This article was downloaded by: [ECU Libraries] On: 20 April 2015, At: 11:48 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Health Care for Women International Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uhcw20
Mental health problems of translocated women Barbara Ogur M.D.
a
a
Harvard Medical School Published online: 14 Aug 2009.
To cite this article: Barbara Ogur M.D. (1990) Mental health problems of translocated women, Health Care for Women International, 11:1, 43-47, DOI: 10.1080/07399339009515874 To link to this article: http://dx.doi.org/10.1080/07399339009515874
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution,
Downloaded by [ECU Libraries] at 11:48 20 April 2015
reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
MENTAL HEALTH PROBLEMS OF TRANSLOCATED WOMEN Barbara Ogur, M.D.
Downloaded by [ECU Libraries] at 11:48 20 April 2015
Harvard Medical School
Cambridge, Massachusetts, though often thought of as the quaint background for the northeastern intelligentsia, is actually a crowded city of ninety thousand occupants, with large communities of new immigrants from Central America, the Portuguese-speaking Azores and Brazil, and Haiti. In the past few years Cambridge has had the opportunity of providing basic health services to these communities through a system of bilingual, bicultural clinics, with strong emphasis on culturally appropriate mental health teams. In our work with our patients we have found recurring themes arising from the process of immigration. Uprooting oneself from one's country and culture of birth and resettling in a land with people of different languages, customs, and, sometimes, race, is always a difficult process. Women may have special reactions to immigration. They are more likely to feel torn by family dispersal as they make the difficult choice to leave young children or old parents behind, to feel devalued by intergenerational alienation as the younger people assimilate into the new culture, and to be victims of violence or sexual abuse. In this paper I will present the stories of three women, each of whom illustrates some of the typical problems encountered by immigrating women. I have chosen stories of women of different ages who are at different phases of immigration in an attempt to illustrate some of the acute trauma of the initial uprooting, the difficulties of redefining the social network in the new country, and the ongoing problems of intergenerational and cross-cultural alienation. In our multidisciplinary team, we place special emphasis on the important role of our bilingual, bicultural outreach workers.
This article was originally presented to the Third International Congress on Women's Health Issues, Tampa, Florida, November 10, 1988.
Health Care for Women International, 11:43-47, 1990 Copyright © 1990 by Hemisphere Publishing Corporation
43
44
B. Ogur
THREE CASE STUDIES
Downloaded by [ECU Libraries] at 11:48 20 April 2015
Case 1: S. C. S. C. is a 53-year-old Salvadorean woman who came to me for her primary medical care, complaining of severe pain in her left shoulder, which had begun a month earlier, after an injury at work. She had severe spasms of her neck muscles, felt tenderness over her left shoulder, and could not lift her arm at all because of the pain. X rays did not show any underlying bone disease. She began therapy for a tendonitis of the shoulder. Anti-inflammatory drugs did not help. Injections of steroids offered only minimal relief. She went to a physical therapist once but was unable to communicate with the therapist, who spoke only English. She did not go back because it was too painful. She was referred to an orthopedist, who agreed that she appeared to be developing a reflex sympathetic dystrophy, a serious complication of tendonitis, which is treated either with intensive physical therapy or with a difficult injection into a nerve center in the neck. Because she did not keep her physical therapy appointments, the injection was attempted. When she went for the injection, however, there was no one there who spoke Spanish. She became very agitated, so the procedure was stopped. By this time, several of the health care providers had begun to wonder if she really wanted to get well. During this time, we had begun to find out a little about S. C.'s home situation and knew that she was having considerable conflicts with her daughter, with whom she was forced to live now that she was unable to work. We asked S. C. to tell us the story of her immigration to this country, in an attempt to understand some of the problems that she was facing at home. S. C. had lived in a small town in El Salvador with her three children, having separated from their father when the children were small. She supported them by selling bread from a stall in the marketplace, where she managed to make an adequate living. In 1981 the civil war had escalated to the point that gunfire was a regular occurrence. Distant relatives of S. C. had been murdered or had disappeared. She began to have anxiety attacks and difficulty sleeping. When three men were shot on her doorstep, she decided that she could not remain there, borrowed $500 from her oldest son, who had already emigrated to Boston, and began the journey north by bus, leaving her 15-year-old daughter and 12-year-old son with her mother. She was robbed on the way and was apprehended by Immigration and Naturalization Service (INS) at her first attempt to cross the border, through a drainage pipe. She finally made it to Los Angeles, where she worked in a factory by day and
