La migration, qu’elle soit volontaire ou subie, reste une épreuve particulièrement éprouvante. Outre les différentes pertes subies, le sujet est pris d’assaut par des questionnements existentiels touchant essentiellement son identité dans son rapport avec des dyades : mêmeté–ipséité, temps–espace, ici–là-bas ; présent–avenir ; illusion–réalité, etc.

À partir d’une vignette clinique issue de notre expérience dans le champ psychiatrique, nous proposons de mener une réflexion sur les déterminismes psychologiques et culturels liés à la question du deuil et des traumatismes. Il s’agit de M. B., admis pour un syndrome anxiodépressif majeur caractérisé entre autres par une tristesse de l’humeur, une perte d’appétit et de sommeil ainsi qu'un ralentissement psychomoteur. Il a arrêté sans motif précis de se rendre à son travail et av perdu ses habitudes de vie (salle de sport, lectures du soir, berceuses aux enfants). Outre le traitement antidépresseur, l’exploration de facteurs étiopathogéniques possibles, comme celui de la trajectoire migratoire, a permis de co-construire avec le patient et son épouse un dispositif de psychothérapie transculturelle où les données culturelles ont servi de leviers thérapeutiques.

La compréhension de ces déterminismes par le soignant permet ainsi de proposer une offre thérapeutique adaptée au patient venant d’un autre univers de sens en tenant non seulement compte des signifiants culturels mais aussi des schémas de pensée auxquels il se réfère par rapport à la question du normal et du pathologique. Cela conduit ainsi à aborder la question du deuil des racines et des racines de deuil en mettant en évidence l’impact des substrats culturels dans une situation d’entre-deux et à enrichir le champ de la clinique inter et transculturelle.

Wars and/or natural disasters have long been sources of trauma. Today, it has been demonstrated that migration can also constitute a traumatic reality. Migration can be an acute traumatic phase for some people, even if not all traumas always have negative effects and not all individuals are at equal risk of traumatization. Whether voluntary or forced, Migration remains a particularly trying ordeal and a crisis, which imposes a logic of breaking historical cultural references, changing social references, a reorganization of identity and a psychological transformation. It involves a loss of cultural heritage and the discovery of new resources and potential. Indeed, people who go into exile lose their home, their kinship, their language, their community and their roots. In addition to the various losses suffered, the subject is assailed by existential questions, essentially affecting their identity in their relationship with dyads: sameness–selfhood, time–space, here–there; present–future; illusion–reality, etc.

Based on a clinical vignette drawn from our experience in the psychiatric field, we propose to reflect on the psychological and cultural determinants linked to the issue of grief and trauma. This case concerns Mr. B., admitted for major anxiety-depressive syndrome characterized, among other things, by moodiness, loss of appetite and sleep, and psychomotor retardation. He stopped going to work without any specific reason and had lost his usual lifestyle habits (sport, reading at bedtime, lullabies for the children). In addition to antidepressant treatment and the exploration of possible etiopathogenic factors, such as the migratory trajectory, it was possible to co-construct a transcultural psychotherapy program with the patient and his wife, where cultural data served as therapeutic levers. As such, the migratory trajectory taken as an intercultural variable can be considered here as one of the etiopathogenic factors of depressive syndrome or other related disorders to the extent that it reactivates the ontological elements linked to the basic personality of the subject and confronts them in another universe, that of the host or adopted country. In this configuration, it was necessary for us to mediate between the maternal uncle and the couple following the example of transcultural mediation developed by Bouznah.

The caregiver's understanding of these determinants will thus allow for a therapeutic approach adapted to the patient from a different world of meaning, considering not only cultural signifiers, but also the thought patterns to which they refer in relation to the question of normal and pathological. This clinical case raises several observations that influence the therapeutic approach to patients in migration situations. The first observation concerns decoding the cultural meaning given to the question of normal and pathological. Indeed, this decoding is based on the premise that “every culture defines categories that allow us to read the world and give meaning to events”. The second observation concerns access to the interpretation of the patient's etiological system. Mr. B indicated that the antidepressant treatments administered to him will not be able to cure his illness. His illness is not natural. It is the consequence of disobedience towards an important symbolic figure: his maternal uncle. The third observation is rooted in the two others cited above and concerns the need to use certain cultural references of the patient as therapeutic levers. Based on the patient's and their family's narrative, a cultural ethos was mobilized to unleash the sacred value of speech within the symbolic order of the patient's culture. The fourth observation concerns the need to determine the profiles and different defensive arrangements of patients belonging to other cultures. This serves as a compass to guide the way in which clinical investigations and the therapeutic proposals that follow will be conducted. This article clearly constitutes one of the gateways to addressing the question of the roots of grief, highlighting the impact of cultural substrates in an in-between situation and enriching the field of inter- and transcultural clinical practice.