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The surprising challenges of reintegration after trauma

Posted on 06-27-16 in Coping, Mental Health, Trauma

The surprising challenges of reintegration after trauma

The premise is disturbing. After surviving what most people have not or cannot, you came out alive. Your life was at stake every minute of every hour, death in your peripheral and insanity at your heels. But as abruptly as the trauma began, you are brought out. Suddenly your long-lost loved ones are staring you face-to-face in the free world.

Often, the hasty return to mainstream life is as difficult as enduring the initial trauma. For the U.S. military, there’s an adjustment period right after coming back from combat to American soil and before going home to family: demobilization transition.

No such help for the 63 kidnapped Nigerian girls who escaped their Boko Haram captors and returned home. Nor for more than 10,000 solitary confinement U.S. inmates released directly into mainstream within a 12-month period. For these displaced individuals, a similar transitional reintegration could have restored their lives.

Outcasts in their own homes

A militant group trying to overtake northern Nigeria has been abducting girls and women in the country. Schoolgirls, wives and mothers were kidnapped, raped, and forcibly married to captors. Most are still missing. For the traumatized females who escaped or returned to their villages, an unexpected horror met them: rejection by family and community members.

According to a UNICEF report titled “Bad Blood,” many females conceived or returned pregnant after rapes. In addition to post-traumatic stress disorders, communities largely fear the women were brainwashed or will later manifest a Stockholm Syndrome-type zeal to kill or recruit others for Boko Haram’s cause.

Some of the impregnated females have abandoned or tried to abort babies from their captors. “The lack of livelihood opportunities for women … especially for those who have been rejected by their husbands and separated from families, has reportedly created destitution. Some women and girls have exchanged sexual activities for money.”

Solitary confinement

Here in America, prisoners are often moved from a completely enclosed and isolated cell, no larger than a home’s half-bath, to complete freedom. In fact, those who have served the entirety of their sentence have no parole officer overseeing their return to mainstream life.

Analysts in California and Washington enumerate up to a 35 percent higher recidivism rate for those coming from solitary confinement compared to the general prison population.

Forensic psychiatrist Terry Kupers, M.D., explains that “the longer prisoners suffering from or prone to serious mental illness are consigned to isolated confinement, the more severe their mental disorders become and the worse their disability and prognosis.”

After dozens of months or even decades in solitary confinement – such as the “Angola Three” prisoners who were freed after 29, 41 and 43 years in isolation – being thrust into mainstream life can be overwhelming. Such was the case with Kalief Browder, who committed suicide two years after returning home following a 17-month solitary confinement.

The world didn’t stop while they were gone

“Listen, something is going to slap you right across the face when you get home, within the first 72 hours, and it’s going to let you know that life has continued on in your absence.” That’s a word of caution from Col. Tim Newsome, during a demobilization briefing for troops who had just returned from deployment.

“Four-foot-tall children are now four and a half feet tall. Babies are toddlers. Teenagers are adults. Pets have died. Friends and family members have died. Life has moved on, and no one knows how to reconcile what ‘was’ with what ‘is,'” one military wife describes to the New York Times. Like a horrific case of jamais vu, response to changes can be more pronounced for returnees and longtime prisoners.

Demobilization as the model

In the last few decades, clinical advances in understanding PTSD have put the military both in the hot seat and on the pedestal for effective responses to natural mental health consequences of mayhem.

Though not surefire, the Department of Defense initiatives to reintegrate troops exposed to the crude and traumatizing realities of war is arguably the most comprehensive effort for displaced individuals in the world.

For a few days, troops undergo debriefing paperwork, health screenings, mental health assessments, and even allotted time to meditate on how going home could be hard. Soldiers are strategically given several hours of leisure time daily to mentally and emotionally unwind from deployment.

If the veteran is going to retire, there is a weeks-long reintegration inclusive of financial prep, therapy and family planning to mindfully enfold them in civilian life. It would seem the same proactive measures should be established for any demographics who have experienced trauma – as well as their loved ones.

The surprising challenges of reintegration after trauma

Tips and tools for reintegrating the displaced

  • Mindful practices to re-establish closeness. After all the trauma, it may seem insignificant, but seemingly simple practices to help loved ones and their displaced family members regain closeness can be gleaned from author Gretchen Rubin’s “Happier at Home”:
    • Greeting and saying goodbye to every family member as they come and go
    • Face-to-face physical affection (avoid ambushing someone with PTSD) every morning and night
    • Planning weekly one-on-one time, alternating between what each family member and the reintegrated member want to do
  • Mental Health Step-Down Unit. Kupers has conducted extensive research into improving the mental health outcomes for prisoners. In his data, he points to the court case Presley v. Epps, which resulted in measures to de-escalate serious mentally ill prisoners in solitary confinement with treatment not unlike residential outpatient care.“In the first phase, they learn about their illnesses and are educated about how to appropriately cope with anger, impulses, and anxiety. An incentive plan rewards appropriate behaviors, with incrementally more time alone in an activity room” where Kupers details they can practice self-directed alternative therapies. “Group treatment and psychoeducation permit interconnectedness among prisoners” in solitary confinement. “A group of four prisoners meet weekly for group treatment.”
  • Sensitization for the returnees. UNICEF explains the community stigma of Nigerian returnees “tainted with bad blood” and subsequent mistrust and marginalization point to the need for community education and sensitization workshops. To their credit, the bereft communities agree that the returnees will require comprehensive rehabilitation before returning home to avoid additional trauma.As mentioned in our expose on China’s leftover women, there are several therapy approaches for those ostracized by their community.
  • Warrior transition program and family involvement. In addition to demobilization and reintegration initiatives, the military hosts Warrior Transition Programs, which include family involvement education. This template could be utilized for the prisoners and returnees ahead of homecoming. Features include:
    • Providing emotional support and stability for the soldier
    • Supporting the soldier in achieving personal goals
    • Tutorial of available benefits and programs
    • Collaborating the soldier’s medical, vocational and psychiatric care

The Sovereign Health Group is cognizant that trauma is varied from one group to another, one person to the next. The only constant is the displacement that survivors feel upon their return to their lives. Therefore, we customize treatment for each individual, making rehabilitation tailored to each person’s mental disorder or addiction issues. Call our 24/7 helpline to learn more.

About the author

Sovereign Health Group staff writer Kristin Currin-Sheehan is a mindful spirit swimming in metaphysical pools with faith as her compass. Her cover: a 30s-something Cinderella breadwinner of an all-sport blended family. Her repertoire includes writing poetry, lifestyle articles and TV news; editing, radio production and on-camera reporting. For more information and other inquiries about this media, contact the author at