Cultural Anxieties: Managing Migrant Suffering in France

By Stéphanie Larchanche

Cultural Anxieties is a gripping ethnography about Centre Minkowska, a transcultural psychiatry clinic in Paris, France. From her unique position as both observer and staff member, anthropologist Stéphanie Larchanché explores the challenges of providing non-stigmatizing mental healthcare to migrants. In particular, she documents how restrictive immigration policies, limited resources, and social anxieties about the “other” combine to constrain the work of state social and health service providers who refer migrants to the clinic and who tend to frame "migrant suffering" as a problem of integration that requires cultural expertise to address. In this context, Larchanché describes how staff members at Minkowska struggle to promote cultural competence, which offers a culturally and linguistically sensitive approach to care while simultaneously addressing the broader structural factors that impact migrants’ mental health. Ultimately, Larchanché identifies practical routes for improving caregiving practices and promoting hospitality—including professional training, action research, and advocacy.

• Language: English
• Publisher: Rutgers University Press
• Release date: Mar 13, 2020
• ISBN: 9780813595399

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CULTURAL ANXIETIES

MEDICAL ANTHROPOLOGY: HEALTH, INEQUALITY, AND SOCIAL JUSTICE

Series editor: Lenore Manderson

Books in the Medical Anthropology series are concerned with social patterns of and social responses to ill health, disease, and suffering, and how social exclusion and social justice shape health and healing outcomes. The series is designed to reflect the diversity of contemporary medical anthropological research and writing, and will offer scholars a forum to publish work that showcases the theoretical sophistication, methodological soundness, and ethnographic richness of the field.

Books in the series may include studies on the organization and movement of peoples, technologies, and treatments; how inequalities pattern access to these; and how individuals, communities and states respond to various assaults on well-being, including from illness, disaster, and violence.

Ellen Block and Will McGrath, Infected Kin: Orphan Care and AIDS in Lesotho

Jessica Hardin, Faith and the Pursuit of Health: Cardiometabolic Disorders in Samoa

Carina Heckert, Fault Lines of Care: Gender, HIV, and Global Health in Bolivia

Alison Heller, Fistula Politics: Birthing Injuries and the Quest for Continence in Niger

Ciara Kierans, Chronic Failures: Kidneys, Regimes of Care, and the Mexican State

Nolan Kline, Pathogenic Policing: Immigration Enforcement and Health in the U.S. South

Stéphanie Larchanché, Cultural Anxieties: Managing Migrant Suffering in France

Joel Christian Reed, Landscapes of Activism: Civil Society and HIV and AIDS Care in Northern Mozambique

Beatriz M. Reyes-Foster, Psychiatric Encounters: Madness and Modernity in Yucatan, Mexico

Sonja van Wichelen, Legitimating Life: Adoption in the Age of Globalization and Biotechnology

Lesley Jo Weaver, Sugar and Tension: Diabetes and Gender in Modern India

Andrea Whittaker, International Surrogacy as Disruptive Industry in Southeast Asia

CULTURAL ANXIETIES

Managing Migrant Suffering in France

STÉPHANIE LARCHANCHÉ

RUTGERS UNIVERSITY PRESS

New Brunswick, Camden, and Newark, New Jersey, and London

Library of Congress Cataloging-in-Publication Data

Names: Larchanché, Stéphanie, author.

Title: Cultural anxieties: managing migrant suffering in France / Stéphanie Larchanché.

Description: New Brunswick: Rutgers University Press, 2020. | Series: Medical anthropology | Includes bibliographical references and index.

Identifiers: LCCN 2019020422 | ISBN 9780813595382 (cloth: alk. paper) | ISBN 9780813595375 (paperback: alk. paper)

Subjects: | MESH: Centre Françoise Minkowska (Paris, France) | Mental Health Services | Ethnopsychology—methods | Emigrants and Immigrants—psychology | Culturally Competent Care | Stress, Psychological | France

Classification: LCC RC450.F7 | NLM WA 305 GF7 | DDC 362.2/10944361—dc23

LC record available at https://lccn.loc.gov/2019020422

A British Cataloging-in-Publication record for this book is available from the British Library.

Copyright © 2020 by Stéphanie Larchanché

All rights reserved

No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, or by any information storage and retrieval system, without written permission from the publisher. Please contact Rutgers University Press, 106 Somerset Street, New Brunswick, NJ 08901. The only exception to this prohibition is fair use as defined by U.S. copyright law.

