Trauma and the Lasting Psychological Impact of the Current U.S. Border Policy

President Trump and his administration’s “zero tolerance policy” of migrants coming to the U.S. borders has separated thousands of children from their families. There are thousands of documents of abuse and neglect, reports of denying children the right to hug their siblings, and reports of children held naked, handcuffed and beaten. The current suffering has led parents to commit suicide. The trauma will last for generations.

What is Psychological Trauma?

Psychological trauma is a type of damage to the mindbody that happens as a result of either a singular distressing event – or a multitude of stressful events over time – that exceeds our ability to cope. This can include (but isn’t limited to): forced separation from one’s parents, physical, sexual, and emotional abuse, isolation, accidents, natural disasters, oppression, bullying, abandonment, or neglect. In fact, you can experience psychological trauma just by witnessing or learning about an event. In the case of secondary trauma, exposure to someone who has been traumatized becomes traumatic.

The Scars of Trauma

The basics of our stress response system is our fight-or-flight reaction. The mindbody can take this to extremes during traumatic events. When flight to safety isn’t possible, flight from the present can be the next step. In such cases the mind may detach from the body, turn inward, and withdraw from its connection to the present moment. If the fight instinct is activated it can project immense energy outward, expressed in tension, explosive emotions (like anger), thoughts, and behaviors in order to gain control.

When psychological trauma occurs the mind undergoes some fundamental changes in its assumptions of reality. The mind may learn lessons like: the world is unsafe, other people are threats, or that the self does not have the tools to cope with reality. The mind may rationalize that such traumatic events occur because the Self is evil, unloveable, incomplete, or deserving of trauma. These narratives shift people’s worldview and connection with the Self and as a result they become very sensitive to any sign of potential threats including: feeling trapped, close connections to others, isolation, or any physical, mental, or emotional reminders of the trauma.

As a whole psychological trauma disturbs thinking patterns, arousal, concentration, memory, sleep, appetite, attachment, and energy. Psychological trauma also makes the autonomic nervous system more sensitive to stressors, which makes it more difficult for people to regulate and self-soothe. Trauma can disrupt every phase of life. Below is a general list of acute stress symptoms, note that some people may only present with a few symptoms while others with many.

• Recurrent memories, thoughts, dreams, or nightmares that are about, or related in content to, the traumatic event(s)

• Flashbacks, feeling disconnected from body (some people describe it as though they are watching their life as it were a movie)

• The feeling that the world is fake/an illusion, or lack of awareness of surroundings.

• Attempts to avoid distressing thoughts, memories, emotions, or reminders about the event.

• Negative alterations of thoughts and mood. Inability to experience positive emotions

• Persistent negative beliefs or expectations about oneself or the world.

• Persistent negative emotional states: fear, horror, anger, guilt, sadness, shame, irritability.

• Loss of interest or reduced participation in normal activities

• Feeling detached or estranged from others.

• Amnesia about the events

• Explosive anger, irritability, or sadness/crying outbursts with little or no provocation.

• Reckless or self-destructive behaviors. Substance use to self-medicate.

• Feeling keyed up, tense, the need to know everything going on, constant worry

• Exaggerated startle responses

• Problems with concentration, or memory

• Impairment in social, work, school, family or other realms of functioning.

Everyone Experiences Traumatic Events, Why Doesn’t Everyone Have the Symptoms?

Not everyone who experiences traumatic events will develop psychological trauma. Genetics, environment, experience, coping mechanisms, vulnerability factors, and resources all play a role as far as how susceptible to trauma a person is.

Risk Factors Include

• Social Isolation of Families

• Not getting developmental needs met

• Poverty, economic disadvantage

• Family disorganization, dissolution, or violence

• Emotionally, physically, or sexually abusive caretakers

• Parental stress, Family History of Abuse

• Community Violence

• Parents/Grandparents were Traumatized

• Previous Exposure to Traumatic Events

Protective Factors Include

• A supportive and nurturing home environment

• Dependable and stable family relationships

• Receiving healthy affection

• Higher Socioeconomic Status

• Economic Stability

• Adequate housing

• Caring adults inside and outside family who provide nurture and act as role models

• Access to health care and community support

As for the thousands of migrants currently being held in detention, they come from areas where they are at an economic disadvantage, victims of violence, and are having a lack of family continuity. This means that the migrants who come to the U.S. borders are at elevated risk of experiencing trauma, and that the current policies remove protective factors and increase the risk of psychological trauma.

