LITHUANIAN QUARTERLY JOURNAL OF ARTS AND SCIENCES
Copyright © 2010 LITUANUS Foundation, Inc.
Volume 56, No.4 - Winter 2010
Editor of this issue: M. G. Slavėnas
The Mental Health of Third-Wave
Problems, Causes and Prevention
LAIMA ZAVITAUSKAS, MS, LPC, MA, works at World Relief Du Page and Choices Inc. Areas of special professional interest include immigrant and refugee mental health, cultural barriers, and integration and acculturation.
The mental health problems of Lithuanian “third wave” immigrants residing in North America are not identified and professionally addressed either on a scientific or societal level. In the process of adjustment, newcomers experience many challenges arising from cultural change, and they display symptoms of mental health disorders triggered or exacerbated by this change. The author defines the main stress factors that affect the emigrants’ mental health of the “third wave” Lithuanian-Americans. She also discusses intervention and prevention strategies and services that are available.
The so-called “third wave” (trečia banga) is a designation that has become popular in the Diaspora to describe the latest large wave of Lithuanian emigrants who left their country in the course of the last twenty years, just before and after the reestablishment of Lithuania’s independence. It originated as a way to distinguish them from the previous immigrants now referred to as the “second wave,” consisting of post-World War II refugees who saw themselves as political émigrés. The “first wave” were pre-World War I, predominately economic, migrants.
During the period of adaptation and the process of acculturation, all newcomers experience many challenges related to cultural changes. The third wave Lithuanian immigrants in the United States are likewise encountering psychological problems that arise from finding themselves in and adapting to a foreign country. They experience culture shock, language barriers, separation from their native land and neighbors, a change in their social status, unfamiliar customs and traditions and different social norms.1 These changes have an impact on their mental health and trigger or exacerbate various symptoms of the mental health disorders that are common among immigrant populations. However, for many reasons and in many cases, mental health problems of the Lithuanian immigrants remain undiscovered and underserved. They are not identified or professionally addressed either on a scientific or societal level. Despite this large-scale exodus, psychologists, scholars and researchers in Lithuania and abroad have so far shown very little interest in studying the mental well-being of its nationals living in the Diaspora. There is no cooperation between Lithuanian psychologists and psychotherapists in the United States. There is no generalized statistical database that could be used to model interventions for Lithuanian emigrants, create preventive programs, inform and educate the Lithuanian community and cooperate more closely with American professionals, thus improving the quality of psychological help. Although mental health services are widely available for the mainstream population, services available to the immigrant population are limited. The immigrants as a rule lack assistance by professional Lithuanian specialists and have limited access to educational and psychological literature in their native language. American psychologists and psychotherapists working with Lithuanian immigrants often lack the expertise of dealing with psychological problems specific to this population.
Emigration is a complicated process psychologically and emotionally. Even prior to leaving their native country, future emigrants experience conflicting emotions of anxiety, sadness, anger, hope, joy and fear. They are disappointed with their country’s economic, social and political system, angry at government corruption and tired of dealing with life’s uncertainties, and the lack of security and prospects for themselves, their children and their dependents. By emigrating they hope to create a better life abroad and to fulfill the goals that could not be fulfilled in Lithuania: to get an education, achieve financial stability, rise on a career ladder and create a secure future. Of course, there is no guarantee that these hopes and aspirations will be fulfilled. Consequently, even before leaving, they are tormented by anxiety, sadness, and the fear of the unknown that awaits them.
Having arrived in the United States, our fellow countrymen encounter unforeseen difficulties of life as immigrants. They suffer from the loss of their native country and language and separation from family, relatives and friends as well as a crisis of values and lack of familiarity with new traditions, culture and standards of behavior.2 Daiva Kuzmickaitė stresses that one of the most difficult experiences reported by recent Lithuanian immigrants is the loss of friends and close relationships in the homeland.3 A radical change in social status, stress at work, superficial interpersonal relations, the new fast pace of life, and competition among fellow Lithuanians are some of the reasons that cause strain and stress and easily lead to loneliness and various mental and physical health problems. By not addressing their problems through professional help, such individuals face the threat of developing serious illnesses, not only mentally but also physically.
The period of adaptation and the process of developing strategies for coping during this time of adjustment become complicated tests in the emigrant’s journey. Although the intensity and quality of these processes depend on individual circumstances and the person’s mental makeup and experience, nevertheless, they apply to all emigrants irrespective of their country, nationality, sex, and education.
According to the theory of adaptation developed by Dr. Dennis Hunt (1998), new arrivals experience four stages of adjustment to the new country and culture. The first stage is the arrival, or the “honeymoon” stage. At this time, the newcomers experience elated, joyful feelings because the obstacles and delays associated with their emigration and immigration have been overcome. Ahead are new experiences and the hope for a better quality of life. At the same time, the new immigrant is confronted by many unfamiliar things, such as language barriers and a lack of knowledge about the new culture and traditions, and succumbs to feelings of stress and anxiety. However, these feelings do not yet predominate.
