6. Discussion papers. Discussion paper 1: Dominant psychological paradigms in refugee literature and. humanitarian interventions
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1 Discussion papers Discussion paper 1: Dominant psychological paradigms in refugee literature and humanitarian interventions THE AUTHOR Sister Maryanne Loughry currently holds the appointment of Pedro Arrupe Tutor at the Refugee Studies Centre (RSC), University of Oxford. She is a psychologist with research interests in the field of health psychology, child psychology, communication and development, particularly with reference to refugee work. In the late 1980s she was actively involved in the Philippines and Hong Kong, as a counsellor and trainer in the Vietnamese camps. From 1993 to 1995 she worked in Vietnam with a Scandinavian agency assisting the Vietnamese government to address the needs of the returnee population. In recent years she has trained refugee workers in South East Asia, Africa, Sri Lanka, and the Middle East. Maryanne is a member of the Academic Board of the Diploma in Community Mental Health for the Gaza Community Mental Health Programme and the Islamic University, Gaza, and a consultant to the Jesuit Refugee Service for staff development. Currently, she is researching the psychosocial adjustment of former child soldiers in Sierra Leone and northern Uganda. Maryanne is also researching the concerns of refugee children from a child focus.this project aims to develop an appropriate methodology for assessing children s concerns and worries in conflict settings. She has practised as a child psychologist in Australia and is currently an adjunct lecturer in the Faculty of Health Sciences and the Faculty of Education, Humanities, Law and Theology, Flinders University of South Australia. At the RSC Maryanne teaches about the psychosocial impact of the refugee experience. maryanne.loughry@qeh.ox.ax.uk ABSTRACT This paper analyses dominant psychological explanations of the experiences and behaviour of refugees and forced migrants. It introduces psychology as a relatively new discipline, and outlines the evolution of five paradigms that have been applied to refugee situations in the literature and in interventions.the paper critically assesses each paradigm, and traces their evolution as a response to the shortcomings of each one s predecessor. OBJECTIVES The objectives of this discussion paper are to: outline the evolution of dominant psychological paradigms that are found in refugee literature and humanitarian interventions elaborate on the basic tenets of psychodynamic, behavioural, cognitive, humanistic, and psychopathological approaches to explaining refugee behaviour and to discuss their psychotherapeutic manifestations, in light of the way they perceive refugee experiences and the usefulness of intervention make the reader aware of criticisms of each explanation, and how each approach seeks to remedy these faults. CONTENTS 1. Introduction 2. The psychodynamic explanation 2.1. Psychotherapeutic interventions with refugees 3. The behavioural explanation 4. The cognitive explanation 5. The humanistic explanation 6. The pychopathological explanation References
2 INTRODUCTION Psychology is the explanation of behaviour, and in recent times has been used to explain the behaviour of refugees and other forced migrants. Psychology s formal origins can only be traced to a century ago and the first psychologist Wilhelm Wundt, who developed the first laboratory to explore experimental psychology.while psychology is a reasonably young discipline, it is only very recently that psychology has been recognized as having a role to play in the examination of forced migration, the impact it plays on refugees lives, and how refugees can be assisted to manage the experience of forced migration. Below I will outline some of the dominant psychological paradigms that are found in refugee literature and humanitarian interventions. 2. THE PSYCHODYNAMIC One of the early founders of psychology was Sigmund Freud ( ). Freud has had a strong influence over modern-day psychology, although he has never been without detractors. He developed a theory of psychoanalysis that was developed primarily from his casework and his own self-analysis. Freud s psychodynamic approach has the following features: Behaviour is viewed as driven or motivated by powerful mental forces and conflicts within these forces. Humans are often unaware of these powerful mental forces as they are unconscious forces. Human actions stem from the basic biological drives of sex, hunger, and aggression.these drives are in turn modified by personal needs and society s demands to act appropriately. Human mechanisms for control are developed in early childhood and this is a critical period of development. Motivation is a key concept with deprivation, sexual arousal, conflict, and frustration determining behaviour. Humans only stop acting when needs are met and drives reduced. Each human is a product of heredity and early childhood experiences. A human s personality is the product of conflict between personal desires and social restrictions. The structure of the personality consists of: The id, the unconscious part of the personality that stores the basic drives The superego, which is