|
Textes en ligne © aiep - 25 avril 2005 - www.clinique-transculturelle.org
Pour citer cet article : The point of departure of this work is my clinical practice and my present multi-disciplinary research being done on the children of immigrants. I. The context : the ethno-psychiatric consultation The Bobigny (1) ethno-psychiatric clinic that I am presently directing has been open for some fifteen years (2). It receives about two hundred new families per year. Most often these are second, even last resort, consultations. The patients have already consulted a number of doctors, psychiatrists or psychologists, even faith-healers, of all sorts. The families come from everywhere, victims of the whims of economic disasters, political caprice or international migratory movements. They come from North Africa, Sub-Saharan Africa, Southeast Asia, Turkey and the eastern-bloc countries… Added to the pain of exile are the traumas prior to the trip, economic, linguistic, administrative, even legal difficulties and social exclusion. Not to mention this dull psychic suffering by my patients. They sometimes come to me for themselves, but more often for their children. Most of these children have been born in France. They are called upon to live in this strange but hopeful world. Yet this hope runs up against a multitude of barriers : social, cultural, psycho-pathological, scholastic, etc.… These are children born in France of immigrant parents who have left their countries to come to France to work. I will concentrate on the immigrants called “economic” and will refrain from analyzing the consequences of imimmigrations that took place in other circumstances such as for political refugees. Each situation must be considered in its own right. Aware of these immigrant children's suffering, I undertook a series of exploratory research (3) that go with my clinical experience. II. Exploratory research : immigrant children's specific vulnerability I have done a good deal of exploratory research since 1988. These cross-studies have dealt with a cohort of children from 0 to 3 years old, then from 5 to 8. I will give a few significant findings from these studies. 1. The child of immigrants from 0 to 3 years old 11. Hypothesis The child of immigrants presents a specific psychological vulnerability from zero to three years old. 12. Definition of the concept of psychological vulnerability 121. Background It is a concept made popular (4) by the American child psychiatrist, Anthony, in 1978 and introduced to France in 1982. It is a relatively recent idea in child psycho-pathology, even if there are no lack of precursors such as M. Mahler and A. Freud. We speak of biological vulnerability - though important, this dimension will not be analyzed here - and psychological vulnerability, which will be the subject of our study. 122. Definitions Vulnerability is a state of least resistance to harm and aggression (Tomkiewicz and Manciaux, 1987). To describe this vulnerability Anthony (ibid., p. 23) uses the image of Jacques May's three dolls : one is of glass, the second of plastic, and the third of steel. They each are hit with a hammer with equal force. The blow “completely shatters the first, leaves an indelible scar on the second, but the third remains apparently unscathed” (5). The doll that is dropped will therefore break with more or less facility depending on the material it is made of. This is intrinsic vulnerability ; depending on the kind of ground it is thrown on, this is the environment ; according to the force of the blow, this is the aggression and exposure to harm. The advent of dysfunction depends on the interaction of these three categories of factors, their interaction and not just their addition (Tomkiewicz and Manciaux, ibid., p. 737). 123. The concept's origins There are two ways to analyze the child's pathology (Anthony, ibid.). 1 - “tunnel vision”, i.e. isolate the child and consider him as a whole of interacting dynamic structures, independent of the nature and quality of external support (6). There is no room in this model for the notion of vulnerability, at best intrinsic vulnerability. It is clearly insufficient to think in terms of this concept. 2 - The second way is analyzed in detail by Wertheim (Anthony, 1982, p. 37-55). It proposes a model for thinking in terms of vulnerability : the child with its potential of affects and thoughts is part of a complex interactive system. Any rupture of one element leads by a ricochet effect to changes in the child's functioning. These processes are found between the mother, the father, the family, the outside and the child. Inside this interactive system, the child is developing. The system oscillates between two poles, that of rupture and that of reciprocal adaptation. It is in fact the developmental process that is vulnerable and not the child itself, as Anna Freud demonstrated, “vulnerability cannot be explained by the child's individual characteristics ; it must be understood in more general, impersonal terms. I am now of the opinion that the child's progress along the lines of development towards maturity depends on the interaction of a number of favorable outside influences with favorable innate gifts and a favorable evolution of the internal structures” (A. Freud, in Anthony, 1982, p. 13-14). This vulnerability is therefore a dynamic concept above all else since it affects a developmental process. The psychic functioning of the vulnerable child is such that a minimal internal or external variation leads to a large dysfunction, an often tragic suffering, a blockage, an inhibition or a reduced development of potential. This fragilization is manifested on the psychological level by “sensitivities and weaknesses” that are real or latent, immediate or deferred, “dormant or explosive”. The expressive degrees of a same trait are variable (Anthony, ibid., p. 486). The concept of vulnerability cannot be defined without comparing it to its opposite, invulnerability. Certain children, faced with dramatic situations, seem to react like steel dolls being hit to no effect with a hammer (what about the long term though ?). This observational datum about certain children's apparent invulnerability is indeed difficult to confirm with rigorous research that must necessarily be done over a very long time. 124. Risk, controlling risk and the critical period This concept has numerous practical consequences on the prevention level insofar as a risk implies controlling it under certain conditions to be defined. But an adequate environment must still be established for the child depending on his/her degree of fragility so that once the risk is controlled, there remain only “the chances that any event potentially contains” (Tomkiewicz and Manciaux, ibid., p. 740). The concept of psycho-pathological risk is therefore tied to two corollaries that are the controlling of risk and the notion of a critical period in which the child's vulnerability is at a maximum. The notion of risk is quantitative ; it has in fact been developed by epidemiologists. On the other hand the notion of vulnerability is above all clinical ; it is complex and difficult to quantify because it allows for complex and varied modes of expression. Yet indicators that take this vulnerability into account can be defined. Vulnerability can be evaluated by the dysfunctions it provokes. 