The phenomenon of emigration is as old as the history of man who, having the desire and strength to change how he lived, abandoned what was familiar to him to venture into the unknown. To emigrate was never been considered a pleasant change but a brutal one that uprooted one's life. One does not leave one's land and culture unless driven by poverty, war, unemployment, overpopulation, environmental disasters (earthquakes , floods) and epidemics (malaria, typhoid and cholera) even if many times emigrants left their hometowns to be reunited with other family members already established abroad. 

Emigration was an often a destabilizing experience: it meant dealing with the unknown, jeopardizing one's identity. The departure was thought to be a dive into the darkness of an unknown nation which the migrant’s ignorance did not even allow him to picture it on a geographical map.  After his arrival, the abrupt and painful environmental change created disorientation and confusion especially when he realized the linguistic and cultural differences between his native and adoptive country.  Also, he did not really know if his separation would be short and momentary or long and definite and if his hope for a better life would become a reality. Was it a dream that would become a reality? Could he really improve his economic and social condition with hard work and sacrifice?  Would he be able to return to his hometown to buy a real home and would his children be able to graduate from college? 

Now he had to face the dramatic differences found without having had any orientation about them. The easygoing attitude and sentimentalism in his hometown clashed with the pragmatic and puritan culture of the United States. Not being able to express one's emotions in an environment where self-control was the rule, where crying represented an exaggerated weakness and where cheerfulness was considered pure exhibitionism, one can understand the origin of their disorientation and consequent affective and humoral distress.

At the time, multiculturalism was not accepted and instead there was a melting pot mentality where every ethnic group had to lose its uniqueness to blend with American values and culture since if immigrants wanted to be respected and appreciated, USA had to be considered "God's Country".

Many native Americans labeled Italians (especially Southern ones) as being illegal, poor, ignorant and at times violent perhaps affiliated to the Black Hand, to anarchy, socialism or communism. At times, against them, were used derogatory names, such as, «dagos» (from the Spanish "Diego"), "guineas" ("guinea pig") and "wop" ("without papers”, meaning without legal documents to emigrate). In reality, the discrimination was not directed against them as Italians but against poverty in general. They arrived poorly dressed, with suitcases tied with cords and many loose packages. 

Males complained of work-related problems: the automated assembly line, the salary based on piecework, the constant demand for greater productivity, the competition between laborers where some, not always for merit, advanced at the expense of others and the fear of being fired, all this was distressing because it was easy to become unemployed where unions did not have much influence.

These situations made Italians feel different from Americans and thus, many reacted by isolating themselves and settling down in the Little Italy neighborhoods of various cities. There, they showed nostalgia for the traditions and memories of old times, idealized the past and cultivated the hope to return back to their native villages. The long shifts of heavy and long work depersonalized them, leaving little room for their own social and personal life.

The Italian physician Tullio Suzzara Verdi (1829-1902) who emigrated to the USA in 1850 where he lived until 1902, claimed that Americans overestimated their institutions which they considered to be the most democratic and liberal in the world. He added that if Italians wished to be welcomed and appreciation by American society, they had to avoid criticizing its institutions, customs and traditions, showing instead to understand the great values of the nation.

There were also inadequate housing conditions in old tenement houses in the various ghettos of New York.  Five or six other Italian immigrants typically occupied a single bedroom where they could not rest well, did not have sufficient space for their privacy and could not properly take care of their personal hygiene. As for the diet, protein and vitamins were scarcely sufficient and consequently, after a few years, they became malnourished, anemic, asthenic, gastritic, colitic and anorexic and sometimes dyspnoic. These ailments were the physical and chemical basis of their anxiety-causing, depressive psychopathologies.

Emigration problems can be divided into three phases: those before departure, those during the departure and those after departure. During the first phase, a we must consider if the immigrant had any psychological vulnerability, mood disorder, phobia or personality disorder. In the second phase there was often a mourning reaction and sometimes a "cultural shock" syndrome that could slow down or render impossible adaptation or assimilation. In the third phase, inter-personal conflicts could emerge between parents who were part of the old world and their children acculturated to the new environment especially in the choosing friends and future spouses. In American society the conception of egalitarian marriage was innate, implying free choice and marrying out of love. Among immigrants, however, in the old codes of many rural Italian towns, the daughters had to accept that their parents would choose their spouse among family friends usually from the same town of origin. These intercultural and intergenerational gaps could lead to violent verbal confrontations that forced their children to leave the home of their original family, and when this occurred, feeling dishonored, parents began to regret immigration.

In a patriarchal family, the mother played a secondary role to her husband and usually did not try to mediate between the external American world and the internal family world. Many women, especially those over 50 years of age, never learned English or the American culture because they only associated with countrymen and made purchases only in Italian shops. Many women were psychologically distressed because of their dual roles,  that of mother and that of factory worker. When they were in the hometowns they were used to dedicating a lot of time to their children and family with patience and love. Instead, now, after spending ten hours working in a factory, it was difficult for them to also gracefully and patiently take care of her husband, children and household chores. Nevertheless, the harsh manual and repetitive factory work, represented for her a chance to become economic independent and socially emancipated. A new form of life was now suspended between two worlds, two cultures, two languages, halfway between tradition and emancipation, torn between material well-being and psychological needs, uncertain on how she should face her situation as a woman, wife and worker.

The children of these immigrants, because of their schooling and the knowledge derived from having American friends, were the only family members who spoke English well. Sometimes they felt foreigners in their own family and were embarrassed to be Italian, thus manifesting serious identity crises. The father held a central role ("patriarchal family structure") while in American society this role was occupied by children ("child centered society") who wanted to finish school, live independently, without sermons and paternalisms. Their goal was not to save money but to consume them by buying fashionable clothes to blend with American friends by dressing as they did.

In conclusion, meeting new cultures, an Italian immigrant was always forced to re-evaluate his family, health, happiness, religion, morality, friendships and democratic values. The way of perceiving his existence constantly changed as the new socio-economic situations forced him to restructure his thought and emotions. He could preserve his past values or accept new ones through continual compromises that could lead him to be excessively attached to his cultural roots (morbid nostalgia) or to be blindly and opportunistically in favor of American modernism (depersonalization). He risked suffering from trans-cultural distress.

For many immigrants it took years before they found a well-paid job, they learned the new language and new customs and began having economic well being. Acceptance, adaptation and integration allowed them to uproot themselves in the new land and to think about the country of origin with a different spirit, not only that of poignant nostalgia, but of a place to visit willingly and occasionally for the Christmas or summer holidays. In fact, after so many years, a definitive return would represent another emigration ("return emigration") with the repetition of all the problems mentioned above. On returning to the country of origin, the places of childhood or youth are no longer found, but a new social and economic structure. Thus, “returning home” must be decided with great caution, aware that their personality and self-image is now changed.