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Mental Health

BronxNet interview discussing mental and emotional health screening services in the Bronx

BronxNet host, Javier E Gómez, speaks with Raven Maldonado-Brown of Astor Services for Children and Family, about mental and emotional health screening services for children and families in The Bronx

 

Diálogo Abierto: Recursos Astor Services | Trasplante Exitoso del Riñón | Pro Arte Musical

 

El presentador Javier E. Gomez habla con Raven Maldonado-Brown de Astor Services for Children and Family, sobre los servicios de pruebas de salud mental y emocional en el condado de El Bronx para niños y familias. Luego, la cantautora Sophia Angelica nos cuenta cómo las redes sociales ayudaron a salvar la vida de su hermano Christopher, quien necesitaba urgente un transplante del riñón. Y por último, conoce el trabajo de Pro Arte Musical, una organización sin fines de lucro dedicada a la preservación de la música puertorriqueña. Our host, Javier E Gómez, speaks with Raven Maldonado-Brown of Astor Services for Children and Family, about mental and emotional health …

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Liberation Psychology

I first encountered Ignacio Martín-Baró’s liberation psychology when I volunteered for the Salvadoran Archdiocese Health Project in 1987. At the time, physicians working with the poor in El Salvador were persecuted. Aesculapius International Medicine, a small non-profit organization, responded to the Salvadoran Archdiocese’s request for health professionals who would be less likely targets of dollar-backed bullets. We would travel to towns in conflict zones to teach volunteers to diagnose and treat the most common diseases. Poor survivors in remote areas became health promoters for their neighbors. Seeds of liberation were sown.

Martín-Baró’s work continues to sustain me in my work as a community psychiatrist in the Bronx, New York. Since he wrote in Spanish, his work before he died was barely known beyond Latin America. After he, his five Jesuit university professor colleagues, their housekeeper, and her daughter were dragged into a university garden and shot in the head on November 16, 1989 by the US-trained Atlacatl Battalian,1members of the Committee for Health Rights in Central America translated some of Martín-Baró’s works so they could be available beyond Latin America.2His colleagues created the Ignacio Martín-Baró Fund, which has supported hundreds of community mental health projects in marginalized communities throughout the world (www.martinbarofund.org). With this paper, I offer liberation psychology as a resource for child psychiatrists.

Liberation psychiatry affirms the role of mental health professionals in identifying oppressive structures in our communities so that we might advocate for their trans-formation. In my Bronx context, it has inspired me to not only care for children affected by disproportionate minority confinement but to partner with the Osborne Association (www.osborneny.org/) to advocate for children of incarcerated parents. It affirmed my work with AACAP’s Juvenile Justice Task Force that ultimately led to my co-editing the book, Mental Health Needs of Young Offenders.3It inspires me not only to diagnose and treat children affected by threats of parental deportation, but to participate in Physicians for Human Rights’ Asylum Network, wherein the voice of children and families fleeing persecution might be heard. It leads me to not only detect disorders affecting academic functioning, but to educate parents about their children’s educational rights. Liberation psychology invites all mental health professionals to root ourselves in our particular context, to detect structures that systematically inflict psychic harm, and to join in efforts for social transformation in the service of mental health.

A Psychology of Liberation

Ignacio Martín-Baró PhD, a Spanish-born, University of Chicago-educated, Jesuit social psychologist, was the vice rector of the Central American University in El Salvador during its protracted civil war. The tools he learned abroad left him helpless as he witnessed unspeakable horror. And so, Martín-Baró fashioned new tools that would bear witness to and support the spark of life and hope for liberation in the face of brutal oppression. Though these tools are relevant to an assessment of structural issues in all communities, they are still little-known outside of the Latin American context where they were born.

Martín-Baró’s liberation psychology was deeply influenced by the liberation theology flourishing amongst marginalized communities at that time. African American,4Asian,5and Latin American6theologians shed the notion of theology as reflection on a universal God. Instead, they saw God present in marginalized communities’ struggles for justice and peace. They spoke of God’s “preferential option for the poor.7” They noted that the Bible tells of a God who parted the Red Sea to liberate the people of Israel from Egyptian bondage. In the Christian tradition, they reminded the poor that Jesus walked among them while he confronted oppressive structures. They affirmed that poverty was not an individual flaw, but the product of structural sin that perpetuates injustice.