125. The specificity introduced by the transcultural situation It is not easy to measure the impact of a life event - immigration - on psychic functioning. All the less so in that the consequences of this harsh change of environment that exile signifies can become manifest a long time after the event itself and concern the entire family (7). Faced with such complexity we must classify the analytical levels and define the partial problems. 13. Methodology To analyze the impact of immigration I conducted a comparative study of the evolution of two groups of children, one group of children of non-immigrant parents (G-I) and a group of children of immigrant parents (G-II). My first comparative study derives its source from data gathered by research done by a team of psychiatrists and pediatricians under the direction of S. Lebovici. I made a comparative analysis of the data of this study as a function of cultural origin. G-I and G-II constitute cohort E. It is made up of infants less than a year old at the beginning of the study, selected from health certificates (8). The parents, volunteers for this study, patronized four public dispensaries. It is a non-representative group of the population in general but one known as high psycho-social risk. Comparable underprivileged populations can be found in a number of Parisian suburbs. This study was conducted with 114 clinical observations (video-taped) (E=114). Each observation contains a clinical evaluation at three months, one year, two years and three years. It deals both with the somatic, psychological and social aspects of the child's development and with the mother-baby interactions. These data are systematized in the form of items (112 items) intended for processing by computer (9). 14. Description of cohort E 141 Spread of the children as a function of cultural origins I have defined several categories within E. G-I : non-immigrant children (n =32, 28% of E), G-II children of immigrants (n = 82, 72% of E). Cultural origins in E (in %)
• G-IIm (n = 45, 40% of E) : Arab, Kabyle and Berber, from northern Africa (Algeria, Morocco or Tunisia). The ethnic majority are Algerian Arabs. • G-IIan (n = 15, 13% of E) : from sub-Saharan Africa, mostly Bambari, Soninki, Fon and Peul. They come from Mali, Senegal, Cameroon and Benin. The ethnic majority are the Soninki. • G-IIdt (n = 22, 19% of E) : from the French dominions and overseas territories, 2/3 natives of Martinique, 1/3 from Guadeloupe. The comparative strategy is the following : comparison of the two main groups G-I/G-II, then sub-group by sub-group, G-I/G-IIm, G-I/G-IIan, G-I/G-IIdt, G-IIm/G-IIan, G-IIm/G-IIdt, G-IIan/G-IIdt. 142. The socio-demographic characteristics There is no significative difference in the social level, which is generally under-privileged. Moreover the differences in access to care (10) of the two groups is not emphasized either. 15. The comparative analysis of immigrants to non-immigrants I have retained a few qualitative and quantitative indices concerning the health of the mother and the child from zero to three years old. For the child there are 2 significative differences to be noted in the quantitative indices (table 1). Table 1 - The child's pathology (0-3 yrs.) G-I/G-II
SD= Significative difference (statistical signifiance) 16. Discussion (1) 161. The specific vulnerability of the children of immigrants under 12 months A bundle of arguments validate the hypothesis of the specific vulnerability of the child of immigrants during this period. (1) In this population the babies of immigrants under 12 months are more often depressed than others. One clinical hypothesis may explain this : the baby's depression could indicated a pathology of mother-child interactions and/or the mother's pathology that expresses itself in this way. This symptom is more easily observable in the child than the pathology properly speaking in the mother. This depression by the baby is mostly expressed in the first year when the child is the most dependent on its mother. After the first year a reciprocal adaptation seems to occur, and the symptom is not found to an excessive degree in the population of babies of immigrants. The symptom is therefore linked to the mother's disarray. A number of authors have noted the same observation (11). This insecurity is very intense in the first months of the child's life. (2) We found a large number of antecedents of deceased children in the immigrant families - the difference is significant for north-African families. The parity factor - the greater number of children in north-African families - is not enough to explain this difference. Moreover, the two populations are of a comparable social level and have the same access to care. There is little choice but to recognize that this difference is linked to the transcultural situation, the sole important distinguishing factor between the two groups. What can this finding be linked to ? Our hypothesis follows the line set out by Bourguignon (1984) in what might be called the “transmission of death”. It demonstrates that in certain families the death of a child, whatever the cause, is an indicator of a psycho-pathology of the whole family. Here the death of a child would translate a pathology of adaptation to the new cultural framework. This hypothesis establishing ties between “the death of children” with “immigration” should be validated by a cohort study in the general population. In any case, despite the studies remaining to be done to establish this causality in a formal way and describe the determinants, the study leads us to think that the family's adaptation to a foreign environment, often perceived as hostile, can be expressed through a child's fragility. The clinical study shows that the most exposed child is the first born in France. In too many cases a immigrant woman's first pregnancy in France ends in the child's death, either in utero, at the birth or in its first days of life. As surprising as this finding is, it coincides with those of other studies, e.g. the Ondongo study of 1987. In our study the veritable risk of death that weighs on certain children of immigrants constitutes one of the elements of its vulnerability. 