The article, "Developmental Indices Among Central American Immigrants Exposed to War-Related Trauma: Clinical Implications for Counselors," by K.K. Asner-Self, and S.A. Marotta, explains that Central American immigrants go through levels of depression, anxiety, and post-traumatic stress. The developmental disruptions that plague Central American immigrants results in mistrust, identity confusion, and isolation. Furthermore, children who have experienced war violence also experience different psychological effects. The article, "A Risk and Resilience Perspective on Unaccompanied Refugee Minors," by J. Cacciatore, B.E. Carlson, and B. Klimeck delineates coping strategies to help child refugees adapt to a new environment. These strategies include a positive outlook, use of healthy coping mechanisms, religiosity, and connection to prosocial organizations.
This research is on children; however, the results are relevant for adults. In "Psychological Problems in Refugee Children Exposed to War," by L.A. McCloskey and K. Southwick, the article also discusses how war violence affects children differently than adults. While children are usually only treated for physical not mental health, refugee children are more likely to have both physical illnesses and mental health problems. Meanwhile the article, "Mental Health and Health-Related Quality of Life Among Adult Latino Primary Care Patients," by D.P. Eisenman et. al., explains that Central American immigrants have mental health disorders at higher rates. This article also recommends that health care providers should ask about their patients' histories as their exposure to war could reveal necessary background information.
Lastly, "Common Mental Health Problems in Immigrants and Refugees: General Approach in Primary Care," by G. Hassan, L.J. Kirmayer, and L. Narasiah, research how the three phases of migration (premigration, migration, and postmigration) have specific risks and exposures for immigrants. The specific challenges immigrants face regarding their mental health includes communication difficulties, acceptance, and intergenerational conflict.
Background and Discussion
Alma Vazquez is the woman I interviewed. She was born on May 23, 1968 in San Salvador, El Salvador. In 1984, Vazquez came to Los Angeles, California at the age of sixteen with her mother, father, older brother, and older sister. I interviewed Alma at her house in Lancaster, California for thirty minutes. She is my maternal aunt, and I chose her for this interview because she was also exposed to war violence.
The interview began as Alma Velazquez described the violence she had witnessed when she was a child in El Salvador. She told me that her earliest memory of violence occured when she was eight years old. Alma was watching the funeral of a priest on television and then a shooting started at the funeral between the Salvadoran army and the FMLN (Farabundo Marti National Liberation Front). This was a traumatic experience because the priest was well loved and respected in her community for helping the poor people. While this was her first memory of a traumatic incident, Alma said she experienced violence on a daily basis in El Salvador until she left the country. She explained that she saw the army walking throughout her town every day. Alma said, "Like in a week, the army came marching six days out of seven, so it was like constantly." The army's presense was always around Alma and her family. She also described instances when the FMLN army would come to her school. She said there was always one person watching at the school to see if the army was coming. Alma stated that "when the person saw the army coming, he would ring the bell and then the teachers would start yelling 'everybody get to your home right now because the army is here and they are going to take you.'"
Another violent incident from Alma's childhood was set at a carnival fair in town. The carnival had many rides including a Ferris Wheel. Alma was with her older sister when the lights of the carnival went out and she heard gunshots. The shooting started by the FMLN army and Alma heard everyone screaming. Alma and her sister were able to reach their house unharmed, but when they arrived home, they noticed their brother was not home. Alma stated, "I was very scared when I couldn't find my brother. I was scared that he got shot." Her brother finally made it back to the house and they sat in silence until the shooting stopped.
Alma's parents decided to move to the United States because of the violence. Alma said that her mother had previously worked in the United States and wanted her family to move. But Alma's father did not want to move at first because of his job. Alma's family had financial stability in El Salvador and they were able to live comfortably. Alma said, "We had our house and my father's salary was good and he would take us to the movies or to restaurants on the weekend." She was also afraid to move to the United States because she did not know English and did not know the country. When Alma's family decided to leave, they had to leave quickly because the FMLN army was in town grabbing children. Alma stated, "We got our luggage carrying as much as we could and we just left. We didn't know what happened to our neighbors because we just left."
When Alma came to the U.S., she did not seek help for any mental health issues. She was not aware of any resources that were available for Central American immigrants when her family came to Los Angeles. She said, "The community from El Salvador in the U.S. was kind of small because of immigration stuff; they were afraid of being deported." Alma also explained that her parents were not interested in receiving any help. Once her parents got jobs, they felt okay. She felt safer in the U.S. because she didn't have to see the FMLN army, though she did feel some fear because of gangs. Alma said, "When I came to the United States, there was the drug issue and there were gangs that started like the Salvatrucha and the 17 and 18. I didn't know what the numbers meant and I just stayed away. I was getting away from the dangers in El Salvador and I didn't want to be in danger of the gangs here."
Alma went to high school in Los Angeles, but she didn't make many friends. Her lack of friendships can be related to the article, "Developmental Indices Among Central American Immigrants Exposed to War-Related Trauma: Clinical Implications for Counselors" (Asner-Self, K.K., and Marotta, S.A., 2005). The article states, "These studies and others have indicated that people exposed to trauma exhibit higher levels of mistrust, identity confusion, difficulty in development of intimate relationships, and isolation." This means that Alma's exposure to war violence in El Salvador may have affected her ability to create friendships. She may not have been able to trust her classmates and decided to isolate herself. Alma also had a fear of gangs by living in Los Angeles. This fear could be because she developed higher levels of mistrust.
