How can HCI be used to implement self-help methods for non-citizens and international students to cope with immigration-related anxiety?
Disclaimer: Some names and identifying details have been changed to protect the privacy of individuals.
The Problem:
In the fall of 2016, I moved to the United States to pursue a graduate degree at New York University (NYU). A few months after my relocation, President Donald J. Trump assumed office as the 45th President of the United States of America (USA). At that time, I saw a growing sense of fear and anxiety creep within the immigrant communities.
Only a week after his inauguration, the situation appeared to have exacerbated when the President signed the Executive Order 13769 - or more commonly referred to as the Muslim Ban (or the Travel Ban).
From then onwards there has been a cloud of uncertainty looming over the status of many immigrants, regardless of whether they were undocumented, illegal or even legal.
Attending a university such as NYU, I was fortunate enough to meet several students who had similar concerns but were unable to speak out or express themselves out of a fear of law enforcement action.
After listening to their stories, I thought what if there was a medium or method of self-help for such people to address their problems, rather than seeking external help.
This idea also takes root in a more personal struggle of mine. During the past few years, I have experienced many mental health problems. There have been times when I have felt completely dejected and helpless. Even countless sessions with mental health practitioners have not helped in understanding the reason behind these recurring bouts of depression.
In the process I realized the importance of self-help and how it can be the first step towards curing mental illness.
After conducting preliminary research, which comprised of interviews with international students, psychiatrists and school administrators, I zeroed in on the idea of integrating or using Human Computer Interaction (HCI) to treat mental health problems.
Background:
Gathered around a dining table in their living room, three Pakistani students spoke of the despair and uncertainty that they had been feeling of despair and uncertainty that had been surrounding their lives for the past 11 months. The full-time students, all of them aged between 22 and 23, were pursuing undergraduate degrees at NYU.
“It's been pretty stressful for me,” said Usman, the oldest of the three roommates. “Things aren’t looking for international students right now. It’s been just utter chaos under this administration. Until November last year, everything appeared to under control… but ever since then, I just feel like I’m stuck in a never-ending downward spiral,” he added.
Ever since President Trump was sworn in as President in January, there has been an increase in immigration-related arrests and deportations by approximately 38% and 31% respectively. While this immigration crackdown is currently aimed at illegal and undocumented immigrants, it has done enough to set off alarms within the international student communities at various schools within the country. \cite{keierleber2017}
One group of students that is particularly worried by this trend is that of the international Muslim students studying in American universities. A notable example of this is the international Muslim student community at NYU.
“Of late, I’ve felt a lot like an outsider,” remarked Bilal, a Junior at NYU. “I mean it’s not like I’ve been mistreated by anyone within the NYU community. But in this current political climate, opportunities are starting to look very limited,” he explained.
What is immigration-related anxiety?
Given the inter-communal nature of immigration, it brings together individuals from different walks of life. So, it become even more imperative to pay attention to the socio-political and cultural aspects of anxiety that stem because of immigration. \cite{kirmayer2011}
A person’s culture can have a far-reaching impact on their mental health and their ability to adapt to new surroundings. This may include the manner in which they interpret and respond to the symptoms of a particular mental disorder.
The experience of integrating into completely new culture and surrounding can deteriorate a person’s mental well-being; leading to a feeling of alienation creeping in. \cite{kirmayer2011}
This explanation of anxiety identifies psychosocial stressors as potential triggers when it comes to mental health issues which are a result of immigration. Isolation and a lack of networking opportunities in the host country tend to deprive immigrants of much-needed emotional support. \cite{kirmayer2011}
In the case of international students, this problem may be exacerbated due to separation from family and loved ones.
Entering a new country - students may experience a culture shock due to the difference in norms and values of the host country from the native land. “I remember my first time here [in New York], I was taken aback by how people were interacting with each other or how they were dressed. I mean some of the street style I saw was… outrageous,” exclaimed Nabil, a senior at Cornell University, from Bangladesh.
“Everyone here seemed to mind their own business, which is refreshing at first but after a while it becomes kind of strange. I mean, you think twice before approaching someone or talking to a stranger,” he adds.
Due to this sense of loneliness, striving for personal goals becomes even more stressful and takes a toll on the individual’s psyche. The difference in the economic opportunities available to international students in the host country and their own aspirations, adds to their struggles.
