The challenge of diagnosing cultural syndromes: A narrative review.

BACKGROUND: In 2022 the total world migrant population was 281 million (an increase of approximately 62% compared to year 2000), of whom 169 million were migrant workers. The number of refugees, asylum seekers and others in need of international protection increased by 22% compared to 2021. Research has shown that the forcibly displaced have high rates of mental disorders (including depression, post-traumatic stress disorder (PTSD) and anxiety), with an estimated prevalence almost 6 to 7 times higher than the general population. Given the increase of the overall migration phenomenon and the challenge raised by the cultural features concerning mental health, we consider that this is an area that requires close attention to ensure that culturally sensitive health services be available to the migrant and displaced population. AIMS: The aim of this narrative review is to provide a background to the issue and take stock of what is currently available in the literature regarding culture-bound illnesses and the relevant diagnostic tools. METHODS: A comprehensive search was performed in PubMed, Psychinfo, Embase, Google Scholar, organized in stages to assure inclusion of all the relevant studies. Of the 703 papers initially identified, only 30 papers finally satisfied the inclusion criteria. RESULTS: Eleven diagnostic scales were found, only two of which are being used for displaced people. CONCLUSIONS: Further work is required in this field, including a debate as to whether scales are indeed an appropriate tool for use with this population.

The Extremes of Contemporary Violence: From a State of Paralysis to the Transformation of Trauma.

Psychoanalysis is today faced, clinically and conceptually, with extremes of violence and forced exile, creating a need to rethink clinical work with patients whose life has been marked by disaster. In work with foreign patients, difficulty in speaking about trauma is sometimes attributed to a linguistic barrier; however, the experience of terror can in any situation whatever be expressed only with difficulty. Cultural differences must not be ignored, but the clinician must find a way to facilitate speech in a subject experiencing a state of dread. Speaking cannot be forced. Offering a presence in which the analyst accepts being the recipient of what is unbearable and recognizes the subject's current state of chaos is essential in establishing or mobilizing transference in work with patients subject to unlinking. This can initiate a transformation of the trauma, as is shown in two clinical vignettes of refugee patients in France who were victims of terror in their countries of origin. The approach discussed here differs from the earlier ethnopsychiatric method, which would reduce these others to exotic envelopes of their culture, independent of their subjectivity.

Mental health, normativity, and local knowledge in global perspective.

Approaching mental health on a global scale with particular reference to low- and mid-income countries raises issues concerning the disregard of the local context and values and the imposition of values characteristic of the Global North. Seeking a philosophical viewpoint to surmount these problems, the present paper argues for a value-laden framework for psychiatry with the specific incorporation of value pluralism, particularly in relation to the Global South context, while also emphasizing personal values such as the choice of treatment. In sketching out this framework, the paper aims to overcome the clash between universalism and relativism about psychiatric categories by focusing on how overlaps between cultures can contribute to ontology-building. A case study analyzing ethnopsychiatric research in the context of South India will illustrate the proposed view, while also pointing out avenues for further research on the causal efficacy of local shared beliefs about mental disorder. If approaches across different traditions and theoretical frames are shown to work in treating similar ailments, causal connections appear to cut across the different ontologies. Ethnopsychiatry would play a central role in such research, namely in disclosing the variables and mechanisms at work within the local approaches.

[Integrating beliefs and religion into psychiatrie care]. / Intégrer les croyances et la religion dans le soin psychiatrique.

The mission of the mobile ethnopsychiatry team (EMIE) is to provide consultations to patientsfrom an emigrantbackground whopresent problems of acultural nature. Ayoung Congolese is in the grip of rituals and black magic.Heistorn between his father'sinfluence,his mother'sopinions and his place in the familycircle.His story is aperfect illustration of the specific role of the EMIE in the health and immigrant caresystem.

What kind of in-patient psychiatry for Africa? Report from Zimbabwe.

The expanding global mental health field has paid little attention to evaluating the culture of psychiatry prevailing in in-patient settings across Africa. For example, in Zimbabwe in-patient psychiatry has been heavily pathologising, with over-reliance on the diagnosis of schizophrenia and on antipsychotic polypharmacy. It is not helpful that the next generation of African doctors are learning unmediated Western psychiatry, with little credence given to background cultural factors and mentalities shaping presentations. Some of the psychiatric and social consequences of this for patients in Zimbabwe are discussed.