162. The protective effect of certain cultural patterns One thing is worth stressing : in our population Antilles children demonstrate fewer behavioral problems than others. Every culture has its own specific mothering techniques. Polished by generation after generation, every mothering technique introduces multiple variables into its system that have different consequences for the child's psychic development (Stork, ibid.). Certain care techniques preserved by the mother despite her separation from the original environment can have a protective effect on the child's development, as here the importance of the interactions of proximity, touch and kinæsthetics. These mothering techniques are inherent to the cultural framework that supplies them and keeps them operational. They are part of the cultural patterns, i.e. the transmitted cultural structures (Devereux, 1972). Cut off from this human environment, they sometimes lose their meaning, become rigid and are no longer effective. They are intimately linked to the cultural group as a whole, to the women's and mothers' groups. From which is derived our proposal of the mother's insecurity being linked to the loss of support from her own cultural framework. Which leads me to think that the protective effect of certain patterns can be found in therapeutic care that emphasize the mother's own ways of doing things. 163. Consequences for continuing the research This first exploratory study therefore introduced the need of specificity on three levels : 1 - on the observational and data-gathering levels. To be able to study the workings of the mother-child interactions we are obliged to put them in a context, i.e. to consider the cultural and migratory contexts. 2 - On the level of the vulnerability's genesis. 3 - And finally on the therapeutic level, since from this specific-vulnerability concept derives the need for treatment adapted to this clinic. This specific mother/child vulnerability leads us to think of care that takes cultural representations and the mother's (and her group's) own ways of doing things into account. It is interesting to test the stability of this hypothesis in time. Which explains the second exploratory study to find out if this specific vulnerability is temporary and fleeting (limited to 0 to 3 years old) or if it expresses the child's development at other moments (Cohort study). 2. The child of immigrants from 5 to 8 years old 21. Hypothesis A second hypothesis emerged in this framework. In the defined population I wanted to see if the “immigration of the parents” parameter constitutes an additional and specific risk factor for the 5- to 8-year-olds. I propose showing that at this age, the vulnerability of the children of immigrants might manifest itself by the magnitude of the pathology and by their difficulties in acquiring the intellectual mechanisms necessary for the important scholastic first-steps. 22. Study strategy My strategy contains three phases. The children emerge from the first study at 3 years old. How have they evolved ? These children are assessed two, three, four and five years after leaving the first study. In all I obtain an E 1 sample of 45 children with G-I composed of 18 non-immigrant children and G-II of 27 children of immigrants (12). 23. Description of the E 1 cohort (13) There is no significant difference for the children's age and sex or in the socio-demographic characteristics in the two G-I and G-II groups. The cultural spread is comparable to that in E. 24. Psychological and scholastic assessment : methodology (14) 241. Psychological evaluational methods First I conduct a semi-directional interview with the child and its family (15), then a verbal projective test (16), the ten fables of Düss (1971) (17). Then the children are asked to draw (a person, a person of the opposite sex, the family). 242. E valuation of intellectual and language capabilities There have been several tests carried out with the transcultural situation of G-II (18) taken into consideration : (1) Terman-Merrill measures the intellectual level with a battery of cognitive tests (19). (2) Raven's Progressive Matrixes evaluate the perception of non-verbal forms and intelligence (20). It is a test of perceptive reasoning. (3) The Reversal Test is a test of temporal and spatial organization that seeks to highlight the necessary aptitudes for learning how to read, i.e. the perception of forms, the manner of situating oneself in space, the possibility of remarking differences and of differentiating the symmetry of reversal (21)… (4) A battery of tests taken from “Tests for Examining Language” by Chevrie-Muller (1981). 4 tests are used : a - a phonology test : the repetition of easy words (REP). b - A test of expression, i.e. making up a story from several pictures showing “a fall in the mud”. It is the number of ideas per story (NIS) that are evaluated. c - 2 tests of understanding : the “difference” test (DIF). The understanding of the word “difference”. The child applies it to 3 properties : form, color and size. The “similar” (SIM) test. The principle is the same. (5) An evaluation of the quality of bilingualism for the children of immigrants is then carried out with the help of an interpreter. The definitions by Hamers and Blanc are used (1984). I.e. two linguistic systems L 1 (mother tongue) and L 2 (French). L 1 and L 2 refer respectively back to two cultural systems, C 1 and C 2. Additive bilingualism can be written L 1 <==>C 1 and L 2 <==>C 2. The use of each language refers to its respective culture with an easy manipulation of both. This implies that L 1 and C 1 are not devalued. Subtractive bilingualism can be written L 1 <==>(C 1 and C 2 ) and L 2 <==>(C 1 and C 2 ). The use of each language refers simultaneously to the two cultural references ; this is the consequence of an insufficient mastery of the 2 linguistic codes and the 2 cultural codes. 243. Questionnaires filled out by teachers This questionnaire seeks to evaluate the child's adaptation to school, his/her ways of acquisition, his/her results, his/her attitudes in relation to the school and his/her parents' attitudes. 25. Main results 251. Evaluation of intellectual and language capacities 2511. Evaluation of intellectual capacities Table 2 - Intellectual evaluation (G-I/G-II)
The differences are significative concerning the intellectual level for all ages, only at 8 years old for reasoning tests (non-verbal intelligence, form and symmetry perception). 2512. Language test (French) Only the main results for 8-year-old children are summarized in the table. Table 3 - Recapitulation of the language test (French)
Key : Repetition of easy words, REP ; number of ideas per story, NIS ; “difference” test, DIF ; “Similar” test, SIM. “a”, average ; “s”, standard deviation. In conclusion, the 8-year-old children of immigrants in our study have more phonological problems, more problems of expression and more understanding problems. 2513. The bilingual quality Table 4 - Evaluation of bilingualism (22) In all 80% could be considered as not being truly bilingual [(3)+(4)]. It will be noted that the child with the best quality of bilingualism, also possesses the richest French and has the best scholastic results. In E 1 those who speak their maternal tongue the best also speak French the best. These results go in the same direction as the work by Hamers and Blanc (ibid.) : “Mastery of a first language helps with a rapid and good-quality mastery of a second, even a third…”. 252. Scholastic evaluation The results of the statistical comparison of G-I/G-II can be found in table 5. Table 5 - Comparison of scholastic difficulties, G-I/G-II
