“I’ve been struggling with my mental health since I was 10 or so,” said Sara, a petite 22-year-old who works as a teacher at a junior high school. Sara lives with her parents in a midsize city just southwest of Phoenix, where she was born and raised. Her mother came to the United States as a Cambodian refugee in the 70s—a process that forced her to “grow up faster than anyone should have to,” in Sara’s words. “She still has a lot of trauma to unpack.”

This article appears in VICE Magazine's Borders Issue . The edition is a global exploration of both physical and invisible borders and examines who is affected by these lines and why we've imbued them with so much power. Click HERE to subscribe to the print edition.

The children of immigrants may never pass a physical border, but they still face serious barriers to accessing mental health resources in the United States. There’s the challenge of financing therapy or psychiatry and any associated medications—especially given the number of immigrants who are uninsured, which is roughly 23 percent of lawfully present immigrants and 45 percent of undocumented immigrants (excluding elderly populations), according to a recent Kaiser Family Foundation analysis. There are language barriers. And there are race barriers—with fewer people of color using psychological resources and fewer people of color working in psychology.

Her mental health was never really a consideration for her mother—instead, trauma became a point of comparison. “Every time I tried to talk to my mom about [my mental health], the conversation would steer toward how I had nothing to be depressed about,” Sara said. “We are an upper-middle-class family. My upbringing was cushy and sheltered compared to her own, so she’s not completely wrong, but we only know our own realities.”

With an immigrant mother and an American-born white father, Sara spent much of her childhood struggling to find a sense of belonging. “The community I grew up in is mostly white and conservative, so there weren’t many people who looked like me, let alone who could relate to my experiences as the daughter of an immigrant,” Sara said.

The majority of new immigrants to the U.S. are people of color, meaning both parents and children must navigate the realities of racism, but each generation experiences discrimination differently. While U.S.-born children of immigrants don’t have to weather the traumas of migration itself, they may have a harder time enduring discrimination, thanks to having a “singular frame of reference,” said Tomás R. Jiménez, a professor of sociology at Stanford. Parents instead have a “dual frame of reference,” which means “parents are judging life in the United States based on their comparison to the place that they left,” Jiménez added. “Kids only know the kinds of discrimination they face in the United States. And that often leads them to conclude things are a lot worse [than what their parents faced] or that they’re pretty bad.”

It’s an experience that’s often overlooked in broader conversations about immigrant mental health, despite more than 18 million people under age 18 living with at least one immigrant parent as of 2017, according to the Migration Policy Institute —a figure that represented 26 percent of the 70 million kids in the U.S. at that time. While there’s no way to catalog the specific stressors that affect such a wide swath of cultures and countries—and it would be disrespectful to consider the category of “immigrant” itself as a monolith—there are fairly universal cultural barriers. Having U.S. citizenship doesn’t render children immune to immigration-related stressors. They must learn to be flexible, able to withstand constantly straddling the culture their parents came from and the culture they’re currently growing up in.

But the strictly cultural barriers are just as pervasive, though they’re harder to quantify. In reporting this story, second-generation immigrants have shared with me, myself a second-generation immigrant, the sense that “therapy just didn’t exist” to their parents, or was “deeply stigmatized.” (The people interviewed asked to remain anonymous to protect personal details and medical history, and also to protect the identity of their family members.)

To be fair, all children wrangle with the disparities in their and their parents’ worldviews in regard to age—every generation feels their parents just don’t understand them. But children of immigrants deal with a generational and cultural gap. And this gap is exacerbated by distance and time: Immigrant parents may have a more conservative view of their culture than the people currently living in their country of origin do. “If they came 30 years ago, then the culture is 30 years old,” Choi explained.

“Children of immigrants who are shouted at and told ‘Go back to your home country,’ don’t have that country to go back to—this is the only country they have,” said Yoonsun Choi, an associate professor at the University of Chicago school of social service administration. “But for parents being told ‘Go back to your country,’ they at least know what that means. They have a country they can identify with.”

