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Migrants in Translation
Caring and the Logics of Difference in Contemporary Italy
By Cristiana Giordano UNIVERSITY OF CALIFORNIA PRESS
Copyright © 2014 The Regents of the University of California
All rights reserved.
ISBN: 978-0-520-95886-9
CHAPTER 1
On the Tightrope of Culture
The potential [of ethno-psychiatry] lies in the possibility of getting closer to the experience of the other, ... not with the aim to "understand" ... him, but to recognize his discourse ... as irreducible to dominant paradigms, something that clinical work with the local population rarely shows; the risk lies in potentially encouraging projective mechanisms of representation where the pain of the other appears as circumscribed and distant and the suffering of the migrant as exotic and culturalized.
—Simona Taliani and Francesco Vacchiano, Altri corpi
Mary was in her early thirties when social services referred her to the Centro Fanon. She wore an open expression on her face, often smiling and always willing to talk about her experiences and concerns, but she also looked sad. I met her on a late November afternoon at the Centro. She had migrated from Nigeria approximately three years before we met, and she was still undocumented. Over this period, she had gone back to Nigeria once. When she returned to Italy, she was pregnant and had just lost her husband in a car accident in Nigeria. She went to the hospital for a prenatal visit, where she was diagnosed as HIV-positive. Social services subsequently placed her in a locally funded program for pregnant HIV-positive foreigners. She lived with her sister in what social workers described as very precarious economic conditions, in a small, dark apartment where a lot of people of all ages, mostly Nigerians, cycled in and out. Her sister was probably involved in prostitution, but it was unclear whether Mary was as well. She gave birth to an HIV-positive son who became negative after several months of retroviral treatment. A year after giving birth, the social workers thought that she was "depressed"; she was crying a lot and felt guilty about her health and her son's future. They referred her to the ethno-psychiatric center, where the doctors knew, as one social worker put it, "how to deal with cultural difference."
A short time after the initial referral, Mary became one of Dr. L's patients. I sat in on her therapy sessions for several months, often conversed with the practitioners in charge of her case at the Centro, and spent some time with her outside the clinic, at the apartment she shared with her sister. Three people participated in Mary's sessions: Dr. L, a trainee, and me. In this case, no Nigerian mediator was available to assist in the consultation, but Mary spoke enough Italian and the doctor enough English for them to understand each other. In general, ethno-psychiatrists at the Centro would meet patients together with a cultural mediator who helped with issues of translation or cultural interpretation when necessary. Dr. L had a lot of experience working with Nigerian patients and had conducted several years of ethnographic research in West Africa on curing techniques, childhood, and witchcraft. Like other practitioners at the Centro, she held degrees in both psychology and anthropology and was committed to bridging the practices of both in her clinical work.
Over the course of several consultations, Mary spoke of her difficulties in Italy: she did not have a residence permit; she was afraid of getting caught by the police and sent back to Nigeria; she feared for her life and her son's future; and she was terrified at the idea that other Nigerians in Italy might find out about her HIV status, which felt like a death sentence to her. She was haunted by dreams about her dead husband and could not talk about him without ending in a desperate cry. The threat of death was a refrain in her stories. Although Dr. L explained to her that her illness did not mean imminent death and that retroviral treatments could make a great difference, her fears persisted. She once said, "If I take the medicines here, I will heal, but if the police send me back there, I will die." Because she referenced death in different ways, I wondered whether she was alluding to different kinds of death, not just corporeal. In this clinical context, patients often voice or express through symptoms the fear of social death (both in Italy and back home), the shame of returning home without proof of success, concern about family members' jealousy and envy, and the threat of revenge. Death also speaks to ruptured relationships, to symbols that no longer grant meaning to experience, and to the failure of her migratory process.
We spent a lot of time speaking about which social program could grant her a residency permit. Because she was the mother of a minor who was born HIV-positive in Italy, she could qualify for the "health reasons" that the state uses to recognize parents of offspring affected by life-threatening conditions. At first, the stories that emerged in our discussions were mostly about Mary's life in Italy and the pressing concerns she had about her health and legal status. As another ethno-psychiatrist pointed out to me:
It is easier to collect accounts of migrants' lives in Italy than to find out about their lives before they migrated; when you try to get to those stories, they are often impenetrable. In these cases, you gently try to reorient them to their cultural background by establishing connections with family members, practices, and rituals, so that slowly another story can be told.
