Support groups have been the long-standing bridge between formal treatment and isolation. They are typically organized for individuals with a common diagnosis or experience. And they serve as a forum for sharing strategies to cope with illness or tragedy. But for the Bosnian refugees participating in a new study, support groups will offer families the opportunity to look within to see the positive and reach out to build on it.

"There are a great many people in the Bosnian community who are suffering, but choose not to access mental health services. There is a lot of stigma associated with it," says Stevan M. Weine, MD, associate professor of psychiatry and co-director of the Project on Genocide, Psychiatry, and Witnessing in the Department of Psychiatry at UIC. "So, how do you reach them? I envisioned a new approach. Instead of emphasizing individuals, you emphasize families. And rather than addressing the psychopathology—the debilitating effects of their experience— you focus on strength. I believe people are strong; and they can become stronger."

The new approach to support will be examined over the next three years through the Bosnian Family CAFES (Coffee And Family Education and Support), funded by the National Institute of Mental Health and based out of the SPH’s Health Research and Policy Centers. Approximately 225 families, including a control group, are expected to participate in formal interviews four times within a two-year period to measure improvements in social support and networks, knowledge and attitudes concerning mental health, family processes and communication, and service utilization. Half of these will meet in small groups of seven or eight families for coffee and informal discussions in a community setting—the CAFES—for a total of nine meetings over fifteen weeks.

"Most of the families here feel isolated and alone. This is a great opportunity to be together, to socialize, and to share their experiences," says Yasmina Muzurovic, a CAFES group co-leader. "It is amazing to listen to them, to see how they try to help each other by exchanging advice about different services. I am a refugee, too, so I am able to understand their needs. If I see that I am able to help them, even just a little, I am very satisfied."

Dr. Weine, who is principal investigator for the project, explains the crucial need to explore innovative solutions. "There has been very little research on interventions with refugees or on methods to help people traumatized by enormous suffering. Refugees are essentially healthy individuals and families, without prior history of mental health problems. They have been exposed to extreme events and losses. And, because of that, they have high rates of depression, traumatic stress, family problems, self-esteem issues, and dysfunction at home, work, and school."

Of the 16,000 Bosnian refugees in Chicago, the largest concentration in the U.S., fewer than 10 percent have actually accessed formal mental health services. It is estimated that 70 percent of them exhibit post-traumatic symptoms related to the atrocities witnessed or experienced during ethnic cleansing in Bosnia-Herzegovina. The military aggression, which lasted from 1992 to 1996, claimed the lives of 250,000 and displaced nearly two million people.

"Families who are struggling with resettlement forget that they can depend on each other to get through things," says Yasmina Kulauzovic, project coordinator. "The topics in our CAFES groups highlight how to work together to face hardships, overcome communication problems, get help through service organizations, and connect with other families."

For the refugees who participate, the CAFES will offer the opportunity to write a new chapter in their lives and learn to live with the memories that haunt them. In his book, When History is a Nightmare: Lives and Memories of Ethnic Cleansing in Bosnia-Herzegovina (Rutgers, 1999), Weine investigates the survivors’ attempts to reconcile the memories of horrific ethnic atrocities with their remembrances of living together in a cherished, multi-ethnic society. He describes the daily struggle faced by these survivors and families: "When you awaken from a nightmare, you do not bounce out of bed to greet the new day. You sit up slowly, put your feet on the floor, and pause while you slowly rub your palm across your forehead. You stand up tentatively, and may sit back down for a few more minutes before trying again to get up. Should you trust the day? You are not so sure. The nightmare image that is left with you radiates too strongly to be forgotten. Still, you have no choice really but to get up and get on with things. It’s time to get busy."

Contributed by Marion Lawler