Keywords

Introduction

Acculturation is a term of fluid use in a variety of social sciences, historical and even philosophical topics [1, 2]. Although preferentially incorporated in the literature related to migration phenomena and their resulting changes, adjustments and adaptations across time, location and context [3, 4], it is also the subject of journalistic inquiries, methodological documents, social policies, political debates, and even fiction masterpieces. From a predominantly psychiatric perspective, acculturation occupies significant spaces in diagnostic and therapeutic areas: it plays a pathogenic role as a precipitating factor of a number of clinical conditions [5], and can be the source of therapy-oriented approaches for a variety of emotional disorders in members of different ethnic or cultural groups.

In spite of its very long history as a unique process of human interactions, the systematic and consistent study of acculturation may have started only in the first decades of the twentieth century when social scientists fixed their research interests in the complex process of world migrations and their many modalities, causal factors, evolvement, and outcomes. Culture, traditionally defined as a repository of experiences, traditions, habits, religion, values, and identities of human groups or communities [6, 7], entails also as a dynamic process, a changeable scenario resulting from the growing interactions between migrant groups and host collectivities [8]. Such unavoidable interactions take place in a variety of circumstances, dressed up by a variety of emotions: curiosity, predisposing aversion, hatred, fear, resignation, wish to help or compassion, among the members of the host society; and expectations, hope, illusions, uncertainty, fear, defensiveness, or anxiety in the migrant population. The concept, practice, and study of acculturation, thus generated, defined it as the uniquely contextualized process of experiential exchanges between the two protagonist groups of the migratory encounter, the resulting set of habits, beliefs, customs and everyday life practices in migrants and hosts [9].

There are many approaches to the study of the acculturative phenomena, depending on a variety of methodologies and perspectives covering different magnitudes of change [4, 5, 10]. The first criterion entails a causal approach, i.e., the reasons compelling people to take the route of migration: Was it voluntary or forced? If the former, be that determined by economic, occupational, deliberate factors and more or less planned organization, an open, amenable disposition to face the acculturative process and its specific experiences can be expected. If forced by social, financial, political reasons, or even by natural disasters, migration can become a profoundly traumatic event with refugee or displaced crowds unwillingly compelled to abandon familiar places and enter into unknown, even hostile scenarios [11, 12]: acculturation would then be an unexpected, imposed, multiplied traumatic process. An additional component has to do with whether the migration is internal (i.e., within a known territory such as the same country or region) or external, implying the crossing of international borders and the confrontation with more complex, testing, and demanding circumstances.

Among the many types or cases of migratory phenomena across world regions or continents, the movement of millions of Hispanic or Latin American (Latino) groups towards North America (mostly the United States) has a number of unique characteristics [13]. To cite a few of them, it can be said that most of the migrants come from Central American countries and Mexico, most are of modest socio-economic population segments, take on the route pushed by labor and work needs, and use either plain walking or crowded transportation means (i.e., buses, trucks, or trains) for their displacement to the Mexico–US border. At that point, they start probably the most complicated phase of the process, choosing either an uncertain chain of bureaucratic procedures, or the desperate and costly illegal entry led by demanding, abusive, unscrupulous “guides,” properly called coyotes [14]. These immigrants are mostly adult males, but thousands of women, adolescents, children, and even senior people also make this dramatic journey.

This chapter will briefly examine different aspects of the acculturation of Hispanic immigrants in the USA, described both as a socio-cultural process and as a specific human experience [10, 15, 16]. It will mostly focus on the health (physical and, mostly, mental or emotional) implications of acculturation, centering on the acculturative stress as both a critical component of the adaptational process, and a clinical condition, eventually recognized by classification manuals and other diagnostic resources. It will finish outlining management steps when necessary, and elaborating didactic conclusions and recommendations related to the various perspectives on the topic.

The Process and the Experience of Acculturation

Individual and collective changes induced by acculturation have been systematically studied through a variety of models and across several domains. The process generates changes in attitudes, behaviors, values, and cultural identity. Many authors mention acculturative motivations, availability of resources, and modeling factors as varied as personality dispositions, vocational interests, food preferences, peer relations, and media usage patterns [17,18,19]. In turn, these acculturation models vary in function of uni- or pluri-dimensional modeling factors. Perhaps the most consistently accepted approach to the study of this issue is Berry’s orthogonal, two-factor model of acculturation [20, 21] determined by the ethnic-heritage, and the dominant-culture mainstream dimensions whose dynamic, reciprocal interactions produce four distinctive, grade-based acculturative states: integration, assimilation, separation, and marginalization. Like in many other fields of scientific inquiry, this approach is not unanimously accepted, as purely socio-demographic and socio-economic factors seem to play a larger role than acculturation itself on the mental health implications of migration [22]. Furthermore, moderating factors such as cultural intelligence and perceived diversity climate of the host entities seem to be powerful pivots of a positive international acculturation [23].

