R O B E R T S E T. A L . | U L Y S S E S S S Y N D R O M E & W A Y S T O H E A L 38 VO L . 4 , I S S U E 2 keywords: Ulysses Syndrome, Migratory Mournings, Five Protective Factors, Migrants, Immigrants, Refugees, Healing, Trauma, Cultural Bereavement, Stress abstract As a director of a community-based organization who works predominantly with immigrants and refugees, Lucy Morse Roberts noticed immigrant clients and colleagues were often experiencing ill-defined malaise, headaches, and insomnia. After visiting doctors, the immigrant clients and colleagues were still unwell. She and her team sought to understand and address this suffering and seek ways to heal. Research on migratory mournings by Joseba Achotegui offered her team one lens through which to understand and better respond to the physical and psychological ailments experienced by immigrant and refugee clients. Achotegui’s research, including that on the Ulysses Syndrome and cultural and situational responsiveness, directly changed the programming and priorities at Hui International under Lucy Morse Roberts’ leadership. This article first defines migratory mournings and the Ulysses Syndrome. Second, the article offers community partners’ personal and professional insight as to how and why this research is relevant and transformative. Lastly, the article offers an organizational framework for effective application and intentional community engagement. I have long loved what one can carry. I have long left all that can be left behind in the burning cities and lost even loss – not cared much or learned to. I turned and looked and not even salt did I become. From Solmaz Sharif’s poem, “Without Which” Sharif’s poem continues, “I am-even when inside the kingdom-without” (Sharif, 2022). As an immigrant herself having been born in Turkey and raised in Iran and in California, her poems often speak to the challenges faced by the world’s diaspora. Hers is a single voice that speaks to the experiences of many. According to UNHCR, over 100 million people are currently “without” (displaced) worldwide (UNHCR, 2022). Those displaced find themselves labelled by their plight of absentia from their land of origin and often struggle to create new lives in new places. Many of those who find themselves new to our communities feel without, without a sense of place and with a sense of mourning for what was once a part of their lives and is no more. Understanding the Ulysses Syndrome, Effective Engagement, and Ways to Heal Authors LUCY MORSE ROBERTS, Executive Director of Hui International/CalGalsMedia JOSEBA ACHOTEGUI, Psychiatrist. Tenured Professor of the Barcelona University RACHEL C. ALLEN, Director of the Peace and Justice Institute at Valencia College MARTHA LOPEZ, Program Coordinator for Hui International MUZHGAN FAKHRI, Host of the Unlimited Possibilities podcast, a Hui International/CalGalsMedia project ENGAGE! | e xo d u s & e n t ry 39 According to Dr. Joseba Achotegui, from the University of Barcelona, this sense of “without” experienced in the extreme can lead to physical and psychological symptoms and can adversely affect one’s health and well-being. These symptoms caused by migratory mournings in difficult situations are often referred to as the Ulysses Syndrome (Achotegui, 2002). Dr. Joseba Achotegui first wrote of the Ulysses Syndrome, named after the Greek mythological hero Ulysses, in 2002 and the migratory mournings in 1995. The Ulysses Syndrome is not a mental disorder but extreme migratory grief. “Today, migration is becoming for millions of people, a process that has such intense stress levels that they can exceed the adaptive capacity of human beings” (Achotegui, 2015). The most important stressors of Ulysses Syndrome as pointed out by Achotegui (2002) are: 1. Loneliness and the enforced separation, especially in the case when an immigrant leaves behind his or her spouse or young children. 2. The sense of despair and failure that is felt when the immigrant, despite having invested enormously in the emigration (economically, emotionally, etc.), does not even manage to muster together the very minimum conditions to make a go of it. 3. The fight merely to survive: to feed themselves, to find a roof to sleep under. 