Impact of Trauma on Attachment and Relationships

People who have unhealed psychological trauma tend to have problems with interpersonal relationships. One challenge is that trauma interferes with people from communicating emotions in a socially acceptable manner. Trauma itself can prevent people from experiencing humor or joy. Emotions like sadness, anger, guilt, or anxiety are often interpreted by the mindbody to be a threat (as they are associated bad experiences) and thus can set off even more explosive reactions or a dissociative (withdrawing) responses. This makes it very difficult for people with psychological trauma to interact with others.

People who have unhealed psychological trauma tend to have problems with attachment. Some people who have experienced trauma try to keep people at a distance, for fear of being too vulnerable. Romantic relationships and friendships involve a certain level of intimacy. If someone developed the narrative that other people are dangerous, becoming close to someone is a threatening proposition. Alternatively, if someone incorporated the idea that they are unloveable, becoming closer to people means that those people might find out how unloveable they are, which represents the threat of abandonment. Withdrawal, flight, irritability, betrayal, and anger are often great tools for keeping people at a distance,

Other trauma reactions are to pull people in close. People who experience neglect, isolation, or abandonment as a trauma might cling closely to those who they connect with, for fear of abandonment again. Anxiety, worry, excessive kindness and even self-harm are frequently tools used to try deepen connections. Unfortunately, such reactions usually push people away. Other people experience a confusing mix of both reactions where they both crave and fear closeness to others. This process is sometimes referred as disorganized attachment.

People who experience psychological trauma are more likely to enter into abusive relationships. They tend to have more problems with romantic relationships, friendships, and authority figures compared to other people. Given the trauma of loss of family, the abuse by jailers, and the horrors faced at home, the children being held in detention facilities here in the U.S. are more likely to develop all of these social problems.

The Impact of Trauma on Learning

Psychological trauma causes problems with thinking clearly, reasoning, and problem solving. The traumatized mind’s default is crisis mode. It has learned that the world is unsafe and needs to be aware of potential threats. It does this by identifying and criticizing problems of the past, analyzing potential threats in the present, or anticipating catastrophes of the future. As a result people who have experienced trauma have problems staying calm, regulating behavior, and learning new information.

All of this brain activity makes it incredibly difficult to concentrate, let alone navigate the rigors of education. Children who have a history of trauma demonstrate developmental delays, learning difficulties, and behavioral problems in school. Without an intervention they are less likely to achieve in the academic realm, and more likely to have problems achieving stable, high paying employment.

The children being held in detention already had a socioeconomic disadvantage when they arrived at the U.S. border. The current policy and environments these children and their parents are being held in makes it worse. Remember, some of the risk factors for developing psychological trauma include economic disadvantage and having parents who experienced trauma. The current policy of treating immigrants like prisoners is more likely to create psychological trauma not just for those being held, but also their future children. This type of policy manufactures inter-generational trauma.

Impact of Trauma on Mental Health

In short, psychological trauma is bad for mental health. The negative worldview, self-view, and hyper-arousal trauma creates leads to all sorts of mental health issues. People who have a history of psychological trauma are more prone to volatile, oppositional, and extreme behaviors. Emotionally they tend to be prone to defensiveness, aggression, spaciness, and difficulty regulating emotions. They are also more likely to demonstrate dangerous behaviors like self-harm, unsafe sex, recklessness, substance use, and suicide. There is plenty of data which demonstrates that childhood trauma alters brains development.

Children who experience trauma are more likely to develop the following types mental health disorders later in life: Schizophrenia (and other psychotic disorders), Post-Traumatic Stress Disorder, Depressive Disorders, Anxiety Disorders, Eating Disorders, Obsessive Compulsive Disorder, and Personality Disorders. As a clinician who has worked on healing with hundreds of people who navigate hallucinations, delusions, or personality disorders I have yet to meet a person experiencing such a disorder that was not exposed to childhood trauma.

Poor mental health does not just cause psychological suffering and problems with functioning, it is associated with increased risk of physical health issues as well. People with mental health issues are at increased risk for heart-disease, diabetes, and inflammatory conditions. People diagnosed with serious mental illness (schizophrenia spectrum, bipolar disorder, or severe depression) have a decreased life expectancy by 20 years.

