Published: Monday, December 8, 2008

Part II: Alone Among Us
Dan Bates / The Herald  (click to enlarge photo)
Jordan Torres, 15, hugs his mom, Tina Torres, at his graduation from Sea Mar's Renacer Youth Treatment Center in Seattle. At right is Jordan's uncle, Johnny Torres.

By Sharon Salyer, Herald Writer
and Alejandro Dominguez, La Raza del Noroeste
By the numbers
14: The age by which half of all lifetime cases of mental illness begin. Anxiety disorders often begin in late childhood. Mood disorders, such as depression and bipolar disorder, in late adolescence.

24: The age by which three-fourths of all lifetime cases of mental illness have begun.

1 in 4 people age 18 and older suffer from a diagnosable mental disorder.

1 in 17 people suffer from a serious mental illness, such as clinical depression or bipolar disorder.

1 in 11 Hispanic Americans have a mental disorder. Fewer than 1 in 11 contact mental health specialists, while fewer than 1 in 5 contact general health care providers.

More than 20% of Hispanics are open to seeking professional mental health care. The barrier: A lack of mental health coverage in their health insurance plan -- 20 percent fewer of them have this coverage compared with the overall population.

25% of Hispanic high school students meet the criteria for clinical depression. Hispanic adolescent girls reported higher rates of suicide attempts than their African American or non-Hispanic white peers.

Sources: National Alliance for Hispanic Health and Centers for Disease Control and Prevention; National Institute of Mental Health; American Psychological Association; U.S. Surgeon General's report: Mental Health: Culture, Race and Ethnicity.
The only place 13-year-old Jordan Torres seemed to find comfort was in his darkened bedroom.

"I would just lie in bed ... not wanting to do anything but lie around all day ... not even wanting to get up," he said.

"My mom would ask, 'What's wrong?' I wouldn't say nothing and just be in the room in the dark."

He remembers feeling the same way, and not knowing why, when he was much younger, just 6 or 7 years old.

Hiding in his room was one way of coping with the turmoil in his life, which he said included the verbal abuse of his mother, the physical abuse of his brothers, being beaten himself when he was 8 years old, binge drinking by a family member and the emotional upheaval caused by his parents' separation.

His major emotional support was his grandmother, who encouraged him to talk to her and gave him comfort. But when she died, he felt he had no one to turn to.

One night, his mom, Tina Torres, came home from work and noticed Jordan acting strangely, grabbing his stomach and his head. Her "mom's radar" told her she had reason to worry. She rushed him to the hospital.

On the way, she kept asking him what was wrong.

Finally he said, "It's my fault; I'm going to die."

Her 9-year-old son told her he swallowed some of her prescription pain medications.

It was just the first in what would be a series of attempts Jordan made to injure himself or take his life.

A self-inflicted stabbing, by luck, caused a non-life-threatening puncture wound. His brother tackled him, preventing a more serious injury.

Drug problems didn't help him feel any better. Once, when he said he was using cocaine, he thought about shooting himself. "My brother had a gun in his room."

On a drive to Yakima in the spring of 2007, a quarrel with his mother quickly spiked into a stormy clash of words and wills. He tried to jump out of the moving car, but his mom was able to stop him.

Jordan said he can't remember when someone finally gave him the word for what he was feeling.

"I didn't know much until they told me why I was feeling down all the time and hopeless," he said. "The doctor said it was because I had depression."

Yet he bristled at the idea of taking prescription medications. He saw them as a signal that some deep part of him was broken.

Jordan's refusal to admit he had a problem is common among Hispanics -- both adults and children.

While stigma over admitting to mental health problems is widespread in American culture, the shame is even more profound among Hispanics.

Seeing a counselor or other specialist for mental health troubles is a foreign concept to immigrants coming from countries where such services aren't widely available, said Claudia D'Allegri, vice president of behavioral health services for Sea Mar Community Health Center.

The nonprofit organization provides medical and mental health services in Western and Central Washington. Its services are open to anyone, but it specializes in helping Hispanics.

"Just coming to a counseling center is really scary for our community. We call it loco -- crazy," she said. "We definitely stereotype people with mental illness."

