What is it like to be a refugee with psychosis?

We're in the midst of a "migrant crisis" as tens of thousands of brave, desperate people seek new lives in Europe, risking life and limb to get here. Amidst the tragedy and controversy, the continued plight of those people who actually make it to relative safety is often forgotten. Unsurprisingly, given all they've endured, refugees often have serious mental health problems, including hallucinations. As an indicator, research published in 2011 reported that 80 per cent of 130 young Somali refugees surveyed in Minnesota had symptoms of psychosis.

Now a timely, heart-wrenching study published in the journal Psychosis has reported the results of in-depth interviews with seven African refugees or asylum seekers in the UK (aged 26 to 43; one woman), all of whom reported experiencing symptoms of psychosis. The researchers' aim was to gain insight into the "lived experience" of their participants. This is the first time the first-hand perspective of refugees with psychosis has been documented. "Such information is crucial for understanding and working with such clients," the researchers said.

Clinical psychologist John Rhodes and his colleagues analysed the interview transcripts and identified six key, recurring themes in their participants' accounts. The first was bleak agitated immobility – the participants' sense that their lives were going nowhere. One participant likened the feeling to being in a never-ending race. Similarly, Amine (aged 43) said: "I feel like I'm finished. There's no life, there's no future, there's no anything anymore. I think everything is going to become like darkness."

The second theme was trauma-related voices and visions. These tended to be the sounds or sights of lost relatives or attackers from the past. Belvie (aged 30, female) heard voices of a past torturer and the torture itself also had a voice: "Some voice I have it's like from the past. But some of them are not from the past. I don't know. Sometimes it's like a voice of the thing that was done to me when I was back home, when I was tortured. Sometimes I hear the voice of that person."

Reflecting on the nature of such symptoms, the researchers see them as distinct from the flash-backs associated with post-traumatic stress (PTSD). "The trauma-related intrusions did not appear to be relived experiences in the classic 'PTSD' sense," they explained, "but rather to be engrossing and believable perceptions 'flavoured' by past trauma." Such experiences do not fill well with conventional Western psychiatric categories, they argued. Rather than interpreting their participants' hallucinations as indicative of schizophrenia or PTSD, they suggest a neutral description: "complex trauma with perceptual disturbance."

The participants also described their powerful feelings of fear and mistrust. Belvie feared a man on a bus was planning to kill her just because he looked at her. All the participants also had a sense of a broken self. "My emotional state has changed and my personality has changed, … I really haven't been alright," said Frederic (aged 39). They also described the pain of losing everything. "The degree of loss for these participants is difficult for us to understand," the researchers said. "They have lost their worlds. A new location or role does not replace 'home', that place of familiarity and warmth." Consistent with this, many of the painful feelings described by the interviewees, such as there being no future, were the same regardless of whether they'd be granted asylum (as four of them had) or if they were still waiting to hear about their status.

The final theme concerned the attraction of death. Several of the participants described past suicide attempts and the unbearable strain of life. "The worst part," said Sando (aged 26), "is I keep harming myself, … and you know knocking my head to the wall, kinda too much stuff in there, you know, I just want to open my head and finish with this." Yet, the participants also expressed optimism. The researchers described the participants' wish to die "held in tension with their wish to live and build a purposeful and worthwhile life." This final theme is important for clinical services, the researchers said, which "need to recognise that while many [refugees] speak of building a new life, there is an attraction to suicide as escape."

Further reading

Rhodes, J., Parrett, N., & Mason, O. (2015). A qualitative study of refugees with psychotic symptoms Psychosis, 1-11 DOI: 10.1080/17522439.2015.1045547