The Approach of Synergic Therapeutic Complexity with Involuntarily Dislocated people ** **
Renos K. Papadopoulos
 An earlier version of this paper was published in Italian: Papadopoulos, R.K. (2015) Trauma e processi di resilienza; un approccio psicosociale. Prospettive Sociali e Sanitarie, XLV, 2, 6-9. I am immensely grateful to Nikos Gionakis for all his work in translating and revising this paper from the Italian original into Greek as well as to Myrto Alampanou for translating it, then, into English. Finally, I revised and updated substantially both versions for this publication.
This paper focuses on trauma in relation to the refugee realities. In order to develop a comprehensive understanding of the relevant experiences it is necessary to articulate an appropriate framework, introducing some new concepts. The phenomena of people leaving reluctantly the spaces they consider ‘home’ are, tragically, too familiar through the media of mass communication and, consequently, tend to be viewed in stereotyped ways. Therefore, it is imperative to sharpen the precision of our language in order to avoid incorrect conceptualisations, and my explicit intention here is to develop an accurate terminology that reflects the complexity of the phenomena examined. Accordingly, I will attempt to reconceptualise key processes and phenomena, e.g. resilience, the phases of involuntary dislocation and the idea of homecoming .
To begin with, it is crucial to understand the key characteristic of the central phenomenon, i.e.that people abandon their homes against their will. It is for this reason that I introduced the term ‘involuntary dislocation’, toaddress the entire range of phenomena associated with situations that arise when people are compelled to involuntarily leave their home. This occurs when one abandon’s one’s home due to various types of upheavals: political, environmental, climatic as well as socio-economic. Here we should also include ‘psychological exile’ and other forms of social marginalization. However, although we need not to neglect the clear differences between the various forms of involuntary dislocation, at the same time, we should not forget their shared central characteristic. Obviously, it is a different experience, for example, for one whose home was destroyed by accidental fire from the experience of one who had to flee due to war; moreover, these experiences would be completely different from the realities of one who had to abandon one’s home community dueto one’s sexual orientation. It is important to identify both the similarities and the differences.
It is for this reason that instead of the usual term ‘forced migration’ or other similar terms I prefer the biblical term “apoikesia” (which I translate liberally in English as “Involuntary Dislocation”), referring to the movement away from home spaces with the implication of involuntariness. I borrow this from the biblical context of the ‘Babylonian exile‘(usually dated between 600 and 515 BC).
I argue that the characterisation “involuntary” is more appropriate than “forced” because physical violence is not always present, and the term “dislocation” as opposed to “migration”, because “migration” is a more generic term: “migration” is even used regarding birds, as a “natural” phenomenon, while the term “dislocation” describes more accurately the unique experience that a human being endures. In English, there is also a lexical analogy, e.g. a dislocated shoulder refers to a part of the body thatwas dislodged from its usual and habitual location, it creates a dysfunctionality and also causes considerable pain. Analogously, involuntarily dislocated people experience comparable forms of suffering and dysfunctionality, whilst always feeling out of place.
So, what are the fundamental features of this type of involuntary dislocation? I would argue: disorientation and a state of transition. A time of waiting and expectation interconnected with the desire to return to the place of origin. Indeed, the key question that people ask themselves is: how temporary is this situation? Some people have lived in another country for a long time and still say: “I thought I would stay for a couple of weeks and instead I have been here for years”. It is important to identify the key dilemma that is inherent in this type of dislocation. Do I have to adapt to this new place where I am now, or do I have to focus on the desire to return to my place of origin? Part of this dilemma is also the related question: Do I have to move to somewhere better?
These questions show that people experience being in a state of suspended transition: not knowing whether they belong to the place they are currently in or whether they belong to the place they come from. Not knowing whether they should accept the new situation and the new reality,or to continue being bonded to their old and familiar forms of ‘home’ in terms of language, values, traditions, and way of life. In other words: how can the ephemeral be accepted? It is not easy to live ephemerally.
