The semiology of migration | Revista Colombiana de Psiquiatría (English Edition)

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It is a move that responds to that need for novelty but far more to escaping from a hostile environment for some reason, the nature of which can be diverse. Every migration process occurs in the context of deprivations, humiliations and restrictions people experience which impel them to seek alternatives away from the place they live.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> This has implications, such as voluntary or involuntary social exclusion, which can generate submission to circumstances, predisposing to difficulties in adaptation, psychological alterations or, worst cases, mental disorders.It is not easy to define the concept of migration, as it has many expressions and many ways of describing the experience of moving away from the place of one’s usual life. However, we use the following definition by Delgado as it is comprehensive enough for this article, “Displacement of people or groups from their place of origin or residence to another geographically distant, different place is associated with the expansion of the human being and the fight for survival”.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Today’s migration is an international phenomenon involving a displaced population that can exceed two hundred million people each year. These circumstances can have potentially negative and positive consequences on people’s health and well-being.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>Types of migrationInterest in migration processes in the field of health dates back to the studies of Ödeggard<a class="elsevierStyleCrossRef" href="#bib0025">5</a> in the 1930s in relation to Norwegian emigrants to the United States and the mental health problems they presented. Migration as a human phenomenon includes a very heterogeneous group of people who manifest different responses due to the experience. It ranges from those who are seeking to improve their professional aspirations and those setting off from a favourable starting point because they are responding to possibilities explored or determined beforehand, which they acquire to migrate with the security of knowing their destination and activity, to those who are suffering an urgent need to move to exist and survive due to the impossibility of doing so in their country of origin, migrants in the orbit of poverty, to those who are exposed to life-threatening situations resulting from the sociopolitical conditions of their country of origin, such as refugees, persecuted people, exiles and others, all of whom are particularly vulnerable to suffering from post-traumatic stress. Some migrate for family reunification, or those seeking to expand their knowledge and education migrate to places where they can incorporate academic training, such as students, researchers or academics. Then there are the massive movements of populations which uproot in search and exploration of safer regions, displacements of population groups due to the construction of significant infrastructure works (for example, dams, roads and megastructures), and those who move in search of better economic conditions than in their places of origin. All of them, to a greater or lesser degree, mean a human disaster, resulting in impoverishment, malnutrition, increased morbidity, dependency, breakdown of communities and loss of social capital.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>One important aspect when dealing with the phenomenon of migration which affects considerations about mental health is the difference in the migration experience according to whether it is from a poor to a rich country, between countries with similar socioeconomic conditions or from a rich country to one with worse economic and social conditions.It is also important to clarify the difference between migration, emigration and immigration. Migration refers to moving from one place to another in general terms. Emigration is moving from the place of origin to another distant and different place, leaving the place of origin. Meanwhile, immigration is arriving in a new place, from another different place, and arrival in the host country.Migration termsA series of terms have been constructed in the human imagination around the migratory process, which, although all expressions of migration have very different meanings, evoke different ideas and have different nuances, all depending on the degree of voluntary or involuntary displacement. All of these terms signal the great complexity implicit in the very nature of the migratory phenomenon which has accompanied individuals and communities in their journey through the world throughout human history. If we stop and look at each of these terms, we can see that human beings use the entire arsenal, covering the whole range between love and hate, solidarity and contempt, when referring to the migratory phenomenon. They are a concise record of the human condition and its relationship with its fellow human beings:Exile: being far from one’s natural place as a result of leaving the country voluntarily or forced by some circumstance, generally political.Expulsion: sanction that is applied to a person and consists of forcibly removing them from a country.Displacement: forced migration within the same country.Banishment: penalty imposed by the State consisting of expelling a person from a place or territory.Exclusion: a penalty consisting of the expulsion of a convicted person from a territory for the duration of the sentence.Ostracism: banishment of a citizen who was considered suspicious or dangerous to popular sovereignty in ancient Greece.Proscription: public, official identification accompanied by the banishment of a person as a public enemy.Confinement: penalty that consists of forcing someone to live in a place different from their own within the national territory and under surveillance by the authority.Uprooting: loss of social and family roots which affects personal identity with a loss of essential, cultural and social meaning.Disengagement: undoing or breaking the ties between people or institutions.Relegation: an afflictive penalty that was served overseas in places assigned for that purpose; it could be temporary or perpetual without loss of citizenship.Deportation: perpetual exile with occupation of property and deprivation of civil rights.Expatriation: the temporary or permanent residence of a person in a country other than their own, generally for work or professional reasons.Diaspora: the dispersion of ethnic or religious groups which leave their original place of origin and are spread around the world.Segregation: separation or marginalisation of a social group due to gender, race, culture or ideology.Exodus: the migration or departure of a people or a mass of individuals from a place where they live and are settled for various reasons. It may be considered immigration when it occurs within borders or emigration when it crosses them.All the terms listed express the complex and varied way human beings have managed to affect their fellow human beings in relation to the permanence or separation of people from their places of origin. Whether economic, racial, religious, cultural, ideological or political, human beings have always understood that one of the most painful and terrible punishments can be inflicted is the migratory movement in its different forms.Emotional experiences of migrationThe emotional experiences generated by migration are also broad and varied, but the most common are those described below. No matter how well the migration phenomenon takes place, some of these feelings are always present: sadness, ambivalence, ambiguity, isolation, abandonment, loss, grief, loneliness, frustration, failure, impotence, insecurity, being overwhelmed, experiences or feelings which, as they are difficult to process, can take the form of somatisations<a class="elsevierStyleCrossRef" href="#bib0035">7</a> due to the impossibility of processing them symbolically and resolving them effectively. This accumulation of emotions has been evolving over generations of migrants into a more complex feeling, which is that of “being far away”.Emigration means being far away, at a distance from one’s place of origin or usual home environment, having left for some reason, knowing that you will have no local physical contact with that place for a time or never return. This distance from the people, places and things that are part of our lives until the point when we emigrate awakens particular emotions for which, in the Iberian culture, constantly emigrant for centuries, we have different expressions: nostalgia [nostalgia]; morriña [homesickness]; saudade [yearning]; añoranza [longing]; and murria [the blues]. All these terms can be condensed into one expression, “homesickness”, and they express sadness, pain, absence and distance.Nostalgia, a word of Greek origin coming from the term nostos (home) and algia (pain), is understood as the feeling of pain due to being away from home, it is a pain for home, for not being able to be at home, for being away from the house. It is an intense pain of not having the closeness of loved ones and those you crave much-needed affection from at such a distance and with the loneliness of an unfamiliar place. The specific pain of not being in the place of loving sustenance, pain for home.Morriña [homesickness], a word of Galician-Portuguese origin, comes from two interpretations originating from Latin words. One, from the word mori (to die), which gave rise to the term morrinha to derive over time into morriña. The other is from the word morro, which originates from the Latin word emurria, meaning sadness. It seems that these two terms at some point in their evolution come together to originate and engender the term morriña, which is understood as “dying of sadness”. A feeling that expresses the intense and deep affection that comes with being away from what you love and what will be beyond reach for a long time.Saudade [yearning], that very Portuguese feeling whose origin is in the Latin word solitate, which translates into the feeling of soledad [solitude] in Spanish, in Portuguese soledade, eventually evolving into soidade, and after many experiences, ending up as saudade. However, there also seems to be an Arabic origin for this Portuguese word, as a product of the 700 years of Arab presence in the Iberian Peninsula. The Arabic term sawda (black, black bile, denial or melancholy) would also have given rise to saudade, whose meaning is a “sad loneliness”, a feeling so close to the soul of the emigrant.Añoranza [longing], a word expressing the feeling of Catalan origin, has its roots in the Latin word ignorare, which means to be unaware, not know something, not have any news of someone. In its evolutionary journey Catalan, it became enyorança, which is a feeling of sadness for not having heard from or of someone significant with whom one has an emotional bond. Longing is to miss someone, wish for the closeness of someone you love, but it is also the sadness of knowing the absence is unavoidable, that their presence is impossible. It is the “sadness of the absence” of the presence of the other.Murria [the blues], a Castilian word that hides its roots in the Indo-European term mur, which means mouth and is origin of the word “morro” and the Castilian expression “estar de morros” (to be angry), becomes in Latin the word moerare, which means being sad, isolation, melancholy. Murria is then understood as that feeling of sadness and isolation mixed with anger. It is a “being sad, isolated and angry” at such a distance and with the remoteness of a foreign and unfamiliar place.In summary, it could be said that the emigrant experiences feelings connected with being far away: the pain of home of “nostalgia”; the dying of sadness of “homesickness”; the sad loneliness of “yearning”; the sadness at the absence of “longing”; and sadness and anger due to isolation of “the blues”. We cannot ignore that all these feelings that we attribute greatly to people who emigrate to another place also affect, to some extent. However, probably with less intensity, those who stay behind, from whom the emigrant has separated.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> As a metaphor for this, we should think of the character of Penelope, Ulysses’ wife, who restlessly waits for her husband to return home after years of absence and who shows with great precision the deep feelings of absence and longing narrated in The Odyssey.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>Migration processesEmigration as a human phenomenon has consequences for those who undertake this move away from their place of origin or habitual residence. Emigration is a process subdivided into several processes that can be seen either as a linear sequence of events or a transverse sequence happening in parallel in people who emigrate. These processes involved in migration are:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Separation: the separation of people and places forming part of the usual day-to-day life of the individual, whose emigration means physical and temporal distance (people and places), which makes contact difficult but does not necessarily eliminate contact by some means.</li><li class="elsevierStyleListItem" id="lsti0010">•Severance: a severing of contact, relationships and communication with the place of origin and people as a consequence of extreme situations of emigration that make it necessary, for security or the implicit risks, to cut the ties of the past. This does not mean that it is definitive, it is generally temporary while things are consolidated and certain goals are achieved which provide security and guarantees for reconnection.</li><li class="elsevierStyleListItem" id="lsti0015">•Acculturation: a process that results in a person or a group of people acquiring a new culture or at least some aspects and characteristics of another culture different from that of origin. It is a natural phenomenon which happens when two different cultural references come into contact, and this involves changes in both cultures. Generally, one of the cultural groups has more dominance over the other and generates acculturative stress. This can happen due to colonisation processes in which people from the subjugated or dominated culture adapt (acculturate) by incorporating dimensions of the dominant culture. In the case of emigration, this process happens in the opposite direction, the migrant is the one who arrives and incorporates aspects of the host culture.<a class="elsevierStyleCrossRef" href="#bib0055">11</a></li><li class="elsevierStyleListItem" id="lsti0020">•Deculturation: process through which there is some cultural loss when someone or a group of individuals have progressively left behind cultural characteristics they possessed or had acquired at some point. In the case of emigration, it represents the loss of aspects of the culture of origin when living in another culture into which one arrived as an immigrant.</li><li class="elsevierStyleListItem" id="lsti0025">•Enculturation: a process in which an established culture teaches and illustrates to a person, formally or with the repetition of its norms and values accepted by the community, the fundamental aspects of that culture. The intention of this is that the person from another culture can become an accepted member of society and find an appropriate role in it. It generally focuses on showing what is appropriate and not accepted in the social framework, it is a contextualisation of limits. In the case of emigration, it refers to the teaching programmes that the host countries provide free of charge to migrants for the language, the laws and the political system for example.<a class="elsevierStyleCrossRef" href="#bib0060">12</a></li><li class="elsevierStyleListItem" id="lsti0030">•Transculturation is related to the process by which a social group, a people or an ethnic group receives forms of culture from another to the point where they can partially or completely replace their own customs, habits or patterns. In the case of emigration, they are those two-way changes that occur between emigrants and the host places through which both adopt customs from the others.<a class="elsevierStyleCrossRef" href="#bib0065">13</a></li><li class="elsevierStyleListItem" id="lsti0035">•Communication: this human dimension is interfered with by emigration, first of all, by the language when it is different from that of the country of origin or, although the same language is spoken in the host country, the idiosyncrasy of its interpretation is different. Changing cultures and countries implies that the cultural communication processes carried out in one’s own culture become processes of interpersonal intercultural communication, which involve overcoming cultural borders to access new cultural horizons.<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a></li></ul>Migratory griefEvery migration process generates grief, a grief which is different from other types of mourning and has its own characteristics. Migratory grief involves an individual dimension of the person who left, it becomes a collective mourning shared with the people in their relational world and can even extend beyond the limits of the individual and become a transgenerational mourning when it is not adequately resolved in the first generation (those who actually emigrated). Unconscious delegations of the ego, the id and the superego arise,<a class="elsevierStyleCrossRef" href="#bib0080">16</a> or invisible loyalties appear<a class="elsevierStyleCrossRef" href="#bib0085">17</a> which are demanded of future generations as a toll from the family past, or it also becomes a family secret when the origin of the reasons for emigration has not been clearly passed on or is hidden for guilty, shameful or fearful reasons.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>Causes of migratory griefThe most common causes of migratory grief are loneliness, the feeling of failure, the fight for basic survival and the fear and dread they have had to go through in threatening situations due to mafias, authorities and other circumstances. Those who are at greatest risk of their grief becoming pathological are those who travelled to live and work in another country and only ended up in conditions of exploitation and isolation. Those seeking refuge from hunger, violence and political unrest. Those who, due to the urgency of the situation and with the consequent lack of preparation, have to decide to emigrate quickly and suddenly. Those who face the unexpected risk of death. As a life-changing process, emigration involves a series of losses and gains. This means a process of having to work through difficulties and risks, which make it a risk factor for mental health. It is also grief that becomes a paradox: how to mourn what you decided to leave?Loneliness is one of the most potent aspects for generating grief, as leaving the family, separating from loved ones, small children, and older or sick parents who cannot be taken to the new place or cannot be visited for different reasons catapult the individual into unavoidable pressing loneliness, highlighting the importance of ties and attachment and the pain of separation, which cannot be resolved in the short term.The feeling of failure is closely connected with the fear of failure of the migratory goals, and the hopelessness felt when the migrant does not achieve even the minimum conditions that might open up opportunities and help pave the way towards obtaining documentation, work and decent conditions after the physical and financial investment they have made in migrating. Added to this feeling of failure is the painful and shameful point that returning to your homeland as a failure becomes even more difficult. Then migrants find themselves in a kind of existential trap, which can paralyse them and cause them to become marginalised and socially excluded, a situation worse than the one they had in their country of origin.The fight for survival is the unavoidable fate of any emigrant in any context. Obviously, there are different degrees of survival depending on each person’s specific circumstances. However, those in extreme situations are the ones who suffer the most from the need to fight for their survival. This often affects nutrition, with undernourishment a constant among emigrants due to the poor quality of their food and lack of a balanced diet. Finding housing is another problematic survival aspect, leading to overcrowding, with the associated stress, lack of privacy and, in the most extreme case, having to live on the street.Fear, that permanent companion of the emigrant, commences with the uncertainty of what is to come, continues with the frequent physical dangers they have to overcome during the journey, heightens with the life-threatening situations they face while travelling and reaches its peak in the threats, coercion, blackmail, harassment and humiliation which attack their psychological and mental integrity.