By Todd Stump
Everyone in Arbaz's family is dead.
One brother disappeared more than two decades ago and another died after losing a leg in a bombing and an arm to the Taliban, who sawed it off at the shoulder.
Arbaz's hosts have generously provided for his material needs and attended to his physical injuries, but after 11 months as a refugee in Germany, this is the first time the 23-year-old Afghani opened up about the trauma he experienced in his home and during his journey.
"Nobody knows my heart is crying," he told Dr. Shaifali Sandhya at a Red Cross refugee center in Berlin. "When I would tell people at home, they'd treat it as an ordinary thing."
To people in his homeland his experience is unexceptional, common enough not to be examined or thought about too much. The same is true for people in his new home. His fellow refugees lived through their own traumas and the staff at the resettlement centers have heard many similar stories.
Sandhya -- a Delhi-born, Cambridge-educated psychologist -- has counseled hundreds of immigrants in her career. She says the psychological effects of trauma from war -- loss, privation and social isolation -- may be a better indicator of an immigrant's ability to successfully adapt than characteristics governments tend to focus on, like country of origin and religion.
Sandhya left her home in Chicago in November 2016 to conduct a 10-day fact-finding trip in Germany, the first part of a study of how trauma among refugees manifests itself in individual and group behavior. Sandhya, 44, speaks five languages and is learning German as well. She financed the project herself.
She visited four cities, spoke to government ministers, visited refugee centers and met more than 100 refugees, videotaping interviews with some of them, including Arbaz. Names of the refugees have been changed to protect their identities because they fear the recent backlash against Muslim immigration in Europe and are concerned that President Donald Trump's travel ban will force them to return to their home countries, where they likely will face retribution and even death.
At the outset of the trip, Sandhya considered herself well-suited for the research. An immigrant herself, she has lived in five different countries, including Muslim ones, and studied the interpersonal dynamics of non-Westerners in Western countries. She counsels immigrant families confronted by colliding cultures, but while examining the physical and psychological journey of refugees, she began a journey of her own.
She arrived at the first refugee center in a bustling Berlin neighborhood dotted with ethnic restaurants, where 40 percent of the residents are immigrants.
The refugee center is in a recently converted department store, the exterior of which was decorated with children's drawings -- it could have been a school or a recreation center. The elevator was covered in graffiti, but not the kind an American city-dweller might expect. Instead, these were images of dinosaurs with kitten's heads and other fanciful children's scribblings.
Germany's refugee population is primarily from Afghanistan and Syria and is mostly male. All the residents at the refugee center have experienced some form of trauma.
The scar that runs down the face of Ferhad, a 20-year-old unmarried Syrian immigrant from Aleppo, is a lifetime reminder of the torture he suffered under interrogation. Arbaz contracted an infection during a long boat journey, causing severe abdominal pain and blood in his urine.
"These are clear signals to health professionals that they are in need of help. But what of the wounds that can't be seen?" Sandhya asked.
With Sandhya next to him, Arbaz sat patiently while questions and answers were translated from English to German to Urdu and then back again. Frustrated, he finally turned to Sandhya and surprised her, asking in her native Hindi, "How do I explain what goes on in my heart?"
In her years of counseling immigrants and helping them to cope with new environments and personal relationships, Sandhya learned that what might seem to be a matter of the mind to a mental health professional is frequently a matter of the heart to a patient.
"I've learned that you can't help a person if you ignore culture and family considerations, but until now, I've seen it mostly from the female perspective," she says. "This new experience has taught me that the traumas women suffer are often related to the traumas experienced by the men in their lives. But men in these cultures are reluctant to talk about them, so the problem goes untreated."
Hassan – whose name, like Arbaz's, has been changed to protect his identity -- told Sandhya that he had been a darji, a tailor. He was born to a Kurdish family of seven siblings in Afrin, a land wild with olive groves known as "liquid gold" in northern Syria.
"I had a normal life," the 32-year-old refugee said. "After my marriage, I stayed with my wife and children."
