25 February 2016
"Childhood maltreatment is the main cause of mental illness; it is not in our genes," says acclaimed author and psychologist Oliver James. In this guest blog ahead of his new book of the same name, ‘Not in Your Genes’, Oliver explores the emotional and psychological impacts of Europe's refugee crisis on children, and warns of the huge public health crisis that is looming as a result.
A great many of the millions of children who have become refugees because of the civil war in Syria may have suffered harmful experiences: such as emotional or physical neglect and abuse, including cruelty, or victimisation. This will greatly increase their risk of mental illness in later life.
Exposed to dead bodies, witness to acts of violence, or worst of all, attacked themselves, children are at great risk of developing Post Traumatic Stress Disorder.
There is a direct relationship between the number and the severity of harmful experiences and the level of mental illness that results. At the most extreme, a child who has suffered five or more kinds of harm is as much as 193 times more likely to become a schizophrenic adult than a child who has suffered none. Children who have been through severe harmful experiences are 46 times more likely to develop schizophrenia than children who have been through mild harmful experiences.
For refugee children, in the first instance, loss of their home is enormously distressing. Even without the turmoil and harm that goes with civil conflict, American children who move house frequently are more at risk of mental illness. To have your house bombed or to have to leave it for fear of being murdered is an extreme loss of a safe base.
Even more damaging will be the gruesome scenes that so many children have witnessed. Exposed to dead bodies, witness to acts of violence, or worst of all, attacked themselves, children are at great risk of developing Post Traumatic Stress Disorder (PTSD).
The main symptom for children suffering from Post Traumatic Stress Disorder is dissociation from one’s surroundings – faced with unbearable threats, we check out, emotionally, becoming numbed and absent. From time to time the traumatic events switch on in the traumatised person’s mind, like a video. Suddenly they are transported back to the original situation, reliving it as if it is in the present. Just as dreams feel as real as waking life, so do these ‘videos’.
Other PTSD symptoms include sleeplessness, febrile emotions, loss of concentration and permanent anxiety. Tragically, a high proportion of refugee children are likely to suffer from these.
Another major impact of becoming a child refugee is the change in their parents’ ability to provide them with their basic needs and give them a safe environment to grow up. For children with parents who are also traumatised, this may also affect the way they interact with each other.
Play is vital to a child’s wellbeing and that is only possible if the child feels safe. When ordinary toddlers are separated from their main carers for more than a few minutes, they stop playing, looking perturbed, withdrawn and angry. Because refugee children are liable to be made to feel unsafe by witnessing traumatic events and because their parents may not be able to tune into them as much as usual, the capacity to play is severely reduced.
Play is vital to a child’s well-being and that is only possible if the child feels safe.
Complete and prolonged separation from the parents is disastrous; seeing them die is the worst of all. Following this, suddenly being cared for by strangers in itself is a trauma which devastates. As studies of Romanian orphanage children have shown, if the separation is permanent, there are drastic changes to the brain’s electro-chemistry. It is also proven that simply being evacuated at a young age during the Second World War doubled the risk of depression in later life.
The ‘fight or flight’ system, which is activated in response to threat, leads to constant secretion of the stress hormone cortisol. Flooded with it, children may be frozen or numb, or have attention deficits and develop conduct disorder (CD) - a serious behavioural and emotional disorder that can occur in children and teens. A child with this disorder may display a pattern of disruptive and violent behaviour and have problems following rules. Separated or orphaned children are at great risk of high cortisol levels, with lifelong damaging effects.
A public health crisis of huge proportions
So far most of the debate in Europe has been focussed on the politics of migration resulting from the conflicts in the Middle East. We need to wake up to the fact that the massive number of refugees could be creating a public health crisis of huge proportions - a mental illness time bomb in millions of innocent children, as well as their parents.
ActionAid mother and baby centres on Lesvos are providing a safe place for mothers to care for their children and give them a moment’s relief following the traumatic experiences they have been through.
Oliver James's new book 'Not In Your Genes' is out this Saturday. He has also written The Real Reasons Children Are Like Their Parents and Vermilion. Follow him on Twitter at @oliverj_psych.