Chapter 5: Mental Health

Dr. Carrie Hanson-Bradley (Family Social Science Alumna, University of Minnesota) and Dr. Liz Wieling (Family Social Science, University of Minnesota)

Introduction

“After all, when a stone is dropped into a pond, the water continues quivering even after the stone has sunk to the bottom.”

–Arthur Golden, Memoirs of a Geisha, 1999, p. 265.

Immigrant and refugee journeys are often idealized in literature, art, and historical accounts. Their experiences are repeatedly distilled into tales of extreme adventure where rugged courage and the intense desire for a better life overshadow all other experiences. Individuals and families become characters in larger than life stories, archetypes of human heroism and determination. As observers, we are often drawn in by the rich stories of survival, pain, and loss where people flee oppression and sacrifice to find unparalleled freedom and endless opportunity. These are the stories that incite respect, shock, and awe. However, immigrants and refugees are more than stories, more than the romanticized inspiring tales. They are real people who have suffered the loss of loved ones, homes, and communities. The multilayered impact of displacement is frequently manifest in one’s mental health and felt for multiple generations.

Leaving home, by choice or by force, is a disorienting experience. Through migration or via displacement and resettlement, immigrants and refuges are often confronted with a new world, new language, and new social norms. They face culture shock in everyday life events experienced as foreign. Immigrants and refugees experience disruption in their sense of self, often having to give up previous occupations, privilege, and social status. They lose community and established systems of social support. In addition to expected adjustment difficulties, immigrants and refugees may face additional challenges wrought by poor physical and mental heath resulting from exposure to multiple traumatic events and extensive histories of loss. They may experience severe and long-lasting psychological struggles including depression, anxiety, posttraumatic stress symptoms, and adjustment problems. Compounding these difficulties can be logistical complexities such as a lack of jobs, affordable housing, culturally and linguistically appropriate health and mental health services, financial resources, and social support.

In spite of the myriad of obstacles, struggles, and daily stressors, most immigrants and refugees demonstrate tremendous resilience as they persist in finding ways to work around, cope with, or overcome displacement related challenges. Some, especially highly skilled immigrants with means, might not experience a great deal of negative stress. Unfortunately, this represents a small segment of the total immigrant population. Refugees and undocumented immigrants come with inherent risk factors and many other immigrants share experiences of loss and traumatic stress, including multiple exposures to traumatic events.

This chapter reviews some of the shared and unique experiences of immigrant and refugee populations with particular focus on mental health implications and relational risk factors associated with exposure to traumatic stress. Mental health treatments and emerging directions for future prevention and intervention research are also discussed.