These past 6 weeks, I’ve had an opportunity to work under the tutelage of a psychiatrist at Bellevue’s Program for Survivors of Torture (PSOT), a program that provides psychiatric, medical and legal care for asylum-seekers of NYC. This experience has been especially poignant in the recent weeks given the immigration crisis precipitated by the Trump administration. The Trump administration decided to begin to separate parents from their children at the border in order to prosecute those adult(s) for crossing illegally, before forwarding their cases along to immigration officials if the parent(s) were applying for asylum. Rather than releasing those asylum-seekers if their claims cannot be processed within the mandated 20 days, the Trump administration would like to hold these asylum-seekers indefinitely. Additionally, Jeff Sessions has discussed removing domestic violence and gang violence as reasons eligible for asylum, a decision which will certainly impact thousands of asylum-seekers and result in the deaths and injuries of an untold number of people. Lastly, there are reports that legal checkpoints for asylum crossing are turning away asylum seekers, in violation of both federal and international law. 
I could go on and on about the policies of the Trump administration, but there are more think-pieces out there to address this topic than one can possibly read. Admittedly, most of these writers are much more skilled political analysts than I am, and these writers are more capable of exposing the truth behind the current administration’s lies. Instead, I want to write about my own personal experiences working in PSOT and the lessons I’ve learned from these incredible patients, the very asylum-seekers being targeted by these current policies. 
Time and time again, I was astounded by the resiliency of these patients, some of whom had experienced unimaginable cruelty, discrimination and violence in their home countries. I met women asylum-seekers fleeing civil wars in Africa who had experienced acts of repeated sexual violence, men who had been imprisoned for political activism and underwent severe torture, gay men who were threatened with violence for loving their partner. All of these patients, while experiencing extreme symptoms of PTSD, were gainfully employed, working hard to provide a better life for their family and doing the jobs that most Americans deem to be beneath them. A Tibetian man in his 60s, just 1 year following a debilitating illness and long-term hospitalization, described with pride the backbreaking work of pouring concrete, literally building the foundation for NYC’s newest buildings. Another complained of insomnia, a symptom concerning for PTSD. However, upon further investigation, his insomnia was a direct result of working 8 hour days of manual labor in a factory before going to class for 6 more hours to learn English. That is a 14-hour work day, not including transport to all of these sites which may easily add on four more hours. Restaurant workers described even longer commutes, one talking about a two-hour commute one way just to serve rich financial bankers in Midtown. Despite their horrific past trauma, many of these patients, with the appropriate psychiatric and medical support, were able to better both their own lives and American life in general.
These patients also trusted in a very broken immigration system and in America to redeem its promise to them. Many patients described long wait-times, some waiting over three years for their asylum cases to go to trial. They felt “in limbo,” unsure if they could settle down. They were unable to feel comfortable in this new home, with their legal immigration status in question. They were constantly on edge, waiting for the court summons to present their case. Despite this, they mostly expressed gratitude for the American justice system and for the opportunities that America had provided. However, delays in the immigration process was frustrating for them, and often worsened their underlying PTSD and anxiety, making it hard for them to fall asleep at night, precipitating terrifying flashbacks and nightmares and making work so much more difficult. 
These immigration challenges also prevent many patients from re-connecting with loved ones back home and from bringing close family members out of danger to come live with them. One patient tearfully recollected the desire to travel home to see his dying parents. Without citizenship, most patients fear that they will not be able to re-enter America and thus cannot see dying family who lives overseas, separated by war, terror and now the American immigration system. Many patients are separated from dear children, many of whom are still in danger in their home country. The best they can do is send money home and pray to God for their children’s safety. 
Lastly, these patients are scared by the current administration’s policies. Trump and his compatriots have successfully sown uncertainty and fear to legal immigrants, undocumented migrants and asylum seekers. While the staff of PSOT tries to instill in their patients a confidence in a broken system, physicians are worried about making promises that they are no longer sure that they can keep. With patients struggling with PTSD, the thought of having to return back to danger in their home country is almost unbearable. I recently was talking with a patient from an Eastern European country who is naturally suspicious given his experiences of political persecution and torture in his home country. He has become increasingly paranoid and suspicious, changing his apartment every couple of weeks, changing his phone number every few months because he is sure that ICE is out to get him and will track him down (despite having the paperwork to apply for asylum). While this is an extreme manifestation of the fear experienced by most asylum seekers (and an expression of his underlying psychiatric pathology), asylum seekers still have a legitimate reason to be terrified. 
My patients deserve better than the Trump administration. America deserves better than the Trump administration.

Jayne CaronComment