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Identity crises, being torn between two identities, shifting identity
On the mutism of migrant children: It is a huge mistake to “psychiatrise” the silence of migrant children (a symptom well known to educators and school psychologists) by regarding it as a psychiatric symptom of autism. It is difficult to see what clinical approach might follow from dramatising the problem in this way [...] It is a withdrawal, the aim of which is to keep the love one of the parents originally bore. It is a way of taking shelter from the realm of speech, not a rejection of the ethical issues of speech. Children say nothing in order to express the exhaustion they feel at being torn between the demands of family and those of school. Mutism defeats the workings of transfer and translation between home and host country. The child’s mutism often coincides with renunciation by the parents, who are overcome by a longing to relocate or share memories of home.
Loss of occupational status and social recognition, renegotiation of social relationships, conflicts of loyalties and a feeling of marginality, rejection and exclusion are other factors that may result in distress behaviours that can bring about confusion and lead to misunderstandings. Some disorders may be a way of displaying psychological suffering and attracting attention. They may also reflect a failure to adapt adequately. Identifying a problem and making a diagnosis are not always the result of a neutral perception of the person or objective observation of the situation. For example, in situations in which immigrants display signs of distress, a worker may be tempted to link the problem with the person’s immigrant condition or cultural differences. In this case, action will focus on the specific nature of the immigrant’s needs. But a completely different diagnosis (and choice of action) might be suggested by concentrating solely on the symptoms of distress. From this other (more medical and therapeutic) standpoint, the specific needs of the individual may be considered in the more general light of the universal needs of a human being. In addition to their occupational attitudes, the convictions and prejudices of operators may affect their assessment of the problem. There is a real risk of misdiagnosis if operators do not critically examine their own professional practices.
Source: Dahoun Z. K. S., Les couleurs du silence – Le mutisme des enfants de migrants, Calmann-Levy, Paris, 1995, quoted in Samacher R. (ed.), Psychologie clinique et psychopathologique: Premier et second cycles universitaires, 2nd ed., Bréal, 2005.
Diagnosis in a cross-cultural situation – How to avoid labelling and misdiagnosis The literature on misdiagnosis shows that some immigrant populations are diagnosed as psychotic more frequently than other populations and that this overrepresentation is based on misdiagnosis. Such diagnosis may lead to interventions that deprive patients of their freedom (compulsory hospitalisation) and the prescription of inappropriate treatment that may reduce their ability to act, express their opinions and demonstrate that their mental capacities are not those of a psychotic. In view of these serious misdiagnoses and the particular nature of psychological suffering associated with exile and the problems of adapting to new living conditions, a whole body of literature has sprung up around diagnosis and classification in cross-cultural situations. The authors all agree on the need for a diagnosis that includes consideration of living conditions and the cultural features of communication as well as critical reflection on the foundations of psychiatry.
Examples of challenges in interpreting symptoms and disorders Diversity in a medical context When immigrants are treated for psychological disorders, it often happens that psychological suffering goes unnoticed and no therapy is proposed. This failure is often linked to communication problems and professionals’ lack of awareness of psychological disorders with atypical symptoms (sleeping disorders, pains, etc.). It is also the case that this failure leads to disorders being treated as medical or psychiatric problems when they arise from a situation characterised by social problems and difficulty engaging with institutions. Even if action by psychiatrists is useful or indeed necessary in such situations, it needs to be part of a holistic strategy which examines the social aspects of suffering and questions the effectiveness of engagement with institutions. Unless the causes of the disorders are analysed, we risk ending up with the “psychiatrisation” condemned by Zerdalia Dahoun.
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Functions of the clinical psychologist The main functions of clinical psychologists are diagnosis, counselling, treatment and training (educating/re-educating). The status and functions of clinical psychologists vary between European countries and institutions with the emphasis on one or other of the following: the specialist function, the institutional function or the treatment/diagnostic function. The
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Translation, mediation and assessment: communication tools