The children of immigrants have more difficulties in math and repeat grades more often. The latter indicator is interesting for it is general and highlights the inharmonious scholastic functioning of these children. In conclusion, school in our population appears to be a traumatic place for most children of immigrants, a place where they sustain multiple failures. 253. Psycho-pathology of the children Table 6 - Psycho-pathology of the children (average age : 7 years old)
Table 7 - The psycho-pathology of E 1 children - g -I/G-II comparison
There is a significant difference in the population studied concerning the psycho-pathology of the children in E 1. But there is no difference concerning the nature of the disturbances (neurotic disturbances, depressions…). Because of their large quantity, these results seem especially disturbing to me. Yet they are consistent with daily life in these wounded suburbs in the Paris area. Let us not forget however that the whole of the population is very underprivileged on the social level, and the ties between psycho-pathology and underprivileged social classes are well known (Chiland, 1971). Consequently it might be thought that the extent of pathology in the population is correlated with the low social level. But the difference between the two groups on the same social level might be linked to the “immigration of the parents” factor. 254. The itinerary followed by the children and their parents Some important elements emerge from the analysis of the data gathered through interviews : 1 - immigrant families live in a “patchwork” cultural universe the anthropological rationales of which we know very little but which blend elements of the two cultural systems with a strong presence of the original cultural representations concerning disease and the dealings with the children. 2 - In a transcultural situation : the child of immigrants is first of all a guide, a guide for the parents in an unknown world run by rules hard to incorporate. Based on this study, we could make a phenomenological description of these “public scribe” or “social worker” children, who, as soon as they have the rudiments of reading and writing, fill out the administrative forms and handle all the problems of daily life for the home in its relations with the outside. This position as guide is all the more important for the parents' social milieu being underprivileged. The parents then have fewer means for adapting to this new world (e.g. knowing how to read and write in its language, especially in French). This leads to a veritable inversion of the generations with the child becoming “his/her own parents' parent”. 26. Discussion (2) Despite its limitations, this study shows that the evolution of the two groups of the cohort is different : at 8-years-old, the children of immigrants in our population have more psycho-pathological disturbances, more intellectual and cognitive difficulties and more scholastic problems than the non-immigrants. Even inside the group of children free of pathologies differences continue concerning intellectual, language and scholastic evaluation. Therefore for our population structuring on the affective as well as the intellectual levels is compromised in transcultural situations. This exploratory study establishes the links between “psychological vulnerability” and the fact of being “children of immigrants”. But the nature of the links and the mechanisms of a possible causality remain to be established. Link does not necessarily mean causality ! These are the mechanisms we must now explore. 3. The vulnerability of the children of immigrants : clinical facts and theoretical hypotheses Let us analyze the genesis of this vulnerability based on the qualitative indicators gathered during pregnancy and the early days of infancy. 31. Pregnancy in migratory situations This research shows that pregnancy is not a happy experience for a good deal of immigrant women. Yet these women - Arabs, Kabyles, Bambari, Fons - traditionally have good pregnancies when in their customary cultural framework. Pregnancy is culturally important, and the pregnant woman is carried along by the entire group of mothers (Lallemand and al., 1991). The difference between the traditional attitude towards pregnancy and what is experienced in a migratory situation has led us to reflect on the specific experience of pregnancy in exile. Several facts must be looked at to understand this result. (1) Any change in condition is a moment of psychological vulnerability. And a woman's first pregnancy where she passes from her status as a girl to that of a mother is a particularly fragile moment. The subsequent pregnancies, even if the process becomes less unfamiliar for the woman, nonetheless remain complex phases the happy resolution of which is never a foregone conclusion. The main mechanism that determines this vulnerability is confusion : confusion about the categories of inside/outside, me/not-me, life/death and confusion of generations. Pregnancy is for any woman a moment of regression, of a rekindling of her own childhood conflicts, but also a moment of doubting her own filiation (Racamier, 1979). That doesn't happen, as for any human phenomenon, without a certain dose of disorder. This is why the phase is codified by the cultural group that furnishes the woman and the couple with representations and support. (2) In non-western societies pregnancy and giving birth are considered to be an initiatory phenomenon that is accompanied by the group (Rivière, 1990). With immigrant women the external and internal rupture caused by the immigration introduces a discontinuity in the process of passage. It is this temporal, spatial and ontological structure that confers the difficult status of founder on the child. In intracultural situations the woman, through pregnancy and giving birth, is enrolled in the “mothers'” group ; it is a veritable process of affiliation. In transcultural situations the woman does not find the necessary external support for stanching her internal confusion : accompaniment of mothers and co-mothers (23) in sub-Saharan Africa, the sisters-in-law in north Africa and the protective rituals and measures everywhere. From whence "springs the potential for mechanisms of confusion in exile" (Moro and Nathan, 1989, p. 698). The loss of the cultural framework leads to a lack of holding. Then the child arrives in the world, and the mother is going to establish interactions with him/her that are ever more complex in this unstable transcultural context. Based on this exploratory research, how might we represent the dynamics of mother-infant care in a transcultural situation ? 