All Lismari Montes, 15, had to do was find the bottle of prescribed sleeping pills that were hidden in her parent’s room. “I’m done” was all she could think as she walked upstairs to her room, yearning for escape from her exhausting fight with depression.
Anger drove her to this point. She was angry at her family and herself. “I like to think of it as a snowball,” she said. “It went from this little tiny issue … to the point where I didn’t think [it] was worth living.”
With tears in her eyes, she glanced down at the pills in her hand, not thinking about what would happen next. As soon as she swallowed the pills, Montes said she felt instant regret. She lay down and closed her eyes as her heartbeat began to race. Not long after, she woke up in a sweat with an aching stomach. Montes waddled to the trashcan to puke. She said she doesn’t know how she managed to tumble downstairs to tell her mom — the only person home at the time — what she did.
Before waking up in a hospital bed in the same black T-shirt and shorts from the previous day, the last thing Montes remembers was listening to her mom talk to the 911 operator in her best broken English.
Montes lives in the heart of the South Side at 1243 S. 18th St., close to Cesar E. Chavez Drive, where the majority of the Hispanic population lives in Milwaukee. Although she, her older sister and three older brothers were born in the U.S., their Spanish-speaking parents have not forgotten their conservative Mexican traditions and values.
Montes is the rebellious baby in her Latino household. She believes rules are meant to be broken and strives to create her own path away from her parents’ expectations.
Montes may seem like a sassy, outgoing and creative teenager. But behind her cheery demeanor and smile, she hides her silent suffering in a mountain of notebooks and journals that document her childhood years of sexual abuse, bullying and low self-esteem.
When she learned about the risks of self-harm in the sixth grade, she couldn’t imagine doing it, she said. But the first time she put the blade on her skin, she felt the rush.
Montes said she couldn’t get rid of the voice in her head telling her she wasn’t good enough. Cutting herself offered a haven from her insecurities. As her self-esteem sank, she cut every two or three weeks, and developed an eating disorder. She attempted suicide on Sept. 5, 2015.
Latinas' mental health
Latinos born in the U.S. have a higher rate of depression and anxiety than Latino immigrants, according to studies in several medical journals.
“What has been consistent across those studies is the idea of the immigrant paradox where we find Latinos who are U.S. born have (double the rate) of depression than their immigrant or foreign-born counterparts,” said Lucas Torres, an assistant professor in the psychology department at Marquette University.
According to Torres, this paradox exists because U.S.-born Latinos are more embedded in American culture, adding stressors that immigrants do not experience. For girls such as Montes, the risk of being diagnosed with a mental illness is even higher than the general Latino population.
“Just looking at depression rates in general across ethnic groups, it is around ages 11 to 13 that there is a spike in girls,” Torres said.
At an age when identity development, which relies on the intersection of gender, sexuality, socioeconomic and ethnic backgrounds, is at its peak, the way a girl manages the stress of negotiating gender roles and pressures in her Latino household is crucial to her mental health. And for Latinas specifically, mental illnesses are more likely to lead to fatal results.
According to a 2008 study in the Journal of School Health, Latinas have disproportionately high rates of anxiety, suicidal ideation and suicide attempts. “Depressive symptoms among Hispanic adolescent females are especially alarming, with suicidal and self-harm behavior nearly three times higher than adolescents from the general population,” wrote Ritika Batajoo, an MD/MPH candidate at University of Wisconsin School of Medicine and Public Health, in her dissertation on the topic.
Melissa Waldo, a licensed clinical social worker and psychotherapist at Sixteenth Street Community Health Center, treats more than 100 clients, about one-third adolescent females. She said cutting is more likely for them due to their tendency to internalize problems and emotional pain until it becomes overwhelming.
“Physical pain at that point feels better to them than an emotional pain,” Waldo said. “Sometimes … they’re numb.” For others, self-harm can be a form of punishment.
