Immigrants experiences with depression and anxiety
Transcript
Kwame McKenzy, Psychiatrist
I am an immigrant. I came to Canada eight years ago. When I came, I got involved with the Mental Health Commission of Canada. We produced a report with them which is issues and options for improving services for immigrant, refugee, ethnocultural and racialized groups. The Mental Health Commission took that up and said, “Improving services for these populations is one of the six most important things that we need to do in Canada.” Recently, we looked through what everybody had done. If you look across Canada, apart from Alberta, which has some language in their health policy about improving services for diverse populations, no mental health strategy has any real plan to improve services for diverse populations.
Marie Salib, Psychologist
Once you have gone through the airport, it is just you and your resourcefulness, you and your luck, whom you’ve met, you and your luck whether you have found a job or not, your luck if you have a language class that provides you with a babysitting service so you can attend… I don’t feel it’s the same for everyone; each person has their own journey and their luck, whom they’ve met and when. The policy view is that when you arrive at the airport, you are all equal. That’s it.
Ellen Rosenberg, MD
It’s a situation where I feel often, what would make things better would be if society treated them more fairly, which is not something that I as a doctor can do anything about. I may try to do something, I don’t actually, but I may, one might try to lobby, one might try to have public health education interventions with groups of people, to say “If you say you wanted engineers, you brought them here, and then the order of engineers looks at the papers and says, ‘Oh, no, we have to have a different training. Maybe you could go back to the beginning and start all over again.’” I feel guilty. I feel embarrassed for my society that they’ve done this. Now, if they’re actually depressed, I try to treat them for depression, but I feel like it seems like the wrong thing to do. If I could get them a proper job, they wouldn’t need all that.
Hugues Belisle, Kinesiologist
For sure, there’s a huge distinction between women and men. Men arrive more quickly to physical activity. Women – not always but often – need to re-establish a sense of trust, they’re experiencing new things, for example, most of them have never played [for fun].
Bernardo Dubrovsky, Psychiatrist
You know, people who wake up in the middle of the night, with panic attacks, or crises, and so on. The fact that they don’t feel that people can understand them, or even being ashamed, or it’s exposing some of their ideas because they think that they don’t have – in many cases – they don’t even think that they have the right to demand things because they live in very impoverished circumstances from the country from which they originate.
Maria Dudek, Psychologist
Very often they are just desperate. They come in a state of great suffering. We can say that immigrants in search of a psychologist always do so for a good reason.
Catherine Chan, Social Worker
In one of the hospitals that I consulted to, they actually have a crisis line that is affiliated with their services. Therefore, if they have clients who call in or email in and need support, they can go right into community mental health, or their hospital based services which is very much integrated services. But, we don’t have something like this here in Canada.
Key reflections from the study
Family First
There is a need to manage children’s problems, if, for example, they have kids; or to offer help to their wives if they are depressed. Men feel responsible for their wives and children so very often they don’t want to talk.
Say, for example, with some of our clients, they may realize that they get very depressed and they get very anxious. But, because they want to sponsor their family here and they want to have enough income in order to sponsor their family here, so they struggle everyday when they go into work. When they go into that minimum pay job. And, when they are underemployed but they want to just press on, and when they go into work they want to look normal. But, after the family comes here and after they start with their mortgage, they can no longer hold onto the look of normalcy, so to speak, so they start to seek help. By this time, they might be here for ten to fifteen years.
What do immigrants say to care providers about the system?
People say they don’t have enough time. They’re more likely to be prescribed pills than to be given the sort of treatment that they want. They don’t get the support that they need. It feels like people don’t listen to their concerns. And, they find it very very difficult to find their way through the system.
How do immigrants talk about anxiety and depression?
Often they talk about the more visible symptoms: “I can’t sleep” or “I don’t know what’s wrong with me: I can’t concentrate” or “I’m always arguing with my wife and children”.
Most of the time, it’s expressed through the body; they will talk about physical symptoms. They’ll rarely talk about feelings. This is where you see a difference between newcomers – new immigrants – and immigrants that have been here for, say, ten years who can express their emotions.
Medication
Most of the time, they are afraid to take medication. Their relatives would never take medication for this type of problem, so they are suspicious, they don’t want to, they refuse.
They are very aware of what they are taking: they know the dosage, the name. Depression and anxiety treatment is heavily medicated. They talk about it believing it will heal them. In this respect, they are often disappointed.
