Let’s start by stating the obvious: COVID lockdowns prevented most of us from being with loved ones – from them being just outside our bubbles to way overseas, we were left phoning, zooming or writing in order to stay connected. Distress at this state of affairs was widely normalised and legitimised. Refugee young people had been there before COVID; only the distances are greater, the reunion less predictable and their responses often pathologised. 

This review intends to reflect on the obvious and then try to explore further with particular focus on the experience of separations from a refugee perspective.  

Most research on the impact of separation for refugees has focussed on family separation. The shape of this separation varies:  certain conflicts resulted in great scattering of families and greater challenges in resettling families in the same host country. With a longer lens, we see families separated and unable to reunite through the will of governments where policy explicitly prohibits it.  Practically though, it is impossible for the “whole family” to travel together – extended family has other extended family; in-laws are part of a family by their attachment to one person, but they are also attached to their family of origin. Somewhere, someone will be left behind. An impossible situation. 

Research into impacts of family separation on settlement and on the mental health of refugees has shown unsurprising results: there is an association between family separation and delayed integration and elevated mental health symptoms in refugees. This has been directly shown in Australia (The Refugee Adjustment Study; Liddel et al, 2020; Savic et al 2013), the USA (Miller et al, 2017) and the UK (Oxfam, 2018). Miller, et al (2013) took it further, finding that separation from a family member or loved one to be a significant variable determining mental wellbeing, regardless of trauma exposure. Newman and Mares’ (2021) article is an excellent summary of some of the mechanisms and dynamics of these processes. 

The above conclusions recognise the fundamental importance of the family unit and research participants’ comments from all studies reflect the assumption that the family unit underpins community and individual wellbeing (e.g., “my family give me meaning”, “family is life”).  An aside here: I believe we need to have a more nuanced take on this and consider two other perspectives. Firstly, some reflections on family are idealised – family does not always provide the needed support and sometimes introduces levels of trauma that are very difficult to recover from.  Ironically, it seems that loss of people (through death or separation) with whom we have an ambivalent or unresolved relationship is far more difficult to navigate. 

Secondly, separation from non-family can also be devastating for young people with refugee experience but there is less research on this. The tendency to prefer to spend more time with friends than family is noted, particularly in “Western” society, as beginning in early adolescence. While this is culturally mediated, refugee adolescents quickly settle into a pattern of turning to peers for support, understanding and influence. A source of distress and conflict for refugee parents, it can become a battleground or an opportunity for expanding a sphere of connection for the whole family.  

We know that the loss of an attachment figure (through death or separation) has significant negative consequences for very young children, with negative impacts seen in older children as well.  A child’s attachment partners do not always accompany them on their refugee journey. Parents will need to be particularly available to the child and sensitive to their needs for renewed attachment, a hard task for parents battling their own loss and trauma. Other family dynamics shift significantly too; as the family “unit” loses some of its parts so some young people take on new roles that they are not developmentally prepared for. In addition, parental grief about family left behind can be confusing and undermining; when a father says he is preoccupied with worry about his oldest son in Syria and spends all of his energy and money trying to get him here, I wonder how that is experienced by the children who are here with this father … does it perhaps feel as though their presence is not enough? 

By the time we are adults, we probably have become able to fill those empty spaces once filled by the people we miss. Mental representations can be used but the capacity to create and evoke these in times of need is developmental and not something that young people are always capable of. This is particularly so if their attachments have already been disrupted in the course of chaos, war and refugee flight. In this case, it becomes very difficult to learn the slow process of secure attachment. Being able to think about loved ones is a healthy but difficult skill. Not the same as rumination, which is associated with poorer outcomes for the grief process, it might need to be facilitated by safe others. 

• Some will seek distraction through work or study, although the grief process can make it difficult to engage in work and study. Doing something practical can alleviate sense of powerlessness and guilt – sending money, joining community action (Savic et al, 2013) 
• Socially, young people with refugee experience might be able to start to build attachments. But they tell us that this is easier said than done. Why might this be so? The ARC report (Liddell et al, 2020) noted that some respondents felt that “family separation itself interferes with the natural instinct to seek social support in order to cope with stress” (p16).  Cultural and language differences are part of it. However, more potent is that it can be painful to reconnect if we fear repeat of the loss. Our attachment style also impacts here – avoidant or anxiously attached young people tend to avoid connections with others or have great difficulty making them.  
• Some ways of coping relate to mindset:
  • Hope for future: Either for reunion with loved ones or for more meaningful connections; for being able to establish new connections.  
  • Acceptance – being able to recognise limitations and accept where we have no power to make change happen 
  • Ability to practice “Mindfulness” to manage in the moments of distress – That is, being able to “notice” the feeling of missing without slipping into being overwhelmed by the feeling. For some, deeper work might be needed when the distress becomes evidence of closeness for the young person – “when I cry, I can really feel close to my brother, if I don’t cry it means I don’t miss him”  
  • Finally, and most obviously, are the ways of keeping in contact that we all became familiar with: phoning, messaging, video calls and social media. All of these are possible and largely (although variably) available to young people with refugee experience. There are particular challenges e.g. financial cost and device availability. The complication of timezone differences as one young person has talked about for years. Some adjust their own sleep routine, just to be able to connect with someone overseas: “It has to be me to fit in with them because I left them”.  The consequences for sleep hygiene are evident to teaching staff. 

