Physicians For Human Rights: Dr. Eddy Ameen
In this, the second installment of “Evaluating Asylum Seekers,” Sampsonia Way speaks to Dr. Eddy Ameen, a licensed professional counselor who works as a volunteer in Physicians For Human Rights’ Asylum Network program.
A young woman from Honduras was forced to join a violent gang; a young woman from El Salvador faced multiple domestic abusers. Neither of them had found solace through their own government’s protection, so they decided to flee to the United States in hopes of survival. They didn’t know each other, but they shared similar struggles, including symptoms similar to Post Traumatic Stress Disorder, like insomnia, a sense of alienation, and flashbacks. These symptoms often manifest both physically and mentally in an individual—and are common experiences when adjusting to displacement and the aftermath of trauma.
While they were not conscious about sharing those symptoms, and maybe didn’t know about the existence of one another, upon arriving in the States they were both attended by the same physician, Dr. Eddy Ameen, who evaluated their cases and backed up their claims in court.
Dr. Ameen is a volunteer for Asylum Network at Physicians for Human Rights (PHR). Though he recently started at the organization, the Asylum Network has provided forensic evaluations for asylum seekers for over twenty years. In that time his colleagues’ evaluations have helped many asylum seekers be granted asylum or protection from a foreign government. Last year, they did over 400 evaluations altogether.
Aside from being involved with PHR, Dr. Ameen is the Assistant Director of the American Psychological Association of Graduate Students. Before this, he provided therapeutic services to unaccompanied, traumatized immigrant youth in detention in south Florida. After completing training and an extensive mentoring process, Dr. Ameen was prepared to begin work through PHR’s Asylum Network.
In this interview Dr. Ameen discusses the process of evaluating asylum seekers, the symptoms of trauma that they face, and what the average person can do to help those in exile.
The PHR website states that its counselors determine whether or not the injuries sustained by an applicant are consistent with the account of his or her personal experiences. In what ways do you determine this?
The psychological evaluation adds credibility to the client’s story; I am an additional party that independently interviews the client and reports on my findings to the court. Furthermore, I have the ability to determine the causes, nature, and severity of a client’s symptoms. Then I compare the story that the client tells with that report of symptoms and the history of functioning with such life experiences. I speak to the way that these factors align, or don’t align, in every report.
Volunteers also write affidavits for asylum seekers in court. What is this process like?
The affidavit is like a psychological evaluation that you might receive from your own doctor, although it’s written in a standard legal format. First, there is an establishment of my own skill-set and credibility, followed by a generally chronological narrative of the client’s pre- and post-torture functioning, as well as details about the relevant circumstance for which the client is seeking asylum. It’s concluded by a discussion of the client’s mental health and an assessment of the items I described previously.
How long do you work with each asylum seeker before the case is taken to court? What is the hardest part of this process?
A thorough interview can take two hours, or it can take six, or eight. It depends on the level of trust that the client establishes with the evaluator, as well as their readiness and comfort in engaging in detail about torture and trauma, and the amount of history one must cover to do a thorough report. The process of synthesizing that information and writing the affidavit can take several hours, and consultation with additional parties (attorneys, the youth’s family, therapist, school, etc.) can add additional time. An option that is strongly recommended is that evaluators also agree to participate live or via telephone in the client’s court hearing. (I have yet to do this.)
Many people in exile often experience symptoms similar to those diagnosed with Post Traumatic Stress Disorder (PTSD), including flashbacks, a sense of alienation from others, insomnia, and depressed or suicidal thoughts. As a therapist, have you noticed any patterns like this across the asylum seekers you’ve worked with?
Trauma seems to be a common factor in asylum seekers’ pasts. The way that trauma is manifested in psychopathology in an individual is determined by a complex set of factors. Often, when the individual cannot process the trauma, he or she relives it and it wreaks havoc on one’s body and mental state. The phenomenon most closely descriptive of this experience is known as PTSD. Not every client has PTSD, even when they’ve endured significant trauma. And not every individual with PTSD acts, functions, or copes in the same way. That is the diversity of life that evaluations try to uncover to inform a client’s case.
What are some other symptoms that might not be as obvious, and how, in your experience, do they manifest in the asylum seeker’s daily life? How should the asylum seeker deal with these symptoms?
PTSD is one of the few diagnoses that actually connects cause and effect. However, if you draw a Venn Diagram with ‘history of trauma’ in the middle, it would be connected to just about any other progressive diagnosis in any western or non-western index of disorder. Trauma’s course in an individual’s life is incredibly differentiated from person to person. Symptoms that cause pain or dysfunction need to be examined in a constellation, in relation to trauma.
As to how someone should deal with trauma, I would suggest that a good evaluation and evidence-based treatment with a culturally competent mental health provider can go a long way in providing a foundation upon which a client can build a way out of the darkness.
How do teenagers manifest the aforementioned symptoms? In comparison to younger children, how do they adjust psychologically?
In my opinion, symptoms in and of themselves aren’t terribly different across the life-span. Teens have the ability to articulate what they are feeling and develop a language-based relationship to the traumas they have endured; this is useful (but not essential) in diagnosis. Often, a younger child will act out the trauma but not have a vocabulary to comprehend it. Some researchers say that the earlier, the more severe, and the more chronic the trauma was, the more it will pervade someone’s well-being. That’s not always the case, as there are a host of protective factors that each individual may have or develop.
If you could change U.S. policy to help improve the lives of asylum seekers, what would you change?
I am not yet well-versed in asylum policy, but I do not believe the detention system for undocumented immigrants is humane, nor does it reflect the sort of immigrant society that once was America’s emblem of pride. Somehow in our political history, we’ve gone astray and treated people as illegal, instead of treating them as people.
What can the average citizen do to help spread awareness about these cases and why is it important to remain educated about asylum seekers and the trauma they face? How do you think immigration plays a role in this?
No one is completely removed from the plight of immigrants. There are three ways to help: The everyday citizen would benefit from reflecting on the level of integration between immigrant and native groups that he or she facilitates or inhibits in the workplace, the neighborhood block, the barbershop, the schoolyard, the town hall, the local newspaper, and any other public or private space. Where there is the potential to raise up the immigrant family next door, and to dispel common myths that keep groups marginalized, there is also an opportunity to claim that responsibility as one’s own.
In my own life, particularly when I’m volunteering, I’m very conscious about the role that trauma plays in someone’s understanding of the world and their safety in it. As a helping figure, I take a trauma-informed approach, which means that I work on the assumption that everyone carries some traumas through life and my job is to not trigger anyone’s primal fear system in the interactions I have or the questions I ask.
Finally, if you are a licensed mental health provider, MD, or lawyer, sign up with PHR’s Asylum Network to take on a pro-bono case here and there. If you’re not in any of these fields, share this link with someone who is.
What three recommendations would you give to organizations that work with asylum seekers or people in asylum?
I would encourage organizations to ensure that their clients have psychological evaluations—not only for legal purposes but for also assessment of treatment needs—and receive proper follow-up care. I would encourage organizations to promote cultural competency through trainings, teach-ins, culture sharings, and openness to different communities. I would finally encourage organizations to empower their staff to practice self-care, so they do not suffer vicarious trauma as helpers and healers.