|
| |
 |
|
| PRESIDENTIAL ADDRESS |
|
| Year : 2023 | Volume
: 5
| Issue : 1 | Page : 9-14 |
|
The Dynamics of Globalization and the Effects on Mental Health: Social, Anthropological, and Phenomenological Aspects
Rachid Bennegadi
President, World Association of Social Psychiatry, 2019–2022; Medical Referent of the Sigmund Freud University, Paris, France
| Date of Submission | 12-Mar-2023 |
| Date of Decision | 13-Mar-2023 |
| Date of Acceptance | 14-Mar-2023 |
| Date of Web Publication | 26-Apr-2023 |
Correspondence Address:
Dr. Rachid Bennegadi
Sigmund Freud University, 14 Rue Alfred Roll, 75017, Paris
France
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/wsp.wsp_12_23
How to cite this article:
Bennegadi R. The Dynamics of Globalization and the Effects on Mental Health: Social, Anthropological, and Phenomenological Aspects. World Soc Psychiatry 2023;5:9-14 |
“A genuine and authentic encounter with the other is similar to a spiritual journey: The other allows me to progress by helping me decentering from myself: His face questions me.”
–E. Levinas
| Phenomenology, Bicultural Identity, and Globalization | |  |
In this presidential address, I will develop three topics, which, like a system, are linked, whereby one cannot go without the other, and they are:
- The dynamics of globalization and the effects on mental health
- The acculturation process with a psycho-anthropological slant, that is to say everything that acts upon a person when cultural references and personality elements are interfaced
- And third, the phenomenological approach that I would like to introduce as the energy of this system. Phenomenological, that I restore to the philosophical universe that it came from, but I desecrate it by placing it in contact with reality.
I will try to rhetoric, in the hope that it does not awaken an aftertaste of ideology in you because I'm not naive about the power of words. I speak from a 30-year clinical experience that is both long and emotionally charged. I have helped people of all cultures because the institution where I work, the Minkowska Centre, offers consultations to people in a situation of migration or exile, coming from all continents.
When it comes to expressing one's suffering, each has their particular genius, from the feelings of worthlessness to megalomania. I have been through the mode of highlighting cultural difference as a key factor in removing colonial guilt. Even if I understood the danger, nothing could stop this mode. We must never ignore the part of the social and political dimension in this kind of strategy. Of course, I also experienced the mode of the right to resemblance. This dance in which the music played by the orchestra and the dance danced by the actors resemble a true cacophony. Despite all the obstacles that were confronted on the acculturation path, most people knew how to face them and only a minority suffered mental illness or psychological disorder. It is therefore a deliberate choice for me to talk about the psycho-anthropological aspects first, before addressing psychopathology.
| Some Reflections and Some Questions | | |
Ever since I have been practicing as a therapist in the field of mental health, the same question has been nagging me.
I turned to psychiatry after having practiced general medicine for 3 years in the Sahara. I attended to semi-nomadic populations, and I faced the particular challenges a physician has to face when he is in charge of handling all types of situations, from classical general medicine acts, to minor surgical interventions, child delivery in the middle of the desert, or scorpion stings. I was also involved in end-of-life care with persons affected by diseases or injured in accidents.
I probably absorbed many things and experiences which value I could grasp only later, after I made the decision to join the France and its remarkable health-care system.
My experience as a psychiatry resident in Paris and as a Fulbright senior research associate at the University of Berkeley where I studied the relationship between culture and personality, together with the nourishing encounters I had with outstanding individuals, altogether give me confidence in my ability to address this issue which has most profoundly affected me in my long professional life attending to immigrants who suffer physically, socially, or mentally: the issue of the incommensurability of knowledge in front of suffering.
Not that I lacked the scientific tools, nor the empathy necessary to practice my job, but I often felt perplexed in front of the gap between what had to be done and what I could do. Out of necessity, I had to confront my experience with patients whom I was fortunate meet, but also with the therapeutic strategies suggested here and there, meaning across the globe, and not only in France.
So today, in my discussion, I would like to build bridges between the three concepts phenomenology, bicultural identity, and globalization and the dilemmas of multiculturalism. I believe that building those bridges is a central challenge for us in apprehending the 21st century and the globalization of time and space.
