By Amy Harris

Every human being is unique, and what one person experiences as traumatic is not necessarily traumatic for another. In English, we use “trauma” to describe an actual terrifying or life-threatening event or series of events, as well as its resulting devastating emotional and psychological aftermath. The American Psychological Association defines trauma as “an emotional response to a terrible event like an accident, rape or natural disaster.”

“Finding freedom is only the first part. Living free is a whole other.”

Ta-Nehisi Coates, The Water Dancer

Most New Mainers did not choose to leave their home country or family, and carry trauma with them as survivors of political or religious oppression, war, migration, and/or the resettlement process. An essential part of their resettlement and acculturation process is healing from traumatic experiences. So by better understanding human responses to trauma, we can all create a more welcoming, safe, and nurturing home in which healing is possible. Amjambo Africa spoke with several New Mainers to learn about supporting our newest community members.

The types of trauma New Mainers bring with them
Before fleeing home, immigrants may experience imprisonment, property loss, loss of job and career, hunger, physical assault, terror, rape, or torture. The flight itself can take days, months, or years. During flight, migrants may experience further trauma, such as separation from family members and friends, and assaults on themselves or others. Many who flee have to live for years in extremely harsh conditions in refugee resettlement camps before being officially approved for resettlement in a new home, such as in the United States.
Sexual violence is traumatic, and is used as a weapon of war in many parts of the world. Rape, gang rape, violent forced impregnation or sterilization, psychological terror, humiliation, or bodily mutilation are all examples of endemic weapons in conflict zones. And sexual violence affects the immediate victim, but also their whole family and community, with everyone traumatized by their inability to offer protection, and by witnessing sexual violence against community members.

Unfortunately, the stigma and shame surrounding sexual violence make it nearly impossible for many victims to disclose their history of abuse to others or receive treatment. This is true both at the time of the assault and even many years later, in a different country. Alice from Burundi and Ridelphine from the Democratic Republic of Congo (DR Congo) described the “internal cultural silencing” that many women experience. “Culture and environment are big things. They have the power to keep those kinds of things quiet. They say, ‘Yeah, you will be fine. Just keep quiet. Yeah, just keep quiet,’ ” Alice told Dr. Anne Hallward during a 2015 interview for Safe Space Radio.

“Culturally, you cannot talk about, you know, anything related to sex. You can’t talk freely. It’s just hard given the culture,” said Ridelphine. “And so we didn’t hear the word. We didn’t know the word. We needed to figure out – how are we going to go about this, talking about, you know, women being raped – in local languages, in the media.” A human rights activist, Ridelphine worked in the DR Congo in 2010, in what the United Nations has called the “rape capital of the world,” and ultimately fled the country for her safety. But before her flight, she worked with a group of women’s organizations to formalize an official word in Swahili for rape – ubakaji. Rape was so stigmatized and taboo that Swahili did not even have a word for it. As Hallward noted, preventing sexual violence, or healing from it, is very difficult work if you don’t even have a way to name it.

Trauma is hazardous to your mental health
After experiencing trauma, it is normal for the human mind to shift to a constant state of fear and anxiety, often called the “fight or flight” or “survivor” mode. Living in this chronic state of fear can bring depression, anxiety, anger, confusion, or lack of focus. Physically, survivors may feel a racing heartbeat, muscle aches and tension, exhaustion, have difficulty sleeping, or experience fainting spells.These are common reactions in trauma survivors. They vary from person to person, and can come and go. Sometimes, years may pass after the initial, triggering event before a person feels these reactions.

Post-traumatic Stress Disorder
Not everyone who experiences trauma will develop post-traumatic stress disorder (PTSD), but many will. When you have PTSD, you may have nightmares, flashbacks, and recurrent memories of the traumatic event; try to avoid reminders of the event, or associated emotions; feel constantly on edge, nervous, or anxious (called hypervigilance), or have difficulty sleeping; or suffer from distressing thoughts, or have overwhelming emotional reactions.

According to the Refugee Health Technical Assistance Center (RHTAC), the percentage of refugees who experience PTSD after trauma are estimated at 10-40%. One out of every four survivors of torture develops PTSD; the younger someone is when they experience trauma, the more likely to develop PTSD; 50-90% of adolescent survivors of trauma are diagnosed with PTSD. When someone has PTSD, tolerating stressful or difficult situations is hard. They can be emotionally triggered by anything that resembles the original trauma, such as a loud noise or seeing somebody who looks like their assailant.

Frequently, trauma survivors develop depression in response to their emotional distress – PTSD and depression are closely linked. According to RHTAC, rates of clinical depression reported in refugee populations range from 5% to 15%. However, ongoing stigma in relation to mental health problems means that many suffer in silence, so the actual number may be much higher.