“I never knew what was normal,” said Michaela, a 35-year-old who works as a graphic designer in San Francisco, about her childhood in North Carolina. Michaela’s parents emigrated from Venezuela to the United States in the 70s to pursue higher education. She recalled navigating the culture shock and uncertainty of coming of age in an immigrant household, even as someone who physically grew up in the United States. It was an accumulation of little things. “I would notice friends sending Christmas cards—and I’d be like, Can I send Christmas cards? Can I do that thing that seems like a normal thing that my friends are doing, that you’re supposed to do?”

This is all compounded by the challenges of assimilating to Western culture, a process called acculturation, which encompasses learning new governmental infrastructure—vital procedures related to education and voting can be confusing to understand—social classes and gender roles, and social rituals like how close you stand to another person while conversing or what clothing you’re supposed to wear in different contexts. Even grocery shopping can be completely disorienting.

It’s a lot of pressure. In the book Children of Immigration, Carola and Marcelo M. Suárez-Orozco interview a Ghanaian taxi driver in New York City who hopes his 10th grade son will get into Harvard—his two eldest are already attending Duke and Brown. “I make sure I know my children’s friends, and if they want to come to my house they have to follow my rules,” he said. Sara felt a very similar kind of force throughout her childhood from her mother. “She wants better for my sister and I, and wants us to be better than her, but she has very defined expectations of success, which affect us,” Sara said. “If we aren’t surgeon-lawyers in space, we aren’t successful and she can’t brag about us to her friends.”

“It’s more explicit for parents who are immigrants. They want their kids to make good on the sacrifices their parents made. In this case, the sacrifices are picking up their entire life and moving to a different part of the world,” Jiménez said. “Sometimes that can be implied and kids just know the deal—they know what their parents went through and they know why they came, and think, I’ve got to keep the bargain.”

This is especially true when it comes to American ideologies of “find[ing] your passion,” which may be fundamentally incompatible with an immigrant parent’s extremely high expectations for how their children can and should succeed, according to Jiménez.

While acculturation builds “ resilience ”—a term that reflects the tendency of children of immigrants to be unflappable or have “grit,” according to Jiménez—it can also create an incredibly stressful home environment, in which the child has to juggle parents’ expectations and behaviors in a world that doesn’t quite fit. Because U.S. born immigrant children tend to be more adept than their parents at picking up Western culture and language—which makes sense, given that they grow up in it—the gulf between parent and child only grows larger.

This invalidation eventually becomes internalized and turns into guilt. “Whenever I searched for stories like [mine], I stumbled across stories of people who had the ‘right’ to be depressed,” Sara continued. “My experiences seem small compared to what my mother went through. But I now understand they are valid in their own way.”

“I was sad all the time. I was having intrusive thoughts that I didn’t want to be thinking,” Jasmine said. “Everything scared me and I was unable to sleep. Finally, when I got to the point of having a breakdown, I told my mom what was happening. She was really scared, because she didn’t know what was happening either.” Jasmine’s parents did the only thing they could think of—they took her to their Catholic church.

“We started by visiting churches, because my mom didn’t know where else to take me,” Jasmine recalled of her trials with anxiety at the age of 16. Now 28, Jasmine is a huge advocate for mental health access, frequently blogging about her depression and anxiety using the Road Runner, from the classic cartoon, as a metaphor for her racing mind. Jasmine’s parents emigrated from Mexico to the United States in the 80s and then obtained dual citizenship. She grew up in Chicago in a predominantly Mexican neighborhood. The community was tight-knit, and even with the support of friends and family, she knew something felt wrong. But she didn’t have the words to describe it—and that only made the terror worse.

There may also be separate cultural stigmas attached to seeking therapy. “Immigrants who are in a small community may not want others to know their business—they may also be unfamiliar or uncomfortable with the idea of sharing their private details with someone they see as a stranger,” Shiraishi explained. And sometimes family members are explicitly against seeking medical help for mental illness. “My mom took my brother and I to a family counselor,” said Ella, 22, who works with students with autism spectrum disorder and is wrapping up her psychology BA. Ella’s mother emigrated from the Philippines after meeting her father, who was abroad serving in the U.S. Marine Corps. “We had to hide it from my dad because he claimed that the counselor was ‘brainwashing us to hate him.’”

