Through our therapeutic practice we acknowledge the fact that the treatment of trauma is a chronic and painful process. The biopsychosocial disorganization that usually affects the individual causes erosion to the core of his/her existence and to the systems he/she belongs, while it penetrates into the future generations if it remains untreated. This case study explores the traumatic experience of refugeeism from a male perspective and how this impact is transferred intergenerationally. Through the clinical case of a man who is the descendant of a family of refugees from Asia Minor, his family’s lost homeland and the significance of this loss on the formation of his own personal family and male identity are being explored, while at the same time perspectives of understanding emerge which interpret and process the refugee trauma which can be utilized in the present.
Key-Words: intergenerational transmission of trauma, refugeeism, silence, lack of internal cohesion, loss of male identity, redefinition of self.


   In this difficult period of rapid economic and geopolitical changes mental health professionals face phenomena and situations which did not consist of a common part of the everyday clinical experience and practice up to now. Many of our colleagues who work in the front line with Syrian refugees come face-to-face with the primary refugeeism trauma and therefore feel frustrated as they are unable to meet the needs of this vulnerable population (particularly men) adequately.
   In Syria, the publication of a guide entitled ”Self-help booklet for men facing crisis and displacement”* is characteristic, as a psychosocial support action for those men who live in inaccessible areas whilst their lives are threatened. According to the description of the booklet, the primary purpose is to help men understand the causes of stress they may experience, while proposing ways to address it, taking into account the relationship with their wives and children. The booklet highlights that there are several actions that support the female population but none for men, who are in great need as they face unprecedented issues such as the loss of their traditional role and are reluctant to seek help.
   The humanitarian crisis brings in the horizon social inequality, poverty, unemployment, immigration and refugeeism, challenges that we have to approach and manage with empathy, sensibility and great sensitivity. The lens of our focus is called upon once again to go into wide-angle mode to include and clarify the widespread confusion and uncertainty and connect these challenges with our past and bridge them with the future.
   For many peoples, including us Greeks, all these distressful phenomena are not unprecedented or unfamiliar. Having experienced poverty, immigration and refugeeism during the last war, we can feel the pain, the sorrow and the uncertainty of those who have experienced traumatic events. Through our own losses, the reverberations of which are still part of our everyday lives, we have the opportunity to explore how a collective traumatic event is filtered, metabolized and finally absorbed on individual, family and social level (Pomini, 2011).
   But how deeply must a traumatic event of the distant past be registered in order to be transferred to the next generations? What are the conditions that favor the transmission and keep the trauma alive? How can the pain, the helplessness and the humiliation that were experienced by the ancestors re-emerge and overwhelm the lives of their offspring? How do men manage the losses and trauma?

