Immigration, Mental Health and Psychosocial Well-being

ABSTRACT

Anthropological approaches to “immigrant mental health” as an object of ethnographic inquiry can illuminate how psychosocial well-being – or decline – and the therapeutic realm of mental health is always enacted by a variety of institutions and social actors. The ways that mental health is understood and approached across different geographical and social settings are constitutive of a range of cultural meanings, norms, and social relations. The authors in this special section provide crucial insights into the landscape of immigrant mental health and how the experience of multiple exclusions influences collective psychosocial well-being. They also illustrate the extent to which narratives shape the production of knowledge around immigration and health, engendering direct effects on public policy, social imaginaries, and community health. Future research in the anthropology of immigration and mental health will need to further elucidate the structural underpinnings and racial capitalist origins of psychosocial decline.

KEYWORDS:

• Immigration
• immigrants
• mental health
• psychosocial well-being

Concern over the psychosocial well-being of minoritized populations, particularly people migrating from the Global South to the Global North and their descendants, continues to intensify as nationalist and populist discourses have become more prevalent in global politics in recent years and heightened by the COVID-19 pandemic. The political and social articulation of contemporary populist attitudes overlap with and echo much of the rhetoric that has historically been deployed to deem migrants and immigrants unworthy of formal belonging. Incendiary words and phrases such as “unfit” and “undesirable”, that we often associate with poor physical or mental health status of individuals, communities, and entire societies, are reminiscent of the language used by nativists and ethno-nationalists in the early 20th century against various ethnic and religious minoritized populations. Further, such public and political constructions of migrants and immigrants specifically as “illegitimate” and “unwanted” social groups have been utilized to justify policies, processes, and institutional mandates that exclude these groups and hinder their social, economic, and linguistic integration.

Researchers have long attended to broad forms of exclusion – political, economic, social – that engender feelings of anxiety, stress, and depression among immigrant populations, both in the United States and elsewhere in the world. Anthropologists, in particular, have utilized the notion of “structural vulnerability” to describe the embodiment of these dynamics of exclusion and how complex forces – ranging from economic exploitation, political marginalization, social discrimination – lead to immigrants’ physical and emotional suffering, including the internalization of individual and collective unworthiness (Haines 2013; Heyman 1998; Quesada et al. 2011). Others have used the framing of “abjectivity” to describe the feelings, thoughts, and emotions of worthlessness and precarity that accompany immigrants’ experiences of non-belonging, xenophobia, and social marginalization (Gonzales and Chavez 2012; Willen 2007). These broad forms of exclusion, when encountered over months or years, often portend a range of emotional and psychosocial consequences (Gonzales and Chavez 2012; Gonzales et al. 2013; Greenhalgh and Carney 2013; Menjívar and Kanstroom 2013; Salas et al. 2013; Viruell-Fuentes et al. 2012).

While the immigration experience in itself may and often does induce symptoms of depression, post-traumatic stress disorder, and chronic anxiety, immigrants without formal status in some countries, such as the United States, are often prohibited from accessing care due to legal restrictions, high cost of services, discrimination, or fear of being reported to authorities (Carney 2015; Castañeda et al. 2015; Chavez 2012; Holmes 2013; Salas et al. 2013; Sangaramoorthy and Guevara 2016; Sangaramoorthy and Kroeger 2013; Vélez-Ibáñez 1996). Intense stigma around mental health in many immigrant communities also hampers access to and utilization of mental health care services (Carney 2017; Jenkins and Carpenter-Song 2008; Korht and Mendenhall 2015). In attempts to render immigrants “legible” to the state, mental health service providers frequently must also participate in the process of validating certain forms of suffering, while ignoring others, in prescribing therapies (Fassin and Rechtman 2009; Horton and Barker 2009; Ticktin 2011). Service providers and institutions might thus be implicated in the construction of belonging and non-belonging by medicalizing the experiences of immigrants and prescribing notions of a “normal” life (Kenworthy 2012). This contributes to extant stigmas around immigration and mental health (Jenkins and Carpenter-Song 2008). Importantly, immigrants may experience further alienation when service providers interpret and re-inscribe social problems as “emotional” and prescribe medical and behavioral interventions as a form of treatment (Pupavac 2004).