Alma has not visited El Salvador since she moved to the United States. She stated, "I have my children and I try to stay positive. I don't even talk about what happened over there. And I thank God for protecting me." This method of having a positive attitude is mentioned in the article, "A Risk and Resilience Perspective on Unaccompanied Refugee Minors" (Cacciatore, J., Carlson, B.E., and Klimek, B. 2012). The article states, "The sources of resilience includes positive outlook, use of health coping mechanisms and religiosity, and connectedness to prosocial organizations." Cacciatore et. al. explain that these sources of resilience have been seen in refugee minors as well as adults, like Alma. Her resilience is her positive outlook and her religiosity as she has four children and attends church. This is able to help Alma forget about her past exposure to the war violence she experienced by focusing on her family and religion.
Alma mentioned that she does not talk about the war violence she experienced in El Salvador. The article, "Mental Health and Health-Related Quality of Life Among Adult Latino Primary Care Patients Living in the United States With Previous Exposure to Political Violence," explains that Latino immigrants are more likely to have chronic pain and have lower perceptions of general health (Eisenman, D.P., Gelberg L., Liu, H., and Shapiro, M.F., 2003). The article states, "Only 3% of 267 respondents who had experienced political violence reported ever telling a clinitian about it after immigrating, and none reported their physician asking about political violence." This article explains that Latino immigrants rarely talk about their past with their doctors. Alma and other Central American immigrants who have witnessed war violence should explain this to their doctor because it could affect their overall health.
Alma and her family did not search for any resources that were available for them. The article, "Common Mental Health Problems in Immigrants and Refugees: General Approach in Primary Care" explains that this is common for many immigrants (Hassan, G., Kirmayer, L.J., Narasiah, L. Munoz, M., Rashid, M., Ryder, A.G., and Guzder, J. 2011). This article states, "Immigrants and refugees are less likely to seek out mental health services. This can reflect both structural and cultural barriers, including the lack of mobility or ability to take time away from work, lack of linguistically accessible services and the desire to deal with one's problems on one's own." This can be seen when Alma's family came to the United States, and they were focused on getting jobs to secure their financial stability. They weren't aware of any resources that were available for them and did not search for any resources. By not seeking any mental health services, this could have affected Alma's family's mental health.
Alma commented regarding the issue of war violence, "I know that because of what they saw in El Salvador they drink and smoke and even get depressed, you know, and they have to take pills because they get nervous, but I think after all my time in the U.S., I'm okay." The article, "Psychosocial Problems in Refugee Children Exposed to War," states, "This finding indicates that after a period of time, if a family remains intact, children and parents can heal from political abuse and the impact of war, but the immigration experience itself poses a profound stressor" (McCloskey, L.A., and Southwick, K., 1996). Alma seems to have healed from the war violence after being in the Unites States for thirty-three years. I do not know if Alma's mother and father have healed from their exposure to war violence, but it would be intriguing to compare their experience with Alma. Furthermore, Alma's viewpoint of El Salvador seems to be negative. She stated, "I don't want to remember what happened and I don't want to go back. I know that El Salvador is beautiful, but it is still dangerous." Alma's exposure to war violence has affected her viewpoint on the country. She does not wish to return for a visit to El Salvador. Her reluctance to return to El Salvador is a psychological effect of her exposure to war violence.
Central American immigrants who have been exposed to war violence go through psychological struggles that affect their mental health. The interview I had with Alma Velazquez, a Central American immigrant exposed to war violence, showcases the struggles outlined in the five studies examined in this paper. There is also a question on how my interviewee's psychological effects are different from her parents. There is also a question of how my interviewee would react if she ever returned to El Salvador. Central American immigrants have psychological effects that affect them differently, and doctors should always consider how past war violence will affect the daily lives of immigrants.
Asner-Self, K.K., and Marotta, S.A. (2005). "Developmental Indices Among Central American Immigrants Exposed to War-Related Trauma: Clinical Implications for Counselors." Journal of Counseling & Development: JCD, 83(2), 161-171.
Cacciatore, J., Carlson, B.E., & Klimek, B. (2012). "A Risk and Resilience Perspective on Unaccompanied Refugee Minors." Social Work, 57(3). 259 - 269.
Eisenman, D.P., Gelberg, L., Liu, H., & Shapiro, M.F. (2003). "Mental Health and Health-Related Quality of Life Among Adult Latino Primary Care Patients Living in the United States With Previous Exposure to Political Violence." JAMA, 290(5). 627 - 634.
Hassan, G., Kirmayer, L. J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A.G., Guzder, J., Pottie, K., & Rousseau, C. (2011). "Common Mental Health Problems in Immigrants and Refugees: General Approach in Primary Care." CMAJ: Canadian Medical Association Journal, 183(12), 959-967.
McCloskey, L.A., & Southwick, K. (1996). "Psychological Problems in Refugee Children Exposed to War." Pediatrics, 97(3). 394-397.