Abstract
My initial reaction to reading Salman Akhtar’s first chapter, “The Trauma of Geographical Dislocation,” which discusses the loss of natural environment for an immigrant, was one of annoyance: I found him exaggerating the loss and underestimating the happiness that some immigrants may feel, having escaped from their politically oppressed home countries and been welcomed in America. Shortly thereafter, I recovered an important memory that melted away my defensive “annoyance.” Visiting Berlin a few years ago to attend an IPA Congress, I experienced a nostalgic reaction to the scent of blooming linden trees. I was pleasantly surprised to learn that my hotel was diagonally across from the Romanian embassy and just around the corner from the American embassy. Ensconced between the two embassies, with the linden trees reminding me of my childhood days in Romania, I found that the geography, indeed, brought together my two disconnected lives. Like many “strong” immigrant families, mine had suppressed sentimentality, and it has taken me years to permit myself to experience my own nostalgia for my country.
The contemporary version of the American dream is colored by an atmosphere of self-criticism and guilt as America experiences itself as a multicultural, postmodern, and relativist nation. Riding this wave in the context of psychoanalysis, Akhtar has successfully described some important phenomena regarding immigration. These include issues that in the past were minimized or ignored in the name of the supposed “universality” of human nature. In particular, the immigrant analysts who fled for their lives during World War II were grateful to be accepted by America and were not prepared to look at differences in experience or to acknowledge the hardships of immigration.
Akhtar’s contributions are those of the next generation, following that of Grinberg and Grinberg (1984). This volume, the latest of several contributions by Akhtar to the topic of immigration and acculturation, follows his 1995 prize-winning paper “A Third Individuation: Immigration, Identity, and the Psychoanalytic Process” and a subsequent book, Immigration and Identity: Turmoil, Treatment, and Transformation (1999). Akhtar’s experience and training further qualify him as our guide: an immigrant from India since 1973, he has a nuanced understanding of separation-individuation and of severe character pathology that requires close attention to the treatment frame. Akhtar took those lessons about attention to the frame, transference-countertransference, and the “unobjectionable part of the transference” (Stein 1981) to look through these subtle lenses at immigration and transcultural phenomena.
As a cultural anthropologist, Akhtar has made a systematic study of these issues as they arise during the life span and how they apply to the therapy or analysis of immigrants. He draws his material from a variety of sources, including his own and others’ clinical work, as well as epidemiological research, to expand on Immigation and Identity. Whereas the earlier book is aimed primarily at analysts and psychodynamic clinicians, Immigration and Acculturation targets a wider audience that could include friends, spouses, relatives, teachers, and coworkers. It familiarizes the reader with the depth and breadth of the immigration experience in order to cultivate empathy for immigrant families and their children. Akhtar’s book is valuable to both native and immigrant clinicians. He tackles precisely those transcultural issues that make us most uncomfortable as clinicians and that we therefore tend to gloss over. We analysts sometimes narcissistically overestimate our ability to understand individuals from a very different cultural background.
This book’s subject matter is indeed timely. At the APsaA meeting in Chicago last June, the University Forum and two panels were devoted to the subject of immigration: immigrant children, immigrant patients, immigrant analysts, children of immigrants. These panels addressed the rich interplay between the general psychoanalytic experience and the specific issues of immigrant patients and their analysts.
Akhtar addresses both the issues of individual immigrant experience and broader themes. In researching immigration from a sociological, anthropological, religious, political, and psychoanalytic point of view, he examines issues that arise during various stages of the life cycle, including work, money, marriage, friendship, youth, and aging. Intertwined with the immigration theme, he offers observations about the dilemmas of life. Such observations made me want to share this book with my immigrant family members and friends. I wanted to use it as a springboard for discussion of issues we had considered unique to our passage, and not addressed in ordinary discourse.
A review of the contents of the book shows the breadth of Akhtar’s research. The first part, “Leaving and Arriving,” addresses the “trauma” of geographical dislocation with all its nuances. Akhtar talks of the adjustments that immigrants must make to the “mundane paraphernalia of identity” (p. 5) like clothes, wallet, shoes, eyeglasses. He also describes how some immigrants adapt to the loss of their old home by repudiation and “counterphobic assimilation,” or by a fantasy of returning some day off in the future. Other adaptations include homes that “acquire a shrine-like quality” as an attempt to replicate the lost homeland. Reunion and reparation complete the cycle of dealing with the loss of home. Akhtar gives treatment guidelines for dealing with immigrant patients, such as validating their feelings of dislocation, dealing with their nostalgia both affirmatively and interpretively, and allowing them more time for physically settling into the analyst’s office. He also discusses cultural differences in the subjective experience of time. These include “time of the mind” versus “time of the heart,” meaning precise Western time as opposed to more spontaneous and inefficient Eastern time, as experienced in settings of less industrialized countries.