This deep cultural stigma may be part of the reason why, even at such a young age, Jordan didn't want to admit that anything was wrong.

Taking medication for his depression "made me feel other boys were better than me because they were not taking the pills," he said.

In search of an identity

Dan Bates / The Herald  (click to enlarge photo)
Before the graduation ceremony at Sea Mar's Renacer Youth Treatment Center in Seattle in June, counselor Phillip Leija waters plants while Jordan Torres, 15, sits in his office.
Jordan Torres' experience is an example of the mental health challenges faced by Hispanic youth.

U.S.-born children of Latinos are more likely to have mental health disorders than their foreign-born parents, according to the National Institute of Mental Health.

Second- and third-generation Hispanic teens and young adults have more problems with drug and alcohol use than first-generation immigrants from Mexico, said Dr. Sergio Aguilar-Gaxiola, professor of internal medicine and director of the center for reducing health disparities at the University of California Davis School of Medicine in Sacramento.

And teenage Hispanic girls have higher rates of suicide attempts than their black or white peers, he said.

Some of these problems may be caused by adolescent conflicts between kids and parents, heightened by conflicts over values, beliefs and customs, Aguilar-Gaxiola said.

"American culture encourages them to be sexy and assertive," he said, while the family expectations for Hispanic teen girls is to be modest and submissive.

The lack of strong ties to relatives, communities and customs also may play a role in the problems faced by second- and third-generation Hispanic children and adolescents, he said.

Teen girls may be using suicide attempts as a cry for help as they struggle with feelings of powerlessness and frustration, living in families where parents are often absent, working long hours to make ends meet, Aguilar-Gaxiola said.

These trends among youth occur in a culture that tends not to recognize mental illnesses, such as depression, are a problem. Hispanics, perhaps more than any other ethnic group, have low rates of using mental health services, he said.

"When you compare the different ethnic groups, Latino is perhaps the single ethnic group with the lowest rates of mental health utilization -- as well as Pacific Islanders," he said.

Aguilar-Gaxiola was the project director of a study done on seasonally employed workers on how often they use mental health services.

The survey found differences among generations in the Hispanic population in their approach to mental health services, he said. Among farm workers, one in 10 used mental health services compared with one in six of the first generation and one in three of those born in the United States.

"The second generation is different than the first generation. The second generation feels displaced," said Aguilar-Gaxiola, referring to the second generation's struggles with its cultural identity, feeling caught between two worlds.

Aguilar-Gaxiola does not know why the differences exist between the generations.

Economic status is not a factor, he said, which causes "a Latino paradox." Generally, poverty and low socioeconomic levels tend to be associated with higher rates of mental illness. This does not happen in Hispanics, Aguilar-Gaxiola said.

Hispanics, in spite of being socially and economically disadvantaged, tend to be healthier, he said.

He figures Hispanic immigrants benefit from the protection found in traditional, close-knit families. The problem is that these protective behaviors are deteriorating, he said. Families are no longer intact and the divorce rate of second-generation Hispanic families has increased to nearly 50 percent. Thirty years ago, the divorce rate was 20 percent, Aguilar-Gaxiola said.

"We see erosion of behavior in 13 years, due to acculturation," he said.

Not easy being a teenager

Dan Bates / The Herald  (click to enlarge photo)
Jordan Torres' mother, Tina Torres, stands between him and his uncle Johnny Torres for a closing prayer during Jordan's graduation ceremony at Sea Mar.
Young Hispanics face the combined challenges of being both teenagers and immigrants at a stage of their life when they are more open to experimentation, said Wendy Messarina, Spanish parent community liaison for the Marysville School District.

Messarina helps supervise a group of about 16 Hispanic high school students participating in a special online program to help them graduate.

From what her students tell her, worries over their immigration status affect their general mental health.

They feel anxious searching for employment, applying for a driver's license or even going to school events. Parents are afraid to meet with teachers or attend PTA meetings. The students feel neglected, she said.

Misunderstandings about the school system also contribute to their apprehension. For instance, parents do not know they have to report their child's absences from school. Unreported absences become truancies, and if things wind up in court, students and the parents get anxious because they believe they will be deported, Messarina said.