Downloaded by [ECU Libraries] at 11:48 20 April 2015
Mental Health and Translocated Women
45
cleaned buildings at night to pay back the person who had helped her cross the border. She then made her way to Boston and got her two younger children out of El Salvador. By the time she got her son out, he had already fled to the hills to join the guerrillas. She believes she was fortunate to have been able to save him at all. Once they arrived in the United States, her children found jobs, learned English, and married. Their spouses did not want S. C. to live with them. S. C.'s daughter had a difficult marriage and was now separated. Although they lived together, the daughter was moody and given to violent outbursts. She had hit S. C. once or twice. S. C. said of her work that it was the only place where she was happy. She had supported herself all her life and was used to being independent. She now cared for all six of her grandchildren during the day so that her children could work, but she received no money except to buy the children food. She said of her children that whereas on the one hand she did not blame them for the way they treated her, because they had their own problems, on the other hand she did not know why she had worked so hard all those years to bring them here so that they could abandon her. After this long interview, S. C. went home and began doing the physical therapy exercises on her own. Over the next 2 months, her arm completely recovered function. She was now participating in psychotherapy with a Salvadorean counselor and was in a support group of other recently immigrated Latino women her age. She was well enough to go off disability and return to work. The day she returned, the company laid her off, presumably relieved to be free of its obligation to this older employee with a history of health problems. Case 2: W. M. W. M. is a 21-year-old woman from Guatemala, who worked as a nurse in her country before deciding to emigrate to the United States for economic reasons. She came to see me in the clinic because of nausea and abdominal pains that had been occurring for 4 months, beginning shortly after she had left home on a journey that had taken her and another woman several months. They often traveled at night, frequently hitching rides with truckers. In Mexico, W. M. had begun having nausea and abdominal pain. She went to a clinic, where she received an unknown antinausea medicine. Similarly, in southern California, she sought treatment, and another medicine was prescribed. I asked if there was any possibility that she could be pregnant, and she said no. During further questioning, however, she admitted that she had not had her period since she had left home. When I asked her when she had had sexual relations, she said that the only time she had ever had intercourse
46
B. Ogur
Downloaded by [ECU Libraries] at 11:48 20 April 2015
was when three men had assaulted her and her companion en route. On examination, she was, in fact, found to be 12 weeks pregnant. She had no money. She did not want to tell anyone here her situation, because she was living with a distant cousin and would have felt ashamed for her to know. I asked her what her beliefs were about abortion. She said that she believed it was wrong but wished to have it done. As she put it: " I never even saw his face when he did it to me." W. M. had her abortion through the generosity of one of the local clinics. She never returned for her follow-up or the counseling that she had agreed to in the first few days after learning that she was pregnant. I believe that she is a young women with a great many personal resources who will, nevertheless, carry some scars from the process of immigration. Case 3: M. M. M. M. is a 65-year-old Puerto Rican woman who has lived in this country for 20 years. She came to see me in the clinic for routine medical care for hypertension. She frequently came with symptoms of insomnia, headaches, and back pains, but was irregular about keeping appointments and following up on referrals. After several visits, I began to ask her about her home situation. She had had 13 children, of whom 11 were still living. She lived in a public housing complex with her husband, who had diabetes, who had had a leg amputated, and who now had metastatic cancer. She expressed many concerns about her children. A son was involved in drugs and was in jail, as was the husband of one of her daughters, who was pregnant with her third