The main components of acculturation as a process are, of course, the protagonists of the encounter: members of the migrant group and the host community or society. As important as they are, however, a crucial component is the set of circumstances that resulted in the migration itself, that is, a series of factors that evolve, silently or noisily, as triggers of a more or less predictable type of reception. For instance, if the migration was related to political situations (civil wars, dictatorships, persecutions, formal or violent exile, etc.), the reaction of the host society may include either sympathy, compassion and open support or rejection, distrust or different levels of uncertainty [19, 24, 25]. On the other hand, if migration responds to economic needs, joblessness in the country or region of origin, or pervasive levels of poverty and subsequent violence, the migrants will do it out of desperation but still embracing levels of hope, while the hosts may feel this as an opportunity of increasing its workforce at a relatively low cost, or as an inappropriate attempt to take over existing jobs [26, 27]. Whether the migration process takes place within or outside legal frames of reference, adds an important conditioning factor to the process.

The setting in which acculturation occurs is also a critical component. It has to do with the part of the host community where the immigrant arrives or decides to settle down. Massive migrations like that of Hispanics into the United States, usually lead to more or less deprived urban or peripheral areas in large cities [28] to the point that they seem unable to establish direct contact with members of the host communities: however, the fact is that the acculturation process starts almost immediately, regardless of whether the protagonists are or are not aware of its occurrence [29, 30]. Even though living in areas with high concentration of Latinos seems to make acculturation advance more slowly [28, 31], newly arrived immigrants are constantly reminded of the fact that they are in a different milieu, facing a different reality, subjected to new rules that they may, at first, attempt to deny or minimize, compelled to familiarize themselves with sets of psychosocial boundaries (i.e., language, food or communication styles, gender relationships, family life, authority principles, educational and religious practices, etc.) that in the end will generate a different behavioral repertoire [32, 33]. Acculturation as a process, however, may be more a portrait, an academic description, even an animated narrative.

As an experience, on the other hand, acculturation is, in many cases, an agitated, dynamic, at times chaotic succession of events, a personal story of intense learning and confronting circumstances and situations whose outcome remains uncertain for long periods. The constantly changing contexts (neighborhood, school, workplaces, churches, streets, transportation) challenge the adaptive capacities of migrant individuals and groups in a sequence that may be extremely disorganizing [17,18,19, 26, 28, 34, 35]. The environment into which the immigrant has arrived makes him/her aware of his otherness [36, 37], of his precarious standing of anonymity that, paradoxically, is not going to make him/her less visible, quite the contrary. And the problem becomes even more complicated because the immigrant is not or, many times, does not want to be aware of this collective ambiguity.

Acculturation is, therefore, a process that defies polite academic descriptions because it is constituted by intense experiences and variations. The most sophisticated research describes different outcomes, mostly qualified by the degree in which the newcomer adopts, absorbs, tolerates or rejects the social and cultural rules of the host society, against the background of individual personality, mood, cognitive, and other psychobiological traits [30, 31, 38,39,40]. Many authors consider the extremes of this process (i.e., total, almost unconditional acceptance vs. total, almost absolute rejection) as undesirable. The former, because it may reflect total subjugation or subordination to the “new” norms and the forging of a new form of renegade renouncing to history and legacies; the latter, because it would show unwillingness to reasonable adaptations, an unrealistic denial of the practicality of changing to advance without abandoning the telluric essences of one’s own self.

Acculturation in Hispanic Communities

Perhaps more than any other ethno-cultural group among migrant communities, Hispanics (or Latinx) coming into the United States offer the best examples of the good and bad sides of the acculturative phenomenon. Currently being the largest minority population in the country and having made unquestionable progress in a variety of areas, it is clear however that a lot remains to be done [41, 42]. The majority of Hispanic immigrants are from Mexico and Central America. A large proportion continues to be immersed in deep levels of poverty, unstable occupational and labor positions, deprived living conditions and risks of discrimination, stigmatization and neglect [43, 44]. A good percentage of the Hispanic population in the USA is made out of immigrants mostly devoted to rural, agricultural or moving work locations with predictable family instability, financial limitations, and scarce opportunities of physical, social, and emotional well-being [27, 29, 33, 45]. Its political impact is still far lower than the other largest minority group—African-Americans—and it is not yet possible to speak of strong or consistent efforts to coordinate and solidify common objectives.

