Tuesday, March 1, 2016

Sitting Here in My Safe European Home: How Neuroscientific Research Can Help Shape EU Policy During the Syrian Refugee Crisis

By Joseph Wszalek, J.D. and Sara Heyn

Joseph Wszalek, J.D., is a fourth-year PhD student in the Neuroscience Training Program/Neuroscience and Public Policy Program at the University of Wisconsin. His research work focuses on the interaction between social cognition, language, and traumatic brain injury, with an emphasis on legal contexts. He holds a law degree cum laude and Order of the Coif from the University of Wisconsin Law School, where he was a US Department of Education Foreign Language and Area Studies Fellow through the Center for European Studies and a member of the Wisconsin International Law Journal’s senior editorial board. 

Sara Heyn is currently a graduate student pursuing a J.D. along with a PhD in Neuroscience at the University of Wisconsin-Madison. Her research interests include psychopathy, decision-making processes, and the use of neuroscientific evidence in the courtroom. 

Ethical guidelines are a fundamental aspect of the legal profession. The modern attorney serves three simultaneous ethical roles: he is an advocate for his clients, he is an officer of the legal system, and he is a public citizen with special responsibility for the rule of law (ABA Model Rules, 2014). These ethical obligations do not merely prohibit unacceptable conduct: they impose positive duties on licensed attorneys to actively promote and improve the administration of justice in all three capacities. In stark contrast to the legal profession, however, the ethical obligations of the scientific profession are considerably less well-defined. So-called research ethics are concerned more with establishing responsible research practices and less with encouraging active social duties. Put another way, while the modern scientist has an undeniable ethical obligation in his role as a member of the scientific community, it’s unclear whether or not this obligation extends to his role as a general citizen, and it’s unclear whether or not he, like his lawyer counterpart, has a “special responsibility” to actively improve society.

Despite this ambiguity, organizations like the International Neuroethics Society make it clear that the scientific community should play a more active role in translating scientific expertise to societal problems. As scientific methodologies and findings become more and more sophisticated, the ability of science, including neuroscience, to define and characterize the human condition gives data and findings more and more pragmatic utility. One such area of research is child development and the impact of environmental stressors. Because neuropsychological research has effectively characterized the risks associated with adverse childhood experiences (ACEs), we argue that these findings can (and should) support evidence-based initiatives targeting one of modern society’s most catastrophic problems: the Syrian refugee crisis.

Syrian Refugees in the European Union 
The Syrian civil war, one of the most catastrophic human rights disasters since World War II, has created some 4.2 million refugees who seek asylum all around the globe (United Nations High Commission, 2015). Their primary destination in the West is the European Union, which as of November 2015 has received asylum applications from nearly three quarters of a million displaced individuals (European Commission, 2015). Despite the refugees’ stark plight, however, religious and geopolitical tensions have complicated international response and have trapped hundred of thousands of men, women, and children in a social and legal limbo. With one in ten of the Syrian refugee population being a child under the age of five, (United Nations High Commission, 2015), this calamity implicates the lives of many children.

Fortunately, EU law has long recognized the importance of establishing additional legal protections for children. Even though the European Union does not have general competence (i.e., formal legal authority) in the area of fundamental child rights, both the Treaty of the European Union and the Charter of Fundamental Rights of the European Union explicitly address the need to recognize and respect the child’s best interest in actions related to children. Additionally, a 2011 Communication from the EU Commission detailed the EU Agenda for the rights of the child, proposing: “The purpose is to reaffirm the strong commitment of all EU institutions and of all Member States to promoting, protecting and fulfilling the rights of the child in all relevant EU policies and to turn it into concrete results” (EU Agenda for the Rights of the Child, 2011). This Agenda laid out three priority areas: child-friendly justice (including access to justice and registration of documents relating to civil status), targeted protection of vulnerable children (including asylum seekers), and the accommodation of children in the European Union’s external actions (including the protection of children in areas of armed conflict). However, the Commission noted that the “significant lack of reliable, comparable and official data” was a “serious obstacle for the development and implementation of genuine evidence-based policies,” and it affirmed its commitment to cooperate with relevant organisations to produce basic data and information to guide decision making” [emphasis in original]. Clearly, then, this legal framework has the potential to address and accommodate basic neuroscientific research relating to the effect of ACEs on childhood development in the refugee context.

