The Stakes for Immigration and Mental Health

As we sat in the back office of a crisis center, Rosa recounted her darkest moment. An immigrant from Ecuador working a low-wage job, Rosa was facing seemingly insurmountable abuse from her husband. With few language skills, resources, or support, she had contemplated suicide as her only means of escape. Yet as a Pentecostal Christian and a mother of two, she battled within herself. For Rosa, this was a “lucha interna”—an internal struggle, one where “tú decides: obedece Dios o demonios”—you decide to obey God or demons. Ultimately, her faith and this crisis center extracted her from the darkness, and kept her moving forward. 

Over the last several decades in the United States, mental health has emerged as a battlefield on many different fronts, from political debates around gun control to campus activism around sexual assault. The topic of mental health has been drawn into a tornado of contentious social, economic, and political divides. From anthropology’s vantage point, mental health has been considered across a wide variety of ethnographies. These projects have brought anthropology’s study of mental health far beyond basic examples of cultural competency, forcing us to also consider complicating factors around unequal access and quality of care.

Yet as many critics have pointed out, media on mental health is often white-washed, and little evoked when considering the inner lives of people of color. Such critiques have sparked initiatives like the People of Color & Mental Illness Photo Project, working to diversify this media attention. In anthropology, we can play an important role in maintaining this conversation. As we delve into an increasingly dark era for immigrants in the U.S., this emphasis on mental health must remain at the forefront of our research agendas, as many long-time immigrant residents are finding themselves in more precarious positions than ever before.

Multiple Perspectives on Mental Health

Scholars and activists have well documented the barriers for immigrants, particularly Latinx, for seeking and receiving mental health services. Yet as I began to speak more in-depth with Latina immigrant women at the domestic violence crisis center where I conducted my doctoral research, I heard many stories of severe depression, anxiety, and thoughts of suicide, and how many of these women were embedded in various clinical psychiatric services. While I had been trained to consider the many ways people understand their mental health, when speaking in Spanish with them, I was struck by the alignment between how they spoke of their experiences and Western medical perspectives. Latinx women demonstrated an agility, navigating disjointed webs of services and different ways of talking about their mental wellbeing.

Most Latina clients had been in the U.S. for over ten years, and despite limited resources and short-term models of care, they continued to utilize this center for up to ten years. They would attend support groups long after leaving their abusive relationships, making the center their port in a complex sea of services by toggling together a fragmented yet diverse set of providers in an attempt to meet their complex needs.

These women intermixed their  spiritual practices and beliefs—a core group had either formally converted to evangelical Christianity or would informally follow evangelical Christian practices– with their other understandings of mental health, influencing their decision-making and filling in the gaps where other providers fell short. As with Rosa, their experiences of depression and confrontations with suicide were informed by this evangelical lens. Some drew strength from daily interaction with God or gained peace through regular prayer. For many, following God’s path led them directly to this center, while God also led them to reject some of the center’s teachings.  

In light of the potential barriers to care for this immigrant community, the agility that I found among these clients is an important example of the creativity many immigrants employ when seeking to meet their needs. While many qualitative studies of mental health distinguish between immigrants and first or second generation Latinx communities, these women demonstrate how we must also distinguish between the understandings and experiences of more recent immigrants and those who are long-time residents of the U.S. For this particularly savvy group, their sensibilities were highly influenced by the evangelical church and their years of interaction with Western medical, mental health, and social service systems. This savviness can serve as an example of paths to mental health for long-time immigrant residents now facing increasing crisis and uncertainty. In this time of chasmic-like divides, perhaps these creative ways of reconciling multiple lenses can also teach the rest of us a thing or two about overcoming ideological differences, pooling together resources, and moving forward with dignity and respect.

Allison Bloom is a PhD Candidate in Anthropology at Rutgers University.

[Editor’s note: For those interested in reading further, see Bloom’s thoughts on how to do careful and ethical ethnographic research on mental health issues in a politically-charged environment.]