<a class="elsevierStyleCrossRefs" href="#bib0095">19,20</a>The particular nature of migratory griefIn migratory grief, there is a series of circumstances which make it very particular and different from any other type of mourning. This is because migration is a life-changing phenomenon and, as a process of change, it involves gains and losses, but not always with a healthy balance between the two.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> Migratory grief has its own particular features and they are characteristic of the situation: partiality, recurrence and multiplicity.<a class="elsevierStyleCrossRef" href="#bib0110">22</a>The partiality is implicit in a concrete fact: the country of origin does not disappear, the separation is partial, an absolute and definitive break does not occur, and it is not, therefore, an irreparable loss. Except in extreme situations, there is the opportunity to re-establish contact, return, visit the country again, and this is a and real possibility. As a partial phenomenon, separation is stressful in nature, as the individual is not exposed to the blow of a complete loss. Partiality is then a substrate for ambivalence, ambiguity and confusion, which are accompanied by a great deal of anxiety and can have a dissociative character. This is because partiality requires a reorganisation of temporal and spatial dimensions, which the migrant knows exist elsewhere and that they belong to, at least in the imagination, and that feel like a weight that is difficult to let go of and to experience as a parallel reality. Questions like, “What are my family, friends, etc., doing right now?”, or, “At this time, I would be walking along the esplanade in my town?”, can be part of that parallel world, which is happening in another place that the emigrant accesses through their imagination and fantasy as a way of being present from afar without being there.Recurrence sets in as a consequence of the persistence of the ties with the country of origin. When fantasies and longings fuel this bond to return to their homeland again, the mourning can become challenging to resolve. If the person thinks, longs and fantasises about returning, how do they accept a loss that has not occurred in its entirety? Return fantasies in principle, may contain a function that protects the person from the impact of distance, isolation, loneliness, helplessness and other feelings in the grieving process. However, today, more than ever, recurrence, which in other eras could last for a time because the chances of returning were often remote or communications were very precarious, has become almost permanent, as the possibilities of travelling are greater. Communication is easier and more effective for revitalising ties and maintaining contact with the culture in the country of origin.The connection with deep-rooted childhood aspects is another important characteristic. Early childhood is a time of great sensitivity in human beings, as that is when links are made with those close to us, language, landscape, social group, culture and beliefs. Events are experienced with a conditioning power over the way the personality is constructed. When the person emigrates, they are already conditioned by what they experienced in childhood, and depending on how their adaptive skills have been built, they will also come forth in the new circumstances. Relationship fragility, the capacity for frustration, the management of attachment, working through separations and desertion, and many other relational aspects will be activated in the way in which they were incorporated during development when working through current circumstances.The multiple nature of changes involved in the migratory grief process does not occur in any other type of grief. It includes at least seven types of loss: family, language, culture, land, social status, contact with the group of origin and risks to physical integrity. As Achotegui suggests, not even the death of a loved one entails so many changes and variables. To these losses, we add an eighth, which has to do with temporality, the loss of the past or at least the continuity of the narrative of the past in another time and another place, due to commencing life in a place where one does not have a lived past, an aspect that we analyse later.The defence mechanisms of the emigrant in migratory griefGrinberg and Grinberg<a class="elsevierStyleCrossRef" href="#bib0115">23</a> state that “being an emigrant is very different from knowing that one has emigrated. It involves fully and profoundly assuming the absolute truth and responsibility inherent in that condition. Recognitions of this type belong to a mental and emotional state that is difficult to endure. This explains the need to resort to multiple defensive mechanisms, to remain only in the knowing and not in being emigrants”. Migration is such a long process that perhaps it never fully consolidates, and, as the authors say, it is similar to the loss of an accent that is never wholly lost. The insecurity experienced by emigrants who have recently arrived in another country is primarily determined by uncertainties, anxieties and anguish in the face of the unknown and by the unavoidable regression that these anxieties cause. The regression makes the emigrant feel helpless, which inhibits and even stops them from effectively taking advantage of the resources they carry in their baggage. This is why the emigration process has a psychological impact that awakens and sets off different defence mechanisms, which can impede adaptation to reality and interfere with properly processing grief. The following are representative of this process:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0040">•Regression: regression to more primitive levels of mental functioning are common in emigrants. It is a way of avoiding contact with reality in a mature and realistic way. It involves dependent childish behaviours, complaints and tantrums directed at social and health services as substitutes for their absent distant support network. This frequently leads to over-diagnoses of anxiety and depression, when in reality, they are conditions of a reactive, impulsive and regressive nature that emerge in situations of very acute stress with overwhelming anxieties that fuel the “acting out”.</li><li class="elsevierStyleListItem" id="lsti0045">•Denial: expressed in statements such as “everything is the same as in my country”, “there’s no difference with my country”, “everything’s different in my country, but that doesn’t bother me”, “I haven’t noticed any difference from how people live in my country”. Statements like these show how the emigrant can distort reality to avoid the pain, but all they are doing is increasing their level of emotional confusion.</li><li class="elsevierStyleListItem" id="lsti0050">•Projection: the mechanism by which everything bad is in the culturally different other, which generates xenophobic attitudes, racist behaviour, and discriminatory actions, all of them based on the consideration that the other or others are repositories of defects, deficiencies and cultural and social abnormalities, which are simply different. It translates into expressions which constantly compare the benefits of the culture of origin against the simply different aspects of the host culture. “In this country, they don’t know how to cook”, “this is a country of aggressive people”, and many others that can be exemplified show the projective nature of many of the emigrant’s complaints, manifesting themselves as a defence against difficulties in adapting.</li><li class="elsevierStyleListItem" id="lsti0055">•Idealisation: it alters reality, both of the country of origin and sometimes of the host country. It is often intolerable or burdensome for the emigrant when they find it challenging to adapt and incorporate into the host society. Everything in their home country was wonderful, perfect and certainly better than they found in their host country. Or quite the opposite, the host country is extraordinary and far superior in everything to the country of origin.</li><li class="elsevierStyleListItem" id="lsti0060">•Ambivalence: “Sometimes, migration can revive the Oedipal triangular situation between the two countries, as if they symbolically represented the two parents against whom ambivalence and conflicts of loyalties resurface. Sometimes, it is experienced as if they were divorced parents with fantasies of having established an alliance with one of them against the other”.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> This ambivalence is shown in the emotional contradictions the emigrant frequently manifests when faced with events and situations requiring some commitment, such as identification with national symbols. Following the experience of leaving their land, their feelings of love for their country and culture connected to their first ties are contrasted by feelings of rage for having had to leave their land. This dimension of ambivalence is linked to primitive aspects of development in the sense of evoking the mother’s abandonment. It is experienced with the longing for her presence and with the rage about her absence, as if the country of origin had been a bad, neglecting mother and the host country, which is hostile, is simultaneously a good, welcoming and protective mother.</li><li class="elsevierStyleListItem" id="lsti0065">•Reaction formation manifests itself in hyper-adaptive behaviours and denial of original traditions. The emigrant acts contrary to their impulse dictates, even adopting against their will behaviours, which are absolutely inappropriate in their culture. This generally has a high cost in anxiety, which is frequently somatic and overcompensated in the symptoms.</li><li class="elsevierStyleListItem" id="lsti0070">•Rationalisation: different types of justification for emigration which have nothing to do with the real reasons, which can be humiliating. When an emigrant does not wish to reveal or needs to conceal what really drove them to emigrate, whatever those reasons may be, they develop rationalising and credible explanations to safeguard against the risk of their background being discovered.</li><li class="elsevierStyleListItem" id="lsti0075">•Dissociation: with the intensity of the emotions generated by their new life experience and the negative and destructuring emotions, the emigrant often chooses to make a separation between their idea of emigrating to obtain a better life and the painful experience of the emigration itself with its many problems. To avoid that connection, ideo-affective dissociation is necessary.</li><li class="elsevierStyleListItem" id="lsti0080">•Split: as when origins are denied and the original cultural identity is rejected or when adaptation is so difficult and persecutory ideas of rejection begin to be projected, which can lead to delirium. The ego suffers a fracture, resulting in psychosis with essentially paranoid symptoms.</li></ul>With these defence mechanisms in action, which can occur in people without any previous disorder or history of predisposition, the emigrant can gain time to mourn the losses that the phenomenon represents. If the emigrant is not able to deal with the process and the defences remain in place, this can lead to a psychopathological response, which may vary from depressive disorder to psychosis.Transgenerational griefIn the migration process, grief can transcend the limits of the emigrant’s experience and be projected into the future to subsequent generations. This happens due to the identification that the children of emigrants make with the figures of their parents and through contact with and internalising their cultures of origin.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> This is a more complex type of mourning and causes a higher rate of mental disorders in the descendants of first-generation emigrants. The experiences of pain and loss do not seem, in some cases, to be exhausted in the person of the emigrant, and especially when they are not adequately worked out, they are transmitted to the next generations.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> It is a harmful transmission in which untransformed, unrepresented elements are transmitted, which invade the psychic field and block the transmission of thought, and the psychic material of the experiences of uprooting is projected to children and grandchildren of the subjects who have emigrated and becomes an alienating psychic experience.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> The parents deactivate their role as guarantors for the child in the sense of facilitating the search for psychic truths, and these are replaced by what the parents say or do not say.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> Then, the children cannot appropriate their desires, and an alienating identification occurs, establishing a continuity of identifications that crosses the generations. In other words, an experience of loss is transmitted, which is not worked through and affects the sense of identity from generation to generation. This can be seen in children and grandchildren as feelings of being uprooted, disorientation, and not finding themselves, ultimately affecting their sense of identity.In emigration, the person’s adaptive capacities can be overcome by contextual demands to which the person does not know how to respond or cannot respond effectively enough to neutralise or work through them. This can disorganise the psychic balance<a class="elsevierStyleCrossRef" href="#bib0135">27</a> and lead to a process of denial, which is then transmitted to subsequent generations.In the first generation (the parents), those who do not work through their emigration experience turn that experience into something “unspeakable”, which remains psychically present. However, they cannot talk about it. They fail to construct a mental representation of the words to express the experience. However, it tacitly leaves a mark on the children who have not directly lived through that traumatic experience. The unprocessed experience of the parents is separated from their ego, in some way, that split-off part is installed in the children’s psyche. What was unspeakable in the parents is no longer configured as such in the children but instead becomes something “unnameable”; that is, it cannot be the object of verbal representation. They do not know the contents of these elements the parents keep separated, but their presence is suspected or sensed, like a questioning feeling, that challenges the individual’s tranquillity, as if they are missing knowledge about something.In the third generation, they are no longer aware of what was split off and not worked through. The very existence of the events they did not experience or know from the story makes it “unthinkable”. They do not know of the existence of a trauma that has not been overcome. Still, it acts as a subtle and insidious secret and tacit contamination articulated with the unconscious and has the power to access the individual’s psyche.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> The member of this third generation, who may be the grandchild, may perceive sensations, emotions or impulses that seem strange, not explainable by their own psychic life or by their family life.<a class="elsevierStyleCrossRef" href="#bib0145">29</a>Somehow, the pain of unresolved losses seeks its place in intergenerational dynamics and finds a way out into the transgenerational dynamics of family life,<a class="elsevierStyleCrossRef" href="#bib0150">30</a> to finally express itself in symptoms which affect people far removed from the primary experience. Failure of the parents to work through migratory grief leaves a mark which increases the disturbed and self-destructive potential in children and grandchildren that affects their ego functioning. It is not uncommon to find feelings of not belonging to one place or another, with the distillation of an experience of existential emptiness that steers behaviours towards introversion, maladjustment to the environment, and the constant feeling of being uprooted. This is why it is so important to work through the process of migratory grief in the first generation of those who experienced it.The seven lossesThe difficulties the emigrant has to overcome from that “being away” we mentioned earlier can be condensed into one, which involves finding “their place” in the new community and society to recover the position in life (social, professional, work, etc.) that they had in their place of origin. In the new place, no one knows them; they feel like an anonymous and disconnected individual, exacerbating their inner insecurity. Even the locus interius that Saint Augustine said,<a class="elsevierStyleCrossRef" href="#bib0155">31</a> which is the territory of personal intimacy, is filled with the recurrent dreams that emigrants have, which deal with the difficulty of finding a place. The disorientated being that is the emigrant feeds on the feeling of loneliness, on the experience of isolation that intensifies the feeling of loss, on the experience of abandonment that remoteness induces, without having anyone close to turn to for support in working work through it. Under these conditions, according to Calvo,<a class="elsevierStyleCrossRef" href="#bib0160">32</a> the emigrant has to make a huge, extraordinary effort to endure and cope without allowing devastating feelings, the pain of what has been lost, to culminate in a breakdown. That in addition to being aware of the need to make huge efforts to continue responding adequately to the demands in hand. There are a number of losses, seven in particular, that Achotegui<a class="elsevierStyleCrossRef" href="#bib0165">33</a> believes occur in emigration and cover a wide spectrum of the person’s existence:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0085">1.Family and loved ones. Children, partners, parents, relatives. Not knowing when they will see them again. Not coming back for a long time or ever. Difficulty getting emotional support far away. Grief in this context is experienced in two dimensions: one part of the grief is activated by what the person leaves behind, loved ones far away, and the other is the effort required to adapt to what is coming, such as the search for new affective relationships.</li><li class="elsevierStyleListItem" id="lsti0090">2.Language. The loss of the everyday experience of the sound of the language, not knowing the local language, is an experience that must be worked through as part of a grieving process. Not knowing the local language causes adaptation difficulties, and in everyday life, it makes it challenging to deal with basic situations (transport, doctor, market). “The limits of my world are the limits of my language”, said Wittgenstein, and according to a Czech saying, “To lose your language is to lose your soul”. A kidnapping in the middle of another culture.</li><li class="elsevierStyleListItem" id="lsti0095">3.Culture. In a broad sense, it is a way of understanding life and existence. Culture brings together customs, the meaning of life, beliefs, religion, music, food, festivals, and many other things. This means working through the pain of losing or reducing ties with one’s own culture of origin and, at the same time, the effort to connect with and adapt to the new culture.</li><li class="elsevierStyleListItem" id="lsti0100">4.Land. Landscapes, colours, smells, temperature, luminosity of the environment and background sounds are dimensions of reality which have emotional correlates that affect the emigrant when they disappear from their everyday lives. The person is faced with a different and unknown world. The absence of these elements, which they cannot access, from what was part of their world has an impact on their emotional world and, above all, on the process of adaptation to the new environment. The distance from these emotional places that constitute identity generates stress, loneliness, and isolation.