THE ULYSSES SYNDOME

Migration and Mental Health

Several years ago, I had written a Shrink Box blog on “Immigration and its impact on Hispanic families” (see Shrink Box blog). The focus of that article was that many immigrant families face significant hardships and challenges that impact their mental health. This article addresses an associated syndrome frequently identified in the immigrant population. My intention here is to provide useful insights to those working with immigrants so that they become more familiarized with the challenges immigrants face and be ready to address them.

Lately, immigration has become a “hot topic” here and around the globe. Many individuals and families are forced to leave their homes and countries of origin due to multiple and unsurmountable circumstances.  They will start this long and stressful journey to their new destination usually full of tribulations and, once they have moved, a long period of adjustments and adaptations to their new environment begins.

Although it may seem like a recent phenomenon, human migration is in fact a fundamental aspect of our species. From their origin in northern Africa, humans have spread to all corners of the globe. Our human capabilities of cognition, mobility and collaboration with groups has equipped us for migration.

While working with immigrants and refugees in Catalunya in 2002, Spanish psychiatrist Joseba Achotegui, MD noted that many immigrants arriving in Spain were suffering chronic stress. This led him to identify and coin the term the “Ulysses Syndrome”.

The “Ulysses Syndrome” came to him after reading “The Odessey” (Homer, 700 BC) that tells the story of the hardships experienced by “Ulysses” after leaving his country (Greece) to fight in the Troyan war. This resulted in a 20-year exile, that led to tribulations, sadness, loneliness, and loss of identity, often referring to himself as a “Nobody”. Dr. Achotegui noted a similarity between the experience of Ulysses and the experience reported by immigrants that he was seeing in his work and research who were experiencing significant chronic stress.

This syndrome can present with a combination of signs and symptoms seen in many of the immigrant population, these include sadness/irritability, fearfulness, muscle tension and somatization (headaches and body aches), Insomnia, confusional states (distractibility, derealization, depersonalization), learned helplessness and hopelessness.

The Ulysses Syndrome is not considered a psychiatric disorder or illness, such as Major Depressive Disorder or Schizophrenia. Instead, this syndrome can be considered more along the lines of other syndromes like the Stockholm Syndrome, burnout, bullying and grieving processes.  Because of the prevalence of significant stress in this population we need to identify those that can benefit from support and interventions. It is also important to avoid fitting this syndrome into a psychiatric disorder and medicalize interventions. On the other hand, it is crucial to detect those that are suffering from other psychiatric health conditions who can benefit from evidence-based treatments.

It is important to have a good understanding of the socio-cultural, psychological and biological implications present in the Ulysses Syndrome.  Let’s look at each component that makes up this syndrome and some of its implications.

Socio-cultural aspects of this syndrome include customs and interests that are well established and ingrained in most populations, such as types of clothing, foods, leisure interests, intimacy, humor, language, show of affection, etc. Many try to preserve their customs and attempt to pass them on to the next generation. At the same time, they also acquire and adopt the new culture of their new environment, which will usually make life easier. Eventually they become fully integrated. Some helpful tips include keeping the best from the past yet, being open to the new ways, learning the language and finding employment. This can enhance social networks and provide financial and housing security. For children, immediate enrollment in school will ensure these needs are partially met.

Psychological stress can present with sadness, loss, loneliness, learned helplessness, guilt of leaving others behind and identity issues, frequently feeling like the Spanish song, “I am not from here or from there”. Some of these concerns are presently ameliorated with new technologies like smart phones and video communications, making it easier to continue close contacts with those left behind and providing connectivity with new acquaintances. Support groups like church, sport groups and other affiliations can provide a sense of belonging.

From a biological perspective, a better understanding of the way the brain deals with acute versus chronic stress is paramount to understand its impact and the importance of developing coping skills. In acute stress the brain responds with a cascade of chemical reactions that ultimately release cortisol, this promotes an adaptive and restorative response. Alternatively, in chronic stress, often seen in the Ulysses Syndrome, the brain stress response remains in overdrive and on high alert, leading to a wear and tear in cognitive abilities that affect problem solving, result in feelings of hopelessness and helplessness. Learning stress reduction technics and activities can be protective and useful in managing the Ulysses Syndrome.

Other specific guidelines and interventions that can be beneficial in this syndrome also include sleep hygiene, psychoeducation, coping skills and rapid adaptation to new environments.  In addition, for more recommendations, please refer to my previous Shrink Box blog “Immigration and its impact on Hispanic families.

In conclusion, as difficulties increase around the globe, we are likely to see a surge of displaced populations where many are forced to flee their homes and countries and can be affected by chronic and multiple stress (The Ulysses Syndrome). We can ignore this prevalent presence in our communities or be part of the solution while sustaining a humanistic approach and being advocates for those suffering chronic stress as they attempt to adapt to their new world.

References:

1. Immigration and its impact in Hispanic families. Shrink box inc.  Daniel Gutiérrez MD
2. The Ulysses Syndrome, 2021 Joseba Achotegui MD
3. La inteligencia migratoria 2018, Joseba Achotegui MD