Deuil des racines, racines des deuils : à propos d’un cas clinique

Introduction

Wars and/or natural disasters have long been sources of trauma. Today, it has been demonstrated that migration can also constitute a traumatic reality. Migration can be an acute traumatic phase for some people, even if not all traumas always have negative effects and not all individuals are at equal risk of traumatization. Whether voluntary or forced, Migration remains a particularly trying ordeal and a crisis, which imposes a logic of breaking historical cultural references, changing social references, a reorganization of identity and a psychological transformation. It involves a loss of cultural heritage and the discovery of new resources and potential. Indeed, people who go into exile lose their home, their kinship, their language, their community and their roots. In addition to the various losses suffered, the subject is assailed by existential questions, essentially affecting their identity in their relationship with dyads: sameness–selfhood, time–space, here–there; present–future; illusion–reality, etc.

Method

Based on a clinical vignette drawn from our experience in the psychiatric field, we propose to reflect on the psychological and cultural determinants linked to the issue of grief and trauma. This case concerns Mr. B., admitted for major anxiety-depressive syndrome characterized, among other things, by moodiness, loss of appetite and sleep, and psychomotor retardation. He stopped going to work without any specific reason and had lost his usual lifestyle habits (sport, reading at bedtime, lullabies for the children). In addition to antidepressant treatment and the exploration of possible etiopathogenic factors, such as the migratory trajectory, it was possible to co-construct a transcultural psychotherapy program with the patient and his wife, where cultural data served as therapeutic levers. As such, the migratory trajectory taken as an intercultural variable can be considered here as one of the etiopathogenic factors of depressive syndrome or other related disorders to the extent that it reactivates the ontological elements linked to the basic personality of the subject and confronts them in another universe, that of the host or adopted country. In this configuration, it was necessary for us to mediate between the maternal uncle and the couple following the example of transcultural mediation developed by Bouznah.

Conclusion

The caregiver's understanding of these determinants will thus allow for a therapeutic approach adapted to the patient from a different world of meaning, considering not only cultural signifiers, but also the thought patterns to which they refer in relation to the question of normal and pathological. This clinical case raises several observations that influence the therapeutic approach to patients in migration situations. The first observation concerns decoding the cultural meaning given to the question of normal and pathological. Indeed, this decoding is based on the premise that “every culture defines categories that allow us to read the world and give meaning to events”. The second observation concerns access to the interpretation of the patient's etiological system. Mr. B indicated that the antidepressant treatments administered to him will not be able to cure his illness. His illness is not natural. It is the consequence of disobedience towards an important symbolic figure: his maternal uncle. The third observation is rooted in the two others cited above and concerns the need to use certain cultural references of the patient as therapeutic levers. Based on the patient's and their family's narrative, a cultural ethos was mobilized to unleash the sacred value of speech within the symbolic order of the patient's culture. The fourth observation concerns the need to determine the profiles and different defensive arrangements of patients belonging to other cultures. This serves as a compass to guide the way in which clinical investigations and the therapeutic proposals that follow will be conducted. This article clearly constitutes one of the gateways to addressing the question of the roots of grief, highlighting the impact of cultural substrates in an in-between situation and enriching the field of inter- and transcultural clinical practice.