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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 laid “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.

Norma, age 5, poses for her kindergarten graduation photo.

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.

Getting that diagnosis came at a high cost. A few weeks after she was released from jail, Norma received a call from U.S. Citizenship and Immigration Services. Her appointment to take the oath of citizenship had been canceled, pending the outcome of her criminal case. She’d been charged with driving under the influence. And although she has lawful permanent residency in the U.S. through a marriage to her high school sweetheart (which ended in an amicable divorce), a DUI conviction might bar her from reapplying for citizenship for five years. There was a chance it could disqualify her altogether.

I’d say, ‘Oh no, that’s for veterans or whatever,’ because my childhood didn’t fit neatly into that criteria. When someone finally said that, I was like, ‘What? This whole time?’Norma, on learning she had PTSD

Norma knew the fears that still kept her up at night weren’t irrational. Early one morning, when she was 14 years old, she experienced a real-life version of her worst nightmare. She was jolted awake at her family’s home in a town near the border when an immigration agent shined a flashlight in her face. Norma and her older sister, both undocumented at the time, watched alongside their father as agents escorted their mother to a white van outside and drove away. “It felt like I had imploded,” Norma said. “Nothing is safe.”

A few days later, Norma’s mother picked her up from school as if nothing had happened. Her mother remains undocumented and subject to deportation, but immigration authorities have allowed her to stay in the country and work legally so that she can care for Norma’s chronically ill younger sister, who is a U.S. citizen. Norma’s father, who was detained and put into deportation proceedings after a worksite raid in the late 1990s, was also given permission to stay in the U.S. on the same, common discretionary grounds.

Norma’s parents declined to speak on the record about that deportation, out of fear of jeopardizing their tenuous permission to remain in the country. But the event left a lasting impression on Norma’s family. Her parents started keeping the window blinds shut. Her youngest sister refused to go to school. Her oldest sister started having panic attacks.

And Norma often thought about her mother’s deportation. But she never realized that a trauma like that could play a role in provoking PTSD.

U.S. Immigration and Customs Enforcement agents approach a house in the pre-dawn hours to make an arrest in San Diego in 2006. (File photo)

The disastrous mental health impact of growing up undocumented was extreme in Norma’s case. But it wasn’t unique. An emerging body of research indicates that just living in the United States without legal immigration status could be wreaking havoc on the mental health of hundreds of thousands of immigrants.

When human beings experience traumatic events — whether the violence of combat, sexual abuse, natural disasters or other frightening episodes — the mind can carry the burden long after the danger has passed. One of PTSD’s main triggers is chronic stress, which causes oversecretion of the hormones adrenaline and cortisol, leading to outsized emotional responses to even small occurrences — in a word, “hypervigilance.”

Hypervigilance makes people acutely aware of their surroundings, perpetually guarding against perceived threats and portents of danger. Unrelated events can send them mentally back to the moment they suffered a trauma.

As Norma entered treatment, the crises and neuroses that had bedeviled her for much of her twenties began to make more sense.

Norma had struggled with depression and anxiety since she was a child, but it was only when she moved to Austin, for graduate school, that she’d felt her grip on her mind begin to slip. Hispanics are by far the majority in the Rio Grande Valley, where she grew up. In Austin, she felt like a minority for the first time.

In graduate school, she clammed up when it came time to speak in class, frozen by feelings of inadequacy despite having earned a full-ride scholarship. At her new job, she sometimes worried that her co-workers were talking down to her, their sentences ending with a rising cadence the way someone speaks to a baby or a dog. She joked with her friends that white people made her uncomfortable. They laughed. The sentiment embarrassed her, but she meant it. She felt like she was in danger. But for years, she couldn’t understand why.

Now, armed with her new diagnosis, Norma could understand the source of her anxieties. The constant sense of foreboding, the extreme fear of speaking in class, the guardedness around her white colleagues — these were classic examples of PTSD-associated hypervigilance.

Feeling constantly on edge, as Norma did, repeatedly jolts the amygdala, the part of the brain that triggers fear. The resulting sensation, often referred to as the “fight or flight” response, is a normal evolutionary protection against danger. The pang of anxiety triggered by looking down off a high ledge or the jitters that shake us before a big public speech are our amygdalas telling us to pay close attention to the world around us, because the stakes just got higher.

