Today, almost half of all refugees worldwide are children and adolescents, nearly a quarter of whom arrive in Europe as Unaccompanied Refugee Minors (URM).
Many URMs have experienced the cumulative stress of being exposed to both the adverse environmental conditions that drive forced migration and the traumatic experience of displacement and resettlement. These experiences, coupled with other developmental stressors, may impede their overall development and increase their likelihood of mental health problems.
Despite the evident vulnerability of URMs, much controversy currently surrounds the legitimacy of their arrival in host countries, and their mental health is often given little consideration. While knowledge is mainly accumulating through reports by governments and non-governmental organizations, there is little information on URM mental health within them, and statistics on mental health are lacking. [https://www.sciencedirect.com/science/article/abs/pii/S0145213419303230]
When is a refugee child doing well?
The almost unanimously ratified UNCRC (UN General Assembly, 1989) gives all children equal rights to a childhood, to be treated fairly, to have safety, protection, education, and to be heard.
However, URMs, as both vulnerable and resilient individuals, have not always fully enjoyed their rights—especially those concerning protection and safety—and their voices are rarely heard.
So, how do we know when a refugee child is doing well?
Children are seldom asked about their experiences, and even when they are, their views are not always respected.
Why is it important to care about their feelings, though controversial?
Each child, if given the opportunity, has a unique story to share, and it is most likely that embedded within their experiential stories are essences of resilience.
Unaccompanied foreign children migrate carrying with them traumatic and extremely painful experiences. [https://www.infanziaeadolescenza.it/archivio/1063/articoli/11653/]
Regarding the correlation between trauma and subjective psychological states, from a clinical perspective, studies have found that the development of post-traumatic stress disorder (PTSD) or its associated symptoms (such as anxiety, depression, and dissociative tendencies) is one of the dysfunctional outcomes related to exposure to traumatic events.
There is a clear correlation between the status of unaccompanied foreign children, their traumatic experiences, and the development of PTSD-related symptoms.
Moreover, specific symptomatology tends to emerge in children who have lived in communities for more than six months but less than a year, and it declines in minors who stay in residential contexts for more than one year. [https://www.infanziaeadolescenza.it/archivio/1063/articoli/11653/]
It is important to care about their feelings to help them settle and regain a sense of normalcy within their new surroundings.
Can they all be considered part of the same group just because they are “refugees”?
It should, however, be carefully considered that, beyond the common denominator of having lost their home and parental support, URMs are not a homogeneous group.
They are diverse not only in terms of gender, age, ethnicity, and religion, but also in terms of their past experiences and current life situations.
Despite the overwhelming number of stress-related risk factors and limited social support, not all URMs experience the adversities they encounter with the same intensity or to the same extent.
Young refugees are often referred to as a silent group that is easily overlooked.
In terms of their needs and emotional and physical strengths—on which there is little research—the stories of the URMs have not been heard enough.
What are the challenges?
The major challenges to children’s subjective well-being can be categorized into four themes:
- Experiencing forced migration
- Stress and lack of a sense of coherence
- Anxiety and significant loss of human and material resources
- Relationship conflicts (also with professionals) leading to perceived social rejection and exposure to cultural insensitivity
In the last case, relationships with professionals presented various challenges and were sometimes a source of social strife, often precipitated by what the children perceived as cultural insensitivity.
What does “ethno-psychiatry” stand for?
Ethnopsychiatry is the study of mental illness in a cross-cultural perspective, including its definitions, classification, causality, and treatment of mentally ill persons in different cultural contexts.
Other terms used in psychiatric literature for ethnopsychiatry are cross-cultural psychiatry or transcultural psychiatry. [https://www.researchgate.net/publication/8940825_Ethnopsychiatry_-_A_review]
Mental illness in the context of ethnopsychiatry
In the context of ethnopsychiatry, defining mental health has not been an easy task, as there is disagreement over the boundaries of normal and abnormal behavior.
How would one define normal mental health? This question appears simple, but the answer is complex.
It seems that a mentally normal person in one society or culture may not be considered normal in another, due to the existence of substantial trans-cultural variations worldwide.
For example, if a person speaks and laughs excessively, if they are violent, self-harmful, disinhibited, or emotionally unstable, they may be labeled as “psychically disturbed” in one socio-cultural context but not in another.