Now, let us focus on the two moments and phases of the involuntary dislocation phenomenon. The usual understanding of dislocation suggests movement from one country to another because the place where one lived before is no longer safe, so one has to go to a safer place. However, an important clarification is needed: before a geographical dislocation takes place, we should discern another type of dislocation. Due to certain types of upheavals, people experience that the very spaces where they felt at home and safe and were familiar spaces now are experienced as being no longer safe. Our connection with a home space creates a sense of solid familiarity which also produces a sense of predictability. These are extremely important parameters that construct basic experiences of security, stability and constancy. And these are the experiences that alter radically as a result of the interrupting upheavals, resulting in the pulpable feeling of being dislodged from the very experience of feeling at home at one’s home. It is then that becomes clear that one has to leave. Therefore, this first moment of the experience of involuntary dislocation is the one in which the person loses the predictability of the familiarity of their safe space and no longer feel comfortable in it. Then, one becomes dislocated from the feeling of ‘I am at home’.
We could call this state as an “internal” or “psychological” dislocation, and it is the first and most important moment of dislocation. But it is more fundamental than just psychological; it is also existential – their beliefs, identity, their whole being feels “dislodged” from the previous predictable state. The second moment comes only after one feels dislocated on this “internal” level, when one no longer experiences their previously familiar space as home: it is at this point when one mobilises everything needed and moves on to the second moment of dislocation, i.e. the physical and geographical dislocation. Therefore, moving out and away from the actual building or geographical spaces is the consequence of the primary, of the initial dislocation and it is very important to distinguish these two moments. The concept of forced migration refers exclusively to this second moment, and the first one is not even visible at all.
My argument is that most of the difficulties that people experience are related to the primary dislocation. Another point that needs to be emphasised is that dislocation is a process and not an one off, fixed-time event. This process is part of a broader process leading from dislocation to relocation, the search for a replacement home.
Usually, in forced migration, three phases are identified: before leaving, leaving, and after leaving. More accurately, we must distinguish at least 6 phases of the process from dislocation to relocation.
(a) The ‘internal’ dislocation, i.e. When people no longer feel at home whilst being in their own home spaces.
(b) The physical, geographical dislocation: the involuntary abandonment of the familiar spaces people considered as their home.
(c) The search for a new home, a new sense of belonging to a place that can be safer than the previous one.
(d) The discovery and inhabitation of this new place.
(e) The struggle to settle in that new place, in a way to make it feel as home.
(f) The attempt to assign meaning to all these different experiences of home throughout this entire process.
In this last phase, a more specific struggle takes place in which the individual endeavours to grasp the inter-relationships between the previous familiar space, the current one, and the ideal. All involuntarily dislocated persons have a very real sense of an ideal familiar space, regardless of how explicit this may be. Accordingly, inevitably, they are confronted by at least three images of familiar spaces. The old familiar space, which existed in the past. The _ideal _ familiar space that everyone aspires to have, which can exert a facilitating and purposeful orienting function or a tyrannical and disheartening obstacle. This is because, on one hand, it inspires hope in people for a better home space, but on the other hand, the tendency to idealise it can also become a source of constant frustration. Finally, the _current _ home space, which often is experienced negatively, because in the light of the idealisation of the old or future homes the current one appears flawed and imperfect.
Keeping in mind these three forms of homes is an essential part of grasping the complexities of the involuntary dislocation process.
In The Odyssey , Homer offered us vivid and intricate images of homes, starting with Odysseus expressing his fervent desire _to see the smoke rise from his land before he dies. _ These words denote home not just as a building, but delineate a notion of home through two of its diametrically opposite constituent elements: ‘smoke’, which is the least tangible element, and land , in the geological sense of the word, i.e. the soil, the most tangible and solid earth. Thus, I would argue Homer proposes that we grasp home as the product of this unique combination of these two opposite elements: the most elusive and immaterial the most concrete and tangible parameters.