Impact of Current Policies as a Whole

In this article we explored the nature of psychological trauma, its effects on the mindbody, and the long-term outcomes. The Trump administration’s current policies are traumatic acts that will cause lasting harm. Indefinite detention, keeping people in cages, and family separation, of migrants who are already fleeing violence will cause the development mental and physiological health problems. These policies are likely to cause economic and academic, and long-lasting inter-generational trauma. It is impossible to tell the totality of suffering this is creating now. Reuniting families, ending indefinite detention, and creating humane solutions that involve healing, nurturing, and hope is essential for our collective health in the present and the future.

Mental Health Stigma

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Mental Health Stigma (hereby referred to as stigma) are the negative attitudes, stereotypes, and beliefs that people hold towards folk living with mental health disorders. Stigma can be external (held towards other people) or internal (directed at oneself). Stigma motivates people to fear, reject, avoid and discriminate against people with mental health issues.

There are plenty of examples of stigma in the public domain. This happens when we blame mass murders by White men as mental illness, but other acts of killing as terrorism, war, or standing ground. It happens when we blame traumatized people who struggle with addiction for not having stronger willpower. The effects of stigma are likely present each day when 22 veterans kill themselves and do not receive the help they need.

Stigma happens behind closed doors too. It plays a role when a doctor dismisses a patient’s pain concerns as hysteria, only for her to discover after years of suffering that she actually has had fibromyalgia all along. It occurs when a teacher assumes a child with a learning disability is lazy or stupid instead of connecting them with the assistance they need. It’s present when a guy gets bullied for being a coward, because his panic reaction is so severe his nervous system causes him to freeze with tension. It’s the casual statement of some obscene act being labeled “cray cray.” There are widespread beliefs that people with mental health issues are more dangerous, have high rates of criminality, are lazy, and are more likely to be incompetent compared to people who do not.

Meanwhile the evidence demonstrates that mental health disorders are normal stress reactions and not indicative of character flaws. People with mental health disorders are more likely to be the victims of violence, not the perpetrators of it. And we know that mental health issues are incredibly common, about 25% of Americans will experience a mental health issue, that’s 3 times as common as asthma. Furthermore about 78-89% of adults polled believe mental health issues can be treated effectively. Would we be so callous as to blame the people with asthma for their breathing problems?

The problem is, is that there are some pretty significant effects of stigma. Stigma, when internalized, can be a major source of shame. Such shame can be so severe that it prevents people from seeking out and receiving the treatment they need. It also tends to increase the severity of anxiety, depressive, traumatic, and hallucinogenic symptoms. According to NAMI the average time between the onset of mental health symptoms and receiving professional intervention is an 8-10 year waiting period. Of the approximately 63 million adults who experience a mental health disorder this year, only 41% of them will seek treatment. That means over 37 million people, more than 10% of the entire U.S. population will struggle with a disorder that impairs functioning and causes distress without treatment. In a society of such great abundance and knowledge, that seems like a fact worth changing

Cultural and demographic groups in the U.S. react to stigma in a variety of different ways. For example, Hispanic and African Americans will seek out treatment for mental health issues at 50% of the rate of Caucasian Americans. Asian Americans tend to seek out mental healthcare even less, only 33% compared to Caucasian Americans. As a group, African Americans tend to look upon mental health treatment more favorably than other groups. As for gender differences, it’s been observed that on average males will wait longer, and develop more severe symptoms before they seek treatment compared to females. In one study, men cited embarrassment as the most common reason they did not seek out treatment, whereas women cited the cost. Some theorize our cultural norms and toxic masculinity are likely causes for such gender differences.

Not only does stigma affect how people approach (or rather avoid) getting treatment, it affects the way that communities treat people perceived to be having mental health issues. People are more likely to create social distance between themselves and persons with a mental disorder. This reaction results in a rather vicious cycle of events. The people experiencing mental health disorders become isolated, which in itself exacerbates the disorder making the symptoms more severe. As a result there is a desire by the community to create more social distance and there tends to be a void with regards to ensuring suffering people get sufficient human contact and dignity. Research shows that persons with mental health disorders that live within inclusive and accepting cultures tend to have less severe symptoms and distress compared to people who live in other cultures. Other research demonstrates that Americans who have an education about, or a solid relationship with someone who has a mental health issue, stigma decreases significantly.

Stigma has a pretty significant impact on our health and economy as well. Problems with mental health are the number one cause of disability in the U.S. Additionally people who are living with severe mental health issues – roughly 1 in 10 Americans – are at increased risk for developing chronic health issues, and more likely to die of treatable physical conditions. Their life expectancy is 25 years shorter than the average Americans. Mental health problems cost the U.S. economy approximately $210 billion annually due to reduced productivity for people at work, and increased absenteeism. It’s pretty clear that mental health disorders, and the stigma associated with them cause a lot of illness, suffering, stress, and challenges with productivity.