Every culture must deal with mental illness to ensure its stability.
However, it is important to recognize that standards of mental illness are relative, as the social context in which a behavior occurs affects whether it is judged normal or abnormal.
Depending on the situation, the same behavior may be considered a mental disorder, criminal, or even socially acceptable. [https://www.researchgate.net/publication/8940825_Ethnopsychiatry_-_A_review, under Concept of Mental illness in the context of etnopsychiatry]
About curers
In the context of ethnopsychiatry, a number of curers are identified for the treatment of mental illnesses. The types of curers found in a society, and the acts in which they engage, logically stem from the etiologies they recognize.
Personalistic systems, with multiple levels of causation, logically require curers with supernatural and/or magical skills, because the primary concern of the patient and their family is not the immediate cause of the illness, but rather “Who?” and “Why?”.
The shaman, with his supernatural powers and direct contact with the spirit world, and the “witch doctor,” with his magical powers, are the logical responses in personalistic, multiple causality, and alethiological systems.
Once the “who” and “why” have been determined, treatment for the immediate cause may be administered by the same person, or the task may be transferred to a lesser curer, such as an herbalist. [https://www.researchgate.net/publication/8940825_Ethnopsychiatry_-_A_review, under Shamans and Other curers]
Illness is often conceptualized as a disturbance of normal bodily functions.
The causes of this disturbance may include external agents: in many traditional cultures, illness is seen as an external object that has intruded into the body.
Thus, the healing procedure consists of removing the offending substance, which may be either inanimate or animate, from the sufferer’s body.
How do they remove the spirit from the body? Treatment methods adopted by these practitioners include communication with spirits, reciting special prayers or verses, examining horoscopes, using holy water (sometimes with herbs added), talismans, and incantations. [https://www.researchgate.net/publication/8940825_Ethnopsychiatry_-_A_review, under Potential for Collaboration].
It is important to underline that traditional medicine is an ancient form of health care, practiced long before the emergence of scientific medicine, and is part of the culture of many peoples.
It is accessible to people in even the most remote areas and does not require sophisticated equipment.
However, in some cases, it is important to apply specific therapeutic approaches that allow intervention in clearly defined clinical cases. Here are some examples:
- EMDR (Eye Movement Desensitization and Reprocessing): This technique is aimed at patients who have experienced trauma, particularly those suffering from Post-Traumatic Stress Disorder (PTSD). It helps process traumatic memories through eye movements.
- Sand Play Therapy: This is a “hands-on” psychological method and an adjunct to talk therapy. The client creates a concrete manifestation of their imagination using sand, water, and miniature objects. This technique allows the expression of stories that, in words, would be incomplete or hard to communicate, thus requiring the appropriate support.
There is, however, the potential for treatment not only at the mental level but also at the physical level, particularly through physiotherapy and dental care.
On one hand, physiotherapy has a dual function:
- It treats psychosomatic disorders, often related to post-traumatic stress
- It attempts to restore the therapeutic value of body touch, with resulting healing effects
Dentistry also plays a crucial role, especially in cases where the individuals have suffered physical torture, including the removal of teeth
[http://dspace.unive.it/bitstream/handle/10579/17104/967448-1251410.pdf?sequence=2, pp. 55-56]
Potential for Collaboration
Given the low number of qualified psychiatrists and allied mental health practitioners, and the large number of alternative practitioners who serve as good counselors, the possibility of collaboration is worth exploring.
There is a clear need to pursue an interdisciplinary approach that fosters continuous interaction between various fields of knowledge, such as anthropology, psychiatry, and psychotherapy, with a view to a critical redefinition of their study objects. Without this, therapeutic interventions will inevitably be partial and, in some cases, even harmful.
https://www.infanziaeadolescenza.it/archivio/1063/articoli/11653
https://www.sciencedirect.com/science/article/abs/pii/S0145213419303230
https://www.sciencedirect.com/topics/psychology/traumatic-experience
https://www.researchgate.net/publication/8940825_Ethnopsychiatry_-_A_review
http://dspace.unive.it/bitstream/handle/10579/17104/967448-1251410.pdf?sequence=2