This is not an abstract reflection; this is the very reality of home. It reminds me of a PhD I supervised of a Turkish psychologist working with ethnic Turkish Bulgarians who had been expelled from Bulgaria and lived in Turkey. The research explored the nature of the specific bonds they had with Turkey and Bulgaria. In different contexts, each country represented for thema unique home space. Bulgaria was the home of their birth, where they grew up and had childhood memories, where they experienced the land, the climate, the landscape, the vegetation, the food, etc. Turkey was the home of their language, ethnic traditions, religion, culture, etc. Here we have two countries, two types of homes and two types of identities. It was remarkable to note how these people succeeded in connecting with both belongings of home. Whilst living in Turkey and enjoying the benefits of their “Turkish identity”, at the same time they connected with their “Bulgarian identity” by bringing actual soil from Bulgaria along with tomato seeds, growing Bulgarian tomatoes in Turkey in pots filled with Bulgarian soil! What an ingenious solution of combining the two dimensions of home! We could say that, almost literally, their soul was still connected with the Bulgarian soil whilst also enjoying their Turkish “homeland”.
This is exactly what Homer was conveying: the combination of the intangible element (represented by the link to the cultural dimensions) and the concrete link to the actual soil. The concepts of homeland and homecoming emerge from the unique and exclusive amalgam of these two parameters.
When children draw a home, almost always they draw it with a smoking chimney, regardless if they live in a block of flats. When Odysseus was looking for the “smoke” from his homeland, he was not looking for something abstract. The smoke comes out of the chimney, the fireplace, the hearth that in Greek translates as hestia . In Greek mythology, the goddess Hestia is absolutely indispensable. She tends to be present in most significant mythological events and yet she is virtually invisible, her presence always taken for granted. Home is always taken for granted, as the constant background, until one loses it. What does a smoking chimney? Essentially, that the place is inhabited and it is not an empty building: fire burning suggests cooking, i.e. food (nourishment), people gathering together (family, community), warmth and light (liveable space). All these provide the basic conditions for life and thriving, the space of home.
Refugees lose both their actual houses and home spaces (soil) as well as all the intangible, and yet, so real life-giving and life-sustaining ingredients – their cultural, linguistic, ethnic, historical, spiritual etc “homes”. Refugees as well as those who work with them find it difficult to grasp the complexities of these combinations and tend to focus either on their soil-losses or on their smoke-losses. Yet, what they are actually missing is their unique combination.
There are many connections between Homer's Odyssey and what I discuss in this article.
Odysseus is away from home for 20 years: 10 years of war and 10 years to return home, a clear symmetrical division of two halves. In other words, there are two distinct phases that we should be aware of: wandering and homecoming. The question is: when does Odysseus truly return to his homeland?
The colloquial understanding of the word “odyssey”, nowadays, refers to an “external adventure”, until the hero achieves his objective. According to this, we would expect Odysseus' return home to take place at the end of The Odyssey , with a neat happy ending that his odyssey was finally completed, embracing his wife, everyone celebrating his successful and long-awaited homecoming. But, as we know, this is not what happened: Odysseus arrives in Ithaca precisely in the middle of the epic. Another Homeric symmetry. So, if the goal was to “return home”, what happens to the other half of the book? Homer conveys very clearly that, in effect, there are two fundamental aspects to homecoming: to arrive home, and after we return, to rediscover and reconnect with that space and people making it real home. After arriving at Ithaca Odysseus must still rediscover his connection with his land, with his people, with his familiar spaces (not just physical and geographical but also relational, political, cultural, etc), and re-gain his place, fighting against all the obstacles. _The Odyssey _ ends with the brutal struggle to re-claim what he had lost. The last violent and bloody scenes dispel all superficial and simplified myths of easy and romantic homecomings.
Therefore, we can identify three types of homecomings: the first is the “external” odyssey, the experience when one struggles to reach one’s intended destination. The “second odyssey” would refer to the recovery, recreation and restoration of the interpersonal relationships with people within a social network but also with objects and places and narratives etc, and the “third odyssey” would designate an “internal odyssey”, which aims to re-establish a sense of an overall continuity and relevance that was initially lost. This means that when we consider the reality of home, the dimension of time must always be present in our mind: the past, the present, and the future. Moreover, in the context of involuntary dislocation there is not place without time and time without place; hence we should always think of spacetime! There is a constant dialectic between going back to the past as a place of origin, between the present in which we are now and our visions for the future. Home is not only the place of origin (back in the past) but also the fulfilment of our goals, desires and aspirations. When, finally, we achieve a certain goal (find the perfect partner, secure the desired job, etc) usually the feeling is that we have, at last, ‘arrived home’.