32. Primary care in immigrant situations (24) Let's look closely at the “presentation of the world” function as defined by Winnicott as being a part of primary care on a par with holding and handling (Winnicott, 1969). The mother apprehends the world according to categories determined by her culture. Her experience of reality is “fractional” and “limited”, exposing her to the risk of confusion with any attempt to escape these categories. What she perceives of the world through this reading matrix are not objects in themselves but the interaction of this reading system structured by the culture with external objects. This cultural coding is transmitted from generation to generation. It is on this level and on the outside slope first of all that the immigration creates a harsh rupture : the reference system is no longer the same, nor the categories used ; all reference points start to waver. The consequences for the mother are of two types : she loses the confidence she'd acquired in the stability of the external framework ; the outside world is no longer safe, and a certain degree of confusion enters her way of perceiving the world (Nathan et Moro, 1989). In such a way will she potentially transmit this kaleidoscopic perception of the world to the child, which in turn may generate anguish and insecurity. The child's reality is built from the first relationship he/she has with its mother (Stern, 1989). This envelope is constituted by a series of operational acts (care techniques), corporal and sensorial acts (mother-infant interaction), acts of language (words said to the child) and psychic acts (maternal representations…). Immigrant parents cannot teach their children about “the world in small doses” as described by Winnicott (1969). Consequently on a daily basis these children meet this exterior world in a traumatic way. It is in this context of relative insecurity that the child grows up and is led to separate from the family milieu (the inner world) to insert him/herself in the scholastic world (the outer and foreign world). 33. The specific vulnerability of school-age children of immigrant parents This exploratory study has in effect demonstrated the hazards of cognitive-intellectual structuring and the child's structuring of reasoning in a transcultural situation. At 8 years old we find : 1 - an overall intellectual level in children of immigrant parents much lower than that of non-immigrants ; 2 - less good results in certain language tests (25) ; 3 - less good results in the non-verbal intellectual structuring test, i.e. problems with reasoning for perceiving and differentiating between form and content, perceiving forms, integrating symmetry and integrating the formal differences and similarities (26). Several explanatory series can explain the ties observed between the affective, cognitive and cultural levels. 331. Elements of ethno-psychiatry Here we must consider two of ethno-psychiatry's founding principles : a - the equivalence between the external cultural framework and the internal psychic framework (the internal cultural framework) (27). From these two series of facts we infer the existence of “cultural structuring”. This process is indispensable for understanding the genesis of the cultural framework interiorized by the child. When adults transmit a culture to the child, “they put at his/her disposal not only the contents but a complex structure composed of (depending on the model) tangled opposites, inside-outside, manifest-latent”, Nathan (1986, p. 34). Cultural structuring recognizes dichotomy-style reasoning : the same/other or human/non-human, meaning/non-meaning, good/evil, adult/child, man/woman… It ends by determining the “implicit knowledge” common to all the individuals of a given group. Having acquired this function from her own parents, the mother transmits it progressively to the child. In this way the child acquires its psychic structuring (the “I”) and its cultural structuring (“I am a Bambari”) in a concomitant manner. This cultural structuring will happen independently of the psychic structuring but maintains a relationship of equivalence with it, as the psyche maintains equivalent relationships with the culture. The bond linking the psychic and cultural series takes its place during childhood, but it is kept vivid and operational throughout one's existence thanks to the homeostasis resulting from permanent exchanges between the individual and his/her cultural environment. (Nathan, ibid.). The child of immigrants who grows up in a transcultural situation consequently acquires cultural structuring built on a splitting between two worlds of different natures. Because it is not unified, this structuring is necessarily uncertain and fragile. In effect to grow up, the child of immigrants must patiently build a necessary cleavage between the world attached to the family culture - the affective world - and the outside world, school for example - the world of rationality and pragmatism. And there are a lot of cleavages. Phenomenologically they operate on the topographical level (within/without as, for example, family/school), on a temporal level (before/after the immigration), on a spatial level (there/here) on the ontological level (the same/the other)… Necessarily created by the child to enable him/her to move around in these two worlds, these cleavages are nonetheless sources of inhibitions and anxieties (28). They can be structured and become a permanent method of psychological functioning in the form of a veritable splitting of the ego in the psychoanalytical meaning of this expression (Freud, 1949, p. 284). This quasi-obligation to “split the ego” among children of immigrants is accompanied by a process of denial to which they are constantly obliged to run to. The "main target of the denial is filiation, and this denial is shared by the family" (Moro and Nathan, 1989, p. 686). The child of immigrants is in effect perceived as a foreigner within the family (Ibid.). This is where fantasy, representations from myths or legends come from to explain this foreigness (Rank, 1909). If he/she doesn't resemble his/her father or mother ; if he/she shows such understanding of this outside world that seems so complex to the parents, it is because the child is "the reincarnation of an ancestor", "the gift from a genie" or "some earth divinity" (Kouassi, 1985 ; Moro and Nathan, Ibid.)… The cultural structuring and the psychical structuring of children of immigrants are therefore built on insecure cleavages in unstable contexts. This cleavage mechanism should from here on out be considered as a determining factor in the specific vulnerability of children of immigrants. 