Washington University in St. Louis Washington University Open Scholarship All Theses and Dissertations (ETDs) 1-1-2010 Cultural Anxieties and Institutional Regulation: "Specialized" Mental Healthcare and "Immigrant Suffering" in Paris, France Stéphanie Larchanché Washington University in St. Louis Follow this and additional works at: https://openscholarship.wustl.edu/etd Recommended Citation Larchanché, Stéphanie, "Cultural Anxieties and Institutional Regulation: "Specialized" Mental Healthcare and "Immigrant Suffering" in Paris, France" (2010). All Theses and Dissertations (ETDs). 193. https://openscholarship.wustl.edu/etd/193 This Dissertation is brought to you for free and open access by Washington University Open Scholarship. It has been accepted for inclusion in All Theses and Dissertations (ETDs) by an authorized administrator of Washington University Open Scholarship. For more information, please contact [email protected]. WASHINGTON UNIVERSITY IN ST.LOUIS Department of Anthropology ECOLE DES HAUTES ETUDES EN SCIENCES SOCIALES - PARIS Ecole doctorale de sciences sociales Anthropologie sociale et ethnologie Dissertation Examination Committee: Carolyn Sargent (Chair, WU) John Bowen (Co-Chair, WU) Didier Fassin (Co-Chair, EHESS) Ahmet Karamustafa (WU) Rebecca Lester (WU) Richard Rechtman (EHESS) Brad Stoner (WU) Mahamet Timera (Paris VII) CULTURAL ANXIETIES AND INSTITUTIONAL REGULATION “SPECIALIZED MENTAL HEALTHCARE AND “IMMIGRANT SUFFERING” IN PARIS, FRANCE By Stéphanie Larchanché A dissertation presented to the Graduate School of Arts and Sciences of Washington University in partial fulfillment of the requirements for the degree of Doctor of Philosophy August 2010 Saint Louis, Missouri Abstract This dissertation looks at “specialized” mental healthcare expertise in France as a lens through which to address the institutional management and representations of cultural difference in France today. By “specialized” mental healthcare centers, I refer structures that provide culturally-sensitive mental health services to immigrants specifically. I identify and explore three contemporary expert approaches: namely, transcultural psychiatry, clinical medical anthropology, and ethnoclinical mediation. By providing a genealogy of specialized mental healthcare institutions, and by construing them as “meta-discursive nodes”—that is, as points of encounter between state, institutional, and individual ideologies—I provide an analysis of the cultural anxieties, contradictions and double-binds that arise from the opposition between a regulative, universalist republican ideology, and a field of expertise which strives to promote culturally-sensitive mental healthcare for immigrants. I argue that, as a product of the conflation of the “immigrant issue” (la question immigrée) and the “social issue” (la question sociale), “immigrant suffering” (Sayad, 2004) has become a medium that problematically couches immigrants’ “difficulties”— whether they relate to mental health pathology or structural problems—in terms of cultural difference. As a result, generic cultural representations of immigrants are uncritically reproduced, making it difficult to identify and address the structural inequalities that do engender suffering. ii Acknowledgments I would not be the anthropologist I have become today without the support of my family. I am ever thankful to my parents, Michel and Marie-Claude, for being so loving, first of all, and for teaching me perseverance, but more importantly for instilling me with a strong sense of altruism that I believe significantly shaped my career choice. I know how difficult it was for them to let me go on my American adventure, and yet they encouraged me all the way. I share this accomplishment with them. I am also fortunate to have a loving sister, Elodie, who, inspired by the same values and principles, chose to become a doctor. She makes me so proud, and I am thankful for her enduring support as well as for her partner’s, JR, who is a great addition to our family. I know it was not easy to not have her sister around for the past decade almost, but I feel like this experience ultimately brought us closer than ever. This accomplishment is also the fruit of the loving relationships that provided me both with stamina and inspiration. To Steve, who, wherever he may be, will always be part of my story, and certainly is part of this one. To Drissa, whose strength, spontaneity, and amazingly positive spirit have taught me so much. I have also been blessed with wonderful friendships through the years, both in France and in the United States. Though it is impossible for me to acknowledge them individually, I want to thank them all for sharing moments in their lives with me. I must, however, make an exception for my long- time