This article first appeared in the St. Louis Beacon, Aug. 20, 2009 - Keeping our emotions in check while the stress of work, family and bills roil under the surface is like keeping a beach ball underwater -- it takes a continual, focused outpouring of energy to prevent it from popping up. For the tens of thousands of Bosnians who immigrated to St. Louis in the 1990s, the ball is often bigger than the pool.
On top of the everyday struggles that plague us all, their special concerns are many: unfamiliar surroundings, a new language, trading the trappings of their white collar jobs in Bosnia for mops and brooms, and separation from family members and friends. For many, these issues are horrifically compounded by having been held captive, raped or tortured, and living with the loss of murdered fathers, sons and brothers.
It would be wishful thinking to suppose that many of the estimated 50,000 local Bosnians aren't living with depression, anxiety and other mental-health concerns. But this community doesn't readily accept help -- and talking about mental health is strictly taboo.
"For Bosnians, having mental health issues like depression equates to being 'crazy,'" said Ajlina Karamehic-Muratovic of the Missouri Institute of Mental Health, who came to this country as a student.
'BREATHTAKING' CRUELTY
While working with Bosnian women with breast cancer several years ago, Karamehic-Muratovic realized the pressing mental-health needs of the community. To get grant money for services, she needed documentation: What exactly are the issues? How widespread are they? Gathering that information is the goal of a one-year Missouri Foundation for Health-funded study begun in December for which she is principal investigator.
The atrocities that prompted her research occurred between 1992 and 1995 when minority Bosnian Serbs and the Yugoslav army killed 200,000 Bosnian Muslims, including 3,500 children. Thousands of males were systematically slaughtered in villages, cities and in concentration camps. Some were buried alive. Others reportedly committed suicide to avoid having their lips, noses and other body parts chopped off.
Rape was used to terrorize the women and children who remained after the men were forced into camps.
"The cruelty that took place in this war was breathtaking," said Jean Abbott, clinical director of St. Louis' Center for Survivors of Torture and War Trauma.
Thousands of the 2 million refugees were relocated to St. Louis because of affordable housing and availability of jobs that didn't require knowing English. Many came with nothing but the clothes they wore. Scraping together enough money for food and shelter kept them in survival mode.
Now, 10 to 15 years later, many Bosnian families are not only surviving, but in many ways, thriving. Most are homeowners. Many of their children have completed college. But the gradual lifting of day-to-day stress gives them time to think -- and feel.
"The post-traumatic stress disorder (PTSD) starts to catch up with them," Abbott said.
GRANDPARENTS, MOM AND DAD, KIDS HAVE DIFFERENT ISSUES
For older Bosnians in St. Louis, isolation is often a problem that can lead to depression, noted Hisako Matsuo, a Saint Louis University researcher also involved in the mental-health study. It's not uncommon for those who arrived in their 60s and 70s to speak and understand only their native language.
"They can't enjoy watching TV; they can't communicate with their grandchildren. They can't drive; they stay at home," Matsuo said.
For mid-life adults at the height of their careers when they fled Bosnia, loss of status is often an issue. Once in the U.S., Bosnian doctors, lawyers and other professionals who spoke no English took jobs cleaning motels, driving taxis and working in meat-packing plants.
"It's a humiliating experience," Matsuo said.
With many of their relatives' bodies still missing, grief is compounded by a lack of closure. On top of that, the PTSD of those who survived concentration camps can be debilitating. Nightmares keep them awake and sleep deprivation makes them irritable. It's difficult to think well when constantly re-living the trauma. Even celebratory events can take on life-threatening connotations.
"The Fourth of July is hell on some of these people, even if they're saying to themselves, 'they're just firecrackers,'" Abbott explained.
The slightest interaction with authority figures can also be a PTSD trigger, Abbott said, remembering one specific incident in which a client overreacted after being pulled over by the police.
"The police came up to him because he rolled through a stop sign, and he went into a flashback," Abbott said. "Now he doesn't want to leave the apartment because if it happens again, he'll be in jail."
Children old enough to remember the horrors of the genocide suffer from a loss of innocence and may experience an identity crisis, feeling both Bosnian and American, according to Matsuo. Younger children become the family translator as early as age 5, thrusting them into a responsibility for which they are not developmentally ready. Children whose parents protect them from the details of the genocide see the pain in their parents' faces and know that something terrible is going unsaid.
"If the parents don't deal with it, the children will. They're acting out and they're seen as troublemakers," Abbott said.
IF YOU BUILD SUPPORT, WILL THEY COME?
Local Bosnians, many of whom felt betrayed by Serbian friends, the United Nations and a myriad of other people and institutions they once believed in, are hesitant to open up to anyone.
"What makes it hard for Bosnians to access the mental-health system is that lack of trust," said Hazira Cause, a counselor at the St. Louis International Institute, who came here from Bosnia. "They ask, 'Who is the provider? Is somebody benefitting from our pain?'"
Many are in the habit of drinking to dull the pain instead of seeking therapy. But news of several suicides in the Bosnian community is spurring some to overcome their resistance to getting help.
"It has frightened many of them because they realize that could be them someday," Abbott said.
When the study is completed, and money is available for expanded services, Karamehic-Muratovic says providers must walk a fine line to encourage people to take advantage of treatment. "Something that gets the community involved is important. At the same time it should be very private," Karamehic-Muratovic said.
Already, prominent Bosnian organizations are on board, such as the Bosnian Media Group, the Islamic Community Center and survivor groups.
As president of the Association of Survivors of Concentration Camps in Bosnia and Herzegovina in USA, Sejad Muhic is helping others to document their experiences by compiling a book of stories about the camps. During his own seven months of captivity, Muhic's days were filled with beatings, hard labor, hunger and the screams of others being beaten and killed.
"People cry; you listen -- every day, 24 hours a day. You cannot sleep," Muhic said.
Conversations such as those Muhic facilitates with his organization can help start the healing, Matsuo said, envisioning the kind of group therapy that other Bosnians might accept.
"They don't have to have one-on-one counseling," Matsuo said. "They just need someone to talk to."
Nancy Larson is a freelance writer in St. Louis.
