Skip to main content


  • Derek Summerfield

What prior assumptions might a psychiatrist bring into the room when the patient is an asylum-seeker? First, as a member of the public he or she is likely to have a view on asylum-seeking as a sociological phenomenon – up to 5 million have sought asylum in Western Europe in the past decade – and on how ‘deserving’ the average case is. After all, two adversarially opposed constructions of asylum-seeking have predominated. Governments, and the conservative social sectors, have stressed the prevalence of ‘bogus' applications by people who are essentially economic migrants, portraying them as wily, determined and tough rather than as having suffered. On the other side are the agencies and interests who support asylum-seekers, and the liberal and radical social sectors. They portray asylum-seekers as people who had no choice but to run from their countries, innocent of any thought but to escape further persecution and the risk of death. This portrayal invokes the image of suffering and vulnerability rather than resilience and agency. The reality is the muddied, uneven terrain that lies between these two entrenched positions. Many asylum-seekers do not have stories that easily fit the definition of a political refugee in the 1951 United Nations Convention. Even those with the clearest-cut cases – such as those with a credible history of torture – usually cannot prove it; few are vulnerable in any medically attestable sense and, however much they have suffered, they continue to make choices and actively engage with their situations. All asylum-seekers are looking for a better life for themselves and their children.

Hide All
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.
Duffield, M. (1996) The symphony of the damned: racial discourse, complex political emergencies and humanitarian aid. Disasters, 20, 173193.
Eastmond, M. (1998) Nationalist discourses and the construction of difference: Bosnian Muslim refugees in Sweden. Journal of Refugee Studies, 11, 161181.
Gorst-Unsworth, C. & Goldenberg, E. (1998) Psychological sequelae of torture and organised violence suffered by refugees from Iraq. British Journal of Psychiatry, 172, 9094.
Kirmayer, L. & Young, A. (1998) Culture and somatization: clinical, epidemiological and ethnographic perspectives. Psychosomatic Medicine, 60, 420429.
Mezzich, J., Kirmayer, L., Kleinman, A. et al (1999) The place of culture in DSM–IV. Journal of Nervous and Mental Disease, 187, 457464.
Summerfield, D. (1999) A critique of seven assumptions behind psychological trauma programmes in war-affected areas. Social Science and Medicine, 48, 14491462.
Summerfield, D. (2001) The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category. BMJ, 322, 9598.
Tribe, R. (2002) Mental health of refugees and asylum-seekers. Advances in Psychiatric Treatment, 8, 240247.
Watters, C. (2001) Emerging paradigms in the mental health care of refugees. Social Science and Medicine, 52, 17091718.
World Health Organization (1992) The ICD–10 Classification of Mental and Behavioural Disorders. Geneva: WHO.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed


  • Derek Summerfield
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *