Researchers call it the "immigrant paradox"—I call it my life as an anxious, overachieving kid.

By Jonathan Borge
July 27, 2020
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When I began to regularly visit a psychotherapist in my mid-20s, my parents were alarmed. “Pero que paso? Vamos a rezar (But what happened? Let’s pray),” they said. In Latinx households like the one I grew up in, mental health is not a topic of conversation at dinner time, and it’s a rare privilege to have the option of seeking professional help. My family didn’t have the luxury of affording a therapist, which can be expensive if you’re not equipped with the right education and access to resources. Putting food on the table was their priority. If I appeared sad or full of worry as a child, I was encouraged to practice positivity, to hope for a better tomorrow, or open up the Bible.

My family was not alone in this. According to the Centers for Disease Control and Prevention, Latinxs experience social and economic obstacles to health and health care because many come from lower income groups, are uninsured, or have undocumented legal status, among other reasons. Data from the American Psychiatric Association (APA) also shows that only 1 in 20 Hispanics receive services from mental health specialists; per the APA data, this could be the result of stigma, discrimination, a lack of knowledge, and/or lack of insurance.

The adults in my life helped their children self-soothe with silly nursery rhymes they were raised with like, “sana, sana, culito de rana (heal, heal, little frog’s tail),” which my folks would jokingly reference into my adolescence and adulthood each time I expressed emotional pain they couldn’t quite understand.

Though they’re supportive of my mental health treatment, my parents have never wholly understood why I’ve struggled in ways they haven’t. I was born in the US, which has inherently granted me access to the education and rich life experiences they wanted for me. My parents and two elder siblings fled Nicaragua in the late 1980s, escaping the socialist rule of the Sandinistas, a left-wing political organization that made living conditions for working-class families like my own harsher. Though they left behind relatives and faced life-threatening violence on their journey to the US, they arrived with pockets full of optimism and the will to prosper in a country and language foreign to them. Their indoctrination into American society wasn’t easy, but they consider the perilous experience of crossing the border one of their biggest life hurdles—something that is now decades in the past. However, the realities of vacillating between two entirely different cultures has come with its own set of mental health challenges for me.

Yes, my parents, siblings, and Nicaraguan-American relatives suffer from their own mix of anxieties. However, I’ve always been singled out as the one whose a tad bit more…in their words, sensitive. How is it that immigrant folks who fled their native country appear to have better mental health than me, an American who was raised in safety with comforts like Fruit Loops and Nickelodeon? Experts call this phenomenon the “immigrant paradox.”

Jonathan Borge and his mother at her naturalization ceremony in 2019. She became a citizen after living in the US for over 30 years.
Jonathan Borges

The immigrant paradox has been defined by the Society for Research and Child Development (SRCD) as a phenomenon that explains why US-born youth are more likely to experience higher rates of mental health problems than youth who immigrated from a foreign country. Amy Marks, PhD, a professor of psychology and department chair at Suffolk University, who has written about the paradox for years, underscores the research and tells Health that folks who were born abroad seem healthier than folks born here in the US—though this is different for some Latinx groups.

Though the outcome of anyone’s mental health is multidimensional (for immigrants, factors such as national origin, race, how they arrived to their new country, gender, and socioeconomic status are important to consider), according to a 2009 study published in the American Journal of Public Health, the longer immigrants spend in the US, the higher their risk of psychiatric disorders become. This is partially due to the systemic discrimination, victimization, and rejection these families collectively face in this new country, plus family conflict that arises as a result of acculturation—the adjustment to new cultural and social norms.

According to Marks, immigrants and first-generation folks from immigrant families are acculturating into a society built on racist and oppressive systems that have existed for hundreds of years. In other words, people from Spanish-speaking Latin American countries are adopting a predominantly white, English-speaking norm. “If you’re born into that system and you come from a non-European background with darker skin, that may have more pronounced effects on you,” Marks says, explaining how discrimination affects the mental health of populations such as the Latinx community. Positive social standing, “family harmony,” and easier integration into US culture offset the risk of developing mental health disorders.

Despite the love and coddling I received as a child, my household was also rife with alcohol overconsumption, which exposed me to the long-lasting harms of domestic violence and other forms of physical and emotional abuse. Some of my earliest memories are of crying in my bedroom, slamming the door in fear, and feeling isolated after witnessing drunken altercations between my mother and father.

Marks says that it’s well-documented that alcohol and drug use are linked to mental health disorders, and that while the reasons for this consumption are murky, they’re essentially coping mechanisms that lead to disorders like depression, which trigger further challenges. She notes that while these patterns are prevalent in US society, particularly for young people, there’s a disproportionate surge in groups that are more oppressed—like my own Latinx community.