the repository for the individual s and society s values and norms.the superego closely resembles the conscience The ego, which is the individual s view of reality. Conflict between the id and the superego is often dealt with by defence mechanisms that push desires out of conscious awareness into the unconscious. Major defence mechanisms include: denial, displacement, projection, reaction formation, and repression.these mechanisms are mental strategies that reduce conflict and anxiety in individuals Psychotherapeutic interventions with refugees According to the psychodynamic approach, a person s reaction to traumatic experiences depends on the quality of the person s personality structure. Remembering that the foundations of this structure were laid down in early childhood, it is necessary to assist the person to return to early points of conflict in order that they might now be able to address the recent trauma effectively.the psychodynamic approach is characterized by psychotherapy, an indepth form of therapy characterized by intense exploration of the person s unconscious motivations and conflicts. Psychotherapy can take the form of one-to-one therapy, group therapy, psychodrama, and art therapy. All of these are therapeutic modes for tapping into the unconscious. Although it is subject to great criticism for its lack of scientific evidence, the psychodynamic approach is still a dominant influence in psychology, and as such has influenced the therapeutic interventions used to assist victims of trauma and torture.the use of psychotherapy is very strong in certain geographical regions such as Latin America, Europe, Israel, and Gaza.
3 THE BEHAVIOURAL The behavioural approach can almost be perceived as an extreme response to the psychodynamic approach. Unlike the work of Freud, behaviourism has no concern for the matters of the mind. It is a more mechanistic view of humans as individuals reacting to events in the environment.there is no concern for the individual s thoughts or feelings, but rather the scientific study of the overt and measurable behaviours of that individual.watson first developed behaviourism in the 1920s. The behaviourists explain all human behaviour using an ABC formula: A= the antecedent or triggering event that elicits behaviour. B= the measurable changes in behaviour and C= the consequences that the behaviour has on the environment. Behaviourism looks at causes of behaviour outside the person, in the environment, and the stimuli that led to the behavioural responses. Learning is explained by the concepts of classical and operant conditioning. In behaviourism, a person s problem behaviour is treated according to assumptions made about its origins. If the problem behaviour is thought to be classically conditioned, the association of a new stimulus to a familiar stimulus resulting in an attachment of the same response to both, then classical conditioning techniques are used to modify the behaviour. If the human response is thought to be operantly conditioned, then changes in its consequences, reinforcement, or punishment are applied to bring about the desired effect. The conditioning process can explain responses to trauma.the same principles are also used to explain passivity and attitudes of helplessness. Of particular interest in refugee literature is the Seligman (1975) explanation of learned helplessness. Seligman found that if you expose animals to uncontrolled electric shocks they eventually acquire characteristics that resemble human depression, even to the point of not taking the opportunity to escape the shocks when it is possible to do so.the principles of conditioning can explain this.the animal s initial avoidance behaviour was not followed by either positive or negative reinforcement; as a result it was extinguished and the animals came to exhibit no avoidance whatsoever. Consequently they displayed reduced motivation and apathy.victims of torture and trauma can often display the same characteristics. Behaviour modification is used in many settings including educational institutions, parent training programmes, penal institutions, and market management programmes. In refugee settings interventions such as food distribution are often conducted using the principles of behavioural modification. 4. THE COGNITIVE The behavioural explanation of human behaviour and its disregard of mental processes have been seen as limited.the cognitive explanation of human behaviour concentrates on how humans perceive, interpret, think, and remember. In refugee literature the cognitive explanation is used to help us understand stress and coping, and the different coping styles of humans. As illustrated in Figure 1, different people have different reactions to traumatic events because of a combination of reasons including: perceptions or appraisal of events/stressors sense of social support and resources coping styles previous experience. More commonly, the cognitive explanation is combined with the behavioural explanation to give a cognitive behavioural explanation. Looking again at the diagram, the person s previous experience with stressors can also be explained by what behaviour has been positively or negatively reinforced in the past in response to stressors. In situations of trauma, principles of conditioning can explain behaviour. Unconditioned stimuli are usually paired with unconditioned responses.that is, a stimulus does not elicit any particular behaviour. However, if such a stimulus (e.g. a white coat) becomes paired with a traumatic event (e.g. torture), then it can become a conditioned stimulus and this
