This document summarizes a presentation on the mental health and well-being of children from refugee, internally displaced persons, and migrant families. It discusses three lenses through which to view this issue: children and culture, children and trauma, and culture and trauma. It emphasizes that development, family, and culture are important factors to consider when working with traumatized children and families. The presentation also notes that the COVID-19 pandemic has created an "experimental childhood" for many children around the world by altering their development in unprecedented ways.

1. Plenary Session:
The Mental Health and Well-Being of Children from
Families Who Are Refugees, IDPs and Migrants
Co-Chairs:
Prof. Helen Herrman (Australia)
Prof. Vincenzo Di Nicola (Canada)
III Congress on Mental Health:
Meeting the Needs of the XXI Century
“Children, Society, and Future”
Moscow, Russian Federation
October 8, 2021

2. Prof. Vincenzo Di Nicola
MPhil, MD, PhD, FRCPC, DFAPA, FCAHS
Professor of Psychiatry,
University of Montreal
Clinical Professor of Psychiatry
The George Washington University
Global Mental Health Teaching Faculty
Harvard Program in Refugee Trauma, Harvard Medical School
Family Matters
The Family as a Resource for the Mental, Social,
and Relational Well-Being of Youth Migrants,
Asylum Seekers, & Other Displaced Populations

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Image courtesy of Jaswant Guzder

4. The Presenter has no conflicts of interest to declare
Email:
vincenzodinicola@gmail.com
Conflicts of Interest

5. Educational Objectives
The presentation will sensitize participants to appreciate
basic questions about working with traumatized children,
youth, and their families across culture to create trauma-
informed care:
• Why development matters – and how it changes the
clinical presentation of trauma at different ages
• Why family matters – and how it creates models for the
experience of trauma that attenuate or amplify both
developmental neurobiology and sociocultural influences
• Why culture matters – and how it offers or limits the
range of socially privileged perceptions and culturally
sanctioned solutions

6. Children, Culture and Trauma: Three lenses
Children & Culture: “Looking Across at Growing Up”
Children & Trauma: “Changelings”
• “The Nightmare of Childhood”
• “The Longest Shadow”
• “The Experimental Child”
Culture & Trauma: “Two trauma communities”
• Clinical and cultural trauma studies
Healing
Rebrith
Outline

7. Three Lenses
Trauma
Culture
Children

8. children
Photo: María del Pilar García Ayensa / Studio
Olafur Eliasson © 2010 Olafur Eliasson

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Image courtesy of
Jaswant Guzder

10. culture
Image: Vintage Central Anatolian Tribal Rug.JPG,
Public domain, via Wikimedia Commons

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Image courtesy of
Jaswant Guzder

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trauma
Image courtesy of V Di Nicola

13. Who can tell from the sound of the word ‘parting’
What kind of bereavements await us
– Osip Mandelstam
Osip Mandelstam, “Tristia” in Osip Mandelstam: Selected Poems,
translated by Clarence Brown and W.S. Merwin (London: Oxford University Press, 1973, p. 23).
Image courtesy of Jaswant Guzder

14. The Figure of the Migrant
“The migrant is the political
figure of our time.”
–“The Figure of the Migrant, An
Interview with Thomas Nail.” Critical
Theory, December 1. 2015.
www.critical-theory.com

15. Children & Culture
Trauma
Culture
Children

16. “Looking Across at Growing Up”
•To study children across cultures is
to revision how we think about
development
• Cultural anthropology (Charles Super)
• Culture-inclusive developmental
psychology (Jaan Valsiner)

17. V Di Nicola,
De l’enfant sauvage à
l’enfant fou: A prospectus
for transcultural child
psychiatry
In N Grizenko, et al (eds),
Transcultural Issues
in Child Psychiatry
Montréal: Éditions Douglas
(1992, pp. 5-53)
Image courtesy of publisher

18. Children & Trauma
Trauma
Culture
Children

19. the changeling
The devil steals a baby, leaving
a concealed changeling
Early 15th century, detail of
"The Legend of St. Stephen"
by Martino di Bartolomeo
19
Image: Martino di Bartolomeo,
Public domain, via Wikimedia Commons

20. “Changelings”
changeling noun 1 archaic: one that waivers;
2 obsolete: a fraudulent substitute
surreptitiously left in place of a valued object
or personage
adjective 1 archaic: wavering, inconstant;
2 markedly altered from an original or native
condition
– Webster’s Dictionary (1966)
Webster’s Third New International Dictionary, 1966

21. “The Nightmare of Childhood”
The history of childhood is a
nightmare from which we have
only recently begun to awaken.
– Lloyd deMause
The History of Childhood (1988)

