Living on the margins : illness and healthcare among Peruvian migrants in Chile
De los Angeles Núnez Carrasco, L.
Citation
De los Angeles Núnez Carrasco, L. (2008, September 16). Living on the margins : illness
and healthcare among Peruvian migrants in Chile. Retrieved fromhttps://hdl.handle.net/1887/13105
Version: Corrected Publisher’s Version
License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the University of Leiden
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Part III
Migrants’ Mental Health Status in Chile:
Old and new illness experiences, idioms of distress and Coping mechanisms in a
hostile context
art three explores the surfacing of illness experiences of Peruvians living and working in Chile. Most migrants’ emotional distress is directly connected to their experience of being uprooted, of having left their families behind, and of having lost their social/emotional support. Part three deals with migrants’ experiences of emotional distress connected to both the displacement of their lives as well as the social and economic exclusion to which migrants are exposed in the host society. Related to exclusion, migrants’ emotional distress is linked to the poor living and working conditions they must endure in the new country.
Migrants’ social suffering may trigger a variety of forms of emotional distress. Some of these forms are already known and previously experienced by them, while others are new to them and experienced for the first time while living in the host country. The term “emotional distress” is therefore used in this context to refer to a broad range of forms of distress elicited by the group studied. These include depression, stress and nerves, heart illness, envy, daño and chucaque. Migrants belonging to this group were, at the time of the study, not seeking medical assistance.
The three chapters of part three examine experiences and perceptions of emotional distress as well as changes in meanings and forms of managing distress resulting from migrants’ interaction with various agents in the new society. They explore the idioms used by migrants in expressing this distress and debate the extent to which these experiences disclose the nature of migrants’ relationships with the Chilean society. Ultimately, the impact of this relationship upon migrants’ bodies and subjectivities is also here assessed.
Two perspectives are applied in the analysis of migrants’ emotional suffering. Firstly, the perspective that sees human suffering and specifically emotional distress as a socially produced condition; as an experience emerging from structures of power and domination in which migrants’ lives are embedded. Secondly, the perspective that views emotional distress inter- subjectively constructed, also as an idiom through which migrants interpret, articulate and communicate social experiences of suffering.
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Through the chapters I explore how personal narratives convey migrants’
‘lived world’, their suffering and the action undertaken to manage that suffering. This exploration follows the cross-cultural stance of the anthropology of emotions, which aims at “investigating indigenous definitions of situations of loss, blocked goals and the socially organised response to them” (Lutz 1985:92). The analysis looks at the cultural construction of migrants’ goals and motivations emerging from this construction. Further, it examines forms of expression migrants’ emotional distress may take in the face of loss and frustrated goals. Concepts of explanatory models, chain complex and prototypes are used as crosscutting analytical tools and are applied to the analysis of migrants’ narratives (Groleau 2006).
Chapter seven presents an overview of migrants’ mental health status after their arrival in Chile. This assessment includes a measurement of the presence of depressive and anxiety symptoms as defined in standard medical terms among a sample of migrants. Contextual factors surrounding migrants’
emotional suffering are considered by establishing the relationship between the presence of these symptoms and migrants’ family situation, employment situation, legal status, as well as access to health-care. This chapter also introduces illness narratives of a smaller group of migrants chosen from the previous group and opens up the analysis of migrant’s personal accounts which are also explored in depth in the following two chapters. Short biographical notes of the interviewed group are presented at the end of part III.
One question immediately addressed in the analysis of the narratives is how migrants perceive, experience and interpret their own emotional distress. In light of the disruptive effect of migration, chapter seven examines various situations where migrants’ emotional distress emerges. The analysis explores migrants’ family circumstances as well as their marginal position in the host society. It discusses the extent to which these forms of distress reflect the displacement of migrants’ lives as well as broader social and economic forms of oppression migrants are subjected to while living in Chile.
The analysis compares the cultural construction Peruvians made of their own emotional distress in Peru with the construction they have fabricated in the Chilean context. Chapter eight begins by presenting folk forms of distress that can be observed only within the community of migrants – such as daño, evil eye and chucaque, which in turn, emerge as a consequence of migrant’s positioning in a hostile context.
In order to understand the connection between migrants’ subjectivities and the effect of shifting contexts it is necessary to look at the influencing components. These are cultural systems, values and meanings mediating the connection between social relations and the individual’s affection as well as cognition. Here existent cultural structures underlying migrants’ own experiences and explanations of their distress are examined. I investigated migrants’ use of the category of ‘nerves’ as an explanatory model to understand what happens in their bodies while experiencing various forms of emotional distress. Migrants’ conceptions of the self-in-relation-to-others are
also examined, as well as how this relation is interrupted by migration, thus causing emotional distress.
Migration also involves coming into contact with new languages and socially organised responses regarding migrants’ old and new forms of emotional distress. Chapter eight discusses the process of transformation of expressions of migrants’ emotional distress taking place in Chile. The analysis of narratives indicates migrants’ expression of emotional distress is moving away from the use of a popular language of affliction prevalent in Peru. Folk categories of nerves, weakness and sadness are being replaced with the use of medicalised language through the incorporation of the terms depression and stress. These latter terms have been initially appropriated by Chilean people, incorporated into their vocabulary and currently circulating in Chile as popular labels of affliction. However, unlike the Chilean population, Peruvian migrants seem to resist medical treatment associated with these illnesses.
Using an interpretative perspective, depression and stress are approached as
“experienced by the sufferer as a reality (…) viewed as a set of symptoms or a condition expressed and interpreted in local idioms, and using local explanatory frames” (Good 1985:381). The discussion then focuses on the extent to which this new language of distress serves migrants to understand and communicate new forms of suffering as well as adjusting to the challenges of a changing and often adverse environment. It deals with the question of whether or not this language serves to communicate experiences, which result from the power relations in which migrants’ lives are embedded in the host country. Specifically, here, I look at their interactions as patients with medical doctors and as workers with their Chilean bosses.
Chapter nine gives an account of both the socially and medically organised responses to migrants’ distress in the new environment. Through a brief comparison between migrants’ previous and current experiences of distress, the discussion centres on circumstances underlying the current mechanisms migrants put in motion to deal with their distress. This chapter also discusses how notions of masculinity and femininity influence the coping mechanisms used by migrants. Specifically social practices, such as dancing and drinking among the migrant community, are explored and then focus upon the use of alcohol among distressed male migrants.
This chapter also analyses the ways in which migrants’ emotional distress is dealt with in the medical sphere as well as in the workplace. In the first sphere, an incipient process of medicalisation of migrant’s emotional distress is observed and migrants’ strategies to resist this process are discussed. In the latter sphere, attention is placed on women domestic workers.
Forms of managing distress are seen in the context of employer-employees relationship. Among these aspects, difficulties in accessing medical care are often linked to restrictions imposed by employers upon the women’s mobility.
Finally, this chapter discusses the relationship between idioms of distress and coping mechanisms migrants use. In addition, the effect of this relationship on
migrants’ well-being, on their bodies and agency over their distress is discussed.