Considering all these complexities, involuntary dislocation inevitably engenders a sense of disorientation, pain and suffering, a sense of undefined bewilderment, and we must really pose the question: is ‘trauma’ really the best word to describe this highly complex phenomenon?
I do not object to the use of the term “trauma”. However, I am concerned about the inaccuracies that are created, nowadays, when this term is used. Instead, I have found that the term “nostalgic disorientation” which I have introduced, conveys in a more precise way the experience of people who are involuntarily dislocated, regardless of whether, in addition, they suffer or not from any actual psychological or even psychiatric disorders. When addressing situations from a mental health perspective, it is important to avoid inappropriate pathologization. The widespread usage of PTSD is most unfortunate because this refers to a very specific and serious mental disorder and not just to any general traumatic experience. Regrettably, this distinction has become extremely blurred with alarming consequences.
There is an important element in “nostalgic disorientation”: nostalgia. The word “nostalgia” has many meanings today. I use the conceptualization based on the Homeric meaning of the terms that compose it: nostos means returning home and algos means pain, suffering. “Nostalgia” refers to the pain that one feels in striving to return home. Hence, “nostalgic disorientation” is not a form of psychiatric pathology, but a human experience that results in a lot of discomfort and pain (even including clusters of debilitating consequences); however, at the same time, includes possibilities for revitalisation and transformation, as an inevitable consequence of establishing a meaningful sense of home.
The nostalgic dimension of disorientation in involuntary dislocation has two groups of effects. On the one hand, it complicates the process of home-searching, home-finding and homecoming by creating illusory or even delusional images of inappropriately concretised homes (past or present). The nostalgic urgency tends to form an over-concretisation of the dislocation-relocation process by tyrannically focusing on reified forms of “homes”. Without denying, of course, the legitimacy of appropriate requests by refugees for specific forms of help, refugee workers should be careful not to confuse them with seemingly magical solutions, which are products of the nostalgic disorientation. Experiences in the field provide us with endless examples when such repeated requests fail to quench the thirst for a settled sense of home and, instead, intensify increasingly more the nostalgic algos. In effect, what the involuntarily dislocated people are looking for is the (re)creation of a real sense of home which, as we saw, consists of the complexity of the unique combination of the tangible and intangible dimensions of home.
Elsewhere, I referred to the state that is nostalgically yearned for, as the state of “onto-ecological settledness”. This is a state of familiarity that is produced by the unique way that the totality of one’s being (i.e. physical, psychological, moral, spiritual, social, cultural, etc parts of oneself) connects with the totality on one’s experienced environment (human, natural, geographical, cultural, narrative, etc). This is what people had before they were involuntarily dislocated, and this is what they are nostalgically looking for. It is this unique sense of home (with all its complexity) that generates the sense of familiarity, stability and predictability and it is the absence of this that they feel acutely. This sense “onto-ecological settledness” is not for an ideal arrangement and it does not represent any state of perfect harmony. Instead, it is the working and dynamic arrangement of the different elements of the unique combination of home elements that a person becomes familiar with.
Defined in this way, nostalgic disorientation also can have positive effects insofar as it motivates people to look for and strive towards attaining appropriate forms of homes, providing an important source of refreshing energy.
The American psychiatrist, Jonathan Shay, studied the symptomatology and phenomenology of PTSD in US soldiers and came to understand that the psychiatric dimension is not appropriate to grasp sufficiently the complexity of traumatic effects on the human soul, when a person is at war. Accordingly, he introduced the term “moral injury”, understanding that it is not only the psychological part of people that can be traumatised but also their very moral fibre. All forms of violence are inhumane, but some tear down the very essence of humanity, e.g. when people perpetrate severe forms of violence or torture. There are countless stories of people who have testified about human suffering due to inhumane behaviour, such as Primo Levi. In these accounts, the limits of human understanding are stretched beyond comprehension, and these experiences cannot possibly be understood entirely as psychiatric phenomena.
