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Book Review

Immigration and Acculturation: Mourning, Adaptation, and the Next Generation

John Racy, MD

Published: June 15, 2012

Immigration and Acculturation: Mourning, Adaptation, and the Next Generation

by Salman Akhtar, MD. Jason Aronson Inc, Lanham, MD, 2011, 294 pp, $70.00 (hardcover).

Salman Akhtar, a distinguished analyst, Professor of Psychiatry at Jefferson Medical College, and a Training Supervising Analyst at the Psychoanalytic Center of Philadelphia, immigrated from India as a fully trained adult. He is the author of many books and articles and has received many honors for his scholarly work. He has written here a fine book on the immigration experience, particularly in the United States. The book consists of 4 large parts and an Appendix.

Part I, Leaving and Arriving, consists of 1 chapter, "The Trauma of Geographic Dislocation." As the title of the chapter indicates, the author regards immigration as a traumatic experience that requires 5 major steps in adaptation: repudiation (I’ m not here, I’ m not one of them), return (the country of origin is not the same when revisited), replication (recreating the past in the host country, sometimes in a shrine-like fashion), reunion (a nostalgic relationship with the original country), and reparation (a release of creative energy). A noteworthy feature of this first section is the attention to the non-human environment, including adaptation to unfamiliar flora and fauna and the immigrant’s different view of time. It also provides guidelines for the treatment of the immigrant patient, essentially a mirroring and allowance for the stages of adaptation described.

Part II is entitled Being and Becoming and consists of 4 chapters. "Work and Money" addresses the psychological necessity of work and the difficulty many immigrants find in locating suitable employment commensurate with their abilities and interests. The author then addresses the major role of money in the life of the immigrant. "Sex and Marriage" confronts the powerful themes of the place of women and the experience of sexual repression in a more open environment. Marriage, private or arranged, becomes a central issue in the life of the immigrant, whether with a member of the same culture (homoethnic group) or a member of the host culture (heteroethnic group). A separate chapter entitled "Friendship and Socialization" explores the tension between seeking friends from one’s own culture and friends from the host culture. A related and sensitive issue is that of loyalty to the host country, which sometimes is suspected by people in the host country. This is lightly touched upon in poetry that the author has written: "And now, we hum the national anthem, but our pockets do not jingle with coins of patriotism" (p 91). The central role of food is also richly addressed, including emphasis on its availability and variety, often compared to deprivation in the original country.

A final chapter, "Religion and Politics," recognizes these elements as major motives for immigration. Noteworthy is a thoughtful discussion of immigration and its effect on the economy of the host country. Further, there is sensitive discussion of the relationship of the new immigrant with African American citizens. The author makes a helpful distinction between the experience of the immigrant who chooses to change country and the refugee or exile, who may have no choice. Finally, the author writes entertaining and constructive comments on the role of the therapist’s own religion in therapy.

Part III, The Dusk and the Dawn, a largely developmental section, includes 2 chapters. The first, "Encountering Middle Age and Getting Old," centers on challenges of middle age, retirement, becoming a grandparent, and preparing for one’s own death. A difficult decision facing the immigrant at this point concerns burial in the host country or in the original country. A creative solution is cremation, which allows for burial in 2 places. The second chapter, "The Next Generation," considers the challenges faced by the children of immigrants, both those who were born in the original country and those who were born in the host country. A major theme is guilt induced by parents ("We came to this country so that you can have a better life") (p 17). The author also recognizes the particular difficulties faced by Arab and Muslim children after the Twin Towers attack (9/11/01). Four kinds of identity consolidation are seen in the young as they grow up in the host country: ethnocentric (most comfortable with one’s own group), hyperassimilated (renunciation of the parental culture), alienated (not bonded with either culture), and bicultural (flexibly adapted to 2 cultures). Clearly, those most likely to need therapy are the alienated. On the other hand, those who are bicultural fare best. The chapter includes guidelines for the treatment of immigrant youth and concludes with "A Plea for Empathy for Immigrant Parents."

Part IV, The Wounded Healer, considers the challenges of being an immigrant therapist. This is perhaps the most personal and densely analytical section of the book. Difficulty may be faced in maintaining cultural neutrality both with patients of one’s own culture and with those from a different culture. A related and complex issue is the use of 2 languages in therapy.

The Appendix lists and briefly describes films about immigration from 18 countries. The Notes at the end of the book are extensions of or reflections on material in the text. Many are quite instructive.

The book is enriched by vignettes, anecdotes, and quotes from other authors. Some of the richest come from the author’s own personal experience and clinical practice.

Akhtar is a distinguished and prolific psychoanalyst, hence the book’s strong analytic orientation. For the analytically oriented reader, the book presents a coherent and internally consistent discourse on immigration and therapy for the immigrant. For someone who is not analytically informed and inclined, there are passages that are difficult to understand or believe. But regardless of one’s analytic orientation, there remains a treasure of accurate, well-documented, well-illustrated, and often surprising observations of immigrant life. Hence, the book is rewarding to all who are interested in this profound experience, whether they are immigrants or not.

I, for one, being an adult immigrant to the United States, found the book instructive and entertaining. I do not necessarily agree that immigration is a traumatic experience—challenging, yes, but not necessarily traumatic. For the same reason, I am also not sure that the immigrant healer is always a wounded healer. Nonetheless, I recommend this book.

John Racy, MD

Author affiliations: University of Arizona College of Medicine, Tucson.

Potential conflicts of interest: None reported.

Volume: 73

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