Immigration limbo is a ‘tug of emotions.’ It’s also a mental health issue.

He’s walking on the edge of an abyssal, black lake, painfully aware of what lies beneath the water. Ominous waves keep crashing ashore, reaching for him.

That’s how Ravi Ragbir sees the trauma that engulfs his long and scarring deportation battle. It didn’t spare his mental health: sudden spasms of sadness, his chest closing up, tears choking his throat, his heart racing. They’re all signs that he’s getting too close to the lake — the imaginary place where he confines his suffering.

“I don’t want to fall in; I will break down,” says Ragbir. The water is a psychological tool he uses to curb his recurring emotional anguish.

“I basically shut down for a day or two, most of the time closed in myself. It drains me.”

As he talks about the lake, he breathes deeply to regain composure, straddling a fine line between trying to describe the fresh pain that wells up unpredictably and not letting that pain overwhelm him.

Ragbir is a former green card holder who became a popular immigrant organizer in New York City when he decided to transform his deportation case into a vehicle of resistance. In March, after nearly a decade of nerve-wracking check-ins with federal immigration agents, he was told to start preparing travel documents to return to Trinidad, which he left in 1994. When he walked out of the meeting, his whole body was trembling.

Ragbir says he started to feel the weight of his immigration struggle in 2010, a few years after he was ordered removed from the US. Since then, he’s been through appeals and check-ins with authorities and has had many depressive episodes. He calls them a “tug of emotions” and never talked about them before. But after his last intense crisis in June, he decided to open up.

Over 43 million immigrants who live in the US could be affected, directly or indirectly, by the turn of the screw of the Trump administration’s policies on immigration enforcement. Immigration and Customs Enforcement’s new policy is to no longer tolerate anyone without papers, and Donald Trump has endorsed legislation that would significantly decrease legal immigration. While the Obama administration came around to a targeted deportation strategy, the Trump administration has proclaimed that it will “take the shackles off” immigration enforcers.

“I’m privileged to be able to speak about it,” says Ragbir. As the director of the nonprofit New Sanctuary Coalition of NYC, he helps undocumented people stand against detention and deportation. “I’ve a lot to lose, but there are many people who have a lot more to lose, and are unable to speak because of the fear of loss.”

More about Ravi Ragbir: ‘The fear of living as a fugitive is very high.’

With nearly 11 million undocumented immigrants nationwide and 17.6 million people with at least one undocumented relative, large communities are now experiencing anxiety about separation from their families. Some are having flashbacks to the violence they experienced in their home countries. Some are retreating into the shadows, afraid to drive, bring their children to school or even seek medical care.

“We have children who have nightmares,” says Father Juan Carlos Ruiz, the co-founder of the New Sanctuary Movement, about immigrants who attend his weekly legal clinics. “We have high school kids who don’t go to school anymore, that are depressed, that are suicidal because their parents are threatened.”

Meanwhile, recent statements made by John Kelly, the former secretary of Homeland Security who recently became Trump’s chief of staff, indicate that undocumented immigrants brought to the US as children might no longer be protected. The uncertainty around DACA, Deferred Action for Childhood Arrivals, is testing the emotional fiber of over 750,000 recipients, who depend on the 2012 program for work permits and some relief from their uncertain status.

For Laura López, a 29-year-old DACA recipient in Provo, Utah, the news has reawakened old traumas. Sometimes, when she feels close to having a panic attack, she busies herself to suppress those feelings.

"I start talking to myself. I say, ‘I'm safe, I've got my family,’" she says. "If I know it's coming but it's not terrible, I have to get up and start doing something. I have to do a physical activity." López was brought to the US from Mexico at age 13. When she hears about other people like herself, with children to care for, being deported, that adrenaline of her own migration experience sets in.

"I wish my body could tell the difference between border crossing danger and the feeling of the unknown, even if I'm just sitting at my desk."

When she was a child new to the US, López learned to curb anxiety by telling herself, "I didn't cross the border to be sick. Your parents are working so much, and you came here to finish school, so you can't let this stop you."

And now, she’s looking for other ways to cope. Three years ago, she tried to visit a psychologist, but it didn’t help. The session, she says, was dismissive of her concerns about her immigration status.

"Why are you afraid of immigration? They don't know where you are. They're not going to get you," she remembers being told. That didn’t help ease her fears of being separated from her family.

"We don't talk about it enough, to be honest," López says about the inner lives of immigrants. There is a lot of political organizing, but "we do not have a lot of resources on dealing with this."

More about Laura López: ‘It's harder than people think, to pack up your bags and leave.’

But the mental anguish experienced by millions of immigrants has been cause for concern at New York University, where clinicians launched a new psychological program called the Immigration and Human Rights Work Group.

“We want to offer treatment to those who want it,” says Dr. Spyros Orfanos, who designed the service to help refugees and people in fear of removal.

The resource is badly needed both in New York City and around the country, he says, due to a lack of both funding and skills. The grief associated with both the uprooting experience and severe immigration enforcement is not imaginary.

“People do suffer,” he says. While different people manifest “emotional scars” in various ways, clinicians should take into account individuals’ profiles, socio-economic reasons for migration, how long people have been in the US, and the quality of their lives here; a prolonged period of inner distress affects both mental and physical health. Hormonal changes occur in the body that, over time, can lead to health issues like heart problems, or PTSD, he says.

Since the November election, even his American-born patients have shown anxiety related to the Trump administration and his supporters’ tough attitude towards immigrants.

“It’s definitely affecting my Jewish patients,” he says. Many American Jews who had relatives murdered in the Holocaust are upset. They listen to Trump’s speeches, his accusations against the press and against foreigners’ impact on the US, and they start worrying that history is repeating itself. The white supremacist protests in Charlottesville last week, and Trump’s response to them don’t help.

