The Trauma of Leaving Everything Behind

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Every community does mental health differently – some, more than others. For the Latinx community, which has largely ignored issues of mental health and addiction, a facility exists in Washington DC where community members can access medical, mental health, and addiction treatment all in one place. On this week’s episode, Nzinga sits down with Angie Castro, a mental health professional from La Clinica Del Pueblo, for a fascinating conversation about boundaries, barriers and bridges to well-being.

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[00:46] Dr. Nzinga Harrison: Hello, everybody. This is Nzinga and you are listening to In Recovery. This week we’re talking about mental health and substance use disorders in the Latinx community. Addiction and mental health changes from one community to the next. Just like it changes from one individual to the next. There are so many different factors that make trauma and thus mental health take a different shape in each and every one of us and each and every one of our communities. And this relationship between trauma, addiction and mental health cannot be ignored.


[01:41] Claire Jones: And we’ve been thinking about this a lot lately because of so many different things that are going on in the U.S. So we decided to bring on Angie Castro, the mental health clinical manager at La Clinica Del Pueblo, a nonprofit that provides culturally appropriate medical and mental health services and substance use treatment to the Latinx community in Washington, D.C. and Maryland. 


[02:02] Dr. Nzinga Harrison: We wanted to talk about this because, well, like many things on this show, it’s not really talked about because of stigma, racism, marginalization, etc. And you know we like shining a light on the things that we are typically pushing in the dark.


[02:20] Claire Jones: Yeah, we do. So let’s bring Angie on to talk about how La Clinica works to cater their care towards the specific needs of its community and why that’s so important to do everywhere. 


[02:32] Dr. Nzinga Harrison: So, Angie, we are super excited to have you here. Can you start us off by telling us a bit about yourself? And then also about your role at La Clinica.


[02:44] Angie Castro: Thank you for having me. I’m originally from Colombia. I’m an immigrant. I came to this country more than 10 years ago and I got my bachelors and masters at Florida International University. There, I discovered that the Latinx community, where it is spoken about many issues, but mental health was something that we didn’t talk about within our own community. Then I moved to the Washington area where I’ve been working as a clinical mental health manager. So I played supervision to other mental health providers. 


[03:33] Dr. Nzinga Harrison: So, Angie, we talk a lot here on In Recovery about compassion for being able to understand what another human being is going through. And so I have a question, but I kind of want to set it up by helping our listeners drop into a context of possibly being able to understand just a little inkling about the trauma and the loss associated with immigrating to this country. So think about it. It’s like when you’ve ended up with a much smaller environmental change where you felt like a fish out of water. So if you’ve ever, like, moved to another country for three months or if you found yourself in a part of town that you’ve never been in before and you get like discombobulated and you’re like, where am I? Who am I? I don’t even know how to know what’s safe. I don’t know who to talk to. And if I talk to them, I don’t even know what to say. It’s just like the state of uncertainty and fear and then take that experience that you’ve had, which is much smaller, and put on top of that that you had to leave your country to come to this country for some traumatic, scary reason that literally just drove you away from everything that you’ve known your entire life. 


[04:56] Dr. Nzinga Harrison: And even though that scary thing and that trauma in that country drove you out, still in your home country, you had a support system that is now not with you in the new country. And in that country, you spoke your native language and you understood the native customs and you knew what the food was going to be. You knew what a certain type of eye contact meant. And coming over to the United States — and just like COVID ripped the rug out from us, all of our natural routines, and we’ve been struggling with just losing those natural routines, even though we’re still in an environment that we recognize — think about that to the infinite degree, and we’re all experiencing something similar, even though we still have our same language, our same city, our same house. Think about the way you feel. Just by having those routines ripped out and layer on top of that coming to a completely new country with no support system, having been traumatized. And so the question is, once we access that compassion and try to understand what that could possibly be like, how do we help? How do we help people? One, how do we help people overcome the stigma and the fear of asking for help, which I’m guessing is even higher, especially if you’ve come here as an immigrant. How do we help people get over the barrier of asking a stranger for help? And so, Angie, this is one of the first questions that I want to ask you is how does La Clinica do that outreach and get to those communities who may even be suffering under the fear of even just being able to take that first step to reach out and ask for help? 


[06:48] Angie Castro: So it is a community that we build. So it’s not only about having a physician, but is having a whole group of professionals and paraprofessionals that work together with the community. So one of the things that we have in La Clinica that has helped us to see that we are not just a clinic, that we are a community and having health promoters that actually are not part of the staff, but they are trained by La Clinica staff to talk about health, to talk about diabetes, to talk about nutrition, to talk about the health of the community. So we have many health promoters outside talking and doing something that we haven’t seen before, normalizing conversation about health. Like at this moment we have so many promoters outside that when they see somebody sad, we teach them don’t use words like crazy or tell them you have to figure it out on your own because you are either a man, you can solve your issues by drinking. We tell them, hey, there is this place called La Clinica, somebody that is going to be there to talk to you, to listen to you. 


