Lifestyle "They Are Struggling": A Child Psychiatrist Writes from A Texas Shelter By Amy J. Cohen, M.D. Updated on June 25, 2018 @ 05:00PM Pin Share Tweet Email Photo: John Moore/Getty Images Victor*, 11, all dark eyes and stiff smile sits beside his big sister in the playroom area of Sister Norma’s Catholic Charities Humanitarian Respite Center in McAllen, Texas. With small children on the floor pushing plastic dinosaurs, all within arm’s reach of their parents, Victor seems to look at nothing—only glancing occasionally at his mom—and I sense that he is struggling. As a child psychiatrist with 30 years of experience in acute and long term effects of trauma, I am trusted to interact with the children here and so I sit down with him, his 15-year-old sister, and their mother who has been fitted with an ankle monitor. I discover that Victor spent seven days pacing in a pen with other boys at the vast and chilly border patrol station, having been separated from his mom and sister after they’d crossed the Rio Grande together and turned themselves in. Unable to so much as see his mom, Victor’s panic and desperation became overwhelming as hours and days passed. Nightmares jolted him from brief periods of uncomfortable sleep on the concrete floor. He was unable to keep down any food, vomiting up whatever the guards had cajoled or frightened him into trying. His family is together now, reunited through a somewhat arbitrary—or at least opaque—process that has failed to benefit so many others, and he’s tormented by a worry that his mom will be taken from him again. He says he has experienced flashbacks, a kind of waking nightmare to that moment in the detention center when she disappeared from sight. For now, Victor is experiencing a predictable response to a terrifying experience, one that left him with the previously inconceivable fear that his mother could just disappear. This fear will stay with him for a long time. For the more than 2,000 children who have been taken from their parents and transported on buses or planes to locked confinement centers in the desert or distant cities, the outcome is even more uncertain, and the devastation likely to be permanent and disabling. While President Trump’s recent executive order has called at least a temporary halt to this child separation policy, there have been no announced plans to reunite those already separated from their parents who came here seeking asylum. I believe what we have inflicted on these children is the psychological equivalent of cancer. In the past week, I have spent time meeting with families like Victor’s who have shared with me stories of the terror at home and the arduousness of their journeys here. One mother lowered her blouse to reveal an eight-inch scar across her chest, where gang members, unable to find her husband whom they were after, instead cut her open in front of her young daughters. Nevertheless, like many mothers in the shelter, she attends constantly to her girls: holding them, reassuring them, urging them to eat. One can see how these children are soothed by the proximity of their parents, how they cling to dusty pant legs, lift their arms to be picked up and rocked. Despite their own exhaustion and trauma, parents here are constantly attuned to the needs of their children. It's a sight that exemplifies the cruelty of separating families in the first place. Understanding Trauma There are many of us who have been affected by traumatic events and who have, sometimes with the help of therapy, recovered, sometimes completely. Our capacity to manage these experiences depends on both the nature of the trauma (anything from a fear that doesn't materialize to a life-threatening experience) and our relative vulnerability when it happens. For example: a mentally healthy adult with a good support system may withstand moderate trauma with few after-effects; a young child who has already endured a stressful journey, whose body and brain are still developing, is far less likely to. The children who have been taken into Office of Refugee Resettlement (ORR) custody are continuing to experience what professionals would consider severe trauma, and at the same time have the fewest resources for coping. This is why the impact on their brains and bodies is likely to be severe and sustained, even permanent. Here’s why: Humans are programmed to rely on the sight, smell, and touch of their parents as a first experience of safety and security and, later, as the principal mitigating, soothing presence at times of danger or chaos. Even for an otherwise safe and protected child, losing a parent is experienced as a trauma. Experiencing that loss in a situation of unfamiliarity and stress is enough to throw any child into a state of panic. Anna Freud (child psychoanalyst, and daughter to Sigmund) found that children airlifted from concentration camps in World War II recovered more easily from the trauma of war than they did from the loss of their parents. Meet the Women Defending Migrant Children on Our Border But these children at the American border haven't merely lost their parents. They have been removed from them without warning, explanation, or the ability to say goodbye. They have often been tricked into going with strangers. They are shuttled from one unfamiliar place to another in the company of other distressed, screaming and crying children. Once at their destination, most are locked in and permitted to go outside for only short periods of time, sometimes not more than once per day; some have reportedly been drugged against their will (and, obviously, without parental consent). A former worker at one such shelter told the L.A. Times that the staff were told to forbid the children from hugging one another, even siblings. This is inhumane, and to the children's very clear detriment. No Way to Cope A common way to process trauma is storytelling, or stringing together events into cogent narratives. People rely on this as a defense mechanism in all kinds of stressful situations, but it's a skill that develops as you age. Without this capacity to make sense of the world around them, a small child experiences trauma as pure and disconnected pain without context: arbitrary and unbidden, meaningless. This deepens a panic which can completely overwhelm their ability to cope. Exacerbating this, kids perceive time differently than adults, too. An hour feels like a day, a week like a month, and inconceivably horrible events can feel infinite. Having, then, few internal defenses to protect against this experience of random, extreme and protracted pain, the small child’s system breaks down, both psychologically and physically. Emotions are raw and unmodulated. The child is in a kind of nightmarish free-fall with two likely outcomes: to express their pain through lashing out—screaming, tossing over chairs and tables, hitting themselves or others, as many in these detention centers reportedly have—or to stop feeling all together: shutting down and withdrawing from all experience, both negative and positive, becoming detached. The acute physiologic symptoms of trauma, many of which can endure for months or years, render these children even more vulnerable. As I have seen in my own practice and here at the border, children and parents report to me an inability to sleep, frequent nightmares when they do, an avoidance of sleep arising from fear of nightmares or of the dark unknown. Reported, too, are chronic gastrointestinal symptoms, the product of increased levels of the body’s chemicals naturally arising from stress. These children are often without appetite and unable to hold down food. They frequently suffer from diarrhea. Many older children regress and begin wetting the bed, peeing or defecating in their pants. These physical symptoms only deepen the child’s experience of trauma; pain and humiliation compounding withering fear. Many of the more enduring symptoms of trauma will come from direct damage to neurological pathways: the consequence of the neuron-destroying impact of the young body’s chemical response to prolonged panic. These children will have a more difficult time learning and succeeding in school. Friendships and family relationships will suffer as their emotions remain unregulated, difficulty with social relationships, obsessional worries and problems with concentration. Studies have shown that exposure to this kind of trauma can permanently sidetrack the cognitive and social development of children, impeding their chances in later life. We have done a terrible thing to small and innocent children in exposing them to the physical and psychological dangers of severe trauma. Although their predictable misery should have been enough to prevent such a policy, the equally predictable long-term damage to their minds and bodies renders this a true atrocity. These are thousands of individuals whose life course has been shifted, who may never fulfill any of the hopes and dreams their parents came to America seeking. And for what? More importantly—now what? We should do all we can to immediately reunite these children with their parents and to offer them long-term support and services for the damage our country has caused. We should learn from this, too, and do whatever we can to stop letting devastating history repeat. VIDEO: Nearly 2,000 Children Have Been Separated From Their Families During Trump Border Crackdown *Name has been changed. Amy Cohen, M.D., is a Harvard-trained child and family psychiatrist who’s worked with highly vulnerable and traumatized child populations in the inner city, Appalachia, Juvenile Hall and South Sudan. She serves on the Medical Advisory Board of the National Center for Youth Law and lives and works in Los Angeles.