The Basic Adverse Childhood Experience Data 
Children of Syrian refugees are being subjected to numerous
ACEs, image courtesy of Wikimedia Commons 
Neuropsychological studies (i.e., studies which investigate how the structure and function of the brain relate to emotion, cognition, and behavior) have repeatedly shown that environmental stress risks a broad range of undesirable health outcomes. For example, From Neurons to Neighborhoods pioneered studies into the adverse and dramatic effects that childhood stress can have on current and future health and development (Shonkoff and Phillips, 2000). This project defined “stress” as the set of changes in the body and the brain that are put in motion when there are overwhelming threats to physical or psychological well-being. Perhaps unsurprisingly, severe or chronic stress is associated with a host of cognitive and neurological deficits, including reduced cerebral volume and hemispheric integration, impaired executive function, and dysregulated reward and emotion responses (Petchell & Pizzagalli, 2011). The amygdala and the hippocampus are prime targets, and recent findings suggest that the amygdala modulates stress-induced memory and learning deficits by reducing the expression of memory-related genes in the hippocampus (Rei et al., 2015). Animal models have confirmed that the effects of stress on the amygdala and hippocampus cause disruption to learning, memory, and cognitive regulation (Malter Cohen et al., 2013).

ACEs, then, are an umbrella term for detrimental childhood experiences that are likely to produce severe or chronic stress. Experiences such as maltreatment, abuse, neglect, and trauma, are associated with a host of behavioral, physical, and mental outcomes (Petchell & Pizzagalli, 2011). In addition to the deficits explained earlier, sequelae of ACEs include, but are not limited to, reports of: poorer emotional well-being, self-harm and suicidal ideation, delinquent behavior, obesity, diabetes, poorer quality of adult relationships, substance abuse, and cardiovascular disease (Kalmakis & Chandler, 2015). It is clear that ACEs, and the stress they cause, now represent a much more comprehensive threat to an individual’s overall health than previously thought.

Finally, scientific findings also suggest that refugees face almost-certain risk of ACEs. Pre-refugee events (e.g., armed conflict, infrastructure failings, environmental disasters), migration events (e.g., separation from family, dangerous travel conditions, exploitation by traffickers), and post-migration events (e.g., discrimination, lack of personal and societal support networks, uncertain asylum status) are all difficult and traumatic situations, and the rates of negative mental and emotional outcomes for refugees children are staggering (Bronstein & Montgomery, 2011; Jensen, Skårdalsmo, & Fjermestad, 2014).

In summation, ACE research paints a bleak, but ultimately informative, picture of the challenges and risks that Syrian refugee children face as the flee to Europe. With this basic data in mind, then, we would end our essay with a brief example of how this data can be used to drive evidence-based policy to accommodate and ameliorate the effects of ACEs.

Recognizing Potential Deficits in Language and Advocacy 
ACEs may cause refugee children to struggle during
legal proceedings, image courtesy of Wikipedia
The EU legal system, like all legal systems, represents linguistic demands at their most challenging. Navigating the asylum process may require, inter alia: communicating with lawyers, administrative judges, and law enforcement officials, often through an interpreter; reading and understanding information relating to visas, immigration law, and other legal texts, again often through an interpreter; and arranging for living or work arrangements, whether unofficial or official. Perhaps recognizing the overwhelming difficulty presented by these language demands, the European Parliament passed a recent directive establishing “Guarantees for unaccompanied minors” (EU Directive, 2013). This directive requires EU states to ensure that representatives represent and assist these children by explaining their rights, helping prepare them for personal interviews, and acting in the best interest of the child.

We now know, however, that child refugees who suffered from ACEs might struggle with these seemingly simple demands because of the many detrimental sequelae that ACEs can cause. A child might have disregulated connections between his amygdala and his hippocampus, which could cause him to struggle to learn the procedural demands and to tell consistent narratives. A child might have impaired white-matter pathways, which might impair her ability to integrate cross-modal information while communicating and to understand figurative and abstract language (Kovic et al., 2010; Kasparian, 2013). A child might have executive function deficits, which could disrupt his ability to regulate his speech and communication and to follow confusing lines of questioning (Henry et al., 2015). Finally, a child might have lower cortical volume overall, which could manifest as lower levels of overall intelligence and delayed language acquisition or use (Pangelinan et al., 2011). All of these outcomes are known effects of ACE, and all of them would cripple a child’s ability to represent himself during these legal proceedings.

Fortunately, the same basic data that revealed these nuances provide solutions to evidence-based policies, and neuroscientists are in a position to address this “special responsibility.” For example, encourage the representative officials to adopt best practices relating to interviewing child clients: this might include a formal language competency assessment and the use of open question–based techniques (Snow et al., 2012). Advocate for documents and materials that are written not just at a standardized reading level but at an even lower level so that refugee children with delayed language impairments can understand them. Suggest formal administrative policies could recognize that inconsistent narratives or communication impairments do not always represent intentional deception. Ensure that the “best interest of the child” standard, which is always assessed on a case-by-case basis, considers ACE-related deficits as part of the child’s “particular vulnerability and protection needs” (Parsons, 2010). These relative minor modifications, all based on the neuroscience data on stress and ACEs, could net major benefits for the child, for the EU immigration system, and for society as a whole.

