Symptoms of the syndrome can confuse diagnosis with depression or post-traumatic stress.
“You shouldn’t expel people from your land or country, not by force”, said the Argentine poet Juan Gelman (1930-2014). But there are around 281 million international migrants worldwide (3.6% of the world’s population), according to 2020 UN data.
Some people emigrate because they want to, but others are forced to emigrate. At the end of 2019, more than 79.5 million people were forcibly displaced, according to UNHCR, the United Nations Refugee Agency.
Whether willingly or not, migrants can feel, as Gelman put it, a “monstrous plant”, with roots thousands of miles away from the stem and leaves.
And there will always be circumstances, upon arrival at your destination, that will reduce or exacerbate this situation. All of this undoubtedly has repercussions on mental health.
The border between mental health and disorder
Spanish psychiatrist Joseba Achotegui is secretary of the World Psychiatric Association and works on migration-related issues. He started noticing certain changes in 2002.
“Borders were closed, stricter policies against migration were created, people no longer had access to documents and there was a huge struggle for survival,” he told BBC News Mundo, the BBC’s Spanish-language news service.
This new situation had an impact on the way patients arrived to consult him. “They were helpless, scared, they couldn’t move forward,” he said.
Specifically, he noted that many migrants who go through difficult situations had “a very intense, chronic and multiple stress reaction picture.” Achotegui called this condition “Ulysses syndrome”.
The psychiatrist clarifies that it is not a pathology, since “stress and grief are normal in life”, but emphasizes the peculiarity of the syndrome that leaves the migrant, once again, on a non-geographical, but psychological, border between health mental and disorder.
Migratory grief x Ulysses syndrome
We usually associate the word “mourning” with the feeling that arises after the death of a loved one. But psychologists relate the term to any loss suffered by the human being, such as leaving a job, the separation of a couple or changes in our body.
“Each time we experience a loss, we have to get used to living without what we had and adapt to the new situation. In other words, we have to work on grief”, explains Spanish psychologist Celia Arroyo, a specialist in migratory grief.
Thus, migratory mourning is associated with this great change in a person’s life. But it has characteristics that make it special, as it is a “partial, recurrent and multiple” mourning.
Partial because it is not a total loss, as with someone’s death; recurring because, as with any trip, it can be reopened by communicating with the country or simply looking at a photograph on Instagram; and multiple, because it is not just one thing that is lost, but many.
Joseba Achotegui has grouped these losses into seven categories.
The most obvious is often the loss of family and loved ones. There is also the loss of social status — something that, according to Arroyo, usually occurs with the condition of migrant, but if, in addition, “the country is xenophobic, great adversity arises”.
Another mourning for the migrant is the loss of land: missing, for example, a mountainous landscape or sunny days.
Added to this is the mourning of the language, which will be stronger in cases of migration to a country where another language is spoken. It can be a strong barrier, for example, for bureaucratic procedures or for sending a simple email.
There is also the loss of cultural codes. It can represent something as simple as not having anyone to dance to a typical song with or having a local drink from the country of origin.
And associated with this loss is the loss of contact with the group we belong to — those with whom we can speak in the same codes, who will understand our slang and the way we see life.
Ulysses syndrome occurs when, in addition to having to go through these normal griefs, the migrant faces difficult conditions, according to Achotegui.
“When there are difficulties or the person is rejected in the society that welcomes them, this syndrome can happen”, explains Guillermo Fauce, professor of psychology at the Complutense University of Madrid, in Spain, and president of the organization Psychology without Borders.
Arriving in a new country with a stable job is very different from having no security at all; as well as having or not guaranteed shelter and food, or entering with a visa or legal status to be defined. Having or not having certain conditions adds points and stress.
“The rejection that can cause more impacts is not having documents or not being able to access certain resources”, says Fauce.
Achotegui explains that this situation makes the migrants unable to move forward, generating tension and survival problems – another triggering factor for the syndrome.