4 143 Figure 1: Mediating and moderating processes in psychosocial stress (Taylor & Aspinwall, 1996) can in turn elicit a conditioned response (e.g. fear). Interventions with victims of torture can focus on an undoing of these links. People are taught relaxation therapy in the presence of the conditioned stimuli so that they can avert the response that they have come to elicit.with time the victim of torture can be counter-conditioned. Many humanitarian workers are given advice on stress management that is derived from a cognitive behavioural perspective. Advice is given on stress reduction techniques such as relaxation therapy and rational emotive therapy.these interventions rely on the workers reappraising their thoughts of the situations that they are in and how they can best manage them. 5. THE HUMANISTIC Just as behaviourism evolved partially as a reaction to the lack of measurable evidence of Freud s theory, the humanistic approach developed in response to both the limited concept of humans in behaviourism and the pessimism of the psychodynamic perspective of humans.the humanistic approach emphasizes the uniqueness of humans and their perceptions of the world. It concentrates on the present and the future, and conceptualizes humans as striving to realize themselves once their basic needs have been met. Central to humanistic psychology is the belief that all humans are striving to reach their full potential. The individual is self-directing, and within a healthy environment individuals determine their own behaviour. Abraham Maslow (1943) was a significant humanistic psychologist who analysed the needs of human beings. He argued that higher level needs only emerge when basic needs are met. He described human beings as having a hierarchy of needs (see p. 144). Within humanitarian interventions it is possible to see how this explanation has played a role in determining what are the basic needs of individuals. Often in emergency settings strong emphasis is placed on food, shelter, and water as well as the security of the refugees. Many times the interventions stop here, in the belief that once the basic needs have been met the refugees can get on with determining their own lives. 6. THE PSYCHOPATHOLOGICAL This approach focuses on what human behaviours constitute psychological disorders, and is concerned
5 144 Figure 2: Maslow s hierarchy of needs with behaviours that go outside of the range of normal human behaviours. In most instances an expert evaluates a person s functioning to identify if they are exhibiting out of the normal or abnormal behaviour, based on an agreed understanding of what is normal. In many instances the abnormal behaviour is observed and in turn analysed. Should the behaviour match a series of preconceived descriptors, a diagnosis of a psychological disorder is made.two classification systems are commonly used to determine the correct diagnosis: the Diagnosis and Statistics Manual (DSM) which is in its fourth edition, DSM-IV and the International Classification of Diseases (ICD).This classification is in its tenth version, ICD-10. In diagnosing abnormality it is difficult to determine precisely when behaviour changes from normal to abnormal. One way around this is to think of behaviour as being on a continuum of normal to abnormal. Early research on refugees focused on the differences between refugees and immigrants, and the population they had moved to. Data was gathered on such measures as admission rates to psychiatric hospitals. In countries of resettlement, refugees would be assessed for measures of anxiety and depression as well as major psychiatric disorders. Checklists were developed to measure symptoms, and cut-off scores were used to indicate possible clinical cases. In recent times post-traumatic stress disorders (PTSDs) have been used to explain refugee behaviour.the refugee flight is conceptualized as a traumatic experience and the behaviour of refugees once in camps, countries of resettlement, or postconflict is assessed for signs of extreme stress.the use of such a diagnosis has helped us to understand the nature of the problems experienced by refugees, and provides a means by which this understanding can be quantified in research and need assessment. A major critique of the use of this disorder is that it pathologizes the suffering of refugees and limits assistance to refugees of professional mental health workers. A further concern is the relevance of such a diagnosis in the non-western settings where the majority of refugees are found. REFERENCES Maslow, A (1943). A theory of human motivation. Psychological Review, 50, Seligman, M. E. P. (1975). Helplessness: On depression, development, and death. San Francisco: Freeman. Taylor, S. E.. & Aspinwall, L. G. (1996). Mediating and moderating processes in psychosocial stress. In H.B. Kaplan (Ed.), Psychosocial Stress (pp ). San Diego: California.
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