4. The fear, the afflictions caused by the physical dangers of the migratory journey, the criminalization of the migration, helplessness. The harmful effects caused by the adversities and dangers that the immigrant must face are greatly increased by a whole series of unfavorable characteristics associated with stressful situations, which, as Achotegui (2002) points out, are the following: • Multiplicity (the greater the number of adversities and dangers, the greater is the risk to the mental health). • Chronicity. These situations of extreme hardship can affect immigrants for months on end, even years. • The feeling that whatever the individual does he will not be able to change his situation (learnt helplessness, Seligman, 1975). • The enormous intensity of the stressors (quite unlike the stress associated with being stuck in a traffic jam or sitting an examination). • The marked absence of any network of social support, absence of social capital (Coleman,1984). • The symptoms themselves (sadness, weariness, insomnia, etc.) become an additional handicap that hinders the immigrant in his attempts to survive. To all this, we need to add the classic shocks the immigrant must come through (coming to terms with a new language, culture, environment) and, to these shocks, we must now add the severity of the present extreme stressors. What’s more, the health system often does not provide adequately for individuals suffering from physical and psychological symptoms associated with the Ulysses Syndrome: either because this problem is dismissed as being trivial (out of ignorance, a lack of sensitivity, prejudice and, even, racism, etc.) or because this condition is not adequately diagnosed and immigrants are treated as being depressive or psychotic, thereby giving the immigrant even more stressors to face. Their psychosomatic symptoms are not seen as connected to psychological issues and they are therefore subjected to a series of tests (such as colonoscopies, biopsies, etc.) and given inadequate, costly treatment. The health system, though intended to be a solution, then can become a new stressor for an immigrant. R O B E R T S E T. A L . | U L Y S S E S S S Y N D R O M E & W A Y S T O H E A L R O B E R T S E T. A L . | U L Y S S E S S S Y N D R O M E & W A Y S T O H E A L 40 VO L . 4 , I S S U E 2 Migrations and misunderstandings related to the migrant experience have coexisted for a very long time. Migration is ancient, as old as humankind. Physically, we are designed to move. We have feet and have evolved to move as needed. Migration is one of the three evolutionary pillars along with mutation and natural selection. Culturally, we evolved to recognize migration as part of our human experience. All three of the Abrahamic religions include welcoming the stranger as inherent to being an adherent. Our literature also reflects the strengths and sorrows of the immigrant. The Odyssey by Homer is a classic example of the “displaced” from which Dr. Achotegui drew his reference for the Ulysses Syndrome. Because migration is part of human history, many now and in the past have experienced the Ulysses Syndrome. Unfortunately, however, few have heard of it. For those focused on engaging the newcomer in their land and those who are the newcomer, understanding the Ulysses Syndrome and ways to heal is essential. This understanding is foundational to empathy and empathy is foundational to effective engagement. Because information on the Ulysses Syndrome is key to effective immigrant and refugee outreach, the challenge facing agencies and individuals was/is how to translate Dr. Achotegui’s research and present it in a way that is accessible to all. Community partners, Martha Lopez, Arezoo Pamiry, and Muzhgan Fakhri helped create the solution. Together with Hui International, they developed info sheets and videos as tools to share information on the Ulysses Syndrome and ways to heal. The goal of the info sheets and videos is to help disseminate Dr. Achotegui’s research in a way that is accessible to agencies and individuals. Lopez, Pamiry, and Muzhgan are from Mexico and Afghanistan, respectively. Their experiences and input helped Hui International not only see the relevance of Achotegui’s research but also the need to share it more widely. Martha: I heard about the Ulysses Syndrome during a seminar I attended for work. The moment I heard about it, I wanted more people to be aware of Ulysses Syndrome and the physical and psychological symptoms associated with the stress of migrating from one place to another. Hearing about the Ulysses Syndrome also made me reflect on my own personal experiences when I came to the United States at age 10 from Mexico. My dad had been working here and acquired the green cards for the rest of our family and me. I still remember feeling sad, rejected, and unsupported when I started school and hurt by other students who made fun of me for not speaking English. After attending the seminar, I began to wonder what others experiencing the Ulysses Syndrome would need to do/have to become more resilient and thrive in new places. I work with other immigrants and know some people who have gone to the doctor to get medicated for different reasons like those associated with the syndrome. Often the medication eased their symptoms but did not address the cause of these symptoms. That’s when I realized that the work that I do can help heal the root cause of the suffering many new to our country experience. I love working with families to help, support, and empower them by providing educational information, resources, and new techniques that teach them about the importance of adapting the Five Protective Factors into