</li><li class="elsevierStyleListItem" id="lsti0105">5.Social status. When people emigrate, they usually seek, among other things, to improve their social status, not only financially, but also the possibilities of access to cultural goods, expression, etc. Among these possibilities are access or lack of access to specific opportunities (work, housing, health services, migrant status). It is common for their social status to be higher in the place of origin, so arrival in the host country only offers frustration. When they do get a job, it is often different from their profession, contributing to more significant difficulties in adaptation.</li><li class="elsevierStyleListItem" id="lsti0110">6.Contact with the social group. It is related to the fact that people identify with a group they feel they belong, which contributes to constructing their identity. When they emigrate and are far from their group of origin, they feel the break with a part of themselves that has been left far away. This experience of not belonging to a group in the host country alters personal identification and one’s social identity. Being the stranger in the new place exposes you to that anthropological disposition that shows all human groups have prejudices against other groups. These prejudices can be the basis from which feelings of rejection, racism, xenophobia, discrimination, contempt and other harmful thoughts can arise, which make the process of mourning for the decrease in or loss of contact with the group of origin more painful, if possible, and this is intensified by having to go through the stress of making ties and integrating with a new group, which is often reluctant and evasive towards the stranger.</li><li class="elsevierStyleListItem" id="lsti0115">7.Risk to physical integrity. The migratory journey is long, dangerous, full of uncertainty, without documentation and involves physical and mental abuse by traffickers, authorities and assailants, hunger, dehydration, frostbite, animals, etc. Emigration involves risks and often hostile changes. All of this generates insecurity and a lot of uncertainty. The emigrant has to deal with the grief associated with the reduction in or loss of physical safety they may have felt in their country of origin and face up to the new risks that need to be combated and the consequent dose of stress.</li></ul>In addition to the losses cited by Achotegui, we consider it necessary to signal two others who, in the experience of emigrating, blend in with the other seven and go unnoticed. They are existential and ontological in nature, but no less important than those of a physical nature:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0120">8.Past. Emigration is a break with the past. Life before emigration was one, and now, a new existential dimension begins. The discontinuity of a time in a place provokes a rupture of the existential discourse until now and opens time to a new narrative of existence. In this new context of the host country, the old narratives of the past lack effectiveness, cease to be operative and fade away. We are in a context, and the context shapes a large part of who we are. In our past, we were one way, and now the new context requires us to be another. This involves a type of mourning that is not easy to bear because it begins a different way of living, being and existing in the world with different others.</li><li class="elsevierStyleListItem" id="lsti0125">9.Loss of previous identity. Due to emigration, the person with a certain identity corroborated and nuanced by the presence and gaze of the others with whom they lived and interacted now cannot be brought up to date in the encounter with new people. The person is an unknown and a stranger that the others do not recognise. They see the emigrant as someone with no clear identity to them. The emigrant, therefore, has to face a fact: they will have to co-construct their new identity with what they bring from their world and what they can rescue from the relationships they will start building in their new place.</li></ul>So many losses make migratory grief a process which is only understandable if we use a metaphor; it is a rebirth, with everything that rebirth implies for a human being: a new place, a new time, a new world, new others, a new life, but above all, a new existence.Factors that predispose to mental disorderAccording to Bojorquez,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> there are two possible paths of association between migration and mental health, one that establishes a causal relationship and sees the phenomenon of migration as a risk or precipitating factor for the development of mental health problems, and another that considers that with migration a human natural selection takes place; emigration would be a self-selection phenomenon which maintains that people with mental health problems are more likely to migrate.The explanations for why migration can cause mental health problems can be interpreted from at least two perspectives. One considers Pearlin’s stress model,<a class="elsevierStyleCrossRef" href="#bib0170">34</a> which emphasises the individual’s ability to respond to stressful situations, considering personal capabilities and the primary and secondary stressors to which they are exposed. Migration as a stressful event tests the ability to cope with different stressors, such as separation from loved ones and adaptation to a new society. This requires the mobilisation of individual capabilities and sources of social support. In the absence of resources, the conditions can be created to develop mental health problems. The other approach would consider the accumulated stress<a class="elsevierStyleCrossRef" href="#bib0175">35</a> that the complexity of migratory grief would generate in the person. The difficulties of adapting to the new country due to the distance from family and friends, language difficulties, lack of work, discrimination, exclusions, etc., maintain a level of stress that lasts over time, and its penetrating, lasting and constant nature would work away, accumulating intensity like a snowball.<a class="elsevierStyleCrossRef" href="#bib0180">36</a>It is also necessary to consider how people carry through the process of adaptation to immigration. The adaptation process can follow different pathways<a class="elsevierStyleCrossRef" href="#bib0105">21</a>: integration, through which the person preserves their own cultural aspects and incorporates those of the new culture; separation or resistance, in which a rejection of a new culture occurs and the elements of identity with the culture of origin intensify; assimilation, which involves abandoning one's own culture in favour of adopting dominant cultural components in the host society; and marginality, which is the distancing and exclusion from both one’s own culture and the host culture. These adaptation processes are frequently subject to different vulnerability factors,<a class="elsevierStyleCrossRef" href="#bib0105">21</a> which influence the type of outcome. Authors like Bhugra<a class="elsevierStyleCrossRef" href="#bib0185">37</a> suggest a series of such factors:<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0130">•Pre-migration factors include the age of migration, life cycle, gender, personality type, skills deficit, language, occupation, conditions before displacement such as persecution, being forced to migrate, previous expectations and opportunity to prepare for leaving.</li><li class="elsevierStyleListItem" id="lsti0135">•Migration factors: losses that emigration represents, types of grief involved, the presence of post-traumatic stress, how the adjustment goes once in the host country, the type of stresses that have to be faced in the field, how the new social world welcomes them (for example, acceptance, discrimination, rejection or ambivalence).</li><li class="elsevierStyleListItem" id="lsti0140">•Post-migration factors: how they cope with the culture shock, the cultural conflict, the possible discrepancies between their previous aspirations and their later assessment in terms of satisfaction or failure, the chances of recovering their normal levels of functioning before emigration, the balance between the welcome that facilitates integration and the rejection that comes from discrimination.</li></ul>These vulnerability factors, which put people at greater risk of developing disease, can be compensated for and balanced on the scales with protective factors which modulate the impact of the process, such as the voluntary prior preparation the emigrant may have made before setting off on their journey, the social support they receive in the host country, the socioeconomic and cultural advantages they obtain once they are an immigrant, stability in every sense. In most cases, as Gonzalez-Rábago says,<a class="elsevierStyleCrossRef" href="#bib0190">38</a> the adaptation process of the emigrant to the host country is considered an integration process, which includes quantifying adaptation parameters to the receiving society as a place of integration. However, the author proposes a process where the society of origin and the bond the immigrant maintains with it should be considered. It makes evident that the integration perspective needs to be broadened. The perspective of origin and the subjectivity of the immigrant person should be incorporated. Hence, they become actors who can question, decide and transform the patterns and contexts in which integration occurs. This is corroborated by studies showing that belonging to an emigrant group with a large and robust presence in the host country becomes a protective factor against mental illness.<a class="elsevierStyleCrossRef" href="#bib0195">39</a> The incidence of psychotic disorders seems to be higher among immigrants who live in neighbourhoods where the representation of the ethnic group they belong to is deficient compared to the rest of the people.<a class="elsevierStyleCrossRefs" href="#bib0200">40,41</a> Under this new perspective, it is possible that vulnerability and risk factors could be significantly minimised so that the potential for mental symptoms and disorders does not lead to a mental disorder. These aspects have been studied extensively in the Latino immigrant population in the United States by William Vega, who found a relationship between perceived discrimination, accumulated stress and mental health consequences,<a class="elsevierStyleCrossRef" href="#bib0210">42</a> with a higher prevalence of mental disorders in Mexican immigrants than in the local population<a class="elsevierStyleCrossRef" href="#bib0215">43</a> and greater alcohol consumption in migrant adolescents.<a class="elsevierStyleCrossRef" href="#bib0220">44</a> Also worth highlighting are the contributions of García Campayo’s group on immigration and psychopathology<a class="elsevierStyleCrossRefs" href="#bib0225">45,46</a> in relation to emigration in Spain.It should be noted that there are positive aspects of migration which, in terms of the host places, result in greater intercultural and transcultural communication and other social and economic phenomena, which benefit the whole society. At an individual level, this results in the long-term in, the emigrant achieving a final situation better than the one they left in their place of origin, where their social and economic conditions were generally precarious. It is also worth noting the phenomenon of the Hispanic epidemiological paradox that Hispanics in the United States show better levels of health than the population average, in contrast to what we might expect, as their socioeconomic indicators are lower than those of the population as a whole. However, it is not within the scope of this work to explore that area.Pathological and psychopathological processesSymptomsThe most common and frequent symptoms immigrants may develop as an expression of their adaptation difficulties are many and varied: anxiety, insomnia, nightmares, apathy, hypochondriacal fears, tachycardia, tachypnoea, generalised pain, gastric discomfort, reflux, irritable bowel, weight-loss, headache, asthenia, adynamia, generalised fatigue, dizziness, vomiting, sadness, irritability, substance use (alcohol, psychodysleptics), loss of interest, anhedonia, attention and concentration difficulties, memory failures, ideas of disability, ideas of guilt, musculoskeletal somatisations and dissociative symptoms (confusion, spatio-temporal disorientation, dissociative fugues).Clinical profilesThe medical literature identifies the following clinical profiles or disorders associated with the pathological processes typical of emigration:<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0145">•Stress disorder is a clinical condition of an adaptive nature associated with the acculturation process, acculturative stress or what some authors called “psychological distress syndrome”<a class="elsevierStyleCrossRef" href="#bib0235">47</a> at some point. Migration is a process of organic transition that inevitably impacts a person’s development. It means a readjustment in the person's entire life and existence<a class="elsevierStyleCrossRef" href="#bib0240">48</a> which, if it fails, generates stress as an experience in which the individual feels that the demands of the environment exceed their resources to cope.<a class="elsevierStyleCrossRef" href="#bib0245">49</a> According to a study by Patiño Rodriguez et al.,<a class="elsevierStyleCrossRef" href="#bib0250">50</a> males and females react differently to migratory stress; females tend to use avoidance strategies more, ultimately leading to depressive symptoms.</li><li class="elsevierStyleListItem" id="lsti0150">•Post-traumatic stress disorder: one of the most frequently diagnosed in the immigrant population, particularly when the migratory process has been tainted by extremely grim, threatening or catastrophic events, which can lead to greater difficulty in working through the grieving process. This type of disorder is more common in situations of exile, refugees, subjects of political repression, victims of torture, or war situations in countries of origin.</li><li class="elsevierStyleListItem" id="lsti0155">•Depressive disorders: disorders affecting mood may be those most associated with migration, as they are virtually the next step if the migratory grieving process fails. What perhaps most characterises depressive disorders in migration is the strong component of somatisation in the expression of symptoms that prevails over other components which, although they may be there, are less intense. There have been studies related to depression in emigrants for a long time, with different names. Psychosomatic maladjustment syndrome of the emigrant,<a class="elsevierStyleCrossRef" href="#bib0255">51</a> hypochondria of the emigrant<a class="elsevierStyleCrossRef" href="#bib0260">52</a> and chronic adaptive disorder of the emigrant<a class="elsevierStyleCrossRef" href="#bib0265">53</a> are different ways of expressing a series of symptoms which, ultimately, are manifestations of a chameleon-like disorder, such as depression.</li><li class="elsevierStyleListItem" id="lsti0160">•Somatic symptom disorders: among the most common are a group of non-specific symptoms, which include headache, back pain, neck pain, low-back pain, abdominal pain, reflux, gastritis, different intestinal transit disorders, irritable bowel, permanent and generalised fatigue, dizziness, nausea, vomiting, atopic dermatitis and a long list which shows how the impact of the migratory experience translates into the impact it produces on the emigrant’s life. As it is often a difficult experience to digest, symbolisation becomes difficult through the cortical route and is diverted towards a somatic response directed by the autonomic nervous system. According to some studies,<a class="elsevierStyleCrossRefs" href="#bib0270">54,55</a> there seems to be a higher incidence of somatic-type psychosomatic responses in the population of immigrants from developing countries. Difficulties with the use of the host language, with the consequent difficulty in accurately expressing the symptoms, appears to be an aspect which has a strong influence.</li><li class="elsevierStyleListItem" id="lsti0165">•Psychotic disorders: it is not uncommon to find excessive diagnosis of psychosis in immigrants, as the adaptation difficulties caused by the fact they are migrants are attributed to psychotic disorders, when in reality they are misinterpreted feelings of mistrust in response to the conditions of isolation, loneliness, discrimination, exclusion or social rejection; these feelings can lead to a great deal of anguish and anxiety, often expressed with paranoid overtones. In fact, Kinzie and Feck.<a class="elsevierStyleCrossRef" href="#bib0280">56</a> used the expression “paranoid reaction of the foreigner” or “paranoid reaction of the refugee” to describe the symptomatic expressions of an acute paranoid nature observed in immigrants. As is known, schizophrenia was the first psychosis to be looked at in detail,<a class="elsevierStyleCrossRef" href="#bib0285">57</a> with investigations at the time showing that there was a higher rate of first hospitalisation in the immigrant population. However, the results of more recent studies<a class="elsevierStyleCrossRefs" href="#bib0290">58,59</a> were inconclusive and no assertions could be made, so the question still remains. With regard to psychotic disorders, it can be said that the causes of an apparently higher rate in the emigrant population may possibly be explained by demographic differences which suggest greater vulnerability, high rates of psychosis in the country of origin, the selective migration of subjects with predisposition, the migratory experience itself, which is a stressor, and also a tendency to over-diagnose schizophrenia in the immigrant population due to the cultural limitations of the healthcare professionals. It should be noted that major psychiatric syndromes are phenomenologically universal, but clinical expression is usually determined by cultural aspects. So culture creates characteristic ways of presenting the disease in different societies. We therefore have disorders associated with the culture of origin, and when people emigrate they also take these ways of expressing the disease with them<a class="elsevierStyleCrossRef" href="#bib0015">3</a>: amok, dhat, bouffé délirante, brain fog, fallin-out, ghost sickness, koro, latah, mal de ojo, etc.</li><li class="elsevierStyleListItem" id="lsti0170">•Substance abuse and dependence disorder: studies on this matter are inconclusive. However, there are studies, such as that of Arallanez Hernandez,<a class="elsevierStyleCrossRef" href="#bib0295">59</a> which show that the very fact of migration, along with the migratory stress generated, is a strong enough influence to lead a person to opt for using drugs as a response to the difficulties that the phenomenon generates.</li></ul>Ulysses syndrome (emigrant syndrome due to chronic and multiple stress)This syndrome expresses a direct relationship between the degree of extreme stress that emigrants experience and the consequent development of psychopathological symptoms. As Achotegui<a class="elsevierStyleCrossRef" href="#bib0300">60</a> described twenty years ago, the manifestations of the syndrome include a combination of grief and psychological and somatic symptoms, which explains the difficulties of working through migratory grief. According to this author, the emigrant has to deal with three potential types grief: simple grief, the type that can be resolved easily without symptoms; complicated grief, which, as the name suggests, means the person has difficulty in working through the grief, which becomes entrenched and disturbed; and extreme grief, which is the type that cannot be worked through because it exceeds the emigrant's capacity for adaptation. In the case of extreme grief, the response acquires some greater degree of symptomatic expression and manifests as Ulysses syndrome.What makes it more difficult to work through the grieving process is the existence of stressors and their influence is very important. The following are the most prominent:<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0175">•Loneliness: as a stressor, the situation of loneliness in which the emigrant lives is a direct consequence of the forced separation from family and loved ones, and involves suffering activated by memories, emotional needs and different types of fear, all of which are linked to constant feelings of insecurity.