Project Untangled: A Journey of Hope and Healing

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PORTRAIT OF A PSYCHIATRIST

–Series Editor: H. Steven Moffic, MD

At the tender age of 6, after losing my 14-year-old sister to brain cancer, my dream was to become a neurosurgeon. I would, however, faint every time I entered the operating room, pushing me to my true calling-taking care of emotional needs. I was meant to work in psychiatry. It is my delicious cup of tea. There is nothing I love more than healing invisible wounds, mending broken hearts, wiping children’s tears, and helping families build bridges of trust, open channels of communication, to reconnect and heal. Here is how I got there.

Psychiatry born from trauma

In July of 1999, I was returning home from a typical day of work as an emergency department physician in my hometown of Benghazi, Libya. I found my father waiting at the front door. He handed me cash and urged me to flee the country immediately. He discovered that my name had ended up on the government’s “blacklist” because of my humanitarian activities and psychosocial work with trauma survivors and their families. Confused and heartbroken, I had only minutes to say goodbye to my family. I never thought it would take me 12 long years to return to my home country, under very different circumstances, trying to help heal the wounds of war and interpersonal violence.

I crossed the Mediterranean in a boat, eventually landing in the United Kingdom. The judge rejected my application for asylum due to “lack of evidence for physical torture.” That theme-to ignore the psychosocial impact of forced displacement-struck me as I continued my journey to the US and became a psychiatrist. Many people dismiss mental anguish and emotional pain as “real” out of ignorance and stigma. Stories of trauma are often hidden behind closed doors and eventually morph into the elephant in many of our rooms.

In February of 2011, I was horrified to learn of a bloody war on the streets of Benghazi. Unable to reach my family, I felt like I was losing my mind. When I finally got hold of my mother, she told me that “orders came to wipe out the city.” I was certain I would lose my whole family to genocide. Mom told me that she loved me and was proud of me-we would meet again in paradise. The voice of my mom and what I thought were her last words haunted me in my dreams-I understood what PTSD must feel like.

I asked my wife and three children to let me go on a medical mission. With heavy hearts we said our goodbyes, not knowing if we would ever see each other again. I was fortunate to connect with Medical Teams International, a nonprofit organization in Portland, Oregon, that provided me with about half a million-dollars’ worth of medications to take with me.

I took multiple flights and entered Libya through the border in Egypt. The minute Mom saw me, she almost fainted, I last saw her in 2006 in Egypt where she was undergoing treatment for a minor heart attack, and she now looked decades older-a result of the war. I delivered the medications and spent some time working on psychosocial education, training, and capacity-building. The physical wounds were prevalent, and there was too little attention paid to the emotional wounds of trauma and its impact.

Since then, I have been to Libya seven times, working on multiple healing and reconciliation projects. We have used dialogue to bring people on both sides of the conflict together, to grieve and to heal together. Play and art therapy with orphan and traumatized children was the most rewarding experience of my life.

Storytelling: a powerful therapeutic tool

Trauma survivors need to be heard. I was blessed to graduate from the Harvard Program in Refugee Trauma (HPRT) where I learned valuable skills on how to care for refugees and victims of violence. The sacred and private experience with traumatized individuals plays a major part in nursing wounds and mending hearts.

We can do a lot of damage if we fail to listen to patients’ stories. This brings to mind one young woman admitted to my unit who was prescribed antipsychotics for schizophrenia. When I asked her about the nature of the voices, it turned out that she was reliving the memory of “hearing” two women screaming as her father drove drunk and killed them in a car crash. At a young age, she told herself to find the families of these women and apologize on her father’s behalf. It turned out that the diagnosis was indeed PTSD. Ultimately, treatment of therapy combined with a short course of medication management significantly lessened the voices.

In another case, a Syrian boy witnessed his father shot by a sniper, rendering him quadriplegic. The young patient made progress in therapy but continued to fidget with his fingers. When I asked him about it, he shared that he feels like the man of the house now. He massaged his father’s hands every night, and the fidgeting ritual was his way of taking away his dad’s pain.

Most of my work focuses on family bonding and youth empowerment. A theme common to refugees is the family dysfunction caused by trauma and forced migration. Parents often work long hours and more than one job to provide for their children. A young Somali boy was extremely anxious because his father was leaving for work at 6 am and coming home at 12 midnight, seven days a week. Although he provided materialistically, his child’s emotional needs went unfulfilled (an example of losing the American dream while chasing it). These are but some cases of many.

Self-care

Working with traumatized children and their families and caregivers is an extremely rewarding but emotionally laden and exhausting experience. Violence is ugly, and it leaves heavy and long-lasting imprints on the psyche. Many trauma survivors do not enjoy their life due to their daily struggles with memories in the aftermath. Wounded healers are no exception. For psychiatrists, self-care is vital to prevent vicarious trauma, commonly referred to as burnout or compassion fatigue. We cannot care for others unless we take care of ourselves first. Healers need to know their limits and be assertive and mindful not to carry a load heavier than what they can realistically handle.

In addition to my loving family I use academic writing as a means of catharsis, which helps me cope with the graphic stories I hear of atrocities and the dark side of humanity. My wife and three daughters are the driving force behind the work I do, and they are also heavily involved in the refugee cause.

In October of 2016, I was heartbroken as I flew to Benghazi to spend one final week with my mother in the ICU before she died. I was glad to be next to her in her last hours. I am very much a mama’s boy-she is the one who made me who I am today. She told me to stay busy mending broken hearts. If I cannot be the source of someone’s joy and delight, I should never be the cause of their pain and distress. Rest in peace Mom; I hope to make you proud.

Concluding thoughts

My goal is to help untangle the deadly web of dysfunction and to break the cycle of trauma. I founded Project Untangled (https://projectuntangled.org), a model of psychosocial care for refugees and trauma survivors to help families bond and empower the youth. The objective is to celebrate inner strength, culture, coping styles, and resilience, so they become an active part of the solution rather than part of the problem. Untangled helps heal traumatized individuals, families, and communities through education and training, providing access to safe spaces and culturally sensitive resources and clinical care.

Disclosures:

Dr Reda is a psychiatrist at Providence Health & Services, Portland, Oregon.