The paper used in this publication meets the requirements of the American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI Z39.48-1992.

www.rutgersuniversitypress.org

Manufactured in the United States of America

For my daughter, Julia

And for my husband, Zanga

CONTENTS

Foreword

BY LENORE MANDERSON

List of Abbreviations

Introduction

A Day at Centre Minkowska

PART I: THE CONTEXT

1 A Genealogy of Migrant Suffering

2 Transcultural Practice at Centre Minkowska

PART II: REFERRAL NARRATIVES AND ETHICAL DOUBLE BINDS

3 Cultural and Linguistic Difference as Obstacles to Care

4 Managing Migrant Youth

PART III: ETHICALDELIBERATIONS

5 Enacting Cultural Competence

6 Psychotherapy at the Borderland

7 Beyond Anxieties: Praxis

Conclusion

Acknowledgments

Notes

References

Index

FOREWORD

LENORE MANDERSON

Medical Anthropology: Health, Inequality and Social Justice is a new series from Rutgers University Press, designed to capture the diversity of contemporary medical anthropological research and writing. The beauty of ethnography is its capacity, through storytelling, to make sense of suffering as a social experience, and to set it in context. This series is concerned with health and illness, and inequality and social justice, and central to this are the ways that social structures and ideologies shape the likelihood and impact of infections, injuries, bodily ruptures and disease, chronic conditions and disability, treatment and care, and social repair and death.

The brief for this series is broad. The books are concerned with health and illness, healing practices, and access to care, but the authors illustrate, too, the importance of context—of geography, physical condition, service availability, and income. Health and illness are social facts; the circumstances of the maintenance and loss of health are always and everywhere shaped by structural, global, and local relations. Society, culture, economy, and political organization as much as ecology shape the variance of illness, disability, and disadvantage. But as medical anthropologists have long illustrated, the relationships between social context and health status are complex. In addressing these questions, the authors in this series showcase the theoretical sophistication, methodological rigor, and empirical richness of the field, while expanding a map of illness and social and institutional life to illustrate the effects of material conditions and social meanings in troubling and surprising ways.

The books in the series move across social circumstances, health conditions, and geography, as well as their intersections and interactions, to demonstrate how individuals, communities, and states manage assaults on well-being. The books reflect medical anthropology as a constantly changing field of scholarship, drawing diversely on research in residential and virtual communities, clinics, and laboratories; in emergency care and public health settings; among service providers, individual healers, and households; and within social bodies, human bodies, and biology. While medical anthropology once concentrated on systems of healing, particular diseases, and embodied experiences, today the field has expanded to include environmental disaster and war; science, technology, and faith; gender-based violence; and forced migration. Curiosity about the body and its vicissitudes remains a pivot for our work, but our concerns are with the location of bodies in social life, and with how social structures, temporal imperatives, and shifting exigencies shape life courses. This dynamic field reflects an ethics of the discipline to address these pressing issues of our time.

Globalization has contributed to and adds to the complexity of influences on health outcomes; it (re)produces social and economic relations that institutionalize poverty, unequal conditions of everyday life and work, and environments in which diseases increase or subside. Globalization patterns the movement and relations of peoples, technologies and knowledge, and programs and treatments; it shapes differences in health experiences and outcomes across space; and it informs and amplifies inequalities at individual and country levels. Global forces and local inequalities compound and constantly load on individuals to affect their physical and mental health, as well as their households and communities. At the same time, as the subtitle of this series indicates, we are concerned with questions of social exclusion and inclusion, social justice, and repair—again both globally and in local settings. The books will challenge readers to reflect not only on sickness and suffering, deficits, and despair, but also on resistance and restitution—on how people respond to injustices and evade the fault lines that might seem to predetermine life outcomes. While not all of the books take this direction, the aim is to widen the frame within which we conceptualize embodiment and suffering.

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Over one in ten people in France are born outside the country, and with their children, around one-fifth of all people come from immigrant backgrounds, including various former French colonies. The vast majority of immigrants are now from North African, sub-Saharan, and Turkish and Middle Eastern backgrounds, and live in Paris, the tentative end of journeys precipitated by environmental decay, economic decline, violence, and poverty, and by aspirations for different pathways for their descendants, if not for themselves. The routes by which they travel to France are varied—a mix of formal immigration, visa extensions and overstays, and country entry by stealth. Across the city and countrywide, various hospitals and clinics seek to provide mental as well as physical care for people from these diverse populations.