We all use these media to share big activities, plan things and provide support. But while the use of communication technology is experienced as a healing method, overcoming physical distance as a way to receive and give support (Shah et al, 2019) and reduce the sense of isolation or distress (Juvonen, et al 2021), it can also be also a source of distress. People speak of being kept aware of the situation people are still in, sometimes being exposed to the sounds of ongoing conflict. The sense of guilt and helplessness can overwhelm the positive impact. People who use video calls note that on one hand they don’t want their family overseas to see them distressed but they also don’t always want them to see that they are doing well.  

The importance of proximity

Regardless of our access to phones with a video function, we do know how it feels to not be able to see the person live, to touch them and breathe the same air. I’m at a loss to articulate exactly what that is about, but suspect it relates to one of the core process outcomes of attachment – proximity. 

Attachment theory holds that the journey by which we develop our capacity for relationship and by which we become human begins very early and the first step involves proximity.  

‘‘Seeking proximity to a caregiver and attaining face-to-face communication with eye gaze contact is hardwired into the brain from birth. It is not learned’’  (Siegel, 1999, in Fishbane, 2013). 

The other (usually birth mother or parent) is close by and can perceive when help is needed. This proximity ensures survival as the parent can rescue the infant from danger – “phew, lucky Mum was there to catch me” – as well as provide nourishment and soothing by virtue of their proximity.  

The next two processes or outcomes are the safe haven (where the close other helps regulate distress) and secure base (when we feel confident enough in the presence of the safe other to be able to step out and explore). Friends can become safe havens who we go to in times of distress but, if we learned that safe havens are not so stable/safe, we might struggle with that. 

Siegel (2003) talks of the brain being constructed in the process of interaction with others and Platt (2018) repeats the mantra, giving it an evolutionary frame – that we are wired to connect because there are things we, as a species, cannot do on our own. This goes beyond the obvious (reproduction) and fits nicely into the collectivist notion – I am because we are. Liddell et al (2021) review the impacts of collectivism/individualism and the lack of congruence with host society.  The need for family/community in early settlement is heightened when there is this discrepancy. 

Image source: Sue Thompson, Flickr

The importance of physical touch 

While virtual contact with loved ones can be good enough and we have an argument above about the attachment imperative for proximity, there is another layer: touch. A regulator of behaviour as well as fulfilling an expressive function, touch can encourage or discourage, it can show affection and caring or anger and dislike. Touch, with the right people, stimulates the release of “feel good” hormone-neurotransmitters, while reducing stress hormones (Field, 2010). Field’s research also showed positive changes on MRI and EEG as well as other markers like pulse and blood pressure.  Interestingly, touch, between people who have a significant attachment, can also provide pain relief. Goldstein and colleagues (2018) measured concurrent EEGs of couples, one member of whom was given a pain stimulus (the control group would have been two people not known to one another). EEGs showed synchronous brain activity associated with empathy as well an inverse relationship between the degree of synchrony and the amount of pain: Holding hands with someone we are close to will reduce our experience of pain.  

Hints and Tips for Supporting Young People Struggling with Separation from Loved Ones 

 “… having more numerous and deeper connections predicts better health and well-being” (Platt, 2018) and some of the barriers to these connections are a part of the refugee experience.  How can we work with young people with refugee experience on this?  

Here are some ideas:

• Encourage contact with trusted loved ones, even if it feels painful; 

• Support young people with having conversations that connect them to others. For example:  
  • Support sharing of stories in group settings to the extent that students feel comfortable  
  • Support young people on how to talk with old friends about new friendships, that is, gently and with compassion. Good, old friendships can be models for new ones but young people might feel they need “permission” and encouragement to make new ones.   
  • Support the young person to find one good thing to share about their connections with others. 