[08:20] Angie Castro: Because of COVID, we have utilized media, Facebook, Instagram. We have created a lot of campaigns in a language that is simple to the community. That was one of the things that we did, is like to talk about, hey, we are confused, let’s get together and talk about what is COVID, how do you use a face mask, how not to use a face mask. Things that seem simple, but we understand that we have to explain it. That’s how we have been able to get in our community. And something that usually happens with immigrant communities is that once you know somebody that looks near to you, closer to you. You go and ask hey, I know your name. You know my name. So if something happens, we know that we are similar. If we speak the same language, that means that we are a little bit closer. So through word of mouth, people have been talking about La Clinica because it offers different different services. 


[09:35] Dr. Nzinga Harrison: I love this. So the idea of a promotoras, I love that because they’re like your ambassadors that are taking the community out to the community so that people know that it’s safe. Right. Saying like, I’m being proactive about letting you know you may feel sad and there might not be something that we usually talk about, but this is a safe place to talk about. You may be drinking too much and you’re worried about your own drinking, but you would usually never tell anybody because of the stigma that comes with that. The promotora says we are not going to judge you for that. There’s not gonna be stigma for that. Come to talk to us. 


[14:43] Dr. Nzinga Harrison: I know one of the things that we’ve been noticing in our show is about addiction is drinking going up, smoking going up, overdoses going up as a result of the pandemic. I could imagine that just taking the harrowing path of immigration to this country could be putting people at increased risk for addiction and drinking and other mental health disorders. And put COVID on top of that and put our hostile landscape on top of that. And so I loved what you said, one of the ways La Clinica empowers the community is with education. And so talk to me about what you’re seeing with addiction in your community, attitudes towards addiction. How are you using education to kind of get stigma down and welcome people to the community in a way that you can help them?


[15:37] Angie Castro: Well, in La Clinica we have a program that is called Going Back to Life, for Spanish speakers who have substance use issues. It’s a program that has been with us for the last 18, 19 years. And it is a very well specialized program that teach what is substance use, not from a medical perspective, but from a Latino perspective, how we have normalized the use of alcohol since we were like 14, 15 years old. How every time that we have either happiness or grief, we go to alcohol. And that’s a way for us to be able to talk and normalize that. It is a value that we inherit from our community, but we also need to understand how it affects us and try to help people to understand and make decisions. If you have a lot of problems, there are ways to cope with feeling upset. Something that we have noticed, especially in the male community, they are not used to talking. They get overwhelmed very easily, and now have two stayed at home with kids, with wife, no working. That’s a trigger. That’s a trigger. And that has created a lot of issues in our community with either the male gets upset and they start arguing or just go and disappear and try to go and find some alcohol or drugs. And something that I do in clinical supervision is to try to explain to my providers that we have to teach our parents that they need space for them. They love the kids, but they need also their space as adults.


[17:46] Dr. Nzinga Harrison: Yes. We love you kids. But get out for a few minutes.


[17:52] Angie Castro: And the boundaries. And that’s something that we in the Latinx community and many immigrant communities, we don’t see the boundaries. And we think we as parents, we are supposed to be with our kids 24/7. The word “boundaries” doesn’t even exist in Spanish. So when you come to this country and say boundaries, they’re like, what boundaries? And now with the COVID, it has created more conflicts because now everybody’s on the same space. Kids are Americans, or if they came really young, they start learning about having boundaries, having my space, that’s very common here. For parents it is like, what’s space? This is my home. We have to eat together. Something that we have noticed is that many families, when they see they have alcohol issues or drug issues in their families, they try to use the kids to convince parents not to use. For example, I have a case where a mom asked daughter to ask dad not to use drugs.


[19:19] Dr. Nzinga Harrison: That’s difficult. 


[19:20] Angie Castro: And because what they don’t understand the complex of substance use. And that’s something that we have to teach parents. No, kids are not supposed to be that. Kids are kids.  They have to just worry about school at this moment, homework, and their chores. That’s something that the group does. They not only address this substance use to the user, but to their partners and families to teach them substance use is this. What is your role as a partner? What is your role as a kid? If a wife, mother, parents, and kids are not involved either they’re going to have triggers for the person that is using, you know, helping them or actually they will be allowing things because they think that that’s love. 