child. M. M.'s husband was now very dependent on her, to the point where he was unhappy whenever she left the house. She had few contacts outside the home and expressed feelings of being trapped, unable to negotiate the larger world because she has never learned English, and unable even to get out to church because of her husband's demands on her. I attempted to get her to come out regularly to see a therapist or to talk to me, but her attendance was very erratic. I felt that she was isolated and depressed, but unmotivated to actually get help. Her husband was also my patient. When in the course of his illness he became unable to come to the clinic, I began to visit them both at home. In that setting I saw a very different M. M. Her house was always a center of activity. Grandchildren played in the living room or napped on her bed. Her sons, a daughter-in-law, and her daughter frequently dropped in to be fed lunch, to pick up dishes she had made for their evening meals, or to check on their father to see if he needed anything. I was never permitted to leave without some homemade Puerto Rican specialty, or without having a cup of coffee with her. She continued to
Mental Health and Translocated Women
47
have chronic physical complaints and insomnia. However, it became clearer to me that although in some respects isolated from the larger world by language and cultural differences, she had created a very strong interpersonal network in which she was active and vital. Rather than individual counseling to address a lonely and isolated woman, it seemed more likely that she needed support from others in a similar situation, who were also confronting the difficulties of seeing their children and grandchildren grow up in a dramatically different and dangerous society.
Downloaded by [ECU Libraries] at 11:48 20 April 2015
CONCLUSION These three Latino women have experienced several different aspects of the disruption and trauma of immigration: (a) vulnerability to violence and sexual abuse in the journey itself; (b) the problems of enforced separation and of different rates of assimilation into the new culture, which disrupt the family (countered by the need for mutual support in the new land, which can strengthen family ties); and (c) isolation from the new homeland, caused by cultural and language differences and intensified by the racial and ethnic prejudices of this country. Our work with these women stresses the importance of seeing their mental health problems in the context of these major themes of immigration.
Health Care for Women International Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uhcw20
Mental health problems of translocated women Barbara Ogur M.D.
a
a
Harvard Medical School Published online: 14 Aug 2009.
To cite this article: Barbara Ogur M.D. (1990) Mental health problems of translocated women, Health Care for Women International, 11:1, 43-47, DOI: 10.1080/07399339009515874 To link to this article: http://dx.doi.org/10.1080/07399339009515874
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution,
Downloaded by [ECU Libraries] at 11:48 20 April 2015
reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
MENTAL HEALTH PROBLEMS OF TRANSLOCATED WOMEN Barbara Ogur, M.D.
Downloaded by [ECU Libraries] at 11:48 20 April 2015
Harvard Medical School
Cambridge, Massachusetts, though often thought of as the quaint background for the northeastern intelligentsia, is actually a crowded city of ninety thousand occupants, with large communities of new immigrants from Central America, the Portuguese-speaking Azores and Brazil, and Haiti. In the past few years Cambridge has had the opportunity of providing basic health services to these communities through a system of bilingual, bicultural clinics, with strong emphasis on culturally appropriate mental health teams. In our work with our patients we have found recurring themes arising from the process of immigration. Uprooting oneself from one's country and culture of birth and resettling in a land with people of different languages, customs, and, sometimes, race, is always a difficult process. Women may have special reactions to immigration. They are more likely to feel torn by family dispersal as they make the difficult choice to leave young children or old parents behind, to feel devalued by intergenerational alienation as the younger people assimilate into the new culture, and to be victims of violence or sexual abuse. In this paper I will present the stories of three women, each of whom illustrates some of the typical problems encountered by immigrating women. I have chosen stories of women of different ages who are at different phases of immigration in an attempt to illustrate some of the acute trauma of the initial uprooting, the difficulties of redefining the social network in the new country, and the ongoing problems of intergenerational and cross-cultural alienation. In our multidisciplinary team, we place special emphasis on the important role of our bilingual, bicultural outreach workers.