That changed in 2006 when Syrian President Bashar-al-Assad's forces pulled Hassan from his shop and out of his normal life. He was detained in a secret prison for his "political activities" and his quest for a new life began.
Upheaval in the lives of refugees like Hassan can cause trauma that manifests in ways having profound effects on both refugees and the countries where they settle.
Sandhya said psychologists know that when no constructive outlets are available for mental anguish, symptoms can emerge as what they call "somatic" pain, or pain related to the body and distinct from the mind.
"Somatic pain can manifest itself in many guises including malaise or chronic bodily aches, but has no diagnosable medical cause," she explains.
Further disguising the problem is that these trauma manifestations may be shaped by culture, so they deviate from the typical ways Americans, for instance, may experience PTSD, Sandhya said.
"Salvadoran female civil war refugees can suffer from "calorias"-- a perception of intense heat in their body. For Cambodians, it is sometimes manifested as hallucinations of vengeful spirits," she said.
Headaches, Sandhya learned, was how Syrian men here are experiencing the phenomenon.
"I have huge headaches. I feel sad but I don't cry . . . I am living with men and I cannot have them see me cry," Hassan said.
"Have you spoken to Aliya and Imran since you left?" Sandhya asked, inquiring about Hassan's children.
Rubbing his temple, Hassan replied, "I have a headache. I am sorry. I want to tell you more… but I cannot."
Another coping mechanism is unwavering faith. Many refugees credit Allah with their survival. Yet another is dissociation, a term psychologists use to describe the separation of normally related mental processes, which results in one process functioning independently from the rest.
"It is a coping mechanism to help the person continue to function in the aftermath of emotionally traumatizing life events," Sandhya said. She sees it regularly when refugees tell their stories, describing horrific events in anodyne, emotionless ways.
Arbaz told his story as if he was reading a telegram; short declarative sentences delivering horrifying news and ending abruptly.
"I saw little children take pictures of the war, of dead corpses."
"People were being flagellated, strung up as chickens with their flesh torn up."
Even before he turned 13, four of Arbaz's siblings died, lost to bombing and Taliban attacks. When he was 16, another sibling died. His parents, unable to cope with their misfortune and without treatment for their own trauma, died in quick succession, grief-stricken.
Left out of his retelling was any description of his own horror at having witnessed such events, the terror he must have felt under constant fear of death, or the heartbreak of watching his parents die.
By the time a refugee arrives in a host country, he has spent an average of $9,000, traveled through six countries and many cities, endured two years of intense hardship, and attempted unsuccessfully to settle in a safe haven at least twice. But, most significantly, he has likely witnessed repeated brutalities to family members, loved ones and traveling companions.
"What an outsider might see as a casual acceptance of death is the brain coping with overwhelming trauma," Sandhya said. "Dissociation limits and alters the access to intense sensory and emotional memories that would otherwise inhibit basic functions."
While this protective mechanism alters the impact of terror on our bodies, it does so at the price of silencing victims whose experiences are vital to understanding the effects of trauma. Sandhya recommended that refugees be encouraged to share these traumatic episodes both for their own health and for their successful integration into their new communities.
Through her study, Sandhya said she hopes to gather knowledge of civic innovations that lead to more successful integration with less conflict. She said the lessons can be applied to refugee settlement in the U.S.
While there are misgivings among the general public about the level of resettlement in Germany and a growing political backlash, Sandhya said that everyone from the most senior elected officials to the caregivers in the refugee centers were united in their unwavering belief that the experiment will succeed. Frequently, the commitment is quite personal; many Germans involved in the resettlement efforts are married to immigrants or are immigrants themselves.
But their efforts on behalf of the refugees can be suspect. In their home villages, many were told that Germany is a dangerous place where Muslims were unwelcome. Rania, an 8-year-old from Syria, at first refused to believe one of the center's workers was, in fact, German.
Rania said to her, "I can't believe it because you smile all the time."
This article was published on US News' website on February 15, 2017.