But the human body isn’t designed to live in a fight-or-flight state constantly. Over time, stress hormones get depleted. The first symptoms of that depletion are often physical ― stomach pains, headaches. As the condition progresses, mental disorders, like anxiety and clinical depression, become common. When compounded by trauma, like the deportation of your mother, hypervigilance can develop into full-blown PTSD, complete with nightmares, flashbacks and explosive reactions to events that trigger the worst memories.

That progression — from hypervigilance, to anxiety and depression, to PTSD — appears to be what happened to Norma.

Norma now works as a criminal justice and mental health services organizer at the advocacy group Grassroots Leadership in Austin.

Something similar is likely happening to many more immigrants as well. Nearly a quarter of the 248 undocumented immigrants interviewed for a study last year in one Southern California town showed signs of suffering a mental disorder ― most commonly major depressive disorder, followed by panic disorder and generalized anxiety, according to Rice University psychology researcher Luz Garcini. Both that study and a follow-up found that younger immigrants, those between the ages of 18 and 25, were more likely to show the most profound effects.

The personal histories Garcini took from her survey respondents also suggested that their mental health problems resulted from life here ― not in their country of origin. “What the data is showing us now is that, unfortunately, most of the trauma happened while living in the United States,” she told HuffPost.

European researchers reached similar conclusions in a 2012 study of 391 refugees who visited a free clinic in Italy. Some 10.2 percent of them suffered from PTSD. Some had migrated from war-torn countries. But the ones most likely to show symptoms of PTSD were those who hadn’t obtained permission to live legally in their new country, exposing them to unemployment, isolation and the persistent fear of arrest.

The growing consensus that undocumented immigrants face urgent mental health risks doesn’t surprise Luis Zayas, dean of social work at the University of Texas at Austin and an expert in trauma among recently arrived Central American immigrants. The constant fear of arrest or deportation predisposes undocumented immigrants to hypervigilance, he said.

“Imagine what it’s like to leave your home every day, looking over your shoulder, so to speak,” Zayas told HuffPost. “You’ve heard about men and women coming back from war and they hear a firecracker or a car sound? They might be brought back to a moment on the battlefield. Well, when you’ve had ongoing traumatic events, any new event could bring you back to it and you feel the same feelings. Your heart rate increases. You have wet palms. Your mouth dries up. … You have to imagine this on a daily basis. Most of us don’t see it because it’s not our experience.”

What the data is showing us now is that, unfortunately, most of the trauma happened while living in the United States.Rice University psychology researcher Luz Garcini

Conversely, protecting people from deportation can improve their mental health. In 2012, the Obama administration implemented the Deferred Action for Childhood Arrivals program, which shielded young undocumented immigrants who’d entered the country as children from deportation and allowed them to work here legally. A 2016 statistical analysis of datafrom the U.S. National Health Interview survey showed that 40 percent of those eligible for DACA reported improvements to their mental health after the program began.

The negative effects of living without legal immigration status and the positive effects of DACA extend to the undocumented immigrants’ U.S.-born children as well, researchers have found. When parents suffer from mental health disorders like depression, their kids will often share the symptoms. They’ve internalized their parents’ fears.

“These are their protectors. These are people they love and admire,” Zayas said. “The fact that at any moment they can be taken away from you by a government agency because they don’t have papers ― that’s as damaging to the children as it is to the parent.”

Between the 11 million people currently living in the U.S. without legal immigration status and the roughly 5 million U.S. citizen children with at least one undocumented parent ― not to mention the adult citizens with undocumented loved ones ― nearly 1 in 20 people in the U.S. could be at risk for mental health problems related to immigration status.

Individuals react differently to chronic stress and trauma, so not all of those 16 million-plus people will struggle. But the level of mental health distress recorded in the studies so far is likely “the tip of the iceberg,” Atheendar Venkataramani, an assistant professor at the University of Pennsylvania’s Perelman School of Medicine and a co-author of last year’s DACA study, told HuffPost.

“We’re probably underestimating it,” he said. “And given the pervasiveness of the types of events that can trigger hypervigilance, perceptions of risk, trauma ― I think the burden could be quite deep.”

A sign at the Grassroots Leadership office calls for the defense of DACA, the Obama-era program that gives undocumented immigrants who arrived as children protection from deportation and allows them to work legally.

And the burden could be getting deeper. In January 2017, as Norma’s criminal case inched its way through court, President Donald Trump entered the White House, promising the harshest immigration crackdown in a generation.

