Flexner Book Club Blog

2011 Mary Flexner Lecturer: Judith Butler

Externalized Pathology and Internalized Identity

I work with refugees in Philadelphia. Butler’s chapter Melancholy Gender/Refused Identification makes me reconceptualize my clients’ struggles in the resettlement process. Butler expands on Freud’s idea of melancholia into a discussion of melancholic incorporation, arguing that identity results from disavowed grief. She states, “the lost object is, in that sense, made coextensive with the ego itself” (p. 247). Many of the refugees I encounter exhibit melancholia—where they are “unwilling to avow and hence grieve” the loss of their homeland. For these refugees, perhaps melancholia is what enables them to internalize their national identity.

As an example I’ll discuss one of my clients, a Bhutanese refugee I’ll refer to as Bihan. Bihan’s presenting problems involve a chronic health condition and his family’s difficulty adjusting to life in Philadelphia. Bihan is 46 years old and was born in Bhutan. He and his family fled to Nepal in the 1990s, where they lived in a refugee camp until their arrival in Philadelphia on August 1, 2011. Bihan has a cheerful disposition and is usually wearing Western clothing and a jaunty hat—either a cerulean knit cap or a dhaka topi. He does not speak English, so I rely on Nepali interpreters to communicate with him. Bihan is preoccupied with his health and his employment. He is reluctantly employed at a meatpacking factory and has been facing conflict with his employer because of absences. A few days ago, Bihan saw a doctor, who addressed his health concerns, but also diagnosed Bihan with anxiety and prescribed him an SSRI.

I really question the validity of this diagnosis. I speculate that underlying Bihan’s “adjustment difficulties” is unresolved grief over the loss of his home and national identity. Bhutanese refugees are Nepali-Bhutanese people, ethnicized as Lhotshampas. They made up about 35% of Bhutan’s population until the government introduced a series of “Bhutanization” policies in the late 1970s and 1980s, which led to the exclusion of the Nepali-Bhutanese people. The Citizenship Acts of 1977 and 1985 enabled the Bhutanese government to revoke citizenship from the Lhotshampa people. By the early 1990s the majority of Nepali-Bhutanese had left Bhutan; most settling in refugee camps in Nepal. Nepal and Bhutan are unwilling to give citizenship to these people. The Bhutanese government denies Nepali-Bhutanese people reentry, claiming that they were never Bhutanese. Some government officials go as far as to say that the Nepali-Bhutanese people have “willingly” left Bhutan.

By revoking these people of their citizenship in such an insidious manner, the Bhutanese government made their exile into an ungrievable loss. Butler writes that “if melancholia appears at first to be a form of containment, a way of internalizing an attachment that is barred from the world, it also establishes the psychic conditions for redaring “the world” itself as contingently organized through certain kinds of foreclosures” (252). Clinical social workers and health care providers are often quick to identify pathologies and dispel symptoms. But in reading Bulter’s chapter I wonder if melancholia is an important lived experience. Perhaps Bihan’s “signs and symptoms” are externalized manifestations of a melancholia that is necessary for the perpetuation of his national identity.

3 Comments

  1. I think you are on the right track. Typical Western psychological diagnoses probably miss the mark. However, Freudian ones should be expected to do so as well as they likewise arise from a specifically Western cultural context. Western sociologists and psychologists will have a hard time fully grasping what’s going on with refugees as long as they don’t wrestle well with the specific anthropological and diasporological dynamics relevant to their cases. For example, the above doesn’t make mention of survival and dependency issues and the male-emasculating affects of camp life. There is no mention of the influence of folk Hinduism, high-context communication, or social collectivism on Bihan’s situation. So again, I think you are on to something and I applaud it. Health professionals must be challenged to go deeper and think more critically about these cases if wellness is truly desired.

  2. I think it’s wonderful that you had this insight while reading Butler. There’s something wacky about our notions that we must move through things as soon as possible, rather than living in them. Transitions, for example. And grieving and melancholia.

  3. Thank you for the comments. I think the refugee resettlement agencies and health providers are making progress in being more culturally sensitive by hiring case aides– resettled refugees, to represent and work with their own communities. WHYY had a radio broadcast about refugee mental health several weeks ago.
    http://www.newsworks.org/index.php/nwtonight/item/29085-new-mental-health-initiative-reaching-out-to-refugees