Social isolation and relationship difficulties
When refugees flee, they leave entire support systems of friends, family, tribes, and communities behind in their home countries. Living in the individualistic American culture after the collective, group-focused African culture can be a significant shock. Many immigrants experience overwhelming loneliness. Building new interpersonal relationships is challenging for survivors of trauma, who are more likely to isolate themselves as a form of self-protection. Yet close social connections are a critical ingredient of healing after trauma. Unfortunately, the isolation caused by PTSD may increase their risk for depression. Rising stress, anger, and problems with communication can lead to higher rates of interpersonal violence. People with PTSD are more likely to engage in intimate partner abuse than people without PTSD. However, this does not mean that everyone with PTSD will become violent, aggressive, or perpetrate interpersonal violence.

Prolonged grief
The extreme losses that some immigrants experience often result in prolonged grief. Mariella, a survivor of the 1994 genocide against the Tutsi in Rwanda, witnessed the murders of her parents, grandparents, her older four siblings, and their children, as well as other members of her extended family, when she was 14 years old. Mariella feels that she was unable to fully grieve the loss of her family members because PTSD stood in her way. Although she accessed counseling after settling in the U.S., deep grief still prevented Mariella from fully healing. “After the genocide we had to find ways to live, we had no professional help to go through the traumatic stress,” she said. “After 20 years, when I got stuck (emotionally exhausted) I was also one of the people who thought that depression is white peoples’ sickness. That’s when I started digging deep to find out if I could be having depression as well! That’s when I started the healing journey, and my children’s questions came along, supporting me in making the decision to speak out. So I made the decision. I said, ‘You know what? I have to be strong and be able to talk about genocide now, and trauma.’ ”

Jeanne Mariella Uwimana

Returning to therapy, participating in a women’s genocide survivor support group, and forming her own women’s support group ultimately helped Mariella through her grief and helped her heal from depression.

Difficulty concentrating and learning
Scientists studying brain function in survivors have shown that after being exposed to trauma, learning and processing new information becomes harder. Survivors report difficulty concentrating, memory troubles, confusion, and disorientation. Sleep deprivation can make these symptoms even worse. And yet, in this foggy, cognitively impaired state, refugees and asylum seekers must try to learn a new language, navigate social services, and start new jobs.

Thierry Ndabahagamye

Mental Health is Part of Physical Health
Researchers studying short-term and long-term health outcomes in trauma survivors report that chronic stress is hazardous to one’s health. People diagnosed with PTSD are more likely than people without PTSD to experience conditions such as arthritis, heart disease, respiratory disease or breathing problems, digestive problems and disease (stomach ulcers, loss of hunger, constipation), reproductive system-related problems (trouble getting pregnant, changes in the menstrual cycle), diabetes, or chronic pain.

Mental Health is Part of Physical Health
Researchers studying short-term and long-term health outcomes in trauma survivors report that chronic stress is hazardous to one’s health. People diagnosed with PTSD are more likely than people without PTSD to experience conditions such as arthritis, heart disease, respiratory disease or breathing problems, digestive problems and disease (stomach ulcers, loss of hunger, constipation), reproductive system-related problems (trouble getting pregnant, changes in the menstrual cycle), diabetes, or chronic pain.

Put simply, in order to feel good, one must be able to take care of oneself. But the connection between mind and body means that survivors often don’t engage in healthy behaviors because they are mentally and physically unable to do so. This is why trauma survivors sometimes need the expert help of counselors or mental health providers to get them to a place where they can live a healthier life.

Thierry Ndabahagamye, an actor and filmmaker from Burundi, who now lives in Maine, recently produced the film short “Talk to Somebody.” He made the film to educate immigrant communities about mental health, alcoholism, and domestic violence. One of the film’s main characters tries to convince his newly arrived brother to go to counseling, telling him, “I thought going to counseling, going to therapy, was a white people thing. But little by little, when I started to see the benefit, I thought, you know what? Everyone should do this. For our community to be strong, we need to adjust.” Thierry hopes his film will help destigmatize mental health and educate New Mainers about the benefits of counseling, and how working with a therapist can help with healing.

Alice from Burundi explained how some African cultures view mental health: “Mental health is not known. It is a foreign concept among a lot of immigrants. When you say mental health, that means you’re crazy. There’s nothing between: either you are okay, or you are crazy.”

Licensed clinical social worker (LCSW) Shannon Spillane at Therapy for the People, Portland, described the value of therapy for mental and physical health: “It’s like if you had a splinter and I came and just put a bandage on it. That’s such a natural response for so many people emotionally with trauma. It’s just like – put a bandage on it, then move on. It doesn’t get down deep enough, and the trauma doesn’t get out. It is only like putting a bandage on a splinter.

