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Migration has been a collective experience for humankind throughout history. There has almost never been a society which has not experienced migration in some form or the other, and currently no such society exists. Some societies have sent many immigrants abroad, some have received or hosted, and still others have been in transit along paths of migration; almost all have experienced migration, though to varying degrees and in varying forms. Humankind does in fact owe its current existence to a combination of migration and evolution.

Migration is thus a universal and historical fact. One could list a vast variety of historical samples: migration of early human beings out of Africa; migration of European peoples to the east coast of North America in the nineteenth century; further migration of many of them to the west of North America; migration of people from South America and Central America and Mexico via the US border to the north; migration of workforces from southern and eastern European countries to northern and western European countries in the twentieth century; migration of war refugees during and after world wars; migrations of post-colonial and post-cold war periods; migration of highly educated professionals from developing countries to more developed countries (the so-called brain drain or gain); and recent migration of refugees and asylum seekers from conflict areas, especially from Africa and the Middle East, to more stable and developed countries.

Although these events have their own historical, socio-economic and political reasons and dynamics, migration is used as an umbrella term to signify a wide variety of facts and processes including ‘forced migration’, ‘voluntary migration’, ‘migration of the work force’, ‘economic migration’ and so on. Furthermore, the groups of people taking part in migration are also defined under similar umbrella terms (e.g. immigrants, refugees, asylum seekers, guest workers, etc.). On the other hand, it should be kept in mind that groups of people referred to under such umbrella terms, while sharing some commonalities, also show some distinctive features.

In general, migration is defined as the geographical movement of people from one place to another, but every instance of migration needs to be assessed in its singularity. Such an approach helps to discuss certain special aspects of migration, such as where the demarcation line between voluntary migration and forced migration should be drawn or what the legal and health conditions of refugees and asylum seekers are in different parts of the world at different times and how these could be improved. In fact, the definition and features of migration and the related phenomenon are not consistent in every geographical and historical context (Bartram et al. 2014).

Since there is no ‘one uniform migration’, reviewing its impact on mental health by taking it as an independent variable and examining its effects on the people who had migrated or hosted the immigrants would be misleading. This ‘geographical move’ involves a complex web of cultural, economic, social, psychological and political reasons, motives and implications, including the ones relevant to the mental well-being and mental ill health of the peoples involved. Immigrants do not all prepare in the same way and their reasons for migration are varied. The process of migration and subsequent cultural and social adjustments also play key roles in the mental health of the individual. Clinicians must take these ranging factors into account when assessing and planning unique intervention strategies aimed at the individual in his or her social context.

These mental health implications and traumatic consequences of migration, especially on refugees and asylum seekers, are the subject matter of the other chapters of this book; this chapter, meanwhile, focuses more on the traumatising effects of stigma and discrimination.

The Issue of ‘the Other’

In order to understand the traumatising effect of stigma and discrimination on immigrants, the issue of ‘the Other’ should be briefly reviewed from a historical and conceptual perspective. Different human social groupings are commonly seen as ‘others’ by members of other groups. Mercier (2013), philosopher and novelist, captured it precisely as follows: ‘Others are really others. Others’. We human beings need to set up social networks with our fellows for existence and survival, which inevitably sets the basis for social groupings and, in turn, generates the categorisation of ‘in-groups’ and ‘out-groups’, ‘me’ and ‘others’ or ‘us’ and ‘them’.