Mode of entry to France, the legitimacy (or not) of continued residence, and economic precarity are not why immigrants end up with mental health problems and in need of acute and ongoing care; likewise, social and cultural backgrounds—differences in faith, tradition, and language—are not reasons for care. People’s care needs mirror those of French citizens, even if in the context of mental health in particular, experiences of extreme suffering in their countries of birth and during and after migration have a particularly strong impact. However, economic and educational disparities, differences in faith and interpretations of distress, and difficulties in communication and comprehension in clinical and other settings all interfere with access to and the uptake and effectiveness of clinical care and advice for people whose lives are made liminal because of their undocumented migrant status and rejection as asylum seekers. People without papers are stuck in a borderland that makes everyday living and sense-making deeply troubling.

Stéphanie Larchanché is the director of Research, Teaching and Professional Training at Centre Minkowska and was originally employed to provide training in cultural competence and to review, support, and evaluate clinical encounters. The Centre Minkowska, the setting of this ethnography, is a transcultural psychiatry clinic in Paris, established by psychiatrist Eugène Minkowski with the aim to improve health-care access by and services provided to immigrants. In Cultural Anxieties, Stéphanie Larchanché explores through the analytic of anxiety the logic behind the center’s establishment and operation, and the reasoning behind migrant patients’ referrals to the center. Center staff must negotiate the provision of culturally sensitive care to patients with French republican ideals of universality. The flow between cultural difference and mental illness and distress leads to a notion of migrant suffering, creating the need for clinics like Centre Minkowska to provide specialized care.

Stéphanie Larchanché draws on both her doctoral research at the center and her later employment at the center—including her most recent work as a psychotherapist in training—to describe and analyze patients’ experiences of everyday life, which constitutes the background that they bring, as clients, to the center. Larchanché writes from the borderland—as an anthropologist outsider and psychotherapist insider. She writes of the borderland, too—of the center as a public health institution and as an NGO operating independently of the state system. The center’s clients are also border dwellers, forced to work around, and often with, the administrative tangles of asylum status; residency; and the rights to work, housing, education, and health care. Caught in the nowhere of state bureaucracy, people are socially marginalized, causing distress for some and compounding preexisting suffering for others. Health-care providers, including in this context psychologists, counselors, social workers, and psychotherapists, work to help clients learn to live with the uncertainties of this borderland life. But as Larchanché illustrates, this is especially difficult when the supportive scaffolding of the state and the NGO is also uncertain, leaving service organizations and agencies to struggle with staff shortages, limited training, and budgetary constraints, which limits access to interpreters to negotiate care and support. Both health-care providers and their clients, and others working to link up services, struggle in this borderland on a daily basis. In this beautifully compelling account of an institution, its staff, and its clients, we engage with the challenges of social suffering, state responsibility, institutional engagement, and contemporary ethics.

ABBREVIATIONS

CULTURAL ANXIETIES

INTRODUCTION

Paris, Winter 2015. Terrorist attacks on the headquarters of the French satirical newspaper Charlie Hebdo have just occurred. The country is shaken, and people across France mourn the journalists who have died. They are upheld as icons of republican freedom and secular values, and the political response is rapid: the current prime minister, Manuel Valls, unveils a plan to fight terrorism and radical Islam at home and abroad, including increased surveillance. Meanwhile, media headlines regularly proclaim that an immigration crisis is hitting Europe, which fuels existing fears linked to economic insecurity and global terrorism.

In this context, Moussa, aged sixteen and from Mali, arrived in France illegally and was referred to Centre Minkowska. Centre Minkowska is a transcultural psychiatry clinic, catering specifically to migrants and located in the seventeenth arrondissement of Paris. It is where I have been working as an applied anthropologist since 2010. The referral letter was sent by a psychologist at the children’s social housing institution where Moussa resided, in an outer suburb of Paris. It mentioned Moussa’s depressive state and integration difficulties. The psychologist and the institution’s educational team were concerned about his psychological fragility and permanent state of sadness: He never smiles. During one interview, the psychologist claimed that he seemed annoyed by her questions about the reasons he had come to France. She noted that his father had died in 2011, and Moussa left his home following a dispute with his paternal uncles about his father’s heritage. He expressed that his priorities were to access professional training, get a job as quickly as possible, and send money to his family back home. She commented that this mission he imposed on himself caused him to refuse any form of enjoyment.

