The migrant patient, the doctor and the (im)possibility of intercultural communication: silences, silencing and nondialogue in an ethnographic context

摘要

This paper attempts to reflect on the impossibilities of intercultural communication implied in institutional medical encounters. Drawing from an ethnographic case study among patients of a transcultural consultation for migrants in Portugal, the analysis focuses on the contents and forms of the interaction observed by the anthropologist in the clinical setting. A repetitive pattern of communication between a refugee women patient and her psychiatrist foregrounded the unsaid within the interaction as well as the unwillingness of the refugee to speak about her life with the anthropologist. In this sense, we propose to understand silence as a form of communication pointing to both the condition of the patient but more significantly embedded in the institutional framework of the clinical setting, discursive positions of the participants, as well as their social statuses. Following the theoretical work of Jaworski, Wagner and Winter, our analysis of silence leads us to the critical examination of the question of privilege in intercultural situations pointing to a necessary deconstruction of post-colonial institutional object/subject positions. In practical terms, this challenge corresponds to the work of international cross-cultural psychiatry (in terms of clinical matters) as well as that of biographical research and research on memory among migrants and refugees.