“About how social violence is perceived in the therapeutic and care relationship”.
The violence that we are currently experiencing in Europe undoubtedly has many causes. Among them, there is the one that is the reflection of strong social tensions. And these tensions are regularly perceptible in a very special place: the therapeutic consultation, the place where we provide psychological care.
First of all, let us briefly see what these social tensions are and then how they are expressed in the therapeutic relationship:
1.- Immigrants and minorities frequently live a very negative reality in Europe, suffering situations of discrimination. Thus, in Catalonia, a third of immigrants indicate that they have suffered from racism. In Paris, a recent study showed how sending the same resume, if it was put on the return address that the person had a French surname and lived in the center of Paris, they called him 75 times, but if the person had a North African surname and lived in the Banlieue, the so-called “sensitive areas”, called him 14 times. With the same resume!
In relation to these situations, several studies have shown that immigrants and minorities have lower self-esteem than the autochthonous population, as a consequence of frequently feeling excluded and being socially underestimated, which ends up taking its toll on them.
Added to all this is the drama that hundreds of thousands of refugees are currently experiencing, who have become cannon fodder for the interests of the great powers. In July, two days after the signing of the peace treaty with Iran, the Turkish government, angered by what it considers a great triumph for its Shiite enemies, immediately responded by opening the border with Europe so that hundreds of thousands of refugees could begin to flee. reach the shores of Greece, experiencing the tragic situations that we all know. Now, the European Union offers three billion euros to Turkey so that it closes the border to the refugees turned into a bargaining chip.
2.- How are these realities of discrimination and exclusion expressed in the therapeutic relationship? They are expressed through transference, the emotional relationship of the person seeking help with the therapist. And this emotional relationship is tinged, in the case of these people with hostility, with negative transference, through which the suffering generated by the inequalities they experience is expressed. Although, sometimes, these tensions are hidden, frequently, under the cloak of fearful submission, before the repeated experiences of learned helplessness and the experience of frozen duels that have not been able to be elaborated.
The tension, the negative transfer is expressed, for example…:
… that there is a lot of distrust of immigrants and minorities towards care services and therapists. Thus, the immigrant does not see the professional who attends him as different from the broad layers of the host society that rejects him. The immigrant associates him with the employer, the policeman, the civil servant…of whom the therapist is often a relative, friend, or even physically resembles because he belongs to the same human group. But it is that even the professionals who come from the minorities themselves also generate distrust. They have been called “Uncle Tom” (the submissive slave to his masters). This is one of the problems that must be taken into account with interpreters, as pointed out by authors such as Smith or D’Ardenne. “Would a German Jew analyze himself with a non-Jewish German?” asked Jafo Kareen, one of the most prominent Pakistani psychiatrists in London.
… in which the immigrant breaks all the records of therapeutic non-compliance, as well as treatment abandonment (Veret London and Devourne, Mazzeti, O’Sullivan), showing the distance that separates him from the professionals who care for him and who represent the “host” society.
… as a sample of this tension and negative transfer that is experienced in the consultations. I will give an example: When in the SAPPIR (Service for Psychopathological and Psychosocial Care for Immigrants and Refugees) we pass a test showing some photographs with faces of people who express different emotions (sadness, joy, anger…) so that they tell us which one of them feel more identified, on more than one occasion they have told us: “I don’t know anyone. I have never seen them!”. The immigrants were believed to be in an interrogation. What kind of trust do you have in hospital therapists when you mistake them for policemen in an interrogation room?
… in the well-known case of immigrant minors who have presented themselves with up to 28 different names, one for each center in which they have been. What kind of trust in the therapist does someone have who can’t even tell him his name? An essential premise of the treatment is that it is based on telling the truth, but because the relationship is established between equal citizens, with the same rights and freedoms. What happens in situations of enormous inequality and defenselessness? Should the truth be told to someone who is perceived as hostile, persecuting?
… in a hostility that is strongly somatized. If the hostility or psychological suffering is very intense, they tend to become somatized, as we see with the high incidence of headaches in immigrants with Ulysses Syndrome, a chronic and multiple stress disorder that is not a mental disorder. Up to 80% of these people suffer from headaches. And headache, as the classic studies by Pierre Martí already point out, is related in most cases to repressed aggressiveness.
Social inequalities generate strong tensions, exclusion, and social violence, which is expressed, how could it be otherwise, in the therapeutic relationship itself. I believe that it is important to understand this psychological reality present in the healthcare field in order to find solutions to situations as dramatic as the ones we are experiencing. The psychological is not everything, that would be falling into “psychologicalism”. But without understanding the psychological perspective, a complex social reality cannot be understood.
Psychological intervention takes place within the framework of society and its conflicts. Extreme inequality does not stop being in itself a form of violence. Michael Foucault argued that psychology and psychiatry were part of “biopolitics”, they were not pure sciences, indifferent to social reality. I think that what I have shown is a clear example of the validity of his approaches.