332. Elements of cognitive psycho-pathology Gibello (1988) establishes another kind of bond between the transcultural situation and the problems of cognitive development by proposing the hypothesis of cultural “envelopes”. For Gibello formal structures allow the “thinking machine” to work ; these are the envelopes of neurological, linguistic, cognitive thought relating to space, time, number and reasoning, the envelopes of libidinal thought, the envelopes of narcissistic thought (representations of oneself), the envelopes of family thought and the envelopes of cultural thought. The latter are implicitly conveyed by culture and shared by all members of a same group. They participate in the proper functioning of the thought processes and in the communicability of thought content within a group : “Tradition leads the members of a same culture to give a double meaning to their perceptions : a banal meaning and a cultural meaning” (Gibello, ibid., p. 86). Now when one goes from one culture to another, the implicit cultural envelopes change, and, even if with time they are perceived, they are not interiorized. In transcultural situations implicit elements should be explicitly learned by the child ; they are not just foregone conclusions in the child's cradle ! It is up to him/her to learn them… 333. Elements of the theory of equilibration The work by Piaget and his successors, Lautrey (1984), position intelligence inside the process of equilibration : “a sort of system of regulation of regulations that not only enable one to compensate after the fact for the changes occurring in the environment but also to forecast those that will happen and to act ahead of time in function to them. This assumes that independently of the subject there are regularities, stable relationships between the environment's events (…). The activity of understanding consists for the subject in integrating these regularities into his own structures, in ‘understanding' them” (Lautrey, ibid., p. 50). More often than not the child of immigrants has no guide. He integrates the operating laws of the society in which he lives without understanding them or being able to anticipate them. He has a superficial knowledge of them, not transmitted by his/her parents, thus cut off from all affectivity. But any activity of understanding implies two phases, a first phase of implementing an unbalanced situation and a second of re-establishing balance with the materials supplied by the environment (29). The transcultural situation enhances the development of unbalanced moments, and when the second phase is missing, it potentializes the difficulties of slow learning. The child of immigrants has to confront a two-fold fragility : his/her own, linked to the cleavage on which it is structured, and that of his/her parents linked to the immigration. Yet this instability provokes movement and can therefore have positive consequences : everything is precarious but everything is still possible. 34. The double polarity of the migratory situation The transcultural situation also permits often unexpected and sometimes downright spectacular successes. This point has very rarely been highlighted or studied. The sociologist, Dominique Schnapper, has recently done a study on “the integration of immigrants” in France (1991). Examining the lot of children of immigrants, about the “over-selection” they are submitted to, she concludes that “those who surmount it derive an added profit in the rationale of self-affirmation and in the search of distinction, but the risk of failure is statistically high for those who do not possess the same individual and social advantages” (Schnapper, ibid., p. 198). In the population of children of immigrants who do well or fairly well in school I've been able to highlight three types of cases : 1 - the child lives in a sufficiently secure milieu, rich in all sorts of stimulations. 2 - In his/her environment the child finds adults who serve him/her as initiators to the new world. 3 - The child is endowed with singular personal capacities and a good deal of self-esteem. In the first two cases the initial situation of imbalance finds contextual elements to re-establish a new order and thereby encourages the development of creative potentialities. In the third case the source is found within the child, and we can then speak of the child's (at least apparent) quasi-invulnerability. And in fact in our sample certain children do better than their comrades on the same social plane. There aren't very many of them, but they must not be forgotten if we are to understand the clinical reality in its complexity. Likewise within some immigrant families one child can do brilliantly well at school while the others, who nonetheless live in the same conditions, fail miserably. Of course a number of factors explain such an occurrence : each child's personality, his/her degree of vulnerability, his/her position in the family, parental investment, etc. But one specific factor has been spotted with astonishing consistency : the children of immigrants who succeed in school have someone in their entourage who plays the role of “initiator”. It may be the teacher for one, the older sister for the other or a kind neighbor for the other one. These persons from the “exterior world” enable the child early enough to foresee a few “stable relationships” between the events of the outside environment. Henceforth these few rationale interiorized by the child enable him/her to integrate knowledge about the outside world more easily. If this world is not recognized at least in part as his/hers, how can a person record within him/herself the rationale proper to this universe ? So certain children seem to be “adepts”, but they are not very numerous. And others, the others, seem to be “sacrificed”. These “sacrificed” children sometimes have good intellectual capacities that they are unable to express. They don't necessarily have manifest psycho-pathological disturbances, but they don't “allow” themselves to succeed. They don't succeed in becoming children who are perfectly inserted into the scholastic world, the French world. 35. Becoming in the longer term The cohort study shows that the children of immigrants constitute a group with a specific risk, especially when the mother-child interactions are established during the first year and at the beginning of the first learning processes in school. The few present studies on adolescence seems to confirm a new outbreak of risk with the onset of adolescence, a period when the child is beset by internal conflicts (30). Puberty throws the child of immigrants harshly into insoluble problems of filiation. He/She wonders what his/her place is. Is he like his father ? His grandfather ? Is he foreign to his own filation ? It would seem that for the adolescent of immigrants - "as for any child who, for one reason or another, cannot occupy a well-defined place in his own filiation - adolescence is a particularly difficult moment" (Moro and Nathan, 1989, p. 715). To try to avoid the cleavage, they repeat the traumas : suicide attempts, accidents, drug addiction (31)… Yet subsequent systematic studies would doubtlessly confirm these first findings about adolescence. The transcultural situation, like any borderline situation, in a way potentializes the differences. It doesn't have a one-to-one influence on the children, on their psychic and cognitive structuring but on the contrary admits to a double polarity : possible risk/mastery of the risk under certain external and internal conditions, given or acquired. So I proposed an image to conceptualize this specific vulnerability, that of the exposed child. 