To obtain an overview of the roots of the issue of ‘the Other’, some of the works by scientists of the humanities were reviewed (see, e.g. Şenel 1982, 2003, 2014; Ilin and Segal 1942; Leakey 1994; Engels [1884] 2010; Hirs 2010; Mayor 2012). Historically, during the hunter-gatherer period of humanity, the main categorisation which was used as a crucial tool for survival was the distinction between ‘harmful/poisonous (food)’ and ‘edible/nutritious (food)’. Any obstacle in reaching necessary aliments was to be removed or killed including the other human beings or animals. These ‘others’, however, were not categorically conceptualised as ‘the Other’; they were merely obstacles to be eliminated in order to ensure survival. The establishment of such categorisations (i.e. ‘in-groups’ vs. ‘out-groups’, ‘me’ vs. ‘others’ or ‘us’ vs. ‘them’) has their roots in the historical period in which people were shifting from the hunter-gatherer lifestyle to the period of the first settlements. The first settlements developed near to the big rivers. The Nile, Yellow River, Euphrates-Tigris (i.e. Mesopotamia) and Amazon, with their continuous flow of water, provided the preconditions for the earliest agricultural production. The first horticultural and agricultural societies were formed, and farming offered the inhabitants of these first settlements more sustainable means of nutrition such as wheat, corn and rice. Furthermore, shelters and housing, mainly made of mud and agricultural leftovers such as straw, became the living area; these new homes were obviously more protective than caves had been and were to form protection against the attacks of others. These processes also forced people to create more elaborate social groupings and organisations in these first cities. Göbekli Tepe, in southeastern Turkey, has been shown to be a good example of such a process in modern day (Benedict 1980). This development, in turn, gave way to more clearly defined social strata and the division of labour into categories such as social leaders, priests and workforces. The emerging social classes and hierarchy set the basis for sharing the surplus value and production as well as fulfilling people’s spiritual needs, especially in face of overwhelming natural changes and disasters. These social organisations were established through cooperation, collaboration and solidarity among the members of the ‘in-groups’. Moreover, they were an effective means of defending the group against ‘out-groups’. These modes of production and sharing were also reflected in their corresponding modes of thinking and mindsets. Conceptual categories of ‘members of my city’ or ‘my citizens’ or ‘my civilisation’ and ‘members of other cities’ or ‘non-citizens’ or ‘other civilisations’ or ‘foreigners’ had become a paradigmatic fact of the human condition. The zeitgeist of the city states had developed, and conceptualisations of ‘us/friends’ vs. ‘them/enemies’ had emerged and been established along with the formation of city states and city walls.

The conflicts of interest between members of ‘in-groups’ were solved through the use of inner regulations based on shared goals, ideals, values and rules, while conflicts with ‘out-groups’ were solved either by armed confrontations and wars or negotiations and treaties. Not only socio-economical life itself but also the psychological mindsets and mental structure of humanity gave birth to the categorisation of ‘us’ vs. ‘others’; hence, such categorisation has also been the source of discrimination and stigmatisation in the centuries that followed. This is a reality of human history/existence which cannot be ignored and should not be seen from a romantic idealistic perspective, but rather from a realistic humanistic perspective.

Accordingly, the crucial question is not whether the categorisations of ‘us’ vs. ‘others’ exist, but rather how and by whom these categorisations are determined. In any given society, the ‘social power relations’ determine the stratification of ‘us’ vs. ‘them’ groupings. This stratification works both for intergroup relations and for intragroup relations. Whether a group is to be designated as ‘the Other’ and labelled with prejudice and discrimination will depend heavily on the zeitgeist of the current dominant social power.

Throughout history, the zeitgeist of any social power has evolved alongside socio-economic changes. In the era of empires, the social power was in the hands of a dynasty which also owned the armed forces and land in the name of ‘the holy’. The majority acknowledged the existence of minorities, a sort of ‘parallel existence’, unless these minorities or ‘others’ expressed a will to take over the power. Discrimination against marginalised people, for example, people with mental illness or so-called witches, was an unquestioned exercise like all the other discrimination in the name of ‘the holy and the king’. Moreover, other empires or their immigrants, named barbarians, were considered to be real threats, i.e. ‘the Other’.

In the era of nation states, the social power seems to be in the hands of the state, run by the ‘elected or selected powers’. Nation states, independent of their sociopolitical administrative regimes, relied heavily on the motto of ‘one nation, one flag, one language’; in some cases, ‘one religion and/or one leader’ is also added to this motto. The zeitgeist of the current dominant ‘social power’ and the majority in general do not acknowledge the existence of minorities. Minorities are either exterminated or assimilated. They are defined and discriminated as ‘the Others’, people who have different ethnic origins, belong to other cultures and talk other languages (as their mother tongue). ‘The Other’ is discriminated against in the name of national identity and uniformity. The borders of these states are strictly controlled, and border crossing is regulated by national regulations and international treaties. Travelling documents and working and residence permits are also strictly controlled by national authorities. Other than tourists, anyone geographically moving from one national state to another, either legally or illegally, becomes an immigrant, refugee or asylum seeker and is open to discrimination.

Although some sociologists consider the current historical period as the ‘post-national’ era (Soysal 1994), immigration and refugee policies are mainly controlled by national states and to some extent by international organisations founded through treaties signed by these national authorities. According to the zeitgeist of the current times, ‘us’ denotes productive human resources while ‘the Other’ is anyone outside of this group, such as the disabled. Of course, humanity has also developed policies and taken humanistic steps against such discrimination. The human rights of various minorities, including disabled and disadvantaged groups, immigrants, refugees and asylum seekers are protected by many international laws and treaties (see some of the relevant United Nations documents listed at the end of ‘References’), at least de jure, if not de facto.