People's premigration stories are impenetrable for various reasons. Many patients who are referred to the Center have experienced different forms of violence and abuse. Some have been persecuted and tortured in their countries, have experienced war, and have sought political asylum elsewhere. Stories about "home" often resist narration because they recall an inhospitable place, one that is impossible to reinhabit, both physically and symbolically. At other times, "home" is an opaque reality that has been overshadowed by the urge to assimilate, integrate, and become other in ways that live up to the receiving society's standards of behaviors and of desiring. Italian institutions that grant legal status to foreigners often require clear narrations of their migration trajectories and countries of origin. Such pressure often results in confused accounts that are symptomatic of an impossible encounter between bureaucratic language and the complexity of people's histories. For instance, how does one translate the desire to escape from poverty by accepting prostitution as a lucrative activity? Or understand the desire to use the body as a powerful tool that brings wealth outside of the discourse of trafficking? "Home" can also become an object of impossible desire that exile has turned into a fantasy. There is often a gap in patients' language that points to an impossibility to remember and to speak. It can be understood as the response to trauma that disrupts language and consciousness. In all these cases, the accounts concerning life before migration take time to shape in the clinical encounter, which thus becomes the scene where experiences that cannot be communicated in language are nonetheless forced into the open.
During one consultation, Mary recounted a dream. Her husband had come to see her to tell her that he had died because his family had donevoodoo on them and that she and their son were in danger. She had to go back to their house in Benin City, Nigeria, to find a wire and then return to Italy. If she could not find it, something bad might happen to them. On this occasion, Dr. L told Mary not to fear her husband's visits at night: "If he comes back in your dreams, talk to him, try to find out why his family turned their backs to you." Later, when we were alone, the therapist commented, "In her context, dead people are not just memories or dreams, they are real." She further explained that dreams were "an instrument of the present," an experience that provided memories from the past and reworked them in light of the present.
To me, the doctor's reflection was an invitation to the participant to take her dreams seriously and address them in their ghostly reality. I was also reminded of the fact that dreams can offer a space of doubling, where people who are dead in life are alive in dreams, where the boundaries between life and death are blurred. Dreaming of a dead person may signify that her influence in the dreamer's life is still present or that her death is real only in waking life. In this sense, the therapist was not just alluding to Mary's experience in which dead people could come back to life in dreams, but also to a quality of dreams that makes them not only a screen onto which images and symbols are projected but a moment in which existence is articulated in different forms (Binswanger and Foucault 1986). Or so I interpreted it. The clinical encounter provided a space for her memory, where past and present, death and life became blurred in dreams and where the impossibility to remember could be faced so that the subject may access a different kind of speech.
Mary's dream brought up other stories. Her husband's family was, in her words, from a village where "they did a lot of voodoo." His family was very envious of the couple because they did well financially and were able to buy a house in Nigeria and emigrate to Europe. Moreover, they imagined she had made a fortune during her time in Italy, and now her son would inherit all his father's money and the house. She was afraid of them and the harm they could do. She said they killed her husband, or that they did not protect him enough—"They did voodoo on him"—and that her HIV was the consequence of a spell. She also spoke about the bad worms inhabiting her body. They were red because they sucked her blood. She got them because "bad people had cast a spell" on her when she was pregnant. She almost died, but then she saw a native doctor in Nigeria who helped her; even so, the worms were still in her body. She also heard an ongoing echo in her ears and head that caused her a lot of pain.
She wanted some drugs because she had problems sleeping, which was why she had agreed to come to the Center in the first place. Dr. L, however, did not prescribe any medicine. First, she listened to the other symptoms that Mary presented: she had a strong pain in her ears, and the worms went from her head to her feet, through her shoulders and breast, and then all the way down her spine. Her knees were hurting, too. Mary had seen her cousin, a healer, who poured a powder made of pepper and other things from Nigeria into her ear. Along with suggesting that she undergo further medical tests, Dr. L attempted to go beyond the initial diagnosis of depression. She asked Mary if she could speak to the spirits who were causing her and her family pain. She also inquired if the presence of worms in Mary's body resulted from a failure to perform some rituals as part of her worship of gods and goddesses. In this way, the therapist was letting the patient know that she was familiar with and understood that rituals had powerful meanings and that spirits could speak and be spoken to. Mary explained that the pain had to do with something else. The doctor then asked Mary about her family back in Nigeria: "Do they know about your medical problems? What do they make of them?" Her mother knew, and her father died after she told him about it. She felt tremendous guilt.