36. The exposed child Philosphers have taught us that knowledge in a particular discipline can advance by integrating concepts and images from other sciences (32). In the light of this we would like to propose a heuristic model to conceptualize the child of immigrants in a dynamic way : “the exposed child”. The child of immigrants is exposed to a specific risk, the transcultural risk (Moro, 1989b). Mythology gives us a number of examples of children exposed to a danger, i.e. most often confided to the waters in a chest. Exposed to a life or death risk, the child, if he surmounts it, becomes a hero. This notion of exposure is found in the legends of Dionysus, Karna, Moses, Paris, Perseus, Sargon, Telephesus and, of course, Oedipus (Rank, 1909). Exposure is a kind of abrupt acculturation. We found this image with the immigrant woman and her child, and we experimented with its operability in specific psycho-therapies. It is as if the mother thought - consciously or not - “I've brought a child into a foreign and possibly hostile world”. Later, the child will think - consciously or not - “I've managed to grow up in this different world from my parents' ; so I've made myself by myself, without help ; I've made myself, maybe even created myself”. Others will think, “I can't grow up in this world that is so different from my parents'”. This concept is a source of anxiety, inhibition, self-destructive acts and the pursuit of traumas (Moro, 1989c). This concept of the exposed child is similar to the theories of Margaret Mahler (1978), who, in analyzing her own emigration from Vienna to the United States, posits this factor as a process that can generate regression and inhibition as well as a development of the individual's creative potential. She compares emigration to the process of separation-individuation which she later forged. On the psychological level emigration favors a new birth (individuation) or in cases of dysfunction (failure of the separation-individuation process), disease. Just as the image of the exposed child admits double polarity : there is a transcultural risk ; if the child and its family surmount it well, the risk reverses itself and becomes a dynamic and creative process. Poorly surmounted, the risk will lead to illness, the child hiding his/her potential behind symptoms. And we would say that in this case the child bears the traumatic family experience of emigration. On the psychological level emigration is a borderline situation : it has tangible consequences, but also “dormant” effects, neutralized by other factors like social parameters. On the epistemological level, when we posit the emigration of the parents as a vulnerability factor in the child, we are not talking about linear and absolute causality. The “emigration” factor is not an independent variable but a specific external and internal element. Growing up in a transcultural situation is a risk factor for psychic structuring. This is why, on the methodological level, a immigrant mother and her child can only be observed, a immigrant family and its child can only be treated by integrating these additional elements of the mother's original culture and her immigration. On the clinical level the migratory phenomenon's double polarity enables us to anticipate the possibilities of a reversal of this process of vulnerability and, consequently, the therapeutic strategies for transforming this vulnerability into a strength. One of the devices for pursuing this goal is ethno-psychiatry. III. Family-child psycho-therapies in transcultural situations 1. Definition of ethno-psychiatry Ethno-psychiatry is a method that "devotes equal time to the disorder's cultural dimension and an analysis of the psychic functions" (Moro and Nathan, 1995, p. 423). It has two reference points on the methodological level : psychoanalysis and anthropology (Devereux, 1972). Ethno-psychiatry requires decentering. It "accepts a critical reading of the classification of data, which leads to a revision of the nosological grids" (Moro and Nathan, ibid). "Moreover it compels an analysis in rational terms of the therapeutic resources of traditional societies" (Ibid ). To date it has known three phases (Ibid) ; 1 - first of all, the theoretical construction of discipline (33) — Devereux is the veritable founder of the theory of ethno-psychiatry. 2 - Then anthropological field studies that show that the opposition wild/civilized are not founded (34) ; 3 - clinical research enabled us to develop a technical system and new therapeutic strategies. This clinical work is conducted by a few teams in France (35) and abroad (36). The ethno-psychiatric system depends on two main principles. (1) The first is that of psychological universality : that which defines a human being is his psychic function. It is the same for everyone. From this postulate is derived the necessity of giving the same status (ethical but also scientific) to all human beings, to their cultural and psychic products, to their ways of living and thinking even if they are different and sometimes upsetting ! (Devereux, 1970). Making such a statement may appear obvious, but what is implied by numerous so-called scientific studies conducted yesterday and still today is there to remind us that this theoretical principle is not always respected. (2) Another universal human characterstic is of course that all men and women have a culture, which is perhaps what founds his/her humanity and universality (Nathan, 1990). One of the approaches of ethno-psychiatry is to work on the specific without speculating on the universal, not immediately knowable but too often inferred without passing through the specific. "The universal is probably an asymptotic point of knowledge in the human sciences" (Nathan, ibid.). Ethno-psychiatry for children developped from general ethno-psychiatry (37). 