According to a 2007 study published in the journal Social Science and Medicine, as Latinxs acculturate, they’re likely to adopt unhealthy behaviors such as smoking, excess alcohol consumption, and poor eating habits. My father’s destructive relationship with alcohol only worsened the longer he lived in the US. I had my own coping mechanisms growing up: frequent temper tantrums, overeating, and antisocial tendencies. Of course I didn’t realize back then that these behaviors were actually signs of post-traumatic stress disorder, but I did know on some level that I needed more than nursery rhymes.

It’s not that Latinx immigrants do not suffer from mental health disorders, it’s that first-generation and US-born Latinxs suffer at more disproportionate rates because of systemic pressures and inadequacies they grow up experiencing. The Latinx population is a deeply diverse one, and acculturation and enculturation varies. What that means is that a Latinx person’s experience in the US is vastly different depending on said person’s nationality, socioeconomic status, and ability to assimilate into the dominant American culture, per a 2007 article published in the journal Research in Human Development as well as a 2009 article from Social Science and Medicine

“It’s important to consider the population where immigrants land and where they come from,” Marks says. “Some scholars say the match between cultural practices and how they align or misalign with an immigrant family’s new home changes it all in terms of mental health—whether you can find food familiar to you or bus signs that make sense, for instance.”

My family had a relatively easy time adjusting to Miami, where it’s not rare to find Spanish speakers and rice and beans. But though I grew up feeling safe in a homogeneous Latinx community, Latinxs like me understand that there’s a major difference in having wealthy parents who are light-skinned Puerto Rican-born doctors, for instance, and parents like my mother and father, a dark-skinned Nicaraguan-born lunch lady and mechanic.

Once I went away to college and later entered a predominantly white workforce, I realized more and more just how different my experience had been from a lot of my white friends, despite the fact that we were all born in the US.

I remember feeling the pressure to fit into our dominant American culture as early as elementary school—when I carried the burden of teaching my immigrant parents about the history of Thanksgiving, and why our supermarket sold salt and pepper shakers shaped as pilgrims and Native Americans. There’s a funny-looking photo from my childhood in which I’m seen teaching my parents to sit at a fancy dinner table—something they weren’t used to—and abide by this holiday. Though I was excited to learn how to stuff a turkey and celebrate a new holiday together, I also felt overwhelmed and marginalized by the realization that my immigrant family didn’t automatically practice the traditions I’d watch other Americans follow on television or in pop culture.

Research shows that family conflict is consistently related to the risk of mood disorders. In fact, compared to non-Latinx white and non-Latinx Black populations, Latinx adolescents report higher rates of having seriously considered, attempted, or become injured from suicide, according to the APA. 

In my early adulthood, I turned to self-help books (Barnes & Noble was my best friend) for words of wisdom and solace for disturbing thoughts I ruminated over, like suicide. In addition, running and other sports kept my sanity above water. Over time, I met friends who’d previously visited mental health specialists, so seeking my own was no longer a far-fetched idea. In my 20s, with health insurance and some independence in tow, I turned to ZocDoc and conducted my own research. Google was my mental health guru and it helped me find a psychotherapist I’ve felt comfortable speaking to for nearly three years.

This immigrant paradox theory not only aligns itself with my own experiences, but also numerous other studies. According to a 2008 study published in The American Journal of Psychiatry, for instance, immigrants demonstrate a pattern of lower risk for mental health disorders—particularly depressive disorders, anxiety disorders, and substance use disorders—despite migrating and resettling in a new country, which is associated with its own set of mental health risks. It is hypothesized that these immigrant groups fare better because of the strong family bonds and close-knit communities Latinxs are part of. Older generations of immigrants don’t seek mental health support because their cultures offer coping skills that are key to staying resilient, such as religious traditions that can be implemented into daily life. (My grandmother always keeps her rosary nearby, for example.)

“There’s an incredible amount of will and tremendous hard work and optimism for so many immigrants,” Marks says. “When you talk to the parents who came from abroad, they say they came from very little and still support their family back home. They’re very motivated and they’re not focused on the systems. But the children who grow up here notice their family’s legal status, their own access to higher education, and other factors that take a toll on mental health. If you compare the mental health challenges over time across generations among Latinx young people against their non-Latinx white peers, there’s very disproportionate suffering.”

I was a highly anxious, overachieving kid who fretted about everything. Though they didn’t do so intentionally, my parents freely spoke about their low income and rising debt in front of me. Yes, witnessing those conversations—and already living in an otherwise tumultuous household—took a toll on my mental health, but it also lit a fire beneath me. As early as elementary school, I understood that pursuing a college education was one way to escape the confines of living paycheck to paycheck, the first step in living more prosperously in my adulthood. And so I focused on earning good grades and becoming a model student, one set on achieving the American dream.