Here, as far as the focus of our discussion is concerned, it is important to add that each era had inherited ‘the Other’ of the preceding era. Hence, in today’s societies, all the historical ‘Others’ could be and frequently are designated as ‘the Other’. This explains, why in various parts of the world, many people are still discriminated on the basis of their ‘in-group’ features, i.e. on the basis of race, nation, ethnicity, religion, sex, sexual orientation, gender identity, skin colour, health condition or abilities and mostly socio-economic class and inequalities.

Prejudice and discrimination based on such designations have been causing devastating trauma due to personal cruelty and mass violence and consequently human suffering on a vast scale in almost all societies. Human history is full of violent acts which are examples of specific discrimination of people with migration backgrounds. Today, the challenge seems to be to confront all the discriminative practices which have built up over the course of human history and have been inherited by our current societies. The solutions in such a process of confrontation do not lie in the challenges and solutions of previous eras; modern challenges cannot be resolved by referring to the means of premodern times. Tackling the discrimination of populations with migration backgrounds, whether it is based on nationality, ethnicity or religious belief, should therefore not be based on the values and zeitgeist of previous eras of national states or emperorships. Fundamentalism based on religious beliefs and national identities are premodern suggestions to postmodern challenges and the ones which lead to deepening suffering rather than furthering human collaboration. Our current task is to develop new postmodern ways of overcoming discrimination, thus leading to a more humane cosmopolitanism (Appiah 2006) by enjoying our intergroup diversities and differences. As stated elsewhere (Bartram et al. 2014), national identity is not the focus of attention in cosmopolitanism; people are considered equal as individuals, as global citizens. In today’s world, migration is considered as a key component of social transformation in general. The salience of national identity is a matter of great regret for many people, in part because of its consequences on how immigrants are sometimes treated by host societies. ‘Nationalism is something to be resisted or suppressed, particularly when one considers its consequences. Modern nationalism had fed vicious violence and wars ranging from individual acts of cruelty to genocide’ (Bartram et al. 2014).

Migration and Mental Health

According to Parla (1997), while ‘Self is constructed through confrontation with the mirroring effect of the Other, the Other is discovered through self-confrontation’. The construction of the self-identity is an ongoing joint reconstruction process in which we need Each Other. Migration is a process by which the immigrant and the host meet Each Other. The complexity of migration and related processes, including various modes of acculturation, marginalisation, integration, assimilation, stigmatisation, hybrid identities or multi-identities and multiculturalism or cosmopolitanism, all attract the interest of scholars from various disciplines.

Vulnerability caused by factors related to migration and its effects on the psychological well-being of immigrants, refugees and asylum seekers have been widely revealed in many pieces of research as well as in the other chapters of this book. Three stages of the migratory process and possible vulnerability factors have been defined respectively, revealing a clear picture of the process (Bhugra and Jones 2001). The first stage is the ‘pre-migration period’ where the individuals decide to migrate and plan the move. Immigrants create a network of relations, both in the host and origin societies. The decision to migrate is not usually made in isolation by the individual, but in the context of these relational networks (Hinze 2013). The second stage is the ‘process of migration’ itself and the physical transition from one place to another, involving all the necessary psychological, social and economical steps. Finally, the third stage is the ‘post-migration stage’, when the individuals deal with the social and cultural frameworks of the new society to adapt to new roles and become interested in transforming their group. At these stages, possible factors affecting vulnerability include the individual personality features of the immigrants and experiences of loss, bereavement, depression, post-traumatic stress disorder and cultural shock. Besides this, the attitudes and behaviours of the members of the host society towards the people with an immigration background constitute another domain of vulnerability factors determining mental health outcomes at the post-migration stage. These outcomes could be summarised by a spectrum between the dimensions of assimilation/integration and marginalisation/rejection, depending on the degree to which contact is made with the host culture on one hand and the degree to which the culture of origin is maintained and relations with the home culture are sustained on the other. In fact, most immigrants show a combination of these processes and outcomes.

The migration process is inevitably stressful and stress can lead to mental illness, but does not necessarily do so. Such stress may not be related to an increase in all types of mental illness or to the same extent across all immigrant groups. On the other hand, for many immigrants, migration can bring new opportunities leading to higher living standards and improved quality of life and personal satisfaction.

