“The Recovery from War Trauma Requires an Entire Society”

One hundred years after the première of Wozzeck, the inhumane treatment of vulnerable people is still recognisable. Are the psychological mechanisms of war trauma still the same today?
Geertrui Serneels: “Yes, I think those mechanisms are inherent to human beings and therefore timeless. Trauma arises from a life-threatening event: something unexpected in which you lose control and experience danger. Our stress system then automatically switches to fight, flight or freeze. In post-traumatic stress, that system remains, as it were, constantly switched on. Memories remain very acute and sensory and force themselves upon us through flashbacks and nightmares, among other things.
In trauma therapy, we try to transform these so-called ‘hot memories’ into ‘cold memories’: memories that are given a place and a time and that you can recall yourself when you wish. The neurobiological stress response is universal, but the way post-traumatic stress manifests itself may differ culturally. Refugees, for example, are more likely to present physical complaints. As a result, they often first end up with a GP or paediatrician, while post-traumatic stress may be present underneath.”

“War damages basic trust in other people and in the world” 

Does everyone who experiences war also develop post-traumatic stress disorder?
“No, experiencing war or other traumatic events does not necessarily mean that you will develop PTSD. What war does affect in everyone is basic trust: trust in yourself, in other people and in the world. This is something universal and forms the basis for further development, taking initiatives and building relationships. War can seriously undermine that fundamental trust.”

Can the society in which refugees arrive make recovery more difficult?
“Certainly. I think that is one of our greatest problems today. If, after their flight, people are confronted once again with hostility and exclusion, their environment continues to feel unsafe. Not only does this make the original trauma more difficult to process, but new wounds may also arise.
Do you remember the Chilean refugees who arrived here after the fall of Pinochet? They were welcomed as heroes, even in Parliament. That creates a very different climate, in which people feel welcome and recognised and have more space to process their trauma. That is a fundamental difference from a society in which refugees are told that they are a danger, that they should return, or that they are taking our jobs. The social climate can therefore greatly promote recovery, but can equally stand in its way.
At the same time, we must be careful not to approach refugees solely through the lens of victimhood. Experiencing war trauma does not mean that you cannot work or go to school. On the contrary, these activities provide structure to your day and help you build a future perspective again. Together with the refugee, we need to look at what is still possible. It is important that we help them broaden their identity once more so that they do not continue to identify exclusively with their wounds.”

“Trauma is not passed on automatically”

Trauma can also affect families and subsequent generations. How great is that impact?
“We distinguish between intergenerational and transgenerational trauma. Intergenerational trauma is passed from parents to their children through upbringing, behaviour and attachment. In transgenerational trauma, that impact continues across multiple generations.
Traumatised parents may find it more difficult to provide their children with the safety and predictability required for secure attachment. They may be more irritable, withdraw, or be less emotionally available because of depression. The way they communicate about their trauma also plays a role: some children hear too many details, while others grow up surrounded by a silence that is difficult to understand. This, too, can influence a child’s behaviour and development.
Trauma is not passed on automatically. Children are resilient and various factors play a role. But untreated PTSD can have consequences for future generations.”

What role does Solentra play in this support?
“Solentra emerged around twenty years ago from the child and adolescent psychiatry department of UZ Brussel. We noticed that children with a migration background found it more difficult to access mental healthcare. The main barriers were language, cultural differences, the stigma surrounding psychotherapy and the complexity of the support needs. In addition to war trauma, there are also issues such as loss, grief and the challenges of building a new life.
Today, we work with more than 30 psychologists across four locations in Flanders and receive more than 1,500 referrals every year. We combine specialised transcultural trauma treatment with a community-based approach. We also involve schools, care professionals and other social actors so that they learn to work in a trauma-sensitive and culturally sensitive manner and help build a safe future perspective together with the refugee.”

“We often lose sight of the person behind the refugee”

In public debate, refugees are often presented as one large, anonymous group. What effect does that image have?
“The dehumanisation of refugees is a real risk today. We no longer see the person behind the label and, moreover, we lump together different groups, such as labour migrants, people without legal residence and recognised refugees.
The refugees I know are incredibly courageous people. They have experienced terrible things and yet still find the strength to seek safety, above all for their children. They want to make a fresh start and contribute something to society. But the dominant narrative is often that they are taking our jobs or coming to take advantage of social security. In that way, we lose sight of the person behind the refugee.”

What role can art and literature play in processing war trauma?
“Art can help in two ways. Therapeutically, creative activities such as painting, drawing and theatre can promote emotional regulation. People once again experience that they are capable of doing something, gain greater control over their emotions and are able to take distance from their experiences.
In addition, art has an important social role. It can tell stories and make the person behind the refugee visible. In this way, it helps counter dehumanisation and gives a face to the anonymous masses. That is particularly important today.”

Have we learned anything at all one hundred years after Wozzeck?
“We certainly understand the mechanisms of war trauma much better and have also developed better ways of recognising trauma, treating it and supporting people in their recovery. During the First World War, the focus was mainly on ‘shell shock’, initially attributed to the physical impact of exploding shells. It later became clear that soldiers without direct exposure to explosions could also develop such symptoms. It was therefore primarily about the psychological impact of war experiences. PTSD was only recognised as a diagnosis in 1980. Today, we have scientifically validated treatment methods and know much more about the impact of trauma on both body and mind.
Nevertheless, we should not view trauma purely as an individual issue. A traumatic response, especially war trauma, is a normal reaction to an abnormal event. We must therefore also take the social context into account. Recovery requires not only individual treatment but also connectedness and recognition. People need to be able to find a place and purpose in society again. You cannot do that alone; you need others.”