This article was originally presented to the Third International Congress on Women's Health Issues, Tampa, Florida, November 10, 1988.
Health Care for Women International, 11:43-47, 1990 Copyright © 1990 by Hemisphere Publishing Corporation
43
44
B. Ogur
THREE CASE STUDIES
Downloaded by [ECU Libraries] at 11:48 20 April 2015
Case 1: S. C. S. C. is a 53-year-old Salvadorean woman who came to me for her primary medical care, complaining of severe pain in her left shoulder, which had begun a month earlier, after an injury at work. She had severe spasms of her neck muscles, felt tenderness over her left shoulder, and could not lift her arm at all because of the pain. X rays did not show any underlying bone disease. She began therapy for a tendonitis of the shoulder. Anti-inflammatory drugs did not help. Injections of steroids offered only minimal relief. She went to a physical therapist once but was unable to communicate with the therapist, who spoke only English. She did not go back because it was too painful. She was referred to an orthopedist, who agreed that she appeared to be developing a reflex sympathetic dystrophy, a serious complication of tendonitis, which is treated either with intensive physical therapy or with a difficult injection into a nerve center in the neck. Because she did not keep her physical therapy appointments, the injection was attempted. When she went for the injection, however, there was no one there who spoke Spanish. She became very agitated, so the procedure was stopped. By this time, several of the health care providers had begun to wonder if she really wanted to get well. During this time, we had begun to find out a little about S. C.'s home situation and knew that she was having considerable conflicts with her daughter, with whom she was forced to live now that she was unable to work. We asked S. C. to tell us the story of her immigration to this country, in an attempt to understand some of the problems that she was facing at home. S. C. had lived in a small town in El Salvador with her three children, having separated from their father when the children were small. She supported them by selling bread from a stall in the marketplace, where she managed to make an adequate living. In 1981 the civil war had escalated to the point that gunfire was a regular occurrence. Distant relatives of S. C. had been murdered or had disappeared. She began to have anxiety attacks and difficulty sleeping. When three men were shot on her doorstep, she decided that she could not remain there, borrowed $500 from her oldest son, who had already emigrated to Boston, and began the journey north by bus, leaving her 15-year-old daughter and 12-year-old son with her mother. She was robbed on the way and was apprehended by Immigration and Naturalization Service (INS) at her first attempt to cross the border, through a drainage pipe. She finally made it to Los Angeles, where she worked in a factory by day and
Downloaded by [ECU Libraries] at 11:48 20 April 2015
Mental Health and Translocated Women
45
cleaned buildings at night to pay back the person who had helped her cross the border. She then made her way to Boston and got her two younger children out of El Salvador. By the time she got her son out, he had already fled to the hills to join the guerrillas. She believes she was fortunate to have been able to save him at all. Once they arrived in the United States, her children found jobs, learned English, and married. Their spouses did not want S. C. to live with them. S. C.'s daughter had a difficult marriage and was now separated. Although they lived together, the daughter was moody and given to violent outbursts. She had hit S. C. once or twice. S. C. said of her work that it was the only place where she was happy. She had supported herself all her life and was used to being independent. She now cared for all six of her grandchildren during the day so that her children could work, but she received no money except to buy the children food. She said of her children that whereas on the one hand she did not blame them for the way they treated her, because they had their own problems, on the other hand she did not know why she had worked so hard all those years to bring them here so that they could abandon her. After this long interview, S. C. went home and began doing the physical therapy exercises on her own. Over the next 2 months, her arm completely recovered function. She was now participating in psychotherapy with a Salvadorean counselor and was in a support group of other recently immigrated Latino women her age. She was well enough to go off disability and return to work. The day she returned, the company laid her off, presumably relieved to be free of its obligation to this older employee with a history of health problems. Case 2: W. M. W. M. is a 21-year-old woman from Guatemala, who worked as a nurse in her country before deciding to emigrate to the United States for economic reasons. She came to see