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Displacement, Deterioration, and Despair

Oldham, John M., MD

Journal of Psychiatric Practice®: March 2016 - Volume 22 - Issue 2 - p 75
doi: 10.1097/PRA.0000000000000143


Concerns about immigration, refugees, and displaced persons crowd the headlines these days in many parts of the world. The magnitude of the problem is enormous, ranging from government policy questions such as border control and deportation of illegal immigrants, to humane efforts to provide food and shelter to crowds of individuals of all ages who are now in a foreign land and have lost their homes, their possessions, their language, and their livelihoods. All it takes is a newsclip showing a flimsy inflatable boat overloaded with families, who may or may not make it to a foreign shore, to realize the desperation of these travelers who are fighting for their lives. We see cities and towns savagely reduced to rubble, yet where deadly battles still rage. We understand that if we had been the citizens of these communities, formerly living in these now demolished buildings, we, too, would have fled, whatever the odds of surviving elsewhere.

I realize of course that war is universal and filled with tragedy, and we have had our share. But today’s technology brings the broader impact of the war right into our living rooms—showing not just the faces of those killed or wounded in combat but also the faces of those now homeless and trying to survive. Haunting images can be hard to shake away, such as the faces of starving children in captured or war-torn towns where food and water can’t be found.

What can be done? I wish I had the answer and of course I don’t. But there are ways to help. Refugees are remarkably resilient and many do make it to those foreign shores, including our own. Compassionate care for these families can make a big difference, especially if provided by culturally sensitive clinicians who appreciate the burden of stress carried by these refugees, stress that is intensified by efforts to adjust to an unfamiliar world.

In this issue of the Journal, Kinzie presents 1 model of this badly needed compassionate care, which he refers to as a medical approach to the management of traumatized refugees. He points out that, since 1975, the United States has admitted >3 million refugees and displaced persons. Working in a clinic of the Intercultural Psychiatric Program in Oregon, Kinzie reports that his own caseload of 280 patients includes Vietnamese, Cambodian, Ethiopian, Bosnian, and Somali individuals. Most commonly, these patients have posttraumatic stress disorder and depression. On the basis of decades of experience, Kinzie emphasizes the importance of a combination of supportive psychotherapy and pharmacotherapy, while monitoring for common medical conditions such as hypertension and diabetes. And, most importantly, the clinic has found that its motto of “one patient, one counselor, one psychiatrist forever” maximizes the effectiveness of the program by minimizing disruptive staff turnover and maintaining therapist continuity.

Also in this issue, Licciardi and colleagues describe the impact of Hurricane Sandy in 2012, a powerful storm that pounded the East coast claiming 159 lives and leaving destruction in its wake. In this study at Maimonedes Medical Center in New York, significant increases were seen in visits to the psychiatric emergency room following the hurricane, the impact of which continued for much longer than anticipated and involved an extended need to attend to posttraumatic stress disorder symptoms, particularly in those who had experienced previous trauma such as on September 11, 2001.

John M. Oldham, MD

The Menninger Clinic, Houston, TX

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