I will not summarize all the clichés that are mentioned every day, and which dismiss the tremendous elaboration efforts one faces when concerned with the relationship between culture and personality, a source at once of many ambiguities and creativity.
Today, everyone is concerned by this beneficial exercise. No one can assure that he or she will not relocate 1 day or another. In that sense, the anthropological discourse seems to prime over the psychopathological discourse.
Immigration or asylum does not necessarily produce mental suffering or systematically leads to psychological or psychiatric disorders.
Please note that this is neither a premise nor scientific reductionism. Under certain conditions, the relationship between culture, personality, and environment may cause terrible damage.
I do not seek consensus on this issue either, since research in psycho-anthropology, in social psychiatry, in sociology, and in social anthropology clearly point to how damaging it can be when one's mental structure is under attack from multiple fronts, leaving few chances for the ego to defend itself against external hazards and internal turpitude.
Let us quickly go over visible evidence, before we discuss invisible ones. Psychologists' and anthropologists' contributions to describing mature and immature defense mechanisms, coping, or resilience strategies which are activated in times of survival or in situation of immigration or asylum abound.
Sociologists' efforts are also remarkable as they convince us of the necessity to critically address the issue that those who seek a new life or who seek refuge the social trigger in their host society. The relevance of social determinants can no longer be ignored, but it cannot constitute the sole argument in the identification of causality.
The same recommendation goes for a practice of psychiatry – which luckily has grown unpopular – that stigmatizes on the basis of social or cultural origins.
I admit I have taken some distance from all the assertions that ascribe values to the subject, regardless of researchers' or clinicians' honesty.
| Bi- or Multicultural Identity within a Dynamic Perspective | | |
At this stage of my presentation, I wish to address the notion of bi- or multicultural identity within a dynamic perspective, which excludes neither the psychodynamic approach nor the anthropological or sociological approach.
Throughout my entire career, I have heard solid arguments on different visions of “the other” that magnify and reify difference, and which under the pretense of compassion and solidarity – both of which go uncontested as they appear motivated by goodwill – are sometimes difficult to argument against as they relate to people's deepest emotions, be they rational or irrational. At the other extreme, there are claims to the right of resemblance, an empathetic movement can be justified and which objective is to describe “the other” as one and the same, to the point that no difference can be made, to the point that the face, in Levinas' sense of the term, is no longer visible. I will go back to this phenomenological concept and to my use of it as a useful weapon to escape from these dead ends and illegitimate paradigms.
I do not take this issue lightly, as I believe it is foundational for the majority of the world population who is experiencing change while ignoring the current stakes of the confrontation of both spiritual and cultural values.
Berry's analysis of the acculturation concept, and of the stress experienced from acculturation, called my attention in relation to its theoretical foundations. The notions of gain and loss, which are central to this theory, relate both to the individual and to the group, since the system works as a combination between those who host and those who are hosted. I subscribe to the description of the different personality types, but results evidently differ from hosting multicultural societies to societies who reject multiculturalism.
The substantial changes on personality trigger psychological defense mechanisms, which are difficult to standardize considering each individual has his or her own personal way of coping. Allow me to refer to the impact of this phenomenological discourse on psychopathology by dodging the issue of the consequences it has on mental health and approach it from a psycho-anthropological perspective. As much as Husserl – through his effort to transcend the Greeks and surpass Kant, with his giant wings – managed to remain inaccessible, as much Heidegger managed to excel all the same, in particular by influencing French philosophy, and his influence has continued to spread further.
All philosophers are concerned by this ontology of human relations, and I personally prefer Levinas's approach because it frames this question in a fundamentally different way, suggesting that “the other's face places me in a situation of responsibility.”
Let us reflect on this assertion for a moment, without neglecting the transcendental meaning Levinas wanted to give it. I would like to express what this assertion inspires to me. No need to read all Husserl or Heidegger to understand why this assertion constituted a real breakthrough.
I understand that one must be in a particular state of mind to accept the idea that, beyond what one could call faciality, beyond phenotypes, beyond beliefs, beyond our own historicity, the other's face should immediately trigger a sense of responsibility.
Levinas was often criticized for sanctifying “the one who is not me” and who looks for God beyond himself?