The psychologist’s letter mentioned that Moussa was in a class for non-French speakers and seemed eager to learn. However, the psychologist continued:

Even though he showed an interest to integrate the group further, what we are observing is that he has not established any close relationship with either his peers or adults. He often appears irritable, tending to isolate himself in his bedroom to get away from the group. On a daily basis, we observed difficulties, or even a reluctance to adapt to cultural practices that are different from his. Moussa now refuses to shake hands with women to greet them. In terms of diet, as he only accepts halal food, he simply refuses to consume meat, and during a recent meal, he refused to use silverware and ate with his fingers. This makes Moussa suffer, as he is left with feelings of misunderstanding and even anger towards the educators who regularly try to discuss these issues with him.

Given these observations and Moussa’s apparent reluctance to the idea of opening up to a person culturally different from him, the psychologist recommended psychological support with an ethnopsychiatric approach as appropriate.

Upon reading the referral letter, impressions among MEDIACOR participants—the referral unit at Centre Minkowska—were mixed. (MEDIACOR is an acronym standing for MEDIation, ACcueil, ORientation. The organization and logics of MEDIACOR meetings will be detailed in chapter 2.) Some anticipated that the referral would stigmatize Moussa, whose behavior was likely the object of the housing staff’s anxieties and projected negative representations rather than an actual clinical concern. Others, including Minkowska’s leading psychiatrist, argued that there was no way to ascertain whether that was the case—even though the framing of the referring psychologist’s arguments raised red flags—and that our responsibility was to determine whether Moussa needed our help. He also noted that Moussa, as a recent arrival in France, was unlikely to be seen by a psychiatrist in a mainstream district mental health institution. In the end, an evaluation session was scheduled at the Centre. However, Moussa did not show at this first appointment.

The staff at his housing institution gave no reason for Moussa’s absence, but an educator called the Centre back to reschedule his appointment. On the second try, Moussa arrived in the company of a young educator who was new to his case. As Moussa entered the room, he readily shook our hands—three of us were women, the psychiatrist a man. Moussa said he did not know why he had been sent to the Centre but that he had been compelled by the housing institution’s staff. The Centre’s psychiatrist explained the psychologist’s referral letter, and Moussa was astonished, noting that he had met with her only once. He asked us why she had referred him, and we discussed her concern that he was withdrawn at the residence. He told us that was simply his way of being (c’est ma façon d’être), that he was like that at home, and that he did not need help for it. We then asked questions about why he came to France and about his daily life here. He explained that he was from a village in the Kayes region of Mali, had attended Arabic school, and continued to practice Arabic in private by reading novels or the Quran; he did not want to forget that language.¹ However, he noted that he also reads the Bescherelle, a standard French grammar textbook, to practice French and studies in a French as a Foreign Language (FLE) class, which he finds challenging: the students are all at different levels, and some speak no French. At his residence, he shares a room with a young Pakistani boy who speaks only English, and they communicate using gestures. He revealed that it is important for him to maintain fluency in Arabic because this symbolically ties him to his late father. He told us about poems he wrote in Arabic and then tried to translate into French; the last one he wrote was about a day trip on the Champs-Elysées. Moussa told us that no one at his residence was aware of his writings except for a woman named Aminata, with whom he shared some poems and who once offered him a book in Arabic.

Nothing disturbing emerged from our interview with Moussa. He did not wish to see a psychologist at the moment. Rather, he wanted professional training to become a mail carrier or to work as a security officer, and he reported that he had researched existing job possibilities. At the end of our evaluation interview and with Moussa’s agreement, we asked the educator who had accompanied him to rejoin us. When we asked whether she wanted to relay more of her colleagues’ concerns about Moussa, she timidly confessed that she hardly knew him. She had only recently started working at the residence and was unaware of the others’ concerns. In fact, her impression of Moussa was positive. We ended by telling Moussa he could contact the Centre if he ever felt the need to speak with a mental health professional. After he and his educator left, we spent a few minutes sharing our impressions.