their lives and communities. Immigrants and refugees need to know they are not alone in their suffering, and it is okay to seek help, support, or advice. Having just one person they trust to guide them, support, and uplift them when they might feel like giving up can make a positive difference in a life and each of us can be that person. For me when I was new to this country, that one person was my teacher. Muzhgan: As an immigrant myself during these six years of my life, I had all the mixed feelings and sad emotions that were mentioned in Dr. Achotegui’s research. I was a human rights attorney in Kabul and was forced to leave when my life was at risk. When ENGAGE! | e xo d u s & e n t ry 41 I first arrived in the United States, I felt useless and hopeless. Life where everything was different from my home country, where none of my beloved ones were with me seemed unmanageable. I feared becoming homeless. At that time, I needed someone to calm me and say everything would be alright one day. That is why I feel this topic is important to me and other immigrants. We and others are with them, and our work, videos, and info sheets offer tips and ideas on how immigrants and refugees can heal, accept change, and feel accepted in their new environment. We hope the information will reassure those who struggle, and they find a new life here filled not just with problems but also positive possibilities. The United States is one of the top countries that welcomes thousands of immigrants yearly. Therefore, we must talk about the Ulysses Syndrome and share the information among immigrant communities, so they don’t feel alone. Every immigrant should know that feelings of sadness and emptiness are normal for many and, knowing this, immigrants should not feel embarrassed for seeking help. By creating the Ulysses Syndrome info sheets and videos, we are raising our voices and engaging others so that those who are struggling with their adjustment to a new land do not feel alone. Arezoo, Martha, and I helped design info sheets and videos in a way we believe acknowledges shared suffering and helps fortify individuals and families. The info sheets and videos mentioned by Muzhgan aim to validate migrant experiences and prevent dismissal of suffering and marginalization. The videos and info sheets can be found at https://www.calgalsmedia. io/ava/the-ulysses-syndrome-project. The following graphics on the seven migratory mournings, physical and psychological symptoms associated with the Ulysses Syndrome, and the graphic on ways to heal are based on the info sheets and videos. 7 Migratory Mournings that can trigger physical and psychological symptoms are… R O B E R T S E T. A L . | U L Y S S E S S S Y N D R O M E & W A Y S T O H E A L R O B E R T S E T. A L . | U L Y S S E S S S Y N D R O M E & W A Y S T O H E A L 42 VO L . 4 , I S S U E 2 ENGAGE! | e xo d u s & e n t ry 43 The Ulysses Syndrome, the physical and psychological symptoms associated with migratory mournings, can adversely impact our health and well-being and our relationships with others including our families. The good news is there are many ways to heal, build resilience, and strengthen ourselves and our families. The Strengthening Families’™ Five Protective Factors offer a framework for and strategies to address stress in healthy ways. R O B E R T S E T. A L . | U L Y S S E S S S Y N D R O M E & W A Y S T O H E A L R O B E R T S E T. A L . | U L Y S S E S S S Y N D R O M E & W A Y S T O H E A L VO L . 4 , I S S U E 2ENGAGE! | c r e at i v e a rts 44 ENGAGE! | e xo d u s & e n t ry 45 We can help increase protective factors in our communities by offering programs and resources that support and fortify immigrants and refugees, that support and fortify anyone. We can help build the five protective factors through relationships, too. Social connections are one of the five protective factors and transformative relationships (as opposed to transactional relationships) are essential to effective engagement and building resilience. Transformative relationships offer practitioners and community partners an opportunity to come together and identify and cocreate essential resources. The Ulysses Syndrome videos and info sheets are an outcome of an effective collaboration with community partners. This kind of collaboration was only possible through meaningful engagement and the creation of safe, stable, nurturing relationships and environments. For this reason, how we engage is as essential as the programming we offer. How we engage and receive those new to our communities can be either a risk factor or a protective factor (Achotegui, 2015). Receiving someone with a welcoming heart into a welcoming community helps lay a foundation for healing, thriving, and effective community partnerships The following steps and tools can help organizations and individuals effectively welcome/engage immigrants and refugees and build relationships of trust and transformation. Step 