To better understand these complex challenges, anthropologists have begun to explore the relational aspects of psychosocial well-being as it is negotiated among immigrants and the various social actors they encounter. For many people migrating or immigrating from the Global South to places such as the United States or Europe, departure, journey, and arrival are precarious and fraught experiences. They grapple with new feelings of alienation and anxiety, loss and longing, and relief and optimism. They work to establish new communities and cross-cultural ties and to anchor themselves with the resources at their disposal, including their faiths, cultures, and cuisines. They labor to support family members left behind, sending remittances that sustain not only family units but the economies of low- and middle-income countries. They also contend with new languages, national norms, racial and ethnic categories, and discourses of citizenship that often cast them as “the other.”

These relational encounters, including various forms of discrimination such as racism and anti-immigrant prejudice, have been shown to intersect with immigration status and economic inequality to affect the mental health of immigrants (Giordano 2014; Grzywacz et al. 2010; Lindert et al. 2009; Sullivan and Rehm 2005; Yip et al. 2008). Anthropologists have shown that these forms of individual and institutional discrimination, along with the chronic stigma of social inferiority – internalized feelings of hopelessness, fatalism, a lack of control, abjectivity, and otherness, understood as natural and deserved – can have a negative impact on health outcomes among immigrants in multiple ways (Carney 2015; Chavez 2013; Holmes 2013; Sangaramoorthy 2014). Racism can affect health indirectly by restricting minoritized populations’ economic opportunities and social mobility and produce adverse consequences for health more directly through residential segregation, bias in social and health care, stress and violence from everyday experiences of discrimination, and the internalization of inferiority (Chapman and Berggren 2005; Dressler et al. 2005; Gravlee 2009; Harrison 1994; Sangaramoorthy 2019; Smedley and Smedley 2005; Williams and Mohammad 2009). Despite mounting evidence of these negative health implications, insufficient attention has been focused on the combined impact of racialization, discrimination, economic insecurity, and immigration status on mental health outcomes and psychosocial experiences of immigrants in the anthropological literature. Such examinations would help to advance understanding of the relational aspects of psychosocial well-being and local contexts of immigrant mental health.

In this special collection, the contributing authors illustrate the extent to which contemporary narratives related to an individual’s or group’s extraordinary behavior or mental state shape the production of knowledge around immigration and health. This in turn engenders direct effects on public policy, social imaginaries, and community well-being. The authors also attend to how forms of exclusion and suffering get reinforced through rhetoric centering on pathological bodies and minds. Specifically, they ask: How might psychosocial distress be silenced, overlooked, or amplified, given the everyday abstractions of global, national, and local politics? In what ways does the normalization of mental illness undergird current global political landscapes? How does the medicalization of an array of social responses (such as anger, anxiety, or frustration) occur in everyday encounters? And finally, what are the ways in which people attempt to create opportunities for living in the face of precarious economic conditions and increasingly hostile political climates? The articles in this volume argue for the necessity of engaging in a relational perspective that re-locates “mental health” as a domain of experience that is constructed among various social actors outside of the individual. Notably, ethnographic research on the relational aspects of mental health in the context of migration is increasingly urgent amid projections of climate change and civil unrest-related population-level mental health decline and global human displacement (Carney and Krause 2020; Cattaneo et al. 2019; Gibson et al. 2019; Palinkas and Wong 2020).

This special section of Medical Anthropology emerged from a panel at the American Anthropological Association annual conference (November 2018), “Immigration and Mental Health in the Age of Trump.” In this collection, Cristina Zavaroni, Alessandro Pacco, and Stefania Consigliere; Allison Bloom; Rebecca M. Crocker, Robin C. Reineke, and María Elena Ramos Tovar; and Ryan I. Logan, Milena A. Melo, and Heide Castañeda, each explore how current modes of political and social rhetoric resulting from a rise of nationalist politics in some countries perpetuate the social stigma that people with mental illness are inferior and unworthy of care and compassion. These authors examine how policies and practices enacted and proposed by various political leaders and parties have translated to very real mental distress within the population at large, especially among migrants and immigrants. They also demonstrate how public discourses of mental instability within contemporary political landscapes deeply underscore the moral and material ways in which we collectively perceive and address mental health. In analyzing the relations between immigration, migration, and psychosocial well-being across diverse geopolitical settings and among different populations using an ethnographic orientation, the authors engage with issues related to social and cultural dimensions of policy, institutional ideologies and norms, and everyday forms of collective resistance and mutual cooperation.

