I work as a therapist in left-leaning California, where immigrants are mostly welcome, and your gender and sexuality are your business.
Here you can live free of harassment about your skin colour, your country of origin, or who you choose to love. Well, that was the case until recently.
Since January myself and my fellow therapist colleagues have noticed an uptick in the frequency of clients presenting for anxiety and depression, but anxiety in the main. The people in my caseload hail from all backgrounds and lifestyles: African-American, Latinx, Middle Eastern, gay, trans, and in their own ways gender fluid. There is a large Irish population here.
These people have spent their lives in the US living whatever remains of the American dream, being gainfully employed, paying taxes, raising families and in many ways giving back in whatever ways they can.
But with the dawning of Trump 47, the ominous Project 2025 is playing out here in real time.
News channels – not the ones aligned with the administration – cover daily the raids by Immigration and Customs Enforcement (Ice) officers, as they arrest and detain those they know to be in the country illegally, but also those whom they simply suspect might be, holding them in detention centres notorious for their harsh regimes.
No matter where you are arrested in this vast country, you could find yourself languishing without legal representation in a prison thousands of miles from your home. And, when immigrants are expelled from the country, there is no guarantee they will be on a flight back home, where there may be some semblance of support. Many find themselves in dank cells in countries with questionable human rights records.
My trans, gay and gender-fluid clients are increasingly fearful as they watch their hard-fought-for rights and services being eroded, as support for and the availability of medical procedures, medications and mental health interventions comes to an abrupt end.
And my gay friends and clients had been collectively holding their breath as the Supreme Court of the United States (Scotus) was recently asked to overturn the 2015 Obergefell vs Hodges decision, the historic ruling legalising gay marriage. When Scotus announced it would refuse to hear the case, the celebrations began. They were more muted than usual.
When any client presents for therapy and anxiety is the primary concern, anticipatory anxiety – the “what if?” questioning – is notable immediately. “What if I’m lifted by Ice and my family loses the only income we have?”
I will without fail at some point during our time together quote the Roman Stoic philosopher Seneca: “We suffer more in imagination than we do in reality.”
For all of my clients experiencing the existential dread of anticipating what initiative could be coming next – loss of rights, loss of home, deportation back to an Irish county they left 25 years ago to escape the parochial milieu – they tend to live in the immediate to medium-term future, questioning the what ifs? And what abouts? The potential eventualities are never anticipated to be positive. Not now. Not any more.
The anxiety experienced by the client can be debilitating, and I work immediately on reducing this. My usual refrain goes something like this: “If this is not happening to you right now, can you focus on the things you need to do to keep things [air quotes] normal? Or to prepare for whatever might happen? You’re stressing yourself about one-thousand-and-one possibilities, and yet only one will be your reality. The rest is illness, and maybe collapse.” Words to that effect, but more gentle.
It is impossible to quell all anxieties for all clients, for no one knows the target population or the intensity of the next initiative to roll down from Capitol Hill. But we try, us therapists, to make life just one degree more tolerable, less stressed, more focused on the here and now and the “what do I need to do next?” We try to instil hope, and an understanding that where there is nothing happening yet, nothing may happen. . So, we focus on stability. But also on preparation.
I have a tin sign in my office with that Seneca quote on it, and I look at it every day: we suffer more in imagination than we do in reality. Nice words, comforting words, challenging words, but even I know they are just words, and words often can’t stop or delay the inevitable.
So yes, I too am preparing to leave the US after living here for more than two decades. I was born and raised in Northern Ireland, and it has always been my intention to return. I am a naturalised citizen here, and there are rumblings that we could be next, us interlopers, we whose ancestors didn’t saunter off the Mayflower and into the raw New World.
The rumblings, for now, remain just that for us legal immigrants, something somewhere in the distance, but we are hearing rumours of the administration seeking the denaturalisation and deportation of any naturalised citizen convicted of a crime. This is the proverbial tip of the iceberg for us legal immigrants.
So I’m preparing. I do not have any criminal convictions, I am here legally, I have married and raised a family here. But I too am preparing to leave. I am not suffering in my imagination, but I can in quiet moments hear the knock on my door, and I can feel the unnecessary cuffs tightening around my wrists.
I tell myself that the boxes piling higher around me – filled with clothes and books and all that you can’t leave behind – are my attempts at a long, deep spring clean.
That’s it, I tell myself. I’m spring cleaning.
E R J McKay is a therapist in California, USA. He is originally from Belfast. It has always been his intention to return home. A writer, he publishes on Substack as @erjmckay, and is writing a memoir. His therapy practice details can be found here.
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