Immigrants to the United States have a common goal: to make the American dream come true. For many, this dream means living a life with less fighting than they experienced in their home countries. Africa is the second largest continent in the world and stretches from Senegal to Somali (west to east) and Tunisia to South Africa (north to south). It has 54 countries and a population of around 1.3 billion people. There are approximately 3,000 African tribes, each with their own language or dialect.
The most widely spoken languages in Africa are English, Arabic, Swahili, French, Portuguese, Akan, Hausa, Zulu, Amharic and Oromo. It can be easy for counselors in the United States to assume that one black client is like the other black client, even though one might be born and raised in the United States and the other might be a first generation immigrant from Africa. Such an assumption would be detrimental to customers from Africa as their diverse experiences would be ignored. If these experiences add to the client's presentation problem and are ignored or overlooked by the counselor, treating the presentation problem would be difficult or even elusive.
It is important for counselors to take stock of the unique challenges that African immigrants face and that could make their lives in the United States difficult. Psychiatric counselors are encouraged to pay special attention when working with this population to resolve current mental health problems and other issues that are unique to these clients and which, if not addressed, could adversely affect their wellbeing.
Culture shock
Moving from Africa to the USA is probably a culture shock for the client with a migrant background. In fact, many immigrants from Africa experience culture shock before they even travel to their new country.
The process of securing a visa to enter the United States is a daunting experience that takes months – and sometimes years – to complete. Applicants physically go to the U.S. Embassy offices in their countries or regions to attend interviews and complete official travel-related documents. In these offices, you are likely to see armed white police officers in full gear, including duty belts, guns, sunglasses, and other items dangling from their belts. Applicants may feel intimidated by the sight of these officers, as they were previously used to seeing black police officers wearing less threatening gear.
The interview about being able to obtain a travel visa can go either way and applicants are aware that if they are denied they will not necessarily find out why they were not issued a visa. Obtaining a visa is the immigration authority's prerogative. There is no provision for explanations in cases of rejection, although candidates may submit new applications for examination in the future.
Once African immigrants actually travel to the US, they are likely to experience culture shock in a variety of ways. Depending on factors such as their previous experience of international travel, their country of origin, and the port of entry to the U.S., new immigrants may be shocked by the size of the cities, highways, forests, rivers and lakes, and the sheer volume of cities, of food served on a plate . They also find that cars generally carry fewer occupants than they are used to and that more people drive up and down the streets than people who walk or use public transport. Immigrants from Africa also quickly realize that they are a minority in the United States – a stark contrast to their majority status in their country of origin.
Another cultural experience that can be shocking to the new immigrant from Africa is the sole use of English to communicate. Code switching, as is common with bilingual people, is not possible if only English is used as the language. Other things they learn or observe are the high cost of living, differences in clothing, the prevalence of contextual human interactions, driving on the right side of the road, love of sports reserved only for Americans, people who are homeless, panhandlers on the streets and the threat of opioids to name a few.
The COVID-19 pandemic has made the cultural experiences of immigrants from Africa even more complicated. According to their social nature, these individuals support each other when a member becomes ill by attending and helping them with childcare, cooking, and other household chores. COVID-19's safety guidelines do not allow people to congregate, especially around someone diagnosed with the disease. While the COVID-19 pandemic was peaking, it was common for people to be buried in communal graves. From an African perspective, it is unusual for a person to die and the bereaved to be unable to perform all of the rituals associated with funerals. It can take time for immigrants from Africa to grapple with these tragic experiences.
Past and present trauma
Depending on their country of origin, some immigrants from Africa may already have post-traumatic stress disorder or other disorders that have gone untreated due to events such as war, physical abuse, sexual abuse, accidents, displacement, political violence, interpreter clashes, or terrorism . In countries such as Somalia, South Sudan, Chad, Ethiopia, the Democratic Republic of the Congo, Libya and the Central African Republic, instability has persisted and casualties are high every year. There is ongoing violence in Nigeria, instigated by the terrorist organization Boko Haram.
Survivors of these instabilities can immigrate to the USA as refugees or enter the country under a different status. Their traumatic experiences in their home countries combined with new traumatic experiences in the new country they immigrated to can be difficult to treat. Many of these people may not be aware that they even have a treatable disease.
Solitude
Research indicates the severity of loneliness for mental health. People who immigrate to the United States may experience loneliness for extended periods of time before they form meaningful relationships within their host communities. Loneliness can be exacerbated by instances of rejection, discrimination, isolation, stereotyping, microaggression, etc. in their new communities.