One can add to the picture not having people around us to offer support, not only material (where to live, eat and sleep), but also emotional. “Many migrants suffer situations of loneliness, they are isolated”, highlights Achotegui.
Fauce points out that there is also a symbolic support that, when absent, becomes another triggering factor. It is about the recognition and understanding of the migrant’s conditions in his surroundings, “that he is going through a complicated situation, going through many bereavements and that he is offered a period of transition in the society that welcomed him”.
Sometimes one can think that “the worst” is over when crossing the border in bad conditions. But, in the host country, the feeling of being helpless, without rights and the possible labor and sexual abuses can give rise to a fourth triggering factor: fear.
The experts consulted add that this situation of vulnerability can lead to Ulysses syndrome, especially among women.
What can happen and when should we be alert?
Achotegui explains that the symptoms can be the same as when we go through a bad time: sleeping poorly, difficulty relaxing, muscle or headaches, boredom, nervousness and sadness.
Fauce points out that, on the one hand, the migrant can enter a kind of depressive and sad state, withdrawing into himself, and, on the other hand, he can become hyperactive and anxious, which ends up consuming energy.
This can cause Ulysses syndrome to be confused with other mental illnesses, such as depression or post-traumatic stress, and end up being medicated. But in this case, when the obstacles that gave rise to the syndrome are resolved (availability of work, certain stability, less stress, etc.), the syndrome disappears.
“If the migrant moves on, gets a job and achieves a certain stability, but the symptoms continue, there is something else there to be evaluated and it is necessary to intervene in another way, because there may be something else already in the psychiatric plan, such as a depression”, explains Achotegui.
Therefore, when the malaise becomes permanent or prevents us from carrying on with our lives, the alarm must be sounded.
Other warning signs highlighted by Fauce are occasional tantrums, damage to social relationships or “taking shortcuts, such as drug or alcohol consumption, exorbitant spending or risky sports”.
What to do or not to do
“It is essential to create a social support network, maintain contact with other immigrants and share housing”, emphasizes Celia Arroyo. For this, it is good to look for migrants of the same nationality or specific support groups.
Achotegui says this brings “less risk of mental disorders”, but being too anchored in the home community can cause less progress. “If you don’t integrate into the host society, progress will be difficult. It’s a matter of balance,” he explains.
In other words, the way is to keep “the roots” with water, but without forgetting the leaves, which must stay where they can receive sun.
Achotegui also recommends doing exercises and activities that reduce stress.
Fauce points out that “radical cuts do not work, nor do drastic decisions”, either with regard to the country of origin or the host country, as well as the relations created in the two countries.
Arroyo points out that while it is difficult to provide a precise time, if suffering is not reduced within three months of achieving stability, it is good to ask for psychological help.
what others can do
The host society plays an important role, but those who have not been through this situation may not understand what migratory mourning means, nor the prolonged stress caused by Ulysses syndrome. So you may not know how to help, what to say or what to do.
Celia Arroyo recommends that the migrant’s surroundings allow those in this situation to express themselves freely and talk about what is happening and how they feel.
“It is important not to minimize suffering, nor to generate false hope” in the face of an uncertain future when, for example, visa and work do not arrive. As with any grieving, you need to avoid phrases such as “soon it will pass”, “it’s not for that”, “this is your fear” or “everything will end well”.
Achotegui suggests not pitying or victimizing. “It is necessary to approach with respect and even with a certain admiration. The migrant is a strong person, someone who is moving forward.”
On the other hand, it is important to respect their culture, mindset and worldview.
If emotional connection with someone in this situation is difficult, Fauce reminds you that we have all suffered some loss. Therefore, connecting to that emotion we already had is a good exercise to empathize with the migrant.
And to believe that, as the Uruguayan Cristina Peri Rossi wrote, to emigrate – to leave, in short – is always to break in two.
– This text was published originally in https://www.bbc.com/portuguese/geral-62571893
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