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Migrants Psychic Health and Acting Out
NOTE About : Comments on an article in « Le Point » newspaper « Santé mentale des migrants, le grand tabou ». In its online edition of June 14, 2023, an article in the French newspaper « Le Point » entitled « Santé mentale des migrants, le grand tabou1 » (Migrants' mental health : the great taboo), based on the Annecy tragedy, raises the issue of psychological care for migrants and, in some cases, the possible links with acts of violence. As usual, we have selected and numbered extracts from this article, followed by our comments (JLV in italics). -1- [After enumerating various cases of acting out, including that of Abdalmasih Hanoun, who attacked very young children and an elderly couple in Annecy on June 8, 2023, the journalist writes] : « Again, no apparent motivation, but a lot of questions about the perpetrator's mental health ». JLV : if it's not apparent - if it were, the act might not have taken place ! - what the journalist calls « motivation » undoubtedly exists. Provided we can discern it in the forms taken by delusions2 , which often express a link, however indirect, with the roots of psychosis. In addition, the psychotic subject's impulsiveness, brutality and « apparent » immotivation are often the hallmarks of the acting-out process. -2- « However, there is a consensus among health professionals and humanitarian aid workers alike that the mental health of refugees and asylum seekers is very often damaged...The very fact of stepping outside one's cultural framework increases the risk of behavioral disorders ». JLV : the « cultural framework » is likely to feed the delusional weave, where the religious is often confronted with the sexual. The delirious themes of the patients confined to Beirut's Deir El Salib psychiatric hospital blithely mixed sacred religious figures with sexual orgies3 . In his medical thesis, Lacan himself 1 https://www.lepoint.fr/politique/sante-mentale-des-migrants-le-grand-tabou-14-06-2023-2524486_20.php#11 2 « Its significant clarity is a first characteristic feature of delusion...delusional themes are the expression of affective tendencies unrecognized by the subject's consciousness », J. Lacan, De la psychose paranoïaque dans ses rapports avec la personnalité, Points Essais, n° 115, 1975, p. 293. 3 Weekly « presentations » of psychotic patients took place for medical students under the direction of Prof. Charles Baddoura. wondered whether « psychotic perceptions are similar to so-called animistic perception, in which the primitive imbues the phenomena of nature themselves with personal meaning4 ». -3- « When a migrant arrives in France through legal channels, he or she undergoes a medical examination conducted by the French Office of Immigration and Integration (Ofii). Since a 2018 law, this has included a screening for psychological disorders, which begins with a self-administered questionnaire. » JLV : the self-administration of the questionnaire obviously raises a number of questions. It's fair to ask whether clinical designations, notwithstanding the possible explicitness of symptoms, are likely to make it easier to obtain relevant answers. Not to mention the most human of resistances - which still exist today when it comes to going to see a « shrink » - which consist in not wanting to define oneself or be called « crazy ». We need only mention the difficulty, in a company keen to identify psycho-social failings, of gathering « confessions » of discontent from both managers and employees. The phenomenon of suicides in the French police force is a paradigmatic example, albeit in a multifactorial context. -4- « Psychiatry, often described as the poor cousin of medicine in France, does not exist in many emigration countries ». JLV : it's probably not for the same reasons, particularly budgetary ones. In many « emigration countries », psychiatry is often, if not exclusively, « asylum » when it is not associated with political practices of exclusion. Even that of « correction », as evidenced by the « sentences to psychological care » for Iranian women who refuse to wear the veil5 . -5- « The investigators stated that Abdalmasih Hanoun had no known psychiatric history...There is a medical-psychological center (CMP) in Annecy. If Abdalmasih Hanoun went there, he didn't leave any traces ». JLV : today, the most frequent indicator of « ordinary psychosis » is acting out, rather than delusion or hallucination. And it is this acting out that constitutes 4 Lacan, Ibid., p. 292. 5 Following several of these convictions, four presidents of Iranian mental health associations published an open letter denouncing the « hijacking of psychiatric care » by the authorities. The letter was signed by : Dr Majid Sadeghi, Head of the Scientific Association of Psychiatrists of Iran, Dr Ahmad Ali Nurbala Head of the Scientific Association of Psychosomatic Medicine of Iran, Dr Behrouz Dolatshahi Head of the Scientific Association of Psychotherapy of Iran, Dr Hamid Poursharifi President of the Iranian Association of Psychology. « one of the first behaviours to attract attention in subjects who have apparently shown no sign of any pathology whatsoever6 ». -6- « "He was paranoid, he thought the Swedish government was organizing plots against him, that they were watching him," explained the ex-wife of the Annecy assailant in a lengthy interview with Le Point ». JLV : the « Point » journalist mentions the wife's attempts to alert various authorities - Swedish, Swiss and French - to Abdalmasih Hanoun's troubles. All to no avail. If they were in fact said by the person concerned, such remarks indicate a psychotic structure, the initial consideration of which would have made it possible to define the stage of development. And, if necessary, to prevent any further acts. -7- « A case in point. A young Moroccan is sent to the CMP by an NGO. "Supposedly a minor, we pretended to believe him. He was in the middle of a mystical delirium. With antipsychotics, he stopped talking about Allah, but he was still delirious" ». JLV : if the delusion persisted in another form, i.e. by « displacement », this was probably due to a possible « systematization » - in the psychiatric sense - of the latter. Medication also has the effect of making the most salient effects of psychosis invisible7 . Hence the exponential increase in this « ordinary psychosis », which is becoming an « invisible clinic8 » confused with a generalized discontent in which the human being drowns in the mass an individuality that has become psychically too heavy to carry. -8- « Aware of these realities, professionals seem very reserved about the idea of dispersing suffering migrants all over the country, as envisaged in the 2021-2023 national reception scheme ». JLV : no comment. -9- « An identical fate probably awaits this Eritrean, in France for four years, arrested by the police for exhibitionism, completely delirious. To deal with him, we had to find a Tigrinya-speaking interpreter. "He claimed to be a virgin," says 6 Jean-Claude Maleval, Conversations psychanalytiques avec des psychotiques ordinaires et extraordinaires, Erès, 2022, p. 17. 7 Not least in reference to the DSM criteria, which require hallucination or delusion to categorize a psychosis. Invisibility requires us to supplement the official percentage of psychiatric disorders in the population, as stated by the French authorities, with a « shadow figure ». 8 Jean-Claude Maleval, Ibid., p. 13. the psychiatrist, "and was looking for a woman without a vagina to have sex with without the risk of having children...". After prescribing a treatment, he disappeared into thin air ». JLV : We can see how the delusional themes mentioned by this Eritrean shed light on the probable genesis of the psychosis. The temporary stabilization provided by treatment - if it is indeed followed - will probably not prevent the return of paroxysmal effects in the subject, who will then attempt, by acting out, a desperate - and illusory - strategy of « liberation from the disease9 ». Nice, September 2023, Jean-Luc Vannier 9 P. Guiraud, Le meurtre immotivé, réaction libératrice de la maladie, Annales médico-psychologiques, n°2, 1928, pp. 352-360.