A note to readers: This article contains descriptions of mental illness and suicidal thoughts.
This piece was originally published in Arabic here.
A phone call
I stood on an iron-fenced bridge and looked down on a branch of the Rhine River, which flowed through what looked like a small valley. Rocks and stones waited at the bottom.
I knew this place well. I had been visiting this city for months by this point, to follow up on my refugee papers and matters related to the refugee camp where I was still living. I also wanted to spend some time in a place that looked like a real city. This particular city was more than ten kilometers west of the camp.
My cell phone suddenly rang: my girlfriend, calling from Syria. I saw the rocks, then my phone, which kept ringing, then the water. I looked around. No one would care about a young man standing on a bridge, holding his cell phone in one hand and the cold iron fence in the other. My phone still rang.
Finally, I answered it and spoke to my girlfriend. And although we broke up some time after that day, it was her who persuaded me not to jump.
But when the call ended, I found myself afraid of the bridge’s height. I had wanted an end to my depression and my existence in the dreaded refugee camp, to put an end to the memories I was so tired of carrying. But I was afraid of death.
Eventually, I walked back to my room in the refugee camp; 13 kilometers in the rain. My roommate asked what was wrong, but I couldn’t answer. I took a hot shower and went back to my bed to silently cry myself to sleep, as I did on many nights.
I have never been able to forget that day. Whenever I go through moments of weakness and deep depression—a term my doctor later used, along with "psychological trauma," to describe my case—I remember standing on the bridge.
I was not alone. Many of my friends and acquaintances, Syrians who had left the country after 2011 and moved to Europe, face similar problems. Adapting to this new environment has not been easy, as most of us were forced to flee to escape Assad’s dictatorship and the ongoing war.
Syrian refugees are asked to integrate into new societies as quickly as possible, to join the labor market and to become producers rather than dependents. This means learning new languages, developing skills, finding a job and being upstanding citizens—all at record speed.
This logic completely disregards the stressful new living conditions and psychological needs of Syrians in Europe, not to mention the symptoms of anxiety and other conditions they develop out of fear for their families back in Syria.
So, recently, I posted a series of short questions online via Facebook, targeting a random sample of Syrians who had arrived in Europe after 2011. One of the main questions was whether people believed they were suffering mental illness related to war, exile or asylum. Of the 120 people who answered this question, 92 responded with “yes”:
Aghar Jadid, a Syrian psychologist in Berlin, told me the numbers seemed reasonable.
“I see this in the people I meet,” he said. Many of his patients are Syrian, recent arrivals to Germany.
He stopped short of referring to the ailments reported by my respondents as mental illnesses, though explained they are likely having “difficulties coping” with life in exile due to traumatic experiences in Syria, or perhaps the new environment they must adapt to.
“New things they experience in life may trigger old memories,” Jadid said.
‘Heavy memories’ in Belgium
At 35 years old, Artino has experienced war injuries, multiple surgeries and arrest by the Syrian government’s much-feared security forces.
After a knee injury in 2015, Artino left the embattled East Ghouta suburbs of Damascus for Lebanon. He had worked in East Ghouta as a photojournalist for Reuters, and as a relief activist. The work was difficult. It forced him to witness near daily violence and traumas. They coagulated into what he now calls a “heavy memory.”
From Beirut, he moved to Belgium through a United Nations program. He carried his memories with him from East Ghouta.
In Beirut, Artino suffered severe depression, he said. After arriving in Belgium, he tried to seek psychological help, so he went to the government’s asylum authorities, as well as social affairs authorities, but they didn’t appear to show interest in his condition. His mental health worsened. He grew nervous and violent, suffered panic attacks and could not tolerate loud noises.
He eventually found CGG Vagga, a mental health outpatient facility in Antwerp subsidized by the Belgian government, and saw a psychotherapist for two years. The treatment was offered in return for a small fee: €4 per hour. A PTSD diagnosis led to a PTSD specialist, then another physician, then, finally, medicine prescribed for depression.
