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. 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.
Signs and symptoms The Ulysses syndrome has both physical and psychological symptoms. 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. A lack of social support or access to appropriate medical care may aggravate these symptoms. In some occasions, patients with Ulysses syndrome are mistakenly diagnosed with another medical condition which can further impede recovery.
Causes
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. Forced migration has profound impacts on individuals and families as their lives change suddenly and dramatically. Experiences of modern migrants include the separation of families, dissolution of communities by conflict and disaster, exposure to exploitation, and violence. Migrants remain in prolonged periods of displacement with a median time of four years in exile. 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. 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. Extreme stressors that put individuals at risk for Ulysses syndrome, called "Ulysses stressors", can broadly be characterized into four categories:
Forced loneliness: Separation from family and homeland, especially if the immigrant left his or her spouse and children behind Social and cultural isolation due to lack of language proficiency or familiar cultural and religious institutions Racial discrimination and prejudice in the receiving country Failure of migratory goals: Sense of failure of original reasons for emigration Pressure to earn enough money to support family back in the home country Lack of opportunities to acquire appropriate legal documentation, obtain work permits, and secure non-exploitative quality jobs Poor access to housing and health services, Dangers of the journey: Crowded rafts and boats without life jackets Fear of arrest and deportation Physical and sexual abuse Struggle to survive: Difficulties procuring basic necessities such as food, water, and shelter 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.
Diagnosis 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. By definition, this syndrome cannot be diagnosed if another mental disorder is present. 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:
Acute stress disorder: Ulysses syndrome is brought about by chronic exposure to toxic stress, whereas the symptoms of acute stress disorder by definition are limited to one month. Depression: Although depressed mood is common, Ulysses syndrome does not include many other cardinal symptoms of depression such as apathy or thoughts of death. Immigrants, unlike people suffering from depression, have the motivation to go forward and struggle in order to reunite with their families and have a better life, despite their current difficulties, and do not lose their interests. Rather, they try to maintain their social and professional activities. Adjustment disorder: One of the central diagnostic criteria for adjustment disorder is distress that is out of proportion to the severity or intensity of the stressor or stressors. On the other hand, Ulysses syndrome is an appropriate response that manifests as anxiety, insomnia, sadness, etc., precisely due to the extreme nature of the stressors. Moreover, deterioration of social and occupational functioning, which is often present in adjustment disorder, does not occur in Ulysses syndrome. Post-traumatic stress disorder: Both PTSD and Ulysses syndrome stem from a response to fear. However, disturbing thoughts or feelings about traumatic events as well as distress and avoidance of trauma-related cues do not occur in Ulysses syndrome, but does in PTSD, whereas stressors such as social isolation, lack of opportunities, discrimination, and prejudice are common for Ulysses syndrome and not for PTSD. Although clinically distinct from mental health disorders, Ulysses syndrome exists on a spectrum between normal and disease. 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.
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