</li><li class="elsevierStyleListItem" id="lsti0180">•Grief due to failure of migratory goals: this originates from the failure of the migratory project, from not achieving the least opportunity, from access difficulties (documents, work, exploitation) instilling the feeling of constant failure which can translate into discrimination, exclusion or rejection.</li><li class="elsevierStyleListItem" id="lsti0185">•Fight for survival: the difficulties with diet (little, poor quality and newness and tastes) and housing (overcrowding, little privacy, living on the street) create a state of things that prevents intimacy and consolidates precariousness and poverty at levels that affect human dignity.</li><li class="elsevierStyleListItem" id="lsti0190">•Fear: develops as a result of the physical dangers related to the journey (coercion from mafias, trafficking networks, detention and expulsion, abuse by authorities, future uncertainty), creating a context which is threatening and hopeless.</li></ul>These stressors that form part of the migration phenomenon can become intensified as factors arise which enhance them. Most common problem is the multiple nature of the stressors, with a single stressor not the same as several acting in parallel, and chronicity, with the stressors persisting for long periods. The intensity and relevance of the stressors has a strong influence; the lack of a sense of stress control, the lack of a social support network; the classic stressors of migration such as culture, language, landscape; the development of disabling symptoms and, lastly, the prejudices of healthcare staff and officials.Symptoms of Ulysses syndromeThe symptoms are varied and wide-ranging and cover different dimensions of psychopathology. They can be summarised as follows:<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0195">•Depressive area: sadness, crying, guilt, ideas of death (very rare). Obsessive ideas, ideas of handicap which are consolidated to the extent that the situation is not resolved.</li><li class="elsevierStyleListItem" id="lsti0200">•Anxiety area: tension, nervousness (in the face of adversity), excessive and recurring worry, irritability, difficulty initiating sleep, intrusive recurrence of memories.</li><li class="elsevierStyleListItem" id="lsti0205">•Somatic area: somatoform symptoms (headache, fatigue, musculoskeletal), contractures, joint pain, back pain.</li><li class="elsevierStyleListItem" id="lsti0210">•Confusional area: failures in attention and memory that lead the individual to feel lost, even physically. This confusion is linked to having to hide, become invisible and in the end not know whether you are coming or going. An existential dislocation.</li></ul>This summary of the clinical profile we have provided as a brief outline is not strictly speaking a condition we have to include primarily in the field of psychopathology and clinical psychiatry, but rather it transcends these dimensions and should be included in the broader field of mental health, as the conditions and circumstances come from contextual events, the powerfulness and stressor potential of which exceeds people’s tolerance limits. It is a door or hinge between mental health and mental disorder. It belongs to the field of prevention, rehabilitation and the psychosocial area, rather than to the territory of medicalised treatment. However, in the absence of alternatives and options, it is very easy for it to cross over into psychopathological and clinical territory as the final phase in difficulties with resolution.We must not forget that there are other clinical conditions that need to be taken into account when considering Ulysses syndrome. The most important due to the similarity of the symptoms are post-traumatic stress disorder, adjustment disorder, uprooting disorder, migratory grief, depressive disorder and psychotic disorder. Post-traumatic stress disorder involves the symptom of apathy and generally a single traumatic event. In Ulysses syndrome, there can be multiple stressful events and apathy does not present as a symptom. In adjustment disorder, the subject shows excessive reactions to problems. In Ulysses syndrome, the problems are terrible and the individual cannot adapt because they are outside the system. Concerning depression in Ulysses syndrome, there is no apathy (unlike in depression). Still, there are thoughts about life, family, dreams, and positive thinking towards the future that they are there and will not give up.A phenomenological reflection on migrationTalking about migration as an existential experience means broadening the view of the individual in their structural limits. From this perspective, we propose that an individual is their body plus their context, that is, their corporeality plus the world at their disposal. The body, an open system, is a structure whose matter, of a biological nature, needs to sustain itself and preserve its constitution and functioning in a world or environment that can provide it with inputs to survive. It lives in a space-time context that is part of its totality and provides a vital ecology to which it is profoundly and intimately linked. Let's say that organically they form a whole.<a class="elsevierStyleCrossRef" href="#bib0305">61</a> As Heidegger would say, “being there” in the world, a world that is part of that body.When we think about the physiology of an individual, we consider that they are made up of their physiology plus the physiology of the other, which means understanding that the physiology of a human being does not end in the skin, it continues in the skin of the other. The others acquire a transcendental dimension in our lives. The other as a legitimate other is part of me, I need the other who recognises me as someone also legitimate and from whom I need affection, company, closeness, tenderness, etc., aspects that act on my physiology and without which I get sick, because their presence is part of the totality that we are as individuals and of what we consider our existence, “being there with another” in the world.Relationships are a dimension of our totality as individuals, each individual includes “the self plus the others”.<a class="elsevierStyleCrossRef" href="#bib0310">62</a> The self has no meaning without others; our identity comes from belonging to a group, being part of a we. Being and being among others is part of the construction of our identity, which is forged by all the residue that significant relationships leave as a product of their moulding and modelling influence. We are part of a community, and that community is what builds our mind, which needs at least two brains in relationship for it to emerge from the depths of the central nervous system. As Aristotle said, the mind is a social phenomenon, an expression taken up by Bartra<a class="elsevierStyleCrossRef" href="#bib0315">63</a> when they said that our mind emerges from an endobrain housed in the skull, which protects countless neuronal connections, and an exobrain, which is made up of the extracranial connections we maintain with other brains with which we interact. Our mind is sustained by the fact of being and being among others.So we all have a life, an existence and a mind. Migration causes a rupture of the totality that is an individual. Context, the other and relationships are cut off from the total unit that is the individual, as if they have lost half of themselves. This means that the tensions that were worked through and contained in its environment are now free and uncontained by the context it houses, the other it contains and the relationships it shelters. Then, as a containing existential ecology does not gather them up, the tensions retreat into corporeality in the form of somatisations in response to the physiological injuries of the loss of context, physiology and relationships, and symbolic injuries in response to one's own cultural provisions, which become almost inoperative in the new culture, in which and from which a new symbology has to be created and recreated in an attempt to make up for the deficiencies of one's own, which provokes a psychic response of suffering and stress that leads to mental symptoms. To lose half of one’s totality is to come into contact with Thanatos. The individual finds themselves in a kidnapping (voluntary or involuntary) in another culture, in a suspended and transitory death that sometimes lasts until the illness develops. The lack of dichotomising output between success and failure is established, resulting in tension that leads to stress. In a way, migration is always an existential debacle whose solution is not the same for all individuals. However, solidarity, cooperation and generous understanding will be the keys to getting out of this debacle and what has been a catastrophe for some.FundingThe authors declare that they have not received any funding for this article.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:17 [ 0 => array:3 [ "identificador" => "xres2003322" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1716455" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2003321" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Discusión" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1716454" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Types of migration" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Migration terms" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Emotional experiences of migration" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Migration processes" ] 9 => array:3 [ "identificador" => "sec0030" "titulo" => "Migratory grief" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Causes of migratory grief" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "The particular nature of migratory grief" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "The defence mechanisms of the emigrant in migratory grief" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Transgenerational grief" ] 4 => array:2 [ "identificador" => "sec0055" "titulo" => "The seven losses" ] ] ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Factors that predispose to mental disorder" ] 11 => array:3 [ "identificador" => "sec0065" "titulo" => "Pathological and psychopathological processes" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0070" "titulo" => "Symptoms" ] 1 => array:2 [ "identificador" => "sec0075" "titulo" => "Clinical profiles" ] ] ] 12 => array:3 [ "identificador" => "sec0080" "titulo" => "Ulysses syndrome (emigrant syndrome due to chronic and multiple stress)" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0085" "titulo" => "Symptoms of Ulysses syndrome" ] ] ] 13 => array:2 [ "identificador" => "sec0090" "titulo" => "A phenomenological reflection on migration" ] 14 => array:2 [ "identificador" => "sec0095" "titulo" => "Funding" ] 15 => array:2 [ "identificador" => "sec0100" "titulo" => "Conflicts of interest" ] 16 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-02-19" "fechaAceptado" => "2021-05-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1716455" "palabras" => array:4 [ 0 => "Migration" 1 => "Emotions" 2 => "Migratory grief" 3 => "Psycopathological processes" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1716454" "palabras" => array:4 [ 0 => "Migración" 1 => "Emociones" 2 => "Duelo migratorio" 3 => "Procesos psicopatológicos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThe phenomenon of migration generates a series of experiences in the human being that are translated into emotions, feelings, adaptation processes, grief and psychopathological processes, and even pathological expressions, represented by clinical pictures of different kinds. ObjectiveThe purpose of this article is to carry out a conceptual and clinical reflection on the semiology around the concept and experience of migration, in order to illustrate the complexity that it entails as a human phenomenon. MethodsA reduced narrative review, circumscribed and restricted to the semiological, psychopathological and clinical aspects of migration. DiscussionThe separation, ruptures and losses that derive from migration do not go unnoticed by the individual. They are inscribed in his/her corporality as physiological injuries that affect his/her life and as symbolic injuries that affect his/her existence. ConclusionsMigration supposes a rupture of the totality of being. The context, the perception of others and relationships are cut off from the total unity that is the individual, as if he/she lost half of him/herself." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl fenómeno de la migración genera una serie de experiencias en el ser humano que se traducen en emociones, sentimientos, procesos de adaptación, duelos y procesos psicopatológicos, hasta expresiones patológicas representadas por cuadros clínicos de diferente índole. ObjetivoLa intención de este artículo es realizar una reflexión conceptual y clínica de la semiología en torno al concepto y la experiencia de la migración, para con ello ilustrar la complejidad que entraña como fenómeno humano. MétodoRevisión narrativa reducida, circunscrita y restringida a los aspectos semiológicos, psicopatológicos y clínicos de la migración. DiscusiónLa separación, las rupturas y las pérdidas que se derivan de la migración no pasan inadvertidas al individuo, se inscriben en su corporalidad como lesiones fisiológicas que afectan a su vida y como lesiones simbólicas que afectan a su existencia. ConclusionesLa migración supone una ruptura de la totalidad del ser. El contexto, el otro y las relaciones quedan cercenados de la unidad total que es el individuo, como si perdiera la mitad de sí mismo." 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The semiology of migration

Semiología de la Migración

José Antonio Garciandía Imaza,

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jose_garciandia@hotmail.com

Corresponding author.

, Isabella Garciandía Rozob

a Departamento de Medicina Preventiva y Social, Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia

b Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The human being fluctuates between a sedentary lifestyle&#44; which responds to their need for roots that sustain them and customs on which to settle&#44; and nomadism&#44; which compels them to search for new experiences that expand the spectrum of their world&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; migrating is not innate in the human person&#46; It is a move that responds to that need for novelty but far more to escaping from a hostile environment for some reason&#44; the nature of which can be diverse&#46; Every migration process occurs in the context of deprivations&#44; humiliations and restrictions people experience which impel them to seek alternatives away from the place they live&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This has implications&#44; such as voluntary or involuntary social exclusion&#44; which can generate submission to circumstances&#44; predisposing to difficulties in adaptation&#44; psychological alterations or&#44; worst cases&#44; mental disorders&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is not easy to define the concept of migration&#44; as it has many expressions and many ways of describing the experience of moving away from the place of one&#8217;s usual life&#46; However&#44; we use the following definition by Delgado as it is comprehensive enough for this article&#44; &#8220;Displacement of people or groups from their place of origin or residence to another geographically distant&#44; different place is associated with the expansion of the human being and the fight for survival&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Today&#8217;s migration is an international phenomenon involving a displaced population that can exceed two hundred million people each year&#46; These circumstances can have potentially negative and positive consequences on people&#8217;s health and well-being&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Types of migration</span><p id="par0015" class="elsevierStylePara elsevierViewall">Interest in migration processes in the field of health dates back to the studies of &#214;deggard<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in the 1930s in relation to Norwegian emigrants to the United States and the mental health problems they presented&#46; Migration as a human phenomenon includes a very heterogeneous group of people who manifest different responses due to the experience&#46; It ranges from those who are seeking to improve their professional aspirations and those setting off from a favourable starting point because they are responding to possibilities explored or determined beforehand&#44; which they acquire to migrate with the security of knowing their destination and activity&#44; to those who are suffering an urgent need to move to exist and survive due to the impossibility of doing so in their country of origin&#44; migrants in the orbit of poverty&#44; to those who are exposed to life-threatening situations resulting from the sociopolitical conditions of their country of origin&#44; such as refugees&#44; persecuted people&#44; exiles and others&#44; all of whom are particularly vulnerable to suffering from post-traumatic stress&#46; Some migrate for family reunification&#44; or those seeking to expand their knowledge and education migrate to places where they can incorporate academic training&#44; such as students&#44; researchers or academics&#46; Then there are the massive movements of populations which uproot in search and exploration of safer regions&#44; displacements of population groups due to the construction of significant infrastructure works &#40;for example&#44; dams&#44; roads and megastructures&#41;&#44; and those who move in search of better economic conditions than in their places of origin&#46; All of them&#44; to a greater or lesser degree&#44; mean a human disaster&#44; resulting in impoverishment&#44; malnutrition&#44; increased morbidity&#44; dependency&#44; breakdown of communities and loss of social capital&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">One important aspect when dealing with the phenomenon of migration which affects considerations about mental health is the difference in the migration experience according to whether it is from a poor to a rich country&#44; between countries with similar socioeconomic conditions or from a rich country to one with worse economic and social conditions&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is also important to clarify the difference between migration&#44; emigration and immigration&#46; Migration refers to moving from one place to another in general terms&#46; Emigration is moving from the place of origin to another distant and different place&#44; leaving the place of origin&#46; Meanwhile&#44; immigration is arriving in a new place&#44; from another different place&#44; and arrival in the host country&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Migration terms</span><p id="par0030" class="elsevierStylePara elsevierViewall">A series of terms have been constructed in the human imagination around the migratory process&#44; which&#44; although all expressions of migration have very different meanings&#44; evoke different ideas and have different nuances&#44; all depending on the degree of voluntary or involuntary displacement&#46; All of these terms signal the great complexity implicit in the very nature of the migratory phenomenon which has accompanied individuals and communities in their journey through the world throughout human history&#46; If we stop and look at each of these terms&#44; we can see that human beings use the entire arsenal&#44; covering the whole range between love and hate&#44; solidarity and contempt&#44; when referring to the migratory phenomenon&#46; They are a concise record of the human condition and its relationship with its fellow human beings&#58;</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Exile&#58;</span> being