Inflexões epistemológicas: a Etnopsiquiatria / Epistemological inflexions: the etnopsychiatry

A Etnopsiquiatria, fundada por Geroges Devereux, surge enquanto possibilidade de refletir o encontro intercultural e seus desdobramentos quanto à compreensão do adoecimento psíquico e à coerência entre terapêuticas e etiologias deste adoecimento. A síntese teórica que levou à criação da disciplina emerge de inflexões baseadas principalmente nos estudos de Freud, Malinowski, Róheim e de contribuições posteriores de Lévi-Strauss e Bastide. Tobie Nathan é responsável pela criação do modelo de intervenção que coloca em prática a aplicação da teoria. Este artigo visa apresentar o histórico dos princípios precursores que levaram Devereux à síntese teórica e à criação da Etnopsiquiatria e expor as considerações da experiência adquirida na aplicação da disciplina pelo modelo proposto por Nathan e multiplicado por outros clínicos. Do postulado da universalidade do psiquismo que se constitui na particularidade da cultura, compreende-se uma relação intrínseca existente entre cultura e psiquismo, em que a cultura utiliza-se dos mesmos elementos, processos e mecanismos de defesa do psiquismo. Adotando o duplo discurso - Psicanálise e Etnologia - a disciplina define-se complementarista. A Etnopsiquiatria surge enquanto possibilidade diante da lacuna que a lógica da psiquiatria ocidental deixou para explicar o adoecimento psíquico e seu modelo de intervenção viabiliza o posicionamento de aprendiz no encontro intercultural.(AU)

The Ethnopsychiatry founded by Geroges Devereux emerged as a possibility to reflectabout the intercultural encounter and its unfolding regarding the understanding of psychological disorders and the coherence between therapeutics and etiologies of this psychopathological states. The theoretical thesis that led to the creation of the discipline arises from inflections based mainly on the studies from Freud's, Malinowski's and Rheheim's theory, along with later contributions by Lévi-Strauss and Bastide. Tobie Nathan is later credited for creating an intervention clinical model and a practice. This article aims to present the history of the precursory principles that led Devereux to the theoretical thesis and the resulting creation of Ethnopsychiatry and also to make considerations about the experience acquired in the application of the model of practice proposed by Nathan and multiplied by other clinicians. From the postulate of the universality of the psychological structure which is particularily constituted by culture, the discipline comprises an intrinsic relation existing between culture and the psychic functioning, in which culture uses the same elements, processes and defense mechanisms as the psyche. Adopting the double discourse method - Psychoanalysis and Ethnology -the discipline defines itself as complementary. Ethnopsychiatry emerges as a possibility to look at the gap that Western psychiatry left to explain psychological disorders, as well as to show how its model of intervention advocates to position the discipline as an apprentice in the intercultural encounter.(AU)

Culture and psychism: the ethnopsychoanalysis of Georges Devereux.

This paper introduces the significant theoretical contribution of Georges Devereux (1908-85) on the relationship between culture and psychism, which he developed in his work at the interface of anthropology, psychoanalysis and quantum epistemology during the mid-twentieth century. Devereux was one of the key early contributors to the field of transcultural psychiatry; he was in touch with its most important exponents, although he remained critical of many of the popular trends developed in this field of research in the USA, where Devereux conducted most of his research between 1932 and 1963. As a part of his critique, he founded a new epistemology: ethnopsychoanalysis, which was largely based on the concept of complementarity and countertransference.

Political Therapeutics: Dialogues and Frictions Around Care and Cure.

In 1978, Italy passed a law establishing the abolition of the mental hospital. Up to that time, the traditional asylums were still governed by the 1904 law that positioned psychiatry within the criminal justice system by assigning it the function of custodia (control, custody) rather than of cura (care). In the 1960s and 1970s, Italian psychiatrist Franco Basaglia initiated a movement of de-institutionalization of the mentally ill that revolutionized psychiatric care in Italy. It also had a deep impact on restructuring the psychiatric system in other European and Latin American countries. In this article, I discuss the different psychiatric practices and imaginaries that resulted from the movement of democratic psychiatry and Basaglia's visions for a community-based and diagnosis-free care of the mentally ill. I ethnographically trace what I call the "Basaglia effect" in today's psychiatric practices, and focus on ethnopsychiatry as a counter clinic that emerged from Basaglia's legacy. I reflect on the frictions between care and cure that ethnopsychiatry re-articulates and works with in the context of contemporary migrations to Europe.