The second stage is that of reality. The realization sets in that their expectations and reality differ. Many obstacles surface that need to be surmounted: work, school, living accomodations, and financial arrangements. There is a heightened realization that in a foreign country there are more difficulties to overcome than originally envisioned. Feelings of disappointment, loss and dissatisfaction become stronger. Realizing the challenges and ordeals that need to be resolved, the new immigrant frequently begins to regret his or her decision to emigrate and starts comparing the new country to the native country, which he or she idealizes. Homesickness and longing for old friends and neighbors multiply. Often there are also feelings of resentment against other immigrants who have succeeded in improving their status or quality of life.
The third stage is two-fold. Depending on character, education, personality traits, ability to adapt, and their system of values and convictions, some immigrants turn to adaptation, others to separation. The first group takes the initiative to overcome obstacles, learn the language and create a new circle of acquaintances and friends. Such people do not forget the trauma of displacement or the difficulties they have faced, but they are able to deal with them. At the same time, they concentrate their energy on trying to fulfill their dreams and to strive towards their goals.
The other group, having chosen the road of separation, experiences increased feelings of loneliness and estrangement. They become apathetic, lose initiative, draw apart from friends and acquaintances and isolate themselves from the community. They are unhappy living in the present, mourn the loss of the past and continue to cling to old habits, refusing to change them. Such emigrants find it difficult to accept challenges, to create a new social network and to adapt to new cultural norms and rules. They feel misunderstood and rejected and as a result are angry with themselves and others and supercritical of the system under which they find themselves. They frequently experience symptoms of depression and anxiety.
The fourth stage also takes two directions. Individuals who have successfully overcome the adaptation phase begin transitioning into the integration phase. Integration in psychological parlance means the immigrants’ ability to maintain the unique national characteristics of their own culture while at the same time participating in the culture and activities of the surrounding community. During this period, after obtaining new skills and information, there is growth in self-confidence and creativity. Experiencing success strengthens self-esteem and the ability to have a clear understanding of one’s status as well as to assume control of one’s life choices. Such people begin to integrate into the new culture while continuing to maintain their national and cultural roots. They are able to transmit their personal and ethnic system of values to their children, thus providing meaning to their lives and ensuring a continuation of values. It could be said that they “acquire” two native countries – the one in which they currently live and the other where they were born and raised.
On the other hand, immigrants who have not been able to constructively resolve the problems that arose during the previous adaptation stages, transition into the last or the marginalization phase. Marginalization refers to a situation where immigrants lose their unique national heritage and the support of their national minority yet fail to acquire the skills to integrate into the majority group. During this period, negative attitudes, dependency and feelings of helplessness solidify and further prompt the destruction of personality. Such persons feel suspended between heaven and earth: they do not feel accepted in the United States, nor are they any longer able to view Lithuania as their home.
On the surface, immigrants seem to experience more psychological challenges than the rest of the population. Therefore, one would expect a higher incidence of mental health problems among them. However, statistics indicate that individuals born and raised in this country are more frequently diagnosed with depression, anxiety and panic attacks than newcomers. Statistics of the National Health Interview Survey, 1999, indicate that the percentages of individuals born here and abroad suffering from depression are 31.3 and 29.0 respectively; from anxiety, 37.5 and 26.6; from panic attacks, 33.8 and 23.5.4 On the other hand, these numbers do not reflect the real situation because of several important factors. Immigrants who do not have health insurance or financial resources for mental health care are not included in such surveys. Another reason is that in many cultures, and that applies to Lithuania too, mental health problems are not considered a priority or of equal importance to other medical problems. Moreover, mental problems are viewed as a personal issue to be resolved by the individual or with the help of friends, clergy, or community leaders. Admitting to having them is considered shameful. Therefore, a large number of immigrants never enter a psychologist’s office and choose to struggle on their own. Requests for psychological help are made only in moments of great need or as a result of a court order.
As mentioned before, we lack statistical data about mental health breakdowns, their frequency and their causes for Lithuanians who emigrated in the last ten years. Below I will present my observations, based on three years of experience working with them. The psychological consulting agency “Choices” in a western suburb of Chicago provides help to Lithuanian clients in their own language. Most of them, 53 percent, are women, 40 percent men, and 8 percent children. Thirty-eight percent are thirty to forty years old, 30 percent forty to fifty. Most frequent problems are mood, anxiety and somatoform disorders, especially for middle-aged clients, mostly women. The causes for their disorders are varied: destructive relationships within the family, conflicts between children and parents, children’s problems at school, inability to adapt to new circumstances, financial stress, problems of anger management, spousal infidelity, spousal abuse and so on. Frequently, emotional and behavioral problems arise in the workplace or because of demanding work environments. Women working as live-in caregivers, taking care of the elderly twenty-four hours a day, and men working as long-distance truck drivers, spending many days away from their families, often complain that they are lonely, alienated from life, isolated from the community and estranged from their families. They suffer from increased irritability, anxiety, and mood disorders and often have anger management issues. It might be added that many of our clients come to us because of a court order and would never have come on their own. This is especially applicable to men. The prescribed therapy can last from ten to sixty counseling sessions, and our clients are very often amazed at the benefits and new insights they gain.
