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More editorial cartoons from Harvard Public Health:

• “Artificial opinion,” by Natasha Loder
• “It ain’t over when it’s over,” by Natasha Loder
• “(Climate) change of plans,” by Natasha Loder
• “A sound idea,” by Jenna Luecke
• “Post-pandemic paranoia,” by Jenna Luecke
• “Climate change bites,” by Jenna Luecke
• “Environ-mental shift,” by Jenna Luecke

The post Death by a thousand “likes” appeared first on Harvard Public Health Magazine.

So he approached the Plaza Giordano camp with papers and markers. As an artist, he understood the power creativity could unleash, and he asked them to draw how they got to Mexico. The pictures shocked him. “There were kids who expressed their passage through the jungle—how they were assaulted, robbed,” Contreras recalls.

The approximately 60-mile stretch through the Darién Gap—the “land bridge” that connects North and South America along southern Panama and northwestern Colombia—is a common route for migrants from Africa, Asia, and Central and South America searching for the American Dream. In the first half of this year alone, nearly 198,000 migrants crossed there, according to the Panamanian government. It is an arduous journey fraught with dangers natural and human—predatory animals, scarce food, as well as violence, robberies, and sexual assault, whose victims include children.

“[A] five-year-old that’s crossed three countries, [through] the jungle—that’s not a typical experience for a boy or girl of that age, right?” Contreras says. “That’s when I realized [art] was indispensable for them…. It could give their experiences a shape.”

Art, games, and toys are proving powerful tools for addressing the mental health and trauma of migrant youth in Mexico. With initiatives from individual volunteers like Contreras, as well as psychologists and humanitarian organizations like Doctors Without Borders (which even produced an animated film with children’s drawings), unstructured play is becoming an important if under-discussed part of the humanitarian response in Mexico City and along the U.S.-Mexico border.

Children play and draw at a migrant encampment in Plaza Soledad in Mexico City in October.

Research shows that play therapy and art therapy are important for child development and can allow children to process complex trauma. One 2022 study found that art can promote feelings of hope, empowerment, and optimism among kids with minor mental health difficulties. Art can also be important, the same study showed, “for expressing complex emotions and feelings that cannot be easily verbalized.” And a wealth of scientific studies show that a child who has experienced trauma but has “one trusted adult” in their lives is less likely to experience negative mental health outcomes, and more likely to develop self-confidence.

Contreras became that trusted adult for many kids at the plaza. He began holding an informal “school” for two to three hours, Monday through Friday. Most of his “students” hadn’t been in school for months, a risk factor for negative mental health and learning loss. Contreras became “profe,” shorthand for “teacher” in Spanish, and his “class” grew to 20 migrant kids. “They’d always ask me, ‘Are you going to come? Are you going to come?’” he says.

During Mexico’s Children’s Day, Contreras put on a public art exhibition of the kids’ work. Haitian kids sang in their native Haitian Creole, and Contreras projected their drawings with a projector to show Juaréz “their humanity”—an initiative that felt especially important given its timing. In the months before the exhibition, neighbors had protested against the migrant camp and asked the government to shut it down—something the kids noted and sometimes interpreted as racism or hate, Contreras says. When they saw their drawings projected, he recalls, “they were so excited. They said, ‘I made this in school! I made this in school!’”

For kids living in migrant camps like the plaza, the unknown can cause anxiety. And there are many unknowns: When will the immigration appointment come? What will this new country be like?

Drawing “allows them to feel some sort of agency and control” and make sense of an uncertain situation, says Sita Patel, a community psychologist at Palo Alto University who specializes in mental health in immigrant communities. This January, she and other psychologists visited a migrant camp in the Mexico border town of Reynosa, Tamaulipas and asked kids to draw a house. Despite the kids’ reality of living in tents, details immediately sprang to mind: They drew their imagined future, she says.

Hope is a recurrent theme across the migrant camps of Mexico. Unprompted, 12-year-old Doriana, a Venezuelan living in the Plaza Soledad migrant camp in Mexico City’s downtown, imagined and drew her “new home” in the United States. It had a red-tiled roof, a tree in the backyard, and blue specks showering the scene to represent snowflakes, even though she’s never seen snow before.

