Music Therapy for Refugees

1. Introduction

During a Refugee Convention in 1951, refugees were defined as people who have left their place of habitual residence, because of a well grounded fear of persecution for reasons of religion, political opinion, race or nationality (United Nations High Commissioner for refugees, 1992). The situation in our own country where 1.5 million Zimbabweans are believed to be in South Africa is a prime example. According to the United Nations High Commissioner for refugees, from 1980 to 1985, the number of estimated refuges worldwide increased from 8.5 million to 10 million. By the end of 1992, the estimated number was 18.5 million. In 1992, Africa had the highest number of refugees than any other continent, an estimate of 26% of global refugees.

Inherent in the situation is the experience of a loss, which has major effects on any person's emotional, behavioral as well as cognitive life. There is the loss of community, work, finances and loved ones. There are intangible losses such as the loss of one's status and trust in fellow man. Apart from careers, people and familiar surroundings, there are also many things that people treasure as their evidence of achievements, life and history. I think about photos, belongings from school and university, books and degree certificates, many of these become lost in the repercussions of becoming a refugee. This loss is experienced in addition to the trauma they were confronted with because of violence and prejudice in their own countries. The result is that these individuals experience an imbalance on a biological, psychological as well as social domain and these all contribute to a psychological disturbance (Elkin, 1999).

2. The difficulties associated with being a refugee

Considering the mental health of individuals who are sometimes starving and don't have a place they call home, may seem to be a luxury, it is nevertheless very important to recognize that refugees habitually suffer severe mental anguish. There are living difficulties that they have to adjust to, acculturation as well as the possible trauma they experienced before they became refugees. These pre- and post migration factors can impact greatly on an individual's physical as well as mental functioning. Individuals who are living with the effects of trauma often move from states of being overwhelmed by the recollection of the traumatic events to states of emotional numbing. As a result of the trauma, loss and uncertainty, it is not surprising that studies have found that refugees may have an increased risk for mental health disorders and distress when compared to non refugees (Porter & Haslam, 2005).

2.1 Post traumatic Stress Disorder

Post traumatic stress disorder is one of the emotional disorders that could develop as a result of the traumas experienced by refugees. It is an enduring distressing emotional disorder that follows exposure to a severe helplessness- or fear inducing threat. The victim re-experiences the trauma, avoids the stimuli associated with it, and develops a numbing of responsiveness and an increased vigilance and arousal (Barlow & Durand, 2002) . Studies have found that exposure to trauma, and specifically war related PTSD, results in damage to the hippocampal areas of the brain. Considering that the hippocampus plays an important role in learning and memory (Elhai, Ford & Reyes, 2008), it stands to reason that disruptions in memory functions, short term memory as well as the recall of events, have been demonstrated with patients suffering from PTSD. The difficulties associated with the memory disruptions can make the adjustments, that are already challenging, even more so. Often patients with PTSD have involuntary flashbacks of the traumatic events and at other times they are unable to remember what happened. Coming to terms with the emotional connotations to the past becomes even more complicated because the recall and re-experiencing of them are not always voluntary. One of the salient characteristics of PTSD is outbursts of anger (DSM-IV-TR, 1994). Because the sufferer has so many processes happening at a subconscious level, visual and auditory cues from the outside world could set off a ripple of emotional reactions that the person doesn't necessarily understand on a cognitive level.

2.2 Disorder of Extreme Stress Not Otherwise Specified

Post Traumatic Stress Disorder (PTSD) mainly develops from exposure to a single traumatic event, Disorder of Extreme Stress Not Otherwise Specified (DESNOS) is the result of one or more traumas. Complex trauma or being exposed to many traumas and/or high levels of long term stress often leads to what the DSM-IV refers to as Disorder of Extreme Stress Not Otherwise Specified (DESNOS). The repeated exposure could disrupt brain functions and structures, endocrinological function, immunological function, and central and autonomic nervous system arousal. For example, being repeatedly exposed to trauma may result in a chronic over-activation of an individual's autonomic nervous system, which in turn triggers the fight or flight reaction to subtle cues linked to the previous trauma long after the exposure (Doctor & Shiromoto, 1999). Other symptoms of DESNOS may include problems with memory, identity, and emotional regulation, much the same as PTSD. Once again, as with the PTSD victim, situations and experiences that remind them of the event or events they experienced, are often avoided. As a result they live with a sense of emotional numbing which can impact largely on their interpersonal relationships and day to day functioning (Sutton, 2002). Often these individuals are over aroused and may be quick to anger.

2.3 Inability to understand control emotional reactions

Traumatised refugees often choose not to talk about their experiences and often don't verbalise these for decades, because the experiences are often accompanied with shame and guilt (Van der Kolk & Fisler, 1995). The result is that the refugees repress the devastating experiences which maintain all the defense mechanisms they developed in order to carry on with life, care for families and remain "strong." Even though the memories are not shared, they are always present, but remain in a non-processed form. The result is that any situational stimuli can re-activate the memories. The interesting finding is that the unprocessed experiences are seated in the emotion centers of the brain, because the experiences haven't been verbalized and processed they are not stored in the cortex, in word form, but are rather images. The triggers activate brain regions that generate intense emotions, but it is not coupled with the activation of centers