Similarly, Martín-Baró focused not on an individual’s diagnosis but on the psychosocial trauma resulting from civil war. For El Salvador, war between a military-backed democracy and the Frente Farabundo Martí para la Liberación Nacional (FMLN) guerillas would last from 1980 to 1992. By the end of the war, 75,000 civilians had died, more than one million had been displaced, and among the disappeared, an estimated 3,000 were children.8The science of psychology had been used to inflict psychological, “low intensity” warfare that had high intensity effects: torture without visible scars, and propaganda targeting the hearts and minds of the people. All Salvadorans’ abilities to make sense of their reality were threatened by what Martín-Baró would call a “limit situation” – one that could destroy or spark inner resources to imagine a better tomorrow.2

Martín-Baró was ultimately killed by the war he described as a structure built upon violence, social polarization, and lies.9The creed of violence declared “might makes right.” Reason was used to devise military operations instead of fostering debate between conflicting social groups. As aggression replaced words, the roots of social relationships were critically damaged. Martín-Baró feared that many came to believe the solution for violence was violence itself.

Martín-Baró also stated that, with protracted civil war, the social fabric was dissected into factions: us versus them; democracy versus communism; and soldier versus guerilla. This polarization led to dehumanization of the other and created a “crack in the foundation of co-ex-istence.2” Individuals lived in a context that pressured allegiance to one side or another. Many tried to remain “neutral,” to dissociate themselves in an effort to survive.

The third facet of war was the institutionalized lie. Propaganda espoused images and a narrative that distorted reality. Contradicting the official story would place one at risk of being labelled subversive. As a result, many silenced their opinions and feelings or made vague utterances about “the situation.”

Martín-Baró sought to combat psychosocial trauma by identifying war’s toxic structure. He allied with those within and outside El Salvador who sought an end to war through peaceful negotiations. He created public opinion polls as a safe space for Salvadorans to give voice to their thoughts and perceptions. He was inspired by those Salvadorans who never ceased to believe that a just future was possible.

Relevance of Liberation Psychology for Child Psychiatry

Martín-Baró’s liberation psychology can serve as a resource for community psychiatrists who diagnose and treat individuals and families in the context of structures that inflict psychic harm: lack of access to health care and quality education; substandard housing; endemic community violence; lack of access to safe space for play; multigenerational poverty; and disproportionate minority confinement. We see children in families disrupted by incarceration, foster care, deportation, and untreated parental mental illness.

Psychiatrists witness the effects of structural violence in clinical encounters. We may feel helpless, overwhelmed, or, in the spirit of Martín-Baró, see ourselves as agents of structural transformation. AACAP was instrumental in advocating for the end of death sentences for crimes committed as a juvenile through dissemination of knowledge about adolescent brain development. AACAP also cites evidence of the harm inflicted by parent-child separation as it takes a stance against zero tolerance immigration policies. Child psychiatrists have the opportunity to increase chances for individuals to be granted refugee status through the Physicians for Human Rights’ Asylum Network. (www.phr.org). We can support medical students who are creating such asylum clinics as The Weill Cornell Center for Human Rights.10 We can educate parents about their educational, housing, and immigrant rights. We can inform them of recreational opportunities and scholarships. We can link them to legal resources.

Aware of the risks, Martín-Baró chose to remain in El Salvador, as he became inspired by the resilience and tenacity of those committed to heal a broken social fabric. He was inspired by the psychiatrist Viktor Frankl, who not only survived the concentration camps of the Holocaust but created a new form of healing—logotherapy—that placed the search for meaning at the center of mental health.11Martín-Baró found meaning in the development of liberation psychology that would identify the roots of psychosocial trauma, so that they might be transformed. Liberation psychology invites child psychiatrists to work with one another, with our patients, and with other professionals to mend our social fabric in the service of mental health.

 

Take Home Summary

In the context of El Salvador’s civil war, the Jesuit social psychologist, Ignacio Martín-Baró, created a liberation psychology that can serve as a resource for community psychiatrists everywhere. It encour-ages mental health professionals to identify social structures that inflict psychosocial trauma and to work toward transforming these structures in the service of mental health.