Depression dominates the mood disorder category. Common causes include separation from loved ones by distance, divorce or death, breakdown of relationships, job loss or job dissatisfaction, financial problems, and bankruptcy.5 Its symptoms are fatigue, loneliness, feelings of worthlessness and helplessness, and finally despair, which can lead to a total physical or mental breakdown. Since depression is such a common cause, it would be helpful to have statistical data on how prevalent it is among the Third Wave Lithuanians. We are aware that the Lithuanians who seek help at our agency represent a small minority.
Another common diagnosis among our clients is generalized anxiety disorder. It is characterized by excessive concern about everyday events and occurrences, complicated social and work relationships and a general fear of the unknown.The third category is somatoform disorders. The symptoms are often long-lasting and the attempts by medical doctors to relieve them are generally unsuccessful. Clients often stubbornly insist on finding a physical cause for their problems and encounter unpleasant conflicts with doctors. They feel misunderstood and abandoned and succumb to fears about their illness. These disorders are prevalent in older people, many of whom often have a judgmental and conservative outlook toward psychology. Feelings of loneliness are very widespread among all categories.
Family problems usually arise because of changing roles in the family. Women often prove more adaptable in learning the language and developing marketable skills. They are relieved that there is less social pressure than at home to rely on looks and appearances such as, for instance, dressing up every time they leave the house. Their self-esteem improves when they find appreciation from employers and co-workers for the work they perform. As a result, they become overall more self-sufficient. Observing relationships in other couples, many women begin to draw comparisons and develop different expectations in their own relationships with husbands or partners. Moreover, observing the rights and freedoms enjoyed by American women, Lithuanian women begin to make independent decisions for the entire family, often without realizing the effect of their changing role on their husbands, especially in instances where the wife becomes the breadwinner. Husbands, on the other hand, want to maintain their previous roles in the family, but many men are so overwhelmed by the requirements of their new jobs that there is little time left for positive family interaction. Some see their wives and children only on weekends. Alcohol abuse impairs judgment and leads to verbal and physical abuse, alienating them further from their loved ones. On the whole, Lithuanian men still find it unacceptable to admit to problems that they cannot solve and to seek professional help. Therefore, I was surprised to discover that many men in my practice responded positively to therapy and proved willing to discuss their problems and to deal with the changes constructively.
Marital problems among partners of different nationalities or ethnic backgrounds are usually caused by erroneous expectations. A woman married to an American may become disappointed when her husband does not live up to her expectations of sharing household duties or childcare. On the other hand, an American husband may expect his Lithuanian wife to be more compliant with traditional values or even subservient. However, I have not encountered problems just because the marriage partner is of non-Lithuanian background.
Many clients find it difficult to adjust to the values and customs of American culture. They tend to complain of what they perceive as “artificial friendliness,” and compare the “superficiality” in interpersonal relationships here with the mutual interdependence and close, permanent friendships back home. They become much more accepting when they realize the vast difference between the two countries in size, geography, ethnic and religious diversity, and social mobility, all of which dictate the forms and norms of conduct. In fact, more often than not they discover that they prefer American emphasis on politeness and even the so-called “plastic smiles” to public rudeness at home.
One interesting observation is the fact that in our experience there are relatively few instances of situations pushing people to extremes. Resorting to suicide in response to overwhelming problems is unfortunately not uncommon in Lithuania. We too have clients seeking psychological help because of suicidal thoughts or in need of coping strategies after the suicide of friends or relatives, but cases of attempted suicide are fortunately more the exception than the rule in my experience. While I do not wish to generalize, it appears to me that problems facing third wave immigrants in this country are less destructive to the personality and do not lead to total desperation and hopelessness. The different economic, social and political system seems to leave some room for hope and optimism. Many immigrants experience deep disappointment psychologically when they realize that they cannot find work in their previous profession, but they compensate for the loss in prestige with the discovery that they can make enough money to better their life economically and to afford other pleasures, such as travel or cultural leisure activity. There is always the possibility of moving to another location or of returning home. Most important, I think, is the sense of overall security and the satisfaction of being able to provide a better future for their children.
Obviously, there are many reasons why it is important to draw attention to the psychological needs of the recent Lithuanian emigrants and there are positive signs of moving in that direction. At the initiative of Lithuanian psychologists, a free help line on the Internet Psichologinė pagalba žmonėms, paliestiems emigracijos (Psychological help for people affected by emigration) has been established. In Chicago, which has a large concentration of immigrants, there exists a telephone help line (Paguodos telefonas) with volunteers on duty providing psychological counseling. These same volunteers, uniting and coordinating services of volunteer professionals in psychological, sociological and spiritual fields, have created a psychological and spiritual assistance society Psichologinės ir dvasinės pagalbos draugija. It would help to unify and coordinate activities and improve the quality of our work if psychologists would follow the example of other professionals – teachers, historians, artists, engineers, and physicians – who have established cooperative projects to facilitate communication and the sharing of information and experiences among other countries to which Lithuanians emigrate.
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