Child Psychopathology. What is Abnormality in the Syrian Refugee Context in Lebanon?

Table of Contents

The University Experience

The Work Experience

Conclusion

References

I started working with children four years ago following an advice from my psychoanalysis professor in the Lebanese university. I had told him that most of the available jobs were with children and that I abhor working with children. He said a few very meaningful words that stuck with me till today. He told me that when you work with children you will understand the meaning and pure manifestation of each emotion separately. He added that after I work with children, I will be able to classify adult reactions based on their child counterpart. For example: someone that cries while hiding their face is experiencing a different emotion from someone that cries with their eyes open (Robinson & Kivlighan, 2015).

There might be different reasons why you would be reluctant to work with children. It could be a lack of contact with children (if you didn’t grow up with younger siblings for example), or because of the early responsibility it lays on your shoulders at a younger age (people working with children usually start their careers with them). In the end, I think that -like many other entry career people- working with children grew on me gradually.

I mainly worked with mixed groups of children: refugees, host communities, migrants and sometimes street and working children (Surgical and mental health sectors). It was imperative according to “Crisis Response Standards” to classify these children based on the Inter-Agency Response Guidelines pyramid. The pyramid (IASC, 2008) was an intervention-based classification in humanitarian settings:

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Working with a population that had no previously studied data was perhaps the greatest challenge (especially with my little experience). What is abnormal!! Who needs what and when? How should the concept of child protection be integrated into our work? As psychosocial facilitators, are we in the protection department or in a healthcare department? When is cultural sensitivity real and necessary and when is it just another term for accepting child abuse? If the laws contradict the science, what do you follow as a professional?

All these questions are still very vivid in my mind. I may have come to letting-me-sleep-at-night answers for some of them, and other more mature answers for others.

The University Experience

Being a Syrian refugee studying in a Lebanese university had its own racist burdens on these topics, but I won’t get into that. However, during the four years of college that I’ve had in Lebanon, I’ve had many professors show us gestalt shapes, inkblots, thematic apperception tools, and even internet memes to illustrate to us how different our perceptions can be. One the most famous class internet trolls was a picture of a dress three years ago that some people saw as blue and black and others saw as gold and white (Lupkin, 2015).

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An hour after we talked about the dress controversy with rigor, the psychopathology professor enters the classroom next. We take out our DSM 5 (Diagnostic and Statistical Manual for Mental Disorders) and burden our desks with the 7-kilo book. Dozens of diagnosable disorder categories are outlined with each one ending with “Not- otherwise-specified… etc.”. These “Nosses” (meaning halves in Arabic) represented to us a half diagnosis based on inconclusive info. The Nosses were sometimes demonized as tools for over diagnosis and over prescription, but I always saw them as a testament for human diversity that can’t quite be captured with statistics.

A fair question presents itself: Are people with NOS disorders abnormal to the power two? Or are they in a middle ground between normal and abnormal? In other words, are they abnormal for not conforming to the statistically dominant symptoms of everyone else, or are they closer to normal since they exhibit traits that aren’t as similar to “abnormal” people?

The Work Experience

As previously mentioned, we had some constructs to help us detect abnormality based on the required intervention in each case (The pyramid). These constructs were mostly used with a case-by-case attitude and opinion as a guiding principle. Cultural sensitivity was a huge challenge too.

One example is physically abused children. The science or “the civilized world” would say something along the lines of how physical abuse is an abhorrent behavior that harms children on the short and long term. It’s especially bad since children can experience physical abuse as an act of deliberate humiliation on the parents’ part. However, I found myself surrounded by entire groups of children physically abused on a daily basis. If the definition of “normal” was whatever all or most people feel or act like, then physical abuse was normal and raising children without it was the abnormal.

I tried to examine the behavior and attitude of these children more closely, and I could observe their relationship with physical violence and what emotional charge was associated with this violence. Initially, I saw patriarchal behavior, skewed male-female relationships between these kids, clear-cut older to younger hierarchy. Then I started seeing violence being used for humor. Amongst each other, physical violence didn’t always seem to bear a negative emotional charge. It was the verbal abuse that seemed more of a cause for problems between those kids. As if they underwent a normalization of physical abuse.

Another observation that I learnt on the side was that children from lower socio-economics status are likely to be spoiled too. Perhaps, boys more than girls.

It is worthy to note, that sometimes my multi-national co-workers (and myself at times) have underestimated the universal notions of normalcy. We saw so many differences between our idea of normal and what is considered normal in our target population that we dismissed the notion altogether. Which proved to be a mistake in on several occasions. Basic human emotions are very likely to be universal (Crivelli et al, 2016) and we know that psychopathology has been consistent in its forms (not epidemiological findings) throughout many different countries and cultures since books like the Diagnostic and Statistical Manual of Mental Disorders are used in most countries.

This led to bad practices, under-referral, and inappropriate attitudes. One of the examples is the belief that child marriage is acceptable since the culture allows it. This belief ran rampant between relief workers, even though we had every physical tangible evidence to believe otherwise.

Conclusion

One of my favorite things in most books about abnormal psychology or psychopathology is the recognition of personal feelings towards the thought, behavior or emotion at hand. As well as the practicality in our day and age to determine if this behavior or thought is harmful to others. However, when it comes to measuring the harm induced, we need valid scientific statistical tools. Because otherwise, abnormal studies will turn into a fascist tool to control and shape people based on economic benefit, rigidity of tradition, state control, or simply just magical thinking.

Therefore, we need one of two criterions for the abnormal: personal discomfort (it could be the discomfort itself not the thought or behavior), or a well-established harm-to-others quality.

References

Crivelli, C., Jarillo, S., Russell, J. A., & Fernández-Dols, J. (2016). Reading emotions from faces in two indigenous societies. Journal of Experimental Psychology. General, 145(7), 830-843. doi:10.1037/xge0000172

Inter-Agency Standing Committee (IASC) (2008). Mental Health and Psychosocial Support: Checklist for Field Use. Geneva: IASC.

Lupkin, S. (2015). White And Gold Or Black And Blue: Why People See the Dress Differently. Accessed from: https://abcnews.go.com/Health/dress-people-viral-outfit-colors-differently/story?id=29268831

Robinson, N., Hill, C. E., & Kivlighan Jr., D. M. (2015). Crying as Communication in Psychotherapy: The Influence of Client and Therapist Attachment Dimensions and Client Attachment to Therapist on Amount and Type of Crying. Journal Of Counseling Psychology, 62(3), 379-392. doi:10.1037/cou0000090

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