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Abstract
This paper attempts to reflect on the impossibilities of intercultural communication implied in institutional medical encounters. Drawing from an ethnographic case study among patients of a transcultural consultation for migrants in Portugal, the analysis focuses on the contents and forms of the interaction observed by the anthropologist in the clinical setting. A repetitive pattern of communication between a refugee women patient and her psychiatrist foregrounded the unsaid within the interaction as well as the unwillingness of the refugee to speak about her life with the anthropologist. In this sense, we propose to understand silence as a form of communication pointing to both the condition of the patient but more significantly embedded in the institutional framework of the clinical setting, discursive positions of the participants, as well as their social statuses. Following the theoretical work of Jaworski, Wagner and Winter, our analysis of silence leads us to the critical examination of the question of privilege in intercultural situations pointing to a necessary deconstruction of post-colonial institutional object/subject positions. In practical terms, this challenge corresponds to the work of international cross-cultural psychiatry (in terms of clinical matters) as well as that of biographical research and research on memory among migrants and refugees.
Este texto propõe uma reflexão sobre comunicação intercultural num contexto institucional comprometedor da sua possibilidade efectiva. Partindo de um caso ocorrido no trabalho de campo na consulta do migrante num hospital psiquiátrico em Lisboa, é feita uma análise sobre as formas e conteúdos da comunicação entre os interlocutores envolvidos: paciente refugiada, médico e antropóloga. Tanto o caracter repetitivo da comunicação entre médico e paciente, como a recusa da refugiada em contar a sua história à antropóloga, trazem para o centro da análise a questão do silêncio que é aqui entendido como uma forma de comunicação substantiva. Neste sentido são aqui analisados também o peso institucional do contexto nas posições discursivas possíveis bem como o peso dos estatutos sociais dos diversos intervenientes. Seguindo o trabalho teórico de Jarowski, Wagner e Winter, a nossa reflexão sobre o silêncio conduziu-nos a uma análise crítica da questão do privilégio nas relações interculturais indicando uma necessária desconstrução da ‘dominação incorporada’ nas nossas próprias posições de sujeito (médicos e cientistas sociais face a migrantes e refugiados). O trabalho da nova psiquiatria cultural, apelidada de internacional, traduz-se nisso mesmo na prática clínica, bem como o trabalho da pesquisa biográfica junto de migrantes e refugiados.
Funding
This research was funded by The Portuguese National Science Foundation (Fundação para a Ciência a Tecnologia). [grant number FCT/BPD/11548/2002], Instituto de Ciências Sociais da Universidade de Lisboa, [grant number FCT/BPD/26099/2005], CEAS/ISCTE, Lisbon, Portugal.
Notes on contributors
Elsa Lechner, Ph.D. in social anthropology (Paris, 2003), is a principal investigator at the Center for Social Studies of the University of Coimbra where she coordinates a research project on collaborative research among immigrants in Portugal funded by the Portuguese National Science Foundation. She has conducted her doctoral research among Portuguese emigrants in France, and her Post-doc project at the Transcultural Consultations for Migrants in a Psychiatric Hospital in Lisbon (2004–2007). Currently, she is a Fulbright Scholar in the USA conducting an exploratory study about the Portuguese in Newark, New Jersey, hosted by Brown and Rutgers Universities.
Olga Solovova, Ph.D. in sociolinguistics (Coimbra, 2014), is a researcher at the Centre for Social Studies in the Humanities, Migrations and Peace Studies Group. She is a member of the project implementing collaborative research among immigrants in Portugal, and of a European project on learning languages online e-learning. Her Ph.D. thesis examines policies of language-in-education that sustain the existence of complementary schools for Eastern European immigrant children in Portugal. Her research interests include language ideologies and policies, discursive construction of cultural identity in multilingual societies as well as multilingual and biliterate literacy practices.
Notes
1. The transcultural consultation (Consulta do Migrante) at Miguel Bombarda was open to public in 2004 after the initiative of a small group of practitioners with experience with foreign patients or clinical settings. Namely, the founder director of this service had worked for several years in the Portuguese Hospital of Macau, until the transition of the territory Portuguese sovereignty to China.
2. Post-doc project granted by the Portuguese National Science Foundation which produced, among other scientific and academic outputs, an edited volume on ‘Migrations, health and cultural diversity’ (Migração, Saúde e Diversidade Cultural, ICS, Lisbon: 2009).
3. Hawkers are agents of a type of trade that economics dismisses as ‘informal’. However, in Cape Verde, this type of activity forms an important axis of the transnational economic and cultural movements that traverse this island country of migrants and connect it to the world. It involves networks of men and (especially) women that operate at the (often silenced) margins of the economic and cultural hegemonies that make up today's globalised world (Marzia Grassi, ICS, Citation2003).
4. Biographical workshop (Atelier biographique), Univerity of Paris, June 2004.