Psyche and culture: Perspectives based on the contributions and limits of ethnopsychiatry.

The unconscious often appears in the form of a question or answer to the difficult relationship between the psyche and culture, a difficulty that becomes exacerbated when we are dealing with cultural difference. This difficulty, evidenced for example by Freud's thoughts on Islam, reappears, albeit in a very different way, in ethnopsychiatric theory. The author discusses the blind spots of the binary logic of the unconscious present in the work of George Devereux, a logic that eventually leads him into the same trap he had himself criticized. This discussion allows us to open up other perspectives, by moving away from the analogies, confusions and splits between the psyche and culture towards what binds them together. This link is sustained by language and its dialectics, at the crossroads of individual singularity and cultural codifications. The author's approach is supported by two clinical vignettes: one from a case of a young Turkish woman, the other concerning a male Iraqi patient, a survivor of torture. This approach distances itself from any psychocentric view that would see the psyche as closed upon itself and thus ultimately exclude any object-relations and inter-subjective relationships; likewise, it rejects the ethnocentric conflation of the subject with his culture.

Antropología y otredad: la raza como categoría de dominación / Anthropology and otherness: race as domination category

Este artículo presenta algunas de las características que asumió la Etnopsiquiatría en nuestro país, enfatizando las filiaciones de esta corriente de pensamiento con la Escuela Cultural de Viena y la Fenomenología Etnológica y señalando las consecuencias de esos planteos sobre el tratamiento de la otredad. A lo largo del trabajo se muestra además el rol de la Universidad y el colaboracionismo del mundo académico con el desarrollo de estas corrientes. La investigación sobre la que se apoya el artículo consiste en un trabajo de revisión y análisis del discurso de distintas fuentes primarias y secundarias en relación a la Antropología Fenomenológica y la Etnopsiquiatría en el proceso de reducción de la otredad. El método empleado es cualitativo y se vale de la elaboración de reseñas de los distintos autores abordados. A partir de varios de los fragmentos de esas reseñas se presenta aquí un primer avance de nuestra investigación.

This paper studies some characteristics of Ethnopsychiatry in Argentina highlighting its affiliations with the Cultural School of Vienna and Ethnological-Phenomenology, while pointing out the consequences of this approach in relation to the treatment of Otherness. The paper also seeks to study the role of universities and the contributions of the Academia in the development of these schools of thought, and is supported by a research consisting of discourse analysis and review of primary and secondary sources related to Phenomenological Anthropology and Ethnopsychiatry, which simplify the concept of Otherness. We have used a qualitative method that leverages on reviews of the different authors studied in this research. Based on the different extracts analyzed, we intend to show the initial stages of our work.

Italian colonial psychiatry: outlines of a discipline, and practical achievements in Libya and the Horn of Africa.

This article describes the establishment of psychiatry in Italy's former colonies during the period 1906-43, in terms of the clinical and institutional mechanisms, the underlying theories and the main individuals involved. 'Colonial psychiatry' (variously called 'ethnographic', 'comparative' or 'racial' psychiatry) - the object of which was both to care for mentally afflicted colonists and local people and also to understand and make sense of their pathologies - received most attention in colonial Libya, starting in the first months of the Italian occupation (1911-12) and then taking institutional form in the 1930s; in the colonies of what was known as 'Italian East Africa', on the other hand, less was said about psychiatric care, and practical achievements were correspondingly limited.

Elementos do aconselhamento multicultural aplicados à psicoterapia em contexto etnopsicológico / The multicultural counseling elements applied to psychotherapy in the ethnopsychological context / Los elementos de asesoramiento multicultural aplicados a la psicoterapia en el contexto etnopsicológico

Este estudo teórico tem por objetivo refletir sobre os principais aspectos do aconselhamento multicultural que podem ser aplicados às intervenções etnopsicológicas, tendo como cenário as práticas psicológicas ocorridas em um terreiro de umbanda. São enfatizados os elementos típicos do aconselhamento multicultural, adotados pela Association for Multicultural Counseling and Development. No atendimento aos médiuns, embora na maioria das vezes as queixas não se refiram à espiritualidade, há que se considerar constantemente o universo religioso de imersão desses clientes, devendo o profissional não apenas acolher esses registros, como compreendê-los dentro de um modelo complexo de referência que leve em conta a autoconsciência cultural, a sensibilidade ao próprio patrimônio cultural, bem como a necessidade de reconhecer as suas fontes de desconforto com as diferenças que existem entre si e os clientes em termos de etnia e cultura, considerando o propósito de uma prática psicológica mestiça e diversa. (AU)

