Living in fear of de­por­ta­tion is ter­ri­ble for your health

Psy­chi­a­trist James S. Gor­don says dis­crim­i­na­tion and de­ten­tion can cause phys­i­cal and men­tal harm

The Washington Post Sunday - - OUTLOOK - Twit­ter: @JamesGor­donMD

For the past few weeks, the young man’s heart has been rac­ing. His hands are sweaty. Dur­ing the day, he has flash­backs of the world he fled in El Sal­vador: gang mem­bers chas­ing him, threat­en­ing mur­der. Night­mares of the same scenes dis­turb his sleep. He’s not a pa­tient in my psy­chi­atric prac­tice. Just an­other young guy study­ing for his high school equiv­a­lency diploma at the Latin Amer­i­can Youth Cen­ter in Wash­ing­ton. Like the 4,000 other kids tak­ing classes there, he’s been wor­ry­ing as he watches what the cen­ter’s chief ex­ec­u­tive, Lori Ka­plan, calls “the big re­al­ity show . . . on cable news — and the tweets.”

In St. Paul, Minn., Sharif Mo­hamed’s chil­dren are also “pay­ing at­ten­tion” to the TV news, he says. Mo­hamed is an imam, a spir­i­tual leader of the So­mali com­mu­nity there and a U.S. cit­i­zen; he came as a refugee 20 years ago. Ev­ery day, Mus­lim women and chil­dren tell him about be­ing ver­bally abused on the street and in schools. The nearly 100,000 other east Africans in Min­nesota are painfully aware of the pres­i­dent’s re­cent tem­po­rary ban on refugees and visa-hold­ers from their home­land and other pre­dom­i­nantly Mus­lim coun­tries, and of the ad­min­is­tra­tion’s pub­lic state­ments: Michael Flynn, Pres­i­dent Trump’s na­tional se­cu­rity ad­viser, has called Is­lam “a can­cer.”

Sharif says his fel­low So­mali im­mi­grants “love [our] coun­try and can ac­cept the in­cred­i­ble bur­dens” of ris­ing out of poverty. He is proud of his com­mu­nity’s “work­ing peo­ple, sol­diers, po­lice of­fi­cers, politi­cians, busi­ness lead­ers, doc­tors and teach­ers.” But now his chil­dren worry that they will never again be able to visit over­seas rel­a­tives. They worry, even more, that they may not be able to stay in this coun­try, the only home they’ve ever known.

These and other fears are now the daily bread of large numbers of the 42 mil­lion im­mi­grants in this coun­try — in­clud­ing the chil­dren who, years ago, im­mi­grated and be­came cit­i­zens. Physi­cians, ther­a­pists and com­mu­nity lead­ers such as Mo­hamed have for years been us­ing my Cen­ter for Mind-Body Medicine’s model of self-care and group sup­port to help this pop­u­la­tion deal with their stress. They tell me now that fears and pow­er­less­ness and un­cer­tainty are caus­ing many to be in­creas­ingly anx­ious and an­gry, de­pressed and with­drawn. Over time, such chronic stress, un­ad­dressed, will make them far more vul­ner­a­ble to heart dis­ease, asthma, di­a­betes and post-trau­matic stress dis­or­der.

We’re learn­ing that dis­re­spect, dis­crim­i­na­tion and de­ten­tion can have long-term phys­i­cal and psy­cho­log­i­cal con­se­quences — on those who ob­serve as well as those who ex­pe­ri­ence them. Over the past few years, sur­veys and qual­i­ta­tive re­search have be­gun to re­veal the ex­tent of the phys­i­cal and emo­tional ef­fects. And a study pub­lished last month in the In­ter­na­tional Journal of Epi­demi­ol­ogy by University of Michi­gan re­searchers pro­vides hard bi­o­log­i­cal ev­i­dence that these changes can be trans­mit­ted to the next gen­er­a­tion.

The study found that Latino ba­bies born in the 37 weeks fol­low­ing a fed­eral im­mi­gra­tion raid in Postville, Iowa, in 2008 had a 24 per­cent greater risk of low birth weight than the ba­bies who were born to Latina women in the same pe­riod a year ear­lier. (Pre­vi­ous years, too, showed nor­mal rather than de­pressed birth rates.) Low birth weight is associated with long-term risks to phys­i­cal health and men­tal health, cog­ni­tion and aca­demic per­for­mance. What is most trou­bling, as well as sur­pris­ing, about the study is the ex­tent of the ef­fect. Low birth weight and its risks were, per­haps pre­dictably, high among un­doc­u­mented im­mi­grants, but they were just as high among Lati­nas across the state who were legally in the United States. In spite of their ap­par­ent safety, their bod­ies were re­act­ing as if they, too, could soon be de­ported. Years be­fore the lat­est pres­i­den­tial threats and ac­tions upped the im­mi­gra­tion ante, fear was over­rid­ing im­mi­grants’ faith in the de­pend­abil­ity of their le­gal sta­tus.

