Being a refugee by itself has consequences for mental health, partly due to the effects of trauma and resettlement, but also partly due to processes more basic to healthy psychological functioning. By definition, a refugee has been displaced from his home.1 In addition to problems caused by displacement, refugees suffer with issues surrounding identity, belonging and, along with them, internal physiological homeostasis.2
People displaced to new countries with new languages to learn almost always have a new, less-empowered sociopolitical status such that their capacity to re-establish place, re-structure identity, and re-gain a sense of belonging is just that much more difficult. Fullilove has described different dimensions of place as a way of defining the immediate and intimate portion of the environmental unit outside of the person, and also has shown that the psychiatric implications of displacement are significant.3 Place and home can be thought of as the “geographic center,” which facilitates attachment, development and identity, and survival. The geographic center is optimally healthy when it also has non-discriminatory structures that promote the human search for meaning, creativity, and generativity.
“Place” can also be understood as “standing for the human interactions occurring in a given location” and represents the “nodes of the life biography,” important in providing the sum of resources and human relationships in a given location which sets the conditions for human identity. A stable and optimal place offers the best chance for a homeostatic environment. Disruptions to place threaten homeostasis by altering attachments, familiarity, and place identity, and may result in psychological problems of nostalgia, disorientation, and alienation. Loss of place not only affects people’s sense of identity and belonging but is also an identified risk factor for poor mental health.
The disruption caused by displacement changes boundaries of identity and belonging for individuals and communities. Those individuals and groups who think that they have no choice but to leave their homeland often do so because it is intolerable to remain or it would simply be too dangerous to do so. For such individuals, threats to the self and disruption of place has already caused large shifts in identity and belonging, such that removing oneself and one’s family from the now alien place may be seen as the best option to move forward. However, this causes the refugee to have to adapt to at least one, and sometimes many more, “home” situations in which identity and belonging are not a given right but must be formed and re-formed in societies that may or may not fully welcome and respect them. The loss of the sense of identity and belonging is associated with poor mental health in refugees, whether due to war or to natural disasters. For example, in a study of 76 Somali adolescents displaced to the U.S., a greater sense of belonging at school was associated with less depression and higher self-efficacy regardless of the severity of previous exposure to traumatic events.4 In another study of Bhutanese refugees, perceived burdensomeness and thwarted belongingness were significantly associated with suicidal ideation. Those who reported suicidal ideation had greater likelihood of perceiving themselves as a burden and reporting thwarted belongingness than those who did not report suicidal ideation. Those who acknowledged suicidal ideation also had lower likelihood of reporting lower social support levels. In addition those experiencing suicidal ideation were experiencing additional stressors such as anxiety, depression and PTSD symptoms,and low social support.5
In their qualitative work with Bosnian refugees in the U.S., Keyes and Kane identified elements that affected feelings of belonging and adapting. Belonging was promoted by the protection of cultural memory, a sense of identity and respect for difference, demonstrations of empathy and reciprocity, and perfection of speech. Adapting depended on coping with transitions and with memories of past and ongoing losses, coping with the tensions of having to accept and fit into a new cultural space while holding on to their own, and learning the new language.6 The authors identified the concurrent alienation and hope of displaced refugees:
“Implicit in the refugees’ experiences were states of culture shock, loneliness, psychic numbness, grief, nostalgia, and feelings of dejection, humiliation, inferiority, and as if they belonged nowhere. Simultaneously, the refugees reported feelings of relief and safety after leaving behind the threat of death in their old homes, feelings of gratefulness for their new freedom to hope for a better life, and their restored ability to notice beauty, as well as a sense of normalcy in their new lives.”
1. Williams CL, Westermeyer J. Refugee mental health in resettlement countries. Washington DC US: Hemisphere Publishing Corp. 1986; 267.
2. Hollifield M, Fullilove M, Hobfoll, SE. Climate Change Refugees. In: Marsella A, Weissbecker I (Eds). Climate Change and Human Well-Being: Global Challenges and Opportunities. New York: Springer Science and Business Media; 2011.
3. Fullilove M. Psychiatric implications of displacement: contributions for the psychology of place. American Journal of Psychiatry. 1996; 153(12): 1516-23.
4. Kia-Keating M, Ellis BH. Belonging and connection to school in resettlement: young refugees, school belonging, and psychosocial adjustment. Clin Child Psychol Psychiatry. 2007; 12(1): 29-43.
5. Ellis BH, Lankau EW, Ao T, Benson MA, Miller AB, Shetty S, Lopes Cardozo B, Geltman PL, Cochran J. Understanding Bhutanese refugee suicide through the interpersonal-psychological theory of suicidal behavior. Am J Orthopsychiatry. 2015; 85:43-55.
6. Keyes EF, Kane CF. Belonging and adapting: mental health of Bosnian refugees living in the United States. Issues Ment Health Nurs. 2004; 25(8): 809-31.