I have a different interpretation, which has been consolidating every day both at the clinical level through my professional practice, and at the human level through my daily interactions in French society, where I claim to feel as much at ease as in any other society which would inform me on shared responsibility, rather than require from me to change.
Through music, Vladimir Yankelevich understood what Levinas meant, and never ceased to rebel against arbitrary social, cultural, and religious identity assignments. You will object that in Thomas More's Utopia, this is exactly how things are. But I am telling you, this is not utopia. This is exactly how tomorrow will be like. Indeed, how could “we not look for what is human,” as Eugene Minkowski – another phenomenologist who did much for refugees and immigrants – strongly recommended.
Will we confirm Huntington's discourse, even if those who have read it, challenge the idea of a “clash of civilizations.” Levinas asks us to become fully conscious of these things, since it involves responsibility. He goes as far as considering himself to be “the other's hostage,” because to him, what is at stake is well worth self-sacrifice. All the societies advocating multiculturalism as a solid foundation for interhuman relations are well aware that, without each one accepting this responsibility, there can be no consensus?
Levinas wished for us to have this internal impulse. Are the brain and the mind truly ready for such a movement at the level of conscience?
I am optimistic on this point, because in our current relation to the world, we already have a practice of meditation, detachment, and self-awareness, and these have been as determinant as the Freudian discovery of the unconscious.
Neurosciences are likely to take us further in exploring such capacities, but the danger remains that our unique propensity to let what Damasio referred to as our basic emotions influence our feelings, our desires, our surge of solidarity, our fantasies, and our imagination.
Levinas demands that we mobilize our imagination differently, as the infinite filing system for our myths, beliefs, evidence, and errors.
No one is able to represent a sufficient knowledge on his or her own to stand as an authority over what is happening to an individual faced with a situation of change, be it at the emotional or at the cognitive level. We have entered the era of systems, and today, the only way out of obsolete or deficient 21st-century paradigms on the intercultural encounter is to have mentalities evolve.
This is not only about a confrontation of models, of references, between a person and himself or herself, between a person and society, and a person and his/her cultural or spiritual references.
Instead, we are entering an era in which the person is not simply considered to be complex (this is a well-known fact since Homo sapiens exists), but a person subjected to complexity with its rules, its norms, and its imbalances.
This necessary triangulation of a systemic type entails the defeat of the “ego,” to paraphrase “ego's misadventure.”
The first defeat was imposed by Galileo who inflicted it on the human ego by placing it in orbit around the sun, while the ego believed the world gravitated around him.
The second blow came from Darwin who suggested there was another kind of filiation than God's.
Finally, after unveiling the unconscious, Freud announced the ego that “he no longer is the master of his own house.”
Is that globalization will be the equivalent of rebirth for humanity or the last defeat with the end of multiculturalism model?
| Philosophy and Phenomenology: Some Snippets | | |
Socrates denied that he was wise, he had not discovered what virtue really consisted of but he sought the co-operation of his listeners to get out the truth. He was inspired by a deep conviction that universally valid truth exists, that knowledge was the only basis of right action, and that the good life consisted in knowing what was good and doing it.
For Emmanuel Kant, intuition and understanding are the two sources of knowledge. Space and time are the a priori forms of intuition. We cannot perceive anything unless we cast it mentally in terms of space and time. Two words associated with Kant are noumenal and phenomenal. The noumenon is what is known by the mind as opposed to the senses, things in themselves are noumena. We cannot say that they are there by intuition; we must say they have to be there to account for phenomena, which are the appearances we grab through our senses.
Wittgenstein, in his “Tractatus logico-philosophicus,” said that the world is made up of atomic facts; atomic facts are facts which cannot be analyzed into more elemental facts. Propositions are logical pictures of facts. But it is impossible to say anything meaningful in ethics, esthetics, or metaphysics. Such attempts all involve the impossible task of talking about the world from the outside. Wittgenstein saw the world as a totality of facts, not of things. Facts are logical entities; they can only be asserted or denied. They are not hard, red, round, etc., Things exist in space and time, they have shape, color, and consistency.
Heidegger said, “We have forgotten being.” The earliest philosophers had asked “What is being?” How do we now answer the question? We can't, said Heidegger, but what is worse we no longer ask this type of question. We don't even understand what it means.