[20:18] Dr. Nzinga Harrison: This has really got me thinking about cultural humility. And like, I think it’s a human trait for sure, but I think it’s also a very United States of America trait to have a difficult time recognizing experiences that are outside of our own experiences. Like we see the world this way because this is what the world is for me. And so I assume this is what the world is for other people. And like, I’m just listening to you because I could easily see — I’m trying to get to the importance of a culturally shared therapist. So we did our Therapy 101 episode and we told people it’s perfectly fine to look for a therapist like you that understands you so that you don’t have to get over the barrier, for example, of explaining why you asked your daughter to ask daddy not to use. Like, if that mom was in a visit with a therapist who doesn’t understand that cultural aspect from the Latinx community, then there’s like the potential for judgment. And so that is to me, just like reinforcing this idea of how important it is to be in that type of vulnerable therapy relationship with someone who understands, or at least — because I know every community doesn’t necessarily have those resources, but if you’re a therapist or mental health professional psychiatrist, doctor, like, whatever it’s opening yourself to just know what you don’t know. To know that, like, you don’t understand this, so open yourself.


[22:02] Angie Castro: And ask questions. Ask questions. Clients are the ones who are teachers, everything that we know. That’s something that people maybe doesn’t understand. It’s not because I’m Latina, and because I speak Spanish that I know what I know. It is because actually I ask my clients. The community that I serve in Miami is completely different from the one that I serve here. Not because they speak the language and I identify myself as a Latina. It means that I understand my community. Communities are completely different, and all that I know is because I asked my client for clarification. There are cultural aspects even if we are in the same country. I don’t move in the same way that I move in Florida. Two different persons. So imagine the immigrant community. We are so big and trying to say that we all behave the same way is wrong. I always ask for clarification. And they’re more than happy — you don’t know how big it has been, the impact, when we as our kids, even the kids, when we ask what did you mean by that? They are like oh, I mean this, this and this. I’m like, wow, I didn’t know. And they’re like, oh my God, I’m teaching an adult? And that creates a different and that creates a different dynamic in any type of relationship that you have. 


[28:10] Dr. Nzinga Harrison: Angie, I wanted to jump into something that I’ve heard a lot that is said against people who immigrate to the United States. And it’s this judgment that’s like if you love your country so much, then why are you here? Why are you coming to the U.S.? Can you tell me some thoughts about that?


[28:36] Angie Castro: For immigrants, when they come to the United States, they idealize United States as the country that is the heaven. Nothing happens in the United States. And of course, we know it is like any other country, we have good and bad things. And we as immigrants, even though we experience trauma, we have families, we have friends and the landscapes in our countries, the food in our countries make us what we are. They have a history in their home country. They left something there that makes them who they are at this moment. And something that we have to understand as immigrants is that we need to be proud of that part of who we are. That’s our second skin and is part of our personality. And that’s going to help us to accommodate and to learn from this country. It’s not forgetting who we are. It is empowering that beauty of our countries, and that resilience, because just by coming to this country and making it, just shows resilience because you have to overcome I don’t know how many things. Just by you being here, learning the language, learning how the system works, that’s resilience. And how did you get that? Because of the experience that you have in your home country. 


[30:17] Dr. Nzinga Harrison: When a person immigrates to this country, the arms that we need to receive these human beings with are arms of pride and empowering the beauty of the cultures that they have come from. The beauty of the identity that they bring with them. The beauty of the resilience that they are on what is most certainly a painful path. And I think if we can receive with those warm arms, then we can have the conversations about addiction and health and mental health and physical health and community. But the first stance has to be, I am so proud of the country you came from, the culture you bring with you, the resilience that it took to be in this place that you’re standing today. I think that could make all the difference. So, La Clinica sounds like it does more than this narrow concept in the U.S. that we have of medical care, which is just like see a doctor, get a medication, go about your way. It sounds like this more global connection to resources, welcoming into the community, helping you navigate this new environment that you may find yourself in as an immigrant. And so are there any particular individual stories or experiences that you’ve had that you feel like really make the heart and soul of La Clinica shine as different from other resources that are available to the Latinx community in D.C.? 


[31:56] Angie Castro: One of the many, many stories that I can think of that we don’t only think about physical health, but we think about social health, mental health. And we tried to provide a safe space, but not making the people be dependable in the clinic, but providing them support and information so they can continue with their lives. In terms of domestic violence, we have many cases of women who found a safe space in La Clinica. And now they’re empowered to talk about their rights as women, as immigrants. And they know that they have the ability to look for help in many places, regardless of their immigration status. So it’s something that in La Clinica we are building for our community.