Five days after taking office, Trump signed an executive order eliminating Obama-era guidelines that prioritized deporting people with criminal convictions. Soon after, U.S. Immigration and Customs Enforcement began summarily deporting people who were showing up for routine check-ins ― people who, like Norma’s parents, had outstanding orders of removal but had previously been allowed to stay because they had largely clean criminal histories and family ties in the United States.

Stoking fear became a bigger part of ICE’s strategy. “If you’re in this country illegally and you committed a crime by entering this country, you should be uncomfortable,” acting ICE Director Thomas Homan told a congressional subcommittee in June. “You should look over your shoulder, and you need to be worried.” (In fact, many undocumented immigrants committed no crime when entering the United States. Norma, for example, came when she was 3 years old using a border-crossing card ― a visa that allows Mexican nationals to make repeated short trips to the U.S. Overstaying a visa is considered a civil infraction, not a crime, under U.S. law.)

In perhaps the most sweeping change, Trump announced the cancellation of DACA in September. It’s too soon to know whether the program will be phased out as the White House said. Several lawsuits in federal court may delay or overturn the president’s decision. But Venkataramani suspects the Trump administration’s loudly expressed agenda has already begun wiping away the mental health benefits his study documented.

“It’s a different climate,” Venkataramani said. “Around the time DACA repeal was being considered, every other day there was a news article that would quote someone ― a Dreamer or someone who knew a Dreamer ― that would mention the level of anxiety that these folks were facing. It’s not just journalists looking for an angle. It’s just scary to be in their world. I don’t think anyone would doubt that it influences their health.”

The Trump administration’s policies could make mental health disorders even more widespread among immigrant populations, according to Omar Martinez, a professor of social work at Temple University. He co-authored a 2015 study that found not only that immigrants without legal status were more likely to suffer from mental health disorders than the general public, but also that anti-immigrant rhetoric tended to dissuade people from seeking treatment and increased the stress that causes disorders like depression, anxiety and PTSD.

“There was a link between these policies and mental health outcomes,” Martinez told HuffPost. “What we’ve found is alarming. I don’t know what the cutoff is to call it a crisis. But it is definitely alarming and it will continue to increase as long as this anti-immigrant rhetoric continues.”

Norma said she feels committed to sharing her experience with PTSD.

Norma expects to have nightmares for the rest of her life ― mental health treatment doesn’t erase trauma. But she’s learned to notice when her fears start rising to the surface and to disrupt the thoughts before they plunge her back into a crisis — a tactic that mental health professionals call “interrupt and redirect.” Most days, she can coach her mind into a state of calm, even optimism.

“I wouldn’t say I’m good at it, but I’m better than when I was younger,” Norma said.

She’s not afraid of telling her friends what’s going on in her head anymore, either. She’s more likely to overshare, sometimes telling new acquaintances about her PTSD.

“It’s such a loaded term,” she said. “I feel committed now to throwing out the term as much as I can and speaking about it calmly.”

Her work has become more rewarding too. She left her old job at the Texas state capitol at the end of 2016, knowing that the Republican-dominated legislature planned to pass a statewide immigration crackdown that mirrored Trump’s agenda. She now works in mental health and criminal justice advocacy with Austin-based Grassroots Leadership.

Last August, prosecutors went to Norma’s lawyer with a deal. In exchange for her using a breathalyzer five times a day for three months, taking alcohol awareness classes, continuing her psychological treatment and doing 60 hours of community service, they’d drop the DUI charge in 18 months. If all goes well, she’ll be able to reapply for citizenship next year.

But the underlying fears that led to Norma’s condition have grown worse. The threat of deportation still hangs over her parents. And her brother is among the 670,000 who stand to lose work authorization and protection from deportation if Trump’s plan to cancel DACA moves forward. (Congress has yet to move a bill that would restore DACA, although a nationwide injunction issued by a federal judge in California has stopped the White House from phasing out the program for now.)

Norma worries for her family. She also worries about the millions of other people who remain undocumented, as she once was — people who could be walking around with similarly rattled brains. At her worst moments, she feels again like the terrified 14-year-old who woke up to witness her mom’s arrest.

But she remembers that her hypervigilant brain, for all the pain it has caused her, keeps her on guard for a reason.

“There’s nothing wrong with me,” she says. “This is how I survived.”

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