far from one&#8217;s natural place as a result of leaving the country voluntarily or forced by some circumstance&#44; generally political&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Expulsion&#58;</span> sanction that is applied to a person and consists of forcibly removing them from a country&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Displacement&#58;</span> forced migration within the same country&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Banishment&#58;</span> penalty imposed by the State consisting of expelling a person from a place or territory&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Exclusion&#58;</span> a penalty consisting of the expulsion of a convicted person from a territory for the duration of the sentence&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Ostracism&#58;</span> banishment of a citizen who was considered suspicious or dangerous to popular sovereignty in ancient Greece&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Proscription&#58;</span> public&#44; official identification accompanied by the banishment of a person as a public enemy&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Confinement&#58;</span> penalty that consists of forcing someone to live in a place different from their own within the national territory and under surveillance by the authority&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Uprooting&#58;</span> loss of social and family roots which affects personal identity with a loss of essential&#44; cultural and social meaning&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Disengagement&#58;</span> undoing or breaking the ties between people or institutions&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Relegation&#58;</span> an afflictive penalty that was served overseas in places assigned for that purpose&#59; it could be temporary or perpetual without loss of citizenship&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Deportation&#58;</span> perpetual exile with occupation of property and deprivation of civil rights&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Expatriation&#58;</span> the temporary or permanent residence of a person in a country other than their own&#44; generally for work or professional reasons&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Diaspora&#58;</span> the dispersion of ethnic or religious groups which leave their original place of origin and are spread around the world&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Segregation&#58;</span> separation or marginalisation of a social group due to gender&#44; race&#44; culture or ideology&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Exodus&#58;</span> the migration or departure of a people or a mass of individuals from a place where they live and are settled for various reasons&#46; It may be considered immigration when it occurs within borders or emigration when it crosses them&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">All the terms listed express the complex and varied way human beings have managed to affect their fellow human beings in relation to the permanence or separation of people from their places of origin&#46; Whether economic&#44; racial&#44; religious&#44; cultural&#44; ideological or political&#44; human beings have always understood that one of the most painful and terrible punishments can be inflicted is the migratory movement in its different forms&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Emotional experiences of migration</span><p id="par0120" class="elsevierStylePara elsevierViewall">The emotional experiences generated by migration are also broad and varied&#44; but the most common are those described below&#46; No matter how well the migration phenomenon takes place&#44; some of these feelings are always present&#58; sadness&#44; ambivalence&#44; ambiguity&#44; isolation&#44; abandonment&#44; loss&#44; grief&#44; loneliness&#44; frustration&#44; failure&#44; impotence&#44; insecurity&#44; being overwhelmed&#44; experiences or feelings which&#44; as they are difficult to process&#44; can take the form of somatisations<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> due to the impossibility of processing them symbolically and resolving them effectively&#46; This accumulation of emotions has been evolving over generations of migrants into a more complex feeling&#44; which is that of &#8220;being far away&#8221;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Emigration means being far away&#44; at a distance from one&#8217;s place of origin or usual home environment&#44; having left for some reason&#44; knowing that you will have no local physical contact with that place for a time or never return&#46; This distance from the people&#44; places and things that are part of our lives until the point when we emigrate awakens particular emotions for which&#44; in the Iberian culture&#44; constantly emigrant for centuries&#44; we have different expressions&#58; nostalgia &#91;nostalgia&#93;&#59; <span class="elsevierStyleItalic">morri&#241;a &#91;homesickness&#93;&#59; saudade</span> &#91;yearning&#93;&#59; a&#241;oranza &#91;longing&#93;&#59; and <span class="elsevierStyleItalic">murria</span> &#91;the blues&#93;&#46; All these terms can be condensed into one expression&#44; &#8220;homesickness&#8221;&#44; and they express sadness&#44; pain&#44; absence and distance&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Nostalgia&#44; a word of Greek origin coming from the term <span class="elsevierStyleItalic">nostos</span> &#40;home&#41; and <span class="elsevierStyleItalic">algia</span> &#40;pain&#41;&#44; is understood as the feeling of pain due to being away from home&#44; it is a pain for home&#44; for not being able to be at home&#44; for being away from the house&#46; It is an intense pain of not having the closeness of loved ones and those you crave much-needed affection from at such a distance and with the loneliness of an unfamiliar place&#46; The specific pain of not being in the place of loving sustenance&#44; pain for home&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Morri&#241;a &#91;homesickness&#93;&#44; a word of Galician-Portuguese origin&#44; comes from two interpretations originating from Latin words&#46; One&#44; from the word <span class="elsevierStyleItalic">mori</span> &#40;to die&#41;&#44; which gave rise to the term <span class="elsevierStyleItalic">morrinha</span> to derive over time into morri&#241;a&#46; The other is from the word <span class="elsevierStyleItalic">morro&#44;</span> which originates from the Latin word <span class="elsevierStyleItalic">emurria</span>&#44; meaning sadness&#46; It seems that these two terms at some point in their evolution come together to originate and engender the term morri&#241;a&#44; which is understood as &#8220;dying of sadness&#8221;&#46; A feeling that expresses the intense and deep affection that comes with being away from what you love and what will be beyond reach for a long time&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Saudade</span> &#91;yearning&#93;&#44; that very Portuguese feeling whose origin is in the Latin word <span class="elsevierStyleItalic">solitate</span>&#44; which translates into the feeling of soledad &#91;solitude&#93; in Spanish&#44; in Portuguese <span class="elsevierStyleItalic">soledade</span>&#44; eventually evolving into <span class="elsevierStyleItalic">soidade&#44;</span> and after many experiences&#44; ending up as <span class="elsevierStyleItalic">saudade</span>&#46; However&#44; there also seems to be an Arabic origin for this Portuguese word&#44; as a product of the 700 years of Arab presence in the Iberian Peninsula&#46; The Arabic term <span class="elsevierStyleItalic">sawda</span> &#40;black&#44; black bile&#44; denial or melancholy&#41; would also have given rise to <span class="elsevierStyleItalic">saudade</span>&#44; whose meaning is a &#8220;sad loneliness&#8221;&#44; a feeling so close to the soul of the emigrant&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A&#241;oranza &#91;longing&#93;&#44; a word expressing the feeling of Catalan origin&#44; has its roots in the Latin word <span class="elsevierStyleItalic">ignorare</span>&#44; which means to be unaware&#44; not know something&#44; not have any news of someone&#46; In its evolutionary journey Catalan&#44; it became <span class="elsevierStyleItalic">enyoran&#231;a</span>&#44; which is a feeling of sadness for not having heard from or of someone significant with whom one has an emotional bond&#46; Longing is to miss someone&#44; wish for the closeness of someone you love&#44; but it is also the sadness of knowing the absence is unavoidable&#44; that their presence is impossible&#46; It is the &#8220;sadness of the absence&#8221; of the presence of the other&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Murria &#91;the blues&#93;&#44; a Castilian word that hides its roots in the Indo-European term <span class="elsevierStyleItalic">mur</span>&#44; which means mouth and is origin of the word &#8220;morro&#8221; and the Castilian expression &#8220;estar de morros&#8221; &#40;to be angry&#41;&#44; becomes in Latin the word <span class="elsevierStyleItalic">moerare&#44;</span> which means being sad&#44; isolation&#44; melancholy&#46; Murria is then understood as that feeling of sadness and isolation mixed with anger&#46; It is a &#8220;being sad&#44; isolated and angry&#8221; at such a distance and with the remoteness of a foreign and unfamiliar place&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In summary&#44; it could be said that the emigrant experiences feelings connected with being far away&#58; the pain of home of &#8220;nostalgia&#8221;&#59; the dying of sadness of &#8220;homesickness&#8221;&#59; the sad loneliness of &#8220;yearning&#8221;&#59; the sadness at the absence of &#8220;longing&#8221;&#59; and sadness and anger due to isolation of &#8220;the blues&#8221;&#46; We cannot ignore that all these feelings that we attribute greatly to people who emigrate to another place also affect&#44; to some extent&#46; However&#44; probably with less intensity&#44; those who stay behind&#44; from whom the emigrant has separated&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> As a metaphor for this&#44; we should think of the character of Penelope&#44; Ulysses&#8217; wife&#44; who restlessly waits for her husband to return home after years of absence and who shows with great precision the deep feelings of absence and longing narrated in The Odyssey&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Migration processes</span><p id="par0160" class="elsevierStylePara elsevierViewall">Emigration as a human phenomenon has consequences for those who undertake this move away from their place of origin or habitual residence&#46; Emigration is a process subdivided into several processes that can be seen either as a linear sequence of events or a transverse sequence happening in parallel in people who emigrate&#46; These processes involved in migration are&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Separation&#58; the separation of people and places forming part of the usual day-to-day life of the individual&#44; whose emigration means physical and temporal distance &#40;people and places&#41;&#44; which makes contact difficult but does not necessarily eliminate contact by some means&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Severance&#58; a severing of contact&#44; relationships and communication with the place of origin and people as a consequence of extreme situations of emigration that make it necessary&#44; for security or the implicit risks&#44; to cut the ties of the past&#46; This does not mean that it is definitive&#44; it is generally temporary while things are consolidated and certain goals are achieved which provide security and guarantees for reconnection&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Acculturation&#58; a process that results in a person or a group of people acquiring a new culture or at least some aspects and characteristics of another culture different from that of origin&#46; It is a natural phenomenon which happens when two different cultural references come into contact&#44; and this involves changes in both cultures&#46; Generally&#44; one of the cultural groups has more dominance over the other and generates acculturative stress&#46; This can happen due to colonisation processes in which people from the subjugated or dominated culture adapt &#40;acculturate&#41; by incorporating dimensions of the dominant culture&#46; In the case of emigration&#44; this process happens in the opposite direction&#44; the migrant is the one who arrives and incorporates aspects of the host culture&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Deculturation&#58; process through which there is some cultural loss when someone or a group of individuals have progressively left behind cultural characteristics they possessed or had acquired at some point&#46; In the case of emigration&#44; it represents the loss of aspects of the culture of origin when living in another culture into which one arrived as an immigrant&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Enculturation&#58; a process in which an established culture teaches and illustrates to a person&#44; formally or with the repetition of its norms and values accepted by the community&#44; the fundamental aspects of that culture&#46; The intention of this is that the person from another culture can become an accepted member of society and find an appropriate role in it&#46; It generally focuses on showing what is appropriate and not accepted in the social framework&#44; it is a contextualisation of limits&#46; In the case of emigration&#44; it refers to the teaching programmes that the host countries provide free of charge to migrants for the language&#44; the laws and the political system for example&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Transculturation is related to the process by which a social group&#44; a people or an ethnic group receives forms of culture from another to the point where they can partially or completely replace their own customs&#44; habits or patterns&#46; In the case of emigration&#44; they are those two-way changes that occur between emigrants and the host places through which both adopt customs from the others&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Communication&#58; this human dimension is interfered with by emigration&#44; first of all&#44; by the language when it is different from that of the country of origin or&#44; although the same language is spoken in the host country&#44; the idiosyncrasy of its interpretation is different&#46; Changing cultures and countries implies that the cultural communication processes carried out in one&#8217;s own culture become processes of interpersonal intercultural communication&#44; which involve overcoming cultural borders to access new cultural horizons&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Migratory grief</span><p id="par0200" class="elsevierStylePara elsevierViewall">Every migration process generates grief&#44; a grief which is different from other types of mourning and has its own characteristics&#46; Migratory grief involves an individual dimension of the person who left&#44; it becomes a collective mourning shared with the people in their relational world and can even extend beyond the limits of the individual and become a transgenerational mourning when it is not adequately resolved in the first generation &#40;those who actually emigrated&#41;&#46; Unconscious delegations of the ego&#44; the id and the superego arise&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> or invisible loyalties appear<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> which are demanded of future generations as a toll from the family past&#44; or it also becomes a family secret when the origin of the reasons for emigration has not been clearly passed on or is hidden for guilty&#44; shameful or fearful reasons&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Causes of migratory grief</span><p id="par0205" class="elsevierStylePara elsevierViewall">The most common causes of migratory grief are loneliness&#44; the feeling of failure&#44; the fight for basic survival and the fear and dread they have had to go through in threatening situations due to mafias&#44; authorities and other circumstances&#46; Those who are at greatest risk of their grief becoming pathological are those who travelled to live and work in another country and only ended up in conditions of exploitation and isolation&#46; Those seeking refuge from hunger&#44; violence and political unrest&#46; Those who&#44; due to the urgency of the situation and with the consequent lack of preparation&#44; have to decide to emigrate quickly and suddenly&#46; Those who face the unexpected risk of death&#46; As a life-changing process&#44; emigration involves a series of losses and gains&#46; This means a process of having to work through difficulties and risks&#44; which make it a risk factor for mental health&#46; It is also grief that becomes a paradox&#58; how to mourn what you decided to leave&#63;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Loneliness is one of the most potent aspects for generating grief&#44; as leaving the family&#44; separating from loved ones&#44; small children&#44; and older or sick parents who cannot be taken to the new place or cannot be visited for different reasons catapult the individual into unavoidable pressing loneliness&#44; highlighting the importance of ties and attachment and the pain of separation&#44; which cannot be resolved in the short term&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">The feeling of failure is closely connected with the fear of failure of the migratory goals&#44; and the hopelessness felt when the migrant does not achieve even the minimum conditions that might open up opportunities and help pave the way towards obtaining documentation&#44; work and decent conditions after the physical and financial investment they have made in migrating&#46; Added to this feeling of failure is the painful and shameful point that returning to your homeland as a failure becomes even more difficult&#46; Then migrants find themselves in a kind of existential trap&#44; which can paralyse them and cause them to become marginalised and socially excluded&#44; a situation worse than the one they had in their country of origin&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The fight for survival is the unavoidable fate of any emigrant in any context&#46; Obviously&#44; there are different degrees of survival depending on each person&#8217;s specific circumstances&#46; However&#44; those in extreme situations are the ones who suffer the most from the need to fight for their survival&#46; This often affects nutrition&#44; with undernourishment a constant among emigrants due to the poor quality of their food and lack of a balanced diet&#46; Finding housing is another problematic survival aspect&#44; leading to overcrowding&#44; with the associated stress&#44; lack of privacy and&#44; in the most extreme case&#44; having to live on the street&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Fear&#44; that permanent companion of the emigrant&#44; commences with the uncertainty of what is to come&#44; continues with the frequent physical dangers they have to overcome during the journey&#44; heightens with the life-threatening situations they face while travelling and reaches its peak in the threats&#44; coercion&#44; blackmail&#44; harassment and humiliation which attack their psychological and mental integrity&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">The particular nature of migratory grief</span><p id="par0230" class="elsevierStylePara elsevierViewall">In migratory grief&#44; there is a series of circumstances which make it very particular and different from any other type of mourning&#46; This is because migration is a life-changing phenomenon and&#44; as a process of change&#44; it involves gains and losses&#44; but not always with a healthy balance between the two&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Migratory grief has its own particular features and they are characteristic of the situation&#58; partiality&#44; recurrence and