That was why Cielo Ruiz, 14, started cutting herself. Whenever she heard her parents fighting, she thought it was her fault. Like Montes, Ruiz said she never felt good enough as a C-student, a twin sister or daughter.
When her parents found out she was cutting, they sought help from Waldo at the Sixteenth Street health center. Waldo diagnosed Ruiz with severe depression. At one point, Waldo assigned her to write three reasons why she is “good enough.” Ruiz said she never thought of even one reason.
She made a deal with her parents that she wouldn’t cut if they stopped arguing. Although her parents don’t fight in front of her anymore, it’s a deal that Ruiz struggles to uphold.
The same research that demonstrated the high risk of self-harm and suicidal attempts among Hispanic females inspired Waldo and Batajoo to start a support group last February for 13 to 16-year-old Latina girls at Sixteenth Street Community Health Center, 1032 S. Cesar E. Chavez Drive.
The 16-week program is known as SEEDS, which stands for Self-Esteem, Empowerment, Empathy and Discovery of Self.
When Waldo told Montes about the program at their first therapy appointment, Montes declined to participate. She said she refused to tell other people about her problems but knew she needed help. Her mom’s encouragement was the reason she chose to join the group. “It was better than nothing,” Montes said.
According to Montes, the first four weeks of the program were the most awkward. Nobody knew why anyone else was there, but they all knew suffering — emotional and physical.
Montes said it took about four weeks to “break the ice” but they all became best friends eventually. The first 30 to 45 minutes of each session started with a check--in. Each girl took a turn to talk about her day and her feelings before they moved on to other group activities.
“The program is unique because it focuses on mental health treatment in a group setting, but we also touch on a lot of subjects that affect their psychological health but aren’t necessarily considered mental health,” Waldo said. Those subjects include diversity, substance use, sexuality and peer pressure.
Montes said she knew she was warming up to the other girls when she was able to offer her opinion on their problems.
“When they had issues, I’d give my thought about it,” she said. “That helped me because (we) would have similar issues, and I could take my own advice.”
After spending years feeling alone, Montes made friends whose insight she respected and appreciated.
“There’s a lot of benefits to group (therapy) that individual (therapy) does not cover, like the social connectedness with others, hearing from other people,” Waldo said.
Although many of the girls in the program already participate in individual therapy, for some, the group is their first mental health treatment. “The group is really good because it increases access for those who wouldn’t be able to have mental health treatment otherwise,” Batajoo said. “Once the groups are over we can connect them to behavioral health within Sixteenth Street.”
Group therapy saves money and time for Waldo and her clients. Instead of seeing two girls in two hours, Waldo can treat six to nine girls in the same amount of time.
At this point, Waldo and Batajoo have treated three groups of girls. The program is available at only one of Sixteenth Street’s seven locations.
The SEEDS program made a difference in Alisa Olvera’s life.
Olvera, 15, wears more makeup than the average teenage girl, painting her eyes with black eyeliner to match the tone of the metal hardcore bands she listens to, such as Asking Alexandria and Pierce the Veil. Her dark brown hair is ombre-highlighted, giving her a more mature look.
She sees the scars on her arms and wrists as a beautiful reminder of how lucky she is to be alive after she attempted to commit suicide in the sixth grade.
After attending St. Anthony’s Catholic School for her elementary education, Olvera wanted a different middle school experience. She moved in with her cousin, Sasha Olvera, who she considers her sister, and attended Meadowview Middle School in Sparta, Wisconsin. It was her first time at a public school, and it was a nightmare.
Alisa Olvera dreaded going to school every day. At Meadowview, it was obvious she was the minority. “I was like the third or fourth Mexican in that school,” she said. Olvera faced discrimination from most of the students, who told her to go back to Mexico and bullied her. She even felt different from the few other Latinos at the school.
Eventually, Olvera decided to hang herself in a closet of her cousin’s house. Sasha Olvera caught her preparing to commit suicide and stopped her.