Migration forces the immigrant to reconstruct himself/herself along with his/her life story or the answers to the questions ‘who am I, where am I coming from and where am I going?’. What happens when one migrates, or as it is phrased in a Turkish song ‘Bir yiğit gurbete düşse gör başına neler gelir?’ (translated as ‘what happens when one faces homesickness?’). One of the first reactions of the immigrant is a strong desire to return home or at least a dream of doing so; this homesickness characterises the foreigner. The fear of losing one’s affiliations and belongings triggers a phantasised and idealised reconstruction of the lost home. The conflict is between the real (not romanticised) host country that the migrant is living in and the idealised lost homeland that is kept alive in the mind of the migrant; this conflict asks for ‘a dual existence’. This conflictual state is described very well by a Turkish-German writer, Emine Sevgi Özdamar (2000). It is a state of ‘living in between’ (Oren 1987) or a craving to create a new way of living in a ‘third new space’, one which contains both rather than either or Existing in a third space is a process where we meet Each Other. That is exactly why immigrants are not a distinctive group; they are a key part of the whole society, with far-reaching implications for how the people of the host country understand important aspects of themselves. Migration has also been a progressive factor: an opportunity for maturation for the many involved.

Trauma and Mental Health

Various psychological traumas, particularly those experienced in early years, have been widely shown to have detrimental effects on the mental well-being of humans. Such early traumas have been considered as part of the explanatory models for mental disorders which occur in later years, e.g. early loss of a mother connected to depressive states in adulthood. Furthermore, traumas experienced during adulthood also have a crucial impact on the development of post-traumatic stress disorder. When migration is recognised as a traumatic life event for immigrants, the intermediate variables which increase or decrease the traumatic effects of migration and vulnerability become an important focus of attention. We consider stigmatisation and discrimination, among other variables, to have the highest traumatising impacts on the lives of immigrants. Furthermore, we consider stigmatisation and discrimination to be closely and negatively related to the working and living conditions of the immigrants and their psychosocial status in the society. This could lead to a vicious cycle, lower social status causing higher discrimination and vice versa. Discriminative behaviours put the immigrant in a double-bind situation: they must either reject the host society and become marginalised or accept being assimilated. In other words, it creates ghettos on one side or loss of identities on the other. Neither of these alternatives leads to better mental health.

A part of the story that is often neglected is that discrimination and stigmatisation of social groups with a migration background are also harmful for the host societies. Discriminative acts prevent the members of the host societies from finding creative solutions which lead to new possibilities of enrichment via confrontation with different cultural backgrounds. The possibility of reaching ‘transnational citizenship’ (Balibar 2003) is lost due to stigmatisation and discrimination. For all of these reasons, enhancing our understanding of the re-traumatisation of immigrants through stigmatisation is an issue of concern.

Stigma and Stigmatisation

One of the factors mediating the stressful effects of migration on mental ill health is the degree of discrimination and stigmatisation that immigrants are facing. Stigma is considered to be an amalgam of ignorance and stereotypes, prejudices and discrimination (Rose et al. 2007). Here, ignorance could be defined as a lack of knowledge and interest, while stereotypes refers to the cognitive aspect of the social categorisation of people into ‘in-groups’ and ‘out-groups’. Prejudices or negative attitudes towards ‘out-groups’ reflect the emotional aspect of this categorisation, while discrimination, i.e. excluding and avoiding behaviours, refers to the behavioural patterns of the host society towards perceived ‘out-groups’, inevitably harming them (Hinshaw 2007).

From a more sociological point of view, the process which ends with discriminative acts starts with the phenomenon of labelling (Link and Phelan 2001). Any group which is labelled on the basis of their differences stimulates stereotypes towards members of that group and strengthens the categorisation of ‘us’ vs. ‘them’. Such categorisation, whether factual or illusionary, creates emotional responses such as fear, anxiety, anger, pity, shame, alienation, embarrassment, and prejudices which can lead to discriminative acts.

Discrimination of the immigrant in the host society has a crucial role in converting the experience of migration into a traumatic life event. Discrimination against immigrants originates primarily from the categorisations of ‘in-group’ vs. ‘out-group’ or ‘us’ vs. ‘them’, designated by the dominant paradigms in that society. The cycle of stigmatisation and exclusion (Sartorius 2006) starts with the labelling of immigrants, both as a group and individually, as ‘the Other’; this causes alienation and mobilises stereotypes related to that group, in turn leading to ignorance and prejudice and thus causing discrimination and stigmatisation not only against that specific group but also against all immigrants. Immigrants, as a minority group in the host country and culture, are frequently open to accusations by the majority pertaining to any issue which emerges and which is perceived to be related to the minority’s situation. The result of such stigmatisation is policies which demand that minority groups are assimilated and behave, feel, work and live as the majority group do.

