For people who have been forced to flee from their places of home, a long process of integration starts in the destination country in which they received asylum. This process can affect their mental health. The phases of migration can be described as follows (cf. Grinberg and Grinberg, 1990; Sluzki, 2001; Kronsteiner, 2009). Knowing these phases can support you as a physician/health care worker in providing health care:
Preparation phase and actual act of migration
- Contemplation on migration or staying
- Decision for migration
- Redistribution of roles
- Attempt to estimate loss and gain
- Can lead to feelings of guilt towards people left behind
- Flight: often no preparation – shock
Arrival phase and initial time in the new country
- Euphoria-shock – confusion
- Cultural similarities are explored
- Existing behaviours-values are tested in terms of their acceptance and „usability“
- Dominant feelings: grief, fear, yearning, resistance against new things, idealisation of the previous environment
- Rituals of farewell and arrival are lacking
- Loneliness – members of the same ethnic group are important
- Overcompensation – strong adaptation efforts
- No conscious awareness of stress
- High vulnerability, good as well as bad experiences are experienced very intensively
- Experiences with representatives of the hosting society are formative
- Many practical challenges
Decompensation – phase of reconditioning
- Susceptibility to conflicts
- Physical symptoms
- New distribution of roles required
- This phase is difficult but it can lead to considerable development steps
- Susceptibility for depression and identity crisis when there is insufficient possibility for integration – also extreme idealisation of the own cultural imprint
Phase of reorganization
- Mourning process is still ongoing, but influences capacity to act in the present no longer as strongly as before
- New culture is examined in detail
- Partial merge
- Realistic view of both worlds
- Next generation has an important mediating role
- Work is particularly important for the new place in the new society
- Stable relationships to the country of origin and the host country can be built and sustained now
Culture shock: (Bolten, 2007)
- Euphoria: pleasure of something new prevails; reactions on the new are exuberant, because only the (positive) expected is perceived.
- Misunderstandings: the normality rules of the target culture are partially not recognized, which leads to misunderstandings, the newcomer blames him/herself.
- Collision: the causes for the misunderstandings remain hidden, blame is assigned to the others, people partially resign and tend to a strong appreciation of the own culture.
- Differences are accepted and contradictions are withstood. One strives to understand.
- Acculturation: the differences are largely understood and the tendency is towards adoption of culture-specific behavioural characteristics.