Before President Trump began implementing immigration policies that, among other things, limited the number of refugees accepted into the United States and changed the way immigrant families were treated at the border—before he had been inaugurated, in fact—Spyros D. Orfanos (’78 MA,’86 PhD), director of the postdoctoral clinic at NYU’s Postdoctoral Program in Psychotherapy and Psychoanalysis, knew he wanted to do something to help the people who would be most affected in the New York metropolitan area.

The program has long made its services available to a diverse array of clients who cannot afford market-rate therapies. And in 2017, Orfanos expanded the clinic’s pro bono focus by partnering with organizations that help immigrants facing deportation, including NYU School of Law’s Immigrant Rights Clinic, Physicians for Human Rights, and others.

“The way I put it to my colleagues is that I was simmering, simmering, simmering until I came to a boil,” he explains.

Orfanos organized a team of students, faculty, and alumni to assist immigrants with their legal cases and to provide treatment for the psychological trauma they have endured in their countries of origin and in the United States (which has included, under the Trump Administration, the separation of children and families at the border).

Since his initiative—the Immigration and Human Rights Work Group—began in 2017, Orfanos and his team of clinicians have handled 25 cases. They hope to scale up to between 50 and 100 cases in the coming year. Toward that end, Orfanos and Physicians for Human Rights held a daylong training for about 100 interested volunteers affiliated with NYU’s doctoral program in October. The curriculum—normally geared toward medical doctors—was adjusted for Orfanos’s team.

“An internist has to learn about trauma,” he says. “Our people are writing the books on trauma. We need to know something about how to explain trauma to the lawyers.”

In an interview with NYU News, Orfanos shared his personal connection to immigration issues and offered insights on the care that his team provides—and needs in return.

How did you get interested in immigrants’ rights?
Spyros Orfanos

I grew up in a family where I lived amongst a lot of undocumented immigrants. They left Greece because of the severe economic difficulties and also the civil war. When I grew up in the ’60s, I worked in the family restaurant business here in New York and there were many undocumented waiters and restaurant workers. Ironically, our restaurant was called The American Restaurant. As a little boy, I remember the immigration police coming in and conducting sweeps—the restaurants and coffee shops would lose half their staff. I lost a lot of family members.

What kinds of trauma are you seeing for these patients, especially those who experienced separation from their parents at the border?

There’s fear, a horrible severing of psychological attachments, the severe, repetitive cumulative trauma of trying to get to the border, then being separated from your family, and tremendous suspicion of authority of any kind—including authority that presents itself as benevolent, as in this country. A lot of people have suffered immensely because they are living under the sword of Damocles.

Talk a little bit about the short-term and long-term impacts of trauma.

In order for people to survive, they encapsulate the trauma. They freeze it within themselves, but it never stays completely isolated—it affects them going forward. It shows up in the form of depression, all kinds of cognitive difficulties, anxiety disorders—it’s what is often referred to as post-traumatic stress disorder. But the trauma also shows up later—and we have documentation for this—in physical ways: heart conditions, autoimmune disorders, inflammatory conditions. These kinds of ongoing, severe traumas—they don’t stay in the past.

Have the rhetoric and policies of the Trump administration affected your clients?

The immigrants are already terrorized. Where I see a difference is in my private practice, and I know my colleagues report this too. There is an increased anxiety about what’s happening to the country, an increased preoccupation. People talk much more about social realities than they ever did before. Obviously, psychoanalysis is about subjective experience, but what has been validated for me is—and it’s an important point—culture and society saturate subjective experience.

How do you make sure your clinicians are taken care of?

Contemporary psychoanalysis has made massive inroads into understanding how trauma affects caregivers. Superficially, it’s referred to as vicarious traumatization or secondary traumatization, but it goes much deeper than that. We have to make sure the people trying to do the work—the healers, the clinicians—are as psychologically centered as possible, even if they’re highly trained to begin with.

How do you do that?

That’s why we’ve got the books. There’s no shortcut. It’s an understanding of the complexities of interactions between people, an understanding of how even helpers need to be helped—by education, by participating in groups where they can talk about their own reactions.

What’s one case that stands out in your mind?

Our first family case, the mother was abruptly taken away after a decade living in the community. When the judge said the deportation was stayed, the family went out into the waiting room and everybody was crying, including other people who were waiting to get in the immigrant court. The family wanted to take some photographs of the NYU lawyers and me, and, when it came time to say goodbye, one of the children who was practically mute from the trauma, whispers to me, “Are you coming home with us?” It still gets to me when I think about that.