| Ulysses syndrome | |
|---|---|
 | |
| Odysseus (Ulysses in Latin) | |
| Specialty | Psychiatry |
Ulysses syndrome (Immigrant Syndrome of Chronic and Multiple Stress) is an atypical set of depressive, anxious, dissociative, and somatoform symptoms that results from being exposed to extreme levels of stress unique to the process of modern migration. [1] Rather than a mental disorder, this syndrome is a natural reaction to toxic levels of stress seen in migrants who are otherwise in normal mental health. [1]
The Ulysses syndrome has both physical and psychological symptoms. [2] These include migraines, insomnia, recurrent worrying, tension, nervousness, irritability, disorientation, fear, fatigue, sadness, gastric pain, bone pain, low self-esteem, increased tobacco and alcohol consumption, and decreased productivity. [1] [3] [4] A lack of social support or access to appropriate medical care may aggravate these symptoms. [4] In some occasions, patients with Ulysses syndrome are mistakenly diagnosed with another medical condition which can further impede recovery. [4]
Migration in the 21st century has occurred in the context of unprecedented volatility, conflict, and suffering. There are currently more forcibly displaced individuals in the world than at any other time in history, including 22.5 million refugees, 40.3 million internally displaced peoples, and 2.8 million asylum-seekers in 2016. [5] Forced migration has profound impacts on individuals and families as their lives change suddenly and dramatically. [6] Experiences of modern migrants include the separation of families, dissolution of communities by conflict and disaster, exposure to exploitation, and violence. [6] Migrants remain in prolonged periods of displacement with a median time of 4 years in exile. [7]
Migrants often face multiple forms of uniquely intense stressors, such as the death of loved ones, lack of jobs and social support, difficulties in the migratory process, and loss of status and identity. [4] Because many migrants lack access to healthcare in the receiving country, they are often unable to receive appropriate care and continually re-experience the mental trauma of these losses. The cumulative effect may create stress levels so intense that they exceed individuals' adaptive capacities and lead to a failure of the acculturation process. This aggravates other symptoms, including depression, anxiety, headaches, and pain. [4]
Extreme stressors that put individuals at risk for Ulysses syndrome, called "Ulysses stressors", can broadly be characterized into four categories: [1]
Middle-aged and elderly adults are typically more strongly affected than younger people are because they experience a larger loss of status and social mobility, have fewer encounters with people outside of the community through school or work, and are less likely to be exposed to the receiving country's mainstream culture. Moreover, older immigrants typically have greater difficulty learning the receiving country's language, which may substantially impair their ability to understand and interact with the new culture. [9] [10]
Ulysses syndrome is not a mental disorder, but rather a normal stress response by a healthy individual to an extreme situation that overwhelms the normal psychological mechanisms for coping. [1] By definition, this syndrome cannot be diagnosed if another mental disorder is present. [1] There is currently no DSM-5 criteria for this syndrome.
Although often falsely recognized as acute stress disorder, depression, adjustment disorder, or other mental disorders, Ulysses syndrome differs from these pathologies in important ways: [1]
Although clinically distinct from mental health disorders, Ulysses syndrome exists on a spectrum between normal and disease. [1] It can be understood as the extreme limit of normal mental functioning that can still be considered non-pathological. However, an individual with Ulysses syndrome is at greater risk of disease and indeed, at a certain point the stressors may become too intense such that a true clinical mental disorder such as depression or PTSD can develop. [1]
Because Ulysses syndrome is a stress response rather than a mental disorder, the natural response for an individual is to return to his or her normal state of health once the stressors are eliminated. [1] Dr. Achotegui, who first described Ulysses Syndrome, makes the analogy to a stalk of bamboo that bends in the wind. [1] Just like bamboo will bend but not break, those who are exposed to Ulysses stressors are brought to the brink of mental instability and are made more vulnerable to mental disorders, but do not have a disorder yet. When the wind subsides, the bamboo will spring back to its normal state, just as those who face these stressors will return to their normal selves if and when the stressors resolve.