In her article on intimate partner violence (IPV) and psychosocial trauma among Latin American immigrant women in the United States, Bloom richly illustrates how the integration of secular IPV services with evangelical Christian practices can lead to posttraumatic growth among survivors. Moving beyond the broad narratives of “structural vulnerability” and “social suffering” often used to characterize structural and interpersonal violence experienced by immigrant women, she theorizes how an intersectional approach focused on women’s narratives of strength and hope can shift our view of survivors – as those who find meaning in suffering rather than as individuals perpetually suspended in trauma.

Likewise, Crocker, Reineke, and Ramos Tovar provide detailed accounts of migrant families’ experiences of mourning for loved ones who disappear along the US-Mexico border. Their work demonstrates how the various emotionally-laden phases of processing migrants’ disappearances are shared by those who are grieving – Mexican women in particular – manifest as embodied dimensions of ambiguous loss, including chronic disease and psychosocial decline. As these authors assert, “An embodied lens evidences the deep corporeal imprint of border policies on the families of the missing.”

Logan, Melo, and Castañeda explore how economic insecurity, legal precarity, and experiences of discrimination engender persistent anxiety and negative mental health outcomes among Mexican-origin mixed-status families living along the Rio Grande Valley. Expanding on the notion of structural vulnerability, they use familial vulnerability to analyze how structural and social conditions such as restrictive immigration policies, increased risk of deportation, and the rise of nativist rhetoric have an impact not just on the psychosocial well-being of individuals, but entire family units, regardless of their legal status.

Finally, Zavaroni, Pacco, and Consigliere describe the discursive politics shaping sociality and reinforcing relations of power within migrant reception centers in Italy. Alluding to the ways that staff employ the term “ragazzi” (boys/girls or kids) to describe all migrants, regardless of age or other status, the authors draw from observations in a reception center in the city of Genoa to argue that interactions between reception center staff – those providing psychosocial support – and migrant residents cannot be decoupled from Italy’s colonial and fascist history that precedes today’s system of migrant reception and asylum. Moreover, they demonstrate how these interactions discursively reinforce neoliberal configurations of subjectivity and belonging for both migrants and younger generations of Italians whose labor makes possible the reception system.

Future considerations

In this special section of Medical Anthropology, we have begun to contextualize the multiple overlapping issues at the intersection of immigration studies and the scholarship on mental health and psychosocial well-being in anthropology. We envision this collection of articles not as an end point, but as a way to begin to re-imagine some of the ways anthropologists engage with issues of structural vulnerability, legality, and systemic oppression among immigrants. As anthropologists working in the field of immigration, we need to interrogate how and whether structural vulnerability offers new insights into economic, existential, and political uncertainty and suffering. Specifically, we need to ask: How do our interlocutors become marked anew as the “other” within a liberal sentimentalism that repeats the very discursive separation that they have already been marked by, but in new registers? Moreover, how might the related framework of structural violence become an active attempt to instantiate a singular account of vulnerability and oppression over other testimonies of experience, irrespective of local and historical differences within anthropological sites of engagement?

We agree that as anthropologists, we should not be afraid to explicitly name and analyze the structural underpinnings and racial capitalist origins of psychosocial decline as it is unevenly distributed among those who have been displaced, constrained, and sentenced to premature death by the omnipresent conditions of border imperialism (Walia 2021). Settler colonialism targeted Native lands, bodies, and minds for extraction and absorption into settler states, while halting and policing the movement of Black, Brown, and Indigenous peoples – vis-à-vis imposition of the carceral state – and privileging mobility for white, European others (Goeman 2013; King 2019; The Red Nation 2021). Yet, there is an almost joyous exposition of the suffering of others in the use of “structural vulnerability” as an analytic, be they people of color or those whose economic circumstances are troubled and difficult. How might we think about our own privilege in how we position the lives and bodies of those we work alongside?

