Caged today, broken tomorrow - (9/10/2019)

By Dr. Ron Gasbarro

Mandy came into the pharmacy with her twin moppets, aged 6, to get prescriptions for their coughs. As they were waiting, Mandy said to the pharmacist, “Those poor kids in cages down at the southern border! Locked up! No soap, no clean clothes, and no family to love and reassure them! I don’t know what I’d do!” 

As part of its “zero tolerance” policy on illegal immigration, the current administration is holding immigrant children in overcrowded cages after ripping them from their parents. This type of incarceration will come with a hefty price tag as these children mature. A 2016 article in The American Psychologist stated, “Nearly all youth detained in the juvenile justice system have experienced traumatic events leading to Post-Traumatic Stress Disorder (PTSD).” The article suggests that these children will likely commit criminal acts in the future unless they receive treatment for PTSD conditions. Furthermore, the tumultuous reunification process has worsened the problem. 

A report released in September 2019 by the Department of Health and Human Services, showed that separated children experienced more PTSD symptoms, such as fear and worries of abandonment, than those who remained with their caregivers. A 2019 study published in the Journal of Clinical Psychiatry involved 12,288 adolescents who participated in the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of adolescents in grades 7 to 12. The study found that those children who experienced trauma – neglect, emotional abuse, physical abuse, parental incarceration, witnessed or was the victim of violence – were anywhere from 2 to 25 times more likely to be involved with the criminal justice system when they became adults. 

The pharmacist explained to Mandy that all of us experience stress. Most of us deal with it and move on. But there are two kinds of stress: normal stress whereby our blood pressure and heart rate temporarily skyrocket. The other type is chronic stress in which one is relentlessly bombarded by assaults to one’s mind and body. When (and if) the stressors cease, the memories remain and the pathologies, like nightmares, flashbacks, and insomnia, take hold, perhaps permanently.  

Treatment for PTSD is imprecise. The patient could receive a selective serotonin reuptake inhibitor antidepressant (SSRI) such as citalopram (Celexa®) or fluoxetine (Prozac®); these are effective in about half PTSD cases, particularly if treatment is initiated before symptoms become severe. Drug treatment works better if combined with counseling. However, because PTSD manifests itself in many ways, from complete withdrawal to uncontrollable anger, treatment success cannot be guaranteed. 

Cognitive behavior therapy (CBT) seeks to change the way a person feels and acts by changing the patterns of thinking or behavior, or both, responsible for negative emotions. In CBT, individuals learn to identify thoughts that make them feel afraid or upset and replace them with less distressing thoughts. CBT has been an effective treatment for PTSD and is currently considered the standard of care for PTSD by the US Department of Defense. 

The young Christian refugees held at US detention facilities were in shock before they arrived at our border. The countries from which they fled are fraught with violence, coercion, rape, and poverty. Holding them against their will is, in the pharmacist’s opinion, unimaginably cruel and damaging. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Read more at


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