The conditions that maintain trauma

   The initially unsupported hypotheses that the offspring are affected by the traumatic experiences of the parents or by their own exposure to a stressful situations, are now greatly supported by continuous research based on surviving descendants of the Holocaust and other socially vulnerable groups such as the Veterans of Vietnam, the Aboriginals of Australia and Canada, the Armenians, etc. (Denham, 2008; Evans-Campbell, 2008; Felsen, 1998; Hirsch, 2001; Kellerman, 2001; Kupelian, et al. 1998; Robin, et al . 1996; Stamm & Stamm, 1999; Whitbeck, et al. 2004; Wiseman, et al. 2002).
   The collective trauma can have profound intergenerational effects which are not easily observable and measurable, while its maintenance and transmission depends on many factors which act either accumulatively or in coordination, not having the same impact on all people.
   For example, the degree of sadness and shock in the individual and social identity of the descendants of the second and third generation differ from that of the first, while variables such as age (Rosenheck & Fontana, 1998), gender (Parsons, et al. , 1990), the seriousness of the event (Danieli, 1998), family structure and the existing relational family interaction patterns (such as emotional closeness of the family members), functional management of the difficulties, existent social skills, adaptability to change, previous traumatic experiences (Breslau, et al. 2008), resilience etc., play a key role in the management and healing of trauma.  Furthermore, the prevailing socioeconomic conditions, governmental policies, historical influences and the natural environment play an important role in the transmission of the collective trauma.
   It is therefore not surprising that we encounter a wide range of theoretical approaches which seek to illuminate the complex phenomenon we are examining, while there are many different terminologies that try to explain the process of transgenerational transmission of trauma. Miller, Stiff and Ellis (1988) identify it as an ‘’emotional contagion’’, Dixon (1991) talks about ‘’peripheral victims’’ while Albeck (1994) describes the descendants survivors as “having acquired scars without trauma”.
   Focusing on refugeeism trauma, Tata Arsel (2014) refers to the primary refugeeism trauma which temporarily disconnects the person from his individual and social identity while it upsets his internal cohesion and coherence.
    The primary trauma, which is experienced by the first generation, includes the violent expulsion from homeland, losses, social exclusion in the new place, despair, etc. According to Janoff-Bulman (1992), these multiple blows that the individual goes through, e.g. posttraumatic stress disorder, emotional deregulation, fear, the sense of hovering, the loss of life control, social relegation, subjection of the person to psychological exhaustion, leave him vulnerable to new potential risks.
   The Turkish-Cypriot professor of Psychiatry Volkan, V.D. (1997), having thoroughly explored the importance of massive traumatic events and how they are transmitted intergenerationally, claims that the impact of collective trauma to the victimized population and their descendants can continue for decades, contaminating their offspring with the experience of shame, humiliation and helplessness experienced by their ancestors.
   Volkan (2001) broadens the importance of collective trauma by introducing the concept of “chosen trauma”, according to which the trauma takes the form of an obsession by those who experienced it. He argues that the victimized population suffers not only from the losses but from the inability to defend and give value to themselves by utilizing existing social or political strategies that could help them. The traumatized members of a big group, because of their inability to mourn their losses after experiencing a shared traumatic event, and because of their failure to reverse injury and humiliation, tend to internalize an unstructured anger which in the future can take other, equally dramatic dimensions, both individually and collectively.
   Indicating the unprocessed pain that most of the victims of the first generation of a collective traumatic event have experienced, Wardi (1992), having worked with the second generation of Holocaust offspring, says that in most families she came across a child who was functioning as a “memorial” candle for the deceased. She highlights that the victims enclose their experiences as a closely guarded secret, while their inner emptiness, mental disorders and the pain from humiliation and violence are transferred to their offspring. Descendents must, in turn, carry this heavy load in order to lighten their parents’ trauma.
   With this transfer of roles descendants become victims, as they have inherited their parents’ fears and frustrations, carrying all these feelings to their own children, that is, the grandchildren of those who survived. Accordingly, grandchildren are the new victims. Hence the processes of identification and internalization are some of the mental processes through which the trauma of parents can be transmitted to their children (Bandura, 1977).
   Silence, as a means of avoiding and repressing the revival of a painful situation, is an aggravating condition that favors the maintenance and transmission of trauma. The difficulty in verbalizing emotions, a predominantly male characteristic which prevailed because of dominant social structures and stereotypes, is an insurmountable obstacle to the healing process of trauma. Because for centuries male identity was driven by self-control, endurance and self-sacrifice, the conditions did not allow emotional maturation.
   Obtaining status, purpose and meaning through specific roles and behaviors, men did not develop skills in personal and interpersonal issues, such as openness in communication and reflection (Barbaliou, 2014).
   How does a man feel when he loses his dignity under inhumane conditions whilst norms and social stereotypes are being reversed, or when he loses his power and the control over his life? What feelings does he experience when he is humiliated in front of his family or fails to meet the obligations of the male role?
   In the case of male refugees, where stability is overturned, gender roles are compromised. Man stands weakened, helpless and exposed to violence, danger and threat, failing to protect or take care of himself and his family. Prior roles and functions cease to exist, while his male identity is wounded deeply because of his inability to meet his basic obligations.
   In the complexity of the conditions that favor the intergenerational transmission of trauma, the biological factor with the inheritance of genetic material is considered significant, too. Frightening memories and fears are transferred through the biological structures of the body (Perry, 1999). According to growing research evidence (Gapp, et al. 2014; Nestler, 2016; Rodgers, et al, 2015; Yehuda, et al. 2015), the traumatic life experiences of the parents and their exposure to stress are passed to the genetic material of their offspring, affecting the biological, cognitive, behavioral and psycho-emotional condition. In this intergenerational epigenetic inheritance, the genetic transmission of trauma takes place through environmental factors which are capable of causing changes in gene expression.
   The biological factor should not be ignored or underestimated in the therapeutic process as it may explain many of the implicit behaviors and memories of the traumatized individual. Taking into consideration the plasticity of the brain, it is important to understand that trauma is registered and stored in the cognitive (cognitive) and emotional memory, while it accompanies the individual throughout his life. The neurobiological response of the human body to threat, in which all areas of the brain and body are organized to ensure survival, suggests that a traumatic experience can alter the function of the brain in an acute way for years, even for a lifetime (Perry, 1999).

