Our community must begin an open dialogue about mental illness and embrace outside support.
By Dr. Ramina Jajoo-Frindrich | December 2022
So what does a rheumatologist and a psychiatrist have in common? After all, one medical field specializes in musculoskeletal ailments and rare disabling autoimmune disorders, while the other focuses on the emotional and mental well-being of an individual.
It turns out, a lot more than meets the eye. Although one could say it is common knowledge that chronic pain from arthritis leads to anxiety and depression, many people with clinical depression experience physical discomfort and fibromyalgia, an often debilitating, chronic and diffuse bodily pain syndrome. Given extensive persecution and trauma suffered by our people, how does this mind and body connection manifest itself? More importantly, is our community ready to discuss a much-tabooed subject such as psychiatric disorders?
A few years ago, I was treating an Assyrian patient for Sjogren’s syndrome, an autoimmune disorder that causes dryness of the eyes and mouth and, in severe cases, inflamed joints and multiorgan malfunction, even death.
For reasons unbeknown to me, he started flaring. After a few visits, he finally admitted that he never took his medication. Gradually, he became more irate, demanding immediate control of his symptoms yet refusing standard pharmacological remedies. In his words, “I become like a lion when I am in pain. I will destroy anything and anyone in my path if I don’t get what I want.”
After threatening and verbally abusing my staff, even propositioning one of them, I was left with no choice but to prioritize the safety of my employees. A decision was made to discharge him from the practice. Interestingly, I would occasionally run into him at our church during Sunday brunch.
After a few similar incidents, I started wondering if a behavior such as this is a manifestation of cultural upbringing as opposed to prior traumatic events, affecting generations within a community, or even perhaps a combination of the two.
It wasn’t until I started volunteering at Seyfo Center, also known as the Assyrian Genocide Research Center, and through talking with several genocide scholars and attending various lectures on Holocaust and other genocides that I learned about intergenerational, or generational, trauma.
According to the Centers for Disease Control and Prevention (CDC), 1 in 5 Americans experience mental health illness in a given year. In comparison, Sjogren’s syndrome affects only 1% of the population, thus making mental health disease a far more common condition.
The incidence of mental health disorders in the Assyrian community remains unknown for a variety of reasons that are beyond the scope of discussion in this article. However, it may be reasonable to assume that given the extensive and ongoing trauma and persecution suffered by our people, the incidence of conditions such as anxiety, depression, post-traumatic stress disorder, and personality disorders such as borderline personality (BPD) is significantly higher.
One of the most extensively studied group of people with somewhat similar experiences are the children of Holocaust survivors. According to the American Psychological Association, in 1966, Canadian psychiatrist Vivian M. Rakoff, MD and his colleagues recorded high rates of psychological distress among children of individuals who survived the Holocaust, and the concept of generational trauma was first recognized.
Since then, numerous studies have looked at intergenerational trauma among the Jewish people. For instance, a similar study in 1988 found signs and symptoms of trauma in the grandchildren of Holocaust survivors. It is theorized that generational trauma can be induced through in-utero exposure to chemicals involved in maternal stress, such as cortisol, that impact future development or through epigenetic changes. These are the changes to an individual’s DNA as a result of a traumatic experience that can theoretically be passed down through generations.
It is hypothesized that changes in the DNA impact brain development, and affect how the limbic system in the brain regulates emotions and how one responds to stress. This, in turn, impacts personalities, relationships, parenting, communication, and views of the world.
Of particular interest to me was borderline personality disorder (BPD); not to be confused with bipolar disorder. BPD has a lifetime prevalence of 6% and is characterized by instability of interpersonal relationships, self-image, emotions, and impulsivity across a wide range of situations, causing significant impairment or subjective distress, fear of abandonment, increased risk of substance abuse and, in severe cases, self-harm and suicide.
For readers interested in this particular type of personality disorder, I recommend “I hate you, don’t leave me” by Jerold Kreisman, MD and Hal Strauss. In a personality disorder, one’s way of thinking, feeling, and behaving deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time. The pattern of behavior usually begins in late adolescence or early adulthood. Without treatment, personality disorders can persist with devastating outcomes.
Treatment of generational trauma typically involves any combination of individual, group, or family therapy with or without medications in the more severe and debilitating cases. Secondary anxiety, depression and PTSD must be addressed as well.
It is a well-known and researched fact that individuals with strong family ties and community support do much better in terms of coping with stress and trauma. Historically and characteristically, Assyrians have been very family-oriented and support was generally abundantly available in various settings such as extended families and friendships formed through volunteerism at various charitable organizations and churches. However, given mass migration and families losing members due to persecution or simply getting separated from their loved ones, makes this more challenging in the case of genocide survivors and their descendants.
The church and the clergy are particularly in a unique position in that they can provide spiritual support to our traumatized nation. Within the psychiatric world, it is an established and much-studied fact that persons with higher spirituality and self-transcendence have a stronger ability to cope with change and adversity.
Although we as Assyrians can take advantage of these community-based resources with relative ease, we have yet to tap into our broader medical community that can offer professional and target-specific treatments that are currently available.
“Knowing you aren’t alone or helpless and knowing that there may have been factors outside of your control might help process the trauma,” says licensed clinical psychologist and parenting evaluator Melanie English, PhD in an article by Health magazine. “When we process things and understand them, we can then often find coping mechanisms. When we find coping mechanisms, we can heal, and redefine ourselves and reclaim a part of our life.”
As my paternal grandparents barely survived the genocide of 1915 at the hands of Ottoman Turkey and their Kurdish allies, it would have been amazing if services such as counseling had been readily available to them. Regrettably, that is no longer possible.
However, in the aftermath of ISIS, as Assyrians are migrating to the diaspora, we must ensure that our community has easy access to not only community-based resources but also mental health specialists. It is time that we shun the taboo associated with mental health illnesses and become proactive in caring for our emotional as well as physical well-being.
An open dialogue on platforms such as The Assyrian Journal is a step in the right direction, hoping that we can reduce abnormal and counterproductive behavior, such as that elicited by my former patient, and ultimately prevent it from becoming an accepted cultural norm.
Disclaimer: The views expressed here are solely those of the author and do not necessarily represent the views of The Assyrian Journal.
Author: Dr. Ramina Jajoo-Frindrich was born in Tehran and completed medical school in Australia. She is a retired Rheumatologist residing in Phoenix. Dr. Jajoo was previously a partner at Arizona Arthritis and Rheumatology Associates. She currently serves as strategic consultant and president of Seyfo Center, Arizona Chapter.