So, it would not be unheard of for an international student’s academic progress to decline because of their inability to meet the required standards of the host country. \cite{kirmayer2011}
There have been instances of hostility from the natives of the host country and prejudice on their part which have caused additional stress for the immigrant.
According to the National Center for Biotechnology Information, at the time of his or her arrival the health (mental and physical) is perceivably better than that of the natives of the country. For instance, immigrants in Canada had lower rates of mental disorder when they migrated to the country in 2000-01.
The Canadian Community Health Survey deduced that while immigrants displayed lower rates of depression upon arrival, their levels rose to that of the local population (or even exceeded) after a brief period of time. \cite{kirmayer2011}
The nature of a mental illness or disorder tends to vary from community to community or individual to individual. But none of these differences necessarily relate to an individual’s race, religion, or beliefs. For instance, immigration anxiety will most often occur when an individual resettles into or adapts to the policies and practices of another country or society.
It would be interesting viewing this subject matter from the prism (or perspective) of a city as diverse as New York. As the largest city in the United States it has a well-documented history of immigrants - and approximately 3 percent of the residents of the city are Muslim.
Over the past few months there has been an increase in the number of hate-crimes against Muslims within the region which leads us to the question - Is there a feeling of immigration anxiety amongst Muslims within New York City (or even United States)? \cite{lipka2015}
The Focus Group:
Located in the heart of New York, is one of the country’s most prestigious private nonprofit research universities, NYU. Known for its diverse student-body, the university is home to a large amount of Muslim international students. While the exact number of Muslims studying on campus was not disclosed by the Islamic Center of New York University (ICNYU), the college’s website states that approximately 18.6% of the total student body consists of international students. \cite{nyu2014}
The number of Muslim students on campus coupled with the setting of New York, made them an ideal “focus group” for my research.
During my in-person interviews with various international students through the school’s Muslim Student Association (MSA) and ICNYU, I noticed how most of them were hesitant to go back their country of origin due to the lack of opportunities available there or standard of living.
“I’m from Saudi Arabia, personally I like it more here. I have access to so many resources over here that I would not have back home. For instance, I can go and watch a movie here whenever I want whereas there aren’t any cinemas where I come from so I’d have to make the long trek to Bahrain just to go to the movies,” remarked a graduate engineering student at NYU.
Since the imposition of the Travel Ban during the first quarter of 2017, several international Muslim students have even avoided going home during semester breaks or holidays. Unable to go home without the fear of not being allowed back into the country, some students have described this state as being stuck in “No Man’s Land”.
“I’m from Pakistan, so technically I can go back home whenever I want. My country was never on the list to begin with. But everyday you hear stories of Pakistani students not being allowed back into the country. So it’s just a major risk going back. What if they don’t let me back in?” said Shayan.
“Emotionally, I feel as if I am in no man’s land. I’m not an American. I don’t even feel like a Pakistani anymore too - I’ve drifted away from my culture so much. I can’t go back home. It’s just a tough life, but I realise that I will have to make this sacrifice if I want to make it over here,” he added.
Unfortunately, Shayan is not the only one who is experiencing these feelings of anxiety and withdrawal.
A doctoral candidate at NYU narrated to me how he was not allowed to re-enter the country during the travel ban. “I had heard all these stories of people not being let back into the US, and I used to think that may be they did something wrong or they didn’t have the required paperwork in place… until it happened to me,” he recalls.
“In January, I was going through immigration [in Iran] and was told that I would not be allowed to board my flight to the US,” he exclaimed. “At first I thought maybe I had a few documents missing but everything was in place. But they still told me to go back.”
Unfortunately, Shayan is not the only one ensperiencing these feelings of anxiety and withdrawal. A few weeks ago, I happened to run into a Doctoral Candidate at NYU, who told me how he was not allowed to re-enter the country during the travel ban.
“I was not even allowed to board the flight in Iran,” he exclaimed. “I had all my documents in place, everything - but they told me to go back. You have no idea what I felt when I was leaving the airport,” said the student (requesting anonymity) currently in the final year of his PhD.
“I could see nearly three years of hard work going down the drain. And worst of all, I wasn’t even told why.”