Arturo Ortiz is doing similar work to Contreras, though from a different background and with different tools. A former professor of psychology at Universidad Nacional Autónoma de México in Mexico City, he took his last batch of students out of the classroom and down to the plaza for their final meeting of the academic year, in May. His ten students filed into the square; one held a garbage bag full of toys, balloons, and balls.

A handful of Plaza Giordano kids, mostly younger and Haitian, swarmed when they saw Ortiz’s students. The students gathered the children into a circle and passed around balloons; the children laughed and clapped. Some sat in students’ laps.

This was the last day of play therapy for the kids and for Ortiz’s students, who had come to the plaza nearly every Saturday for the semester to engage the kids in unstructured fun. Ortiz hoped it would improve the mental health of the kids, who continued to be exposed to stress but lacked psychological resources.

Take David, a two-year-old Honduran child who still waddles when he walks. David’s seven-month-old sibling Homer caught pneumonia while in the camp—“he wasn’t used to the cold,” their mother, Daniela, says—and died in the hospital in April. Daniela was devastated. She kept Homer’s ashes by their tent, carrying them still when they finally got their visa and moved to Los Angeles. David, too young to understand death, still sometimes asks where his brother is.

Ortiz hoped play could unlock the “pain” to which David was exposed. “Games are like x-rays in psychology,” he says. They help adults peer inside the hearts of kids “because kids don’t have the verbal capacity to express themselves like adults.”

Children sometimes play at things they have experienced to process trauma, says Peter Gray, a psychology research professor at Boston College. This is true in a variety of traumatic settings, from the migrant border communities of today to the Jewish ghettoes of the Holocaust. George Eisen, professor emeritus of history at California State Polytechnic University, says play helps children “understand, to learn or maybe also accommodate reality.” Eisen wrote a book about play during the Holocaust, documenting how Jewish children played make-believe Gestapo agents, among other games that mimicked their reality. “They are preparing themselves in some ways if it happens to them,” Eisen says. “It’s how they cope.”

Doctors Without Borders uses play when visiting the youth in Mexico City’s migrant camps for similar reasons. “It’s very stressful for them. You see when they arrive… they are tired because they had a very long journey,” says Valeria Reyes, a community strategies and health promotion manager with the organization. Her team builds playgrounds, offers toys, holds story time, draws and colors, and teaches health education lessons to the kids. “When they come to the playgrounds, [the kids] really enjoy it,” Reyes says. “They can feel free.”

Mateo, a gruff, three-year-old Haitian toddler who had lived in Plaza Giordano, was known for his perpetual frown—except when he got toys to play with. Once, two Mexican women delivered a bag of toys right to his tent. “JUGETES!!!” Mateo whooped, shouting the word for toys in Spanish—like many migrant kids, he picked the language up in Mexico—and holding the bag of plastic building blocks over his head like a tribute won in a conquest. “Yeah, yeah, yeah!”

Children play soccer and ride tricycles at the migrant encampment in Plaza Soledad in October.

Play also allows youth, especially teens, to take risks, to be independent, and to take control of their lives, which is essential for psychological development. “Children, like the rest of us, need periods of time where we are not being controlled by other people,” Gray says. “It’s extremely important that we allow children to have that time and opportunity to do those things.”

But in migrant camps that’s not always easy to achieve, as Joyce Zangilu, 13, knows. Zangilu’s whole world was confined to the Plaza Soledad migrant camp in Colonia Centro in Mexico City; her mother wouldn’t let her leave its bounds for fear of her safety—not to work under-the-table (because she’s also “too young”) nor go play with volunteers who come once a week. Worst of all, she says, her mother wouldn’t let her have a phone.

Zangilu admitted she’s stressed—the Angolan migrant has nightmares about the corpse she saw before entering the Darién Gap, the first dead body she’d ever seen. She hated living in a tent with her six siblings and mother. “I’m not really used to being poor.”