22. The Hidden History of Childhood Trauma
• Lloyd deMause (1931-2020) Psychohistiorian
• Alice Miller (1923-2010) Swiss psychoanalyst
• Child abandonment
• Selective maternal attachment

23. The Hidden History of Childhood Trauma
Lloyd deMause and Alice Miller have done
nothing less than to rewrite the history of
childhood through the lenses of history and
psychoanalytic reconstruction

24. “Changelings”
“Conspiracy theories have likely been around
for a very long time, ever since we became a
symbolic, linguistic species.”
– Samuel Veissière, McGill University
• “Cognitive biases” – perceptual filters
• Confer advantages
• Resemble magical thinking and paranoia
McDevitt, N. Samuel Veissière on the epidemiology of conspiracy theories. McGill Reporter, January 19,
2021. https://reporter.mcgill.ca/covid-19-qa-samuel-veissiere-on-the-epidemiology-of-conspiracy-theories/

25. “Changelings”
• The evil eye: a cultural elaboration of the fear
of the malevolent gaze is a legacy of trauma,
especially childhood sickness and death
• Crises, collective traumas: spark
conspiracies and scapegoating
• Scapegoats: René Girard’s mimetic theory
The Girard Reader. Ed. by. James G. Williams. New York: Crossroad (1996).

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https://www.bostonglobe.com/pf/resources/images/favicon.png?d=242

27. Azabache
bracelet charm
Source: mons.wikimedia.org/w/index.php?curid=78847621
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28. “Changelings”
• Children’s lives are altered by trauma
• They become – in a modern twist on an
old European myth – changelings
• With greater or lesser severity, across
more or fewer developmental domains,
for decades or months – trauma alters
lives

29. Sequential traumatization –
“A Train of Traumas”
• Layers of trauma
• an imbricated series of triggers across
developmental, cultural and family
predicaments (Cf. Keilson, 1992)
Keilson, Hans (1992). Sequential Traumatisation in Children: A Clinical and Statistical
Follow-up Study on the Fate of the Jewish War Orphans in the Netherlands. Jerusalem,
Israel: The Magnes Press, The Hebrew University.

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Image courtesy of Jaswant Guzder

31. “The Longest Shadow”
• Childhood adversity casts the longest
shadow across the entire human
lifecycle with lifelong pervasive impacts
Di Nicola, V. Family, psychosocial, and cultural
determinants of health (2012)

32. Adverse Childhood Events (ACE)
• In light of the Social Determinants of Health and
Mental Health (CSDH, 2008), notably the Adverse
Childhood Events (ACE) studies (Felitti & Anda,
2010), Global Mental Health (GMH) in partner with
child and family psychiatry and allied professions
must consider our roles for the future of these
“experimental children” around the world
CSDH. Closing the Gap in a Generation: Health Equity Through Action On the Social
Determinants of Health. Final Report of the Commission on Social Determinants of Health.
Geneva, Switzerland: World Health Organization; 2008.
Felitti VJ, Anda RF. The relationship of adverse childhood experiences to adult medical
disease, psychiatric disorders and sexual behavior: implications for health care. In: Lanius RA,
Vermetten E, Pain C, eds., The Impact of Early Trauma on Health and Disease: The Hidden
Epidemic. Cambridge, UK: Cambridge University Press; 2010:77-87.

33. Children & Covid-19
“The Experimental Child”

34. Defining a Syndemic
• A syndemic or synergistic epidemic is the aggregation of
two or more concurrent or sequential epidemics or disease
clusters in a population with biological interactions, which
exacerbate the prognosis and burden of disease
• The term was developed by medical anthropologist Merrill
Singer in the mid-1990s
• Syndemics develop under health disparity, caused by
poverty, stress, or structural violence and are studied by
epidemiologists and others concerned with public health,
community health, and the social determinants of health
https://en.wikipedia.org/wiki/Syndemic

35. Cascade of Consequences
• The impact on children is part of a cascade
of consequences affecting societies at large,
smaller communities, and the multi-
generational family, all of which impinge on
children and youth as the lowest common
denominator (Di Nicola & Daly, 2020)
Di Nicola V, Daly N. Growing up in a pandemic: Biomedical and psychosocial impacts
of the COVID-19 crisis on children and families. World Social Psychiatry, 2020, 2(2):
148-151.