Discrepancies like this are common at Minkowska, and MEDIACOR evaluation sessions were created specifically to address them. That day, we all agreed it was the intersection of the residence staff’s subjective representations around Moussa’s culture, his religious convictions, and his personality that combined to create the psychologist’s portrait of him as experiencing psychological distress. The MEDIACOR team easily identified the influence of social representations from the colonial imaginary, current anxieties around youth radicalization, and clichés about unaccompanied minors on the residence staff’s interpretation of Moussa’s behavior. To the list of things that contributed to Moussa’s mischaracterization by the residence staff, I would add structural determinants, such as host institutions’ lack of resources to provide quality support, the growing number of children within such residences, a high staff-turnover rate, and a critical lack of training to help staff members deal with the complexities around unaccompanied minors. The Minkowska team concluded that in contrast to the residence staff’s assessment, Moussa was experiencing a quite positive acculturation process and employing creative adaptive strategies to maintain relationships with his family and culture of origin, such as writing poetry in Arabic. Moussa was actively cultivating a healthy integration strategy, despite what the professionals who worked with him at the residence seemed to think.

For those of us at Centre Minkowska, it appeared that a combination of the residence staff’s negative social representations, a historically situated context of migrant-related anxiety in France, Moussa’s personal difficulties in relating with others, and a host of structural issues all contributed to the pathologizing of Moussa’s behavior. This raises important questions: How could an evaluation interview with Centre Minkowska’s professionals yield such clearly different results from one by the psychologist at Moussa’s residence? Why did Moussa’s education team send an educator to the appointment who barely knew him and was unable to provide any background information or context for his situation? Equally important, what is the broader social role of transcultural clinicians at Centre Minkowska, who are identified by other institutions as experts in charge of migrants’ suffering? How do these professionals deal with such stigmatizing referrals in their daily practice? How do they define and legitimize their expertise? What are the responsibilities of transcultural clinicians to confront and change the unjust systems of power in which they are embedded?

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This is an ethnography about Centre Minkowska, a transcultural psychiatry clinic where I have been working as an applied anthropologist since 2010. In this ethnography, then, I am both an observer and a participant. I write from a position at the borderland: as a staff member, I am involved in clinical activities, but as an anthropologist, I maintain a commitment to decentered observation of my colleagues, my institution, and my own positionality. This book offers a unique take on how cultural competence is construed and applied at Centre Minkowska, under a republican model that finds it difficult to acknowledge cultural diversity. I consider how the clinical medical anthropology approach and its focus on person-centered care in transcultural psychiatry are deeply intertwined with the Centre’s historical foundations, the personalities of the people who work there, and the constraints imposed by the local public health system. I rely on MEDIACOR meetings—the triage unit for the referral of patients at Centre Minkowska—as a privileged vantage point from which to observe and analyze the enactment of cultural competence. My goal is to analyze how the anxieties experienced by staff at the Centre reflect broader anxieties of contemporary French society and of global society as well. Therefore, my reference to cultural anxieties is polysemic.

First, it refers to anxieties experienced by staff at specialized mental health clinics. By specialized, I refer in my own terms to culturally sensitive clinics catering specifically to immigrant populations. I use this term as an analytic to pragmatically group mental health institutions that cater to migrants regardless of their clinical approach (e.g., ethnopsychiatry, transcultural psychiatry, or intercultural psychology). I describe how specialized mental health experts negotiate tensions between French republican ideals of universality, which downplay differences of race or ethnicity, and their desire to provide culturally sensitive care to their patients. This encompasses the anxieties such agents experience as they work at the edges of the system and seek to fill gaps created by dysfunctional social infrastructures. They intervene in what is known in social theory as zones of abandonment (Biehl 2005). This is particularly true for clinicians working with undocumented migrants and rejected asylum seekers. I use the polysemic notion of cultural anxieties to specifically explore logics behind migrant patients’ referrals to a transcultural psychiatry clinic in Paris, Centre Minkowska. In the research for this book, I discovered that state agents in the mental health field often characterize migrants’ difficult experiences with integration—or simple expressions of cultural difference—as a particular kind of suffering that was not the purview of mainstream mental health but rather the responsibility of institutions like Centre Minkowska. Here I thus focus on how social anxieties may lead state agents to interpret expressions of cultural difference as socially deviant—or as examples of mental suffering or pathology. I suggest that state agents use social representations and discourse to draw parallels between cultural difference and pathology. In doing so, they build legitimate ground on which to validate their ideas about how migrant suffering requires care from expert clinics like Centre Minkowska.