In one context, the paradox explains why children of immigrants outperform the children of native-born US parents. An article published in the journal Social Science Research in 2016 hypothesized that children of immigrants are more likely to enroll in college, be employed or in school, and are less likely to have a criminal record as young adults or to have a child than children of non-immigrants.

Another way to look at this paradox is to consider the anxiety that comes as a result of fear. As a child, I didn’t realize my parents were not US citizens; I assumed they were privileged with the same set of inalienable rights as any of my peers’ parents. However, I realized later in life that the process of naturalization not only takes decades, but is also tiring and expensive. My family spent thousands of dollars working with lawyers to fight to achieve residency status, and later to apply for citizenship.

In fact, my mother remained a US resident, not a citizen, in the early years of the Trump administration, which has worked to limit immigrants in this country. I frantically insisted she apply for citizenship following the president’s inauguration, and the fear of her deportation—a scary threat given the government’s insistence on building walls between Latinx populations and American-born white ones—took a toll on my mental health. She thankfully was able to achieve citizenship in 2019.

To further illustrate this, Marks turns to the example of mixed-status families, in which at least one member of the unit lives in the US with fear of getting deported, while the others have residency or citizenship. “In our research we find that just living in a household with one person who doesn’t have papers is just as stressful and anxiety-provoking than being undocumented yourself. It’s because of the threat of separation, which is a traumatic experience,” Marks says, emphasizing that those worries don’t go away for the US-born children of immigrants who may be adolescents or adults. Marks also notes that these situations can cause first-generation Americans to adopt behavior such as excess drinking or smoking, which is common in the US.

A 2019 study published in World Psychiatry found that growing up in a minority setting also elevates psychiatric risks; these minority populations have less of a sense of belonging and internalize the experience of feeling lesser than. In fact, Latinxs who are able to uphold the hallmarks of their culture are generally healthier. I was raised in a neighborhood where being bilingual was the norm, so despite being a minority in the US, I did not feel like a minority with my Latinx peers. We celebrated our culture collectively, and feeling like my Latinx heritage had a rightful place in American culture prevented me from feeling entirely isolated.

“If you live in a co-ethnic neighborhood, you do better,” Margarita Alegria, PhD, a psychiatry professor at Harvard Medical School and the chief of the Disparities Research Unit at Massachusetts General Hospital, tells Health. “If you go to a school that has a lot of Latino kids and the teachers are Latino, you do better.”

When I finally sought medical help as an adult, I was diagnosed with generalized anxiety disorder. And after several years, I began to heal, thanks to my own Latinx specialist’s mix of cognitive behavioral therapies (CBT) and exercises such as meditation and journaling. Of course, it took many years and plenty of introspection for me to realize that it’s okay to ask for help and to explain my childhood mood swings and mental unrest. I found it especially helpful to talk to a bilingual Latinx provider that wholly understands the nuances of my identity and how it informs the anxiety I have. By establishing a sense of community each session, she’s allowed me to feel prouder of and unapologetic about my Nicaraguan heritage rather than harbor resentment towards the unique set of challenges it has thrown my way.

All of this is to say that first-generation Latinx people like myself are encouraged to seek adequate mental health care. Specifically, Marks says visiting a Latinx provider is especially helpful, and that CBT as well as acceptance-and mindfulness-based services are the most effective ways to address the anxiety that comes from experiencing many adverse events as a child.

“We believe if we learn how to cope, you don’t have to live with this forever,” Alegria says, emphasizing that CBT can help individuals better understand their feelings in order to react to stressors and conflict more positively. Organizations such as the American Society of Hispanic Psychiatry and Therapy for Latinx offer nationwide databases for Latinx specialists, while Mental Health America provides resources in Spanish. If finances are a burden, the Substance Abuse and Mental Health Services Administration refers people to affordable treatment at the local level.

Marks advises that all children of immigrants remember they’re not alone. “Understand that whatever hardships and challenges you’re experiencing, you’re in good company and in many ways, it’s to be expected given the systemic challenges,” she says. “If you seek help, there are lots of ways of supporting yourself. Even the most challenging illnesses are treatable.”

There’s so much beauty in being the son of Nicaraguan immigrants and recognizing just how hard my family has worked to make my life better. However, I certainly wish I’d learn about the immigrant paradox—that US-born Latinxs are more likely to suffer from mental health disorders than their foreign-born parents—much earlier. Had I known, perhaps I would have developed the language necessary to ask for help when I felt like I was speaking into the void, not correctly articulating my emotions. It’s challenging to be a product of the immigrant experience, but I wouldn’t trade it for any other.

Editor's Note: July is Minority (or BIPOC) Mental Health Awareness Month. To learn more about the connection between racism and mental health and gain access to more support resources, check out Mental Health America's BIPOC Mental Health Toolkit.

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