"Ms. A" is a 34-year-old married Syrian woman who came to the Oregon Muslim Medical Association's free mental health clinic for Muslims by Muslims in 2015 for symptoms of depression. She is a lab technician, currently unemployed, and lives with her two young children in Portland. Ms. A reports that she has been struggling with depressed mood, poor appetite, significant weight loss, poor sleep, inability to focus, amotivation, frequent crying spells, and poor energy. She has daily nightmares about the traumatic memories of war and her forced emigration. She denies suicidal ideation, and reports that she continues to be a caring and involved mother despite her severe symptoms. She is from the city of Daraa, which is often labeled as the mother of the 2011 Syrian revolution. The city witnessed a large-scale military invasion and retaliation. Ms. A, like many others, was under sniper attacks, suffered the death of family members, friends, neighbors, and schoolmates, and was forced to be homebound for about a year, for fear of mercenaries and the psychological threats by regime soldiers to torture and rape residents of her ghost city. She was eventually able to escape Daraa to Jordan. Her husband was not allowed to travel with her when she left the Jordanian refugee camp in 2012, and his application to obtain a visa to reunite with her has been rejected five times. Ms. A has minimal psychosocial support through the Muslim community in Portland. The children have no memory of their father. Ms. A meets DSM-5 criteria for both severe major depression and posttraumatic stress disorder. She is treated with an antidepressant and a hypnotic, which significantly improves her mood, energy, appetite, sleep, and nightmares. Both children are currently struggling with anxiety and showing evidence of learning and speech difficulties. Although therapists initially suspected autism, that appears not to be the case.