They are often unable to communicate regularly with family members in their country of origin, as communication by post can take a long time and international phone calls are expensive. Loneliness, coupled with other problems, can lead to depression or thoughts of suicide for this population.
Language
Only a small minority of immigrants from Africa say that English is their mother tongue. Most of them learned other languages before English. Student immigrants from non-English speaking countries have fewer problems as they are usually enrolled in English class in the first semester of their respective program. Others who were fluent in English in their home country are often surprised at how different American English is from other English dialects and accents.
Fluency is important for self-expression and self-esteem. Immigrants struggling with the English language may have a harder time adjusting to their new life in the United States. Another disappointment they usually experience is the inability to change the code, that is, switch from one language to another, as they were used to before they moved. This is because most of the majority culture members they interact with now only speak in English.
New identities
Immigrants from Africa have to change their identity in many ways when they arrive in the USA. For example, in their country of origin there were certain activities and roles such as childcare, cooking, driving, mowing. The lawn, financial management, etc. were classified by gender. In the United States, these responsibilities are more commonly shared between men and women.
If African immigrants were wealthy in their homeland, they likely had used the services of a domestic worker to help with such tasks as childcare, cleaning, laundry, and cooking. These tasks must now be divided between the couples regardless of gender. The assignment of these responsibilities is often a major cause of discord among couples who have emigrated from Africa. This is because in many African cultures it is the responsibility of women to cook, clean, do laundry and take care of the children, regardless of their other daily roles and responsibilities. Once the couple immigrated to the United States, it is often difficult for their families in their country of origin to understand this new form of shared responsibility. Families in the country of origin will often comment that the immigrants have lost their cultural identity.
Loss
Immigrants from Africa suffer several losses when settling in their new country. Examples of loss are identity, wealth, social status, family ties, language, cultural traditions, freedom, innocence, traditional food, goals in life, favorable climate and familiarity. Depending on the impact of these and other losses, immigrants from Africa may need mental health assistance to deal with it.
During the COVID-19 pandemic, it was particularly difficult for African immigrants to deal with the resulting losses. They are used to living a social life in which they congregate for no apparent reason. During the pandemic, they largely lost this aspect of their culture due to restrictions on personal sociability. If other parishioners are hospitalized, they cannot be visited either. When people die of COVID-19, there is additional pain due to limitations in viewing the deceased or performing traditional funeral rites. At the height of the pandemic, people who died of COVID-19 were buried in mass graves while others were cremated. These are not common practices among many cultures from Africa.
Family relationships
In Africa there is a common tradition which indicates that it takes a village to raise a child. Extended family members, relatives, and neighbors are expected to work for the well-being and development of growing children. Immigrant couples typically do not have the luxury of having their children in the US village, whose dominant culture is individualistic rather than collectivistic. When these parents are busy at work, college, or other responsibilities, they take their children to daycare for a fee because they are no longer surrounded by close family members or friends who would have looked after their children. This can become a major cause of family relationship problems for immigrants from Africa, especially when these fathers need to change their traditional attitudes and beliefs to share responsibility for childcare.
Parenthood is another source of strained relationships between African immigrant families. This is partly because the village is now absent and the couple are left with little outside help to care for their children. In addition, parenting styles in the United States are different from parenting styles in Africa. The cultural practice of disciplining a child by African parents can be construed as physical abuse of children in the United States, which can put those parents in trouble with the law.
In Africa the cost of raising a child is low compared to the US. For this reason, immigrant couples may choose to have fewer or no children. There are also differences between the first and second generation of immigrants from Africa. Second generation children are more exposed to and more likely to be influenced by mainstream majority culture. Attempts by parents to teach the second generation the value of maintaining their culture are often met with opposition, which can strain family relationships.
The American Dream
There is a general belief among aspiring immigrants from Africa that the American dream is easy to achieve. Some interpret the dream as having a good education, wealth, good health, affordable health insurance, and stable income.
While some immigrants make the American dream come true, others struggle. For the latter, the lack of achievement can lead to a source of self-pity, shame, and guilt, especially because their family in their country of origin may not understand that not everyone in the United States is rich. Some are beginning to wonder why they immigrated and may consider returning to their countries of origin. Problems can arise when communication within the family is ineffective.
Racism
The Black Lives Matter movement has exposed social ills that have plagued the United States for many years. As a marginalized population, immigrants from Africa can be the target and victim of discrimination, racism, bigotry, hatred, microaggression and other social ills that are often promoted by institutions that are supposed to protect them.