Preventive measures that may help reduce Ulysses syndrome generally revolve around building mental resilience, such as finding closure after losing loved ones, embracing changes in identity as an opportunity for growth, talking with others who have undergone similar experiences, re-evaluating expectations to be more realistic, and learning to live in the present rather than dwell too deeply in nostalgia. [12]
One proposed therapy leverages the ability of community health workers CHWs) to connect with hard to reach populations such as displaced migrants. [4] CHWs better understand the local culture and traditions and may, with the appropriate training, be able to engage affected individuals more effectively. For instance, CHWs can often better advocate for migrant rights and connect migrant populations to the resources necessary to facilitate integration and build community, all of which helps reduce the extreme stressors that lead to Ulysses syndrome.
Dr. Joseba Achotegui from the Universitat de Barcelona coined the term "Ulysses Syndrome" in 2002. [13] It was named after the ancient Greek hero, Odysseus (Ulysses in Latin), who suffered involuntary migration and travelled for 10 years through the Mediterranean to come back home from the decade-long Trojan War. The hardships of his journey are compared to the ones of contemporary migrants, who must struggle with intensely stressful, novel situations in isolation and with little help. [14] Scarcity of their resources makes it impossible to cope with and successfully adapt to the unfamiliar environment of the receiving country, which in turn leads to experiencing a range of detrimental symptoms.
There are accounts that cited the Canadian Mercer Rang as the originator of the term. [15] [14] However, Rang described a different condition in 1972, [16] one that is characterized by ill or side effects of extensive diagnostic investigations because of a false-positive result of laboratory screening. [14] Here, the patient is likened to Ulysses as he embarks on a journey that brings more suffering than he had to begin with. [14]
The term "Ulysses Syndrome" has alternatively been used to refer to the psychological and physical sequelae of misdiagnosis due to a false positive result. [17] [18] For instance, a patient who complains of low risk chest pain may be referred for further cardiac work-up by an overcautious physician. These tests in turn may give a positive result due to high sensitivity, which subjects the patient to further testing that ultimately proves to be unnecessary. Victims of this condition experience the stress of being diagnosed with a condition they do not have as well as the physical trauma of invasive testing. [18]
There is currently no consensus on the definitive use of the term “Ulysses syndrome”. Nevertheless, Ulysses syndrome as it is used to describe the effects of chronic extreme stress in migrant populations is more in line with the definition of a syndrome as used in the medical field, i.e. a set of signs and symptoms that constitute a disease. Moreover, because migrants who experience chronic stress and fear are frequently incorrectly diagnosed with depression or anxiety, it encapsulates the alternative definition of this condition.
Neurosis is a term mainly used today by followers of Freudian thinking to describe mental disorders caused by past anxiety, often that has been repressed. In recent history, the term has been used to refer to anxiety-related conditions more generally.
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.
Postpartum depression (PPD), also called postnatal depression, is a type of mood disorder experienced after childbirth, which can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.
Psychological trauma is an emotional response caused by severe distressing events such as accidents, violence, sexual assault, terror, or sensory overload.
Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.
Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e. commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.
Post-concussion syndrome (PCS), also known as persisting symptoms after concussion, is a set of symptoms that may continue for weeks, months, years after a concussion. PCS is medically classified as a mild traumatic brain injury (TBI). About 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury. Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults.
Gender is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.
Mental distress or psychological distress encompasses the symptoms and experiences of a person's internal life that are commonly held to be troubling, confusing or out of the ordinary. Mental distress can potentially lead to a change of behavior, affect a person's emotions in a negative way, and affect their relationships with the people around them.
Stress-related disorders constitute a category of mental disorders. They are maladaptive, biological and psychological responses to short- or long-term exposures to physical or emotional stressors. The National Institute of Environmental Health Sciences categorizes Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) as stress-related disorders. However, the World Health Organization's ICD-11 excludes OCD but categories PTSD, Complex Post-Traumatic Stress Disorder (CPTSD), adjustment disorder as stress-related disorders.
