"No Five Fingers Are Alike"
Nora Ahlberg
Karnac
'This remarkable book is the second in the International Series of Psychosocial Perspectives on Trauma, Displaced People and Political Violence and it continues to offer what the first volume did - a unique opportunity for English-speaking readers to familiarise themselves with important European contributions in this field which are not usually accessible to them.
Nora Ahlberg allows us to get a privileged close look at her practice and to listen to the voices of her refugee clients. But her book is much more than a reproduction of their tumultuous experiences. It manages to achieve a most sensitive balance between providing authentic testimonies of suffering and endurance, and articulating an authoritative and scholarly methodology for treating this delicate material. I am not aware of any other book that addresses so ably both of these facets of the refugee experience.
Moreover, this is (to my knowledge) the only book of its kind that focuses exclusively on refugee women, and one of the few that limit their scope only to one group of refugees - the Kurds, in this case. Although the book is about Kurdish women in Norway, its appeal and contents are nevertheless of universal value and applicability. Also, although it was first published in Norway in 2000, by no means is it dated.
The general reader will get an unparalleled insight into a therapeutic way of working with refugees and the specialist reader will have a vast range of themes to feast on. These include theoretical considerations of ideas about collective trauma, narrative life stories, working cross-culturally, mental health perspectives on refugees, and the formation of meaning, to mention but a few.'
Contents
Acknowledgements: People and Subjects / 11
Introduction: Towards Interdisciplinary Theory and Understanding / 14
Part One:
A Cultural Study of Clinical Context
1. The Interdisciplinary Challenge
The Extended Use of Clinical Data / 19
Inside-Outside the Therapeutic Room and Migrant Problem
Families / 25
2. Psychological Trauma Reconsidered
The Weakness-Exhaustion-Demoralisation Constellation and Post Traumatic Stress / 35
The Unspeakability of Trauma and Broken Narratives / 49
Like a Therapy-in-Reverse / 55
3. The Torture Versus Exile Trauma
Collective versus Individual Meaning and Management of Trauma / 65
Between the Devil and the Deep Blue Sea / 68
Normative Transgression and System-Oscillation / 73
4. Violation of Gender
The Silence of Women - the Shame of Men / 76
The Complementary Role of Women as Agents of Male Honour / 85
5. Violations of Intergenerational Obligations
The Dutifulness of the Young - the Right of their Elders / 92
‘She who would have cared for her old Mother’ / 96
6. Clientification as a Re-Actualised Trauma
‘Guilt’ and ‘Shame’ in Culture and Treatment Ideology ioo
7. The Collective Dimensions of Trauma
Violation of Ritual and Ritual Emotion / 115
Culture-in-the-Negative and the Innocent without Status / 121
Violation of Human Rights and the Legacy of Despair / 133
Large-scale Loss and Multiple Disaster: The Kurdish Case / 138
8. The Millenarian Heritage of the Modern Age
Urban Discontent and Islamic Fundamentalism / 145
Sharia (The Islamic Law) and Morally Corrupt Women / 133
The Islamisation of Prison Life / 159
9. The Cumulative Effects of Trauma / 167
Part two:
Therapy in a Cross-Cultural Setting
10. Patterns of Exchange in Cross-Cultural Trauma Therapy
On the Issue of Object Relations in Integrating Traumatic Content / 175
Intimacy and Mistrust as Treatment Parameters in a Cross-cultural Setting / 179
The Silence-of-Shame versus the Catharsis-oI-Talking-Therapy / 182
11. The Aesthetics Of Cross-Cultural Therapeutic Interaction
Challenging the Neutrality of the Therapist’s Role / 192
Courtesy and Withdrawal Behaviour in the Triad of Interpretation / 207
Transformation of Basic Schemes: About the Benefits of Therapy / 221
12. On The Narrative Approach And Meaning-Formation Refugee Narratives and ‘Time’ / 230
The Architecture of Kurdish Social Interaction and the Clients’ Childhood Settings / 234
Models for Adaptational Choice: From Cause towards Meaning Resolution / 244
Postscript
13. Symbolic Shelter In A Changing World
Gender Mobility in a Cross-cultural Setting and the As-if Strategies / 263
Divided History - Divided Mind: In Search of Collective and Individual