Now that these diseases become widespread, there is a possibility that they will become additional sources of anxiety and related mental health problems. These immigrants may wonder how safe it is to continue to live in a country where they are openly not sought. Family and friends in their country of origin may have similar questions and feelings and encourage them to return home.
Education
When immigrants from Africa enter the US on an F-1 student visa, they are expected to maintain their student status and follow the strict guidelines of the US Citizenship and Immigration Service until they graduate. Some of the provisions include maintaining full-time student status by attending the required number of courses per semester and maintaining passed grades. You are not allowed to look for work without permission. If given such permission, they can work on campus for 20 hours a week.
The cost of higher education for international students is high. Many students cannot afford tuition fees to complete their studies and may drop out of school. If so, they'll lose their student visa status and start the cat-and-mouse game of evading US immigration and customs for violating their immigration status.
Graduating students have the option to apply for a status change to become permanent US residents, especially if they graduate in high-demand programs such as software engineering, nursing, medicine, computer science, and so on have on. The process takes time, but it is the safer route most students take to ensure their continued sojourn in the country and their eventual realization of the American Dream. Before that happens, they live in constant fear of being deported.
Acculturation
Over time, the continued interaction between immigrants from Africa and the majority population in the US leads to acculturation. Immigrants select aspects of majority culture to be adopted and aspects of their respective cultures to be retained. In a symbiotic and ideal relationship, majority culture also selects aspects of the immigrant population to be adopted. It is important that counselors working with immigrant clients from Africa encourage them to retain aspects of their culture that are important to them so that they do not completely lose their identity.
Another source of family conflict can arise when children give up some cultural aspects of their family in favor of aspects of the majority culture. This happens in the youth and youth years when they develop their identity, which is often influenced by majority culture. It becomes a problem when their parents do not endorse the accepted principles of majority culture.
Drug and alcohol consumption
Alcohol is used for social and traditional purposes in most African contexts. In the mostly communal lifestyles, people look out for one another to avert abuse in the manner of a “brother's guardian”. However, these close relationships are largely or completely absent in the new country of residence of African immigrants. Here they have no close friends or family members to look out for or to share their problems with.
Without education and awareness of psychological counseling, some immigrants from Africa turn to self-medication with alcohol, drugs or both. Addiction is a serious problem for African immigrants today, and it is good practice to assess drug and alcohol use even when this is not the subject at hand that is brought up for advice. If left unchecked, addiction to drugs and alcohol could easily degenerate into a generational problem affecting present and future generations.
Treatment instructions
Professional counselors should keep the following in mind when working with clients who are
African immigrants.
> Assessment: Effective treatment begins with a thorough assessment. In addition to the questions brought to counseling, it is important for mental health counselors to evaluate other questions that are not as obvious. Advice may still be a new concept for customers with a migrant background from Africa. They may not feel comfortable sharing their problems with strangers. As a result, consultants need to choose assessment tools and procedures that are less intrusive.
> Rapport: Research indicates the importance of developing a therapeutic rapport with clients at the beginning of the counseling process. It is also necessary to maintain this relationship throughout the counseling process. It will likely take extra effort to build and maintain a trusting relationship when working with immigrant clients from Africa as counseling may be a new concept for them. In addition, it may be necessary to inform these clients about what psychosocial counseling is about and what roles and responsibilities they have in the counseling process.
> Cultural sensitivity: Psychiatric counselors are cultural beings and bring their culture to the counseling relationship. It is important for counselors to be constantly aware of their culture, including the prejudices, beliefs and stereotypes they hold against migrant clients from Africa. It is also imperative that counselors refrain from imposing their culture on these clients.
It is beneficial for counselors to learn about the unique culture of their immigrant clients from Africa by allowing time to time for culture immersion and participation in ethnically specific cultural activities. They will then use ethnically specific and evidence-based interventions to work with these clients.
> Self-care and wellness: Psychological counseling can exhaust our emotions and energy. Therefore, mental health counselors should implement a self-care regime and follow regular self-care activities and plans to help re-energize. Likewise, it can be helpful to educate our customers who are immigrants from Africa about how to take care of themselves and improve wellness strategies for their improved mental and general health.
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Stephen Kiuri Gitonga is Assistant Professor in the Clinical Mental Health Advisory Program at Lock Haven University in Pennsylvania. He is a licensed clinical mental health advisor licensed in Idaho, Kentucky, Utah, and Pennsylvania. Contact him at [email protected].
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