The Migratory Diagnosis: How the Refugee Role is Making People Sick

Abstract

The present-day refugee claimant is statistically at risk of encountering pre-peri-post migratory trauma (Hynie 2018) and is often pigeonholed as ‘traumatized’ by Global North countries (Summerfield 1999; Weine & Henderson 2005; Gass 2014; Pupavac 2001, 2008, 2012). In an effort to de-pathologize refugees, a psychosocial perspective has been offered by trauma critics to problematize the trauma-centric understanding of the refugee to highlight the refugee’s ‘resilience’ (Maier & Straub 2011; Silove et al. 1998, 2000; Summerfield 2001; Papadopoulos 2002). Despite this, disconcerting data shows that refugees are “highly vulnerable to mental disorders even years after resettling in a high-income country” (Henkelmann, de Best, Deckers, Jensen, Shahab, Elzinga & Molendijk 2020: 6). My work seeks to address this urgent call by closely examining the trauma-ridden “apolitical suffering body” (Ikanda 2018: 582) of the ascribed role, ‘the refugee’.

Through a retroactive analysis of clinical case notes from my clinical practice, which utilizes a resilience-based approach, I develop a therapeutic typology of refugeeness whereby I identify unaddressed, and potentially reinforced (through applied resilience models) tenets of refugeness, where such a typology is not available. A central claim is explained through what I call the migratory diagnosis, which asserts that psychiatric and psychoanalytic approaches to refugee diagnosis and treatment reframes the refugee’s experiences around migration-induced loss and the (un)successful mourning of a pre-migratory self. The migratory diagnosis includes the psychosocial model of resilience, which espouses “strengths based approaches” (Hutchinson & Dorsett 2012: 66) to supplant the traditional trauma-labelling “deficits approach” (Betancourt & Khan 2008; Wessells 2009). Although well-intentioned, rewriting the script from ‘trauma’ to ‘resilience’ simply supplants a trauma ascription with a resilience one. Ascription-assignment is the crux of the problem we are exploring, as it reinforces sickness. Herein lies the trauma trap. This trap reveals that trauma critics from the psychosocial perspective, alongside psychoanalysis, are isomorphic to the field of psychiatry which endorses the PTSD diagnosis. These seemingly diverse therapeutic approaches promote the internalization and reification of the refugee role for the migrant, creating a migratory mind that acts as a blueprint for ‘successful’ and ‘integrative’ behaviour in the exile country that actually causes negative conditions of refugeeness.