friend Marie, my “soul sister,” who is a pillar in my life. Her amazing positiveness and her strong sense of confidence have both been a source of inspiration and comfort to me. While writing at Washington University, I benefited from the warmest community of friends. I want to acknowledge my PhD companions Katie Hejtmanek, for your « mad love », and Ana Jacobsen : I believe this experience tied us all together forever! To my long time friends, Jenny Epstein and Lauren Gulbas, I thank you for your unwavering support, through good and bad times. I am glad we were able to spend two extra years together in St. Louis! To my gourmet friends, Mary Jane Acuña and Abby Smith, and to the bonding power of food sharing and cooking! I feel forever indebted to my mentor and my friend, Carolyn Sargent, and to her husband, David Freidel. Thank you both for your intellectual guidance and emotional support. You are family to me. Carolyn, you contributed to making these past eight years iii most rich and rewarding. You have been my strongest supporter and advocate, pushing me to find a sense of confidence and offering me incredible professional opportunities and experiences. I share this accomplishment with you as well. I am grateful for the intellectual guidance of other scholars who have both trained me and influenced my research. To Didier Fassin, whose work has directly shaped my ideas, and who did me the honor of being willing to co-direct this dissertation. I am most grateful to John Bowen for encouraging me to write in my own voice and to give the library a break. John, you made this writing experience so much less dreadful and isolating. I never thought I would once look forward to go to a writing group! To my jury members: Ahmet Karamustafa, Rebecca Lester, Richard Rechtman, Brad Stoner, and Mahamet Timera, for all agreeing to evaluate my work. Special thanks to Rebecca for her thorough edits and insightful comments! I am equally thankful to professors who, years before I even considered preparing a PhD, had a decisive influence on my desire to pursue my studies: Philippe Cadiou, Catherine Pouzoulet, and Melissa Johnson. To the individuals who made my research project possible in the first place: Marie Rose Moro, Gésine Sturm, and the Transcultural Psychiatry team at Avicenne; to the « Dar a luz » cohort of the Transcultural Psychiatry program, particularly Maryvonne and Lynda ; Rachid Bennegadi, Marie-Jo Bourdin, Christophe Paris, and the rest of the Minkowska team (without forgetting Mylène and Michelle !) ; Kouakou Kouassi and the Jean-Baptiste Carpeaux team ; Ismael Maiga, and the Gepela group, Sylvie Saiti in particular. To Bintou Baraji, for her wisdom and soothing presence all through my doctoral training and fieldwork. To my friends at APS, Claudette Bodin, Kotiary, and Nabakha, who have also followed my research closely the past eight years. To the CIMADE for their warm welcome; to Arnaud Veisse from the COMEDE, for inviting me to participate to the seminar on “Healthcare access and protection of immigrants/foreigners” at the MSH. To the National Science Foundation and the Wenner-Gren Foundation, for funding my research. iv To July, at SMU, for helping me figure out me (well…at least some of it!), and to my women’s group at Washington University, for listening to my joys and sorrows, and for supporting me through my dissertation anxieties and frustrations. To the MAPSS program at the University of Chicago, and to the departments of anthropology at Southern Methodist University and at Washington University in St. Louis. To my maternal grandmother, Jeanne Lootvoet, and in loving memory of my grands-parents, Roger Lootvoet, Fernande and Charles Larchanché. Finally, I would like to acknowledge those who helped shape this final product: Jessica Cooper for formatting my tables, and Katie Hejtmanek for proofreading the whole text for my references! I would have lost my sanity without the help of you both! v Table of Contents Abstract .............................................................................................................................. ii Acknowledgments ............................................................................................................. iii Table of Contents ............................................................................................................. vii CHAPTER 1: Introduction ...............................................................................................1 The context: “Specialized” mental health at the intersections between social policies, immigration, and the discourse on national identity ....................................1 The research and definition of concepts ......................................................................5