No Images? Click here Last weekend, HuffPost's Roque Planas published a gripping tale of one Texan's mental collapse ― and what her struggles could mean for the rest of us. If you've already read the piece (it's on the site here), scroll down for our interview with Planas. If not, now's your chance ― here's the beginning of the story:What Happened To Norma’s Brain?AUSTIN, Texas ― For as long as she could remember, Norma Herrera had trouble getting to sleep. Hours after the rest of her family had closed their eyes, she’d stay up in her darkened room, praying. When she finally slept, she often dreamt the same dream. Men dressed in black suits entered the home her family rented in a South Texas town and dragged her father away by his feet. As Norma grew older, the nightmare changed. Sometimes the men in black chased her, too. Other times, she sensed a presence she couldn’t see. But she knew it was coming after her and she needed to run. The fears that haunted Norma’s dreams spilled into her waking life. The image of her father being abducted popped up during job interviews. Paralyzing anxiety choked her when it came time to speak in public. Benign interactions with work colleagues left her feeling scared for her safety. By early 2016, Norma, then 28, had started bringing up her fears with friends and family. One evening that February, she sat down with two good friends on the patio of an East Austin bar. Over Lone Stars and food from a nearby street truck, she told them she worried something wasn’t right in her head. The confession drew confused responses: She was young, had earned a master’s degree, was bringing in decent money, her friends argued. And after having lived most of her life as an undocumented immigrant, she was 10 days away from taking the oath of U.S. citizenship. Maybe she was complaining too much, she thought to herself. Eventually she dropped the subject. But as Norma got into her car to leave the bar, her mind spun out of control. It was as if someone had thrown a firecracker into her brain, leaving her unable to think. She didn’t know what was wrong. She only knew she had to get to a hospital. She drove two and a half miles up the highway to St. David’s Medical Center, went inside to seek help, and then, panicked and confused, fled back to her car. A few minutes later, a police officer pulled Norma over. She was relieved when she saw the blue and red lights. She stopped in an Applebee’s parking lot, jumped out of the car and ran toward the officer, pleading for help. This startled the officer, who ordered her to get back in the car and wait for him to speak to her. He asked her to hand over her license and registration. He smelled beer on her breath. Norma kept insisting she needed medical attention. She admitted drinking a few beers before getting behind the wheel, but told the officer she’d just come from the hospital. He kept asking for her ID. Swinging between tears and rage, she threw her purse, with her ID inside, on the ground — and then got out of the car to pick it up. According to the officer’s report, Norma lay “on the ground and threw her shoes away from her” and “curled up on the ground yelling and rocking herself.” Then, she asked the officer whether he had his gun. “Can you shoot me with it?” Norma said. When he refused, she charged at him with her hands raised. The officer grabbed her by the right wrist, handcuffed her and loaded her in the back of his car. Instead of finding solace in a hospital bed, Norma ended up on suicide watch in Travis County Jail, facing a criminal charge. But at least she would find out what was going on inside her brain. As a kid, Norma made her bed every morning, tidily arranged her toys and shoes, and obsessed over her grades with such anxiety that it concerned her siblings. But they also recognized their sister was following a script her parents had etched into all their brains: Work hard, don’t complain, stay out of trouble. That simple formula allowed her mother, a home health attendant, and her father, a laborer in the oil fields, to build the family’s life in South Texas for two decades despite their lack of legal immigration status. Before the night of her arrest, Norma never had so much as a speeding ticket. Now, she was ensnared in the criminal justice system. Norma was booked into Travis County Jail in the early morning hours and charged with driving under the influence. At 6:42 p.m. that night, she was released to her sister on a personal recognizance bond, issued on the condition that she check into Brackenridge Hospital — an irony for someone who’d gotten into this legal mess because she was seeking medical attention. After five days of inpatient psychiatric care, five weeks of outpatient therapy and a battery of questionnaires, Norma received multiple diagnoses: generalized anxiety disorder, recurrent major depression disorder, and post-traumatic stress disorder, or PTSD. The last one surprised her. She had filled out mental health questionnaires several times over the years and always ignored the questions about PTSD. “I’d say, ‘Oh no, that’s for veterans or whatever,’ because my childhood didn’t fit neatly into that criteria,” she recalled. “When someone finally said that, I was like, ‘What? This whole time?’” Many factors had taken a toll on Norma’s mental health. Her parents had so much trouble making ends meet when she was a child that sometimes she’d return home unsure whether the lights would be on or whether she’d have to boil water to bathe. Her youngest sister also suffers from a life-threatening illness that constantly worried the family. But Norma’s condition was likely triggered ― at least in part, one of her doctors told her ― by the experience of living as an undocumented immigrant in the United States. Her recurring nightmares were a symptom of her illness. What happened to Norma? What's the science behind all of this? The rest of the story is here. We also asked Planas about his piece. Here's what he told us.How did this story come about? I had long been aware that PTSD is a common result of making the dangerous crossing into the United States or spending prolonged time in detention, but Norma was the first person I met who’d received that diagnosis purely as a result of her experience in the United States. She left Mexico as a kid and crossed through a legal port of entry. It became clear that one of the dominant traumas that accounted for her condition was witnessing her mother’s deportation, along with that persistent fear and anxiety that comes along with knowing that you or your family could get arrested at any moment. But as she explained it, her condition made a lot of intuitive sense. And it seemed like if this were the result in her case, it is probably a lot more common than we might think. So I went to Dr. Luis Zayas, the dean of social work at the University of Texas and an expert in the subject of trauma among migrants, and I posed to him that question — is it possible that there are huge numbers of people at risk for serious mental disorders purely as a result of their immigration status? And his answer was basically “yes.” That got the ball rolling. What was the most challenging part of reporting, writing or editing this piece? The most challenging part was trying to accurately communicate the scope of the problem based on the little research we have available. There are no big national studies about how living without legal immigration status affects mental health, largely because it’s difficult to design them in a way that would pass muster with the Institutional Review Boards that set standards for research on human subjects. The fear is that if you start asking someone about their immigration status in a medical survey, you might dissuade them from seeking treatment. So the studies that exist tend to be small in scale. But the general consensus among people that research the impact of immigration status on mental health is that we’re underestimating the scope of the problem. And given that about 80 percent of the undocumented population comes from Latin America, some experts think other anomalies within the Hispanic population might be caused — at least partially — by the mental health problems associated with lack of legal immigration status. Some of these issues didn’t make it into the piece for lack of data. For example, young Hispanic women have the highest rate of suicidal ideation in the United States. There are researchers who suspect that uncertain immigration status among some of those young women or their families might be elevating that figure. But we don’t have the research to support a contention like that. Or, to take another example, we know that trauma and the symptoms of mental disorders aren’t just in people’s heads — anxiety, depression, hypervigilance, etc. speed the heart rate, create gastrointestinal problems, cause inflammation. Some researchers look at the fact that Hispanics have a much higher rate of diabetes than the Anglo population and suspect that the immigration enforcement trends of the last three decades might have something to do with it. But again, this is all conjecture. And given the difficulties in crafting ethically acceptable research, I’m not sure that we’ll know the answers to some of these questions any time soon. What readers should take away from this piece? I’d like it if people can try to wrap their heads around the sheer scale of the mental health issues our immigration enforcement policies provoke, especially as Congress and the White House debate the future of DACA. The immigration debate right now is dominated by strident and often misinformed voices. If readers can spend a little time considering what it might be like to live in Norma's mind, and then to imagine the possibility that some version of it might be happening in the minds of millions of other people in this country, I would consider the story a success. Love, |