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Refugees, who often have trauma-related problems, increasingly seek help from mental health clinicians. One of the biggest challenges refugees face is in receiving permission to live in a safe country. How can our understanding of a refugee's mental processes help us understand and even inform this legal process?

The definition of a refugee was established in the climate of international cooperation following World War II. At a convention in Geneva, Switzerland, in 1951, 26 nations defined a refugee as someone who "owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion is outside the country of nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country."

There currently are 22 million people in the world fleeing persecution. Approximately 140 countries represented at the convention agreed to provide state protection--asylum--to refugees. As the 1951 declaration makes clear, individuals are considered refugees if they fit the description established by those 26 nations. However, each state has developed its own legal process for deciding whether to officially recognize an individual as a refugee, with the legal rights that such recognition entails.

When the refugee requests asylum, the host country, as a starting point, asks for an account of the refugee's experiences. Grounds on which to accept a person as a refugee include a clear, consistent and believable story--for example, describing state detention due to political beliefs. However, the process of requesting asylum in many countries spans many months and often years. During this time, although new statements and appeals are made, the original statement, often made at an airport or seaport on arrival, stands. So if in a later interview, perhaps with a psychiatrist, the asylum seeker can piece together a more thorough narrative of his or her experience, this now is seen as inconsistent with the original statement.

Understanding the psychological sequelae of traumatic experiences, trauma experts know that constructing a coherent narrative can be difficult, sometimes impossible. Traumatic memories often are perceptual and emotional rather than declarative. They may be in the form of physical reenactment, but without any conscious narrative. Yet the refugee's chance of legal recognition rests on the way he or she processes autobiographical memories.

Up to 50 percent of refugees in western countries meet diagnostic criteria for PTSD. General memory studies and the eyewitness testimony literature illustrate that the accuracy of autobiographical memory may be affected by mood disorder and distorted by subsequent knowledge and questioning. Many factors, such as head injury, chronic pain, sleep disturbance and depression, can add to these effects. Variables related to the accuracy of autobiographical memory in the context of childhood trauma continue to be explored.

Two studies in particular have looked at the stability of autobiographical memories of war situations. Southwick, Morgan, Nicolaou and Charney (1997) gave Gulf War veterans a checklist of 19 significant experiences, one month and two years after their return. Fifty-two of the 59 subjects changed their response to at least one item. The most commonly changed item was "extreme threat to your personal safety," changed by 36 percent of subjects (as many from "yes" to "no" as from "no" to "yes"). Clearly, this has implications for a judicial process that aims to judge claimants' levels of fear based on their past experiences.

Eliciting details of traumatic experiences, Herlihy, Scragg and Turner (2002) performed repeated interviews with refugees from Bosnia and Kosovo who had permission to stay in the UK. Up to 65 percent of the details provided by the refugees changed between interviews, which were from four to 30 weeks apart. The longer the time between interviews, the more the details changed for those who had high levels of PTSD.

Also consider the context in which asylum seekers disclose details of their experiences. Some report immigration interviews in a small, bare room with the exact number of people in attendance as were in the small, bare room in which they were tortured. Women are interviewed by male immigration officers, sometimes with the assistance of male interpreters, and are expected to disclose having been raped. Men also have to disclose being raped. Sexual torture is associated with high levels of shame, making disclosure extremely difficult.

Many issues raised in this article have not been explored with asylum seekers or refugees in the context of the legal system through which they must pass before they can be assured of their safety. Scientific knowledge can be brought to bear on the process of receiving asylum, bringing fairness to those whose lives depend on it.

Jane Herlihy is with the Traumatic Stress Clinic in London and can be reached at jane@herlihyj.freeserve.co.uk.

Herlihy, J., Scragg, P. & Turner, S. (2001). "Discrepancies in Autobiographical Memories: Implications for the Assessment of Asylum Seekers." British Medical Journal, 324, 324-327.

Southwick, S., Morgan, C.A., Nicolaou, A. & Charney, D.S. (1997). "Consistency of Memory for Combat-Related Traumatic Events in Veterans of Operation Desert Storm." American Journal of Psychiatry, 154 (2), 173-177.