Case history

   The trauma of refugeeism and the treatment of healing will unfold through the story of Elias, a forty-five-year-old  father of two boys. Elias first came to see me twelve years ago upon the request of his wife who held him responsible for the crisis in their marriage and was accusing him as ‘incapable’. When the couple finally divorced, he no longer had a strong motive to continue and thus stopped. He came to see me again a few years later, because of the challenging behavior of his adolescent son, who was involved in delinquent actions and had a negative attitude towards his father, expressing it through degrading words as well.
   Fearful, vulnerable and emotionally weak, Elias struggled to create meaningful relationships through his role as a father and husband. Considering himself unworthy to be loved and appreciated, he used to keep a passive and fatalistic attitude, avoiding dealing with his difficulties. He believed that he had no control over his life and claimed that all of his choices had been wrong. This helplessness affected him so much that he was ineffective in his work, while in his personal life he was experiencing depreciation which as a result made him feel constantly exhausted emotionally and physically: “I feel so powerless that I find it hard to do even the simplest things” he used to say, hiding his face into his hands. In addition, he was expressing his fear towards men’s rejection through his interaction with them. His helplessness, his inability to express his feelings and his difficulty to name his personal needs and desires eventually created negative expectations for the future, while they constituted additional risk factors operating negatively towards his mental health.
   According to his narration, he was raised by a family whose emotional environment was full of tension and negativity. It seems that the alienation of parents, which enclosed frustration, loneliness and disappointment, was vented by frequent quarrels between them. His mother, although an assertive woman, often reminded him of how unhappy she was, while in non-verbal communication she kept demanding of Elias to relieve the sorrow of her unaccomplished dreams. His father, on the other hand, was a reclusive man, who seemed to be deeply depressed. He was emotionally and physically unavailable to Elias and treated him like a stranger, which involved talking to him many times in a degrading way.
   Elias was feeling like a persecuted son, who was running to escape from the unexpressed anger and bitterness of his distant father, living in an ambiguous and confusing environment. It was difficult for him to understand his symptomatic behavior, which held him captive and confined. In his family history, there was one component that he talked proudly of during his genogram interview. More specifically he mentioned the existence of a great grandfather, a rich landowner from Smyrna (Mc Goldrick, 1999).
   Elias’s fragmented ego had created a dreamland in the distant past from which he obtained strength, in other words a shelter that served as a positive reference point in his life, something that is often encountered in the first generation of refugees. According to Tata Arsel (2014):
«[… ]It is a cognitive reconstruction that helps the individual’s self-preservation. The propulsive nostalgia for a particular time and place reinforces the feeling that the refugee belonged somewhere, even on a imaginary level. He feels that he belongs somewhere and thus reconstructs the continuity of his ego. The cognitive mechanism that nourishes hope and nostalgia is the creation of associations and images, with the hero, the individual who imagines himself in a better past. His ‘’constructed’’ past is enriched through imagination and placed into a future the way he wishes it to be. In this way, imagination fills the gap of the lost continuity and helps the individual to maintain his self-esteem and strive for his self-preservation. These mechanisms don’t allow him to reject himself as unworthy of acquiring a new homeland ” (p.171).
   Exploring the origins of his family history, from his father’s side, some important information came up.