 

References

  1. Bernabeu A, Blum CP. The road to spain: the jesuit massacre and the struggle against impunity in el salvador.
  2. Martín-Baró I. In: Aron A, Corne S. Writings for a Liberation Psychology. Cambridge, MA: Harvard University Press; 1984.
  3. Kessler CL, Kraus LJ, eds. The Mental Health Needs of Young Offenders: Forging Paths toward Reintegration and Rehabilitation. Cambridge, MA: Cambridge University Press; 2007.
  4. Cone JH. A Black Theology of Liberation. Maryknoll, NY: Orbis Books; 1970.
  5. Chung CH. Struggle to Be the Sun Again: Introducing Asian Women’s Theology. Maryknoll, NY: Orbis Books; 1990.
  6. Burke KF. The Ground Beneath the Cross: The Theology of Ignacio Ellacuria. Washington, DC: Georgetown University Press; 2000.
  7. Gutiérrez G. A Theology of Liberation: History, Politics, and Salvation. Maryknoll, NY: Orbis Books; 1988.
  8. Voice of America. El Salvador’s Military Not Opening Archives For Missing Kids. VOA News. https://www. voanews.com/a/el-salvador-missing-kids/4272321.html. Updated February 27, 2018. Accessed August 4, 2018
  9. Martín-Baró I. La violencia política y la guerra como causas del trauma psicosocial en el salvador. Revista de Psicología de El Salvador. 1988;28:123-141.
  10. Emery C, Stellar K, Dubin K, et al. Student leadership in the creation and operation of an asylum clinic. Health and Human Rights Journal. https://www.hhrjournal. org/2015/11/student-leadership-in-the-creation-and-op-eration-of-an-asylum-clinic/. Accessed August 4, 2018.
  11. Frankl V. Man’s Search for Meaning: An Introduction to Logotherapy. Boston, MA: Beacon Press; 1962.

 

About the Author

Carol L. Kessler, MD, MDiv, works as a community child psychiatrist with Astor Services for Children and Families in the Bronx, NY, and is an ordained pastor in the Evangelical Lutheran Church in America, Chicago, IL. Since 1987, when Dr. Kessler first volunteered in El Salvador during its twelve-year civil war, Dr. Kessler has worked with the Central American community in New York and as a voluntary consultant to mental health programs in El Salvador and in Mexico. She has documented her work in a chapter of the book, Disaster Psychiatry: Intervening when Nightmares Come True. She has been on the faculties of the Albert Einstein College of Medicine, Icahn School of Medicine at Mount Sinai, and Columbia University Vagelos College of Physicians and Surgeons.

JAACAP Connect
Spring/Summer 2018
www.jaacap.com/content/connect

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Suicide Prevention via Facebook

One of the most powerful tools for helping to prevent suicide is something every one of us can provide: being sensitive to signs that someone we know may be suffering from suicidal thoughts and not being afraid to reach out to them and provide support and resources.

In the past, this was most likely to happen during face-to-face conversations or over the phone. Of course, the times have very much changed.

An increasing amount of our communication with family, friends, and acquaintances is now happening online via social networking sites.

Therefore, with the increase in social networking, there has naturally been an increase in people sharing suicidal thoughts and signs on sites such as Facebook.

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Honoring Mental Health Awareness Month

May is Mental Health Awareness Month

In commemoration of Mental Health Awareness Month and Children’s Mental Health Day on May 7, 2015, Astor wants to draw attention to reducing the stigma around mental health, especially for children. 

For too long, the stigma surrounding mental health has prevented many needing treatment from receiving it.

Astor also recognizes the importance of early intervention and diagnoses in reducing the severity of mental illness.

Did You Know?

1 in 5 children, either currently or at some point during their life, have had a seriously debilitating mental disorder. -National Institute of Mental Health

Suicide is a serious public health problem that affects even young people. For youth between the ages of 10 and 24, suicide is the third leading cause of death. It results in approximately 4,600 lives lost each year. -Center for Disease Control and Prevention

40% of child abuse and neglect victims, receive no post-investigation services …

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Pet Therapy Incorporated at Astor

For eight years now, volunteer, Pat Cortese, and her Labrador retriever, Angelina, mostly known as Lina, have worked with the children at the Residence in Rhinebeck. Lina is a therapy dog who provides comfort and a sense of safety, and helps keep the children keep calm.

“It is such a rewarding experience. This is such a tiny thing that Lina and I do to help make the children feel good,” Cortese said.

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Family Counseling When You Need It

In 2013, over 1,400 families came in to our Mid-Hudson Valley Counseling Centers to receive assistance. They arrived with an array of challenges which afflict families during difficult times.