“She totally pushed me harder to keep my head up, so I look up to her a lot and I know I’m doing this for her and for my little brother,” Alisa Olvera said. “Now that I think about it, what if I wasn’t here?”
Now, she lives in Milwaukee with her mom, stepfather, 17-year-old stepbrother and 3-year-old brother. After she barely survived the sixth grade, she transferred to St. Martini Lutheran School to finish middle school.
There, Olvera became an advocate for others who experienced bullying. When she saw a girl with dyslexia getting teased at an after-school tutoring program, she was inspired to ask the school counselor to put together an assembly to stand up against bullying.
In front of the entire school, she shared her story about her experience with cutting, bringing the audience and herself to tears. “It was something amazing,” she said.
But after a solid streak without self-harm, Olvera started cutting again the summer before high school. That was the summer she met her biological dad in Georgia for the first time. Again, a new experience did not meet her expectations. She said her dad kicked her out of the house in a drunken tantrum and she returned to Milwaukee with cuts on her arms.
Ever since, Olvera has struggled with anxiety, she said. But, it’s getting better. To get help, she participated in the first SEEDS group with Montes. She said the group gave her ideas about how to deal with her depressive symptoms.
“(Depression) feels like you’re getting stabbed right in the chest,” Olvera said. “It’s so much pain.”
Waldo and Batajoo suggest that when the girls feel like their mental illness is taking over they should be active, doing things such as hiking, going to the library or hanging out with friends.
“That’s something I’ve been doing a lot lately. And actually, I enjoy it,” Olvera said. “It gets me to think positive instead of negative.”
So far, Olvera’s sophomore year at Carmen High School of Science and Technology has been transformational, in part because of the SEEDS program. As a freshman, she wanted to be a cosmetologist. Now, she is pushing herself to pursue higher education to be a therapist.
“I can share what I went through back when I was younger, and I can tell them I know what they’re going through. I experienced it before,” she said.
Psychological effect of poverty
Batajoo speculates that part of the reason for the high rates of mental illnesses among Latinos is their socioeconomic status.
“I think that because Milwaukee has a lot of segregation and a lot of poverty in different ethnic populations; that may be why Latinos in Milwaukee also have a higher rate,” she said. She added that nationally 25 percent of Latinos are living below the poverty level compared to 15 percent of other ethnicities.
Waldo agreed. “The majority of … clients served here (at Sixteenth Street) are Latino and low income,” she said.
According to a U.S. Health and Human Services survey, those living in poverty are three times more likely than other socioeconomic groups to say they are struggling with psychological distress. The study also found that “in every age group, women were more likely to have serious psychological distress than men.”
According to the Pew Research Center, Hispanic families have the highest number of children in poverty. Compared to 20 percent of children nationally, about 30 percent of Hispanic children under 18 live in poverty.
When Cielo Ruiz’s parents came to Wisconsin 15 years ago, they wanted their kids “to study, to work and keep moving forward.” However, when her dad suffered an injury, her mom became the only working parent in the house.
“We want our children to have a better job than us,” her father, Sebastian Ruiz, said in Spanish. “As of now, we are a poor family. We work to survive.”
In a Latino household, socioeconomic and financial stressors are exacerbated by the culture’s gender roles.
Torres explained two cultural values specific to Latino culture: marianismo and machismo. Marianismo values women as self-sacrificing and fostering. They are expected to stay at home to take care of their family while the men provide income.
On the other hand, Torres said machismo has a positive connotation that often gets overlooked. “The term machismo gets a lot of negative stereotypes and people will often times attribute that to instances of domestic violence,” he said. “There’s also another side of machismo which values that men be family-oriented and … caring for the extended family.”
First-generation Latinas feel an obligation to balance the marianismo values with the more empowering and liberating lifestyle women lead in the U.S. today, which can be challenging.
