Although one in six people will experience a major episode of depression in their lifetime, fewer than half will seek treatment. According to the U.S. Surgeon General's Report on Mental Health, stigma prevents many from seeking care. But among American immigrants, poverty and language barriers also stand in the way.
Elias Lorenzana's basement apartment, in Chicago's Logan Square neighborhood, is tiny… not much bigger than a large, walk-in closet. "I fixed this little room, all of it. It had a wall here in the middle. I took it down. I put down the carpet. So, I don't feel like going out to some place because I have everything here," he says. "Refrigerator, television, music and telephone."
English-language textbooks sit along a windowsill. A few religious statues, Mr. Lorenzana's saints, stand near the bed. Though he is separated from his wife and children now, there is some measure of happiness in his life. Things are looking brighter, he says, after years of dark depression.
"I feel more at peace, happier. I don't feel the fear like I felt it before," he says. "The insomnia that I used to have has ended. I feel more sociable. I can speak to people more openly. Before I didn't do it because I felt shame."
The roots of Mr. Lorenzana's depression grew in childhood. His life was nomadic. His father and mother were not married. He grew up with a succession aunts and uncles, and as a young boy, was homeless for a while. He lived at a movie theater, where he sold bubble gum and drinks in exchange for food and shelter. As a teenager, he was reunited with his father and half-siblings, but remembers it as an unhappy time.
"I felt a lot of loneliness, a lot of sadness and cried too much," he says. "I had fear inside myself. I had a lot of fear- and the truth is I didn't know what I was afraid of."
In many ways, Elias Lorenzana's long struggle with depression is understandable, not only because of the harsh circumstances of his life, but because of his culture. Two years ago, the U.S. Surgeon General completed the most comprehensive study ever on mental health, race, ethnicity and culture. The report found that just one in twenty Latino immigrants suffering from depression and other disorders contacts a mental health provider for help.
Along 18th street, the nerve center of Chicago's Pilsen neighborhood, cumbia music blares from a storefront. Pilsen, near the city's downtown area, has long been a haven for Latino immigrants. Mexican grocery stores, bakeries and taquerias line the sidewalks.
On a recent Sunday afternoon, several men gather around a stone bench, next to a supermarket parking lot. Antonio Gallardo came to the United States four years ago from Mexico. He knows many people who are depressed and most, he says, don't get help.
"They come from Mexico. They come to look for work. They are on the street looking for work. They drink. They smoke weed or something. Because they don't know what they have to do," he says. "They don't know where they have to go to fix the problem."
Around the corner, Louis Gardinez, the son of Puerto Rican and Mexican immigrants, thinks he knows why. He's lived in Humboldt Park, another of the city's Latino strongholds, for twenty-five years. "Remember they come from the country, they come from a farm or a little town with fifty people in it, it's a totally different world," he says. "They might say oh, I've got to go to the doctor. Sure. They don't realize the difference between medical and mental health.."
And so they do not get appropriate care. The reasons are as complex and varied as the waves of Latino immigration remaking the United States. They begin with fundamental differences in the way American and Latino cultures view mental illness.
"It's seen as something that's really different, you know, normal people don't have that," says Mexican-born psychotherapist Susanna Jimenez Schlesinger, who came to Chicago forty years ago.
"Even in Mexico in the higher, more educated levels of society, mental health is really....you have to be really psychotic, seeing things, hearing things, trying to kill yourself or somebody," says Mrs. Schlesinger. "The acute mental health is what is identified. And other kinds of just sad and lonely and anxious and worried... "los nuervios" people have the nerves...they're nervous. I mean that is not seen as an illness or something that needs medical or psychological treatment."
So if Latino immigrants are suffering from depression, their illness can go untreated. Women may internalize their emotional pain, until physical symptoms force them to see a doctor. Men often abuse alcohol and smoke marijuana. If people do reach out for help, as Elias Lorenzana did in those early years in Mexico, it's often to family members, a priest, a medical doctor, and sometimes, a curandero, or faith healer, but rarely a mental health specialist. "When I left my father's house, I went to Acapulco, where I began to work. I went to Social Security to ask if there was something or someone that could help me with the problem that I had and they said no," he says. "They sent me to some center that was called Center of Health. It's a private clinic of the government, but they also didn't have help there."
In 1994, Mr. Lorenzana immigrated to the United States to be with his wife and children, who already lived here. But his depression did not lift. His poverty, the complexity of family life and his inability to speak English all added to his fears and worries. He got a job at a hotel washing dishes, and after three months, became eligible for health insurance. That meant he could try to get some medical help. By then, his family relationships had deteriorated.
"I called my insurance agency and explained that we were having problems at home and we needed to see someone that could help us," he says. The insurance agent referred him to a therapist. "But she spoke English and only gave me three appointments. They were the only appointments I had with her and I had to pay fifteen dollars for each visit. I didn't understand and the person I was explaining my problem to didn't understand either."
Frustrated, Mr. Lorenzana gave up looking for help. His depression worsened as several long years passed. Finally, one morning two years ago, Elias Lorenzana decided to give up the struggle. He got up and walked into the bathroom to commit suicide. "I had a blade. So I was thinking of doing it with that," he says. "But in the moment that I got to the bathroom I saw the sink where my son had left a lot of toothpaste, where he had just brushed to go to school. It was immediately after that.. that I thought that he needed me.."
In desperation, Mr. Lorenzana made a series of calls to local agencies.
"Every time I would try to look for help, it would always be in English. And I wondered if help was available in Spanish, the help that you need. And that would worry me," he says. "But I searched and searched until I found Mr. Raul."
Therapist Raul Castro, who practices at a free community clinic called Association House. The clinic gets state funding to provide mental health services to Latinos living at the poverty level. Mr. Lorenzana has been making progress since he began therapy with Mr. Castro. He's taking English classes, has a new job as a busboy at a local hotel and is working on his relationship with his wife and children. Still, sitting in his small apartment, he says he isn't looking too far into the future.
"First I want to feel well," he says. "I want to think about what I will do. More than anything, I want to cure my depression and after that, I don't know. There will be something to do, right? For the time being, I feel good. I feel satisfied.".
Well-being he attributes to finally finding someone who knows about depression, speaks his language and understands his culture.