Unreliable or costly mental health care?
When you set up the support you need, you find that somebody leaves. So, there’s all of that building up trust, building up networks, and then the system and the way it’s set up, is that therapists, psychiatrists, psychologists, often move or move around. So, then you’re left.
This is health! This is such an important – it’s probably the most important value that human beings have. So, people in this case start to make sacrifices and attend private institutions. They are appearing more and more for the very simple reason: this is not something you can protest like lack of access where you can go on strike.
Empathy and flexibility in care?
I treated a client who told me after a long conversation, “I don’t have anything left. You can phone me or you can come and take care of business for me when I’m gone.” So those are the times that it’s very difficult for the client as well as me. There was one time I actually cried with a client on the phone and I told her “I really care about you because I’ve known you for a while. Tell me what I can do to help you be able to come to the appointment tomorrow and for a long time to come.” In this particular situation, in the end, the person said “I don’t really want to be [inaudible], if I wanted to be [inaudible] I would have gone and called a taxi myself.” So, in the end, we made an agreement that [inaudible] on the phone, also ask somebody else to call 9-1-1 and that they will not put her in handcuffs. That’s the worst thing that a lot of people fear.
Immigrants living with anxiety and depression
Anonymous, Six months since immigrating
Why did I lose time when nothing really happened? The bad things I expected never materialized. More or less this is what depression is: expecting calamities… expecting the worst.
Irene, One year since immigrating
I think it’s about conquering your fears. In concrete terms, it’s about not being afraid because you missed the bus, or because you didn’t take the dog out on time, or were late to class, or fearing that the prof is not going to acknowledge you because you made a mistake. For me, being cured would mean getting rid of those fears. It also means, being able to get through a job interview, and if they hired me or not, not feeling rejected or thinking that I made a fool of myself. In other words, simply feeling like I used to before: someone for whom these kinds of things never used to bother them so much.
Anonymous, Four years since immigrating
She says that because of this situation, she was feeling very very depressed. She wanted to eat but there was not much groceries at home that she could eat. All of these things were happening just after she gave birth.
EH, Six years since immigrating
I had to choose between my dream of becoming someone and raising my children. So I chose to provide them with all my time, all my love. They are my life, my reason for being. I am very happy to have them even though they are the reason for my depression. Perhaps my love for them also helped me overcome [depression], it gives me strength to face forward.
Anonymous, Four years since immigrating
Sometimes, I would call and there wouldn’t be any availability. Sometimes I would call and the person would never answer. So, I approached five or six psychologists before I found one.
Mr. Tan, Five years since immigrating
His understanding of recovery is: don’t think too much, don’t worry too much. Fight it out. Get the treatment, get settled, eat again, sleep again… and that’s the recovery again. You overcome that sense of worry.
Triggers for mental health problems after immigration
God gave me another baby, I am happy but when the insomnia problem arose, I didn’t understand. I said to my husband: “there is something wrong in my brain.”
My husband was sick. I discovered a little bump near his throat. After a delay of maybe fifteen days – it was really awful – we finally got an appointment with a doctor. When she examined him, I asked: “do you think it is normal to have a lump appearing on the neck?” I would say that the doctor didn’t use professional principles. She told me she couldn’t say. At least you should reassure the patient and his relatives. Ultrasound couldn’t reject malignancy. After two months, we were told it was a lithiasis but I spent nights without eating nor sleeping. I spent weeks without sleeping, almost three months.
Basically, what happened, she’s explaining how when her son was born, she’s trying to explain how he was treating her and her son.
Looking for help
At the beginning, when I was looking for psychologists, I would see the ads in English or French. One doesn’t know if there are psychologists who can speak a language other than the official languages. Another issue was: does medicine here require that only official languages be spoken in consultations? Obviously, those kinds of fears are eventually cleared up as one finds out more information, but I didn’t know this until much later.
I called many community centres and associations trying to find out if there were services offered by the health system for women with post-partum depression. I found out there was no follow-up.
Empathy and flexibility
When I cried, when I explained that I had children that I wanted to raise, that I couldn’t continue like that, I asked him: “how can I have a follow-up, I want someone who will handle my situation, I have no family doctor.” He said, “I agree to be your family doctor,” and he gave me a paper right away. I was really touched because this person – and yes, he was a physician – but he showed care for me. This is why he agreed to be my family doctor. This is something that I won’t forget, I am very grateful to him. Same thing with my psychologist, when I leave, I hug her. Before, I had a psychologist who used to start on the clock and say “start talking.” I would talk for 50 minutes. After 50 minutes she would stop the clock and say: “this is it for today, go make another appointment.” There wouldn’t be any interaction between me and her. I found that quite difficult.