1: Identify Intention “What” we do is secondary to “how” we do it. Therefore, it is important to reflect on where we are as organizations and individuals in relation to trauma- informed principles. Do these principles inform your work? Your program design? Mission? Values? The simple matrix below is designed to assist organizations and individuals with assessing their current approach to work and plan for where they want to be. The same type of matrix can be used to reflect on where we are individually and organizationally in relation to being healing-centered. The healing-centered categories in the following matrix are based on work by Dr. Ken Epstein. It is essential to incorporate trauma-informed principles and healing-informed practices internally before a group/organization can effectively apply the principles externally and effectively engage others. Deep sincere reflection often requires wrestling with difficult truths about ourselves and our institutions. Please remember, as you explore the following ideas, give and receive grace and avoid blame and shame. Everyone (colleagues and clients) needs to feel welcome and valued. The following practices developed by Parker Palmer and further refined by the Peace and Justice Institute at Valencia College in Orlando, Florida, can help create an organizational culture conducive to respectful dialogue and community building. The Principles for How We Transformative relation- ships offer practitioners and community partners an opportunity to come together and identify and cocreate essential resources. R O B E R T S E T. A L . | U L Y S S E S S S Y N D R O M E & W A Y S T O H E A L R O B E R T S E T. A L . | U L Y S S E S S S Y N D R O M E & W A Y S T O H E A L 46 VO L . 4 , I S S U E 2 Treat Each Other are practices that develop a trauma- sensitive environment by inviting participants to slow down, suspend judgment, check assumptions, and speak one’s truth among other practices. When used consistently, the Principles support honest and open spaces for authentic dialogue, as well as a foundation for skillful conflict navigation. The Principles move individuals and organizations toward a trauma-informed, healing-centered culture where all individuals are welcome. Organizations can create their own set of principles and read them at the start of each meeting, post them in common spaces, and return to them when conflicts arise and tensions seep into discourse and relations. The following principles are from Valencia College’s Peace and Justice Institute. With intentions set and a framework for engagement ENGAGE! | e xo d u s & e n t ry 47 agreed upon, it is easier to delve deeper into our ideas, attitudes, and work and address possible barriers to effective engagement with immigrants and refugees in our communities. step 2: reflect on... biases “The word welcome confronts us; it asks us to temporarily suspend our usual rush to judgment and to simply be open to what is happening. Our task is to give our careful attention to what is showing up at our front door. To receive it in the spirit of hospitality.” — Frank Ostaseski, The Five Invitations. Everyone has biases. To have a bias is part of human nature. Though natural, biases can be harmful and can perpetuate individual, systemic, historic, and institutional trauma and create barriers to helpful, healing engagement. To effectively engage others in a trauma/healing informed way, we need to better understand the lens/biases through which we see the world and others and examine the impact of our lens/ biases on our relationships and interactions. Implicit Bias: Attitudes, stereotypes, assumptions that affect decisions in an unconsciously. Confirmation Bias: Ideas that confirm our existing beliefs and impair our ability to see another side of a story. Fundamental Attribution Bias: Creating contextual excuses for our failures and seeing failures in others as inherent to their race, gender, culture, etc. How might these biases impact your work? How can you address biases and increase a sense of welcome? intersectionality Intersectionality is a phrase coined by Professor of Law, Kimberle Crenshaw to explain the interplay of “isms” that create and perpetuate systemic, historic, institutional, and individual trauma. Understanding the interplay of “isms” will help organizations more deeply engage parents/caregivers, address and dismantle systems of oppression, and build systems of well-being Is your organization aware of and responsive to the intersection of “isms”? If so, how is this awareness reflected in your community engagement work? If not, how can you and your organization be more mindful of and responsive to the complexity of trauma experienced by individuals and communities?. The Principles for How We Treat Each Other are practic- es that develop a trauma-sensitive environment by inviting participants to slow down, suspend judgment, check as- sumptions, and speak one’s truth among other practices. When used consistently, the Principles support honest and open spaces for authentic dialogue, as well as a foundation for skillful conflict navigation. R O B E R T S E T. A L . | U L Y S S E S S S Y N D R O M E & W A Y S T O H E A L R O B E R T S E T. A L . | U L Y S S E S S S Y N D R O M E & W A Y S T O H E A L 48 VO L . 