The concept of moral injury is another example why we need to expand our understanding of trauma beyond exclusively psychiatric or even psychological terms. This is what the concepts of nostalgic disorientation and “onto-ecological settledness” provide: extending our horizons to grasp more precisely the experiential realities of involuntary dislocation.
What becomes essential is to examine the wide range of consequences when one is involuntarily dislocated. This range includes, most definitely, all the negative effects, e.g. pain, disorientation, as well as psychological disturbance and even psychiatric disorders, but also a lot of positive opportunities for substantial transformation, for a creation of new and appropriate home spaces, for more suitable forms of “onto-ecological settledness”.
The Adversity Grid
In order to provide a working framework to “create space” to conceptualise the wide range of adversity responses, I developed the “Adversity Grid”. It is a framework that tabulates the three possible categories of responses to adversity across four different levels, those of the individual, the family, the community and the wider society/culture.
A crucial clarification is needed: trauma refers to the specific effect an experience of an event has on a person and not to a characteristic of the event itself. We often confuse the event with the experience of the event. When we say that we have been exposed to trauma, we are expressing ourselves incorrectly. In fact, we are exposed to devastating or catastrophic events, which is more accurate to refer to them as “adversity”. “Trauma” indicates the way we experience and react to those adverse events. Undeniably, when we are exposed to adversity there are many “negative” consequences, and it is important, first, to distinguish their different levels of severity. Not all negative effects are of equal severity. The most serious consequence is when a person develops mental (i.e., psychiatric) disorders, and PTSD is the most common one. However, not everyone who is exposed to adversity, especially those engendered by involuntary dislocation, develops psychiatric disorders. Others, develop various types of psychological symptoms that do not amount to a diagnosable form of a psychiatric disorder. I call these “distressful psychological reactions”. Finally, it should not be forgotten that the overwhelming majority of people who are exposed to various forms of adversity, experience another form of negative effects that does not fall under the psychiatric disorders or the psychological symptoms, but can best be characterised as “ordinary human suffering”, which is the least severe form of the negative consequences when one is exposed to adversity. “Nostalgic disorientation” would be one form of this type of suffering.
In addition, the reality is that people, regardless of how severely they have been affected by an adversity, always they also retain some of their existing strengths and weaknesses, which they had before their exposure to adversity. This means that we should not only attempt to identify in what way people were changed by the adversity but also to discern what aspects of theirs (characteristics, functions, qualities, relationships, etc) remain unchanged.
Resilience and Adversity-Activated Development
All the strengths (i.e. characteristics, functions, relationships, etc) of a person, of a family, of a community or of a society that did not change as a result of the exposure to an adversity, in effect, were resilient to that particular adversity. In the literature there are many definitions of resilience. The definition I propose here is not based on any abstract theory but on the empirical findings of what can be observed and experienced in the adversity survivors. According to this definition, a person is not resilient or traumatised in a generalised and impressionistic sense. Instead, we can only say that resilient are those specific characteristics or functions, qualities, etc of a person, family, community or society which were identified as having been retained, despite the exposure to adversity. Resilience defined as a global and undifferentiated state or characteristic lacks precision.
Moreover, all people who survive any form of adversity, in addition to all the other negative changes and unchanged characteristics, also they experience various forms of positive changes. According to the saying that “whatever does not kill you makes you stronger”, everyone who survives any adversity also benefits from some positive life transformation. I termed Adversity-Activated Development (AAD) this category of positive responses to adversity. It refers to all those new strengths (e.g., positive characteristics, abilities, qualities, etc) that did not exist before the exposure to adversity and were activated precisely because of the exposure to that particular adversity. Every person develops new strengths from exposure to involuntary dislocation adversities, in addition to and regardless of all the other negative changes and unchanged characteristics. Having been battered by severe forms of adversity, people’s lives are shaken and re-oriented to new and more appropriate directions. They pause and they are troubled by new and awkward questions about what the purpose of their life is, questioning previous ways of being, etc. One significant characteristic of AAD is the new awareness of the importance of many wholesome aspects of their lives which previously they used to take for granted, e.g., their family relationships, their good health, etc. There are endless examples of AAD, when people review their previous ways of being, appreciating the new chance that they now have and adopt new and more appropriate attitudes to life, upgrading their values and overall cherishing life in a new and fuller way.
