Neuroethics

Moving On: A Refugee Crisis

Lasya Kambhampati


Abstract

The number of refugees throughout the world, particularly children, has skyrocketed in the last decade. The trauma they face, both in the home and host country, causes changes in the hippocampus, reward centers, grey matter, and amygdala. The neurology behind these symptoms is complex and not fully understood yet. These changes are linked to significantly higher rates of mental health disorders among refugees, in some cases 30 times higher than the non-displaced population.

 

Context

As a result of conflict and persecution, 29.4 million people worldwide are refugees or asylum seekers. Over 40% of them are children, a group particularly  affected by the trauma in their surroundings [1][2]. As these statistics increase, countries are struggling to keep up with the influx of migrants and provide them with the support they need. In countries such as the United States, the backlash has caused policies to shift towards keeping migrants out instead of helping them -- at times, even detaining asylum seekers in allegedly inhumane holding centers. 

 

Issue

As the number of refugees has increased, there has been more research conducted on refugee welfare. Scientists used tests, such as the Harvard Trauma Questionnaire, to measure mental health over various time periods. The test results showed that mental health concerns persist if treatment is not received or if detention facilities, chronic family separation, unemployment, or social isolation played a role in the trauma [3][4][5][6].

Cross-sectional studies have found that nearly 15 - 30 % of the refugee population show signs of PTSD and have, on average, two flashbacks per day. In comparison, the rate of PTSD in the general population is around 1.1% [7][8][9]. Other disorders, such as depression and schizophrenia, remain prevalent and severe in refugee groups. With the ever-increasing number of migrants, scientists such as epidemiologist James Kirkbride have termed it a “public health epidemic” - one that is invisible but far too dangerous to go unaddressed. 

Furthermore, studies report that “prolonged detention, insecure residency status, challenging refugee determination procedures, restricted access to services, and lack of opportunities to work or study, combined in a way that compounded the effects of past traumas in exacerbating symptoms of PTSD and depression” [9] [10] [11] [12] [13]. Many of the conditions that refugees are subjected to meet these risk factors and show the need for change in our policies.
 

Effects

Scientists have discovered that the hippocampus atrophies, leading to memory and concentration problems, and the amygdala enlarges, increasing anxiety, aggression. The overactive amygdala is usually controlled by the prefrontal cortex; however, trauma causes this pathway to be impaired, leaving the amygdala unchecked [18] [19] [21]. These structural changes help explain the high prevalence of mental health disorders in the migrant populations.

Further evidence lies in the reward system. Neuroscientists have observed changes in brain structures such as the nucleus accumbens and ventral striatum. The HPA axis, which involves the aforementioned structures, regulates responses to temptations and distractions and is damaged as a result of stress, resulting in the brain needing more stimulation to receive a reward or even anhedonia [20]. Moreover, there is a significant decrease in cortical thickness and surface area, as well as dendrite length. Interestingly, these changes can be reversed if the trauma occurs in adulthood, but not in childhood - confirming children are distinctly vulnerable to the debilitating effects outlined above [21].

These effects are known as toxic stress, which is caused by stressful events such as separation from parental figures. Even when people are able to escape from their source of trauma, the toxic stress on their body, specifically the brain, does not dissipate. Without proper attention, it can develop into mental health disorders – explaining the high rates of PTSD, depression, and schizophrenia observed in refugees.

 

Solutions

As dire as the situation seems, researchers have come up with some solutions.

First, they propose that lawmakers move away from the idea of “quick integration.” Clinical psychologist Thomas Elbert says that “It is illusory to think that people can learn a new language and find work when they can’t function properly mentally. If we want quick integration, we need an immediate plan for mental health.” Moreover, it is essential to reduce the stress that migrants face when entering recipient countries because excess toxic stress can only compound the effects on the brain and body. [22]

Scientists, recognizing that many countries do not have the time or money to provide the necessary treatment, have come up with innovative, inexpensive ideas.

One is an app known as MeWe – an interactive storytelling program made in collaboration with  UNHCR. The creator’s hypothesis is that an arrested story (in which a person feels as though their narrative is written by others) leads to arrested development and mental health issues. These issues, hypothetically, could be alleviated by MeWe, which allows users to take control over their story. Research at Princeton University shows that storytelling can change neuronal coupling and brain structure. Although it would not be as potent as therapy or medication, it can alleviate the negative effects of mental health disorders and improve self-efficacy [23].

Another solution is to train laypeople to guide refugees through the health system and provide basic counseling. Dr. Elbert has conducted research in Afghanistan and Germany showing that systems, where lay people can carry out Narration Exposure Therapy, can alleviate symptoms and free up time for professional psychologists to deal with patients with severe illnesses. This solution has been implemented throughout the world successfully, showing its viability. Not only is it effective, it requires minimal extra resources on the host country, providing benefits for both parties. [22]

Irrespective of the receiving of refugees, research shows those escaping turmoil in their home countries are at heightened risk of mental health disorders and current policies are inadequate in providing the help needed. Furthermore, there are viable solutions available that can change the lives of millions of people. –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

  References

[1] Hirsh-Pasek, Kathy, and Kathy Hirsh-Pasek. “The Enormous Cost of Toxic Stress: Repairing Damage to Refugee and Separated Children.” Brookings, World Bank, 9 July 2018,      www.brookings.edu/blog/future-development/2018/07/09/the-enormous-cost-of-toxic-stress-repairing-damage-to-refugee-and-separated-children/. 

[12] Rees S. Refuge or retrauma? The impact of asylum seeker status on the wellbeing of East Timorese women asylum seekers residing in the Australian community. Australas Psychiatry; 2003;11:S96‐101.

