Suffering as “Symptom”: Psychiatry and Refugee Youth
This chapter purports to challenge the increasingly powerful position of psychiatry as a first-line narrative for understanding refugee youth suffering. We discuss this trend and argue for a model of community-based psychiatric case consultation that focuses on a systemic understanding of mental health, including sociopolitical oppression and its impacts.
Refugee youth face social, cultural, political, and economic pressures that can generate high levels of mental distress and overwhelm individual strategies for coping. These youth may then have their issues described psychiatrically, which may or may not truly capture their struggles. While some youth do experience debilitating emotional reactions that require psychiatric “treatment,” many others are better served through nonmedical avenues. More broadly, concepts of resilience promotion are crucial to addressing the complex issues these young people face.
This is in contrast to the growing power of psychiatry, emerging in the West and spreading worldwide. Critics of this trend see psychiatry as a particular narrative that translates socially related suffering into individual medical pathology. In our clinical experience, as well as in the literature on refugee youth adaptation, it is evident that youth prefer support through nonmedical avenues that can better grasp their overall life context as opposed to contact that is “mental health”.
We propose reducing the medicalization of social suffering, using a model of collaboration with psychiatrists who are embedded in community-based agencies. We also outline psychiatric approaches that can help address the oppressive conditions of life in which refugee youth often find themselves and which are major determinants of their mental health.
Our hope is to see an evolution of psychiatric services. There needs to be more implementation within community settings, and more importantly, a shift in psychiatric theory must take place to address the complex social realities of refugee youth. Finally, we acknowledge the limitations of the psychiatric lens, and the need to support other modes of healing both locally and globally.
KeywordsRefugees Youth Psychiatry Resilience Culture Colonialism
We would like to thank our colleagues at the Hincks-Dellcrest Centre in Toronto, whose superlative clinical and reflective skills have allowed our consultation team to flourish. We also acknowledge our debt to our child psychiatrist colleagues and mentors at McGill University in Montreal (Drs. Jaswant Guzder, Toby Measham, Lucie Nadeau, and Cécile Rousseau). They have offered training to each of us, mentorship in setting up this clinic in Toronto, and ongoing guidance and collaboration.
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