36. “The Experimental Child”
This exceptional set of circumstances—
• in response not only to the biomedical and
populational health aspects but also in
constructing policies for entire societies—
• is creating an “experimental childhood” for billions
of children and youth around the world

37. Impacts
• Children are vulnerable biologically and psychosocially to
the impacts of the pandemic, with particular concern that
protective measures may affect the development of
prosocial skills longitudinally (Di Nicola & Daly, 2020)
• In addition to a perceived deterioration in mental health,
there are substantial mental health service disruptions and
unmet support needs (Hawke, et al., 2020)
Di Nicola V, Daly N. Growing up in a pandemic: Biomedical and psychosocial impacts of the COVID-19
crisis on children and families. World Social Psychiatry, 2020, 2(2): 148-151.
Hawke LD, Barbic SP, Voineskos A, et al. Impacts of COVID-19 on youth mental health, substance use,
and well-being: A rapid survey of clinical and community samples. Can J Psychiatry 2020;65:701–9.
Hanafi S, Dufour M, Doré-Gauthier V, et al. Position Statement: Covid-19 and Canadian Psychiatry. Can
Psychiatric Assoc March 11, 2021.

38. Childhood is a knife
planted in your throat.
You don’t remove it
easily.
– Wajdi Mouawad
Play & film, Scorched
Image courtesy of publisher

39. PSYCHIC TRAUMA
• An exceptional experience in which
powerful and dangerous stimuli
overwhelm the infant and young child’s
capacity to regulate his or her affective
state

40. TRAUMATIC STRESS
(Anna Freud, 1969)
• A shattering and devastating event that
alters the course of future development

41. EVOLVING DEFINITIONS OF
THE CONCEPT OF TRAUMA
Trauma as an event that is generally outside
the range of usual human experience
—DSM-III (1980)
An event involving actual or threatened death or
serious injury or a threat to the physical
integrity of self or others
—DSM-IV (1994)

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Image courtesy of Jaswant Guzder

43. DEVELOPMENTAL MODEL
• Age of the child
• Characteristics of neighbourhood
• Degree of community resources
• Amount and quality of support
• Experience of previous abuse
• Proximity to violent event
• Familiarity with victim or perpetrator

44. EARLY ADVERSE EXPERIENCE
• Derail a child’s developmental trajectory
• Compromise a child’s ability to regulate
affects
• Compromise early and future relationships

45. EXPOSURE TO VIOLENCE
• Affects the way children think about
themselves and the world around them
• Affects the extent to which they view
relationships as trustworthy and
dependable

46. PROTECTIVE FACTORS
• Safety in the environment
• Caregivers who can mediate the dangerous
environment and help regulate experiences
• Support systems in the environment

47. EFFECT ON CAREGIVERS
• Caregiver’s ability to listen may be limited
• Caregiver may not be able to hear child’s
distress
• Caregiver may need to protect herself from
feelings of vulnerability and trauma
• Parent may have more trouble tolerating
child’s resultant anxiety and aggression

48. DEVELOPMENTAL OUTCOMES
WITH TRAUMA
• Greater risk for children who have not yet
attained optimal potential development
• Knowing developmental status is crucial to
understanding the experience of infant and
childhood exposure to violence and trauma

49. Culture & Trauma
Trauma
Culture
Children

50. DICHOTOMISING TRAUMA
• Mimetic vs anti-mimetic theories (Ruth Leys)
• Clinical vs cultural trauma communities (Di Nicola)
Leys, Ruth (2000). Trauma: A Genealogy. Chicago, IL: The University of Chicago Press.
Di Nicola, V (2018). Two trauma communities: A philosophical archaeology of cultural and clinical trauma
theories. In: PT Capretto & E Boynton (Eds), Trauma and Transcendence: Limits in Theory and Prospects
in Thinking. New York: Fordham University Press, 17-52.
50

51. 51
Image courtesy of Jaswant Guzder

52. V Di Nicola,
Two trauma communities:
A philosophical archaeology
of cultural and clinical
trauma communities
In P Capretto & E Boynton (eds),
Trauma & Transcendence
NY: Fordham University Press
(2018, pp. 17-52).
Image courtesy of publisher

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healing

54. HEALING
• What do we want to heal?
• Where would the healing take place?
• Clinical and cultural trauma communities
have divergent missions and different
answers
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“There is a
crack in everything
— that’s how the
light gets in”
— Leonard Cohen
“Anthem”

56. KINTSUGI
• Philosophy of kintsugi
• “Shattered vessels” ‫הכלים‬ ‫שבירת‬
• Shevirat HaKelim
kabbalah
• “There is a crack, a crack in everything,
that’s how the light gets in …”
– Leonard Cohen, “Anthem”
56

57. https://i.pinimg.com/736x/33/44/c7/3344c7593cfc400728a198fd2557bdc3.jpg

58. TREATMENT
• Ambulance arrives AFTER the traumatic
experience
• Principles of triage, crisis intervention
• Identify, remove child from traumatic
situation
• Secondary prevention
• attenuate symptoms
• redirect the traumatic pathway