Memory / 277
14. On Methodological Choice And The Study Of Sensitive
Issues
Defining my Concern on Sensitive Research / 253
Polarities of Methodological Approach: An Issue of Varying Inputs as well as Outputs / 288
Some Problems of the Medical Model in Studying Sensitive Issues / 392
Summing up the Interdisciplinary Challenge: On Context-Dependent
Data and Professional Ethics / 296
Notes / 301
Appendix: List of Clients’ Narratives Found in the Text / 318
Index / 322
Bibliography / 329
SERIES EDITOR’S FOREWORD
This remarkable book is the second in the International Series of Psychosocial Perspectives on Trauma, Displaced People and Political Violence and it continues with what the first one offered - a unique opportunity to the English speaking readers to familiarise themselves with important European contributions in this field that usually are not accessible to them.
Nora Ahlberg allows us to get a privileged close look at her practice and to listen to the voices of her refugee clients. But her book is much more than a reproduction of their tumultuous experiences. It manages to achieve a most sensitive balance between providing authentic testimonies of suffering and endurance, and articulating an authoritative and scholarly methodology for treating this delicate material. I am not aware of any other book that addresses so ably both of these facets of the refugee experience.
Moreover, this is (to my knowledge) the only book of its kind that focuses exclusively on refugee women, and one of the few that limit their scope only to one group of refugees - the Kurds, in this case. Although the book is about Kurdish women in Norway, nevertheless, its appeal and contents are of universal value and applicability. Also, although it was first published in Norway in 2000, by no means is it dated.
The general reader will get an unparalleled insight into a therapeutic way of working with refugees and the specialist reader will have a vast range of themes to feast on. These include theoretical considerations of ideas about collective trauma, narrative life stories, working cross-culturally, mental health perspectives on refugees, the formation of meaning, to mention but a few.
Professor Nora Ahlberg is an eminent academic and clinician, immensely experienced in working with refugees. She is head of the Norwegian Centre for Minority Health Research and professor of psychology at the Medical Faculty at the University of Oslo as well as associate professor at the University of Helsinki. Before taking up her present position she was professor and head of the Psychosocial Centre for Refugees at the University of Oslo and the Department of Religious Studies at the University of Trondheim. By combining the academic disciplines of psychology, religious and psychosocial studies with clinical sensitivity, Professor Ahi berg succeeds in producing an outstanding book that can become an invaluable resource for everybody working in this field.
Renos K. Papadopoulos
Series Editor
Author’s foreword to the present edition
Many things have changed since the therapies described in this book were conducted. Wars, terror and polarised debates about negative sides of cultural traditions complicate attempts to speak cross-culturally. Although issues of health are not ‘hot’ in the same sense, there is more to them than meets the eye. So what lessons have we learnt?
Personally I would still stress a need for acknowledging the cumulative aspects of trauma within “the extended refugee scenery”. Forced migration and a subsequent resettlement as a member of a minority group in a new sociocultural setting, increase the risk for somatic and mental health problems. Different illness profiles in the countries of origin and exile, painful events before and during relocation, as well as problems of integration, all influence the situation. But while cumulative traumas go together, our more specific therapeutic tools may fall short of acknowledging this reality. An example could be a circumcised girl, who is also a distressed refugee, and suffers from retraumatisation while giving birth, involving several of these aspects.
We must to a much larger extent consider an extra-therapeutic framework or the existence of many-sided problems, which are not easily resolved within the consultational space alone.