The little things she could control made her feel better: Telling people she’s 14 even though she’s 13, or renaming herself Joyce. (Her name is really Jordan, her sister whispered conspiratorially.) Zangilu destressed most when borrowing her friend’s phone to play music, removing herself from reality. Her favorite artists are angsty American popstars like Billie Eilish and Olivia Rodrigo. Once the music plays, Zangilu says, “I just calm down.”

The post Migrant children struggle to express themselves in words. Enter art and play. appeared first on Harvard Public Health Magazine.

On a recent Monday night in Falmouth, Maine, Reider went to the room to work different muscles. He opened his MacBook and joined 50 men on a Zoom call. “Tonight’s topic is relationships after loss,” Reider, 39, announces.

With that, he’s kicked off the week’s meeting of The Sad Dads Club. It’s a support group he cofounded for men whose children have died. But it has grown so quickly, and built such deep bonds between its members, that the club is more like a congregation of the faithful in the barren world of men’s grief.

Losing a child is one of the most painful and rearranging events an adult can endure, experts say. No one tracks the exact number of parents living through that experience, but CDC estimates indicate 44,000 children aged 18 and under die annually, and 21,000 babies are stillborn. There’s no roadmap for life or healing afterward. Hospital clinicians often have little bereavement training or time to help. Private mental health counselors are in record demand.

The support services that do exist often focus on mothers. Seventy-five percent of parents in pediatric palliative care research are mothers, while fathers are an underserved population. “People sort of forget about the fathers,” says Katherine Shear, the founding director of the Center for Prolonged Grief at the Columbia University School of Social Work.

Yet grief needs a witness. Telling the story of what happened is crucial to eventual acceptance and to the ability to live with the absence of the person, says Shear. But for generations of American men, grief—with its stew of sadness, yearning and powerlessness—was something to bury, to mask with stoicism, or to avoid with work, even if it came at great cost to mental health.

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Fathers attending the Sad Dads Club retreat in October place items they remember their children by on the mantle in the retreat house. Twice annually, two dozen or so “Sad Dads” gather at a cabin on Panther Pond, for the retreat.

That’s changing. Over half of Gen Z and millennials report they’ve been to therapy, and 90 percent believe more Americans should go. But fathers still tend to grieve in isolation. And their grief is different. Research shows the intensity of grief is higher for mothers immediately following the death of children; their PTSD diminishes over time, while for fathers, it persists.

All of these factors are exacerbated by the mental health care gap men generally experience. Depression-related suicide is a leading cause of death among men in the United States, where they are far less likely than women to seek help due to stigma and lack of access. 

Enter DIY grief groups, like the one Reider leads from his home in fog-soaked Falmouth. Dozens of men of all manner of personalities and occupations dial in from outposts like Prescott Valley, Arizona; Boise, Idaho; Austin, Texas; Calgary, Alberta—even Paris, where it’s 2:30 a.m. when the group logs on.

The men introduce themselves with the names of their lost children. “I’m Mike, Avery’s dad,” says one father from Glen Burnie, Maryland. “Avery was stillborn due to placental abruption.” Mark, Patrick’s dad, explains how his two best friends recently had children, and it’s too painful for him to share in their joy. He feels like he’s losing these friends after losing his child. He wants to know: Has anyone else experienced this?

A Zoom hand raises. Parker’s dad, Spencer, knows this feeling. He told his friends he needed time. Two-and-a-half years later, it’s easier to celebrate their milestones. Grief gets more manageable, he says, and “that’s largely thanks to this group.” Others describe the stab they feel when there are pregnancy announcements at work, or invitations to baby showers. One dad says his own father is surprised that he’s still grieving.

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Rob Reider, Christopher Piasecki, and Jay Tansey cofounded the Sad Dads Club, a nonprofit bereavement organization for fathers. Reider is also its executive director.

No hierarchy

All three Sad Dads cofounders, who are in their 30s, say their experience with professional counseling was lifesaving. The group (now a nonprofit) fundraises to pay for six sessions with private therapists for its dads, at no cost.