This theoretical study aims to reflect on the main aspects of the multicultural counseling that can be applied to ethnopsychological interventions, in the context of the psychological practices occurred in a backyard of Umbanda. We emphasize the typical elements of multicultural counseling adopted by the Association for Multicultural Counseling and Development. The demands do not refer to spirituality, but the professionals must constantly consider the religious universe of immersion of these clients. The psychologist must not only welcome these records, but also understand them within a complex reference model that takes into account the cultural self-awareness, sensitivity to own cultural heritage as well as the need to recognize their discomfort sources with the differences that exist between them and the clients in terms of ethnicity and culture, considering the purpose of a practice psychological mixed and diverse. (AU)

Este estudio teórico tiene como objetivo reflexionar sobre los principales aspectos de la orientación multicultural que se puede aplicar a intervenciones etnopsicológicas, en el contexto de las prácticas psicológicas ocurridas en la Umbanda. Hacemos hincapié en los elementos típicos de la orientación multicultural adoptados por la Association for Multicultural Counseling and Development. Las quejas no se refieren a la espiritualidad, pero los profesionales deben considerar constantemente el universo religioso de inmersión de estos clientes. Estos aspectos deben ser acogidos, sino también entenderlos dentro de un modelo de referencia compleja que tiene en cuenta la auto-conciencia cultural, la sensibilidad a la propiedad del patrimonio cultural, así como la necesidad de reconocer sus fuentes de malestar con las diferencias que existen entre ellos y los clientes en términos de etnicidad y cultura, teniendo en cuenta el objetivo de una práctica psicológica mixta y diversa. (AU)

Elementos do aconselhamento multicultural aplicados à psicoterapia em contexto etnopsicológico / The multicultural counseling elements applied to psychotherapy in the ethnopsychological context / Los elementos de asesoramiento multicultural aplicados a la psicoterapia en el contexto etnopsicológico

Este estudo teórico tem por objetivo refletir sobre os principais aspectos do aconselhamento multicultural que podem ser aplicados às intervenções etnopsicológicas, tendo como cenário as práticas psicológicas ocorridas em um terreiro de umbanda. São enfatizados os elementos típicos do aconselhamento multicultural, adotados pela Association for Multicultural Counseling and Development. No atendimento aos médiuns, embora na maioria das vezes as queixas não se refiram à espiritualidade, há que se considerar constantemente o universo religioso de imersão desses clientes, devendo o profissional não apenas acolher esses registros, como compreendê-los dentro de um modelo complexo de referência que leve em conta a autoconsciência cultural, a sensibilidade ao próprio patrimônio cultural, bem como a necessidade de reconhecer as suas fontes de desconforto com as diferenças que existem entre si e os clientes em termos de etnia e cultura, considerando o propósito de uma prática psicológica mestiça e diversa.

This theoretical study aims to reflect on the main aspects of the multicultural counseling that can be applied to ethnopsychological interventions, in the context of the psychological practices occurred in a backyard of Umbanda. We emphasize the typical elements of multicultural counseling adopted by the Association for Multicultural Counseling and Development. The demands do not refer to spirituality, but the professionals must constantly consider the religious universe of immersion of these clients. The psychologist must not only welcome these records, but also understand them within a complex reference model that takes into account the cultural self-awareness, sensitivity to own cultural heritage as well as the need to recognize their discomfort sources with the differences that exist between them and the clients in terms of ethnicity and culture, considering the purpose of a practice psychological mixed and diverse.

Este estudio teórico tiene como objetivo reflexionar sobre los principales aspectos de la orientación multicultural que se puede aplicar a intervenciones etnopsicológicas, en el contexto de las prácticas psicológicas ocurridas en la Umbanda. Hacemos hincapié en los elementos típicos de la orientación multicultural adoptados por la Association for Multicultural Counseling and Development. Las quejas no se refieren a la espiritualidad, pero los profesionales deben considerar constantemente el universo religioso de inmersión de estos clientes. Estos aspectos deben ser acogidos, sino también entenderlos dentro de un modelo de referencia compleja que tiene en cuenta la auto-conciencia cultural, la sensibilidad a la propiedad del patrimonio cultural, así como la necesidad de reconocer sus fuentes de malestar con las diferencias que existen entre ellos y los clientes en términos de etnicidad y cultura, teniendo en cuenta el objetivo de una práctica psicológica mixta y diversa.