Both Montes and her 26-year-old sister, Kathy Hernandez, said they experienced pressures from their family. Hernandez said it was frustrating when her parents stressed school as a priority even though they couldn’t speak English and help her with homework.
Neither of Montes’ parents went to school beyond the sixth grade. Now, her dad works in construction, while her mom takes care of her five children, niece and nephew.
Knowing how important education is to her parents, Hernandez said she feels a lot of pressure, especially as a minority. “There’s pressure because you don’t want to be that girl that fails in life,” she said. “You want to succeed and go over or above and beyond anybody else.” In addition to pleasing her parents, Hernandez wants to defy the stereotypes about Latinos.
When she was 18 years old, she got pregnant and left home. Her pride and dedication to school kept her going, in spite of the lack of support from her parents or other family members.
“I didn’t let my depression or emotions interfere with my school. If I did, it would just be a failure, so I had to change all that,” she said.
Hernandez still blames herself for abandoning her sister, who was about 4 years old when she left home, and she wonders if that contributed to Montes’ mental health problems. Of all her siblings, Montes is closest to her older sister, despite the 12-year age gap.
“She was the only one that played with me. Nobody else did, so I felt alone,” Montes said. Living with an unaffectionate mother and with her sister gone, Montes was left to question her worth as a daughter and sister. “Everybody expects so much out of you to be … the best you can but sometimes when you know you’re doing your best, it’s not enough,” she said. Hernandez and Montes said they understand their parents were raised differently but sometimes they needed to hear their parents’ appreciation for their hard work.
Different generations of immigrant families experience cultural stressors differently, said Torres. Immigrants feel stress to adapt and learn how to live in a new country. A first-generation Latina has to contemplate how she wants to identify herself, considering her parents’ Hispanic background and culture.
“Now they’re starting to feel the pressure of maintaining the traditional culture,” Torres said. “Meanwhile they still have to fit in or find their place within the broader U.S. society.”
Nevertheless, Torres calls being a U.S.-born Latina “potentially a gift.”
“Unlike other people, you have the opportunity to see a situation from two different perspectives or worldviews. And then you can decide which worldview … fits with who you are and how you want to handle that situation,” he said. Understanding the skills and opportunities that come with being bicultural will help Latinas develop a strong ethnic identity and lessen the risk of experiencing mental health problems, he added.
Standing up to stigma
The machismo culture in the Latino community is just one reason people are hesitant to seek out help and share their problems.
Ursula Flores, co-chair of the Milwaukee Latino Health Coalition’s Mental Health Action Team, knows from personal experience the misperceptions of mental illness in the Latino culture. Typical superstitious beliefs such as brujeria (witchcraft) and mal de ojo (the evil eye) are linked to those with mental illnesses. Beliefs like these stem from the lack of knowledge about mental health.
The Mental Health Action Team has started a speakers’ bureau on topics such as mental illness, cutting, stigma reduction, suicide prevention and crisis intervention.
The team also partnered with a non-crisis support line to include Spanish speakers and created bienestarmilwaukee.org, a website listing mental health resources.
Encouraging Latina girls to use these resources and directing them to support groups such as SEEDS are steps community members can take to help overcome the stigma of mental illness, and perhaps, save the life of a Latina.
Flores attributes the success of the SEEDS program to the ability of girls to share their pain with others who have a similar background. The girls understand each other beyond the pain and emotions that lead to cutting or suicidal thoughts. Being Latina, they share the same frustrations from living in a multigenerational household in the United States.
Because of SEEDS, Montes doesn’t feel as alone or angry anymore. Instead of considering suicide, she worries about doing chores and choosing one of her many passions that could lead to a career path. SEEDS has taught her to talk to her family about her issues, instead of trying to control her insecurities and emotions.
Sharing her experiences with other SEEDS members helped Montes to be more positive and less focused on herself. “I think no matter what, I was destined to go through this and to survive and be able to tell my story.”
You can find other stories about Milwaukee's central city at Milwaukee Neighborhood News Service.