There is a lot of conversation happening these days around appropriate treatments for mental health issues, the place for psychotherapy and medications and the challenges with each. I wanted to contribute to this conversation with some insights of my own.
One population I don’t see being covered in the conversation on psychotropic medication use, but that, in my opinion, is uniquely affected by it, is the immigrant population. I especially am sensitive to this topic, as my father has been mistreated with psychotropic medication to treat his immigration adjustment challenges in the 90s and has been disabled ever since.
There are several interconnected factors that may push immigrants who struggle with mental health challenges toward medication-focused treatment, instead of psychotherapy, sometimes inappropriately and without enough informed consent or adequate ongoing support:
- Language barrier – Many immigrants arrive to a new country without a strong command that country’s language. This immediately limits their access to traditional talk therapy. It is already challenging enough to find a good therapist, even if you speak the language well, but finding one who speaks your language and understands your culture can be nearly impossible.
- Challenging experience – Immigrants face many adjustment challenges, all at the same time. They need to rebuild their careers, learn a new language, learn to fit in in a different culture, establish a new social circle and figure out unfamiliar ways of being. Some people are more resilient than others, but many struggle with anxiety, depression, loneliness, and a loss of identity or status, which are all very appropriate and understandable reactions to the immigration experience.
- Time and money constraints – Immigrants often do not have the financial cushion or support network that would allow them to take it slow, take a break for self-care and recover when faced with mental health struggles. They need to keep going, function, find work, support their families and basically survive. There may not be enough time, money or space for lengthy weekly talk therapy or for taking a break. Medication can therefore be presented as the quickest and most practical solution.
- No support network – Most immigrants also have to rebuild their network of trusted professionals once they move. They no longer have their trusted doctors, friends and relatives who could recommend someone or help them get a second opinion if they need one. They may end up seeing a random practitioner who happens to be available, without knowing whether that provider is trustworthy or a good fit.
- That’s how we do it here – New immigrants may be put in a position by their doctor that they need to accept the new medical system without questioning it. Something along the lines of: “This is how we treat these problems in this country.” Psychiatric medication may be presented to immigrants as the modern progressive solution, especially when language challenges and time constraints might make it difficult to have a more detailed conversation about alternatives.
- Stigma around psychotherapy – In some cultures, there is still a stigma around psychotherapy. A medical explanation for mental health challenges, such as being told that depression is caused by a chemical imbalance, might feel more palatable than speaking with a therapist. Medication then, may feel less shameful and more legitimate.
- No support for issues – If immigrants experience side effects when taking a psychotropic medication, or feel that its not helping them, or want to stop taking it altogether, advocating for themselves in that (often quite challenging) space might be extremely difficult, because of all the reasons described above.
What this creates is a condition where if an immigrant is struggling with their mental health (and lets face it, immigration is a very taxing experience) – putting them on medication may become the easiest and most accessible option. It may be offered to them instead of psychotherapy, without a full discussion of alternatives and side effects, and without adequate follow-up and support if issues arise.
I feel that there is not enough conversation about this exactly because of the reasons I described above – language barrier, people not in positions to advocate for themselves (not in academia, for example), people already taxed with surviving and establishing themselves, etc. Plus, people who are not immigrants themselves, do not understand or relate to this experience and its challenges, and so do not even think to study this population.
Wanted to share this perspective.