Mary referred to her husband by his African name, Osaliato. Dr. L asked Mary what her other name was, and what it meant. "Osatuame," she replied. "It means 'God has pity on me.'" Prompted by Dr. L's questions, Mary said that her father had given her the name. When Mary's mother was pregnant with her, a woman from their village did voodoo, putting her at risk of losing the child. But Mary was nonetheless born healthy, and thus her father named her "God has pity on me." When Dr. L heard this story, she reformulated it by saying, "Your father was right because you are strong, otherwise you would not have been born. You are still strong now." As she later explained to the trainee and me, asking about the name in Edo—Mary's mother tongue—was a way to create a relationship of trust in which Mary could feel comfortable evoking parts of her life in Nigeria and know that the therapist could attend to it. She specified that it was important to know when to ask these types of questions; the purpose is to let the patient express herself in her own terms and let her know that her references are not completely foreign to us and that she can bring them to the therapeutic space.
A couple of months into therapy, Dr. L asked whether Mary talked to her son about his dead father. No, she responded, not without falling into despair. She feared that her son might be doomed to a similar tragic destiny. While discussing the case with me, Dr. L had admitted that it was difficult for her to deal with how the memory of Mary's dead husband played out in the therapy sessions. We knew Mary's sister had gotten rid of any objects related to him in order to protect Mary from her sadness. But he appeared in her dreams and claimed that his family remembered and sometimes helped or protected him. "Why don't you put a picture of him in a corner of the house and build an altar to him?" asked Dr. L. Mary started crying. She felt unable to do it. The therapist reassured her she did not need to rush it but insisted that it would be beneficial to her and to her son. Maybe she could also recite a prayer in Edo, she added. Mary asked if she should light a candle and suggested that maybe it should be white. Sure, the therapist replied, as long as she did it. Mary cried hard but said she would do it and thanked us.
At the end of the same consultation, in a therapeutic/pedagogic way, Dr. L suggested that Mary go to the exhibition of African art currently showing at a museum in town, as a way to reconstitute some connections with "home." Mary answered with some hesitation, asking, "What is an art exhibit?" Dr. L explained that there were life-sized statues from Nigeria and other parts of Africa that represented kings and queens of ancient times. "I don't want to see other people from Nigeria. I don't want them to find out about my illness," Mary replied. Dr. L explained that the statues were not human beings but a kind of object that resembled kings and queens and other humans. I added that she did not need to talk to anyone at the museum; it was a space just meant to exhibit objects. Later I asked myself whether this was an instance of the misunderstandings that could lead to a comedy of errors, where each group's uncertainty about the other confirms preexisting anxieties and misconceptions (Obeyesekere 2005). When Mary said she did not want to see other Nigerians, did she mean other Nigerians visiting the museum? Did Dr. L, and I along with her, instead assume that she did not know what an exhibit or a museum is based on the understanding that they are a Western construction? Perhaps Mary truly did not know what an art exhibit was; or maybe statues are more than mere museum artifacts and can act upon us and see through us, like the gods, goddesses, kings, and queens that they stand for. It is hard to know.
In the context of ethno-psychiatric clinical work, practitioners are engaged in finding an "intermediate space"—a space of mediation—between the therapist's theories and techniques and the patient's ways of expressing suffering in an attempt to avoid reducing symptoms to biomedical diagnostic criteria. At the same time, they encourage patients to maintain relations with their respective backgrounds in forms that range from being in contact with family members, performing rituals, or speaking their mother tongue to attending groups or churches with their fellow nationals.
This intermediate space can also be understood as a space of transference. In psychoanalytic treatment, transference is the term used to describe how the relationship between the analyst and the analys and is translated by and through the lens of the analysand's past relational experience. In the therapeutic setting, old memories and experiences are reenacted and emotions are projected onto the analyst. Through the process of unconscious reenactment, the patient assigns the analyst specific roles that resemble relationships in the patient's life. For example, the patient may transfer feelings of hate and frustration onto the therapist in ways that resonate or coincide with the feelings she may have toward a parent. The setting thus becomes a theater of the unconscious where the patient can act out past traumatic experiences and, with the analyst's support, work through past traumas by revisiting the relationship that caused it. In other words, if the patient had experienced an abusive relationship with the mother, through transference that relationship might be reconstituted to such an extent that its effects can be worked through differently. Thus, transference is a form of mediation—a space of translation—that rearticulates intersubjective relations and the meanings attached to them. Although the ethno-psychiatric setting is not a psychoanalytic one, when ethno-psychiatrists talk about the clinic as a "space of mediation," they are alluding to the process whereby the patient's painful motives and affects are transformed into publicly accepted symbols and meanings. Obeyesekere (1990) called this process "the work of culture," and Winnicott (1967) spoke of cultural experience as that third area between the inner or personal psychic life and the world in which the individual lives as a space of creation.
(Continues...)
Excerpted from Migrants in Translation by Cristiana Giordano. Copyright © 2014 The Regents of the University of California. Excerpted by permission of UNIVERSITY OF CALIFORNIA PRESS.
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