A lot has been studied and written about the strengths and weaknesses of the Hispanic population and communities in the USA. Familism continues to be a well-preserved value among Latinos, together with its solid connections to respect for the elderly, the mother’s figure (and its resulting Marianism), and strong religious (mostly Catholic) devotions and practices [25, 46, 47]. On the other hand, economic factors generate many times family separations, particularly at the start of the migration process, as fathers and adolescents come first leaving the rest of the family awaiting and hoping. The same circumstances may contribute to nutritional deficits and lack of healthy physical practices, disagreements, criticisms, and eventual breaks of domestic violence [43, 45, 48]. Interestingly, there are differences between Hispanic immigrant groups (South Americans, Central Americans, Caribbeans), i.e., heterogeneity about peer choices, willingness to meet guidelines, new habit acquisitions, and other variables [49,50,51].

Throughout the whole time, acculturation’s complex operations are taking place even if the protagonists themselves do not realize it. The appearance of juvenile Hispanic gangs or pandillas has been explained both as a behavior copied from American-born delinquent groups deliberately devoted to the commission of criminal acts, and as a defensive reaction from young Latinos against the systematic hostility and harassments that the population’s majority inflicts on them [29, 43, 52]. The adaptation levels of Hispanic immigrants vary as a result of numerous factors: from the inner disposition to adapt that each individual brings into the new reality to the degree of hospitality of rejection on the side of the host community. The former has to do with the weight and the meaning of the person’s formative years, the shaping up of identity [3, 7, 12, 29, 44, 53], while the latter is a product of collective mentalities shaped up by history, culture, and socio-economic demands [23, 24].

The Clinical Scene

The clinical repercussions of acculturation operate, as well, at the individual and at the group or social level. They can impact both the physical and psychological health of the migrants, and the link with the migration process itself may not always be suspected, as the clinical manifestation may be noticed long after the arrival. The physical problems may be carried on by the immigrants (infectious or chronic diseases, allergies, fragile pre-dispositions, etc.) and triggered by environmental factors in the new setting, i.e., the impact of the “new” diet on an increased prevalence of colorectal cancer in first and second generation Hispanic immigrants [54]. Moreover, situations such as poor food intake and subsequent malnourishment and physical weakness or, on the contrary, disorganized intake, unbalanced diets, population densities in deprived urban or rural areas, and early exposition to alcohol or drugs, may contribute to obesity, hypertension, cardiovascular, respiratory or other conditions [55,56,57,58]. The lack of or difficult access to clinical services (determined by poverty, deprivation, isolation or sheer, systemic discriminatory practices by administrative border agencies [59]) may dramatically contribute to these tribulations [60, 61]. Contrarywise, a number of studies conclude that unidentified protective factors operate effectively among young adult and mature Hispanic immigrants [62, 63].

In the mental/emotional terrain, there is no doubt about the role of acculturation problems as triggering factors of a number of diagnostic conditions. It is appropriate to start with an entity included in both the WHO’s International Classification of Diseases 10th. Edition (ICD-10) [64] and the APA’s Diagnostic and Statistical Manual, 5th. Edition (DSM-5) [65], under the general heading of Other Conditions that may be the Focus of Clinical Attention: Acculturation Difficulty or Acculturative Stress. The difficulties in adjusting to a new culture affect the individual’s functioning and may induce clinical manifestations as varied as anxiety, fear, irritability, anger, “psychosomatic” (mostly gastrointestinal and cardiovascular), and physical (tremor, headaches, myalgias, etc.) symptoms. On occasions, and due to different severity levels of the acculturation process, or to the co-occurrence of other causal events, stress manifestations fit more precisely the picture of post-traumatic stress disorder (PTSD), with a variety of complex and severe clinical findings [66, 67].