For Socrates, philosophy was mainly a matter of getting to grips with ethical problems.
Plato took the theory of knowledge further and developed his theory of the forms.
Aristotle's approach tended to be more practical and less mystical than that of his teacher.
Descartes placed the self-right in the center of philosophical speculation, not at its ethical heart but as the foundation of how we reason about knowledge.
Spinoza's basic idea was that of substance, which we held to be self-evidently true he went on to argue that there's only one substance (God or Nature), and that whatever is, is in God.
David Hume comes quite a different mode of thought. The empirical challenge was simple. All classical philosophies were built up on a foundation that assumes the existence and power of God. The empiricists pulled the theological carpet out from under the feet of classical metaphysics and then sat back waiting for the whole structure to collapse.
Kant's thought was both a celebration of the success of science and a lively critic of empiricists thought. For Kant, the laws of nature described by science were not simply true and universal. They were a priori, that is to say necessarily true and universal. According to Husserl's phenomenology, intentionality means that all consciousness is consciousness of something.
Emmanuel Levinas (1906–1995):
”What we call the face is precisely this exceptional presentation of self by self.
Expression, or the face, overflows images.
The way in which the other presents himself, exceeding the idea of the other in me, we here name face. The face of the other at each moment destroys and overflows the plastic image it leaves me, the idea existing to my own measure. It expresses itself.
The face is a living presence; it is expression. The life of expression consists in undoing the form in which the existent, exposed as a theme, is thereby dissimulated. The face speaks. The manifestation of the face is already discourse. He who manifests himself comes, according to Plato's expression, to his own assistance. He at each instant undoes the form he presents” (Totality and Infinity).
| Clinical Case Exemplar: “What do You See, when You Looked at Me” | | |
An 18-year-old person was referred to my cross-cultural consultation for existential difficulties due to problems of acculturation. According to my colleague, he needed someone who understands what he means, although it is expressed in French, his request seemed ambiguous. I was asked to find out more. In fact, after introducing myself and explaining why he had this conversation with me, he answered me in a funny and provocative manner: I agree to discuss my concerns with you if you answer my question first.
”What do you see, when you looked at me.”
It took me a few seconds to still realize that I actually saw him on the basis of skin color and cultural background and I immediately wondered if this young man had not touched a sensible point with the risk of stigmatization even before instituting the dialogue.
I managed to re-equilibrate the relationship and he described his difficulty living in France. “I lived in London a few years and I never felt that way!”
It is the intention of Levinas to describe the de-centering necessary for any relationship to the other as a de-centering empathic and not a transcendental strategy of distancing by reifying the other by leaving a safe distance. It is rather the opposite that Levinas suggests. For us clinicians and researchers, this dimension is an essential key to apprehend the dilemmas of multiculturalism in the world of tomorrow is a tool that fits well with the urging of the subject in a situation of change. This request puzzled some of us then it strengthens the beliefs of others but the psychic tension remains high. What Levinas offers us is an ethics of ethics. This formulation is nothing esoteric, it is the Gordian knot of intercultural relations.
This is an example of what Levinas wants to tell us!
How to go beyond these stereotypes so present in the consciousness of anyone faced with the presence of the other. Its phenotype was imposed on me, so that it is his face that I'll have to have access, his face that reminds me of this responsibility empathetic with has nothing to do with a cultural complicity or neurotic reaction to any guilt or shame.
| Acculturation is not Necessarily a Psychopathological Symptom | | |
Acculturation
- Mobilizes psychic and physical energy
- Uses the capacities to create bonds, alliances, and solidarity networks
- Tests the flexibility of the psychological mechanisms of defense
- Reveals personality traits in particular in front of the management of frustration.
Harmonious acculturation
- Is an intense and expensive working-through process
- Frequently requested and mobilized capacities of negotiation
- Need for pauses
- Trust matters.
Bicultural identity integration
It is a framework for investigating individual differences in bicultural identity organization, focusing on biculturals' subjective perceptions of how much their dual cultural identities intersect or overlap. Bicultural identity integration (BII) captures the degree to which biculturals perceive their mainstream and ethnic cultural identities as compatible and integrated versus oppositional and difficult to integrate. Individuals high on BII tend to see themselves as part of a “hyphenated culture” (or even part of a combined, “third,” emerging culture) and find it easy to integrate both cultures into their everyday lives. These high-BII biculturals are described as having developed compatible bicultural identities (meaning that they do not perceive the two cultures to be mutually exclusive, oppositional, or conflicting).