Medication
I didn’t find my doctor because he was traveling so I went to another doctor at the same clinic I’d usually go to. I said, listen… there was another resident with him, they talked and went for an antidepressant that was safe with breastfeeding. I was prescribed an antidepressant called Sertraline. They gave me the prescription without explaining to me its side effects. I was given Sertraline as if it was Tylenol. At the beginning, the first month, I was losing my hair in incredible ways. I can’t just mention the reduction of libido, but rather the total absence of libido since taking this medication. As I said, the problem is that they do not explain the side effects, which are very damaging.
Mental health and family
Sometimes, even with my husband, I say to myself, who is he? Why do I trust him and live with him under the same roof? Yet I know he loves me and all…
In fact I’ve stopped talking with my family because I feel that they are going to ask what I’m doing and if one answers, “just studying”, one feels that people are going to judge, “Oh, you haven’t found work” or “Oh, Irene, you’re having a tough time in Canada.” And it’s not true. I don’t feel that I’m having a tough time, but the communication issue is a barrier, as well as the anxiety that I just can’t shake off.
Being jobless and mental health
Because here, when I started job hunting, I was always told no, we can’t hire you because you are overqualified. You do not have the profile we are looking for. Here, of course, I can’t start with a job paying $18/hour so I started to look for general work, anything. Each time I’m told: no, you do not have the profile we are looking for. We are looking for people who don’t have their high school diploma and I have a college degree.
One day I sat down to look at what jobs I could write cover letters and resumés for. I felt that all my education and all my experience didn’t count for anything if I didn’t have the English-French language 100%. And I think that day I cried a lot because I had always worked and I began asking myself if I was really going to be of value here. And I think that that was, like, my lowest point in terms of anxiety because I think it affected my relationship with myself: of feeling capable of finding employment or whether that employment would be good; whether I was going to succeed or not here in Canada.
From struggle to despair
You are never supported, you are always by yourself. When you are happy you’re on your own, when you have an anniversary you’re on your own, when you are in despair, you’re on your own.
If it wasn’t a sin in my religion, maybe I would do it. But I keep thinking that in my religion it is a sin to kill yourself or to kill someone else.
Self-harm, suicidal thoughts and intentions
The fact of starting to feel that I was not capable of even finding work led to a lack of confidence, and possibly self-harm and not eating. I don’t mean causing harm to myself in physical terms, although thinking about hurting oneself in nutritional terms is also causing harm, but it was when I began to get depressed and to have low self-esteem at feeling I was not able to do the things that I used to be able to do.
It happened to him that when he felt too much pain in his head, he just wanted to go away… yeah… die, for himself.
But basically, the situation was too severe for her, so after that they gave her a low-income house and she transferred to the house after the shelter with her baby. And, she was so depressed that she says there was a time that she just wanted to beat herself – she wanted to hurt herself.
Me, I wanted to die. At the end of it all, I wanted peace. I said the only way I will get peace is if I am dead. The company and the insurance company were after me everyday. I wanted peace… give me a break. This is when I started to think about committing suicide. I will end this here – that’s it – it’s over, I’ll be peaceful, I’ll sleep and they will leave me alone.
If I find a way to manage the situation, the symptoms and hallucinations, I won’t think about suicide but, during the peak of the depression symptoms, when I say: why is everything against me? I am not able to find this. I cannot do this. Why? Why me? This is when I think about suicide.
Immigrants’ state of mind and the path towards healing
So happy, so happy. Because she had seen a very difficult situation, but now she has people around her. So she feels good. But still, she wants to be good in language and be financially independent.
He feels it was a combination of, like we were talking about, changes in weather, in community assistance, in medication. He feels it was a freedom, a moral freedom that helped him down the line. Freedom to his understanding is the ability to have a respectful government.
There is always time to start over again. I am 38 years old, I am starting school. Here, in Canada and in French no less so…
Sometimes I feel that I’m going to succeed in finding a good job where I can grow professionally like I did in the past. And at other times, I just don’t see any possibilities.
Right now, do you actually think that there isn’t any treatment that could help you? –– Yes.
To be honest, I want to go back home. That’s all.
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