2. The technical setting We invite the entire family to the session : the mother, the father, the child, the other children, other family members and the team that referred the family to us. They settle in to a group formed by the principal therapist and the co-therapists of varying nationalities and ethnic groups, speaking a wide range of languages. Sometimes, especially for families from Africa where a myriad of languages and dialects can come into play, an outside interpreter proves necessary. The patient is always given a chance to speak in his/her own tongue. This multi-professional and polyglot group (with psychiatrists, psychologists) fulfils three essential functions for the family and child. (1) It is made up of many diverse representations of otherness, of women and men, of whites and blacks, of neither white nor black, close relatives, close relatives of relatives and so on to distant relatives. These parcels of otherness embodied by group members and represented in space enable the family to experiment with another form of otherness that is neither monstrous, threatening or destructive, but on the contrary an otherness that is representable and creative. (2) The group provides a second function whatever the planned on clinical situation : that of holding. Once the family is sufficiently held by the group, it can in turn hold the child. The same logical process is recognizable : A is to B what B is to C. With the child acknowledged in his otherness and effectively held, an exchange relationship can then be established. (3) The group provides the materialization of the passage from one universe to the other. This is a very important function for the child who often identifies with the interpreter and leans on him/her to do this difficult work of linking (outside/inside). In this set-up the two worlds that structure the child can be used, and bridges between these worlds can be built : the parents' world with its specific cultural representations about the child, its disease, the causes, the way to treat it ; the outside world with its own rationales. The therapeutic process consists in allowing the child to rebuild a filiation (insertion in the generations) and an affiliation (insertion in groups). Affiliation requires a necessary and transitory passage through the parents' cultural representations. Rebuilding a filiation without reference to affiliation is not enough for the children of immigrants. Relying on cultural representation opens the way for conceiving this affiliation in order to for the child to build his own road, which for the children of immigrants will be of mixed color. Conclusion From what has been said we can conclude that the child of immigrants has to face several vulnerability factors : the fragility of the parents whose reference points have been blunted by the immigration and the child's own split functionning that relies on a double-reference universe the two poles of which are not solidly implanted. For the children of immigrants any therapeutic technique that does not take their cultural singularity into account only contributes to reenforcing the cleavage that exists between their two referential worlds. We thereby contribute to their de facto exclusion from the receiving society, to their marginalization. Taking their cultural background into account leads on the contrary to favoring individual treatment strategies, the learning process and participation in the receiving society. For coming from abroad, these children are called upon to live in a different world from that of their parents, thus to become mixed breeds. Our role as therapist is to help them bridge the gap between their referential worlds and not to set the worlds against each other. In this way we can think in term of mastering the transcultural risk… Our role as researcher is to conceptualize a set-up that contains their otherness and transforms it into creativity… * M.D., Psychiatrist and Ph.D. in psychology ; Director of an ethno-psychiatric consultation at the Avicenne Hospital, Bobigny, (University of Paris, France). (1) In the Parisian outskirts (France). (2) It was founded by T. Nathan in the service directed at that time by S. Lebovici. (4) The concept was first introduced by Theodore Cohen, but it was Anthony who developed it in greater detail. This explains why I will depend on the work by Anthony (1978). (5) It's my own translation as all the citations of this text. (6) The example used by Anthony (ibid.) in this category is that of the Kleinian theory. (8) The initial criteria are traditional indices in France as indicators of psycho-social risk : e.g. single mother and child not legally recognized by the father, mother under 18 at child's birth, at least 6 previous pregnancies, at least one still-born birth, specific social monitoring… (Job-Spira and al., 1988). (9) Cf. Job-Spira et al. (ibid.). (10) The french health care system covers all residents of the country. (11) Stork (1986) ; Rabain-Jamin and Wornham (1989). (12) The cultural spread being the same as in E (no significant difference). (13) I established the same categories in E 1 as in E. (14) For an in-depth analysis of the evaluational methodology and its limitations, cf. Moro (1989a). (15) We use the interview to trace the family's background, the immigration and the child's background. (16) Verbal tests are less encumbered by cultural factors than other projective tests, cf. Moro (1989a). (17) These are 10 stories that are told to child, who must then answer the question asked at the end. For the methods of testing and analysis, cf. Düss (1971). (18) For a detailed analysis of this method, cf. Moro (1989a). (19) It establishes an intellectual quotient. Cf. Terman-Merrill (1962) ; Cesselin (1959). (20) Cf. Schutzenberger (1981). This test is very sensitive to the spatial factor, to the quality of corporal representation and the acquisition of symmetry. It is traditionally considered “culture free”. The child is presented with a series of drawings. He must find the piece that completes the drawing. To do so, the child must rebuild his reasoning process. (21) Cf. Edfeldt (1955). Geometric drawings are reproduced by pairs, which are identical and located very near one another. The child must cross out all the pairs that are not absolutely identical. (22) For definition of the bilingual forms, cf. supra. (23) I here use the term in the proper sense of “mother with”. (24) On this question, also see Moro (1994a). (25) Which was expected, for it was already seen in previous work (Perron and Misès, 1985). (26) More original findings not described in previous work. (28) Nathan et Moro (1989) ; Moro et Nathan (1989). (29) Piaget (1978) ; Lautrey (ibid.). (30) Pons (1986) ; Moro and Nathan (1989) ; Moro (1989c) ; Schnapper (1991). (31) Pons (ibid.) ; Moro and Nathan (1989). (32) On this fundamental notion of the transfer of concepts from one science to another, of nomadic concepts, cf. Stengers (1987). (33) Freud (1912) ; Roheim (1950) ; Devereux (1970, 1972). (34) Lévi-Strauss (1958, 1962) ; Thomas (1961) ; Devereux (1961, 1970) ; Jaulin (1967) ; Zempléni (1968)… (35) It is very difficult to list them because the labels are different, and the training diversified. We will quote Nathan's Team and Moro's Team, even if there are more and more differences beetween these two research teams. (36) Switzerland, Italy and Canada are countries that are particularly interested in these questions. And teams are now being formed. (37) For the construction of child ethno-psychiatry cf. Moro (1994a). |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