multiplicity&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">The partiality is implicit in a concrete fact&#58; the country of origin does not disappear&#44; the separation is partial&#44; an absolute and definitive break does not occur&#44; and it is not&#44; therefore&#44; an irreparable loss&#46; Except in extreme situations&#44; there is the opportunity to re-establish contact&#44; return&#44; visit the country again&#44; and this is a and real possibility&#46; As a partial phenomenon&#44; separation is stressful in nature&#44; as the individual is not exposed to the blow of a complete loss&#46; Partiality is then a substrate for ambivalence&#44; ambiguity and confusion&#44; which are accompanied by a great deal of anxiety and can have a dissociative character&#46; This is because partiality requires a reorganisation of temporal and spatial dimensions&#44; which the migrant knows exist elsewhere and that they belong to&#44; at least in the imagination&#44; and that feel like a weight that is difficult to let go of and to experience as a parallel reality&#46; Questions like&#44; &#8220;What are my family&#44; friends&#44; etc&#46;&#44; doing right now&#63;&#8221;&#44; or&#44; &#8220;At this time&#44; I would be walking along the esplanade in my town&#63;&#8221;&#44; can be part of that parallel world&#44; which is happening in another place that the emigrant accesses through their imagination and fantasy as a way of being present from afar without being there&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Recurrence sets in as a consequence of the persistence of the ties with the country of origin&#46; When fantasies and longings fuel this bond to return to their homeland again&#44; the mourning can become challenging to resolve&#46; If the person thinks&#44; longs and fantasises about returning&#44; how do they accept a loss that has not occurred in its entirety&#63; Return fantasies in principle&#44; may contain a function that protects the person from the impact of distance&#44; isolation&#44; loneliness&#44; helplessness and other feelings in the grieving process&#46; However&#44; today&#44; more than ever&#44; recurrence&#44; which in other eras could last for a time because the chances of returning were often remote or communications were very precarious&#44; has become almost permanent&#44; as the possibilities of travelling are greater&#46; Communication is easier and more effective for revitalising ties and maintaining contact with the culture in the country of origin&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">The connection with deep-rooted childhood aspects is another important characteristic&#46; Early childhood is a time of great sensitivity in human beings&#44; as that is when links are made with those close to us&#44; language&#44; landscape&#44; social group&#44; culture and beliefs&#46; Events are experienced with a conditioning power over the way the personality is constructed&#46; When the person emigrates&#44; they are already conditioned by what they experienced in childhood&#44; and depending on how their adaptive skills have been built&#44; they will also come forth in the new circumstances&#46; Relationship fragility&#44; the capacity for frustration&#44; the management of attachment&#44; working through separations and desertion&#44; and many other relational aspects will be activated in the way in which they were incorporated during development when working through current circumstances&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">The multiple nature of changes involved in the migratory grief process does not occur in any other type of grief&#46; It includes at least seven types of loss&#58; family&#44; language&#44; culture&#44; land&#44; social status&#44; contact with the group of origin and risks to physical integrity&#46; As Achotegui suggests&#44; not even the death of a loved one entails so many changes and variables&#46; To these losses&#44; we add an eighth&#44; which has to do with temporality&#44; the loss of the past or at least the continuity of the narrative of the past in another time and another place&#44; due to commencing life in a place where one does not have a lived past&#44; an aspect that we analyse later&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">The defence mechanisms of the emigrant in migratory grief</span><p id="par0255" class="elsevierStylePara elsevierViewall">Grinberg and Grinberg<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> state that &#8220;being an emigrant is very different from knowing that one has emigrated&#46; It involves fully and profoundly assuming the absolute truth and responsibility inherent in that condition&#46; Recognitions of this type belong to a mental and emotional state that is difficult to endure&#46; This explains the need to resort to multiple defensive mechanisms&#44; to remain only in the knowing and not in being emigrants&#8221;&#46; Migration is such a long process that perhaps it never fully consolidates&#44; and&#44; as the authors say&#44; it is similar to the loss of an accent that is never wholly lost&#46; The insecurity experienced by emigrants who have recently arrived in another country is primarily determined by uncertainties&#44; anxieties and anguish in the face of the unknown and by the unavoidable regression that these anxieties cause&#46; The regression makes the emigrant feel helpless&#44; which inhibits and even stops them from effectively taking advantage of the resources they carry in their baggage&#46; This is why the emigration process has a psychological impact that awakens and sets off different defence mechanisms&#44; which can impede adaptation to reality and interfere with properly processing grief&#46; The following are representative of this process&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0260" class="elsevierStylePara elsevierViewall">Regression&#58; regression to more primitive levels of mental functioning are common in emigrants&#46; It is a way of avoiding contact with reality in a mature and realistic way&#46; It involves dependent childish behaviours&#44; complaints and tantrums directed at social and health services as substitutes for their absent distant support network&#46; This frequently leads to over-diagnoses of anxiety and depression&#44; when in reality&#44; they are conditions of a reactive&#44; impulsive and regressive nature that emerge in situations of very acute stress with overwhelming anxieties that fuel the &#8220;acting out&#8221;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0265" class="elsevierStylePara elsevierViewall">Denial&#58; expressed in statements such as &#8220;everything is the same as in my country&#8221;&#44; &#8220;there&#8217;s no difference with my country&#8221;&#44; &#8220;everything&#8217;s different in my country&#44; but that doesn&#8217;t bother me&#8221;&#44; &#8220;I haven&#8217;t noticed any difference from how people live in my country&#8221;&#46; Statements like these show how the emigrant can distort reality to avoid the pain&#44; but all they are doing is increasing their level of emotional confusion&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0270" class="elsevierStylePara elsevierViewall">Projection&#58; the mechanism by which everything bad is in the culturally different other&#44; which generates xenophobic attitudes&#44; racist behaviour&#44; and discriminatory actions&#44; all of them based on the consideration that the other or others are repositories of defects&#44; deficiencies and cultural and social abnormalities&#44; which are simply different&#46; It translates into expressions which constantly compare the benefits of the culture of origin against the simply different aspects of the host culture&#46; &#8220;In this country&#44; they don&#8217;t know how to cook&#8221;&#44; &#8220;this is a country of aggressive people&#8221;&#44; and many others that can be exemplified show the projective nature of many of the emigrant&#8217;s complaints&#44; manifesting themselves as a defence against difficulties in adapting&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0275" class="elsevierStylePara elsevierViewall">Idealisation&#58; it alters reality&#44; both of the country of origin and sometimes of the host country&#46; It is often intolerable or burdensome for the emigrant when they find it challenging to adapt and incorporate into the host society&#46; Everything in their home country was wonderful&#44; perfect and certainly better than they found in their host country&#46; Or quite the opposite&#44; the host country is extraordinary and far superior in everything to the country of origin&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0280" class="elsevierStylePara elsevierViewall">Ambivalence&#58; &#8220;Sometimes&#44; migration can revive the Oedipal triangular situation between the two countries&#44; as if they symbolically represented the two parents against whom ambivalence and conflicts of loyalties resurface&#46; Sometimes&#44; it is experienced as if they were divorced parents with fantasies of having established an alliance with one of them against the other&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> This ambivalence is shown in the emotional contradictions the emigrant frequently manifests when faced with events and situations requiring some commitment&#44; such as identification with national symbols&#46; Following the experience of leaving their land&#44; their feelings of love for their country and culture connected to their first ties are contrasted by feelings of rage for having had to leave their land&#46; This dimension of ambivalence is linked to primitive aspects of development in the sense of evoking the mother&#8217;s abandonment&#46; It is experienced with the longing for her presence and with the rage about her absence&#44; as if the country of origin had been a bad&#44; neglecting mother and the host country&#44; which is hostile&#44; is simultaneously a good&#44; welcoming and protective mother&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0285" class="elsevierStylePara elsevierViewall">Reaction formation manifests itself in hyper-adaptive behaviours and denial of original traditions&#46; The emigrant acts contrary to their impulse dictates&#44; even adopting against their will behaviours&#44; which are absolutely inappropriate in their culture&#46; This generally has a high cost in anxiety&#44; which is frequently somatic and overcompensated in the symptoms&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0290" class="elsevierStylePara elsevierViewall">Rationalisation&#58; different types of justification for emigration which have nothing to do with the real reasons&#44; which can be humiliating&#46; When an emigrant does not wish to reveal or needs to conceal what really drove them to emigrate&#44; whatever those reasons may be&#44; they develop rationalising and credible explanations to safeguard against the risk of their background being discovered&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0295" class="elsevierStylePara elsevierViewall">Dissociation&#58; with the intensity of the emotions generated by their new life experience and the negative and destructuring emotions&#44; the emigrant often chooses to make a separation between their idea of emigrating to obtain a better life and the painful experience of the emigration itself with its many problems&#46; To avoid that connection&#44; ideo-affective dissociation is necessary&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0300" class="elsevierStylePara elsevierViewall">Split&#58; as when origins are denied and the original cultural identity is rejected or when adaptation is so difficult and persecutory ideas of rejection begin to be projected&#44; which can lead to delirium&#46; The ego suffers a fracture&#44; resulting in psychosis with essentially paranoid symptoms&#46;</p></li></ul></p><p id="par0305" class="elsevierStylePara elsevierViewall">With these defence mechanisms in action&#44; which can occur in people without any previous disorder or history of predisposition&#44; the emigrant can gain time to mourn the losses that the phenomenon represents&#46; If the emigrant is not able to deal with the process and the defences remain in place&#44; this can lead to a psychopathological response&#44; which may vary from depressive disorder to psychosis&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Transgenerational grief</span><p id="par0310" class="elsevierStylePara elsevierViewall">In the migration process&#44; grief can transcend the limits of the emigrant&#8217;s experience and be projected into the future to subsequent generations&#46; This happens due to the identification that the children of emigrants make with the figures of their parents and through contact with and internalising their cultures of origin&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> This is a more complex type of mourning and causes a higher rate of mental disorders in the descendants of first-generation emigrants&#46; The experiences of pain and loss do not seem&#44; in some cases&#44; to be exhausted in the person of the emigrant&#44; and especially when they are not adequately worked out&#44; they are transmitted to the next generations&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> It is a harmful transmission in which untransformed&#44; unrepresented elements are transmitted&#44; which invade the psychic field and block the transmission of thought&#44; and the psychic material of the experiences of uprooting is projected to children and grandchildren of the subjects who have emigrated and becomes an alienating psychic experience&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> The parents deactivate their role as guarantors for the child in the sense of facilitating the search for psychic truths&#44; and these are replaced by what the parents say or do not say&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Then&#44; the children cannot appropriate their desires&#44; and an alienating identification occurs&#44; establishing a continuity of identifications that crosses the generations&#46; In other words&#44; an experience of loss is transmitted&#44; which is not worked through and affects the sense of identity from generation to generation&#46; This can be seen in children and grandchildren as feelings of being uprooted&#44; disorientation&#44; and not finding themselves&#44; ultimately affecting their sense of identity&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">In emigration&#44; the person&#8217;s adaptive capacities can be overcome by contextual demands to which the person does not know how to respond or cannot respond effectively enough to neutralise or work through them&#46; This can disorganise the psychic balance<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> and lead to a process of denial&#44; which is then transmitted to subsequent generations&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">In the first generation &#40;the parents&#41;&#44; those who do not work through their emigration experience turn that experience into something &#8220;unspeakable&#8221;&#44; which remains psychically present&#46; However&#44; they cannot talk about it&#46; They fail to construct a mental representation of the words to express the experience&#46; However&#44; it tacitly leaves a mark on the children who have not directly lived through that traumatic experience&#46; The unprocessed experience of the parents is separated from their ego&#44; in some way&#44; that split-off part is installed in the children&#8217;s psyche&#46; What was unspeakable in the parents is no longer configured as such in the children but instead becomes something &#8220;unnameable&#8221;&#59; that is&#44; it cannot be the object of verbal representation&#46; They do not know the contents of these elements the parents keep separated&#44; but their presence is suspected or sensed&#44; like a questioning feeling&#44; that challenges the individual&#8217;s tranquillity&#44; as if they are missing knowledge about something&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">In the third generation&#44; they are no longer aware of what was split off and not worked through&#46; The very existence of the events they did not experience or know from the story makes it &#8220;unthinkable&#8221;&#46; They do not know of the existence of a trauma that has not been overcome&#46; Still&#44; it acts as a subtle and insidious secret and tacit contamination articulated with the unconscious and has the power to access the individual&#8217;s psyche&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> The member of this third generation&#44; who may be the grandchild&#44; may perceive sensations&#44; emotions or impulses that seem strange&#44; not explainable by their own psychic life or by their family life&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0330" class="elsevierStylePara elsevierViewall">Somehow&#44; the pain of unresolved losses seeks its place in intergenerational dynamics and finds a way out into the transgenerational dynamics of family life&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> to finally express itself in symptoms which affect people far removed from the primary experience&#46; Failure of the parents to work through migratory grief leaves a mark which increases the disturbed and self-destructive potential in children and grandchildren that affects their ego functioning&#46; It is not uncommon to find feelings of not belonging to one place or another&#44; with the distillation of an experience of existential emptiness that steers behaviours towards introversion&#44; maladjustment to the environment&#44; and the constant feeling of being uprooted&#46; This is why it is so important to work through the process of migratory grief in the first generation of those who experienced it&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">The seven losses</span><p id="par0335" class="elsevierStylePara elsevierViewall">The difficulties the emigrant has to overcome from that &#8220;being away&#8221; we mentioned earlier can be condensed into one&#44; which involves finding &#8220;their place&#8221; in the new community and society to recover the position in life &#40;social&#44; professional&#44; work&#44; etc&#46;&#41; that they had in their place of origin&#46; In the new place&#44; no one knows them&#59; they feel like an anonymous and disconnected individual&#44; exacerbating their inner insecurity&#46; Even the <span class="elsevierStyleItalic">locus interius</span> that Saint Augustine said&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> which is the territory of personal intimacy&#44; is filled with the recurrent dreams that emigrants have&#44; which deal with the difficulty of finding a place&#46; The disorientated being that is the emigrant feeds on the feeling of loneliness&#44; on the experience of isolation that intensifies the feeling of loss&#44; on the experience of abandonment that remoteness induces&#44; without having anyone close to turn to for support in working work through it&#46; Under these conditions&#44; according to Calvo&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> the emigrant has to make a huge&#44; extraordinary effort to endure and cope without allowing devastating feelings&#44; the pain of what has been lost&#44; to culminate in a breakdown&#46; That in addition to being aware of the need to make huge efforts to continue responding adequately to the demands in hand&#46; There are a number of losses&#44; seven in particular&#44; that Achotegui<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> believes occur in emigration and cover a wide spectrum of the person&#8217;s existence&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">1&#46;</span><p id="par0340" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Family and loved ones</span>&#46; Children&#44; partners&#44; parents&#44; relatives&#46; Not knowing when they will see them again&#46; Not coming back for a long time or ever&#46; Difficulty getting emotional support far away&#46; Grief in this context is experienced in two dimensions&#58; one part of the grief is activated by what the person leaves behind&#44; loved ones far away&#44; and the other is the effort required to adapt to what is coming&#44; such as the search for new affective