In terms of research agendas, we might do well to focus on the ways that communities thrive in spite of the multiple forces conspiring against them. For instance, we could look to work on Black fugivity, marronage, precarity, and the resourcefulness of those who have been targeted by state-sanctioned violence and surveillance in the purported “best interests” of their well-being vis-à-vis public health interventions that reinforce relations of paternalism, exclusion, and structural inequality (Garth and Reese 2020; Perry 2013; Sojoyner 2017). How do people subvert systems of oppression and thrive despite the odds being against them? What existing forms of care, mutual aid, and solidarity work against psychosocial decline as it has been imposed by structural forces (see for instance, Carney 2021; Sangaramoorthy 2018)?

Additionally, we need to consider carefully how and why Latinx Studies remains so inextricably linked to the scholarship on the immigration of anthropology. What might this signal and what is precluded in this inherent coupling? How might it have a bearing on the engendering of legality as the organizing feature of immigrant life? We call on anthropologists of immigration to integrate theory from other ethnic studies disciplines and critical social sciences such as Black geographies; critical feminist and race studies; abolitionist politics; and postcolonial and subaltern literatures. An intersectional lens is necessary for thinking about how axes of difference along racial, ethnic, class, gender, and disability lines articulate with and through immigration status and concepts of legality. Rather than interpret contemporary psychosocial decline as simply a condition or reflection of current immigration policies and politics, anthropologists would greatly benefit from interrogating the increasing prevalence of deteriorating mental health as an intentional project of settler states and racial capitalism, of projects, to paraphrase Stuart Hall (1994), to colonize one’s subjectivity. As outgrowths of the settler state, medical anthropology and public health – both as disciplines and professional fields of practice – should be scrutinized in calls for addressing racism as a public health crisis. By foregrounding such a perspective, we may actually inform a rethinking of “interventions” to mental health and approach this domain of human experience through a framework of restitution, reparations, and responsibility (Walia 2021).

As a word of caution, however, such research should be mindful of not reproducing the violence of extraction and appropriation, but rather should originate from a place of accompanying those with whom we work in their quest for transformative justice and dignity. Amid centuries of dispossession, displacement, enslavement, and incarceration we seriously need to engage the spatial dimensions of inclusion and belonging (Gilmore 2002, 2021). For instance, where does “place” in contexts of displacement factor into questions of affective or psychosocial health and well-being? In short, we desperately need a radical reorientation to how we conceptualize “immigration and mental health” in anthropology. Our hope is that this collection of articles leads to more intersectional, feminist, decolonial, and anti-racist research commitments within anthropology, especially as scholars seek to inquire into the nexus of immigration, migration, and mental health.

Acknowledgments

We are grateful to authors featured in this collection including Cristina Zavaroni, Alessandro Pacco, and Stefania Consigliere; Allison Bloom; Rebecca M. Crocker, Robin C. Reineke, and María Elena Ramos Tovar; and Ryan I. Logan, Milena A. Melo, and Heide Castañeda for their thoughtful articles and engagement with our vision for theorizing immigrant mental health. We also appreciate the editorial guidance of Medical Anthropology’s Editors Rebecca Marsland and James Staples, and Editorial Manager Victoria Team. Finally, we would like to thank Lenore Manderson for her support of this special collection.

Additional information

Notes on contributors

Thurka Sangaramoorthy

Thurka Sangaramoorthy is Associate Professor of Anthropology at the University of Maryland and author of Rapid Ethnographic Assessments: A Practical Approach and Toolkit for Collaborative Community Research (Routledge 2020) and Treating AIDS: Politics of Difference, Paradox of Prevention (Rutgers University Press 2014).

Megan A. Carney

Megan A. Carney is Assistant Professor in the School of Anthropology and Director of the Center for Regional Food Studies at the University of Arizona. She is the author of Island of Hope: Migration and Solidarity in the Mediterranean (University of California Press 2021) and The Unending Hunger: Tracing Women and Food Insecurity Across Borders (University of California Press 2015).