I moved to the United States from Pakistan on an H-4 visa (dependent on an H-1 visa holder, an employer-sponsored foreign worker) in October 2017. I received employment authorization soon after moving to the U.S., but the road to permanent residence was seven years long for my husband.

My psychiatry residency training started in July 2018. While I had supportive colleagues and mentors who fostered inclusion and acceptance, my fellow BIPOC colleagues and I faced overt racism and xenophobia. This became evident during rounds when patients uttered racial slurs and inappropriate comments, as well as through implicit bias in the underhanded comments from our neighbors. This was a drastic change from my previous, albeit short, visits to the U.S. on visitor status during 2013 and 2016. I wondered, how much of this social change was enabled and emboldened by federal leadership? How much did people know about immigrants, and what were the lies they believed?

I remained a foreigner for four years but gained an understanding of American health and immigration policy. Although the U.S. health system desperately needs doctors, particularly psychiatrists, they will not accept them from countries like mine without scrupulous vetting to the extent that exceptional talent is passed over. This has caused an extreme psychiatrist shortage. Even worse was the lack of services available to mentally ill individuals leading to their over-representation in the homeless and incarcerated populations. The psychiatrists’ experience was akin to that of Sisyphus because our patients are trapped in the cycle of homelessness, trauma and lack of care in community settings. 

In 2022, I was accepted into a Public Psychiatry Fellowship at Columbia University. This program embodied inclusion and advocacy for its fellows like I had never experienced before; it cemented that the U.S., New York specifically, is putting effort into uplifting disenfranchised communities despite imperfections. I transitioned from feeling like a resident alien, which I was at that time, to feeling at home. The state government funneled funds into addressing homelessness and severe mental illness. Gov. Kathy Hochul approved a staggering one billion budget for intersectional support towards people struggling with mental illness, trauma, and chronic homelessness. The more I learned, the more confident I became in the American promise to benefit “the tired and the poor.” 

My once-solid confidence has been shaken over the past few months. Despite many states taking heroic measures to tackle issues of social injustice and the demonization of minorities in the mental health space, the US effectively and uniformly embodies one thing — not diversity, equity or inclusion, but freedom of thought. Under this principle, people’s core values guide their education and action accordingly. They can choose to learn about welfare projects for the mentally ill, as I did, or they can affirm their biases regardless of their immigrant or non-immigrant identities. This zero-sum mentality is promoted by economic insecurity, misinformation and cultural stereotyping.

Like most Americans, I read President Donald Trump’s birthright citizenship executive order details on Martin Luther King Jr. Day. On a day meant to celebrate a man who fought and died for civil rights, the news was disheartening, and the response by immigrant communities is even more so. I think about the countless people who move to the US on temporary or exchange visas, providing specialized services to the country, only to live in uncertainty about their family’s future and with the fear of being excluded. There is hope in the systems, states, and even the Santa Clara county leadership to defend citizenship rights written within the constitution. Sadly, immigrant communities are pitting themselves against each other, demonizing immigrants from other countries or engaging in the “good immigrant” debates, without realizing these laws are meant to garner support from one specific group while fostering division among all others — an objective this order has successfully achieved. Many others are under the assumption that this executive order only relates to visa holders visiting solely to make babies in the U.S. (birth tourism). It will affect all of us, not only in legality, but also in social climate. 

While overflow of information perpetuates uncertainty, many individuals do not realize that this executive order affects all visa holders, all who engage with economic sectors supported by immigrant labor, and all with a loved one whose immigration status is ambiguous. Many students and skilled workers in the US currently hold temporary visas, including F-1 (student visas), H-1 visas (specialized work visas) and J-1 (exchange visitors), which grant them minimal privileges (evidenced by recent threats to revoke student visas) and exclude them from most healthcare and welfare, despite being held to citizen tax laws. While some plan to return to their home countries, a larger population ultimately hopes to seek permanent residence in the U.S. through an adjustment of status. These individuals stay in the country, tied to their specific jobs, for years, even decades, in the case of Indian and Chinese immigrants. This executive order, originally scheduled to be implemented on Feb. 19, heralds an unsure future, especially if immigrants are pregnant or plan to have children. If they choose to have families here, their children will not be U.S. citizens. They must apply for U.S. visas like their parents. What will their country of origin be? What will their rights be? No one knows.

In the past, America has been able to maintain its promise by division of administrative power and giving a voice to ordinary people. This is the time for both state systems and individuals to work towards a common front — ensuring that the constitutional ideals are upheld. The groundwork has been laid by the California assembly with approval of a $50 million budget to bolster immigrant support. Educational institutions which harbor many students from across the globe can serve to amplify their voices, providing a platform and framework for advocacy efforts. I witnessed a peaceful demonstration to support immigrants at Stanford on Feb. 5. I felt proud that the younger generations are not giving into misgivings and have the strength to fight for their rights. That is the way to foster naturalization and acceptance.

Dr. Anum Khan is a reproductive psychiatrist working at the Women’s Wellness Clinic at Stanford. She has a background in community and public psychiatry with an interest in working with minority populations. She recently moved to the Bay Area from New York.