1. Review
Throughout the history of humankind, people have been changing their habitual locations for a wide variety of reasons. Human beings need both to create a specific habitat for themselves and to change it. Inevitably, all the phenomena associated with this duality of tendencies have formed the subject matter of various facets of human cultural activities, from ancient epic poetry to modern academic investigations. More recently, the health, and in particular the mental health perspectives of these phenomena have gained prominence and this unique volume represents an outstanding example of a most up-to-date account of these standpoints. Locating its theme within its appropriate wide contexts, the book includes contributions from eminent mental health and other professionals (lawyers, general practitioners, social workers) from different parts of the world addressing the multiple complexities of the ‘refugee experience’ and discussing key dilemmas and challenges in refugee (mental) health care.
2. Content
The book is divided into three parts. The first part explores the complex array of ecological factors impacting on the current sociopolitical position of refugees and their mental health. It addresses issues of international asylum and refugee law, needs, vulnerabilities and resources of refugees, as well as cultural, social and historical aspects of assisting refugees with mental health problems. More specific contributions include social psychological and psychoanalytic perspectives that examine the consequences of exposure to violence as well as issues of forced migration. This part also includes the state-of-the-art integrative mental health and psychosocial support interventions for refugees in large-scale humanitarian crisis settings, along with the dilemmas lying at the core of these activities, such as ethical challenges and power differences. These contributions also present and discuss alternative approaches to improving assistance to refugees.
The second part of the book focuses on mental health assistance to refugees in the industrialized, first world host countries. In these settings, refugees face a spectrum of specific psychosocial stressors which add to their earlier experiences of exposure to violence and forced resettlement, resulting in their increased vulnerability to developing mental health problems. In these chapters, the contributors discuss the balancing act between vulnerability and resilience in refugees, focusing specifically on ways of assisting adolescent and adult refugee populations with mental health issues. Some particular aspects of mental health support are also examined, e.g. in relation to refugee detention, the use of interpreters in overcoming language barriers, the role of sport and physical activity in promoting refugee health, and the challenges and risks for the mental health of the helpers involved in assisting refugee populations.
The last part of the book concentrates on certain characteristics of the physical health of refugees, including specific health-care interventions in refugee camps as well as schemes of embedding refugees in the health-care systems of the industrialized host countries.
3. Added value
One of the major and unique virtues of the book is that it combines sound scientific exposition and scrutiny with a critical and reflective stance, constructing a truly integrative framework within which to comprehend the multifaceted nature of the phenomena associated with refugees in the twenty-first century. The very title of the book alerts us, most accurately but also poetically, to the complexities, ambiguities and ambivalences of the position of refugees today, and makes us ponder as to how uncertain is their safety and/or how certain is their unsafety. As stated in the foreword, refugees undergo a major shift from being ‘at risk’ to being themselves perceived as ‘a risk’ by and in their host societies. The book locates boldly its subject matter within a most useful context delineated by the political and financial interests and which is also fuelled by the predominant scientific reductionism in mental health. Such a positioning of the refugee phenomena enables the book contributors to critique many aspects of the current conceptualizations as well as practices of the assistance offered to refugees. This collection not only presents the state of the art of the field but also inspires many innovative directions. Clinical experiences and insights, social engagement and activism, legal complexities, realities of regional sensitivities, organizational dynamics, cultural considerations, all are interwoven within the rich tapestry of this book.
4. Critical notes
Undoubtedly, the editors have gathered together, most astutely, a considerable amount of highly relevant material pertaining to the refugee experience, which will be of enormous help to both relevant practitioners and policy makers. However, unavoidably, it would have been impossible to address every single facet of this multidimensional field, and the critical eye can identify certain gaps, which, had they been filled in, would have made the book even more comprehensive.
To begin with, not all specific groups of refugees are given separate and sufficient coverage and attention; for example, children, families (fathers, in particular) and those suffering from physical disability could have been addressed more thoroughly. These additions would have fitted perfectly within the overall direction of the book, which emphasizes the value of developmental and systemic perspectives in understanding mental health experiences. Other areas that the book could have addressed profitably include the distinct features of different refugee settings, the transgenerational transmission of impacts of violence (although this has been touched upon in the book, it deserves much further elaboration) and the important field of prevention. Especially now, with the proliferation of many different models of health care, it is essential that preventive strategies should be considered more systematically to avoid the deterioration of the consequences of adverse situations.
The book limits its scope to the refugee realities in the industrialized world and it would have been enormously enriched had it also included the specific difficulties that refugees encounter in territories less privileged, where the majority of the world refugees reside as internally or regionally displaced populations. What are the challenges they encounter in these settings and how can their needs (including mental health) be addressed adequately, where resources are scarce and the infrastructure is less developed? Although case vignettes can be found in the book describing such efforts, what is missing is a comprehensive chapter dedicated entirely to this topic.
Another gap in the book is the insufficient coverage of the topic of refoulement of refugees to their home countries. Although this is a relatively new field, it is an area that is not only of extreme interest but also becoming increasingly important in its relevance.
Finally, the book is based, by and large, on the traditional and predominant perspective on refugees, according to which they are identified as vulnerable, as a problem that professionals are tasked to solve. Admittedly, a couple of chapters provide various forms of critique of this approach. The book would have been substantially enhanced had alternatives to this predominant paradigm also been presented and discussed more comprehensively.
5. Summary
This is a most welcome and valuable book. Its encyclopaedic nature may deceive the casual reader, giving the erroneous impression that it lacks precision. On the contrary. The book is full of precious gems that will be of immense value to everybody working in this field, in whatever capacity. For example, it presents a highly specific treatment of the complexities involved in working with interpreters, in relation to staff support, in contexts of refugee detention, etc. It constructs and promotes an integrative, multidisciplinary and contextual approach to refugeehood, imbued with sensitivities about culture and human rights, and critiquing (directly and indirectly) reductionist, narrow and compartmentalized methodologies. The book (both its academic and professional parts) is written with passion, compassion and commitment. The reader gains a clear sense that the authors care deeply about the refugees they write about, from either a research or a clinical point of view.
Two of the main strengths of the book are its practical applicability and its orientation towards the future. It is developed in collaboration with the World Psychiatric Association, and is endorsed and strongly recommended by the United Nations High Commissioner for Refugees. This book will be invaluable for all mental health and other health professionals, policy makers, non-governmental organizations, donors and everybody who is involved in refugee matters from health, psychosocial and legal perspectives. It succeeds in providing a distinctive contribution to the field, it has all the necessary qualities to establish itself as an indispensable text, and it is for these reasons that I have no hesitation in adding my own endorsement of it.