The trauma of resettlement and acculturation
The world feels unsafe for those with a history of trauma. Survivors and health professionals interviewed for this article named several common, post-migration retriggering stressors, such as forced retelling of trauma stories, the harsh reality of immigrant life after a brief honeymoon phase that immediately follows resettlement, the search for a new identity, and the uncertainty of the timeline for work papers, immigration court, and eventually citizenship for some.

Re-establishing a home and identity involves the difficult process of acculturation, whereby a person adopts the practices and values of one culture, while still retaining their culture of origin. Immigrants must navigate acculturation while they simultaneously juggle the tasks of daily living.

For many, post-migration stress quickly overwhelms their already-exhausted coping resources. According to RHTAC, resettlement stress can be equal to or greater than war-related trauma and stress, and post-migration stress severely threatens mental health. During the resettlement phase, immigrants find themselves once again in survival mode, which reminds them of past traumatic experiences.

“I always told myself to be strong once I got here (the U.S.) because I didn’t have any other choice,” Ridelphine said. “If I’m not strong, then what will happen to my family? I don’t have anyone to help me. I don’t see any other way than just being strong, holding myself up, and just keep living day to day.”

Simple things like receiving mail can be traumatizing in a new country. Newcomers worry that the mail has brought bad news or pertains to their immigration status, but they must seek help before they can understand what is in the letter. Similarly, accessing healthcare can be overwhelming and retraumatizing, especially for survivors of gender-based violence who feel vulnerable with strangers. Another contributor to emotional vulnerability is a concern for the safety of relatives and friends remaining in the country of origin, where conflict may be ongoing.

Telling the story, again and again
Telling their story of trauma can be empowering for those who are ready to tell it. But mental health professionals stress that it can take years for survivors to be ready to share their trauma history. Unfortunately, as part of the refugee resettlement or asylum-seeking processes, survivors must repeatedly retell their most painful memories to strangers. Immigrant Legal Advocacy Project (ILAP) lawyer Kate Chesney Esq. described the U.S. immigration system as a “very oppressive and traumatizing system and process” in which organizations such as ILAP do their best to provide trauma-informed legal support services.

Burundian survivor Alice spoke about her experience with the asylum-seeking process in the SafeSpace Radio interview: “I wasn’t ready at that time to talk about it because I was filled with distrust and shame,” she said. “Within my first week at the family shelter, my caseworker brought me to ILAP to have an intake interview. I didn’t even know what it was about, though. So there I am in front of someone I don’t know, and they wanted me to tell her why – what happened – and all of that. So, of course, that was retraumatizing. Yeah, that is difficult. You don’t know. And you can’t say anything because you don’t know, you don’t know those people, you don’t know who to trust.”

The anxiety of even naming what happened may be so overwhelming and terrifying that survivors like Alice stay silent. Although Chesney said ILAP does not need prospective clients to recount their full story during their first intake interview, it is a necessary part of the process moving forward – hopefully only after a baseline of mutual trust and respect between a legal representative and a client has been established.

After Safe Space Radio host Dr. Anne Hallward, a Portland psychiatrist, heard Alice’s story, she recruited a group of volunteer therapists and former asylum seekers to create a safe space for survivors to tell their story of trauma before needing to tell a lawyer. She called the group Hearing Aides. Unfortunately, with the virtual shut-down of asylum approvals under the previous administration, the Hearing Aides stopped providing services in 2018. At this time, resuming their important work is uncertain. Cultural brokers, caseworkers, and groups like the Hearing Aides are desperately needed to help limit retraumatization along the path to citizenship, as the second part of this series will discuss.

The Honeymoon Phase
Immigrants and service providers agreed that most newcomers experience a honeymoon phase, the aftermath of which can retraumatize many immigrants. After coming from war-torn parts of the world, and after many years of dreaming of a better life, newcomers often feel on top of the world during the first weeks of their new lives. Then the harsh reality of immigrant life in what is an entirely different environment closes in, and often proves exhausting, overwhelming, and sometimes devastating.

Layers of identity, including as a ‘New Mainer’
The complex acculturation process requires immigrants to assimilate many different identities in what most experience as a painful and confusing process. As Nsiona Nguizani wrote in Amjambo Africa in April 2021, refugees and asylum seekers did not grow up with childhood dreams of being immigrants in Maine. Refugees and asylum seekers come from every income level, educational background, and walk of life. Yet when they arrive in Maine, they often are labeled as simply “refugee” or “New Mainer.”

In African culture, tribes are an integral part of a person’s identity. Molly Fox, a social worker with Greater Portland Health, feels that many people underestimate the importance of tribalism, which she says can lead to retraumatization. “People have talked to me about not feeling welcome because they feel judged. Just because someone is also an immigrant or from the same country as you doesn’t mean you’re automatically friends,” she said. “It doesn’t mean you have the same religion. Clumping everyone into these groups is offensive because immigrants feel like all their identity has been stripped away.” Suddenly, they become someone who needs General Assistance or needs a shelter, and they hear about racism. “I try to make people feel seen and heard. I try very hard to let them tell me how they want to be defined. And that’s a big part of the work, figuring out who they are, identity wise, now that they’re in the U.S.”