Acculturation also plays a pathogenic role in a variety of other clinical conditions. Anxiety-related conditions, particularly generalized anxiety disorder (GAD), are probably the most frequent diagnoses, characteristic symptoms include irritability, short-temperedness, emotional lability, and insomnia. According to Hovey and Magaña [68], elevated acculturative stress, low self-esteem, ineffective social support, lack of control and decision-making capabilities, low religiosity, and high education are significantly related to high anxiety levels among Mexican immigrants. These patients may also report thinking almost obsessively about family members left behind, inability to concentrate, sudden impulses to run (at times, fantasizing with a return to their native country), mixed thoughts of violence, “anger towards God,” and incessant praying and imploring for divine help. In the relationship with their physical and human surroundings, they may experience a mix of rejection, fear, avoidance, and impulsiveness. Panic-like reactions are not infrequently seen.

Closely related to anxiety-related conditions, depression in different clinical modalities is also present in this population, particularly among undocumented adolescents [69]. To typical manifestations such as sadness, low mood, profoundly nostalgic memories, social isolation, anorexia (or hyperorexia), self-critical ruminations and a sense of failure or profound discouragement, a variety of physical/somatic symptoms, i.e., headaches, shortness of breath, chest pain, or fatigability, can be added [70]. While the disruption of social networks, particularly family separation, is a strong predictor of depression [71], it is important to note, however, that in Hispanic immigrant populations, suicide or suicidal behaviors are, at times, significantly less frequent than among the majority segments: this feature is explained on the basis of religious convictions, shame in the face of suicide’s meaning of defeat, pride and mutual feelings of solidarity and support [47, 72, 73].

Substance use disorders (SUDs) have also emerged with increasing force in the psychopathology of Hispanic immigrants, in spite of genuinely culture- and family-based protective resources and, ultimately, a small association between, for instance, current measures of acculturation and alcohol use among Hispanic immigrants [74]. A normative interpretation of acculturation’s effects, i.e., a more intimate exposure to Anglo culture through, for instance, language use, showed stronger connections with drinking outcomes among Hispanic male and female immigrants [75].

Furthermore, the role of acculturation in these disorders has to do mainly with the opportunistic presence of narcotic traffickers in the midst of the newly arrived human groups, the offer of alcohol or substances as means of relief, the fragility and suggestibility of many newcomers, and perhaps even a sense of being “accepted” if they do what they are “invited” to do. It is clear that some segments of the migrant communities (particularly adolescents) and individual adults may show spontaneous disposition, established habits, and/or active search of drugs and alcohol before the actual transition process [76, 77].

Last but not least, acculturation may trigger true personality disorders in individuals probably predisposed by genetic-biological factors, or contribute to their appearance by inflicting powerful stressing experiences, particularly to immigrant children who, then, become vulnerable to environmental factors leading to the disorders. An important study by Breslau et al. [78] reveals the dramatic increase of behavioral disorders across generations of Mexican origin after migration to the USA: lower in the general population of the country, higher in children of Mexican-born immigrants raised in the USA, and higher still in Mexican-American children of US-born parents; nevertheless, the association with migration was markedly weaker for aggressive than for nonaggressive symptoms. Moreover, it is somewhat surprising that antisocial behaviors reach the highest levels among Hispanic adolescents and young adult immigrants who use the separation (rather than marginalization) strategy of Berry’s model [20, 21, 79]. Finally, without specific epidemiological details, it seems likely that antisocial, borderline, histrionic, and passive-dependent types may be the most frequently personality disorders seen among Hispanic immigrants. Each label would have a more or less precise pathogenic chain of events leading to a final diagnosis [80, 81].

Management of Acculturation and Related Conditions

Although described primarily as a collective process, an event related to and experienced by groups of people and configured by institutional rules and norms, habits and dispositions, acculturation is also, in many ways, an individual phenomenon, a particular set of situations lived and led by a person exposed to a new, different environment, his/her new “home.” Most of the studies conducted in this area, however, use a group-oriented approach, a “public health” perspective [82] together with inputs from a variety of social sciences focused, again, on collective experiences and exchanges (families, communities, neighborhoods, etc.). On its side, the individual approach seems to mostly adopt the form of “clinical cases,” behavioral, mood-related or psychotic-like reports of conditions triggered and/or managed by acculturative factors [83].

The management of acculturation-related phenomena in a group context entails different foci:

  1. 1.