Men’s support groups offer something more than direct help: a foxhole for shared, unfiltered experience. Kinship. Permission to be vulnerable.

Reider, the executive director of The Sad Dads Club nonprofit, has his daughter’s name, “LILA,” tattooed across the front of his neck. In 2017, Reider and his best friend, Jay Tansey, both lost children to stillbirth. Then it happened to Chris Piasecki, the husband of a college classmate. The three men met up at a bar in Portland, Maine, and bawled their eyes out. “When I sat down with Rob and Jay, it was the first time I could let go of all inhibitions,” says Piasecki. “I didn’t have to think, ‘Am I burdening them?’”

Especially for men, peer support has great potential to provide essential social connections, says Paul Sharp, senior lecturer at the School of Health Sciences at UNSW Sydney. One’s partner may not be the best buoy—they’re lost in their own despair. And navigating grief as a couple is also fraught: Researchers have found that when parents lose an infant, the greatest risk to their relationship comes from unequal or different grieving processes.

Piasecki wanted to support his wife first and remembers experiencing “delayed grief.” He remembers hopelessness: How do you help your spouse with something you don’t yet know how to manage? And he remembers guilt: How can your grief as a father compare to the grief of the woman who carried the child in her own body?

In a therapist’s office, men might perceive disclosing their challenges as giving up, admitting defeat, or creating a power imbalance, says Sharp. Men’s support groups, on the other hand, have no hierarchy. You can join a Zoom meeting with the camera off and listen for a year, or join a private channel on Discord, a messaging app, and post with 130 other dads. Fantasy football leagues emerge (there are five in The Sad Dads Club). Men share reading recommendations, hiking paths—contours of a new life.

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For Terry Mayfield, 43, relationships were forced to endure tectonic rearrangement after the death of his infant son. Initially, merely being awake was intolerable. He felt his whole family was just waiting for him to “get better.” Meanwhile, neighbors he barely knew—those who could sit with his sorrow—became central in his new life. He longed for camaraderie and found comfort in people for whom “life didn’t go the way they expected.”

Mayfield sought counseling and a coed grief group. But he didn’t feel comfortable expressing the depth of his sadness until he attended a grief group for fathers sponsored by Full Circle Grief Center in Richmond, Virginia. Dads there spoke of honoring their children and of making meaning from the life still ahead of them (a key grief step, says Columbia University’s Shear). Mayfield soon began coaching the Special Olympics.

For Black men—like Mayfield and his father—vulnerability is especially hard, says Henry Willis, assistant professor of psychology at the University of Maryland. Some men may have learned early on to guard their emotions as protection against racism and discrimination. To struggle with grief for a long time carries a stigma.

“To see a future version of myself”

Grief is permanent, says Shear, but that doesn’t mean suffering is. Grief is the way we experience loss in the moment; it shifts over a lifetime. Willis says support groups can be beneficial if they offer an environment for processing emotion, and for thinking about a new identity.

These needs show up differently at each meeting of the Sad Dads. Like that recent night Reider led a meeting from Maine, where dozens of virtual hands raise. “I felt like I was carrying around this unbearable pain, and the only thing I wanted to do was put it down for a while and rest,” one dad says.

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Fathers attending the Sad Dads Club retreat sign their names and those of their late children on a folding table in the garage of the cabin where they stay.

It’s “non-negotiable to say I only have one child,” says another dad. “I have to acknowledge my daughter,” he says, meaning the one who died.

“I’ve been waiting for her to . . . feel a little bit better, to take more of life in,” says a third dad of his wife. Their relationship roots his life; when she feels better, he will too, he suggests. On alternate Thursdays, one dad tells the story of his loss to the entire group; those sessions are already booked through this time next year.

Seven years after his daughter’s death, Reider’s optimism is real. He no longer associates Lila with only sadness. There’s good in life; transformation. Hospital bereavement packets across the country now list The Sad Dads Club as a resource. He has completed a facilitator training course to become a better listener.