relationships&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">2&#46;</span><p id="par0345" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Language&#46;</span> The loss of the everyday experience of the sound of the language&#44; not knowing the local language&#44; is an experience that must be worked through as part of a grieving process&#46; Not knowing the local language causes adaptation difficulties&#44; and in everyday life&#44; it makes it challenging to deal with basic situations &#40;transport&#44; doctor&#44; market&#41;&#46; &#8220;The limits of my world are the limits of my language&#8221;&#44; said Wittgenstein&#44; and according to a Czech saying&#44; &#8220;To lose your language is to lose your soul&#8221;&#46; A kidnapping in the middle of another culture&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">3&#46;</span><p id="par0350" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Culture</span>&#46; In a broad sense&#44; it is a way of understanding life and existence&#46; Culture brings together customs&#44; the meaning of life&#44; beliefs&#44; religion&#44; music&#44; food&#44; festivals&#44; and many other things&#46; This means working through the pain of losing or reducing ties with one&#8217;s own culture of origin and&#44; at the same time&#44; the effort to connect with and adapt to the new culture&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">4&#46;</span><p id="par0355" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Land&#46;</span> Landscapes&#44; colours&#44; smells&#44; temperature&#44; luminosity of the environment and background sounds are dimensions of reality which have emotional correlates that affect the emigrant when they disappear from their everyday lives&#46; The person is faced with a different and unknown world&#46; The absence of these elements&#44; which they cannot access&#44; from what was part of their world has an impact on their emotional world and&#44; above all&#44; on the process of adaptation to the new environment&#46; The distance from these emotional places that constitute identity generates stress&#44; loneliness&#44; and isolation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">5&#46;</span><p id="par0360" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Social status&#46;</span> When people emigrate&#44; they usually seek&#44; among other things&#44; to improve their social status&#44; not only financially&#44; but also the possibilities of access to cultural goods&#44; expression&#44; etc&#46; Among these possibilities are access or lack of access to specific opportunities &#40;work&#44; housing&#44; health services&#44; migrant status&#41;&#46; It is common for their social status to be higher in the place of origin&#44; so arrival in the host country only offers frustration&#46; When they do get a job&#44; it is often different from their profession&#44; contributing to more significant difficulties in adaptation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">6&#46;</span><p id="par0365" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Contact with the social group</span>&#46; It is related to the fact that people identify with a group they feel they belong&#44; which contributes to constructing their identity&#46; When they emigrate and are far from their group of origin&#44; they feel the break with a part of themselves that has been left far away&#46; This experience of not belonging to a group in the host country alters personal identification and one&#8217;s social identity&#46; Being the stranger in the new place exposes you to that anthropological disposition that shows all human groups have prejudices against other groups&#46; These prejudices can be the basis from which feelings of rejection&#44; racism&#44; xenophobia&#44; discrimination&#44; contempt and other harmful thoughts can arise&#44; which make the process of mourning for the decrease in or loss of contact with the group of origin more painful&#44; if possible&#44; and this is intensified by having to go through the stress of making ties and integrating with a new group&#44; which is often reluctant and evasive towards the stranger&#46;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">7&#46;</span><p id="par0370" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Risk to physical integrity</span>&#46; The migratory journey is long&#44; dangerous&#44; full of uncertainty&#44; without documentation and involves physical and mental abuse by traffickers&#44; authorities and assailants&#44; hunger&#44; dehydration&#44; frostbite&#44; animals&#44; etc&#46; Emigration involves risks and often hostile changes&#46; All of this generates insecurity and a lot of uncertainty&#46; The emigrant has to deal with the grief associated with the reduction in or loss of physical safety they may have felt in their country of origin and face up to the new risks that need to be combated and the consequent dose of stress&#46;</p></li></ul></p><p id="par0375" class="elsevierStylePara elsevierViewall">In addition to the losses cited by Achotegui&#44; we consider it necessary to signal two others who&#44; in the experience of emigrating&#44; blend in with the other seven and go unnoticed&#46; They are existential and ontological in nature&#44; but no less important than those of a physical nature&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">8&#46;</span><p id="par0380" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Past</span>&#46; Emigration is a break with the past&#46; Life before emigration was one&#44; and now&#44; a new existential dimension begins&#46; The discontinuity of a time in a place provokes a rupture of the existential discourse until now and opens time to a new narrative of existence&#46; In this new context of the host country&#44; the old narratives of the past lack effectiveness&#44; cease to be operative and fade away&#46; We are in a context&#44; and the context shapes a large part of who we are&#46; In our past&#44; we were one way&#44; and now the new context requires us to be another&#46; This involves a type of mourning that is not easy to bear because it begins a different way of living&#44; being and existing in the world with different others&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">9&#46;</span><p id="par0385" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Loss of previous identity</span>&#46; Due to emigration&#44; the person with a certain identity corroborated and nuanced by the presence and gaze of the others with whom they lived and interacted now cannot be brought up to date in the encounter with new people&#46; The person is an unknown and a stranger that the others do not recognise&#46; They see the emigrant as someone with no clear identity to them&#46; The emigrant&#44; therefore&#44; has to face a fact&#58; they will have to co-construct their new identity with what they bring from their world and what they can rescue from the relationships they will start building in their new place&#46;</p></li></ul></p><p id="par0390" class="elsevierStylePara elsevierViewall">So many losses make migratory grief a process which is only understandable if we use a metaphor&#59; it is a rebirth&#44; with everything that rebirth implies for a human being&#58; a new place&#44; a new time&#44; a new world&#44; new others&#44; a new life&#44; but above all&#44; a new existence&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Factors that predispose to mental disorder</span><p id="par0395" class="elsevierStylePara elsevierViewall">According to Bojorquez&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> there are two possible paths of association between migration and mental health&#44; one that establishes a causal relationship and sees the phenomenon of migration as a risk or precipitating factor for the development of mental health problems&#44; and another that considers that with migration a human natural selection takes place&#59; emigration would be a self-selection phenomenon which maintains that people with mental health problems are more likely to migrate&#46;</p><p id="par0400" class="elsevierStylePara elsevierViewall">The explanations for why migration can cause mental health problems can be interpreted from at least two perspectives&#46; One considers Pearlin&#8217;s stress model&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> which emphasises the individual&#8217;s ability to respond to stressful situations&#44; considering personal capabilities and the primary and secondary stressors to which they are exposed&#46; Migration as a stressful event tests the ability to cope with different stressors&#44; such as separation from loved ones and adaptation to a new society&#46; This requires the mobilisation of individual capabilities and sources of social support&#46; In the absence of resources&#44; the conditions can be created to develop mental health problems&#46; The other approach would consider the accumulated stress<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> that the complexity of migratory grief would generate in the person&#46; The difficulties of adapting to the new country due to the distance from family and friends&#44; language difficulties&#44; lack of work&#44; discrimination&#44; exclusions&#44; etc&#46;&#44; maintain a level of stress that lasts over time&#44; and its penetrating&#44; lasting and constant nature would work away&#44; accumulating intensity like a snowball&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><p id="par0405" class="elsevierStylePara elsevierViewall">It is also necessary to consider how people carry through the process of adaptation to immigration&#46; The adaptation process can follow different pathways<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#58; integration&#44; through which the person preserves their own cultural aspects and incorporates those of the new culture&#59; separation or resistance&#44; in which a rejection of a new culture occurs and the elements of identity with the culture of origin intensify&#59; assimilation&#44; which involves abandoning one&#39;s own culture in favour of adopting dominant cultural components in the host society&#59; and marginality&#44; which is the distancing and exclusion from both one&#8217;s own culture and the host culture&#46; These adaptation processes are frequently subject to different vulnerability factors&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> which influence the type of outcome&#46; Authors like Bhugra<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> suggest a series of such factors&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">&#8226;</span><p id="par0410" class="elsevierStylePara elsevierViewall">Pre-migration factors include the age of migration&#44; life cycle&#44; gender&#44; personality type&#44; skills deficit&#44; language&#44; occupation&#44; conditions before displacement such as persecution&#44; being forced to migrate&#44; previous expectations and opportunity to prepare for leaving&#46;</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">&#8226;</span><p id="par0415" class="elsevierStylePara elsevierViewall">Migration factors&#58; losses that emigration represents&#44; types of grief involved&#44; the presence of post-traumatic stress&#44; how the adjustment goes once in the host country&#44; the type of stresses that have to be faced in the field&#44; how the new social world welcomes them &#40;for example&#44; acceptance&#44; discrimination&#44; rejection or ambivalence&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">&#8226;</span><p id="par0420" class="elsevierStylePara elsevierViewall">Post-migration factors&#58; how they cope with the culture shock&#44; the cultural conflict&#44; the possible discrepancies between their previous aspirations and their later assessment in terms of satisfaction or failure&#44; the chances of recovering their normal levels of functioning before emigration&#44; the balance between the welcome that facilitates integration and the rejection that comes from discrimination&#46;</p></li></ul></p><p id="par0425" class="elsevierStylePara elsevierViewall">These vulnerability factors&#44; which put people at greater risk of developing disease&#44; can be compensated for and balanced on the scales with protective factors which modulate the impact of the process&#44; such as the voluntary prior preparation the emigrant may have made before setting off on their journey&#44; the social support they receive in the host country&#44; the socioeconomic and cultural advantages they obtain once they are an immigrant&#44; stability in every sense&#46; In most cases&#44; as Gonzalez-R&#225;bago says&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> the adaptation process of the emigrant to the host country is considered an integration process&#44; which includes quantifying adaptation parameters to the receiving society as a place of integration&#46; However&#44; the author proposes a process where the society of origin and the bond the immigrant maintains with it should be considered&#46; It makes evident that the integration perspective needs to be broadened&#46; The perspective of origin and the subjectivity of the immigrant person should be incorporated&#46; Hence&#44; they become actors who can question&#44; decide and transform the patterns and contexts in which integration occurs&#46; This is corroborated by studies showing that belonging to an emigrant group with a large and robust presence in the host country becomes a protective factor against mental illness&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> The incidence of psychotic disorders seems to be higher among immigrants who live in neighbourhoods where the representation of the ethnic group they belong to is deficient compared to the rest of the people&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">40&#44;41</span></a> Under this new perspective&#44; it is possible that vulnerability and risk factors could be significantly minimised so that the potential for mental symptoms and disorders does not lead to a mental disorder&#46; These aspects have been studied extensively in the Latino immigrant population in the United States by William Vega&#44; who found a relationship between perceived discrimination&#44; accumulated stress and mental health consequences&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> with a higher prevalence of mental disorders in Mexican immigrants than in the local population<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> and greater alcohol consumption in migrant adolescents&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> Also worth highlighting are the contributions of Garc&#237;a Campayo&#8217;s group on immigration and psychopathology<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45&#44;46</span></a> in relation to emigration in Spain&#46;</p><p id="par0430" class="elsevierStylePara elsevierViewall">It should be noted that there are positive aspects of migration which&#44; in terms of the host places&#44; result in greater intercultural and transcultural communication and other social and economic phenomena&#44; which benefit the whole society&#46; At an individual level&#44; this results in the long-term in&#44; the emigrant achieving a final situation better than the one they left in their place of origin&#44; where their social and economic conditions were generally precarious&#46; It is also worth noting the phenomenon of the Hispanic epidemiological paradox that Hispanics in the United States show better levels of health than the population average&#44; in contrast to what we might expect&#44; as their socioeconomic indicators are lower than those of the population as a whole&#46; However&#44; it is not within the scope of this work to explore that area&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Pathological and psychopathological processes</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Symptoms</span><p id="par0435" class="elsevierStylePara elsevierViewall">The most common and frequent symptoms immigrants may develop as an expression of their adaptation difficulties are many and varied&#58; anxiety&#44; insomnia&#44; nightmares&#44; apathy&#44; hypochondriacal fears&#44; tachycardia&#44; tachypnoea&#44; generalised pain&#44; gastric discomfort&#44; reflux&#44; irritable bowel&#44; weight-loss&#44; headache&#44; asthenia&#44; adynamia&#44; generalised fatigue&#44; dizziness&#44; vomiting&#44; sadness&#44; irritability&#44; substance use &#40;alcohol&#44; psychodysleptics&#41;&#44; loss of interest&#44; anhedonia&#44; attention and concentration difficulties&#44; memory failures&#44; ideas of disability&#44; ideas of guilt&#44; musculoskeletal somatisations and dissociative symptoms &#40;confusion&#44; spatio-temporal disorientation&#44; dissociative fugues&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Clinical profiles</span><p id="par0440" class="elsevierStylePara elsevierViewall">The medical literature identifies the following clinical profiles or disorders associated with the pathological processes typical of emigration&#58;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">&#8226;</span><p id="par0445" class="elsevierStylePara elsevierViewall">Stress disorder is a clinical condition of an adaptive nature associated with the acculturation process&#44; acculturative stress or what some authors called &#8220;psychological distress syndrome&#8221;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> at some point&#46; Migration is a process of organic transition that inevitably impacts a person&#8217;s development&#46; It means a readjustment in the person&#39;s entire life and existence<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> which&#44; if it fails&#44; generates stress as an experience in which the individual feels that the demands of the environment exceed their resources to cope&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> According to a study by Pati&#241;o Rodriguez et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> males and females react differently to migratory stress&#59; females tend to use avoidance strategies more&#44; ultimately leading to depressive symptoms&#46;</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">&#8226;</span><p id="par0450" class="elsevierStylePara elsevierViewall">Post-traumatic stress disorder&#58; one of the most frequently diagnosed in the immigrant population&#44; particularly when the migratory process has been tainted by extremely grim&#44; threatening or catastrophic events&#44; which can lead to greater difficulty in working through the grieving process&#46; This type of disorder is more common in situations of exile&#44; refugees&#44; subjects of political repression&#44; victims of torture&#44; or war situations in countries of origin&#46;</p></li><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">&#8226;</span><p id="par0455" class="elsevierStylePara elsevierViewall">Depressive disorders&#58; disorders affecting mood may be those most associated with migration&#44; as they are virtually the next step if the migratory grieving process fails&#46; What perhaps most characterises depressive disorders in migration is the strong component of somatisation in the expression of symptoms that prevails over other components which&#44; although they may be there&#44; are less intense&#46; There have been studies related to depression in emigrants for a long time&#44; with different names&#46; Psychosomatic maladjustment syndrome of the emigrant&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> hypochondria of the emigrant<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> and chronic adaptive disorder of the emigrant<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> are different ways of expressing a series of symptoms which&#44; ultimately&#44; are manifestations of a chameleon-like disorder&#44; such as depression&#46;</p></li><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">&#8226;</span><p id="par0460" class="elsevierStylePara elsevierViewall">Somatic symptom disorders&#58; among the most common are a group of non-specific symptoms&#44; which include headache&#44; back pain&#44; neck pain&#44; low-back pain&#44; abdominal pain&#44; reflux&#44; gastritis&#44; different intestinal transit disorders&#44; irritable bowel&#44; permanent and generalised fatigue&#44; dizziness&#44; nausea&#44; vomiting&#44; atopic