The good news is, there is a lot we can do about stigma. Studies demonstrate that stigma significantly decreases when people receive education about mental health, or have experience with a friend or family member who experiences mental health symptoms. If we foster an attitude of openness, provide support for people experiencing mental health issues, embrace educating ourselves and each other about mental health we can normalize common mental health problems. We can be less stressed, healthier, more productive, and happier as a collective. That would be pretty awesome.

To review, mental health stigma are the negative attitudes and beliefs that people hold towards persons living with mental health issues. Despite the fact we know that mental health disorders are incredibly common, and normal stress reactions, stigma persists. Stigma exacerbates symptoms of mental health, takes a toll on the economy, causes significant distress, and tends to isolate people living with mental health disorders. We know that when people gain exposure to knowledge about mental health issues stigma declines. Will you help in the battle against stigma and create a healthier community?


Sources

Pacesepe, A.M & Cabassa Leopoldo J. (2013) Public stigma of mental illness in the united states; a systematic literature review. Administrative Policy Mental Health 40(5) doi: 10.1007/210488-012-0430-z

DHHS (1999) Mental Health: Culture, race, and ethnicity. A Report of the Surgeon General.

National Alliance on Mental Illness (2018) Mental Health by the Numbers. Retrieved from https://www.nami.org/learn-more/mental-health-by-the-numbers

Abizu-Garcia, C. E., Alegria, M., Freeman, D., & Vera, M. (2001) Gender and health services use for a mental health problem. Social Science Medicine 53(7) 865-878

St. Michael’s Hospital (2014) Men, women use mental health services differently.

Doherty, D. T., & O’Doherty, Y. K., (2010) Gender and self-reproted mental health problems: predictors of help-seeking from a general practitioner. British Journal of Health Psychology 15(1) 213-228

Watters, E. (2010) The Globalization of the American Psyche Crazy Like Us. Free Press, New York, NY.

5 Signs you’re Experiencing Burnout

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Classic Burnout Symptoms

  1. You feel exhausted. Some people describe this as feeling worn out, depleted, or a loss of energy. Either way, your energy levels are not where they should be.
  2. Your attitude has shifted. If your attitude has become increasingly negative, cynical, or withdrawn this can be a huge sign of burnout. Sometimes this attitude shifts in client care, other times towards an organization, bosses, or with coworkers.
  3. You’re irritable. You seem to have a shorter fuse than you used to.
  4. You don’t feel productive. Either you feel your work is less valuable, you notice a decline in your productivity, or it just feels hard to cope with the day-to-day tasks on the job. The mundane becomes burdensome.
  5. Your coworkers are burnt out. Burnout, like other mental health phenomena, tends to be a cultural issue. When your coworkers are burnt out, your risk for burnout increases.

Causes of Burnout

Burnout has a variety of causes. The most common contributors to burnout include, too much workload with too few resources. Lack of control over your job tasks, or lack of ability to grow with your job. A lack of community or fairness in the workplace also contribute to burnout. Additionally if there is a values gap between you and the organization you work for there tends to be an increase in burnout.

Effects of Burnout

Burnout doesn’t just contribute to a poor work life, but poor health overall. People who experience burnout tend to demonstrate classic stress symptoms including chronic fatigue, headaches, GI issues, insomnia, and reduced immune functioning leading to an increase in illness. People who are experiencing burnout are also at greater risk for being hospitalized for cardiovascular disease. They also are more likely to develop mental health issues. Additionally people experiencing burnout are more likely to struggle in their relationships, and other areas of life.

Prevention and Treatment

You do have some control over your mindbody’s potential reactions to burnout. You can start by making sure you’re getting adequate self-care, this means making sure you’re getting adequate amounts of sleep, exercise, and eating healthy. Other means to manage burnout include practicing relaxation strategies, taking more breaks on the job, and exploring time-management alternatives. Additional strategies include getting social support from family, coworkers and friends, practicing mindfulness, and utilizing your own emotional coping skills. If you have the opportunity, take a vacation. We all need some time to change things up and recharge our batteries.

A lot of treatment for burnout can come at an organizational level as well. Changing work patterns, increasing community, trust, communication, support, creating more individual autonomy, and reducing the workload to resource ratio are all organizational ways to change burnout.