Understandably, Akhtar separates out refugees and exiles from other immigrants, pointing out that the former typically repudiate, at first, good memories of their country of origin. In coping with differences among other patients, he considers aspects of his work with immigrants as “developmental work”: the immigrant relies on his analyst as a new object, and this reliance is adaptive.
The book’s second part, “Being and Becoming,” includes the chapters “Work and Money,” “Sex and Marriage,” “Friendship and Socialization,” and “Religion and Politics.” These informative chapters provide research findings and reflections on the importance of work and money for immigrants’ self-esteem and self-identity. Akhtar documents the challenges encountered by immigrants in obtaining employment, especially their difficulties continuing in professions they had worked in back home. At the same time, he depicts their internal obstacles and discusses the vicissitudes of immigrants’ marital and friendship choices. He unveils cultural variations in attitudes toward homosexuality and its connection to occasional motives for emigration. In his section on religion and politics, he captures the range of obstacles and adaptations of immigrants. While overall he pays less attention to social class, he makes nuanced observations on the effects of class differences. For instance, he notes that while more privileged people often have a better education, they may have experienced greater loss of comfort in leaving their home countries.
Part three, “The Dusk and the Dawn,” offers rich reflections on the late and early parts of the life cycle in the lives of immigrants and their children and grandchildren. This section provides clinicians examples of culturally embedded traditions of family interactions, showing how some immigrants differ from Americans in their sense of boundaries. He offers sensitive examples of analysts modifying their technique with immigrant families, for example by having more contact with family members if necessary. Akhtar also discusses guidelines for treatment of bicultural youth and offers a plea for empathy for immigrant parents. In his illustrations of how to maintain neutrality and respect for cultural norms, he shows how not to fall prey to either paranoia or indulgence. Here Akhtar gives a vignette (p. 198) of an interview with an Iraqi refugee woman that he conducted with her husband as translator. Part way through the interview, the husband offered Akhtar some baklava as a sign of appreciation, asking that they eat the sweets together. Akhtar accepted the present and thanked him, but stipulated that he needed to work and not eat at the same time. This acceptance of a gift while maintaining professionalism shows his flexible handling of a delicate situation: the husband was not used to his wife having such close contact with a strange man. Presumably, the husband was trying to overcome his discomfort by his offering. Akhtar did not refuse the gift in a rigid fashion, but neither did he feel obligated to break the frame and comply with the request to eat sweets. Thus, he neither offended nor crossed his professional boundary.
In part four, “The Wounded Healer: Challenges of Being an Immigrant Therapist,” Akhtar revisits themes from the 1999 book, including the analyst’s need to maintain cultural neutrality, the patient’s choice of a foreign-born analyst, and the analyst’s challenge in conducting analysis in a language other than his native tongue. This last can occasion misunderstandings of nuanced meaning. The situation of both patient and analyst working in a foreign tongue can create a defensive distance from one’s original culture and from one’s childhood emotions (see Ferenczi 1911; Amati-Mehler, Argentieri, and Canestri 1993).
Akhtar is willing to reveal his vulnerability in working with these issues. He reveals his urge to share his own bond with his native land. In particular he recounts his urge to quote Urdu poetry to comfort a patient in acute grief. As his clinical judgment dictates against quoting the poem, Akhtar relates his own sadness and sense of loss.
Despite these telling experiences and Akhtar’s careful use of the research on trauma, I wonder if we need to consider immigration inevitably traumatic. The initial experience of “culture shock” (Garza-Guerrero 1974) may qualify as traumatic because by definition a trauma is something that overwhelms an organism with its unexpected suddenness. However, past that initial reaction, the immigration experience can also build character and resilience: one is forced to become more humble, flexible, and tolerant. In addition to hardships, immigration can also add flavor, complexity, and adventure to one’s life. For the analyst, this recognition offers a chance to validate immigrants’ new strengths.
Overall, this is an illuminating book. In addition to his vast bibliography, Akhtar offers us an appendix with a list of movies illustrating cultural phenomena and dilemmas of immigration, classified by country of origin. My personal favorite is The House of Sand and Fog (2003): a story where the clash of cultures and the rigid adaptation of a proud officer lead to a family tragedy.
The more I immersed myself in reading Akhtar’s work, the more I came to appreciate his thoughtful and systematic approach, as well as the usefulness of his clinical and nonclinical vignettes. This book is an important addition to the literature of immigration. More broadly, we as analysts are always balancing the universal and the particular. This volume gives us many particulars to contemplate.