With his status as a doctoral candidate hanging by a thread, he told how he saw nearly three years of hard work and research “going down the drain”.
“You don’t know the sinking feeling that I had when I was leaving the airport [in Iran]. And worst of all I wasn’t even given a reason for all of this.”
Even those who end up making it into the country don’t really feel completely confident until they have stepped foot outside the airport.
NYU alumnus, Ali, recalled his first time boarding the flight for New York. According to the Karachi-native, he was nervous throughout his whole 20-hour long flight and was not at peace until he cleared immigration.
“I remember everyone was watching movies on my plane or sleeping. Whereas I had a bag containing all my documents in place on my lap throughout the whole flight,” Ali says while laughing.
“Even when they gave me the immigration form to fill, I made sure to ask them what sort of colored pen should I use and wrote everything clearly. It was just nerve-wrecking and I know I am not the only one who feels this way,” he went on.
What resources are currently available to International Muslim Students?
School administrators across the country have already taken measures to protect their students from immigration authorities. Administrators and deans of different colleges have gone as far as to declare their schools as “sanctuaries” from the current government’s revised immigration policies and reforms.
While there may be a difference in policies, these sanctuary schools are providing their students, and on some instances their families, with facilities to counter any potential problems. These include workshops regarding how to deal with immigration officials and authorities.
NYU has also vowed to protect their students personal information and data from government officials and block federal agents’ access to school premises until or unless they are presented with a warrant.\cite{keierleber2017}
In January 2017, NYU President Andrew Hamilton sent out an e-mail reaffirming the university’s support to the international students on campus.
“We want the group of NYU colleagues and peers affected by this order to know that the University supports them. Their ability to carry on with their studies and their research, their ability to be present on our campus and participate fully and confidently in University life, and their welfare are foremost among NYU's concerns,” stated President Hamilton.\cite{hamilton2017}
The message also stated that concerned students would be facilitated with services such as information sessions with legal experts, Office of Global Services (OGS) and faculty of Law at school to help address any concerns that they may have.
Similar to most college campuses within the country, NYU offers all of its matriculated students health and wellness resources at the Student Health Center and Wellness Exchange. \cite{nyu}
All students can avail counseling services ranging from traditional counseling, such as psychiatry and self-help groups, to more innovative methods like Toolkits and the Relaxation Oasis.
Interestingly, the Student Health Center has adopted an approach along the lines of Human-Centered Design and Human-Computer Interaction. A notable example of this is the usage of Toolkits and Relaxation Oasis.
Toolkits are workshops which have been created for the sole purpose of helping students improve their personal, academic and social well-being. \cite{nyu2017}
On the other hand, the Relaxation Oasis, consists of multiple Mindfulness Resources to help create a healthy environment for students experiencing stress or anxiety. The Relaxation Oasis also has online resources for students such as; Frequently Asked Questions (FAQs) answered by the Mindfulness Initiative Team.
But the most interesting feature of the Relaxation Oasis is the Calming Corner which has audios (mp3 links) for guided relaxation exercises.
Dr. Mae Basow, a Staff Psychologist at NYU’s Student Health Center, notes that the Relaxation Oasis resources are “tailor-made” for students dealing with immigration anxiety. “When it comes to visa or work-related issues you can always refer to the Office of Global Services (OGS) but in regards to anxiety the Relaxation Oasis will be a good fit,” explained Dr Basow.
“Not only are these cost-effective techniques, they are also pretty intuitive so this saves you the worry of reaching out for help all the time,” she remarked.
Aside from these standard resources, the school has an ICNYU and a fully functioning MSA that allows Muslim students with the opportunity to interact with other students and participate in numerous activities to eliminate a sense of alienation. During the course of the Travel Ban, the ICNYU also conducted sessions and workshops to assist concerned students.
HCI and Mental Health:
A few weeks ago, I was listening to a Recode podcast featuring musician-cum-actor, Jared Leto. The Thirty Seconds to Mars frontman was promoting his futuristic sci-film, Blade Runner 2049. During the course of the one-hour long interview, Leto spoke about how he would like to create a technology that, “ could alleviate human suffering”.
That statement really resonated with me - especially given the aspect of HCI in my project. Not only will it be a more efficient and cost-effective solution to the problem, it will also save people from the trouble of using any horrific medication that is normally used to treat illnesses.