Also, the fact that the therapeutic alliance is under such extraordinary challenge, actualizes issues of professional closeness and distance. Due to mutual avoidance behaviour, migrants tend to be in a poorer condition when they arrive for treatment, a fact that might lead to more drastic measures, such as enforced committal or heavy medication. Working in a cross-cultural context increases the risk of inappropriate reactions of over- and under involvement. We may avoid treating Third World migrants altogether, or give them different services, frequently of lesser quality, such as medication in the absence of a more demanding and time-consuming “talking cure”. Also, the use of an interpreter increases the time for consultation at least two-fold; while introducing a triadic constellation that may activate competition about who is in charge, or, alternatively, who is to take the blame when things go wrong.
Cross-cultural migrants are particularly vulnerable in relation to health care because it frequently involves the most personal, intimate or private sphere meeting interventions located in a public space. The problems may not be exclusive to migrants, but there are few instances in which they are as obvious as in a cross-cultural setting. Such is the case, for example, with regard to existing tensions between the protection of citizens in times of ill health or misfortune versus forced intervention in their lives, even when these are seen as part of preventive measures. Between public and private or even transnational micro-space important ethical challenges, which affect our professional work, are thus rendered visible. It may therefore be wise to try to unpack our interpretational frames in order to reflect on the conceptions of clinical reality that we have created.
Nora Ahlberg
October 2007
Introduction
Towards Interdisciplinary Theory and Understanding
Notes on a Wartime Picture
One of the clients brought me a six hour long video tape filled with human tragedy, raids and killings of adults and children alike. Though it was simply overwhelming to view, her point was a different one; that these were the only remaining pictures of her dear Home. It seemed like a compulsive backward glance at a happy childhood through the spectacles of organised social violence; while being, moreover, cast away on foreign soil.
While many minority studies have been written by, and implicitly concerned with men, this one focuses on woman brought up in a traditional setting dominated by gender segregation1. At the same time, however, it is a work about displaced persons whose stories remind us not only of the atrocities of wars fought in their homelands, but of the extent to which wars continue to be waged on the psychocultural level even after its victims have reached what they believe to be a safe haven in a cross-cultural exile.
As for the subject matter, I have tried to present the clients’ truths as I have understood them as a therapist/researcher invited to hear and feel their tragedies and separation from their loved ones. The narratives on which I base my analysis are thus in themselves the products of a cross-cultural encounter involving three people including the interpreter. I feel fairly safe in alleging that it has been an experience of mutual challenge and confidence building. Writing on the life history approach in general, Catani (1981, 212.) aptly describes it as “a two way seduction, a love story that recounts the development of an intense affective relationship whose exchange exists on a purely oral basis”. To ignore this fact in favour of an exclusively documentary approach would be to renounce the fundamental importance of interpersonal communication generally, and therapeutic relationships in particular.
It goes without saying that the mental hospitality of these women, reflecting a more general kurdish attitude of sharing with your guests, has made a deep impression on me. The same applies for their pride …
Nora Ahlberg
"No Five Fingers Are Alike"
Karnac
Karnac Books Ltd
"No Five Fingers Are Alike"
What Exiled Kurdish Women in Therapy Told Me
By Nora Ahlberg
The International Series of Psychosocial Perspectives on
Trauma, Displaced People, and Political Violence
Series Editor: Renos K. Papadopoulos
First published in 2007 by
Karnac Books Ltd
118 Finchley Road
London NW3 5HT
© 2008 Nora Ahlberg
Foreword copyright © 2008 by Renos K. Papadopoulos
Copyright © Solum Forlag a.s, Oslo 2000.
The rights of Nora Ahlberg to be identified as the sole author of this work have been
asserted in accordance with §§ 77 and 78 of the Copyright Design and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior written permission of the publisher.
British Library Cataloguing in Publication Data
A C.I.P. for this book is available from the British Library
ISBN: 978-1-85575-512-3
Printed in Great Britain
www.kamacbooks.com