[32:53] Dr. Nzinga Harrison: Yes. I want to jump on this word empowered because, you know, I am about empowering all people. And so I want to jump on that from a couple of angles. So right now, thinking about racial dynamics, racial and ethnic dynamics in this country, we’re right now in the midst of a huge civil rights movement against police brutality and racism against black people. I think before that, we were seeing a lot of images on the news about the oppression and mistreatment of immigrants. And these basically look like concentration camps and the abuse that’s happening at the border. We talk a lot about vicarious trauma. And I found myself worrying about like my Latinx brothers and sisters that are watching on TV kids in cages and hearing these stories of, you know, people dying as they’re trying to make the trip over and maybe being pushed into hiding for fear of what is happening in the United States with the government towards Latinx-appearing people. And I’m wondering, how did you see that affecting the community members at La Clinica? How was that affecting you as an individual? And how do you empower the community when those events are happening and you’re just being barraged by those images through the media, how it impacts the community? 


[34:29] Angie Castro: Well, from two angles. First one, any of their kids or their families are the ones that are in their borders being separated, or they have been waiting for a family member to come and waiting after months and months, they find out that either they were deported back, they didn’t make it. So it affects personally our community because we have many, many people who have their family members in the caravans trying to come. Running away from something that is making them leave their country. So that’s one way that our community has been affected directly. 


[35:12] Dr. Nzinga Harrison: Directly. This is not just a story on the TV. 


[35:17] Angie Castro: So the other one, the ones who made it past the border, but they were separated from their kids. We have those cases, where we have kids crying, I don’t want to be separated from my mom. We have mothers crying, saying I’m afraid somebody is going to knock on the door and they’re going to take away my kids again. So we know the stories personally. We have heard them. How we have empowered them, is I think empowerment means education, education, education and education. The more education you have, the more perspective you are able to listen to, you’ll be able to understand and be empowered to either ask for help, provide assistance. And that’s what we do in the clinic. We as community, as the ones listen, we try to be informed from different perspectives. We have different connections that help us to understand and advocate for solutions. And that’s something that we do personally — I guess many of us as providers listening to these stories of trauma, extreme trauma, we get burned out. 


[36:48] Dr. Nzinga Harrison: How do you take care of yourself? 


[36:50] Angie Castro: It has been a little bit difficult to be honest, especially through the pandemic, because we have to modify everything in less than 24 hours. So we didn’t have the chance to actually to de-escalate the thing. The things that we usually do. And working seriously, working all the time in computers makes you feel more overwhelmed. So it’s a rollercoaster of feelings. But in the clinic, we have been trying to create the spaces for to talk. How do we feel? Not as professionals, but as a humans. And it’s like, how do we feel? How do those of us who are parents deal with pandemic plus children and school. If we as professionals, we feel frustrated, we can imagine how our patients that they don’t have all the resources that we have can feel about it. So having this phase where we as staff, we’re able to actually express how we were feeling, we felt that we were not alone. And that’s what community does, having spaces where we can actually vent out and say, hey, even if I have three or four or five degrees I’m still a human. We don’t have all the answers. That’s something that we say to many of our patients and clients, that sometimes we don’t have all the answers, that we are trying to help them to also find the solutions, but sometimes is out of scope. Sometimes is something completely new. Sometimes we have to take a break and say, OK, this is new. Like we have cases recently that they tell us things that I have to say, OK, I have to disconnect myself for 20 minutes before I can see the next person. Otherwise, I’m going to affect the person, I’m not listening well. So it’s having those times following what everybody has, eating well, trying to walk, but is not only reading it, but doing it. So it’s like trying to find something that you’ll feel okay. This is something that I feel good about and tried to do that. That’s how we have been able to get past these times. But it is difficult, to be honest. 


[39:20] Dr. Nzinga Harrison: Yeah, it’s dramatically difficult. Like I said, just for those of us who don’t even have the added complexity of being immigrants and being subject to The mistreatment, honestly, to call it what it is. And did you have anything else that you want to add that we didn’t ask or any final words that you want to say?

[39:46] Angie Castro: Mental health is an issue for everyone. Every single race, skin color. We hope it’s getting bigger, the movement about talking about mental health, and we’re all in this together.


[40:03] Dr. Nzinga Harrison: Thank you so much. So this is Angie Castro from La Clinica in Washington, D.C.. We’ll definitely drop their information in the show resources. But I’d say we’re super-value-aligned, the high level themes between In Recovery and La Clinica, which is compassion and community, and talking about the things that are scary to talk about, including addiction, mental health, all of the trauma, other experiences that come along with being an immigrant and then also shared experiences between those who have immigrated here and those of us who have just been here, humans first with a shared experience. There’s no us and them, as I have come to say, just thus. So thank you, Angie, so much. 


[40:44] IDr. Nzinga Harrison: In Recovery is a Lemonada Media original. The show is produced by Claire Jones and edited by Ivan Kuraev. Music is by Dan Molad. Jessica Cordova Kramer and Stephanie Wittels Wachs are our executive producers. Rate and review us and say nice things. And follow us @LemonadaMedia across all social platforms, or find me on Twitter @naharrisonmd. If you’ve learned from us, share the show with your others. Let’s help destigmatize addiction together. 


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