Mental Health Disorders are not Diseases

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Today we are going to explore the nature of mental health disorders. Mental health disorders are real, prevalent, and can impact anyone. 1 in 5 Americans will experience a diagnosable behavioral health condition this year. They cause emotional, physical, psychic, and relational suffering, and can severely impact life functioning. For the most part mental health disorders are not a disease. Rather, they are normal stress reactions, and expressions of variety within our species. The most common threads linking mental health disorders are stress, trauma, genetics, and access (or lack-there-of) to coping skills and resources.

A lot of times the normal emotions that get labeled as “negative” are often healthy responses to our environment. The sadness and fatigue we experience while we mourn the loss of a loved one, tell us to slow down, rest, and take time to understand our loss and make sense of our new environment. The energy of anxiety can propel us into problem-solving action like studying for that big test. The hypervigilance and wariness that trauma survivors experience help us keep on the lookout for danger, a key to survival while living in an unsafe and threatening environment. Many times it is when these healthy adaptations are present when they are no longer needed, or when they become maladaptive and impact the quality of our lives or impact our functioning, that we label them a mental health disorder.

It makes sense that most of us misconstrue and misunderstand mental health experiences. The majority of funding to provide treatment for mental wellness is paid for by health insurance here in the US. Insurance companies operate by the disease model of mental health. That is to say the way they classify mental health is that you either have a disease that is making you unhealthy, or you are healthy and no longer in need of treatment. Clinicians are expected to take notes that use language which indicates they are assessing and treating a disease. Such a model limits our view of mental health, having us merely focus on symptoms. Such a model does not provide credence to wellness factors like resilience, creativity, socializing, perspective taking, courage and other adaptive mental functions which contribute to health.

Another contributor to the misconception of mental health are the marketing and sales of psychopharmaceuticals. Major pharmaceutical companies medicalize normal human conditions such as sadness and worry. There is a multi-billion dollar market out there trying to convince people across the globe that experiencing human misery is a sickness that can be cured with medicine, and not only that, but long-term medicine. This isn’t to say that you should not pursue medicine. Internal and external stressors can cause our brain chemistry to get out of whack and cause needless suffering. Psychopharmaceuticals have helped millions cope, and if it helps you I am glad you’re taking them. What this is to suggest, is that misery is part of the human condition and the perspective of viewing mental health as a disease is problematic.

The problem is, is that the disease model doesn’t hold up under scrutiny. Mental health disorders are culturally dependent, while diseases are not. Cancer, the flu, HIV and other diseases look the same, no matter where you are in the world. Anthropologists have done many studies and have found that mental health disorder symptoms change depending on the geo-cultural location. Depression, anxiety, and schizophrenia, look different in the US than they do in Japan, Tanzania or India for example. Other studies have demonstrated that depending on the culture, traditional medicine folk are about equally effective in treating mental health disorders as mental health professionals.

Culture plays a significant role in our views of mental health as well. The DSM used to classify being gay as a disorder; today being gay, lesbian, pansexual, or bisexual are widely accepted (as they should be) as part of our normal sexual diversity. Emotional and cognitive responses like sexuality, height, and weight, also exist on a spectrum. Some of us are more emotionally sensitive than others, some of us are more expressive, some of us less. 20% of the population will experience a mental health issue this year. This suggests that these are pretty common stress responses. I have yet to work with a person who is experiencing a mental health issue who was living in a healthy environment, felt secure in their needs, had no experience of trauma, was well connected with their community, existed in healthy relationships, was engaging in meaningful activities, and in good health.

And that leads to another important question. Are mental health disorders unhealthy responses to healthy circumstances, or are they healthy responses to unhealthy circumstances. Nobody has ever proven that the collection of mental health disorders in the DSM or defined by the WHO are unhealthy responses to healthy circumstances. There is plenty of evidence to suggest that disorders PTSD, anxiety, and depression are normal stress responses to unhealthy circumstances like abuse, violence, neglect, or not being able to meet ones needs.

So what does this all mean for how we view mental health? Mental health disorders create suffering, have significant impacts on functioning, and are worthy of being treated as the serious and real conditions that they are. Perhaps this means we as a collective have to re-examine our definitions of wellness and how we as a society want to achieve our individual and collective wellness. Perhaps this means we need to re-examine and redefine how we provide resources to treat suffering. Maybe this means we should be a little more gentle and understanding with others and ourselves, knowing that if we’re not feeling well, behaving well, not thinking well, or not communicating well we are doing our best and probably responding to our internal and external environmental experiences. We are only human, after all.