Chapter 14 - Diagnosis as Advocacy

Summary

Considerations around the dynamics of medicalization and social suffering are at the heart of working with refugees, as is attention to and advocacy for families’ social and settlement needs. In this chapter, the authors describe one particular form of advocacy: the generation of medico-legal reports to accompany asylum claims. The authors argue that the increasing medicalization of the refugee experience has led to widespread dissemination of this practice, and suggest that leveraging psychiatric language in a medico-legal report is not without risk to children and families. They cite the emergence of a significant culture-bound syndrome in Sweden, Uppgivenhetssyndrom, felt to be partly related to the language applied by advocating physicians. The United States of America’s recent policy of forcibly separating migrant families has also seen physician activists discuss “toxic stress” and warn of future pathology. The authors discuss the complexity of using psychiatric language for advocacy and suggest some ways of mitigating negative impacts on families. They suggest that physicians consider moving beyond the clinical encounter to advocate for refugee rights on a broader scale.