dermatitis and a long list which shows how the impact of the migratory experience translates into the impact it produces on the emigrant&#8217;s life&#46; As it is often a difficult experience to digest&#44; symbolisation becomes difficult through the cortical route and is diverted towards a somatic response directed by the autonomic nervous system&#46; According to some studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">54&#44;55</span></a> there seems to be a higher incidence of somatic-type psychosomatic responses in the population of immigrants from developing countries&#46; Difficulties with the use of the host language&#44; with the consequent difficulty in accurately expressing the symptoms&#44; appears to be an aspect which has a strong influence&#46;</p></li><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">&#8226;</span><p id="par0465" class="elsevierStylePara elsevierViewall">Psychotic disorders&#58; it is not uncommon to find excessive diagnosis of psychosis in immigrants&#44; as the adaptation difficulties caused by the fact they are migrants are attributed to psychotic disorders&#44; when in reality they are misinterpreted feelings of mistrust in response to the conditions of isolation&#44; loneliness&#44; discrimination&#44; exclusion or social rejection&#59; these feelings can lead to a great deal of anguish and anxiety&#44; often expressed with paranoid overtones&#46; In fact&#44; Kinzie and Feck&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> used the expression &#8220;paranoid reaction of the foreigner&#8221; or &#8220;paranoid reaction of the refugee&#8221; to describe the symptomatic expressions of an acute paranoid nature observed in immigrants&#46; As is known&#44; schizophrenia was the first psychosis to be looked at in detail&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a> with investigations at the time showing that there was a higher rate of first hospitalisation in the immigrant population&#46; However&#44; the results of more recent studies<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">58&#44;59</span></a> were inconclusive and no assertions could be made&#44; so the question still remains&#46; With regard to psychotic disorders&#44; it can be said that the causes of an apparently higher rate in the emigrant population may possibly be explained by demographic differences which suggest greater vulnerability&#44; high rates of psychosis in the country of origin&#44; the selective migration of subjects with predisposition&#44; the migratory experience itself&#44; which is a stressor&#44; and also a tendency to over-diagnose schizophrenia in the immigrant population due to the cultural limitations of the healthcare professionals&#46; It should be noted that major psychiatric syndromes are phenomenologically universal&#44; but clinical expression is usually determined by cultural aspects&#46; So culture creates characteristic ways of presenting the disease in different societies&#46; We therefore have disorders associated with the culture of origin&#44; and when people emigrate they also take these ways of expressing the disease with them<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#58; <span class="elsevierStyleItalic">amok&#44; dhat&#44; bouff&#233; d&#233;lirante</span>&#44; brain fog&#44; fallin-out&#44; ghost sickness&#44; <span class="elsevierStyleItalic">koro&#44; latah&#44; mal de ojo</span>&#44; etc&#46;</p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">&#8226;</span><p id="par0470" class="elsevierStylePara elsevierViewall">Substance abuse and dependence disorder&#58; studies on this matter are inconclusive&#46; However&#44; there are studies&#44; such as that of Arallanez Hernandez&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a> which show that the very fact of migration&#44; along with the migratory stress generated&#44; is a strong enough influence to lead a person to opt for using drugs as a response to the difficulties that the phenomenon generates&#46;</p></li></ul></p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Ulysses syndrome &#40;emigrant syndrome due to chronic and multiple stress&#41;</span><p id="par0475" class="elsevierStylePara elsevierViewall">This syndrome expresses a direct relationship between the degree of extreme stress that emigrants experience and the consequent development of psychopathological symptoms&#46; As Achotegui<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a> described twenty years ago&#44; the manifestations of the syndrome include a combination of grief and psychological and somatic symptoms&#44; which explains the difficulties of working through migratory grief&#46; According to this author&#44; the emigrant has to deal with three potential types grief&#58; simple grief&#44; the type that can be resolved easily without symptoms&#59; complicated grief&#44; which&#44; as the name suggests&#44; means the person has difficulty in working through the grief&#44; which becomes entrenched and disturbed&#59; and extreme grief&#44; which is the type that cannot be worked through because it exceeds the emigrant&#39;s capacity for adaptation&#46; In the case of extreme grief&#44; the response acquires some greater degree of symptomatic expression and manifests as Ulysses syndrome&#46;</p><p id="par0480" class="elsevierStylePara elsevierViewall">What makes it more difficult to work through the grieving process is the existence of stressors and their influence is very important&#46; The following are the most prominent&#58;<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0175"><span class="elsevierStyleLabel">&#8226;</span><p id="par0485" class="elsevierStylePara elsevierViewall">Loneliness&#58; as a stressor&#44; the situation of loneliness in which the emigrant lives is a direct consequence of the forced separation from family and loved ones&#44; and involves suffering activated by memories&#44; emotional needs and different types of fear&#44; all of which are linked to constant feelings of insecurity&#46;</p></li><li class="elsevierStyleListItem" id="lsti0180"><span class="elsevierStyleLabel">&#8226;</span><p id="par0490" class="elsevierStylePara elsevierViewall">Grief due to failure of migratory goals&#58; this originates from the failure of the migratory project&#44; from not achieving the least opportunity&#44; from access difficulties &#40;documents&#44; work&#44; exploitation&#41; instilling the feeling of constant failure which can translate into discrimination&#44; exclusion or rejection&#46;</p></li><li class="elsevierStyleListItem" id="lsti0185"><span class="elsevierStyleLabel">&#8226;</span><p id="par0495" class="elsevierStylePara elsevierViewall">Fight for survival&#58; the difficulties with diet &#40;little&#44; poor quality and newness and tastes&#41; and housing &#40;overcrowding&#44; little privacy&#44; living on the street&#41; create a state of things that prevents intimacy and consolidates precariousness and poverty at levels that affect human dignity&#46;</p></li><li class="elsevierStyleListItem" id="lsti0190"><span class="elsevierStyleLabel">&#8226;</span><p id="par0500" class="elsevierStylePara elsevierViewall">Fear&#58; develops as a result of the physical dangers related to the journey &#40;coercion from mafias&#44; trafficking networks&#44; detention and expulsion&#44; abuse by authorities&#44; future uncertainty&#41;&#44; creating a context which is threatening and hopeless&#46;</p></li></ul></p><p id="par0505" class="elsevierStylePara elsevierViewall">These stressors that form part of the migration phenomenon can become intensified as factors arise which enhance them&#46; Most common problem is the multiple nature of the stressors&#44; with a single stressor not the same as several acting in parallel&#44; and chronicity&#44; with the stressors persisting for long periods&#46; The intensity and relevance of the stressors has a strong influence&#59; the lack of a sense of stress control&#44; the lack of a social support network&#59; the classic stressors of migration such as culture&#44; language&#44; landscape&#59; the development of disabling symptoms and&#44; lastly&#44; the prejudices of healthcare staff and officials&#46;</p><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Symptoms of Ulysses syndrome</span><p id="par0510" class="elsevierStylePara elsevierViewall">The symptoms are varied and wide-ranging and cover different dimensions of psychopathology&#46; They can be summarised as follows&#58;<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0195"><span class="elsevierStyleLabel">&#8226;</span><p id="par0515" class="elsevierStylePara elsevierViewall">Depressive area&#58; sadness&#44; crying&#44; guilt&#44; ideas of death &#40;very rare&#41;&#46; Obsessive ideas&#44; ideas of handicap which are consolidated to the extent that the situation is not resolved&#46;</p></li><li class="elsevierStyleListItem" id="lsti0200"><span class="elsevierStyleLabel">&#8226;</span><p id="par0520" class="elsevierStylePara elsevierViewall">Anxiety area&#58; tension&#44; nervousness &#40;in the face of adversity&#41;&#44; excessive and recurring worry&#44; irritability&#44; difficulty initiating sleep&#44; intrusive recurrence of memories&#46;</p></li><li class="elsevierStyleListItem" id="lsti0205"><span class="elsevierStyleLabel">&#8226;</span><p id="par0525" class="elsevierStylePara elsevierViewall">Somatic area&#58; somatoform symptoms &#40;headache&#44; fatigue&#44; musculoskeletal&#41;&#44; contractures&#44; joint pain&#44; back pain&#46;</p></li><li class="elsevierStyleListItem" id="lsti0210"><span class="elsevierStyleLabel">&#8226;</span><p id="par0530" class="elsevierStylePara elsevierViewall">Confusional area&#58; failures in attention and memory that lead the individual to feel lost&#44; even physically&#46; This confusion is linked to having to hide&#44; become invisible and in the end not know whether you are coming or going&#46; An existential dislocation&#46;</p></li></ul></p><p id="par0535" class="elsevierStylePara elsevierViewall">This summary of the clinical profile we have provided as a brief outline is not strictly speaking a condition we have to include primarily in the field of psychopathology and clinical psychiatry&#44; but rather it transcends these dimensions and should be included in the broader field of mental health&#44; as the conditions and circumstances come from contextual events&#44; the powerfulness and stressor potential of which exceeds people&#8217;s tolerance limits&#46; It is a door or hinge between mental health and mental disorder&#46; It belongs to the field of prevention&#44; rehabilitation and the psychosocial area&#44; rather than to the territory of medicalised treatment&#46; However&#44; in the absence of alternatives and options&#44; it is very easy for it to cross over into psychopathological and clinical territory as the final phase in difficulties with resolution&#46;</p><p id="par0540" class="elsevierStylePara elsevierViewall">We must not forget that there are other clinical conditions that need to be taken into account when considering Ulysses syndrome&#46; The most important due to the similarity of the symptoms are post-traumatic stress disorder&#44; adjustment disorder&#44; uprooting disorder&#44; migratory grief&#44; depressive disorder and psychotic disorder&#46; Post-traumatic stress disorder involves the symptom of apathy and generally a single traumatic event&#46; In Ulysses syndrome&#44; there can be multiple stressful events and apathy does not present as a symptom&#46; In adjustment disorder&#44; the subject shows excessive reactions to problems&#46; In Ulysses syndrome&#44; the problems are terrible and the individual cannot adapt because they are outside the system&#46; Concerning depression in Ulysses syndrome&#44; there is no apathy &#40;unlike in depression&#41;&#46; Still&#44; there are thoughts about life&#44; family&#44; dreams&#44; and positive thinking towards the future that they are there and will not give up&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">A phenomenological reflection on migration</span><p id="par0545" class="elsevierStylePara elsevierViewall">Talking about migration as an existential experience means broadening the view of the individual in their structural limits&#46; From this perspective&#44; we propose that an individual is their body plus their context&#44; that is&#44; their corporeality plus the world at their disposal&#46; The body&#44; an open system&#44; is a structure whose matter&#44; of a biological nature&#44; needs to sustain itself and preserve its constitution and functioning in a world or environment that can provide it with inputs to survive&#46; It lives in a space-time context that is part of its totality and provides a vital ecology to which it is profoundly and intimately linked&#46; Let&#39;s say that organically they form a whole&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">61</span></a> As Heidegger would say&#44; &#8220;being there&#8221; in the world&#44; a world that is part of that body&#46;</p><p id="par0550" class="elsevierStylePara elsevierViewall">When we think about the physiology of an individual&#44; we consider that they are made up of their physiology plus the physiology of the other&#44; which means understanding that the physiology of a human being does not end in the skin&#44; it continues in the skin of the other&#46; The others acquire a transcendental dimension in our lives&#46; The other as a legitimate other is part of me&#44; I need the other who recognises me as someone also legitimate and from whom I need affection&#44; company&#44; closeness&#44; tenderness&#44; etc&#46;&#44; aspects that act on my physiology and without which I get sick&#44; because their presence is part of the totality that we are as individuals and of what we consider our existence&#44; &#8220;being there with another&#8221; in the world&#46;</p><p id="par0555" class="elsevierStylePara elsevierViewall">Relationships are a dimension of our totality as individuals&#44; each individual includes &#8220;the self plus the others&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a> The self has no meaning without others&#59; our identity comes from belonging to a group&#44; being part of a we&#46; Being and being among others is part of the construction of our identity&#44; which is forged by all the residue that significant relationships leave as a product of their moulding and modelling influence&#46; We are part of a community&#44; and that community is what builds our mind&#44; which needs at least two brains in relationship for it to emerge from the depths of the central nervous system&#46; As Aristotle said&#44; the mind is a social phenomenon&#44; an expression taken up by Bartra<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a> when they said that our mind emerges from an endobrain housed in the skull&#44; which protects countless neuronal connections&#44; and an exobrain&#44; which is made up of the extracranial connections we maintain with other brains with which we interact&#46; Our mind is sustained by the fact of being and being among others&#46;</p><p id="par0560" class="elsevierStylePara elsevierViewall">So we all have a life&#44; an existence and a mind&#46; Migration causes a rupture of the totality that is an individual&#46; Context&#44; the other and relationships are cut off from the total unit that is the individual&#44; as if they have lost half of themselves&#46; This means that the tensions that were worked through and contained in its environment are now free and uncontained by the context it houses&#44; the other it contains and the relationships it shelters&#46; Then&#44; as a containing existential ecology does not gather them up&#44; the tensions retreat into corporeality in the form of somatisations in response to the physiological injuries of the loss of context&#44; physiology and relationships&#44; and symbolic injuries in response to one&#39;s own cultural provisions&#44; which become almost inoperative in the new culture&#44; in which and from which a new symbology has to be created and recreated in an attempt to make up for the deficiencies of one&#39;s own&#44; which provokes a psychic response of suffering and stress that leads to mental symptoms&#46; To lose half of one&#8217;s totality is to come into contact with Thanatos&#46; The individual finds themselves in a kidnapping &#40;voluntary or involuntary&#41; in another culture&#44; in a suspended and transitory death that sometimes lasts until the illness develops&#46; The lack of dichotomising output between success and failure is established&#44; resulting in tension that leads to stress&#46; In a way&#44; migration is always an existential debacle whose solution is not the same for all individuals&#46; However&#44; solidarity&#44; cooperation and generous understanding will be the keys to getting out of this debacle and what has been a catastrophe for some&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Funding</span><p id="par0565" class="elsevierStylePara elsevierViewall">The authors declare that they have not received any funding for this article&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conflicts of interest</span><p id="par0570" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The phenomenon of migration generates a series of experiences in the human being that are translated into emotions&#44; feelings&#44; adaptation processes&#44; grief and psychopathological processes&#44; and even pathological expressions&#44; represented by clinical pictures of different kinds&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The purpose of this article is to carry out a conceptual and clinical reflection on the semiology around the concept and experience of migration&#44; in order to illustrate the complexity that it entails as a human phenomenon&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A reduced narrative review&#44; circumscribed and restricted to the semiological&#44; psychopathological and clinical aspects of migration&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The separation&#44; ruptures and losses that derive from migration do not go unnoticed by the individual&#46; They are inscribed in his&#47;her corporality as physiological injuries that affect his&#47;her life and as symbolic injuries that affect his&#47;her existence&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Migration supposes a rupture of the totality of being&#46; The context&#44; the perception of others and relationships are cut off from the total unity that is the individual&#44; as if he&#47;she lost half of him&#47;herself&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El fen&#243;meno de la migraci&#243;n genera una serie de experiencias en el ser humano que se traducen en emociones&#44; sentimientos&#44; procesos de adaptaci&#243;n&#44; duelos y procesos psicopatol&#243;gicos&#44; hasta expresiones patol&#243;gicas representadas por cuadros cl&#237;nicos de diferente &#237;ndole&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La intenci&#243;n de este art&#237;culo es realizar una reflexi&#243;n conceptual y cl&#237;nica de la semiolog&#237;a en torno al concepto y la experiencia de la migraci&#243;n&#44; para con ello ilustrar la complejidad que entra&#241;a como fen&#243;meno humano&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n narrativa reducida&#44; circunscrita y restringida a los aspectos semiol&#243;gicos&#44; psicopatol&#243;gicos y cl&#237;nicos de la migraci&#243;n&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discusi&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La separaci&#243;n&#44; las rupturas y las p&#233;rdidas que se derivan de la migraci&#243;n no pasan inadvertidas al individuo&#44; se inscriben en su corporalidad como lesiones fisiol&#243;gicas que afectan a su vida y como lesiones simb&#243;licas que afectan a su existencia&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La migraci&#243;n supone una ruptura de la totalidad del ser&#46; El contexto&#44; el otro y las relaciones quedan cercenados de la unidad total que es el individuo&#44; como si perdiera la mitad de s&#237; mismo&#46;</p></span>"
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Article information

ISSN: 25303120
Original language: English

DOI:10.1016/j.rcpeng.2021.05.010

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