The importance of Self-Help:
While everyone experiences ups and downs in their lives - anxiety is something completely different. One major aspect of this disorder is that the individual experiences feelings of being hopeless and helplessness.
This affects the person’s daily activities and impairs them of their ability to enjoy life, in general.
People suffering from this illness may take different paths on their road to recovery. While some may seek professional help others may revert to joining support groups.
More often than not, a person suffering from anxiety may resort to isolation believing it to be the easier way to deal with this problem, but it only ends up making it worse.
This is when self-help becomes important. By creating more supporting and meaningful relationships, an individual can ensure that their anxiety levels remain under control. Despite all of these resources and support systems people suffering from anxiety are often hesitant or scared to reach out for help out, mostly out of the the fear of being judged.
Proposed Solution:
Technology and healthcare are fast becoming an area of interest for researchers, designers and developers across the world. The accessibility to technology means that a high number of people have access to technological resources and services than ever before.
Through my research, I have come across two possible solutions to the problem:
Wearable Devices (Personal Tracking): Users of these technologies tend to have an element of agency about them. According to researcher Nataly Birbeck, people use technology out of a desire to change their behavior or lifestyles. Because of this personal tracking devices such as the Apple Watch, FitBit or Garmin are viewed as self-imposed interventions for behavioral change.When it comes to personal tracking, mental health is an area yet to be fully explored. Like other activities, symptoms of mental health are quantifiable in nature such as sleeping, eating, or exercising patterns. \cite{birbeck2016} Personal tracking devices are not without their limitations. For example, such devices often serve as a reminder of the user’s own shortcomings. Secondly, users have the option to turn the device on and off resulting to an inconsistency in data.
Virtual Reality (VR): This medium is growing at light speed on a commercial level. Interestingly, VR has previously been used for training exercises such as for the military or flight simulation for airline pilots to better train them for real-life scenarios.Nowadays, it is also being used as a means to treat pain. With hardware no longer the issue, it's only the application of the technology in the real world that is proving to be a constraint.Once user wears a VR device he or she is transported to a 3-D environment and within the space of a few minutes the user's brain responds to the surrounding as if they were physically present there.The National Mental Innovation Center (NMHIC) at the University of Colorado is already making efforts to get more virtual environment experts involved in the process to help drive their research forward. \cite{baker2017} If successfully implemented, this form of therapy will go a long way in creating a meaningful relation between the user (individual) or the device.
Why choose VR?
As part of my research, I had conducted interviews with International Muslim students enrolled at NYU. While talking about their immigration anxiety a lot of them shared their stories and fear of being held back by the Transportation Security Administration (TSA) at the airport and then being taken to a separate room for further questioning or interrogation.
When listening to their descriptions of their transit experiences, it sounded very similar to The Guardian’s virtual reality journalism feature titled, “6x9: A Virtual Experience of Solitary Confinement”. As an experiment I showed them the video using a Google Cardboard headset.
Some of the responses I received as part of my user testing feedback were just astounding. While some described being held back in transit as being a “scarier” experience. Other were more descriptive in their explanations saying, “As a Muslim, you always have a fear that you’re going to be asked to step out of line during immigration clearance. Right from the time you board the flight from your country till the time you land here - you’re just stressed,” noted Noor, a senior at the Stern School of Business at NYU.
Another person said, “you would only be put in solitary confinement if you did something wrong. But when you’re in pulled aside during immigration you’re not given any reason. You can’t do anything. You’re not allowed to call anyone. You’re just asked to wait patiently while they ask you questions. And sometimes they don’t even do that.”
In a New York Times article recently explored how Colorado-based psychologist, Dawn Jewell, spoke about the growing influence of VR in the field of mental health. Using a technique referred to as exposure therapy, they are providing patients with emotional guidance to overcome traumas by revisiting VR-incarnation of different scenarios. \cite{metz2017}
This technique is implemented through Daydream View, the Google headset, that works in tandem with a smartphone. “It provides exposure in a way that patients feel safe,” said Dr Jewell. “We can go to a location together, and the patient can tell me what they’re feeling and what they’re thinking.”
Using this as a reference point I intend on creating a simulation that mimics an international students arrival into the country in a virtual reality environment.