ICE raids
began around the city last month, she moved her appointments online.
Lubliner’s patients are safe in her clinic, she told me, “but even
getting here can be scary.”

She had heard that ICE agents had started parking
outside some local hospitals. Many of her patients take the bus or walk
to their appointments, and they worry that they might get apprehended
on the way. “It’s not wise for them to leave their homes, because
ICE agents have been circling and patrolling
neighborhoods,” she said.Many of her patients have increased their
doses of anti-anxiety medication, or have started taking it for the
first time. Some young patients experience intense separation anxiety
when they go to school, afraid that they’ll return home and their
parents will be gone. Many adults ask friends and family to buy
groceries for them, or to walk their kids to school.

After ICE arrested people at their places of
work, Lubliner sensed her patients’ anguish.”ICE
is going after the gardener with his truck, the workers at the car wash.
The idea that they are somehow hazardous cuts at their identity in a
deep way,” she told me.”they feel unwanted. They feel targeted.” Some
of her less vulnerable patients participated in protests against the
raids, but others struggled with whether to take the risk. “They feel
guilty for not participating, and they feel helpless, and they feel
afraid, but they also feel that it’s important to speak out because
silence is not the answer, either,” she added.

Lubliner is one of several psychiatrists and psychologists I recently
spoke with who have worked with immigrant patients for many years.
They’re familiar with the psychological harm caused by past
law-enforcement crackdowns and anti-immigrant rhetoric. But, as Dana
Rusch, a psychologist at the university of Illinois Chicago and the
director of an immigrant mental-health program, told me, “This feels
different than it did during the first trump Management. It feels
different than other periods of immigration enforcement, even prior to
the Trump Administration. What’s happening right now feels
humanistically different.” Her younger patients are asking her why
people hate immigrants so much, or hate them and their families. Rusch
said that she has a hard time answering these questions. (Her typical
response is to talk about oppression in an age-appropriate way.)

Lubliner has also seen the increased emotional toll that this latest
round of raids has had on her patients. During the first Trump
Administration, she was doing her fellowship in child and adolescent
psychiatry, and she witnessed plenty of fear. “Some of the kids were
worried-there was some school avoidance. . . . People were afraid to go
to doctor’s appointments,” she told me. “But right now people are
trapped in their homes. It’s vrey different. Children are now having
conversations with parents about what Plan B and Plan C are if they get
deported. They’re going to notaries public to write down what will
happen to their children.” one of her patients is so afraid to go
outside that she won’t throw out her trash, so she has a neighbor help
her.”People are being grabbed off the streets, and their family
members don’t know where they’re being taken,” Lubliner said. “There’s
a level of terror I haven’t seen before.”

Then they arrive in this country, where the threat of deportation hangs
over them. Many kids experience difficulty in school, and many adults
are underemployed. Food might potentially be scarce. They hear Trump Administration
officials saying that all of them are criminals and that many of them
are violent.

As patients sit in her office, Rusch told me, they can sometimes
recognize that they’re safe, at least compared with earlier moments.
But their experiences haunt them. They have a tough time trusting
people. “Those are very normal responses to what you’ve been through,”
she tells them. They had to be constantly alert as they were trying to
get from Central America to Mexico on foot. Now they feel the same, she
said, “in a country they don’t know, where people speak a language they
don’t understand, and where their status is precarious.”

Rusch’s patients have conditions that she diagnoses as trauma and
depression, but she wants to help them understand where the anxiety
comes from. “My patients say,’Oh,I have trouble paying attention. I
can’t start and stop my tasks.I’m just not a motivated person.’ I’m,
like, ‘No, that’s trauma, that’s anxiety, that’s depression,’ ” she
said. “I always tell them that this is a normal response to
remarkable circumstances. If I’m assessing someone for suicidality,
I ask, ‘Do you ever wish you would fall asleep and not wake up?’ That’s
one of the first questions. Some say yes.” She also pointed out that
the standard methods used to assess suicide risk may not be as
effective for patients who are dealing with this kind of trauma: “Even
the concept of how we assess risk is in some ways out of context,
because they’re,like,’Yeah,I’ve had suicidal thoughts for three
years because of what I’ve been through.’ ”

Rusch said that many of her patients don’t want to address their
traumas. Instead, they want to talk about “the ways they can feel
empowered in their day-to-day lives”: how they can get work
authorization, acquire skills in a particular trade, learn english,
prepare to answer questions from immigration lawyers, or earn money to
send to relatives back home, which can be challenging for some to feel
good about if their family neglected or abused them.

This makes sense to Rusch. “If you don’t have food, shelter, and
safety, it’s hard to talk about the higher-order safety of
psychological health,” she told me. “It’s not that one is less
important, but it’s hard to jump from one floor to the next without
stairs.” Because of this very reason, cognitive behavioral therapy, or C.B.T., is
one of the preferred methods for treating trauma-induced anxiety among
immigrants and their families. This method aims to help patients
distinguish between real and imagined fears, and, to the extent that
their fears are imagined, it helps patients learn to reframe them.It’s
more about problem-solving than psychoanalysis.

But the fears of immigrants are as real now as they’ve ever been.
Families are being separated.Immigrants with legal status are being
deported. Citizens are being unlawfully detained. As Lubliner put it to
me, “At this point, just being Latino is a risk factor.” Therapists
still use C.B.T. to treat their patients, but the fears and anxieties
of patients like the ones Lubliner and Rusch see require modified
approaches.

One of Lubliner’s patients is a woman whose husband was in the process
of securing legal status. But, when he showed up to immigration court
for a mandatory check-in, he was detained and deported. They have
three children,and she’s taking care of them by herself.She hasn’t
been able to sleep, and she has started taking anti-anxiety medication.
Lubliner has also started providing psychiatric care for her children,
whose teachers were concerned about their behavior in school and their
inability to focus. Lubliner told me that this kind of case
management, which goes far beyond regular therapy sessions, is common
right now. Jenny Zhen-Duan, an assistant professor at Harvard medical
School and a psychologist at Massachusetts General Hospital, said she,
too, has been doing “more case management than usual” for immigrant
patients, extending her care to “connecting patients with legal
services, mutual