Refugee health is the field of study on the health effects experienced by people who have been displaced into another country or even to another part of the world, as a result of unsafe circumstances such as war or persecution. People who have been displaced can be affected by infectious diseases or some chronic diseases that are uncommon in the country in which they eventually settle. Mental health is an important consideration and can greatly impact people who are displaced. The health status of refugee's can be tied to factors such as the person who migrated's geographic origin, conditions of refugee camps or urban settings where they lived, and personal, physical, and psychological conditions of the person, either pre-existing or acquired while traveling from their homeland to a camp or eventually to their new home.
According to the World Health Organization (WHO), occupational burnout is a phenomenon resulting from chronic work-related stress, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy". While occupational burnout may influence health and can be a reason for people contacting health services, it is not itself classified by the WHO as a medical condition or mental disorder. WHO additionally states that "Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life."
PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.
Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC)
Operational stress injury or OSI is a non-clinical, non-medical term referring to a persistent psychological difficulty caused by traumatic experiences or prolonged high stress or fatigue during service as a military member or first responder. The term does not replace any individual diagnoses or disorders, but rather describes a category of mental health concerns linked to the particular challenges that these military members or first responders encounter in their service. There is not yet a single fixed definition. The term was first conceptualized within the Canadian Armed Forces to help foster understanding of the broader mental health challenges faced by military members who have been impacted by traumatic experiences and who face difficulty as a result. OSI encompasses a number of the diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification system, with the common thread being a linkage to the operational experiences of the afflicted. The term has gained traction outside of the military community as an appropriate way to describe similar challenges suffered by those whose work regularly exposes them to trauma, particularly front line emergency first responders such as but not limited to police, firefighters, paramedics, correctional officers, and emergency dispatchers. The term, at present mostly used within Canada, is increasingly significant in the development of legislation, policy, treatments and benefits in the military and first responder communities.
Special considerations are needed to provide appropriate medical treatment for refugee migrants to the United States, who often face extreme adversity, violent and/or traumatic experiences, and travel through perilous regions. Such considerations include screenings for communicable diseases, vaccinations, posttraumatic stress disorder, and depression.
The COVID-19 pandemic has impacted the mental health of people across the globe. The pandemic has caused widespread anxiety, depression, and post-traumatic stress disorder symptoms. According to the UN health agency WHO, in the first year of the COVID-19 pandemic, prevalence of common mental health conditions, such as depression and anxiety, went up by more than 25 percent. The pandemic has damaged social relationships, trust in institutions and in other people, has caused changes in work and income, and has imposed a substantial burden of anxiety and worry on the population. Women and young people face the greatest risk of depression and anxiety.
Mental health consequences of immigration detention include higher rates of depression, anxiety, PTSD, conduct issues, hyperactivity, compared to the general population. These harmful impacts exist regardless of past traumatic experiences, age, or nationality, or even time elapsed. Immigration detention may take place at country or state borders, in certain international jurisdiction zones, on offshore islands, boats, camps, or could even be in the form of house arrest. The use of immigration detention around the world has increased recently, leading to greater concerns about the health and wellbeing of detained migrants. A 2018 scoping review from BMC Psychiatry gathered information showing that immigration detention consistently results in negative impacts on detainees.
Hispanic immigrants living in the United States have been found to have higher levels of exposure to trauma and lower mental health service utilization than the general population. Those who met the criteria for asylum, and experience trauma before migrating, are vulnerable to post-traumatic stress disorder (PTSD) symptoms. Higher levels of trauma-related symptoms are associated with increased post-migration living difficulties. Despite the need for mental health services for Hispanic immigrants living in the United States, cultural and structural barriers make accessing treatment challenging.
Extreme weather events can have a significant impact on mental health, particularly in the form of post-traumatic stress disorder (PTSD). With the increasing frequency and severity of these events due to climate change, it is important to understand how they can lead to long-lasting psychological trauma and learn to provide support for those affected.
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