Knowing there’s something wrong isn’t the same as having the tools to fix it. The idea of healthcare for mental illness might seem completely inaccessible—or the concept of mental illness itself completely foreign—to immigrant parents, which means that their children often aren’t able to seek treatment until they’re legal adults and able to advocate for themselves. And if a family is aware of mental health resources, they still have to overcome financial barriers, which are a particular concern for the undocumented, uninsured, or working class. “It’s not easy for kids to see their parents struggle, and draining family finances is not an easy thing for [these kids],” said Yukiko Shiraishi, a Chicago-based therapist whose practice includes a large number of children of immigrants.

“I went to talk to the priest,” Jasmine said. “It was so hard for me at 16; I didn’t know what was happening. Luckily he connected me to a nonprofit serving the neighborhood. It was a clinic where doctors donated their time to serve lower-income families in Chicago. And that was my first introduction to the [mental health] industry—to know, yes, there is hope, there’s a whole industry dedicated to this.”

Michaela said she wasn’t able to find a therapist until she moved to New York, about four years after college, when she was an adult and able to advocate for herself. Even now, she doesn’t tell her parents that she’s seeing a therapist, instead choosing to use her physical therapy sessions as a cover. “I go to physical therapy for chronic pain, and whenever I’m calling my mom and I’m on my way, she’ll just ask, ‘Are you going to physical therapy?’ and I’ll be like, ‘Yeah,’” Michaela explained. “I feel totally fine with it right now. I think it’s the best thing I could be doing. And I still don’t need to tell them.” But this acceptance of herself comes with its own baggage and complex emotions. “I feel guilty that I feel resentment towards them,” she added.

Then comes the challenge of finding a psychotherapy professional who is a good fit. There are already fewer people of color than whites using mental health services in the United States—Black and Hispanic Americans at half the rate of white Americans, and Asian Americans at one third the rate, according to the National Alliance on Mental Illness. This reflects the fact that there are fewer mental healthcare professionals of color: As of 2016, ethnic minorities represented 16 percent of the psychology workforce, according to the American Psychological Association. (As small as this number seems, it’s a staggering 92 percent increase from 2007.)

“My first therapist—who was a white male—effectively dumped me,” said Melanie, a 30-year-old freelance writer and editor living in Los Angeles. Melanie’s mother is a Japanese immigrant, and she’s struggled with finding a therapist she can relate to. “The next therapist I saw was second-generation Iranian American, and I think we connected much better, both because we grew up hearing similar things from our immigrant parents, and because we’re both in a POC white/gray area. It made me think about how conditioned I am to present myself as OK and functioning, even when I really need and want help.”

Growing into adulthood, however, means having the opportunity to build your own support system—as in every coming of age story, it means being able to advocate for yourself and your needs. This can hold special value for children of immigrants, who must work harder to establish their ethnic identity after living in the liminal space of “never truly belong[ing] ‘here’ or ‘there,’” as the Suárez-Orozcos wrote in their book. It means finding a community that can empathize. “It’s nice to know we are not alone,” Sara explained, about connecting with others who also know how it feels to grow up in an immigrant household. She’s currently in the process of moving out of her family’s home for the first time.

Growing up may also mean learning to appreciate a parent’s love language and feeling able to give them back the love and sacrifice they gave you. This is especially true of Asian American immigrants, Choi, the University of Chicago professor, noted: “Expressions of love, like ‘I love you’ and hugging—some [parents] believe that this will spoil the kids. But implicit affection, when children do recognize ‘This is how my parents express their love,’ is really beneficial to the children. When children reappraise their parents’ interactions or behaviors later in life, like late 20s and 30s, they actually do the same to their parents. They pay it back by sacrificing.”