    Educational or formative, fundamentally oriented to basic aspects of everyday life that would make the adaptation process more manageable. Primary among them is the learning of the new language. It is well known that most Latino migrants to the USA do not speak English, so a more or less regular language-oriented training would provide them with probably the most decisive instrument for a good, constructive acculturation process [30, 42, 84]. In turn, the role of religious organizations is extremely important both for their purpose of spiritual and emotional support and the concrete actions of solidarity and material assistance [34, 85]. On the immigrant’s side, the use of integration as acculturation style serves as a protective resource [49, 86]. Needless to say, the immigrants are expected to take advantage of these opportunities, mostly implemented by school- and church-based organizations; if they do not, the result is, many times, a growing sense of isolation and self-exclusion [26, 27, 40]. Unfortunately, the numbers of those who adopt such intransigent position, dictated mainly by defensive, self-protective or anger-nourished elaborations, is not small.

  2. 2.

    Social, legal, and administrative rules, dictated by federal, state, county or local legislatures and other public organizations, supposedly in charge of an orderly location of immigrant groups, the implementation of dispositions related to personal documentation, potential job search or arrangements, living conditions, police and public order agencies, social living norms, etc. Undoubtedly well-intentioned, these tools cannot avoid a marked impersonal, bureaucratic flavor that, on occasions, may generate rejection on the side of the immigrants; their deficient use as rules to “reinforce” public order and tranquility can deviate or be interpreted, at times, as arbitrary, abusive, or discriminatory against the newcomers [5, 16, 19, 87]. The role of social media, in turn, makes communications and information-sharing a much more complex process [88].

  3. 3.

    Public Health proper, that is, mostly informative, prevention-oriented, guidelines-providing activities implemented in settings such as community centers, schools, city or municipal agencies or social organizations [89]. Entities formed by previous groups or waves of immigrants, already more or less established or integrated in the host society, occupy a front-line position in the implementation of these strategies [87, 90]. The actual procedures include public lectures, group conversations, home or neighborhood visits, city tours, telephone or online contacts. The newcomers are specifically invited to these activities, and clearly told about their purpose: make them feel comfortable enough to become quickly familiarized with their surroundings, know the rules, initiate job, school, church or other searches, and be reaffirmed in the main objectives of their move [91, 92].

  4. 4.

    The political management of the acculturation experiences falls in the hands of leaders, authorities, agencies, and parties guided by ideologies and doctrines, and implemented by public acts, manifestations, proclaims, and pronouncements. It may have, therefore, both positive and negative implications, with different measures of acceptance, popularity, persuasiveness, and effectiveness. A positive impact of the political management of acculturation is reflected in social order, equities, mutual acceptance, and pragmatic integration of the immigrant and local communities [15,16,17,18,19, 34, 90]. Negative impact, many times due to divisive, demagogic, confusing, changing or opportunistic positions adopted by political leaders, results in social injuries to the forthcoming members of the so-called “human capital” [93] in the form of pervasive discrimination, aversion, racism against “colored” people, and violence of all kinds (domestic, criminal, sexual and even police-led) [94,95,96,97].

The individual clinical management of acculturation-related conditions depends on the nature (physical/medical or mental/emotional) of the disorders. In either case, it becomes the responsibility of medical personnel in outpatient, hospital- or community-based settings: immigrants with acute or chronic physical or medical problems must be treated with the same professional dedication and promptness offered to local patients [98]. In the case of Hispanics, other than the language and communication issues [30, 42] the culturally determined attitudes towards figures of authority (i.e., health professionals) are an important factor for the success of the interactions [99, 100]. As mentioned above, probably the most frequent diagnostic conditions faced under these circumstances are nutrition-related (thinness or obesity), infectious, cardiovascular, gastrointestinal, or respiratory problems [54,55,56,57,58]; nevertheless, acculturation-related factors seem to accentuate ethnic and nativity-related low cardiovascular risk among foreign-born Mexican Americans when compared with non-Hispanic Whites [101]. On the other hand, lack of insurance coverage and financial restrictions among immigrants are definitely damaging factors in their overall management.

The psychological, mental, or emotional clinical conditions with acculturative stress as a point of departure require specialized care in many cases, including psychotic conditions [102]. The use of psychopharmacological agents (i.e., anxiolytics, antidepressants, major tranquilizers) is totally justified in order to treat specific target symptoms. The doses for Hispanic patients may be higher or lower than those required by Anglo-Saxon ones, depending on genetic/metabolic patterns, tolerance levels, side effect occurrences, history of previous use, etc., but the general recommendation is to start with mild to moderate amounts, and continue with periodic increments over a period of several weeks [103]. It is important to keep in mind that anxiolytic agents may induce tolerance, subsequent habituation and with further addiction and physical dependency. If there is a previous history of substance use or abuse, this chain of events becomes a complex management barrier.