Astor’s team faces a tremendous challenge that they hope to overcome: opening the eyes of parents to the role stress plays in their lives and the lives of their children.

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Supporting Children and Families’ Mental Health Year Round

For many families, facing ten weeks of summer with fewer supports and services for their children is a time of significant stress, because good educational programming for at-risk youth can sustain youth and family through times when a child’s behaviors are more challenging or more risky.

Let’s make every month in our communities a month that provides meaningful support so that children can be healthy, happy and productive, and families can receive the support they need to thrive.

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Astor’s Head Start Programs: Support Students in the Classroom!

This I have never understood:

How can anyone, anywhere not want to support a program that gives those who are most defenseless, who are without a voice, without a constituency, without a lobby, a chance?

Head Start works. By all the metrics it has an immediate effect on the kids. On IQ scores, academic achievement, crime, and poor health.

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What Really Prevents School Violence?

School communities are the most critical factor in the prevention of school violence.  The more inclusive and welcoming the school community, the more connected most youth in that community feel.  The more connected youth feel, the more likely it is that any youth contemplating violence will be revealed to caring adults early in the path toward an actual violent act.

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How to Help your Child Grieve

Over 20 years ago, I discussed theses seven steps of grieving in a book called “Bereavement: Counseling the Grieving throughout the Lifecycle” and while some are self-evident others require more explanation.

It is important to stress to a child what you keep after a death.

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Astor Wind Chimes and the Changing of the Seasons

I can only imagine how its making, or rather how the entire arts program at Astor calms, soothes and encourages the children. It gives them a voice, rouses their creative spirit and ensures that the mission of Astor – that every child deserves a childhood – is fulfilled.

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Focusing on Children’s Strength Will Yield High Returns

Mental health treatment providers and educators must work collaboratively with children and families to identify their unique skills, talents and interests.

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Strive to Thrive: Train Your Toddler’s Brain, Part 3

Last fall, I wrote about self-regulation, the important “brain training” that is needed for children to be competent and confident.   Parents can help their babies develop this important skill with warm, responsive, and predictable parenting.  When your children are toddlers, you can continue to train their brains by developing your own calmness, telling your toddler what to expect, and teaching them how to behave.

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Simple Ways to Keep the Holiday Season Fun and Stress-Free

The holiday season seems to start earlier every year!

This year, when I went to look for Halloween candy I saw some Christmas decorations at the supermarket!  And we all know that, when the season is here, we see images of happy, healthy, wealthy folks who seem to have it all together all the time.  But anyone who is raising kids knows…

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Strive to Thrive: How to Train Your Toddler’s Brain, Part 2

Self-regulation, or the ability to choose behaviors that are right for the context a child is in, is very important and we can all help our kids get better and better at it as they grow up.

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Strive to Thrive: Building Confidence in Your Kids, Part I

Did you know that the roots of confidence and competence start when your child is just a baby? In my business, we call these roots “self-regulation,” which is a fancy way to say that a child (or adult) can be in charge of their own thinking, emotions, and behaviors.

By helping your kids develop the ability to be in charge of themselves in a healthy way, you can build their confidence in themselves and make them more likely to do well at home, in school, and with friends.  In short, YOU can TRAIN YOUR CHILD’S BRAIN.

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Strive to Thrive: 6 Ways To Build A Stronger Family NOW!

A discussion on what it takes to be a “successful” family.

I am not talking being a rich family, or a famous family. I am not even talking about being a trouble-free family. I am talking about being the kind of family that endures during hard times and rolls with the punches, stays connected to one another, and raises kids that go on to have the same connected, strong kind of family when they grow up. Scientists have studied families for many years, and they have found that there are some ways to make families stronger.

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Do Families Have to Strive to Thrive?

Astor Services has been helping families and kids thrive for a long time now.  In my job at Astor I try to help staff bring the best practices to our families and kids; I find those practices by reading about what scientists who study families have discovered about helping families and kids heal.

But a few years ago, something changed in my life.  I became a Mom.  When I had my twins, my questions changed from, “How can Astor help families and kids who are struggling with mental health and behavioral issues?,” to “What does the science say about helping all families stay more connected, feel healthy and happy, and help their kids grow and thrive?”  Most importantly, “Can science provide families and kids who are struggling with mental health issues a road map to recovery?”

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