Failures of imagination: The refugee's narrative in psychiatry

Abstract

Refugees coming from war-torn areas sometimes face misunderstanding and frank incredulity when they encounter the psychiatric system. This failure of the clinical imagination reflects both reluctance to confront the enormity of patients' loss and cultural differences in self-presentation, self-understanding, memory and identity. This potential for incredulity is redoubled in the formal hearing before the Immigration and Refugee Board (IRB) where the claim for refugee status is adjudicated. Contemporary psychiatric practice is rooted in taking patients' stories at face value as accounts of their experience or reading through them to identify signs and symptoms of psychopathology. From this perspective any account reveals both the narrator's shifting experiential world and the current functioning of their cognitive machinery. Truth is 'experiential truth' and is relative to the narrator's social position, mental health and emotional state. In contrast, the IRB assesses the narrative of asylum seekers against the notion of a truthful story as fixed and isomorphic to a single historical sequence of events. From the perspective of the IRB members, any deviation from this fixed account is evidence of dissimulation designed to claim the valued status of refugee. The conflicting epistemologies of clinical psychiatry and the refugee hearing throw into relief the functions of social imagination in the construction, interpretation and assessment of the truth-value of narratives of identity and affliction.