Conclusion 
Licensed members of the legal profession have ethical and professional obligations to use their training and knowledge to promote equality and justice. Even though scientists lack such a formal responsibility, we firmly believe that active engagement and consideration of neuroscientific data in light of social contexts is a key component of a scientist’s ethical duties. The example of the Syrian refugee crisis and ACEs is just one minor component of the myriad challenges that society faces, but it is nevertheless an effective and profound example of how scientists, like legal professionals, are in a unique position to use basic data to accept and act on “special responsibilities.”

Works Cited

1. United Nations High Commission on Refugees, Syria Regional Refugee Response Inter-agency Information Sharing Portal, available at http://data.unhcr.org/syrianrefugees/regional.php# (last accessed November 19th, 2015).

2. Israel Bronstein & Paul Montgomery. Psychological Distress in Refugee Children: A Systematic Review. Clin Child Fam Psychol Rev (2011) 14:44-56.

3. Charter of Fundamental Rights of the EU, Art. 24, 2000/C 364/01

4 EU Directive on common procedures for granting and withdrawing international protections, 2013/32/EU

5. National Research Council (US) and Institute of Medicine (US) Committee on Integrating the Science of Early Childhood Development; Shonkoff JP, Phillips DA, editors. From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington (DC): National Academies Press (US); 2000.

6. American Bar Association. Model Rules of Professional Conduct. 2014 Edition.

7. National Research Council and Institute of Medicine (2000) From Neurons to Neighborhoods: The Science of Early Childhood Development. Committee on Integrating the Science of Early Childhood Development. Jack P. Shonkoff and Deborah A. Phillips, eds. Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education. Washington, D.C.: National Academy Press

8. European Commission. ECHO Factsheet – Syria Crisis. November 2015.

9. Pia Pechtel & Diego A. Pizzagalli. (2011). Effects of early life stress on cognitive and affective function: an integrated review of human literature. Psychopharmacology 214:55-70.

10. Rei D, Mason X, Seo J, Gräff J, Rudenko A, Wang J, Rueda R, Siegert S, Cho S, Canter RG, Mungenast AE, Deisseroth K, Tsai LH. (2015). Basolateral amygdala bidirectionally modulates stress-induced hippocampal learning and memory deficits through a p25/Cdk5-dependent pathway. PNAS 112(23):7291-6.

11. Early-life stress has persistent effects on amygdala function and development in mice and humans. (2013). Matthew Malter Cohen, Deqiang Jing, Rui R. Yang, Nim Tottenhama, Francis S. Leeb, and B. J. Casey. PNAS 110(45):18274-8.

12. Karen A. Kalmakis & Genevieve E. Chandler (2015). Health consequences of adverse childhood experiences: A systematic review. Journal of the American Association of Nurse Practitioners 27:457-465.

13. Keselman, Olga; Cederborg, Ann-Christin; Linell, Per (2010). "That is not necessary for you to know!": Negotiation of participation status of unaccompanied children in interpreter-mediated asylum hearings” Interpreting 12:1, 83-104.

14. Pamela C. Snow, Martine B. Powell, and Divie D. Sanger. (2012). Oral Language Competence, Young Speakers, and the Law. Language, Speech, and Hearing Services in Schools. Vol. 43, 496-506.

15. Annika Parsons (2010). The best interests of the child in asylum and refugee children in Finland. National. Rapporteur on Trafficking in Human Beings. Publication 6.

16. Vanja Kovic, Kim Plunkett, Gert Westermann (2010). The shape of words in the brain. Cognition 114:19-28.

17. Kristina Kasparian (2013). Hemispheric differences in figurative language processing: Contributions of neuroimaging methods and challenges in reconciling current empirical findings. Journal of Neurolinguistics 26:1-21.

18. Lucy A. Henry, David J. Messer, Gilly Nash (2015). Executive functioning and verbal fluency in children with language difficulties. Learning and Instruction 39:137-147.

19. Melissa M. Pangelinan, Guangyu Zhang, John W. VanMeter, Jane E. Clark, Bradley D. Hartfeld, Amy J. Haufler (2011). Beyond age and gender: Relationships between cortical and subcortical and cognitive-motor abilities in school-age children. Neuroimage 54:3093-3100.

Want to cite this post?

Wszalek, J., Heyn, S. (2016). Sitting Here in My Safe European Home: How Neuroscientific Research Can Help Shape EU Policy During the Syrian Refugee Crisis. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/02/sitting-here-in-my-safe-european-home.html

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