59. TREATMENT
• Before any possibility of treatment we must
establish a relationship with traumatized
children
• We create a healing environment that includes
our own self-care based on empathy in order to
hear the trauma story (Richard Mollica, 2006)
• We must honour interpersonal ethics in working
with children and families (Di Nicola, 2011)
• The face-to-face encounter – the ethics of
meeting strangers (Emmanuel Levinas, 1998)

60. HOW CLINICIANS CAN PREPARE
THEMSELVES FOR TRAUMA WORK
• Become well informed about trauma
• Engage in debriefing about the event
• Engage in ongoing self-care
• Frequently examine responses, resistances,
and tensions related to traumatic materials

61. There is no greater
insight into the future
than recognizing …
that when we save
our children we save
ourselves.
– Margaret Mead
(1901-1978)
Anthropologist
Image courtesy of V Di Nicola

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rebirth

63. CONCLUSION
• Development
• Attachment and neurobiology
• Family
• “The crucible of experience”
• Culture
• “Looking across at growing up”

64. CONCLUSION
• Children are the “canary in the goldmine”
• They are the most sensitive indicators of
trauma – embodied and enacted in their own
lives
• Truthtellers of the trauma of their community
• Tell their stories through their play, drawings,
embodiment and enactment

65. 65 Image courtesy of Jaswant Guzder

66. Trauma and the determinants of health:
• Di Nicola, VF (1996). Ethnocultural aspects of PTSD and related disorders
among children and adolescents. In: AJ Marsella, MJ Friedman, ET Gerrity,
& RM Scurrfield (Eds), Ethnocultural Aspects of Posttraumatic Stress
Disorder: Issues, Research, and Clinical Applications. Washington, DC,
American Psychological Association, pp. 389-414.
• Di Nicola, V (2012). “What We Talk About When We Talk About Trauma”:
Critical thinking about trauma. Harvard Global Mental Health Alumni Society
Newsletter, March 2012.
• Di Nicola, V (2013). Family, psychosocial, and cultural determinants of
health. In: E Sorel (Ed), 21st Century Global Mental Health. Burlington, MA:
Jones & Bartlett, pp. 119-150.
• Keilson, Hans (1992). Sequential Traumatisation in Children: A Clinical and
Statistical Follow-up Study on the Fate of the Jewish War Orphans in the
Netherlands. Jerusalem, Israel: The Magnes Press, The Hebrew University.
WORKS CITED

67. Two references on trauma
• Di Nicola, VF (1996). Ethnocultural aspects of PTSD and related
disorders among children and adolescents. In: AJ Marsella, MJ
Friedman, ET Gerrity, & RM Scurfield (Eds), Ethnocultural Aspects of
Posttraumatic Stress Disorder: Issues, Research, and Clinical
Applications. Washington, DC: American Psychological Association,
389-414.
• Di Nicola, V (2018). Two trauma communities: A philosophical
archaeology of cultural and clinical trauma theories. In: PT Capretto &
E Boynton (Eds), Trauma and Transcendence: Limits in Theory and
Prospects in Thinking. New York: Fordham University Press, 17-52.
One book
• Terr, Lenore (1990). Too Scared To Cry: Psychic Trauma in
Childhood. New York: Basic Books.
READING LIST

68. History and philosophy of trauma
• Leys, Ruth (2000). Trauma: A Genealogy. Chicago, IL:
The University of Chicago Press.
• Di Nicola, V (2018). Two trauma communities: A
philosophical archaeology of cultural and clinical trauma
theories. In: PT Capretto & E Boynton (Eds), Trauma and
Transcendence: Limits in Theory and Prospects in
Thinking. New York, NY: Fordham University Press, pp.
17-52.
FURTHER READING

69. Trauma
• Agamben, Giorgio (2002). Remnants of Auschwitz: The Witness and
The Archive, rev. ed., trans. D Heller-Roazen. London, UK: Zone.
• Capretto, Peter T & Boynton, Eric (Eds, 2018). Trauma and
Transcendence: Limits in Theory and Prospects in Thinking. New
York, NY: Fordham University Press.
• Eth, Spencer & Pynoos, Robert S (Eds, 1985). Post-Traumatic Stress
Dsorder in Children. Washington, DC: American Psychiatric Press,
Inc.
• Levi, Primo (1996). Survival in Auschwitz, including “A Conversation
with Primo Levi by Philip Roth,” trans. S Woolf. New York, NY:
Touchstone.
• Mollica, Richard (2006). Healing Invisible Wounds: Paths to Hope and
Recovery in a Violent World. New York, NY: Harcourt, International.
• Terr, Lenore (1990). Too Scared To Cry: Psychic Trauma in
Childhood. New York: Basic Books.
FURTHER READING

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Questions
&
Comments
Image courtesy of Jaswant Guzder