What can mental health care offer the more than 1.5 million Syrian refugees currently living in Lebanon? Reflections from a community mental health clinic in Lebanon, which serves Syrian refugees.¹
By Maria Stacke, Alumni in Master of Public Health, Lund University
I’m sitting in a concrete room. The walls are empty. A plastic rug covers the floor. A stove in the middle of the room, and a few cushions to sit on, nothing else.
Maryam² speaks with a soft voice. She occasionally pauses when it becomes difficult to describe what she is going through, and her otherwise steady voice trembles slightly.
Maryam’s story is one of abuse, displacement and acute poverty. As a single mother of two young children, one still nursing, she now struggles to find ways to support herself and her children.
“My son goes outside and searches for plastic that he sells, she explains. And if he doesn’t work we sit without food or anything. Sometimes my neighbors give me food. Sometimes we don’t eat for a full day and go to bed hungry.”
When my colleague Mahmoud and I return to the car we are both quiet. This was a particularly difficult meeting. Maryam has been referred to the clinic for mental health care, but what we do for her then and there, is to make sure she receives a bag of food and a bottle of fuel for her stove. Lebanon gets cold during the winter months.
What can mental health care do for someone like Maryam? Can psychotherapy or psychotropic medication relieve her suffering when it seems it’s intimately connected to the extreme adversity she is living in? In the words of my colleague “there is a humanitarian issue, beside the mental issue.”
In the field of global mental health, efforts to increase availability of psychiatric treatment for marginalized populations, such as refugees, have been met by criticism. Briefly put, critics have argued that psychiatric disorder categories, such as post-traumatic stress syndrome (PTSD), not only often fail to capture to the wide range of mental distress expressed and experienced by people across different cultures, but that psychiatric treatment, with its focus on the individual patient, fails to recognize the impact of poverty and adversity on mental health. Interventions should therefore, they argue, focus on improving socioeconomic conditions, rather than on individual, psychiatric treatment.³
A few weeks after our meeting with Maryam, I am listening as Mahmoud, my colleague, is giving an awareness session on mental health in an informal settlement for Syrian refugees.⁴ One of the women attending the sessions looks profoundly unimpressed with us.
“If I’m feeling upset because I can’t feed my children, what can psychotherapy do for me?” she asks.
Maryam could very well have asked us the same thing. But she didn’t. Rather, she spoke of how her worries affected her health. How it made her lose hope and sleep. How she felt paralyzed. And how talking to a social worker about her worries made her feel at ease.
So I learnt, during my time in Lebanon, that questions of what’s what in refugee mental health are not merely of interest to academics or public health professionals. Rather, I kept talking to service users and providers alike; about the interplay between mental health, context and being displaced. However, for the Syrian refugees I met, and those trying to care for them, the question of what’s what is not merely asked on a population level, but on an individual level. And above all, it is a question of finding ways to meet needs, whether it is psychotherapy or better housing, despite a persistent lack of resources.
While theorizing about problems and solutions is without a doubt important, let’s remember that lived experiences often blur our discrete, scientific categories. And while differing views in academia tend to create debates of ‘either, or’, in practice, perspectives are juggled, negotiated and often bridged. So rather than being stuck in conversations of ‘what’s what’ and ‘either or’, let’s envision interventions which take the blurriness into account, rather than pretend it isn’t there.
- I was based in the city of Zahle, in eastern Lebanon during January to March 2017 with Spanish NGO Fundación Promoción Social de la Cultura who were then running a community mental health clinic in cooperation with NGO Médecins du Monde.
- All names have been changed to ensure anonymity.
- For an interesting summary of the main facets of the debate, see Bemme and D’Souza in their recount of the annual Advanced Study Institute conference hosted by the Social and Transcultural Department at McGill in Montréal in 2012 http://somatosphere.net/2012/07/global-mental-health-and-its-discontents.html).
- Informal settlements are defined by the UNHCR as “settlements informally established by displaced Syrians” UNHCR. (2015). Lebanon Crisis Response Plan 2015-16 Year Two. Retrieved from data.unhcr.org/syrianrefugees/download.php?id=7723, page 15