Dr. Margarita Alegría, a professor at Harvard Medical School’s Department of Psychiatry, also says that national mental health initiatives with an immigration focus are “minimal compared to the exponential need.” Alegría is currently running two trial programs with Latino and Asian immigrants to help them cope with the stress of migration and PTSD. She gets constant requests to deliver the service in other languages — Arabic and Haitian-Creole, recently — but there isn’t enough capacity.

According to Alegría, whose research involves listening to psychotherapy sessions recorded by her colleagues, people go into ruminations. They enter ceaseless states of worry about what can happen to them, particularly around deportation. A growing body of literature shows the effects of living with constant uncertainty, she says. Hypervigilance and sleeplessness are among them.

After Ragbir spent over two years in detention centers in New Jersey and Alabama, his sleeping pattern was never the same.

“A cockroach walking on the carpet can wake me up,” says Ragbir. “My whole body is at an alarm level the whole time; everything is just ready to break down.”

In June, Orfanos’s work group partnered with New York University’s Immigrant Rights Clinic to perform psychological evaluations of both immigrants in danger of deportation and their families. The results will be used in court by lawyers to explain to immigration judges how the emotional health of a family can be affected by one deportation.

Orfanos is himself an immigrant from Greece and vividly remembers the toll of harsh enforcement policies on his relatives. As a child, one of his uncles was deported because he was undocumented.

“The family suffers also,” he says. “People sometimes forget that.”

His work group recently concluded mental health assessments of three children, ages 4, 8 and 12, whose mother is in removal proceedings. If she were to be removed, they found, her children’s emotional development would be affected.

“The other tragedy,” says Orfanos, “is that emotional scarring gets transmitted to children.”

He gives this hypothetical example based on a real-life event: Trump appears on television in January, reading “The Snake” poem to warn Americans of the dangers of welcoming Syrian refugees. And say, in response to that rhetoric, a Muslim father abruptly turns off the TV and a young child in the household notices. If something like that happens repeatedly, and especially if nobody talks about it, a traumatic association will take place. The child will internalize the message that something is wrong, says Orfanos. The child doesn’t know why, but he can tell that his father doesn’t want to listen to that news and that, perhaps, he gets angry.

“These kind of things are always getting transmitted,” says Orfanos. “They’re contagious, like an infection.”

López is keenly aware that her immigration situation can cause stress for her children. Sometimes, if she feels anxiety bubbling up, she’ll ask her husband to take over with her 3- and 5-year-old children. She doesn't want them to see their mother breaking down; they are sensitive to her feelings.

"They will have childhood traumas that I do not want them to have," she says.

Ragbir says it is still painful to remember his daughter, then a child, watching him go to immigration detention years ago. Those memories often come at the start of his breakdowns. Recently, though, what can trigger these feelings has become unpredictable.

His latest episode came in June, right after he taught a public speaking workshop for young volunteers in his organization.

“I felt miserable the whole night and the next day,” he says.

Ragbir is known for cracking jokes and shouldering his emotional load with bravery, to set an example for others. But sometimes, it’s too much to bear. When he got home that night, the dark lake crept closer.

“I started to cry. I couldn’t control it,” he says.

Amy Gottlieb, Ragbir’s wife, has been by his side since they married in 2010.

“It breaks my heart, you know. It just makes me really, really sad. He’s gone through so much in his life,” she says. “The toughest part is not being able to fix it. I’m a fixer. I want to be able to make things better for people, and I can’t reverse what Ravi suffered.”

Gottlieb has learned not to allow her husband’s reality to overwhelm her but also to resist the temptation to deny it. “It’s really easy to say, ‘Oh, I can’t deal with this, I’m gonna go put my head in the sand,’” she says. She finds balance by being grateful for the small, positive things in everyday life and focusing on the moment.

Ragbir is scheduled to return to the New York City immigration office in January — with travel documents to Trinidad — where they will again decide whether or not he will be allowed to stay in the US.

Ragbir came to the US as a legal permanent resident. He was convicted for wire fraud after the mortgage company that he worked for was investigated for fraudulent loan applications. He served a five-year jail sentence, then spent two years in immigration detention while he was in deportation proceedings. He is now seeking to vacate, or erase his criminal conviction, saying proper laws were not followed. If successful, Ragbir could try to have his lawful permanent residency restored. But if he is deported before his case moves forward, he would not be allowed back in the US. In the meantime, he requested a presidential pardon from Barack Obama, which is now pending before President Trump.

“I feel betrayed in some instances,” says Ragbir, who sometimes feels let down by the US and its justice system.

According to Orfanos, he’s not alone. That feeling of betrayal can be especially intense for green card holders who come to the US legally and end up in deportation proceedings.

"There’s the sense that somehow the host country betrayed you," he says. "On the one hand, they say, ‘Pay your taxes, work hard’ and then, boom, somebody says, "You’re not really an American."" 

But Ragbir wants to fight the feeling of victimization.

“They want to break me,” he says about the immigration system he has been fighting to change. “It’s easy to be destroyed unless you keep a check on yourself.”

Like López, he tried therapy in the past, but it didn’t help him much. These days, he keeps his sanity by visualizing the lake and making sure he doesn’t fall in.

To receive services from New York University’s Immigration and Human Rights Work Group, contact Dr. Spyros Orfanos at sdo201@nyu.edu.

One service some people have reported finding useful in moments where they needed additional support is text message-based counseling from Crisis Counselor. To use that service, text HOME to 741741. You might also seek referrals to health care providers from local immigrants rights organizations might be able to help you find resources where you live: Catholic Charities has a directory of  affiliates; the National Immigration Law Center has a list of organizations around the country; as does One America; Welcoming America has a list of nonprofit partners around the country, as well.