• • End the conversation with a plan for future connections 

• Psychoeducation can be really useful; Talking about attachment, being explicit about it being hardwired, can help normalise the distress: “aha, that’s why it’s so hard for me” 
• If you are a Mental Health Professional, involved at a deeper level, for example working with a young person’s grief of separation, it is useful to explore what we need and get from our relationships with others. This makes it easier to be mindful of asking for the validation, stimulation, soothing (and other) from the new people in our lives. Naming what has been lost (along with the who) can be very powerful:  
  • “Ahmed was my best friend – he was the person I told my whole life story to – he was safe” (secure base, safe haven).  
  • “My mother’s mother stayed with me while our house was being bombed (proximity) and I felt safe with her, as though nothing bad could happen.” 

Family (and their extension in close friendships and safe adults) is where we learn to regulate. To be separated from them for short periods creates discomfort. The discomfort can be eased by knowing that there are limits to the length of time the distance makes them feel inaccessible. Unlike COVID restrictions, the forced displacement of people across the globe does not have a time frame for re-entry to the social world as we knew it. Having had small glimpses of that however, will hopefully enable policy makers to respond with empathy. It will hopefully make us all more able to connect with young refugees who are missing their friends and family and struggling to make life work without them close by. 

References

Bowlby, J. (1958). The nature of the child’s tie to his mother. International journal of psycho-analysis, 39, 350-373.

Field, T. (2010). Touch for socioemotional and physical well-being: A review. Developmental review, 30(4), 367-383. 

Fishbane, M. D. (2013). Wired to connect: Neuroscience, relationships, and therapy. The Neuropsychotherapist, 3(Oct-Dec 2013). Accessed: https://www.thescienceofpsychotherapy.com/wired-to-connect/  

Goldstein, P., Weissman-Fogel, I., Dumas, G., & Shamay-Tsoory, S. G. (2018). Brain-to-brain coupling during handholding is associated with pain reduction. Proceedings of the national academy of sciences, 115(11), E2528-E2537. 

Juvonen, J., Schacter, H. L., & Lessard, L. M. (2021). Connecting electronically with friends to cope with isolation during COVID-19 pandemic. Journal of Social and Personal Relationships, 38(6), 1782-1799. 

Liddell B, Batch N, Bulnes-Diez M, Hellyer S, Kamte A, Wong J, Byrow Y, Nickerson A. (2020). The Effects of Family Separation on Forcibly Displaced People in Australia. Findings from a Pilot Research Project. Australian Red Cross, Carlton, Vic. https://www.redcross.org.au/globalassets/cms-migration/documents/stories/unsw-red-cross-family-separation-report.pdf 

Liddell, B. J., Byrow, Y., O’Donnell, M., Mau, V., Batch, N., McMahon, T., … & Nickerson, A. (2021). Mechanisms underlying the mental health impact of family separation on resettled refugees. Australian & New Zealand Journal of Psychiatry, 55(7), 699-710. 

Newman, L. and Mares, S (2021) Mental Health and Wellbeing Implications of Family Separation for Children and Adults Seeking Asylum.   https://static1.squarespace.com/static/580025f66b8f5b2dabbe4291/t/6098d7a95e27054f321251f4/1620629419987/Mental+Health+and+Wellbeing+Implications+of+Family+Separation+for+Children+and+Adults+Seeking+Asylum+-+Drs+Newman+and+Mares+%28updated+bio%29.pdf

Miller, A., Hess, J. M., Bybee, D., & Goodkind, J. R. (2018). Understanding the mental health consequences of family separation for refugees: Implications for policy and practice. American journal of orthopsychiatry, 88(1), 26. 

Oxfam (2018). Safe but not settled: The impact of family separation on refugees in the UK. Oxfam/Refugee Council. https://oxfamilibrary.openrepository.com/ 

Platt, M. (2018) Wired to Connect – Social networks strongly shape our health and happiness. In Psychologytoday.com/au/blog/fine-tuning-human-performance/201807/wired-connect 

Savic, M., Chur‐Hansen, A., Mahmood, M. A., & Moore, V. (2013). Separation from family and its impact on the mental health of Sudanese refugees in Australia: a qualitative study. Australian and New Zealand journal of public health, 37(4), 383-388. 

Shah, S. F. A., Hess, J. M., & Goodkind, J. R. (2019). Family separation and the impact of digital technology on the mental health of refugee families in the United States: qualitative study. Journal of medical Internet research, 21(9), e14171. 

Siegel, D. J., & Solomon, M. F. (Eds.). (2003). Healing Trauma: Attachment, Mind, Body and Brain (Norton Series on Interpersonal Neurobiology). WW Norton & Company.