Often the students isolate themselves, steering clear of clubs or teams or cliques, both American and Hispanic, because they don't want to be easy targets. "They kind of feel like the ugly ducklings," she said.

That sense of not belonging can spread beyond just their social groups, to feeling alienated over living in America.

It can lead them to limit their use of English and undermine their confidence in speaking it.

Even family members of the same generation can have a far different sense of belonging.

Blanca and her family are illegal immigrants who have lived in Lynnwood for the past three years. She asked that only the family's first names be used.

Her son, Jose, 14, and her daughter, Alejandra, 10, have two very different ways of seeing their place in the community.

Alejandra has made friends and loves the U.S. For her, going back to Mexico is impossible, Blanca said.

"My daughter always speaks English," she said, more than any other member of the family. "My son only speaks English in cases of emergencies and at school."

Jose, she said, recognizes this is not his country. His feeling of not being wanted is based on an incident in Monroe two months ago.

While Jose and his father were out fishing on the river, someone scrawled "Go back illegal" in black marker on the windows and on the trunk of the family car, she said.

"Why did they do this to us?" Jose asked his dad.

They cleaned it up and did not report it to the police or tell Blanca until recently.

Blanca said she plans to take her family back to Mexico in two years. In the meantime, she wants her son and daughter to learn as much English as possible to improve their chances for getting better jobs.

A chance to change

Dan Bates / The Herald  (click to enlarge photo)
Counselor Phillip Leija (left) and Jordan Torres' brothers Jorge Castro (second from left) and Bonifacio, 9, listen as Jordan Torres speaks during his graduation ceremony at Sea Mar.
Six years passed between the time 9-year-old Jordan Torres took his mom's prescription pain pills and when he was admitted to Sea Mar's treatment center for teen boys in south Seattle.

Those years were filled with just about every kind of turbulence a young teen could face, including daily marijuana use at 13, which led to harder drugs.

"It made me feel like nothing could really touch me," he explained. "It made me forget about all my problems."

He began skipping school, joined a gang and burglarized homes to buy drugs.

His mom noticed his swollen eyes and smelled the lingering scent of marijuana.

"She knew, but she couldn't make me stop," Jordan said. "I would have to want to stop."

His mom tried every persuasive argument she could think of to get him to change.

"You're the older brother to a 9-year-old, what example are you setting?" she remembers asking him.

"I couldn't sit him down long enough to get him into mental health counseling," she said. "He was so out of control and angry. ... He was on some kind of quest ... to hurt himself."

Finally, the only option she felt she had left was to kick him out of the house. He lived on the street for about a month. In February, he was picked up by police as a runaway.

A juvenile court in Yakima required him to get treatment. He was sent off for 90 days of treatment at Sea Mar's youth treatment center in south Seattle. Its programs help teen boys battling complex, interrelated problems often including drugs, alcohol, gangs and mental health.

The organization has outpatient and inpatient treatment centers to help adults and youth recover from substance abuse and mental health problems. Their facility in Seattle, Renacer -- meaning rebirth in Spanish -- has a military-like schedule: when to get up, when to make your bed, when to eat, when to go class, when to go to group or individual counseling sessions.

To avoid conflicts over gang affiliations, everyone has the same drab wardrobe, including gray sweatpants, gray T-shirts and black canvas slip-ons.

Jordan hated the regimen and being away from home. He called his mom nearly every day, begging her to visit. "I keep praying and God doesn't answer me," he told her.

"He was trying to walk two paths," she said, "telling them what they wanted to hear and still planning on coming out and doing the same lifestyle."

Then, during his second month at Sea Mar, she noticed a change.

Maybe it was the cold dose of reality from group discussions, glimpses of what his future could be if he didn't make a big change. He said he heard stories of being a "crackhead," of living on the streets without any family. He didn't want it to be that way for him.

And maybe it was personal resolve. "I want to make something of myself," he said. "Gangs and drugs are just going to take you away from your life and your dreams. I noticed how it hurt my family. It's not a very proud thing, a lot of broken hearts and tears."

On June 11, three months after he arrived, Jordan sat at the front of a room for a ceremony to mark his graduation from the program. To his left and right were his mom; his brothers Jorge "George" Castro, 23, and Bonifacio Miguel, 9; and his uncle, Johnny Torres of Tacoma.

