a diagnostic construct, which highlight the need for a more nuanced, contextualized and ‘decolonized’ understanding of trauma as being significantly determined by larger cultural systems and historic contexts (Daiute & Lucić, 2010; Wilson, Wilson, & Drozdek, 2004)
As noted by Roth and Lee (Roth & Lee, 2007), the analytic challenges raised by Vygotsky regarding the “atomistic and functional modes of analysis … [that] treated psychic processes in isolation” (p.1, as cited by Roth and Lee, 2007) remain unresolved. Indeed, one of the principal contributions of the Vygotsky-Luria project is the establishment of a “new psychology” – a ‘decolonized’ way of understanding human thought and activity which takes into consideration the inseparable unity of mind, brain and culture in concrete socio-historical settings (Toomela, 2014). Therefore, consistent with major Vygotskian principles of interactive individual–societal development via the creation of meaning in everyday activities (Daiute & Lucić, 2010), this thesis explores the results of a qualitative investigation into experiences of trauma among refugees and asylum seekers. The study incorporates various units of analyses including historicity and context as well as social and material environments in an attempt to go beyond an ‘atomistic’ or individualized framing of psychological difficulties – a particularly relevant consideration for understanding trauma among refugees and asylum seekers in light of the multiple and arguably ongoing environmental stressors with which they are faced as they negotiate material ecologies which both enable and constrain their human activity. It thus offers a subjective analysis of trauma among migrants which takes into account historicity, context, and various levels of analytic scale from within a socio-cultural and historical perspective.
In the summer school, I would like to explore the results of the first two phases of this research project which consisted of a 2 month intervention in July-August 2016 and a 2 week follow-up in January 2017 with NGOs addressing the refugee crisis in Athens, Greece. This intervention included both participant observation and qualitative, in-depth interviews among staff and beneficiaries. Based on principles of ‘action research’ (Reason & Torbert, 2001), the methodology was designed both with regards to the collection of data for research as well as for its potential for transformative action for participants. As such, the design allowed for collaboration with team members of the involved NGOs, local refugee communities and individual beneficiaries, including those diagnosed with PTSD, in order to forge a more direct link between intellectual knowledge and moment-to-moment personal and social action as well as for an analysis of institutional frameworks.
30 health professionals working in the humanitarian sector were interviewed concerning their experiences and understanding of trauma among the refugee population. 10 individual participants were interviewed multiple times during the course of the intervention – they are all victims of torture in their respective countries of origin who subsequently sought psychological and medical attention from NGO clinics in Athens, Greece. 20 refugee community leaders were interviewed in order to broaden our exploration into the multiple traumas to which refugee communities are exposed, and some subjective understandings of ‘PTSD’ as a diagnosis among this population (Schick et al., 2016). Interviewing health professionals, individuals as well as community leaders represents an attempt to gain a deeper understanding of life trajectories, dynamic processes, interactions and the continual development and change in psychological symptoms; an exploration which equally incorporates a focus on the ever-changing cultural and social systems which determine the various forms of individual subjective experience of psychological difficulties (Ratcliff & Rossi, 2015)
The results of these interviews will be analysed through the lens of activity theory, recently defined by O’Connor as ‘a family of approaches to understanding human mental functioning and action that focuses on how culture, history and social interactions shape individual consciousness’ (p. 1), with a focus on the various levels in which to make sense of human mental functioning: phylogeny (the history of the species), the cultural history of the social group, ontogenesis (the personal history of the individual), and micro-genesis (a microhistory of specific events in the life of the individual, including traumatic events). Therefore, in examining trauma among refugees, the focus is on ever-changing cultural and social systems which are in continual interaction with the various forms of an individual subjective experience of mental illness. Furthermore, the individuals interviewed are seen as being deeply embedded in complex and dynamic activity systems in which resources are exchanged - wherein they are both capable of negotiating and influencing this system as well as being influenced themselves by the system. I also explore the dynamics of multiple tensions and internal conflicts faced by these individuals in this particular developmental phase of their life trajectories.
As such, this research project aims to draw on a socio-cultural framework which focuses on the intersubjective, mediational space between the individual and culture-society-interaction (O’Connor, 2015); going beyond reductionist labels such as ‘refugee’ or ‘PTSD’ in order to try account for the experience of humans in time and in particular social and cultural environments (Zittoun, 2012). The results aim to highlight the heterogeneous, fluid and dynamic nature of individual subjectivities and the multitude of socio-culturally determined discourses which may be drawn upon to make sense of life experiences bringing ‘profoundly into question not only the universality of knowledge from one domain to another, but the universal translatability of knowledge from one culture to another (Bruner, 1991) (p. 2).
In engaging in such an exploration, I aim to learn from practices and research traditions of ISCAR to enrich an understandings of ‘historical trauma’ (Gone, 2013) or collective, cultural, and identity-related trauma among refugee and asylum seeking populations, with an emphasis on the social location of human subjects and a recognition that trauma responses may carry a sense of group burden and collective suffering beyond symptomatic individuals. Learning about the impact of dislocation, trauma and loss, of political persecution and human malevolence, and social systems involving abuse, neglect, and ethnic and cultural rejection is crucial to understanding the social and historical perspectives of trauma (Wilson et al., 2004).