me in the clinic because of nausea and abdominal pains that had been occurring for 4 months, beginning shortly after she had left home on a journey that had taken her and another woman several months. They often traveled at night, frequently hitching rides with truckers. In Mexico, W. M. had begun having nausea and abdominal pain. She went to a clinic, where she received an unknown antinausea medicine. Similarly, in southern California, she sought treatment, and another medicine was prescribed. I asked if there was any possibility that she could be pregnant, and she said no. During further questioning, however, she admitted that she had not had her period since she had left home. When I asked her when she had had sexual relations, she said that the only time she had ever had intercourse
46
B. Ogur
Downloaded by [ECU Libraries] at 11:48 20 April 2015
was when three men had assaulted her and her companion en route. On examination, she was, in fact, found to be 12 weeks pregnant. She had no money. She did not want to tell anyone here her situation, because she was living with a distant cousin and would have felt ashamed for her to know. I asked her what her beliefs were about abortion. She said that she believed it was wrong but wished to have it done. As she put it: " I never even saw his face when he did it to me." W. M. had her abortion through the generosity of one of the local clinics. She never returned for her follow-up or the counseling that she had agreed to in the first few days after learning that she was pregnant. I believe that she is a young women with a great many personal resources who will, nevertheless, carry some scars from the process of immigration. Case 3: M. M. M. M. is a 65-year-old Puerto Rican woman who has lived in this country for 20 years. She came to see me in the clinic for routine medical care for hypertension. She frequently came with symptoms of insomnia, headaches, and back pains, but was irregular about keeping appointments and following up on referrals. After several visits, I began to ask her about her home situation. She had had 13 children, of whom 11 were still living. She lived in a public housing complex with her husband, who had diabetes, who had had a leg amputated, and who now had metastatic cancer. She expressed many concerns about her children. A son was involved in drugs and was in jail, as was the husband of one of her daughters, who was pregnant with her third child. M. M.'s husband was now very dependent on her, to the point where he was unhappy whenever she left the house. She had few contacts outside the home and expressed feelings of being trapped, unable to negotiate the larger world because she has never learned English, and unable even to get out to church because of her husband's demands on her. I attempted to get her to come out regularly to see a therapist or to talk to me, but her attendance was very erratic. I felt that she was isolated and depressed, but unmotivated to actually get help. Her husband was also my patient. When in the course of his illness he became unable to come to the clinic, I began to visit them both at home. In that setting I saw a very different M. M. Her house was always a center of activity. Grandchildren played in the living room or napped on her bed. Her sons, a daughter-in-law, and her daughter frequently dropped in to be fed lunch, to pick up dishes she had made for their evening meals, or to check on their father to see if he needed anything. I was never permitted to leave without some homemade Puerto Rican specialty, or without having a cup of coffee with her. She continued to
Mental Health and Translocated Women
47
have chronic physical complaints and insomnia. However, it became clearer to me that although in some respects isolated from the larger world by language and cultural differences, she had created a very strong interpersonal network in which she was active and vital. Rather than individual counseling to address a lonely and isolated woman, it seemed more likely that she needed support from others in a similar situation, who were also confronting the difficulties of seeing their children and grandchildren grow up in a dramatically different and dangerous society.
Downloaded by [ECU Libraries] at 11:48 20 April 2015
CONCLUSION These three Latino women have experienced several different aspects of the disruption and trauma of immigration: (a) vulnerability to violence and sexual abuse in the journey itself; (b) the problems of enforced separation and of different rates of assimilation into the new culture, which disrupt the family (countered by the need for mutual support in the new land, which can strengthen family ties); and (c) isolation from the new homeland, caused by cultural and language differences and intensified by the racial and ethnic prejudices of this country. Our work with these women stresses the importance of seeing their mental health problems in the context of these major themes of immigration.