There was a celebration, cake waiting to be served. But first, the staff and each of Jordan's classmates gave him their last words of advice.

"Every time you said, 'I'm tired of making my mom hurt,' it was exactly what I felt," said one young man with a short buzz cut.

"You and me came here the same day, we fought like brothers," said another teen with long, light brown hair and a small beard. "It's unbelievable how far you've come. Stay strong."

His mother knew the biggest challenge for Jordan was still ahead. "The real work begins when you come out," she said. "You've got to apply what you've learned."

Powerless parents

Dan Bates / The Herald  (click to enlarge photo)
Artwork created by young people in need of help is displayed on the wall in a common area at Sea Mar's Renacer Youth Treatment Center in Seattle.
Children and teens receiving counseling from Sea Mar often are missing a father or mother who had to move to another city or who was deported.

Others have complicated issues involving gangs, said D'Allegri, vice president of behavioral health services for the nonprofit organization.

The cultural gap can be overwhelming. Young immigrants are looking for their identities and language becomes an issue. Second-generation children and teens start forgetting Spanish and have better English.

Both immigrant and second-generation children often become the family's interpreters. This gives them opportunity to manipulate information on issues such as how well they're doing in school, or it can give them complicated responsibilities that are beyond their age or comprehension.

The role of Sea Mar is to give more power back to the parents, D'Allegri said. "We believe we cannot treat the youth unless you treat the family."

Sea Mar has a program staffed by bilingual counselors to help families connect when someone can speak only one language.

When the family comes together, they have to deal with cultural issues, like the family's values versus teen peer pressure, D'Allegri said.

In Hispanic culture, symptoms of stress, anxiety and other mental health problems often are treated as something the individual must handle himself, said Luis Vila, a mental health counselor at Consejo Counseling and Referral Service, a Seattle-based nonprofit that serves Hispanics.

Men don't learn to accept being scared or sad, he said. Instead, they mask their emotions by getting angry. "They get irritable, not happy with anyone or anything, they don't sleep well. They self-medicate with alcohol and sometimes other drugs."

Women who are depressed or have other mental health problems tend to cry more, saying they wish they wouldn't wake up or "I'm ready for God to call me," Vila said.

Children get irritable, sad, have appetite changes, and sometimes, he said, are disruptive or defiant in school.

Children and teens from immigrant families often battle to cope with the stresses of acclimating to a new culture, said Maria Lopez, Consejo's assistant clinical director for children and family services.

Depression is one of the most common problems they see in children, she said. They sometimes turn to alcohol and street drugs to mask the symptoms.

Lopez also sees children with anxiety and attention disorders, sometimes even psychotic conditions and thoughts of suicide, she said.

Tough love

(click to enlarge photo)
Artwork created by young people in need of help is displayed on the wall in a common area at Sea Mar's Renacer Youth Treatment Center in Seattle.
In late August, not quite three months after he graduated from Sea Mar's inpatient program, Jordan walked down the sidewalk into Wapato's 87-degree late summer afternoon sun, on his way to one of his ongoing counseling sessions.

His older brother, Jorge Castro, sat inside the family's home next to an air conditioner set at full blast.

Important milestones awaited Jordan. His 16th birthday was just two days away. The family was making plans for a celebration.

He would begin classes as a sophomore the following week.

Both his older brother and his mom say they noticed big changes in Jordan when he first returned home -- an openness, more willingness to talk.

Jordan still experienced bouts of depression, becoming unusually quiet. That was his brother's cue to push a button on the remote, dampening the volume on the TV.

"What's up?" Jorge would ask.

But in this central Washington town of about 4,500 people, temptations of his old life are never far out of reach.

His mom started sensing that something was wrong with her son, a change, again, in his behavior. One day she confronted him. "Jordan, you're using again," she said.

He denied it, but he was.

For his 16th birthday, Jordan's family planned a group outing. They were joined by Jordan's 19-year-old brother, Oscar Torres, who lives in Canada.

They shopped for school clothes in Richland. At a celebratory restaurant dinner, they had a tough-love family talk.