Second, cultural anxieties refers to anxieties that contemporary state agents—across institutional realms—experience when faced with limited means to provide support to newly arrived migrants in the process of regularization and to older residents who continue to face social and economic challenges. With this use of the term, I touch on the limits of the French welfare state and its increasing disengagement from immigration issues since the 1970s and the end of les trente glorieuses, or the thirty glorious years of postwar economic prosperity. Anxieties in this context are about endless administrative delays in processing visas or asylum status, which leave people in states of social liminality; chronic staff shortages, such as those within asylum seekers’ housing centers, which have only one psychologist who visits on one day per week; and budgetary constraints that prevent funding, training, and creating policies for professional language interpreters to work in public services. These anxieties concern both statutory refugees who remain homeless and freshly arrived migrant youth, who often experience traumatic immigration trajectories marked by confusion and constraint. They may not speak French or may find themselves grouped together in an integration class with a teacher who lacks the resources to teach them. This systemic lack of support produces suffering. Without the means to address such structural suffering, state agents—the psychologist working at the asylum seekers’ housing center, the social worker struggling to find emergency housing for a family whose asylum application was rejected—may find it useful to reframe structural suffering as cultural suffering or to rely on experts on migrants in their search for support for their clients.

Ultimately, the anxieties of both clinicians and state agents relate to the broad anxieties French social actors experience in the face of sociodemographic change and economic insecurity. These anxieties have deep roots in stigmatizing representations of cultural difference, formed during France’s colonial past and inherited from scientific discourse produced in the context of both colonial psychiatry and French ethnopsychiatry in the 1970s (for more, see Fassin 2000). Such representations remain common within the French social imaginary, and anxieties have only intensified over the past three decades with increased migration and consequent changes in the French demographic landscape. More recently, certain events have increased these anxieties: suburban riots in 2005 and 2007, when second-generation North and sub-Saharan African youth expressed discontent toward French institutional resistance to their integration; the influx of fleeing Syrians since 2012, which has led to a media-deemed refugee crisis; and terrorist attacks perpetrated by second-generation French Muslims. The French government interpreted these successive events as threats to France’s national identity, and populist parties have capitalized on that. In recent contexts, the latter depicted migrants and their children as the ultimate threat to the nation’s integrity.

Beyond the French context, anxiety permeates many people’s experience of the contemporary world: growing social and economic inequalities favor the rise of populist and nationalist movements in wealthier nations; natural catastrophes and armed conflicts result in millions of displaced people; and global terrorism is invoked daily in news media. In such times of fear and uncertainty, identity politics tend to emerge: Who are we? Where are we heading? Who will protect us? Lines between those who belong and those who do not often harden. While this dynamic is universal, people in each nation or group draw those lines differently and reflect their own histories and ideologies in the process. Race, ethnicity, and religion are common markers of difference, and social representations that have evolved around them—while shaped by historical context—often travel across time. Anxieties that stem from fear in the face of social change or difference are culturally shaped, and almost without us realizing it, they recurrently crystallize around people who are considered other—migrants and their children.

Anxieties are both social and subjective. Specialized mental health centers like Centre Minkowska have become the theater where these anxieties converge and are enacted. While they are part of the system, such centers function at the margins and provide a space where alternative interpretations of suffering are possible and where people’s humanity is acknowledged. As such, they constitute a unique vantage from which to observe social struggles that have economic and political roots; their presence relates to the failure and unwillingness of the state to deal with processes of change that began with the industrial revolution, colonial imperialism, and the onset of labor migration and continue in the present. The centers also provide opportunities to raise questions as to the contradictions and limits of their existence within the national public health system—particularly the constant tension between their mission of care and the regulating system in which they are inevitably caught and in which they indirectly participate. This tension produces a set of anxieties, negotiated daily by specialized mental health professionals, that rest at the heart of this book.

THE RESEARCH

This book is the fruit of two branches of research. The first is my dissertation fieldwork, conducted over eighteen months between 2007 and 2008, in which I compared mental health-care discourse and practice within three specialized clinics in Paris. The second relies on the accumulated knowledge and experience I have acquired during these past years as I practiced anthropology at Centre Minkowska.

During my dissertation fieldwork in Paris from March 2007 to June 2008, the country’s political context was particularly sensitive. I arrived on the eve of Nicolas Sarkozy’s election to the presidency in April 2007. His victory was due largely to a campaign focused heavily on national security and identity. This 2007 presidential campaign capitalized on fears felt by many in the aftermath of the 2005 Paris suburban riots and the resulting negative, stigmatizing representations produced around visible French minorities—youth of North and sub-Saharan African origin—and immigration in general (Tshimanga, Gondola, and Bloom 2009). In the context