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“You are never going to make progress or help yourself feel better if you don’t face it,” he says, citing vulnerability as “the ultimate form of strength.”

Twice annually, about two dozen of the Sad Dads migrate to a cabin on Panther Pond, northwest of Portland, to kayak, cook pancakes, drink beer, and line the mantle with their children’s mementos—knit hospital caps, stuffed bears. It’s okay for them to have fun. They make friends and plans. They hashtag #worstclubbestguys. Sustained by each other, they live their absences.

Once, when some dads on the Zoom were smiling and laughing, the founders thought to announce that the group is serious, dedicated to the gravity and complexity of loss. No, said another dad—keep laughing. “I came here to see a future version of myself.”

The post “People forget about the fathers.” appeared first on Harvard Public Health Magazine.

Mulheron’s advocacy comes from her own experiences after losing an infant daughter and, later, her father. She came to believe that in the United States, families and communities are losing the capacity to give bereaved people the support they need. She sees the driving factors as smartphone fixation and the monetization of death, especially through digital innovations like AI-based grief therapy apps. Besides worrying that such apps might widely share sensitive personal data, Mulheron is concerned that “you don’t talk to a counselor—you talk to your phone. I don’t think we should be going down a path where we have less human connection.” Mulheron spoke with Bill Donahue for Harvard Public Health.

This interview was edited and condensed.

Harvard Public Health: One of your interviews is with a woman who, after her son committed suicide, was treated with disrespect by the police. How does this disrespect manifest at a societal level?

Mulheron: Let’s look at how the CDC guidelines tell first responders how to handle a sudden unexpected infant death. Within hours, they ask the family to reenact the death event with a fabric doll, and they photograph everything, often while calling Child Protective Services to talk about taking the family’s other children away. This is largely intended to investigate and prevent infant homicide. But if you look at infant mortality data, infanticide is [rare]. It does happen, but why are we almost assuming that you have murdered your child?

HPH: You’ve also talked about the medicalization of grief.

Mulheron: Grief is now, officially speaking, a disease. If, in the wake of a death, you’re deemed maladaptive, you can be diagnosed with something called prolonged grief disorder. That “disease” was added to DSM-5 in 2022, with its own diagnostic code, and there’s a drug for it in clinical trials, Naltrexone. It’s already being used to fight addiction, so now researchers are conducting clinical trials to test if it works on prolonged grief disorder.

HPH: What’s the unifying thread here?

Mulheron: An app, a pill—these things alleviate us from having to knock on someone’s door, from sitting with them, from taking time off our phones and our video games to be with others in community for the collective good of all of us. And when you rely on an app or a pill, it feels scientific. There’s a quantifier at work, so we as a society can say, “How many protocols did we run? How many people got a script for this?” We quantify and tokenize what should be a shared human experience.

HPH: So what are you doing to make life easier for the bereaved?

Mulheron: I’ve begun talking to Capitol Hill staff about the possibility of paid bereavement leave. [Evermore doesn’t] have a lot of money, but in the field we are trying to support weeklong projects focused on helping people who’ve experienced bereavement. We did one in the South Bronx for hip hop therapy and we’re dialoguing [with] another group—this one’s in Seattle—about a project called Pongo Poetry to get people to express their grief through a modality other than [talk therapy]. We’re also working on hosting a national meeting of scientists. We want to understand the demography of bereavement. If we know the shape of the problem, we can begin to fix it.

Image: stellalevi / iStock

Clarification: This story has been updated to note that Joyal Mulheron has not testified before Congress.

The post Is bereavement a public health crisis in the U.S.? This advocate thinks so. appeared first on Harvard Public Health Magazine.

That’s happening amid a global shift that is seeing access to care, health care costs, and public trust are entangled with political and ideological divides.

Kai Ruggeri, a professor of health policy and management at the Columbia University Mailman School of Public Health, is among the authors of a study about the effects of global political polarization on health. Published in Nature Medicine, the study finds that people’s health choices align with their political and social identities rather than with medical recommendations—a circumstance that could have profound implications for public health and health care delivery. This trend toward affiliation-based decision-making is particularly pronounced in the U.S., but it is visible elsewhere—including Switzerland, France, Denmark, Canada and New Zealand, according to the study.