The distant past

In the past history of his family, his great grandfather lived in Smyrna, Asia Minor. He was a man of great wealth and high position. In the Asia Minor disaster of 1922 he was massacred by the Turks, having managed to save his family by getting them on a ship to Greece. His wife and three sons, one of whom was Elias’s grandfather, made it and ended up on an Aegean island, the birthplace of some distant ancestors.
   The only knowledge that Elias had concerning the history of his ancestors came from the few stories of his father and some relatives. According to them, his grandfather went into farming and strove hard to make his own fortune. He married a young refugee woman and had six children with her. His eldest son, Elias’s father, degradingly known on the island as “the son of a refugee”, worked the land with his father since he was a child. When he reached the age of twelve, his father took him out of school and obliged him to work with him. He considered it as the only means to survival and salvation and he seemed to follow, in an unconscious way, the footsteps of his own landowner father in an attempt to reconnect with his roots and regain the lost prestige.
   When Elias’s father became an adult he went into an arranged marriage with a local woman from a socially respectable family with a strong moral code. He was known by his wife’s name (Frosini’s George). George was a weak, silent man of no initiative who vented his unprocessed anger and humiliation on Elias, often calling him by a humiliating name that indicated he was not his own son.
   The ‘lost homeland’ ‘for Elias’s grandfather, apart from the loss of his own father and the loss of his property, signified something deeper: the loss of his cultural, personal and male identity, elements that seemed to have passed into the subsequent male generations of his family. The psychological effects of this uprooting were enormous. His dignity and self-esteem were challenged in the new land. The ‘crossing over’ from one country to another happened in a violent and inhumane way. From the son of an aristocratic family he ended up an orphan, a farmer and also totally humiliated: For the local community he was ”the refugee”, and he failed to save his own son from the same derogatory designation (”the son of a refugee’). According to a story Elias had heard, his grandfather used to relieve his pressure and discomfort by doing the donkey’s work, drawing water from the treadmill by himself.
   His negative emotions seemed to have remained locked deep inside. The conditions and the restrictions imposed by social stereotypes did not allow him to grieve his losses or share his pain. Thus, although he ultimately took roots in the new place, found a job and created his own family, he did not manage to be released from the weight of his unexpressed emotions, while he remained in the position of the expelled without moving towards a substantial transaction and interaction with the local community. This silence was transmitted to his son, who in turn transmitted it to his own son, Elias. Within such an emotional environment, the internalization of a new identity, the one of the refugee, overshadowed all others, making it resistant over time. The shock from the effects of uprooting and the humiliation he experienced remained untouched, were internalized and gradually evolved into self-pity, weakness and helplessness, while they were transmitted on to future generations (Peterson & Seligman, 1984).