Many immigrants left behind successful careers, professional training, and degrees. The language barrier forces them to assume a new professional identity, often at a much lower status. For example, Ridelphine was a lawyer, radio show host, and human rights activist in the DRC. When she got to Maine, she worked at Walmart at first, until her English improved.

The cruel waiting game
The uncertainty and delays that characterize the modern U.S. immigration system, including the asylum-granting and refugee resettlement processes, is one of the most significant sources of ongoing stress and trauma for New Mainers. Recent immigration policies and greatly lowered caps on refugee settlement numbers during the Trump administration intensified this chronic stress. The pandemic further slowed timelines for applications and was used as a justification to refuse entry to asylum seekers looking for refuge in the U.S., exacerbating trauma.

How therapy and counseling helps survivors heal
Healing from trauma is complicated and can take a long time. Trauma can generate powerful emotions that make living a normal, healthy life difficult, no matter how strong someone is. Recovery starts with understanding trauma and being able to talk about it.

“The experience of violence is shaped by shame and silence. Violence is dehumanizing and leads survivors to blame themselves,” said Hallward of Safe Space Radio. “Finding voice and bearing witness can become part of recovery for both individuals and communities.”

Therapy can help survivors understand their emotional responses to trauma and how to process their feelings. It can help survivors break free from harmful patterns that stand in the way of healing, such as self-isolation.
The mental health professionals contacted for this article use therapy to provide concrete survival skills to lessen the daily hardship of immigrant life in Maine. “The work of healing from trauma doesn’t have to be just retelling your story. It can be breaking it down into smaller parts, taking a look at how you’re feeling now, working out concrete coping skills and ways to survive daily life,” said social worker Shannon Spillane of Therapy For the People. “In therapy, we want to help people get to the point of self-trust, self-validation…so that they’re navigating the world with an understanding of what happened to them and the knowledge that their experience of trauma doesn’t have to hinder them. So that it doesn’t have to hurt them all the time.”

What you need to know about counseling and therapy
Therapy, counseling, and other services provided by mental health professionals work to help people live the kind of life they want. Even if someone is not yet ready to talk about their trauma, speaking with a counselor or therapist can still help. Seeking mental health services does not mean that someone is weak, crazy, or disabled. Accessing mental health services or being diagnosed with PTSD will not hurt someone’s immigration status. Clients and patients at any medical or mental health service office have the right to request an interpreter. If, for any reason, they aren’t comfortable with the one they have been assigned – including because an interpreter resembles a former assailant, for example – they also have the right to request a different interpreter. A mental health professional must meet with a client and diagnose PTSD before therapy or counseling can be covered by MaineCare. Asylum seekers are not eligible for MaineCare coverage, however federally qualified health centers such as Greater Portland Health, Penobscot Community Health Care, and others around Maine, offer mental health services for those without MaineCare after someone becomes a patient at the health center.

The survivors who spoke with Amjambo Africa all anticipate that their healing journeys will be lifelong. However, they also see trauma as just one part of their identity and know their recovery involves the creation of new identities for themselves. Mariella, Ridelphine, Alice, and Thierry have found strength and hope through healing.

Their healing journeys involve advocacy.
Mariella started a peer-support group called Women’s Life in Balance and invited social worker Spillane to be clinical advisor and help moderate. The virtual group of women from around the world meet monthly to learn about self care, self-awareness, and finding balance.

Alice works at Through These Doors, a Cumberland County domestic violence advocacy organization, where she works to support survivors and educate New Mainers about their legal rights and U.S. legal definitions of interpersonal violence.

Thierry is SafeSpace Radio board member, and is planning public showings of his “Talk to Somebody” film in post-pandemic release events.

Ridelphine works for an international nongovernmental organization in Washington, D.C., that focuses on re-establishing democracy in African countries “to get at the root of violence so that there don’t have to be any more survivors.”

Through work in support groups, domestic violence organizations, film, and international diplomacy, these immigrants have found strength and hope. “There is hope. There are resources as long as you are willing to use them and speak up and accept them. Healing is possible. It takes time. And it is different for everyone, but it is possible,” Alice said.

By speaking out, Mariella, Ridelphine, Alice, and Thierry hope to help destigmatize trauma, sexual violence, PTSD, and mental health issues, especially in immigrant communities.

The second part of “Finding freedom from trauma: New Mainers’ healing journeys” will appear in the July issue of Amjambo Africa. It will take a close look at different options for treatment and support available to Maine’s newest residents with histories of trauma.