Emil Kraepelin's ideas on transcultural psychiatry.

OBJECTIVE: Prevailing degeneration theory and an increasing number of people in inpatient mental treatment aroused the famous German psychiatrist Emil Kraepelin's (1856-1926) interest to investigate whether the mental illnesses typical for Europe were also characteristic for 'primitive peoples'. He thus dedicated a period spent in the Dutch East Indies (Java) in 1904 to transcultural psychiatric research. This paper endeavours to compile Kraepelin's key findings, aiming to make readers aware of what kind of transcultural research Kraepelin did and what conclusions he came up with. At the same time it provides some background for the question of whether Kraepelin can really be referred to as the founder of transcultural psychiatry. CONCLUSION: Kraepelin assumed that illnesses with exterior causes depended on the type of stimulants widely used in a given culture. Since he found little evidence for progressive paralysis, he concluded that European brains were particularly prone to sequelae of syphilis. For endogenous psychoses he postulated differences in both symptoms and courses, depressions being rarer and milder, and ceasing sooner. By contrast, he found dementia praecox (mainly covered by the concept of schizophrenias later) to be the most prevalent mental illness in Java, explicitly different in form from that in Europe.

Evaluación de síntomas ansiosos y etnicidad en población escolar de la comuna de San Pedro de Atacama / Assessment of anxiety symptoms and ethnicity in students from the San Pedro de Atacama district

La comuna San Pedro de Atacama (SPA) tiene alta población rural y étnica, grupos vulnerables, según la literatura, a problemas de salud mental. El objetivo de este trabajo es conocer la prevalencia de síntomas ansiosos en escolares e investigar sus diferencias respecto de variables étnicas, de edad y género. Para ello se utilizó la escala de auto reporte de ansiedad para niños y adolescentes (AANA). La muestra quedó constituida por 416 alumnos, de ellos se analizaron 335 escalas, cuya media de edad fue de 10 años. Un 60,3 por ciento obtuvo sobre el punto de corte para sospecha de trastorno de ansiedad. El género femenino tenía mayor sintomatología ansiosa, junto con el grupo etario de 7 a 11 años. No existió diferencias significativas para la variable étnica. Respecto a las subescalas, la distribución etaria de la fobia social fue diferente a lo reportado en la literatura, lo que podría derivar del contexto sociocultural, necesario de investigaren futuros trabajos.

The San Pedro de Atacama (SPA) district has an important number of rural and ethnic population, which according to the literature, is more vulnerable to mental health problems. The aim of this research is to determine the prevalence of anxiety symptoms in school age children and to study its differences in relation to ethnicity, age and gender. The AANA (self report anxiety scale for children and adolescents) was applied in a sample of 416 students, from which 335 questionnaires were analyzed (mean age: 10 years). A 60.3 percent of the students were above the cut point for suspicion of an anxiety disorder. Females had a higher number of symptoms of anxiety, as did the group with ages 7 to 11 years. There were no statistically significant differences for ethnicity. In the subscales, the age distribution for social phobia was found to be different from the one previously reported; this could be explained by the sociocultural context, which remains to be studied in future research.

Panic attacks and possession by djinns: lessons from ethnopsychiatry.

This clinical case report shows how important it is for a psychiatrist to have a knowledge of the cultural and religious context of the patient, in order to understand fully his or her complaints. Culture and religion, in fact, are not neutral, but convey symbols, meanings, and myths that should be properly explored to shed light on the patient's inner world. Patient D was a 19-year-old Muslim Italo-Tunisian girl, who consulted a psychiatrist for anxiety and panic attacks, and reported being possessed by djinns (ie, "evil creatures", as described in the Qur'an). A culturally informed interview was carried out, together with administration of psychometric scales, including the Symptom Checklist-90 Revised and Psychological Measure of Islamic Religiousness. Based on her scores and the results of this multidimensional assessment, patient D was treated with transcultural psychotherapy and fluoxetine. After a year of follow-up, she reported no further episodes of panic disorder. For proper assessment and treatment, a combined anthropological, sociological, and psychopathological approach was necessary.