The Adversity Grid helps us discern all consequences of adversity, both the negative and positive as well as the unchanged one. This enables us to have a clearer and more realistic grasp of the complexity of the involuntary dislocation effects, thus avoiding the tendency to polarise and see either the negative or the positive consequences, which is the tendency that the distressful situations create. Rhetorically, I say that “he first casualty of trauma is complexity”, which means that under the pressures of traumatising experiences people tend to lose complexity and they end up exhibiting polarised perceptions and conceptualisations with regard to everything about these phenomena, e.g., seeing the survivors as either “traumatised” or “resilient”, experiencing themselves as either omnipotent or impotent, perceiving authorities as either “on our side” or “against us”, etc. Under severe forms of adversity, it is not only our psychological world that becomes injured but also our very epistemology. That is why I speak about “traumatised epistemologies” and “traumatising epistemologies”, when we are overwhelmed by the distressing situations and all we see are the negative effects of the adversity in us and everywhere else, lacking the epistemological agility to discern the three categories of adversity consequences.
Synergic Therapeutic Complexity
Ultimately, the Adversity Grid enables us to develop a truly holistic view of the people that we work with, freeing us from perceiving them exclusively as trauma caricatures in a mono-dimensional way, ignoring their three-dimensionality. Moreover, by enabling us to perceive them stereoscopically in their complexity, uniqueness and totality, as full human beings with their retained strengths (i.e. resilient functions) and their newly acquired strengths (i.e. AAD), in effect, the Adversity Grid provides a genuine form of empowerment, because we can then identify their strengths so that we can collaborate synergically with those strengths.
It is for these reasons that I termed this approach “Synergic Therapeutic Complexity”. As we have seen, the Adversity Grid framework enables caregivers to discern the complexity of effects that the adversity has on their beneficiaries, and by communicating this to the beneficiaries in a therapeutic way (which means conveying this to them using the appropriate language and manner, and at the appropriate time), caregivers can join synergically their own strengths with those of their beneficiaries. This is a different approach from the usual one that the caregivers are the experts imposing on their beneficiaries their own theories and their own plans of what they think is good to their beneficiaries.
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Papadopoulos. R.Κ. (2019b).Trauma and Umwelt . An Archetypal Framework for Humanitarian Interventions. In Maercker, A., Heim, E. &Kirmayer, L.J. (Eds.) Cultural Clinical Psychology and PTSD . Göttingen: Hogrefe.
Papadopoulos R.K. (2020). The traumatising discourse of trauma and moral injury: distress and renewal. In Papadopoulos R.K (Ed.) _Moral Injury and Beyond: Understanding Human Anguish and Healing Traumatic Wounds. _ London & New York: Routledge.
Papadopoulos R.K. (2021). _Involuntary Dislocation: Home, Trauma, Resilience and Adversity-Activated Development. _ London & New York: Routledge.
Papadopoulos, R. K., & Gionakis, N. (2018). The neglected complexities of refugee fathers. _Psychotherapy and Politics International, _ 16(1)
Shay, J., (2010). Achilles in Vietnam: Combat trauma and the undoing of character . New York: Simon & Schuster.
Shay J. ‘Moral Injury’ Video of Dr.Jonathan Shay at the Narrative Medicine VA Workshop, March 9, 2012, Columbia University Medical Center, https://www.youtube.com/watch?v=XBkCg6_ISpQ
For a more detailed elaboration of the concept of ‘home’ see Papadopoulos, 2002,2005, 2018,2021.