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The Pain and Challenge of Witnessing

Mental health professionals feel the call to engage with migrants.

jos macouzet/Shutterstock
Source: jos macouzet/Shutterstock

Over the past two years, advocates have been fighting the U.S. government’s Zero Tolerance policies of separating and detaining migrant children on the Southern border, and mostly losing the battle. What are mental health professionals doing and thinking about this crisis?

We learned something about this question this summer at a panel in San Francisco, at the American Psychiatric Association’s annual meeting, which brought together researchers, clinicians, and advocates.

At the panel, Maria Baez, a child psychiatrist at Bellevue Hospital in New York who is originally from Colombia, discussed her work in centers that provide care to children detained on the border and who are now being held in foster care. She spoke about how the children she treats are resilient and brave in the face of punishing hardships and uncertain futures. But she also fears that “many of the children will never be reunited with anyone.”

The social work researcher, Dr. Luis Zayas of the University of Texas at Austin, author of Forgotten Citizens (2015), conducts research and advocacy related to children in detention. He shared children’s drawings of scary men with machine guns and cigarettes, the ones who made them flee and seek asylum. He showed a video of a young boy who, upon reuniting with his mother, would not let her hug him and avoided her touch. “Look at what the trauma has done to him,” cries the mother in the video.

Schuyler Henderson, a child psychiatrist at Bellevue, and I detailed how leading mental health and health professionals spoke out against these policies. Dr. Colleen Craft, the President of the American Academy of Pediatrics, said that the policy stripping children from their parents “amounts to child abuse.” Commander Jonathan White of the U.S. Public Health Service Commissioned Corps testified before the U.S. Senate that he had warned the White House that “separation of children from their parents entails significant harm to children” including “traumatic psychological injury.” We discussed how their protests had little impact and rendered us passive.

We expected this panel to generate a vigorous discussion about clinical dilemmas in treating child migrants and about advocacy challenges and strategies. We were less prepared for the many personal and emotionally intense responses of audience members who were largely mental health professionals.

One listener, a psychiatrist from Mexico, shared a traumatic story of being detained for days by U.S. authorities at the border. “If a professional like me has such difficulties then what will happen with these innocent children?”

Another psychiatrist said, “All I feel is rage. Incredible rage. But I don’t know what to do with that rage, so I try to keep it down.”

Another responded viscerally, saying “What we hear today in these presentations reminds me of Nazi Germany. I am sickened.”

It is not as if we are not used to hearing hard stories. As psychiatrists and other mental health professionals, we listen to stories every day. How many trauma stories do we hear, of how many endangered, injured, damaged, frightened, lost and crying people? And more than a few of us are migrants or first or second generation Americans.

Despite this familiarity, many of us in that conference room, it seemed, were weighed down by thoughts and emotions of an intensity that were hard to handle and felt paralyzing.

Maybe this was because it felt incredibly disempowering to realize that as a profession, we spent decades building scientific evidence and clinical knowledge concerning the consequences of adverse childhood events, yet we have very little ability to prevent the traumas that the U.S. government is inflicting upon these children. We listen and want to protect, but see how we have very few tools for doing so.

Or maybe it was because suddenly it became apparent that our evidence and knowledge were not contrary to these policies, as we assumed, but integral to policies intended to hurt children. In an article for the Atlantic, Adam Serwer wrote that the cruelty is the point. Our evidence and knowledge that separation and detention is psychologically devastating for children and families was not evidence against the policy, but evidence for it.

Despite its bureaucratic ineptitude, the Trump administration has been better at using our scientific knowledge to terrorize families and communities than the fields of psychiatry and psychology are at preventing and treating the consequences.

We came to understand that our emotional reactions are real, but we cannot let ourselves be driven by emotions alone, overcome by despair or paralyzed by outrage. Instead, we must decide the different places where we as professionals, want to dig in and do battle.

At the symposium, several areas were identified.

First, we could learn to be more impactful witnesses to injustices. The problem, we saw, was not with empathy or outrage or compassion on our part, but our ability to translate this into effective communications and actions. We can do so by advocating more forcefully, speaking up, writing. We can take our positions of power to ensure that our voices are heard on behalf of those we care about.

Second, we cannot function alone. We can advocate within our communities and our professional organizations to speak up. But even these organizations are not effective when acting alone. We could be better organized into coalitions especially when opposing government policies, as we have done for example in opposing the nuclear arms race.

Third, our research has to go beyond pointing out individual’s traumatic consequences and their treatment. We could be conducting services and implementation research on community-based interventions to support youth and families, where our role is not necessarily about channeling people into doctor’s offices, but using our research expertise to build community and family support.

In any country with cruel or inept government policies towards migrants and refugees, we desperately need mental health professionals to step up for migrants, with smart and tough actions. Let’s keep remembering; the displaced are everywhere and they are us.

This post was co-written by Dr. Schuyler Henderson, Associate Professor of Clinical Psychiatry at the New York University School of Medicine, New York, NY.

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