Seven months later, Artino feels he is improving. He wanted to share his story publicly, he said, as many other Syrians have gone through similar mental health struggles.
“Psychological cases like mine, though they are usually an individual [struggle], are considered collective for Syrians, because [so many of us] have experienced the same events,” he told me.
Rana al-Sayah, a psychoanalyst in France who also works with Syrians, agreed, adding that based on her experience, many Syrians now living in Europe “are still suffering from the effects of trauma."
I also asked people whether they had considered turning to a psychologist or medical clinic for help. I received 109 responses:
Though a large percentage answered “yes,” many Syrians still said they overlook their psychological conditions, oftentimes until they feel the physical effects.
Bassam is a 40-year-old Syrian man living in Berlin. He preferred that I refer to him using a pseudonym to protect his privacy.
He went through periods of loneliness and social isolation after arriving in Germany in recent years. His mental suffering turned into physical pain, backache, weakness and difficulty moving, in addition to his fear for the future, panic attacks, insomnia and nightmares of being detained in Syria. The nightmares were tied to painful memories: Bassam had been arrested twice in Syria before leaving for Europe.
Doctors weren’t sure how to treat him, until he was able to visit a hospital in Berlin that had Arabic speakers on staff. They finally understood Bassam when he explained his symptoms. Afterwards, he received support from programs set up to provide psychological counseling to refugees.
Rana al-Sayah, the French psychoanalyst, told me: “those who resort to psychiatric clinics [often] include people who have been affected physically, cannot sleep, suffer from phobias, anxiety and insomnia and [sometimes] hear voices.”
“Due to the lack of awareness of psychological matters in our society, only a few people seek help and recognize the need for it,” she added. “There is a stigma surrounding mental illness, and many families prevent their children from going to psychiatric clinics. They only go to therapists when they start having suicidal thoughts.”
Jadid, the psychologist in Berlin, shared al-Sayah’s concerns over a lack of “psychological culture” in Syria, including little confidence among Syrians that treatment might work.
“The sentence I commonly hear [from potential patients] is: ‘If I sit down and talk to you about it, will my problem actually go away?’”
Al-Sayah and Jadid summarized several main reasons that prevent Syrians from walking into psychiatric clinics, or seeking out help from psychoanalysts and psychologists.
- The lack of a “psychological culture” in Syrian society, the lack of confidence in therapists and the fear of social stigma if their friends and family find out they are receiving treatment.
- Language. Language is a major barrier for Syrians residing in Europe, with many patients needing an interpreter alongside the psychoanalyst or counselor. However, the presence of a third party can impact the process of building confidence and a safe environment.
- Lack of organizations working with refugees specifically on mental health. In France, according to al-Sayah, psychiatric centers often turn away potential Syrian patients, as there are no specialized programs that can cater to them. As for the psychological sessions offered online or by organizations in Germany, these are often too short to offer adequate support.
- Organizations often face poor management problems and a lack of adequate funding or staffing for psychiatric treatment projects. Psychological aides are usually volunteers with different backgrounds and skill sets.
- The financial cost of psychotherapy, as health insurance does not usually cover such treatments, which hinders the ability of refugees with low incomes to seek help.
I feel the best way to conclude here is simply to cite Jadid. He told me: “The solution, in the long run, is to increase social awareness about mental health.”
*A note from the author
While reporting this piece, I received numerous messages and I met many people who shared details about their lives and what they had suffered psychologically. Had it not been for their trust, I would not have been able to write a single letter. I would like to specifically thank a man called Captain Muhammad, whom I do not know and have never met in real life. Muhammad sent me a lengthy message in response to one of the questions that I posted on Facebook while preparing this article:
Would you like to share any thoughts related to this subject, or share your personal experience?
Many people answered this question. In his own message, Muhammad told me numerous details about himself and his life. I would like to dedicate this article to him, even though I do not know him, as an expression of my gratitude for the stories he shared with me.