[2] Hauff, Edvard, and Per Vaglum. “Organised Violence and the Stress of Exile: Predictors of Mental Health in a Community Cohort of Vietnamese Refugees Three Years after Resettlement.” British Journal of Psychiatry, vol. 166, no. 3, 1995, pp. 360–367., doi:10.1192/bjp.166.3.360.

[13] Li SS, Liddell BJ, Nickerson A. The relationship between post‐migration stress and psychological disorders in refugees and asylum seekers. Curr Psychiatry Rep 2016;18:82.

[3] Lie, B. “A 3‐Year Follow‐up Study of Psychosocial Functioning and General Symptoms in Settled Refugees - Lie - 2002 - Acta Psychiatrica Scandinavica - Wiley Online Library.” Acta Psychiatrica Scandinavica, John Wiley & Sons, Ltd (10.1111), 23 Oct. 2002, onlinelibrary.wiley.com/doi/abs/10.1034/j.1600-0447.2002.01436.x.

[14] Momartin S, Steel Z, Coello M et al. A comparison of the mental health of refugees with temporary versus permanent protection visas. Med J Aust 2006;185:357.

[4] “Two Year Psychosocial and Mental Health Outcomes for Refugees Subjected to Restrictive or Supportive Immigration Policies.” Social Science & Medicine, Pergamon, 1 Mar. 2011, www.sciencedirect.com/science/article/abs/pii/S0277953611000931.

[15] Fazel M, Silove D. Detention of refugees: Australia has given up mandatory detention because it damages detainees' mental health. BMJ 2006;332:251. 

[5] Beiser, Morton. “Language Acquisition, Unemployment and Depressive Disorder among Southeast Asian Refugees: a 10-Year Study.” Social Science & Medicine, Pergamon, 10 Sept. 2001, www.sciencedirect.com/science/article/abs/pii/S0277953600004123.

[16] Bosworth M. Mental health in immigration detention: a literature review. London: Her Majesty's Stationery Office, 2016. 

[6] Mollica, Richard F., et al. “Dose-Effect Relationships of Trauma to Symptoms of Depression and Post-Traumatic Stress Disorder among Cambodian Survivors of Mass Violence.” British Journal of Psychiatry, vol. 173, no. 6, 1998, pp. 482–488., doi:10.1192/bjp.173.6.482.

[18] Taylor, Shelley E., et al. “Neural Responses to Emotional Stimuli Are Associated with Childhood Family Stress.” Biological Psychiatry, vol. 60, no. 3, 2006, pp. 296–301., doi:10.1016/j.biopsych.2005.09.027.https://taylorlab.psych.ucla.edu/wp-content/uploads/sites/5/2014/10/2006_Neural-Responses-to-Emotional-Stimuli-are-Associated-with-Childhood-Family-Stress.pdf

[7] Mollica, Richard F. “The Effect of Trauma and Confinement on Functional Health and Mental Health Status of Cambodians Living in Thailand-Cambodia Border Camps.” JAMA, American Medical Association, 4 Aug. 1993, jamanetwork.com/journals/jama/article-abstract/407715.

[19] Goff, Bonnie, and Nim Tottenham. “Early-Life Adversity and Adolescent Depression: Mechanisms Involving the Ventral Striatum.” CNS Spectrums, U.S. National Library of Medicine, Aug. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC5928787/. 

[8] Beiser, Morton. “The Health of Immigrants and Refugees in Canada.” SpringerLink, Springer International Publishing, 1 Mar. 2005, link.springer.com/article/10.1007/BF03403701.

 

[9] Steel Z, Chey T, Silove D et al. Association of torture and other potentially traumatic 

events with mental health outcomes among populations exposed to mass conflict and displacement. JAMA2009;302:537‐49

[20] Hodel, Amanda S, et al. “Duration of Early Adversity and Structural Brain Development in Post-Institutionalized Adolescents.” NeuroImage, U.S. National Library of Medicine, 15 Jan. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4262668/

 

[10] Silove D, Steel Z, Watters C. Policies of deterrence and the mental health of asylum seekers. JAMA2000;284:604‐11.

[21] Abbott, Alison. “Refugees Struggle with Mental Health Problems Caused by War and Upheaval.” Scientific American, Scientific American, 11 Oct. 2016, www.scientificamerican.com/article/refugees-struggle-with-mental-health-problems-caused-by-war-and-upheaval/.

[11] Steel Z, Silove D, Brooks R et al. Impact of immigration detention and temporary protection on the mental health of refugees. Br J Psychiatry 2006;188:58‐64.

[22] Din, Mohsin Mohi ud. “How Connecting Neuroscience, Storytelling, and Psychology Can Create Measurable Impact for Refugee Youth.” UNHCR Innovation, United Nations High Commissioner for Refugees, 25 May 2018, www.unhcr.org/innovation/connecting-neuroscience-storytelling-psychology-can-create-measurable-impact-refugee-youth/.



    Lasya Kambhampati

    Lasya Kambhampati


    Lasya is a senior at Blue Valley North. She is planning on majoring in neuroscience or biomedical engineering. She first got involved in the IYNA after participating (and placing 7th) at the National Brain Bee. She is now the Director of Chapters and is focusing on helping extend the impact the IYNA has. Lasya also runs a neuroscience blog to help students prepare for the Brain Bee and just learn more about the nervous system. She hopes to help students of all ages and backgrounds learn about the amazing organ that runs our whole lives. In the future, Lasya hopes to be a neurosurgeon and research the molecular mechanisms behind memory. Outside of neuroscience-related activities, she loves to write, read, and play the violin/piano.