Impact of fleeing and journeys: how we work with people who suffer dehumanisation and PTSD

People flee homes and country for a number of reasons, the main ones being war with another country, civil (internal) war/unrest, and the targeting of minority groups.

However, in recent years environmental issues have increasingly played their part in countries becoming destabilised, and civil unrest can also arise from shortages of food, clean water, or other basic means of living.

When people are forced to flee they leave behind not just home and family, but language, qualifications, familiar streets and foods, and the future they believed in.

Often people cannot prepare to flee but need to leave in a hurry, without a sense of where safety may lie, (so no known destination), and often without adequate means.

Many journeys begin on foot, and reaching the UK can take months, and even years. People may cross mountain ranges and deserts, suffer illness, thirst and hunger, are exploited and abused, lack medical attention, and are beaten up on borders.

Many do not survive the journeys, and those who do can be traumatised not only by what they had to flee but also by what happens on the way, including people they have met or with whom they are travelling dying or being killed, making journeys which are often deeply dehumanising.

In order to survive, the human body switches to become a survival machine.

Physiological changes take place when people are multiply overwhelmed: breathing is shallow and lungs expand their capacity to absorb oxygen; pupils dilate to allow as much light in as possible; bowels and bladder empty; adrenalin floods the body; blood rushes into the arms and legs to enable the fight or flight response; and saliva dries up in the mouth.

The frontal lobes in the brain shut down, and the much older 'survival brain' takes over, meaning people react quickly and effectively but do not process anything that happens.

Memories are not created, but nightmares and flashbacks are. These can be accompanied by a host of other physical and mental/emotional symptoms which are very painful and make effective day-to-day living impossible.

When people reach the UK, they meet the 'hostile environment' policy, where asylum seekers are unwelcome, the culture in the Home Office is one of disbelief and denial, and claims are usually refused, often on spurious grounds.

People live lives of enforced poverty, destitution, exploitation. The young are 'age assessed' and usually assessed as in their 20's due to looking and behaving older than they know themselves to be.

At the same time, we expect refugees to be grateful.

Symptoms of Complex Post Traumatic Stress Disorder are the same as the symptoms of overwhelm and survival.

The brain flashes warning messages easily, sleep is hard to come by, trust is tricky to achieve, and people go pale and tremble as adrenalin continues to flood the body, their hearts pound and breathing is shallow.

In order to heal, we need to enable people to relax and feel safe, build a predictable trusting relationship, and not talk about the past too soon.

First the present needs to feel as safe as possible, then good memories, of living and being loved, need to be accessed.

Then the traumatic events and their impact needs to be allowed to unfold very slowly and in tiny pieces, with a skilled professional.

At this time the UK's hostile environment policy is coming under scrutiny as Ukrainian refugees flee – we can only hope that this will mark an eventual re-humanising of the UK's asylum policy.

About the author

Sushila Dhall is a Therapeutic Services Manager and Counsellor educated to MSt (Oxford) level in Psychodynamic Practice (UKCP level) and has been practising as a psychotherapist for over 20 years.

She has worked for the NHS, has a small private practice in central Oxford, and has worked for Refugee Resource for 15 years.