It is a complex task to settle successfully in a new country. Revision of your past and reorientation of cultural values may be required and living a life of double standards - retaining cultural traditions but also integrating in the new culture - is stressful. As health professionals we need tools and competencies to assist our migrant patients in finding solutions that respect their needs.
Hybrid humans
A young male refugee received the following paternal advice when reunited in Denmark: You must always be 1000 times better than them to be as good as them. The experience of being part of an ethnic minority that stands outside of the majority of fellow citizens shapes ones identity. One must form an identity of their own and create a life that may essentially differ from the life of ones parents The attitudes, public discourse, and political statements, as well as the press, are forcing individuals to take sides: are you with or against society? This contributes to how one views society, what societal roles one feels pushed into and what roles assumes of oneself. Environmental pressure and demands for adaptation are internalized, even if one does not identify with the values.
Migration has many phases each associated with mental reactions. The first is the arrival phase characterized by emotions such as disorientation, insecurity, grief, loss, guilt mixed with hope and optimism. Then comes a phase of resistance and hostility toward the massive demands of cultural adaptation, language acquisition, education, and work. This phase is followed by a period of attempts to stabilize and integrate, risking defeat, misunderstandings and social exclusion from ones own ethnic group.
The longest and most grueling phase in exile is the long-standing pursuit of normality and predictability, characterized by alternating success in the balance between the rigidity of home country's cultural heritage and the recipient country's massive demands demonstratively exaggerated as it e.g. is seen in the citizenship test, which signals that immigrants seeking Danish citizenship must have detailed knowledge of cultural values that are less clear in the ethnic Danish majority population. Others have described a third culture: in addition to the culture of the home country (past) and the culture of the recipient country (present), there is a multicultural culture (future) or diaspora, where a new collective culture is formed. This requires individual acceptance and decision-making marked by conflicts between generations over language, culture, values, attitudes, and behavior. The conflicts, together with the recipient country's demands for further adjustment, contribute to identity uncertainty, depression, anxiety and divided families. The result may be that migrants decompensate with psychotic symptoms, personality changes and family existence crises, where trauma from home (and flight) mixes with their current situation to a complex re-traumatization, where all demands from the environment are interpreted as abuse.
Hybrid identity
Salman Türk (2018) describes an integration model with emotional phases of migration based on Jung's concept of individuation (the process of getting to know oneself in youth). Türk compares the migrant's integration process with a repetition of the youth's gradual exposure and (re)formation of the 'I'. The model is interesting because many refugees in the Migrant Health Clinic are bored, some even tired of, the hybrid "version" of those that have been created after they came to Denmark.
As for young people, the migrant must (partially) break the relationship with family and parents to find new friends. This offers a rare opportunity to revise one's past (what to take with me and what to avoid). The future can be seen from a new, more individual, point of view where a cultural and value re-orientation is possible. There may be changes in relational ties, gender relations, religiosity, work, and decision-making processes. Migrants, like young people, may need to innovate, change, move boundaries, navigate unknown social contexts learning new rules, languages, and roles. They live in constant adaptation (acculturation) stress between the ego and the stranger/new ones, slowly developing a new third self and their final identity in the new framework. Great emotions must be unfolded, tested and controlled in relationships, just as the fear of failure and social exclusion threatens ones identity. The anxiety of separation, the grief over the lost (safe family, homeland) lurks behind the scenes. The more open relationships outside the family strengthen the possibility of being able to create a new self-image. But the danger is that in the euphoria and fear of failure, a "wrong" hybrid identity is created, which neither the person himself nor the outside world can come to terms with.
The complex identity you form in the new society is not your own - it is a hybrid version neither the individual nor the majority population is particularly enthusiastic about. It is exhausting to live a double life: on the one hand with one's own reassuring cultural values and routines and at the same time play the role of well-integrated, some would say assimilated, individual in the recipient culture. The new identity is a result of management requirements, mostly cultural routines, and the individual's desire to be free from more pressure. Living two lives at the same time erodes the mental bandwidth and increases the risk of burnout, demoralization, and depression. It is a process in which the migrant for years struggles to compensate for the external pressure by separating the two lives lived. But at some point, a de-compensation process occurs with the collapse of self-care, overview, common coping strategies, morale, motivation, quality of life and ultimately the survival drive disappears.
The extent to which one adopts hybrid identity, and the extent to which one experiences a cultural clash, depends on experience and the social network, but also personality traits contribute. The art is to choose the best of both worlds, and it requires cognitive strength and cultural self-awareness that is not always present. Therefore, it is important that healthcare professionals have tools and knowledge about the often-hidden cross-cultural issues and their background, as well as competencies to assist the patient in creating workable hybrid identity solutions based on the patient's needs, perceptions, and opportunities. □