Reconhecer a diferença: o desafio da etnopsiquiatria / Acknowledging difference: the challenge of ethno-psychiatry / Reconocer la diferencia: el reto de la etnopsiquiatría

Reconhecer a diferença do Outro é o fundamento da etnopsiquiatria, que é necessariamente múltipla e portadora de nuances e de diferenças. É com base na prática clínica no Serviço de Auxílio Psicológico Especializado aos Imigrantes e Refugiados - Sapsir, em Quebec, Canadá, que os autores propõem outro olhar sobre essa disciplina, levando em consideração a dimensão cultural e psíquica da pessoa; apoiam-se também sobre os universos existenciais e humanistas como a necessidade de sentido, de continuidade de si mesmo e de coerência, assim como sobre as diversas dimensões da identidade. O dispositivo clínico proposto, de acordo com os princípios da etnopsiquiatria, articula-se em três eixos: trabalho sobre as relações, trabalho sobre as diferentes dimensões da identidade, trabalho sobre a coerência e o sentido das situações vividas. Essa abordagem permite acompanhar e facilitar as elaborações essenciais implicadas no trabalho psíquico dos refugiados e das pessoas que foram expostas a situações extremas, como a tortura.(AU)

Acknowledging the Other's difference is the basis of ethno-psychiatry, which is necessarily multiple and bears subtleties and variations. Based on their practice at the Service d'aide psychologique spécialisée aux immigrants et réfugiés - SAPSIR, Quebec/Canada, the authors propose another perspective for this discipline, taking into account the individual's cultural and psychological features, the various dimensions of identity, as well as existential and humanistic universals such as the self's need for meaning, continuity and coherence. The proposed clinical approach, according to the principles of ethno-psychiatry, is structured around three axes: working on links, working on different dimensions of identity, and working on the coherence and meaning of experienced situations. This approach allows following and facilitating essential elaborations involved in the psychological care to refugees and individuals exposed to extreme situations such as torture.(AU)

El reconocimiento de la diferencia del Otro es la base de la etnopsiquiatría, la cual es necesariamente múltiple y en sí portadora de sutilezas y diferencias. Es a partir de su práctica en el Servicio de Ayuda Psicológica Especializada para los Inmigrantes y Refugiados - SAPSIR, Quebec/Canadá que los autores proponen otra visión acerca de esta disciplina. Se apoyan en los universales esenciales y humanistas, tales como la necesidad de sentido, de continuidad de sí y de coherencia, así como en el sentido de las situaciones vividas. El dispositivo clínico propuesto se articula alrededor de tres ejes: el trabajo en los enlaces, en las diferentes dimensiones de la identidad y en la coherencia y el sentido de las situaciones vividas. Este paso permite acompañar y facilitar las elaboraciones esenciales implicadas en el trabajo psíquico de los refugiados y de las personas que han sido expuestas a situaciones extremas, tales como la tortura.(AU)

Reconhecer a diferença: o desafio da etnopsiquiatria / Acknowledging difference: the challenge of ethno-psychiatry / Reconocer la diferencia: el reto de la etnopsiquiatría

Reconhecer a diferença do Outro é o fundamento da etnopsiquiatria, que é necessariamente múltipla e portadora de nuances e de diferenças. É com base na prática clínica no Serviço de Auxílio Psicológico Especializado aos Imigrantes e Refugiados - Sapsir, em Quebec, Canadá, que os autores propõem outro olhar sobre essa disciplina, levando em consideração a dimensão cultural e psíquica da pessoa; apoiam-se também sobre os universos existenciais e humanistas como a necessidade de sentido, de continuidade de si mesmo e de coerência, assim como sobre as diversas dimensões da identidade. O dispositivo clínico proposto, de acordo com os princípios da etnopsiquiatria, articula-se em três eixos: trabalho sobre as relações, trabalho sobre as diferentes dimensões da identidade, trabalho sobre a coerência e o sentido das situações vividas. Essa abordagem permite acompanhar e facilitar as elaborações essenciais implicadas no trabalho psíquico dos refugiados e das pessoas que foram expostas a situações extremas, como a tortura.

