An Anthropological Hybrid: The Pragmatic Arrangement of Universalism and Culturalism in French Mental Health

Abstract

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.

Cultural competence in mental health care: a review of model evaluations

“…Careful reading of established training manuals [37,38] show these to be built on complex notions of race, ethnicity and culture, and the interaction with illness experience and behaviour and contexts. Pioneering work is based on experiences of the actual implementation of programmes in many countries in real clinical and service settings [39-41]. In the absence of randomised trials, or clear specification of complex interventions to improve cultural competency, these forms of evidence should be used with care to establish the foundations for future research, training and service development [42].…”

Health services, psychiatry and citizenship in a globalizing world: A perspective from Ireland

“…in response to the war in the Balkans), along with growing recognition of a broader need for generic mental health services to improve cultural competence, especially in segregated areas. In France, the period since the end of World War II saw the establishment of voluntary special mental health services specifically for migrants, refugees and trauma victims, although Fassin and Rechtman [31] suggest that these represented political reactions to an (apparent) unmet need, rather than epidemiologically based service developments based on demonstrated need.…”

Critical Evidence: The Politics of Trauma in French Asylum Policies

“…But under both hypotheses, the ideological climate prevailing among psychiatrists as well as among the military was one of distrust. The way trauma was considered then was part of a "clinic of suspicion" (Rechtman 2005). Moreover, the psychopathological reference, included in the emerging field of psychoanalysis, was the idea of hysteria that also contributed to the discredit of traumatic neurosis.…”

“…Parallel to the juridical construction of these political causes (Gaïti and Israël 2003), which has permitted some improvement in legislation during this period, another process entailing medicalization was at work for the defense of individual cases (Conrad and Schneider 1980). A series of struggles took place to obtain free medical assistance for undocumented migrants, give residence permits to those suffering from serious illnesses, and take into consideration the psychological sequels of exile (Fassin and Rechtman 2005). The appearance of trauma on this scene, however, initiated a particular social-psychological dynamic.…”