The therapeutic process as a safe place for exploring and healing trauma

    In the beginning of the therapeutic process, Elias described himself as a man who has been abandoned, who felt unable to survive, expressing the fear that he would die alone and helpless. “I feel like I’m down in a deep well. I am trying to come out into the light but I can’t make it” he said sadly in a group session. Active listening and empathy for his repeated dramatization played an important role in creating a therapeutic context in which he would be allowed to share his unstructured feelings without any judgment. Through unconditional acceptance he gradually began to realize the extent of his depression and dysphoria from which he wished to be released.
   Realizing all this, Elias tried to join the pieces of the puzzle of his own life in order to gain a complete picture of himself and his male identity. Therefore he began to ask his father about the history of his family of origin. His father’s response was limited to the following few words: ” Let it go, stop looking for answers… ” and then silence followed. Father’s resistance to open up and share important pieces of the family history filled Elias with sadness, while at the same time it rekindled the paternal rejection.
   This lack of narrative memory expressed by his father was brought and processed into the therapeutic procedure. It was bridged with his grandfather’s disconnection during the traumatic event, which may have been a protection from retrieving the traumatic experience. Elias realized that he had inherited the emotional disconnection and discontinuity of the family history from his father and that he grew up trapped in a closed family system where while memories were fading, the shadows of the tragic past of his family were present and defined his future.
   According to Figley & Kleber (1995), there is no need for an individual to witness a traumatic event in order to suffer from its effects; sometimes it is enough to simply know about it. Being exposed to that knowledge, the individual may have to deal with feelings such as agitation, fear and helplessness. The secondary traumatic stress, as it is called, refers to those behaviors and emotions that arise from the knowledge that a family member has experienced a traumatic event. In the second and third generation trauma is transformed, leaving sensitivities that impact lives and relationships.
   A typical example of the revival of the traumatic experience of refugeeism in Elias family is the constant reminder of the degrading designation ‘tourkosporos”, which encloses the historical humiliation the men of the family suffered by the Turks ninety-four years ago. In this way they reproduced in their own relationships the dishonour and abuse their ancestors suffered, devaluing themselves and their dignity.
   It seems that generations make an unconscious effort to resolve the trauma in a very paradoxical way: on the one hand his father tries not to remember, on the other he constantly projects it onto his son.
   Individuals who have experienced trauma seem to expose themselves over and over again to situations that remind them of their original trauma. According to Freud (1896), this compulsive repetition is the victim’s unconscious desire to gain control of the situation. Other clinical studies suggest that these individuals are found to be possessed by inconspicuous concern, emptiness, boredom and stress when they are not engaged with their trauma, and thus to miss other different experiences in their lives (Van der Kolk, 1989).
   During the therapeutic process Elias described another condition that concerned the weak bonding among the members of his paternal family. More specifically, his father’s emotional detachment from his family seemed to be what significantly influenced the lack of cohesion, solidarity and care among them. When Minnuchin (1974) referred to disconnected families, he highlighted the fact that they fail to respond to stress effectively; members receive little or no support and they do not have any skills in solving difficulties. The parent is absorbed by his own pain, thus he does not have the emotional availability or the energy to spend quality time with his own children. His need to keep a distance from his family protects him from the discomfort he feels.
   Family therapy aims to support the traumatized individual, when he feels emotionally prepared, to bring out the repressed trauma along with the suffering that accompanies it, in order to process it and finally integrate it into his identity. This is a long process, as it is necessary for the individual to express his mourning and losses verbally over and over again, in order to detoxify the distressing feelings and no longer dominate his thinking and actions (Tata – Arsel, 2016).
   The therapeutic process comprehends the dimensions of the trauma and takes into account the factors that favor its transmission. It also creates opportunities to restructure and restore individual and family emotional story (White & Epson, 1990), giving a new meaning to the symptom (Alexander & Parsons, 1982, Byng-Hall, 1999).
   Elias continues to struggle with the shadows of his past as they emerge in all phases of his life. Several times he sinks into an ocean of ambivalent emotions where he underestimates himself and questions his ability to manage his life. Although he has found a job he really enjoys and which fits in with his talent, he is still thinking of leaving it, undermining once more his autonomy, as he is already facing financial problems which bring him to an impasse. In these difficult moments, the therapeutic process takes care and heals his traumatized part, strengthening and reinforcing his healthy and positive parts. Moreover, it reminds him that his journey from the lost homeland is no longer hopeless and without orientation as he now owns a map and a compass.
   Elias seems emotionally awakened every time he receives support and care. In his effort to replace the despair of the past with hope and optimism for the future, he invests in the relationship with his son. Although his son calls him to get close, if only through his negative attitudes, Elias responds positively to his needs, talks with him, accompanies him in his sport activities. His paternal role activates him to cultivate this new part of him, unknown until now, which seems to give meaning to his existence. At the same time Elias states that he feels relieved as he has been reunited with his past. Trying to redefine his cultural identity, he reads the history of Asia Minor and shares with the therapeutic group his readings about customs and traditions from Smyrna.
   Elias’s journey from the lost homeland of his family of origin to the search of his own ‘lost homeland’ is long and painful but it is continued, constantly obtaining new meanings. In his attempt to heal his trauma, Elias, begins to recognize that his male identity, his self-esteem and his dignity have to rely on a different value system, which will be irremovable. Having realized that his father refuses to break the silence of the trauma and accompany him towards life, he seeks his male strength in the paternal role, focusing on his father’s virtues. He highlights the sensitive and creative parts of the men, while his fear of rejection gradually ebbs away.
   He is capable of connecting parts of his life with the previous traumas of his family and begins to tell his personal story with empathy and cohesion. He is introduced to taking responsibility for himself; he acquires a different sense of belonging and expresses his feelings. Elias redefines by giving a totally new meaning to his life, with the “return” to a different homeland, something stable which is his deeper and essential self.


   Working with individuals who have experienced traumatic events, it is most important to support them by understanding and empathising, showing them our humanity. Knowing that the process of trauma in the therapeutic procedure passes through multiple phases, let us be ready to confront the internal ambivalent forces of the traumatized, where one part of him/her wishes to be saved and live and the other one wishes to be lost forever, so as to no longer remember the pain and the suffering he/she experienced. Let us accompany him/her with respect in this long journey of redefinition and meaning of his life. In the case of men, let us not forget that in situations of danger and threat, such as the violent displacement from their place of origin and residence, they also need to face the loss of their male identity, which needs to be redefined in new terms in their new living conditions.

 Self-Help Booklet for Men facing crisis and displacement.



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