Failures of Imagination: The Refugee's Narrative in Psychiatry

Refugees coming from war-torn areas sometimes face misunderstanding and frank incredulity when they encounter the psychiatric system. This failure of the clinical imagination reflects both reluctance to confront the enormity of patients' loss and cultural differences in self-presentation, self-understanding, memory and identity. In this presentation, I explore some ways in which the intrapsychic dynamics of refugees' suffering and remembering interact with the larger social dynamics that constitute refugee communities and host societies. The pivot between the realms of the social and the psychological is the narrative construction of the self. Self-narratives may be organized through culturally diverse forms built on specific root metaphors. I discuss some of the root metaphors for the self implicit in psychiatric narratives that may stand in the way of fuller understanding of the refugee's predicament. Recognition of the self as a cultural construction, means that clinicians must rethink the nature of their everyday practice and accept the inherently political nature of medical diagnosis and intervention.