4 , I S S U E 2 attitudes Transformative or Transactional? Is your organization transactional (compliance driven) or transformative (relationship driven)? Transactional organizations engage bureaucratically, policies, not people, are the priority. In transformative organizations, people/relationships are the priority. A transformative/ relational driven aim can be both policy and people focused but it is difficult for a purely transaction driven motive to be transformative. Invitational or Institutional? This question is very much related to the aforementioned question of transformation vs. transaction. The former invites people into programming and opportunities and the latter is based on a more impersonal, institutional process. “I have learnt that when people feel supported by strong human relationships, change happens. And when we design new systems that make this sort of collaboration and connection feel simple and easy, people want to join in” (Cottam, 2018). Collection or Inclusion? Is your organization’s goal a collection of diverse people/voices or the inclusion of diverse people/voices? The former simply brings people to the table. The latter brings people to the table and creates an environment where diverse ideas and opinions are valued and sought. To demonstrate a voice is valued, listen and acknowledge and, if needed, act. To demonstrate a voice is sought, ask. step 3: engage Effective engagement is responsive to changing circumstances and needs. As opportunities emerge to respond to needs of refugee and immigrants in meaningful ways, utilizing the aforementioned tools and framework can provide a foundation for culturally and situationally responsive, trauma/healing informed engagement and transformative work. Research indicates being provided with positive social connections and resources can mitigate the harmful effects of violence and improve the mental health of immigrant and refugee adults and children (Fazel et al., 2011). For Hui International, effective engagement has led to creative collaborations like the Hui International’s Ulysses Syndrome Project. final thought As we search for solutions to help those who hurt heal, to assist those who feel lost find and fuel themselves, and to work toward untangling the systems of oppression in this world, we can start simple. Engage with intention and reflection, smile and listen. Kindness reminds everyone they matter, they are somebody, they are valued within our communities and are not, as Sharif described, “without.” Intentional engagement can mitigate stress experienced by refugees and immigrants, address migratory mournings, and the Ulysses Syndrome, offer ways to heal and, as Muzhgan, Martha, and Arezoo’s ideas and efforts demonstrate, our best ideas for engagement and solutions for healing often come from partnering with those in the communities we serve. ENGAGE! | e xo d u s & e n t ry 49 References Achotegui, J. (1995). Migrar: Duelo y dolor. El Viejo Topo, (90), 31-38. Achotegui, J. (2002). La depresión en los inmigrantes: Una perspectiva transcultural. Ediciones Mayo. Bar- celona. Achotegui, J. (2015). The Ulysses Syndrome: The immigrant syndrome of chronic and multiple stress. Edi- ciones elm undo de la mente. Bandura, A. (1986). Social founda- tions of thought and action: A social cognitive theory. Prentice-Hall. Coleman, J.S. (1994). Foundations of social theory. Harvard University Press. Cottam, H. (2018). Radical help: How we can remake the relationships between us and revolutionize the welfare state. Virago. Fazel, M., Reed, R.V., Panter-Brick, C., & Stein, A. (2012). Mental health of displaced and refugee children reset- tled in high income countries: Risk and protective factors. The Lancet, 379(9812), 266-282. Johnson, H., Perez, C.A., & Mejia, M.C. (2021, March). Immigrants in California [Fact sheet]. Public Pol- icy Institute of California. https:// www.ppic.org/publication/immi- grants-in-california/ Ostaseski, F. (2019). The five invita- tions. Flatiron Books. Roberts, L. & Bourne, G. (2020). The path to effective trauma-/ heal- ing-informed parent and caregiver engagement. Family Hui. https:// www.familyhui.org/wp-content/ uploads/2021/01/path-to-effec- tive-parent-caregiver-engage- ment-20210105.pdf Said, E. (2002). Reflections on exile and other essays (3rd ed.). Harvard University Press. Seligman, M.E.P. (1975). Helpless- ness: On depression, development, and death. Freeman & Co. Sharif, S. (2022). Customs: Poems. Graywolf Press. UNHCR. (2022). Global trends. https://www.unhcr.org/global- trends/ R O B E R T S E T. A L . | U L Y S S E S S S Y N D R O M E & W A Y S T O H E A L