Erica Lubliner is a psychiatrist at the University of California in Los Angeles, who heads a clinic that offers mental health services to Latinos. It offers care to a wide range of patients: immigrants from first to fourth generation, including undocumented immigrants and undergraduate students and UCLA higher cycles, many of which are the first in their family to go to university. She generally meets patients in her brilliant office on the Westwood campus, where Mexican artists’ paintings hang the walls and children’s books are at hand. But, after ICE The raids started in the city last month, she moved her online appointments. Lubliner patients are safe in her clinic, she said to me: “But even arriving here may be scary.”
She had heard that ICE The agents had started to park outside certain local hospitals. Many of his patients take the bus or go to their appointments, and they fear that they are apprehended on the way. “It’s not wise for them to leave their house, because ICE The agents surrounded and patrolling the neighborhoods, “she said. Many of his patients have increased their doses of anti-annual drugs, or have started to take it for the first time. Some young patients experience intense separation anxiety when they go to school, are afraid to return to them and their parents will have left.
After ICE Arrested by people at their workplace, Lubliner felt the anxiety of his patients. “”ICE Go after the gardener with his truck, car washing workers. The idea that they are sort of dangerous cuts to their identity in a deep way, “she told me.” They feel undesirable. They feel targeted. Some of his less vulnerable patients participated in manifestations against raids, but others had trouble taking up the risk.
Lubliner is one of the many psychiatrists and psychologists with whom I have recently talked about who has worked with immigrant patients for many years. They know the psychological damage caused by the repression of the previous law and anti-immigration rhetoric. But, like Dana Rusch, psychologist at the University of Illinois Chicago and director of a mental health program for immigrants, said to me: “It seems different from what he did during the first Trump administration. This seems different from other periods of application of immigration, even before the Trump administration. What is happening right now is currently feeling. ” His young patients ask him why people hate immigrants so much, or hate them as well as their families. Rusch said she had trouble answering these questions. (His typical response is to talk about oppression in an age suitable for age.)
Lubliner has also seen the increased emotional toll that this last cycle of raids had on his patients. During the first Trump administration, she was doing her scholarship in children’s and adolescent psychiatry, and she witnessed a lot of fear. “Some children were worried-there was a school avoidance … People were afraid to go to the doctor,” she told me. “But at the moment, people are trapped in their homes. It is very different. Children now have conversations with parents on what plan B and plan C are if they are expelled. They go to public notaries to note what will happen to their children.” One of her patients is so afraid of leaving not to throw his garbage, so she has a neighbor to help her. “People are caught in the street and family members do not know where they are taken,” said Lubliner. “There is a level of terror that I have never seen before.”
For many of these patients, their fears recall past trauma: from their country of origin, their trips to the United States and their establishment. Those who have memories of their lives in Latin America have reported extreme poverty, abuse of family members or discrimination because they are indigenous. Many of those who remember their North trips remember to have been exposed to extreme violence: murders, physical and sexual assault, abductions, extortion and forced work. “They are forced to work in exchange for food and refuge, or they are told that they must work for a certain period of time in order to go to the next stop on the route,” said Rusch. “It is true for unaccompanied minors, but it is also true for families who have made the trip together.”
Then they arrive in this country, where the threat of expulsion blocks. Many children experience school difficulties and many adults are underemployed. Food can be rare. They hear the officials of the Trump administration say that all are criminals and that many of them are violent.
While patients are sitting in his office, Rusch told me, they can sometimes recognize that they are safe, at least compared to previous moments. But their experiences haunt them. They find it difficult to trust people. “These are very normal answers to what you have experienced,” she said. They had to be constantly alert when they were trying to go from Central America to Mexico on foot. Now they feel the same thing, she said, “In a country, they do not know, where people speak a language they do not understand and where their status is precarious.”
Rusch patients have conditions which she diagnoses as trauma and depression, but she wants to help them understand where anxiety comes from. “My patients say:” Oh, I find it difficult to pay attention. I can’t start and stop my tasks. I’m just not a motivated person. I am, like ‘no, it is a trauma, it is anxiety, it is depression’, “she said.” I always tell them that it is a normal response to extraordinary circumstances. If I assess someone for suicidality, I ask: “Have you ever wanted you to fall asleep and do not wake up? This is one of the first questions. may not be as effective for patients who are dealing with this type of trauma: “Even the concept of the way we assess the risk is in some respects out of context, because they are, as” yes, I have had suicidal thoughts for three years because of what I have experienced “.
Rusch said many of his patients did not want to approach their trauma. Instead, they want to talk about “the ways they may feel independent in their daily life”: how they can obtain work permit, acquire skills in a particular profession, learn English, prepare questions from immigration lawyers or earn money to send parents to them, which may be difficult for some to feel good if their family has neglected or abundant.
It makes sense for Rusch. “If you do not have food, shelters and security, it is difficult to talk about the safety of psychological health of the higher order,” she told me. “It is not that we are less important, but it is difficult to go from one floor to another without stairs.” For this reason, cognitive behavioral therapy, or TCC, is one of the preferred methods to treat anxiety induced by trauma in immigrants and their families. This method aims to help patients distinguish real and imagined fears and, insofar as their fears are imagined, it helps patients learn to crop them. It is more problem solving than psychoanalysis.
But the fears of immigrants are so real now as they have never been. Families are separated. Immigrants with legal status are expelled. Citizens are illegally detained. As the Lubliner said to me: “At this stage, the simple fact of being Latin is a risk factor.” Therapists always use TCC to treat their patients, but fears and anxiety of patients like those that Lubliner and Rusch see require modified approaches.
One of the patients of Lubliner is a woman whose husband was obtaining legal status. But when he appeared before the immigration court for compulsory registration, he was detained and expelled. They have three children and she takes care of them alone. She couldn’t sleep and started taking anti-annual drugs. Lubliner also started to provide psychiatric care to his children, whose teachers were concerned about their behavior in school and their inability to concentrate. Lubliner told me that this type of case management, which goes far beyond regular therapy sessions, is currently common. Jenny Zhen-Duan, assistant professor at the Harvard Medical School and psychologist at the Massachusetts General Hospital, said that she had also done “more cases management than usual” for immigrant patients, extending her care to “connect patients with legal services, mutual assistance and information on their rights”.
The therapists with whom I spoke said they encourage their patients to face their fears directly, and they work with them to find a plan for what to do if the worst takes place. How will they react if they are detained or expelled? Who can children contact if they are separated from their parents? Where will family members try to meet again? These conversations can be difficult, but they can also help patients acquire an agency feeling, the feeling that there are at least certain things that they can control. “I step back if necessary,” said Lubliner, “and I am always aware that as a representative of the medical field, I repeat violations of confidence before the hands of the health system.”
Lubliner also tries to help his patients by putting them in spaces shared with others. She runs a group session called Plática, where Hispanophones can discuss their experiences between them. Because their stories are often similar, said Lubliner, they say things like “yes, what you say is very true, and your fear, your anger, is valid.”
During these sessions, Lubliner tries to “focus on practical things, such as how to get out of the combat or flight mode, because when we are stressed, we cannot think – there is a constant rumination.” Participants meditate. They breathe together, which, she says, does not naturally come to many of her patients because it looks like them to be inactive. She encourages prayer as a form of mindfulness, and sometimes they sigh together, which she described as a kind of collective complaint.