Biculturals low on BII, on the other hand, report difficulty in incorporating both cultures into a cohesive sense of identity. Although low-BII biculturals also identify with both cultures, they are particularly sensitive to specific tensions between the two cultural orientations and see this incompatibility as a source of internal conflict.
Biculturals possess dual cultural perspectives, which can be “tried on” and applied at different situations and times. They are independent under some situations, and interdependent under other situations. They are individualistic at certain times and collectivistic at other times.
Cultural meaning systems may be better conceived as a set of tools individuals have available to use in different situations according to their identity dynamics and situational relevance. This perspective creates a more dynamic view of how culture and mind mutually constituted across and within national boundaries.
The subject always ends by emerging out of his/her culture. When he/she starts talking, all messages saturated by cultural elements do not only represent background noise to the communication: they enhance the communication channel.
No single patient is an ambassador of his/her own culture
Is there a way to imagine a univocal answer on a complex background such as psychic decompensation without putting oneself out of running? How can one argue in the range of universality of unconsciousness without accepting at the same time that paths leading to this universality are particular?
The absence or lack of training in the field of cultural comparison puts the therapist at risk: fictitious fascinations, masked countertransference, wrong therapeutic indications, and/or biased diagnostic. Talking to culture is like talking to a scarecrow. Talking to a subject is recognizing that he has a face (in Levinas' sense).
| Indeed, the Pitfalls are Clearly Identified | | |
- Not be interested in the common language between therapist and patient and to hold interviews based on a rough knowledge of the language is a clinical mistake, acceptable a few decades ago but intolerable these days, as there are many language means available nowadays
- Not wanting to listen to an unfolding story told of psychic pain rooted in cultural references, magico-religious approaches, or other approaches proposed by the patient would also be making the mistake of ethnocentrism
- Sticking completely to the patient's cultural formulations and to his therapeutic proposals regardless of what they are would somewhat signify a catastrophic countertransference
- Rely solely on the linguistic and cultural mediator to conduct the session without input from the therapist would be evidence of lack of control of a three-person session
- Saying that a psychoanalytic approach would not suit this or that culture says more about the therapist's a priori than psychoanalysis
- The belief that mental suffering arises only from social or societal difficulties is also an obstacle to avoid
- To think that only political speech can change the relationship between caregiver/patient and waiting for things to change before being able to respond to the mental suffering of an individual here and now is also an incomplete picture of care
- To believe that only a therapist of the same cultural background as the patient is able to provide the support necessary and the appropriate psychotherapy, is a narrow view of the care system in France, while likely to confine the patient and therapist to the same stigmatization risk
- To superbly ignore the functioning of the health-care system in France, its commitment to the rights for all, its rejection of communitarianism, and its will of access to health care for all is part of a strategy often unconscious, due to poor knowledge of how institutions work
- Wanting to do everything possible to help migrants yet creating only stigmatizing results.
| What i will do with what they did to Me? | | |
Sartre's formulation is ideal for the absurd in which either all unwelcome migrants or those suffering from a personality disorder during their migratory path, find themselves in.
Indeed, how will exile combine with the hope of returning to an existence (voluntarily or after violence) when one has left one's country of origin and finds oneself in another country (more or less friendly), sharing the same language or not, sharing the same values or not.
How to use psychic energy, self-organization, resilience, psycho-anthropological tools for acculturation, mystical or mythical hopes, without losing ground, without losing one's soul, without losing one's personal history, without losing the affection of one's family while hoping to win the esteem of new friends, new alliances.
| Conclusion: When All goes Well, Positive Mental Health Enables All Daring, Learning, Qualifications | | |
When this balance is upset and failures are repeated and erode an individual's ability to maintain vitality and self-esteem, psychological imbalance threatens, psychological suffering can be installed and at worst mental disorder can systematize.
On the other hand, it is clear that the link between migration and mental health, despite being a challenging, daring, and steep learning curve, is often a successful one as well, and it should not be reduced to a limited view, systematically stigmatizing psychopathology.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
|
Search Pubmed for