"Be a man; accept your faults," Jordan's brother, Oscar, told him.

Some days later, his mom searched his belongings, finding what she sensed for several weeks would be there, a stash of marijuana.

"We're all, once again, helping him go through this," his mother said.

One morning in September, Jordan refused to take his medication to help keep his depression in check, throwing the pills aside, she said.

Jordan's problems -- relapsing into old behaviors -- are not unusual, said Philip Leija, one of the Jordan's counselors at Sea Mar. "The one thing that kids face that we don't as adults is peer pressure," he said.

"They relapse because they don't have the support, a lot of the things they need as kids," he said, such as a community gathering spot in Jordan's hometown where Hispanics can say, "I used to have a problem. Now I'm clean and sober."

"This family, for some reason, my heart reaches out to them," Leija said. "I think it's because he's such a good kid. He's got a good heart. He's not strong enough to take charge and do what needs to be done."

The family's battles continued. On Sept. 19, older brother Jorge was in a car accident that left him with life-threatening injuries, on life support in a hospital intensive care unit for three days, his mother said. The night of the accident, Jordan ran away from home for three weeks.

Tina Torres said she put both her sons' problems in God's hands. She prayed for Jorge's healing. Doctors said he made a quicker-than-expected recovery, although he had to use a cane to walk, she said.

She said she prayed for Jordan to come to grips with his life before he hurt himself or anyone else.

His mom said she struggles to balance how much of Jordan's problems are due to severe bouts of depression and how much are caused by being a rebellious teen.

When her son is taking his prescriptions for depression, "he's a totally different kid ... a good kid. That's the Jordan I know," she said, "more balanced and focused."

The message she and other family members try to reinforce with Jordan is that he is accepted and supported by his family. "We say, no matter what, you're my son, my brother and through whatever, we love you."

One picture in the family's home has helped them reflect on all the hopes and setbacks they've faced since Jordan finished his three months at Sea Mar. It was taken on June 11, the day he graduated from the program. He is surrounded by his brothers, mother and uncle.

Jordan had just told them how sorry he was for all he had put them through, and thanked them for never giving up on him, for still showing him love. The photograph captures the moment as Jordan reaches out with affection to his younger brother, Bonifacio, giving him a brotherly pat on the head.

His mom said the first time she saw the picture, she cried, asking herself: "Why? Why? Why can't it just be ... why can't he just be ...?"

Jordan, though, didn't see the photo until late October, when he was living at home again. His mom asked him to bring her a stack of mail sitting nearby, which included an envelope with the photo inside.

"When did you get this?" he asked.

He seemed to reconnect with the moment, a reminder both of what he had once accomplished and that he was back again dealing with many of the issues that first sent him to treatment.

"Did I really do that?" he asked.

"Yes," his mother told him, "and you can do it again."

Reporter Sharon Salyer: 425-339-3486; ssalyer@heraldnet.com.
Reporter Alejandro Dominguez: 425-673-6632; adominguez@raza-nw.com.

Part 3: How cultural traditions can help people improve their mental health.

Sharon Salyer and Alejandro Domínguez’s reporting on the mental health challenges faced by Hispanics is part of a health journalism program offered through the Annenberg-California Endowment Health Journalism Fellowships, administered by the University of Southern California Annenberg School for Communication.

Table of contents
I: Alone Among Us (English)
I: Aislados Entre la Multitud (Español)

II: Fear of 'Loco' Label (English)
II: El miedo de ser llamado Loco (Español)

III: Cultures Turn to Traditional Ways to Heal (English)
III: Mezclando Los Dos Mundos (Español)

IV: Mental illness carries stigma among Asian cultures, too (English)
IV: Hispanos no son los únicos (Español)

Mental Health Resources

Audio and Video
View a video feature about the Immigration and Customs Enforcement detention center in Tacoma.
View an audio slideshow about the practice of Jorge Ruiz Chacón, a curandero or natural healer.
Listen to Cristina Mendez-Diaz talk about being at the ICE detention center and her struggle with depression.
(Click play button below)
Listen to Jordan Torres talk during his time at Sea Mar's youth treatment center about his battle with drugs and depression.
(Click play button below)

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