As in most European countries, the mental health of immigrants in France has recently been the subject of scientific scrutiny. Since the end of World War II voluntary special mental health services for migrants and refugees have been created in France and especially in Paris, but none has been based on epidemiological data. Generally, this lack of objective data gave rise to the assumption that many immigrants might not be getting the type of services they required. The birth of a new type of service (e.g. for migrants, refugees, ethnic groups, trauma and torture victims) was a political reaction to what was, at the time, expressed as an essential unmet need regarding this very specific population. In this article we review, from an anthropological point of view, the different paradigms that have prevailed over the last 50 years.

In the case of long-term major traumatic events such as the Cambodian tragedy there is a close relationship between the individual's clinical history and the collective history of his/her ethnic group. Most of the refugees who have survived a given historical event share the same history with nearly the same trauma, the same loss, the same flight to escape, the same difficult resettlement and so on. However, even if refugees have lived the same events, this does not mean that they have experienced the same trauma. Both trauma and culture shape human experience and may give the illusion of a common destiny that would flatten out varying individual fates, whereas in fact different destinies are contingently linked together. These questions pose a challenge to clinicians' knowledge of the relationship between trauma, culture and subjectivity and of course they challenge the concept of post-traumatic stress disorder as well. While knowledge of cultural differences is essential for clinicians, it is equally essential to be aware of how the individual's psyche may find hidden paths within the constraints imposed by culture, or even by trauma itself. To illustrate this issue, the article focuses on the case study of a Cambodian refugee to France.

The major task in transcultural psychiatry is to combine culturally defined concepts of emotion and pathological behaviors with an individual's singular psychodynamic process. Focussing on the special role that translation plays in individual psychotherapeutic sessions, this paper describes the Southeast Asian psychiatric program created in 1990 in the Community Mental Health Service of the 13th district of Paris where approximately 200 Southeast Asian patients, most of them Cambodian, have been evaluated and treated. A case example illustrates how transcultural psychodynamic therapy with an interpreter is possible with Southeast Asian refugees. Although attention to the cultural background of patients is essential, the author emphasizes the importance of the individual manner in which patients deal with cultural material in the therapeutic process.

Les discours ethnopsychiatriques, axé sur la différence et la distinction l'ethnique, réduisent le migrant à sa seule dimension culturelle, faisant fi de la subjectivité et du degré d'adhésion de l'individu à des croyances, au sein de systèmes de valeurs souvent comparables, de par leur rationalité aux systèmes occidentaux la pratique clinique, elle, distingue essentiellement malades et non-malades et se concentre sur le sujet. A l'appui de cette démarche, l'anthropologie montre que les formes singulières de l'individualité ne se déduisent pas des logiques collectives, que la culture évolue de par la migration, et que tout patient, étant soumis à des codes sociaux préexistants contraignants, développe des stratégies pour y échapper.