Un­doc­u­mented im­mi­grants, who have long lived in fear of de­por­ta­tion, are prob­a­bly the most pro­foundly af­fected. Among them are the 800,000 “dream­ers,” the young peo­ple who came to the United States as un­doc­u­mented chil­dren and are now all but in­dis­tin­guish­able from U.S. cit­i­zens in high schools and col­leges, as they serve in the mil­i­tary and work and marry and raise their own chil­dren. In 2012, when Pres­i­dent Barack Obama cre­ated the De­ferred Ac­tion for Child­hood Ar­rivals pro­gram, he granted them a mea­sure of re­lief, al­low­ing them to ap­ply ev­ery two years for con­tin­u­ing per­mis­sion to stay in the United States. These dream­ers know that the plat­form Trump ran on con­tains a dif­fer­ent kind of prom­ise: to “im­me­di­ately ter­mi­nate” their sta­tus.

The green-card hold­ers and im­mi­grants who be­came cit­i­zens are wor­ried, too. Over the years, they’ve watched roundups and de­por­ta­tions of peo­ple who share their his­tory, speak their lan­guage and work in their com­mu­ni­ties. In re­cent months, Trump’s threats and prom­ises have reawak­ened fears and phys­i­cal symp­toms that pa­tients of mine, long-ago refugees from tyran­ni­cal regimes, thought they’d left be­hind. Like the Sal­vado­ran youth study­ing for his GED, mem­o­ries of the dan­ger and dic­ta­tor­ships they fled are in­trud­ing on their thoughts and ag­i­tat­ing their bod­ies. Dur­ing the past week, many of my and my col­leagues’ pa­tients have been pan­icked by sto­ries of peo­ple with green cards pre­vented from re­turn­ing to the United States.

The dam­age to the next gen­er­a­tion may be com­pounded by other, less ob­vi­ous as­saults on their bi­ol­ogy and psy­chol­ogy. Re­search by Rachel Ye­huda and her col­leagues at Mount Si­nai Hos­pi­tal in New York has demon­strated that the con­se­quences of Holo­caust sur­vivors’ ex­treme trauma can be passed down to their chil­dren and grand­chil­dren, making them exquisitely sen­si­tive to the or­di­nary stresses of rel­a­tively safe lives. Ye­huda and other re­searchers be­lieve that these are “epi­ge­netic” ef­fects, mod­i­fi­ca­tions in the ways genes ex­press them­selves, which trans­mit vul­ner­a­bil­i­ties to stress from one gen­er­a­tion to the next. Though the mech­a­nisms are not com­pletely un­der­stood, an­i­mal stud­ies as well as those on hu­man adults who were abused as chil­dren demon­strate sim­i­lar changes.

“There is no short-term fix for this kind of dam­age,” Lori Ka­plan com­mented sadly, think­ing about the young peo­ple and their fam­i­lies who are anx­iously call­ing her and her col­leagues, re­port­ing phys­i­cal and emo­tional dis­tress, look­ing for an­swers. “We’ve been deal­ing with the trauma of the im­mi­grant ex­pe­ri­ence for so long,” the flight from vi­o­lence, the lone­li­ness, the poverty, the strug­gle to sur­vive in a strange land and the long­ing for home. “Obama was de­port­ing peo­ple, sure, and there was anx­i­ety, but he also gave us hope. And now the roof ’s been blown off.”

As Trump or­ders more bor­der guards and de­ten­tion cen­ters, and as the wall looms large, the fears of young peo­ple and their par­ents at the Latin Amer­i­can Youth Cen­ter grow. Per­haps they’ll be de­nied hous­ing; fired from their jobs; maybe their health care will dis­ap­pear. Latino im­mi­grant par­ents in the Wash­ing­ton area are des­per­ate for their kids to get an ed­u­ca­tion, ex­plains An­gel­ica Gar­cia-Ditta, a coun­selor at the cen­ter, and they’re still send­ing their chil­dren to school. But, she says, they worry that “im­mi­gra­tion au­thor­i­ties will seize them.”

Still, amid a na­tional clamor that di­min­ishes and iso­lates them, im­mi­grants are or­ga­niz­ing. Spir­i­tual lead­ers, lay coun­selors, kids, fam­i­lies and friends are join­ing cir­cles of sup­port, they tell me. They are shar­ing sad­ness and fears, us­ing self-care tech­niques to lower stress, and find­ing con­nec­tions to oth­ers who have sim­i­lar con­cerns. The chil­dren of Latino im­mi­grants, Ka­plan tells me, now un­der­stand that Black Lives Mat­ter is about them, too.

“Our anx­i­ety is very high,” says Sharif Mo­hamed. “We come to­gether as fam­i­lies in our mosques. We are pray­ing to­gether,” hop­ing to re­lieve stress and fore­stall long-term psy­cho­log­i­cal and bi­o­log­i­cal dam­age. “It gives us the ca­pac­ity to ad­dress our anx­i­ety, our hope­less­ness and our anger in a pro­foundly heal­ing way. I and ev­ery other Mus­lim par­ent is guid­ing our chil­dren to hold close to our faith, to God’s love, to kind­ness, to a deep be­lief that we are all here on earth to love and re­spect.” James S. Gor­don, a psy­chi­a­trist, is the founder and ex­ec­u­tive di­rec­tor of the Cen­ter for Mind-Body Medicine.

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