Forced Migration And Mental Health: Rethinking The Care Of Refugees And Displaced Persons

摘要

In 1964, Caplan coined the phrase 'the law of the instrument', referring to the idea that if the only tool one has in one's toolbox is a hammer, everything begins to look like a nail in need of hammering. The law of the instrument aptly describes the overarching response of the mental health community to the perceived needs of political refugees during the past 25 years. The massive displacement of civilian populations from Southeast and Central Asia, as well as Latin America, in the 1980s, coincided with the official designation of Post-traumatic Stress Disorder (PTSD) in the DSM III as the universal response to traumatic stress. Reflecting psychiatry's belief in the universal validity of Western psychiatric diagnoses, it was taken for granted that PTSD captured a universal human response to overwhelming traumatic stress, with cultural influences playing a minimal role in shaping post-traumatic stress responses. Perhaps even more importantly, given the horrific violence to which many refugees had been exposed in their homeland, a second assumption was that PTSD was not only a cross-culturally valid diagnosis, but was also the most important mental health issue facing refugees.