Acknowledging the Other's difference is the basis of ethno-psychiatry, which is necessarily multiple and bears subtleties and variations. Based on their practice at the Service d'aide psychologique spécialisée aux immigrants et réfugiés - SAPSIR, Quebec/Canada, the authors propose another perspective for this discipline, taking into account the individual's cultural and psychological features, the various dimensions of identity, as well as existential and humanistic universals such as the self's need for meaning, continuity and coherence. The proposed clinical approach, according to the principles of ethno-psychiatry, is structured around three axes: working on links, working on different dimensions of identity, and working on the coherence and meaning of experienced situations. This approach allows following and facilitating essential elaborations involved in the psychological care to refugees and individuals exposed to extreme situations such as torture.

El reconocimiento de la diferencia del Otro es la base de la etnopsiquiatría, la cual es necesariamente múltiple y en sí portadora de sutilezas y diferencias. Es a partir de su práctica en el Servicio de Ayuda Psicológica Especializada para los Inmigrantes y Refugiados - SAPSIR, Quebec/Canadá que los autores proponen otra visión acerca de esta disciplina. Se apoyan en los universales esenciales y humanistas, tales como la necesidad de sentido, de continuidad de sí y de coherencia, así como en el sentido de las situaciones vividas. El dispositivo clínico propuesto se articula alrededor de tres ejes: el trabajo en los enlaces, en las diferentes dimensiones de la identidad y en la coherencia y el sentido de las situaciones vividas. Este paso permite acompañar y facilitar las elaboraciones esenciales implicadas en el trabajo psíquico de los refugiados y de las personas que han sido expuestas a situaciones extremas, tales como la tortura.

A identidade como fator de imunidade psicológica: contribuições da clínica intercultural perante as situações de violência extrema / Identity as a factor of psychological immunity in situations of extreme violence: contributions of intercultural clinical psychology / La identidad como factor de inmunidad psicológica: contribuciones de la clínica intercultural a las situaciones de violencia extrema

O corpus teórico da clínica intercultural (etnopsiquiatria) e a prática clínica que a sucede esclarecem certas analogias entre os mecanismos psicológicos, presentes tanto na tortura quanto no terrorismo, particularmente, em sua dinâmica de ação (a intrusão), como em alguns de seus efeitos (o traumatismo). O acompanhamento psicológico de refugiados e vítimas de tortura, realizado no Service d'Aide Psychologique Spécialisée aux Immigrants et Réfugiés (Sapsir) da Universidade Laval, no Canadá, ilustrado nesse artigo por meio de um estudo de caso, demonstrou que alguns pacientes não apresentavam os sintomas teoricamente esperados das violências vividas. Diversos fatores de proteção foram identificados como, particularmente, o enraizamento em uma identidade cultural definida, um forte sentimento de pertencimento, ainda ativo, ao grupo de referência. Tais elementos culturais contribuem para garantir a proteção psicológica do indivíduo e a manutenção de sua segurança interna, inscrevendo-se em um universo de significações e no lugar de sujeito-ativo e não de vítima-objeto.

Both the theoretical corpus of intercultural clinical psychology (ethnopsychiatry) and its clinical practice have identified certain analogies between torture and terrorism, particularly in the action dynamic and in certain effects such as traumatism. And yet, at the Sapsir (Service d’Aide Psychologique Spécialisée aux Immigrants et Réfugiés at Université Laval, Canada) refugees and torture victims often do not show the expected symptoms of exposure to extreme situations. The case study related in this paper, show that important variables appear to be a strong attachment to a cultural identity and an active sense of belonging to the reference group. These cultural elements favour the psychological protection of the individual and maintain an internal sense of security by placing the individual in a rich, meaningful cultural universe, and giving him the status of an active subject rather than a passive victim.

El cuerpo teórico de la clínica intercultural (etnopsiquiatría) y la práctica clínica que resulta de éste resaltan analogías entre los mecanismos psicológicos presentes tanto en la tortura como en el terrorismo, especialmente en su dinámica de acción (efracción) y en algunos de sus efectos (trauma). El apoyo que se le brinda a los refugiados y a las víctimas de tortura en el Servicio de Ayuda Psicológica Especializado en Inmigrantes y Refugiados, Universidad Laval, Canadá, como el estudio de caso lo ilustra en el artículo, se demostró que algunos de los pacientes no tuvieron síntomas que teóricamente se esperan de la violencia vivida. Factores de protección han sido identificados, especialmente el arraigamiento en una identidad cultural. Estos elementos culturales contribuyen a la protección psicológica del individuo y el mantenimiento de la seguridad interior, inscribiéndolo así en un universo de significados y en un estado de sujeto-activo y no de víctima-objeto.