Tag Archives: depression

Emotional Impact of the Separation of Children and Parents at the US Border

On June 20, 2018, the American Psychiatric Association (of which I am an Assembly Member) and 17 other mental health organizations joined forces in a letter to the Departments of Justice, of Homeland Security and of Health and Human Services, urging the administration of President Donald Trump to end its policy of separation of children from their parents at the United States border.

The letter states that “children are dependent on their parents for safety and support. Any forced separation is highly stressful for children and can cause lifelong trauma, as well as an increased risk of other mental illnesses, such as depression, anxiety, and posttraumatic stress disorder (PTSD). In addition, the longer that children and parents are separated, the greater the reported symptoms of anxiety and depression for the children.”1

The separation and detention of minors is a human rights crisis

The United Nations Convention on the Rights of the Child emphasizes the importance of considering “the best interests of the child.”2 These interests include:

  • Protection against discrimination
  • Safety
  • Wellbeing
  • Health
  • Ensuring to the maximum extent possible the child’s survival and development
  • Preservation of the child’s identity
  • Family integrity
  • Protection against the separation from parents against the child’s will
  • Free expression of ideas
  • Freedom
  • Education

The separation of children from their families and their detention under inhumane and deplorable conditions are in direct opposition to all these interests.

The emotional impact of the separation

The negative effects, both physical and emotional, on the children separated from their parents may not be apparent for many years and some may be irreversible.

The short-term emotional effects include:

  • Post-traumatic stress disorder
  • Anxiety
  • Depression
  • Low self-esteem
  • Feelings of helplessness and hopelessness
  • Behavioral problems
  • Irritability
  • Sleeping problems
  • Changes in appetite
  • Loss of interest in pleasurable activities
  • Poor self-care
  • Feelings of guilt
  • Suicidal thoughts or behaviors

The long-term emotional sequelae can be reflected in:

  • Developmental delay
  • Poor psychological adjustment
  • Poor school performance
  • Regressive behavior
  • Aggression
  • Increased vulnerability to physical illness
  • Alcohol and drug use

Studies show that no matter how brief the detention, it may cause severe and long-term psychological trauma and increase the risk of mental disorders.3

Parents may also be affected due to the uncertainty of what may be happening to their child, which may manifest itself in:

  • Increase in physical and emotional problems
  • Anxiety
  • Depression
  • Post-traumatic stress disorder
  • Difficulty in their relationships
  • Suicidal thoughts or behaviors

What is Attachment?

Attachment is the bond between the child and his parents, which plays a fundamental role in the social and emotional development of the child. Adequate attachment fosters feelings of security in the child. Poor attachment can make the child grow insecure, with separation anxiety, self-esteem problems, trust issues, behavioral problems, and even extreme dependence on others.

The relationship between parents and children can continue to be affected even after being reunited, which may be manifested in:

  • Attachment problems
  • Reduction in parental authority
  • Poor parent-child relationship
  • Difficulties in child rearing

How can we prevent these negative effects?

  • Putting a stop to the separation of families and to the inhumane conditions in the detention centers. The separation of a parent from a child should never occur, unless there are concerns for the safety of the child at the hands of his/her parent.
  • Early detection of symptoms through mental health assessments and periodic reevaluations (especially when symptoms may arise later as the separation or detention persists).
  • Coordination of services:
      o Physical health
      o Mental health
      o Legal
      o Interpretation in the child’s primary language
  • Psychotherapy and counseling can help the children and their parents to deal with their feelings or negative thoughts, identify stressors, and strengthen coping skills. Therapy can assist in processing emotions and offer support and hope.
  • Psychiatric medications may also control symptoms of depression, anxiety, post-traumatic stress disorder, or any other mental health condition.
  • Finally, there should be no shame in seeking help, which can improve the lives of the child and his/her family.

Remember…

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

References:

1American Psychiatric Association. (2018, June 20). Mental health organizations urge administration to halt policy separating children and parents at U.S. border. Retrieved from https://www.psychiatry.org/newsroom/news-releases/mental-health-organizations-urge-administration-to-halt-policy-separating-children-and-parents-at-u-s-border/

2United Nations. Convention on the Rights of the Child. Retrieved from https://www.ohchr.org/en/professionalinterest/pages/crc.aspx/

3Linton, J.M., Griffin, M., Shapiro, A.J. (2017, March). Detention of immigrant children. American Academy of Pediatrics. Retrieved from http://pediatrics.aappublications.org/content/pediatrics/early/2017/03/09/peds.2017-0483.full.pdf

Death of a Doctor – Another Victim of Cyber Bullying?

The death of Puerto Rican doctor Gloria Ortiz González is an unfortunate reminder of the power of social media, cyber bullying, the poor conditions of a public health system affecting both patients and their providers, the level of stress and the need for attention to the emotional well-being of healthcare workers, the Hippocratic Oath, and the doctrine “primum non nocere” (“first do no harm”).

Dr. Ortiz González gained notoriety and grew in infamy after a verbal altercation with patients in the emergency room waiting area of Bayamon Regional Hospital in Puerto Rico was recorded on a mobile phone and uploaded to social networks in August 2014. In the video, which clearly begins in the middle of the discussion and does not show the preceding interactions, a patient who is off camera can be heard instigating the physician to the point that she loses her composure and uses language like:

  • “And you’re ignorant, read a goddamn newspaper.”
  • “Who pays for “la reforma de la salud” [Puerto Rican Medicaid] in this country? I do with my taxes.”
  • “Damn it. I have busted myself studying me in the damn Medical Sciences Campus to have to come here and deal with you.”
  • “Bunch of ignorants.”
  • “That is why this country is a mess because what you do is listen to Daddy Yankee. Pick up a goddamn book you ignorant. Pick up a goddamn book.”

The life of Dr. Ortiz González took a huge turn after the video went viral. The doctor was suspended from duty and investigated by the Department of Health of Puerto Rico; an investigation which ceased once she resigned. Although she would later be exonerated of any wrongdoing by the Office of the Advocate for the Patient, the degree of personal harassment and devastating cyber bullying on social media were inescapable.

Even the world famous reggaeton singer Daddy Yankee countered in social networks and through the song “Palabras con Sentido” [“Words with Meaning”], the video of which recreates the moment when the doctor’s outburst was recorded in the waiting room. A young doctor who, in a moment of frustration, lashed out at her patients, whom she swore to treat with “warmth, sympathy and understanding.” A doctor who fell victim to persecution and cyber attacks, chasing her out of her home, affecting her mental health, and possibly contributing to her death.

Although Dr. Ortiz González’s behavior in that moment of anger was unacceptable and unprofessional, we must remember that we are all human and the burnout caused by poor working conditions in a crowded health system marred by inefficiencies, poor pay, and little appreciation, have their weight. While I do not excuse her conduct, as a medical student who walked the floors and hallways of that same regional hospital in Puerto Rico, I understand how difficult it can sometimes be to remain composed under so much pressure.

Now, we should reflect on the impact of the news of her death, the emotional footprint carved out by harassment, and the rampant use of social media to perpetuate a persecution by anonymous abusers behind a keyboard. Many people have fallen victim to this cyber hunt. Harassment, both in person and through social networks, can have lifetime effects on the victim’s personality. The power of demoralization is monumental and erodes at the victim’s self-worth. Anxiety, depression, suicides, and murders. When will it all end?

I hope the death of Dr. Gloria Ortiz González has not been in vain and makes us think twice before casting our hatred on social media, considering the irreversible damage that we may cause.

Rest in Peace, Doctora!

Remember…

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix