"There were times where my dad would start yelling randomly in the middle of the night, sometimes in the middle of the day, and it was very scary," said Randy Kim, whose parents were refugees.
War is often brutal and can have lingering effects for former refugees who escape the conflict — even long after. That can also take a toll on their kids — even those who've never seen war.
"I would hear my dad having nightmares in the middle of the night when I would come downstairs getting a midnight snack or drinking water, ... and I was afraid to wake him up," Kim said.
Both of Kim's parents escaped conflict and eventually came to the U.S. as refugees during the Vietnam War and as the Khmer Rouge ruled Cambodia.
The conflicts in former "Indochina," which included Vietnam, Cambodia and Laos, forced 3 million people to become refugees.
"I feel that my upbringing and that the fact that I was born because of my parents' suffering, it's a very complicated process that I still continue to try to work towards," Kim said. "If none of this happened, I wouldn't be here."
Kim's dad is Cambodian and is now separated from the family. His dad lost a parent, was separated from his family, relocated to different countries and endured the start of the Khmer Rouge. Kim says his dad never talked to a professional about those experiences. It'snot uncommon for refugees from some communities to not talk to a professional because there can be a stigma linked to seeking therapy.
"He had no way to process what was going on and the aftermath of it," Kim said. "And I feel like his life was a tragedy ... these things were things that he didn't cause, these were things out of his control, and I think as he got older, it became very difficult in his relationships and dealing with other people and eventually my own family."
Kim's mom, Hoa Nguyen, is Vietnamese.
When Nguyen and her family first saw the U.S., they weren't put at ease.
"Oh, we so scared. When we got to Illinois, we don't speak at all and we're really scared," Nguyen said.
Kim grew up not knowing much about his parents' stories.
"I tried to tell him about, you know, my kids have to look at where they live, and then they have to work hard, like me," Nguyen said.
Kim said: "For my mom, it was kind of hard for her to talk about these traumas because ... [her family's] mentality was to escape and get away from that past because they were in danger and here we're in the U.S. — we're in safe land, we don't have to worry about the Viet Cong or about the Khmer Rouge getting us."
Sometimes the horrors parents witnessed weren't addressed because there were so many other things at the forefront of their minds.
And while those horrors happened long ago, Nguyen says going home now would still be terrifying.
"Because I live in the United States long time," Nguyen said, "... sometimes, I like comfortable over here better than my country. Right now, to [go] back [to Vietnam] I am scared."
Kim said: "There was a lot of that pressure growing up to make sure that my brothers and I and people of my generation are not having to go through what their parents went through."
Parents from Syria and other countries seem to share that same wish. They want their kids to get an education and to have a normal life without conflict.
"It's not over in three months, or five years, or after citizenship," psychologist Amy Dix said. "Like, the refugee journey continues."
Dix works with refugee communities.
Dix said: "People talk about the triple trauma paradigm, which is the traumas that happen within their home country during the war or whatever conflict situation they were in, so a lot of people witness bombings or have seen family members killed. ... And then there's the trauma that can happen during the flight. So, either the time that they're leaving their country or a second country, and then the time that maybe they're living in that second or third country. … And the same sort of things, they're very vulnerable at that time, they're vulnerable to abuses and attacks."
And the toll that traumas can take on someone's overall well-being can be substantial.
"I could probably venture and say most of people who've experienced these kind of levels of trauma have had thoughts of suicide," Dix said.
A Save the Children report from Syria showed 78 percent of children surveyed experienced "grief and extreme sadness" at least some, or all the time after living through six years of war.
Those children cited the continued traumas they saw — like regular bombings — as reasons they felt that way. And many of the children showed signs of post-traumatic stress disorder, something Dix often sees in her office.
"We see the range," Dix said. "Just like in any population … but for refugees the vast majority is a PTSD-sort-of diagnoses, and there's also a lot of depression. A lot of trauma shows up as depression."
A big challenge, though, is helping survivors from communities that don't talk about mental illness understand what it is and that it's normal.
"It sometimes takes a while for those memories to resurface or for an emotional issue to sort of come to light," Dix said.
Nguyen said: "Sometimes, I think about it when I'm scared, too, but I'm OK. But my father, maybe. My husband, maybe. Right now, he so scared, he talk like they kill him or something.
"Anytime you talk to him, he don't trust you. He say, 'No, no, no, not that way.'"
Trust is a common problem psychologists face when treating certain refugee communities.
"When you're trying to engage somebody who isn't talking about mental health, we just don't use the word mental health," Dix said. "We talk about emotional wellness. We explain things, we don't label somebody. ... Sometimes it's really helpful for people to know what their diagnoses is, but other times, it's easier to explain what's going on — give some explanation of what they're feeling make sense."
And while all of this seems daunting, it's not entirely hopeless.
One study suggests although fathers could pass down psychological disorders to their children, they could also give their children coping mechanisms like goal-oriented thinking to deal with adversity.
Dix said: "We really believe that people can heal from trauma. Sometimes it's very complex trauma, it's one after another, it's very different things. And sometimes people will come and they want to forget it. They just want it to go away. And that's not going to happen; ... you're not going to forget it. But our goal is that you incorporate that as a part of you, as something that happened in your past, as something that is part of who you are but doesn't define who you are."
Dix says the process of treating the effects of conflict on refugees coming over to the U.S. is getting better.
"I have noticed in the refugee resettlement community, recently in the past few years, there's been more collaboration, more attention paid to mental health," Dix said. "... While the stigma is still strong, I think some of the stigma around it is being brought out into the open."
Nguyen said: "I hope when they come to the United States, the government can help them go to the doctor or go to a hospital or something."
As for Kim, he's been on a healing journey, too. He is now on the board of a Cambodian heritage museum — a site he says sparks healing in his community.
"The more his mental health and and relationship deteriorated it also made me focus more about this part of history," Kim said, "because it did affect him and eventually it affected myself and our family. And I think that learning about this inter-generational trauma does carry on."