These considerations make even more important the need to install a truly comprehensive treatment plan that includes appropriate psychotherapy arrangements. As acculturation is an essentially existential experience, the need to establish empathetic connections with the innermost aspects of the Hispanic patient’s psyche is mandatory [96, 99, 104]. Psychotherapy, independent of school-oriented techniques, allows an open discussion of the different phases of the migration process, and particularly the impact of, until then, unknown circumstances. The approach to be used needs to emphasize the common ingredients of all psychotherapeutic procedures [105], but also the recognition of features inherent to the Hispanic condition, such as cautiousness, initial distrust, further demandingness, respect towards authority, and willingness to follow instructions once the relationship has been duly established. Some cultural psychotherapies such as the use of typical short stories or proverb interpretations [106] may be particularly effective. Biculturality in Hispanic migrants seems to predict lower HIV acquisition risk [107]. Actually, prevention and treatment services for Hispanic immigrants, aimed at increasing levels of emotional support, self-esteem, and coping skills [72, 104, 108] are critically relevant.

Discussion

Acculturation as the culminating and most powerful phase of the migration process has, in the case of Hispanic populations, a number of unique features that impose a characteristically complex structure to the bio-psycho-socio-cultural-spiritual texture of this particular aspect of their life experience [109]. In other words, it affects the total human entity of the Hispanic migrant and may become a decisive factor in the final quality of his/her adaptation to the North-American milieu. That is why, pertinent steps of the acculturative journey [110,111,112] must be carefully explored in any kind of interpersonal contact, administrative inquiry or clinical assessment and, if possible, integrated in an individual life report, memoir, or healthcare record.

It must also be remembered that Hispanic migrants bring with them a unique table of values, one in which family ties, religious principles and social interaction norms play crucial roles [96, 99, 110]. Acculturation in the North-American scenario truly puts such values to a critical test as adaptation, no matter how successful, entails both change and permanence: the former as a condition of co-existence with the host population’s norms and lifestyles [113], some of which will be incorporated anyway; and permanence because renouncing totally to their original identity would make the Hispanic immigrant a victim of a blind, cognitive enculturation, a de-personalized, confused, self-damaging and alienated being [114]. That is why the main objective of a healthy acculturation, or of any management process to assist in it, must entail a deliberate search of harmony and balance [92, 96, 115, 116] in the context of a renewed identity [3, 34, 83, 117].

As a subject of research, acculturation offers a wide range of possibilities. Numerous studies on Hispanic immigrants in the USA clearly reflect the importance of the topic. Public Health inquiries suggest the need to refine existing tools aimed at the study of linguistic and other cultural elements looking for validity and usefulness across ethnic and subethnic groups [11, 118, 119]. The fascinating epidemiological “Hispanic Paradox” [120] constitutes a topic of almost endless possibilities in both methodological and clinical (physical and mental) areas addressing its validity and transcendency [121, 122]. Similarly, the theme of resilience and its role in the Hispanic acculturation process and experience, presents a crucial challenge both as an implicit preventive resource and an interventional strategy [123].

The risks of a failed acculturation are enormous. Whether they are originated in the personal structure of the migrant him/herself, or related to adverse features of the host community, the sequel of events in a denaturalized acculturation process go from behavioral and affective traits to well-documented clinical entities. The impact is, likewise, multifaceted because it reaches beyond the individual’s life alone, to touch on his family (by his side or distant, left behind), job, finances, links to socio-political institutions, and existential outcomes. The need of a firm, constructive acculturation is not only a fact relevant to the migrant or his/her family: it is of critical relevance for the fate and stability of the world community as a whole.

Conclusions

The complexity of issues involved in the consideration and the study of acculturation has captured the attention of academicians and researchers alike, as the migratory phenomena become a decisive factor in the current realities of globalization [124, 125]. The purpose of such studies is to dissect the different components of the process from the individual and collective perspectives, in order to take away the undesirable features of a failed acculturation, and make of it, instead, a pillar of constructive coexistences. Research on acculturation is extensive and keeps growing; it has provided interesting routes of knowledge towards its true nature, its phases, ingredients and as a factor of success or failure [126]; at the same time, however, it has uncovered sources of complexity, risks, and inconveniences in clinical, demographic, socio-cultural, and financial spheres. Ultimately, research on this topic can only be thorough if and when international efforts take place in attempts to identify commonalities of constructive acculturation experiences in different parts of the world and with different populations, ethnic or cultural groups—all efforts oriented to the elimination of dissension and conflicts.