It’s time for psychiatry to address the crisis at the border.
PSYCHIATRIC VIEWS ON THE DAILY NEWS
Perhaps like other colleagues and citizens, I have been watching the crisis at our southwest border play out. Off and on for years now, migrants have come in waves. Sometimes children are separated from parents. The exposure to the elements and living conditions at the borders are often abysmal. Now we reach a turning point, what I might call B-Day for Border Day, as the pandemic Title 42 expired at midnight.
Wondering how I might write something useful, I have been tongue-tied or pen-tied, if not heartbroken. Surely, the trauma and losses encountered by the migrants have produced a mental health crisis for them, as confirmed in a prepandemic study from 2018.1 Our country’s staff there must be under stress, too, and possibly suffering moral injuries like soldiers sometimes experience when their work goes against their moral standards.
For me personally, when I see images of the migrants behind the barbed wire fences, my mind associates them with images of concentration camp victims in the Holocaust. I recall how Jewish refugees were turned away from the United States and other destinations. Intergenerational transmission of trauma continues to haunt the offspring, as I have directly experienced when participating in group meetings with the second generation of survivors.
Certainly, there are convincing arguments to limit the inflow of migrants. How many can the United States accommodate adequately? Will the criminal drug trade be affected?
I suppose what I am doing is at least being a journalistic witness from a distance. This kind of disaster is difficult for organized psychiatry to address adequately. For acute disasters like earthquakes, psychiatric disaster teams are prepared to go and help. For slow developing disasters like climate change, time provides the opportunity to develop collective responses like the Climate Psychiatry Alliance I helped form.
But this is something in-between, an intermittent and semi-acute humanitarian disaster, perhaps needing an entirely different kind of social psychiatric preparedness and intervention. Perhaps it requires a new designation as a complex disaster involving acute, ongoing, and intermittent aspects, needing all overlapping levels of prevention: primary, secondary, and tertiary, to reduce the vulnerability of high risk groups, early detection and intervention, and recovery and relapse prevention, respectively.2
Migrants have existed since humans left Africa. Most all of us owe a psychological debt to those who successfully made the journeys to a better life. Let’s pay off that debt.
Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times.
1. Stringer F. Psychologists respond to a mental health crisis at the border. Monitor on Psychology. 2018;49(8).
2. Min J-A, Lee C-U, Lee C. Mental health promotion and illness prevention: a challenge for psychiatrists. Psychiatry Investig. 2013;10(4):307-316.