Jakob Prousalis
„We still have some pioneering to do.“

Bombs, a knife attack in the club, sexual abuse - catastrophic experiences that can trigger a psychological trauma. Experiences that a person cannot process directly and therefore tries to suppress. A trauma is the body's subconscious protective reaction to it. The brain is on permanent alert. It can take up to four weeks for the experience to be processed. During this time, sufferers often have nightmares, suffer from anxiety. With three to eight percent of these sufferers, however, the condition becomes chronic. Anyone suffering from post-traumatic stress disorder (PTSD) has nightmares and flashbacks for years. Images remain linked to emotions and repeatedly trigger stress. People with PTSD feel constantly confronted with danger, which affects their brain, their thinking, feeling and acting in everyday life.

Whether someone suffers from PTSD depends on their own so-called "resilience" but also from how often someone has had a catastrophic experience. After 25 or more episodes, PTSD is even inevitable, as researchers at the University of Constance found out.

20 percent of the population in northern Uganda, for example, are ill with PTSD after living within a civil war for 20 years. But other factors also support the development of PTSD - such as the uncertainty of their residence status. People who come from a crisis or war zone and are still in the asylum process, for example, show more symptoms than refugees who have already been recognized, according to a study by Cambridge University of asylum seekers and fugitives dating from 2015.

A special level of PTSD is the "complex PTSD". Those affected have been traumatized for a long time and then suffer additionally from so-called concomitant diseases: You are addicted, depressed, have an eating disorder or even physical pain. People who have left their homeland because of their sexual orientation are often complexly traumatized, says Psychotraumatologist Jakob Prousalis. He is a member of the Society for Psychotraumatology, Trauma Therapy and Violence Research, and looks after traumatized LGBT* refugees for the Berlin Gay Counseling Service.

Mr. Prousalis, who are the people you deal with on a daily basis?
The people I work with have been exposed to various traumatic stress over years. They come to Germany from politically unstable countries or regions, but they were traumatized even before they fled: Because of their sexual orientation, the family rejected them, society marginalized them or even imprisoned them for a while. Refugees with an LGBT* background project these experiences and experiences of violence - also on an emotional level - onto their own identity, which changes as a result. Above all, sexual orientation and gender identity are sensitive factors in the development of a person's personality.

How do you recognize a psychological trauma?
Often you can't see them. But they remain wounds. A mental trauma is a severe form of self-injury. A lot of people don't know they're affected. It is an excessive demand on the psychological protective mechanisms through war, maltreatment, exclusion. Our body and brain have the ability to resist such traumatic experiences - some people are more resilient than others. But the longer the body is exposed to mental stress, the harder it is to resist it. Time is therefore an important factor.

What is the problem with the treatment of traumatized refugees?
Many refugees have very poor psychiatric connections and care. I observe it over and over again. Frequently, however, traumatization is not recognized at all or is minimized. Only recently, someone came to me who was sent away by a doctor with the note: Adaptation disorder. Some fugitives even say, "I'm fine," although that's not true. Displacement and shame are important characteristics for traumatization - and a strain on the body. Because it remembers what it has experienced. We were able to observe this after the Vietnam war and both Iraq wars: The soldiers returned, initially worked normally, but then gradually a number of concomitant diseases of PTSD occurred that classical medicine could not explain.

What must happen in order to be able to help those affected better?
First, the trauma of each individual must be recognized as such. For refugees with an LGBT background, it is particularly important to stay in so-called "safe houses". A little money, a roof over your head and primary asylum counselling are important, but they are not enough. Above all, people want clarity about their residence status. As soon as they know whether they can stay in Germany, therapy can help them find out who they were before they fled, who they are today and who they want to be in the future.

Why do we know so little about the traumatization of LGBT refugees?
Psychotraumatology is a very young science. Especially in advising LGBT refugees, we still have a lot of pioneering work to do, always doing some fundamental explaining: What's a trauma? What connection to psychosocial care do traumatized people need? And why is a person's sexual identity a particularly vulnerable factor? We need more professionals, psychotraumatologists who know and understand that a person with a trans-, inter- or other gender identity has completely different needs than another traumatized person from a crisis area.

Text & interview: Maria Christoph
Illustration: Franziska Romana