In an interview with Paul Adepoju for Harvard Public Health, Ruggeri points out that health care has long been a politically charged issue, but the level of polarization today reflects a new reality: People are not just choosing one side; they’re actively pushing against the other.

This interview was edited and condensed.

HPH: What made you decide this was a subject worth investigating?

Kai Ruggeri: Obviously, in any election, health is going to be central. Whether it’s a specific health issue, like in 2020 when it was COVID, or if you go back to 2008 when marketplace health insurance was a key issue, health care is always a major component of elections, not just in the U.S. but around the world.

And it’s inherently political. In recent years, with growing polarization, health issues on the election agenda likely influence people in different directions. We’re seeing groups moving away from overlapping views, and this shift influences health care-related topics specifically. The study aimed to track these patterns globally, though we found much of the data was U.S.-focused.

HPH: Were there any unique findings that stood out to you in the study?

Ruggeri: Since we didn’t use original data in this study, I can only speak to patterns we observed. We’re seeing rising animosity between groups. People are not just closely aligned with their group; they’re strongly against the other. This entrenched polarization isn’t about liking one’s own group; it’s about wanting the other group to fail, almost like sports team rivalries, but in health care. This shift affects public health—it complicates stopping infectious diseases, [and it] raises avoidable health care costs, lowers life expectancy, and leads to higher avoidable mortality rates.

HPH: Is this really a uniquely American problem, or is it exaggerated due to intense media coverage?

Ruggeri: Like many issues, it may seem exaggerated because it’s so heavily covered in the United States, which creates a self-fulfilling prophecy. It starts being talked about, gets picked up, and just rolls from there. However, these patterns exist in other places too. The U.S. wasn’t the first to experience health divisions tied to ideology. Other countries have seen similar or even more extreme levels before. But one hopeful aspect is the role of trusted voices. Engaging trusted voices can really make a difference globally. People will turn to those they trust, so if trusted voices provide good health guidance, it can mitigate this division.

HPH: What role did trusted voices play during the COVID-19 pandemic, and what can we learn from that?

Ruggeri: One of the lessons from COVID was the importance of staying ahead of questions and concerns that arose rapidly. It was challenging because some issues developed too quickly to address directly, but a major takeaway was that engaging trusted voices could positively impact public health. Trusted voices are essential to addressing people’s concerns, even if it means accepting ongoing questions. Health agencies need to convey that it’s okay to ask questions and that responses will continue as new information comes in.

Introducing uncertainty is also helpful because people may misinterpret absolute statements. For instance, if they’re told a vaccine is effective but know someone it didn’t work for, they may question its efficacy. Conveying that no outcome is guaranteed—while emphasizing overall benefits—can build trust in the long run.

HPH: In interpreting and accepting the findings, are you concerned that polarization might affect how your study itself is received?

Ruggeri: There will always be people or groups who aim to create division. The real challenge [for public health leaders] is getting ahead of it. Emphasizing responses to concerns rather than simply addressing the divisions themselves is where we can find hope.

HPH: What changes do you hope to see?

Ruggeri: I’d like to see health agencies engage directly, publicly, and actively with trusted voices—community leaders, faith leaders, and so on. They need to provide accurate information in ways that also invite people to ask questions.

Image: wildpixel / iStock

The post Public health vs. politics appeared first on Harvard Public Health Magazine.

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More editorial cartoons from Harvard Public Health:

• “Post-pandemic paranoia,” by Jenna Luecke
• “Climate change bites,” by Jenna Luecke
• “Environ-mental shift,” by Jenna Luecke
• “Artificial opinion,” by Natasha Loder
• “It ain’t over when it’s over,” by Natasha Loder
• “(Climate) change of plans,” by Natasha Loder

The post A sound idea appeared first on Harvard Public Health Magazine.