It has been clearly shown that the discrimination of immigrants is reinforced by expressed signs of difference (Hinze 2013). When differences in race, ethnicity, cultural habits and religious beliefs and rituals are not taken as a basis for enrichment but rather as a basis for prejudice and discrimination, they serve as stress factors which predispose a person to or trigger mental ill health. Furthermore, prejudice and discrimination originating from a single feature of the members of a minority group are usually generalised to the whole person and all of their features. For example, members of a minority group who are discriminated against due to their ethnic or national origins could also be discriminated against on the basis of assumptions about their intellectual performance. This generalisation of stigma leads to the reinforcement of stereotypes and exclusion. Even factual differences such as language and non-verbal communication style differences could become the basis for such generalisations. Moreover, stigmatisation disregards the heterogeneity of various within any one group, instead considering any stigmatised group as homogenous (Mok 1998). In fact, such discrimination has caused vast human suffering in almost all societies across the world, throughout history. Many human-made disasters and acts of mass violence have been executed in the name of such group differences and diversities.

Responses to Stigma

In almost all societies, multiple sources of stigmatisation and discrimination have led to the creation of the society’s own ‘scapegoats’, its very own ‘Others’. In a given society, immigrants, refugees and asylum seekers are one of the most readily available groups of ‘Others’ to be stigmatised. Stigma against people with migration background puts a heavy and complex burden on the lives of immigrants. The difficulties of daily life such as working conditions, social relations and so on, can be wounding enough in themselves, but the extra burden of discriminative attitudes and behaviours can have a deeply traumatic impact on the immigrant’s psychological well-being and social relations. While on one hand aiming to overcome the task of adaptation and integration in the host society and facing the related distress and possible disabling effects of this process, immigrants also often face the traumatisation caused by stigma and exclusion.

Richman and Leary (2009) have described three forms of response to this discrimination. One form of response is to experience the limiting consequences of stigma via the internalisation, i.e. through self-stigma or ‘self-oppression’ (David and Derthick 2014); this involves the devaluation and inferiorisation of oneself and one’s group and diminished self-esteem and self-efficacy. A second response is righteous anger and more active attitudes towards discriminating prejudices, while the third form is indifference. Many immigrants show a combination of these responses to varying degrees, depending on the stage of their migration process and the interaction of their subjectivity with the objectivity of the sociocultural contexts they are living in.

Internalised stigma or self-stigma can be regarded as consisting of three dimensions: self-stereotyping, self-prejudice and consequently self-discrimination (inspired by Hinshaw 2007). Self-stereotyping reflects the cognitive aspects of social categorisation (i.e. ‘I am a member of a disadvantaged, inferior group’); self-prejudices reflect the emotional aspects of differentiation (‘I am different and rejected and deserve this situation’); lastly, self-discrimination refers to internalised behavioural patterns (‘I do not have the same rights; I cannot do what they can do’). Internalised stigma stimulates a vicious cycle of traumatisation via lowered self-esteem and expectations, mixed emotions of anger and shame and frequently learned helplessness and a decrease in personal capacity and coping skills, in turn leading to an increase in the stigmatisation faced in the external environment.

Internalised stigma and oppression are both heavily traumatising and hidden. Furthermore, it is often ignored in scientific circles and theory (David and Derthick 2014). Hence, the voices, concerns and real-life experiences of many devalued and marginalised groups, including refugees and asylum seekers, often remain unheard (David and Derthick 2014). A further consequence of internalised oppression is that the victim of the trauma could very quickly become a perpetrator himself/herself as an act of survival, as illustrated in the case of Stockholm syndrome or analysed and described as identification with the aggressor (Duran 2014).

The Issue of ‘Roots’

On our way to conclusions and discussions of how to overcome the stigma and traumatisation related to migration, the issue of roots deserves to be mentioned briefly, from a sociological perspective (Yumul 2006). Describing people according to their roots and identifying them with their homelands and nationalities have been a characteristic of our zeitgeist. Roots not only feed a tree but also fix the tree to the land. This makes it impossible to belong to different lands at the same time. When the nations and nationalities are ‘fixed’ in homelands, culture and nationalities are strongly linked with that land. In this zeitgeist, culture is not linked with the life journey itself but with roots fixed in a specific country. The migrant is therefore considered to be ‘rootless’, suffering from pathological cultural identities. Along these lines, the words of Deleuze and Guattari further clarify our position: ‘We are tired of trees. We have to give up believing in trees and roots. They have been the reasons for severe human suffering’ (Deleuze and Guattari 1987).

One may ask whether this is possible in real life; are there real people experiencing this position? The film director Fatih Akın and his filmography is a good example of being in the ‘third transnational space’ (Balibar 2003), enjoying ‘rootless’ multi-identities or multiculturalism. In one interview (2007), Akın initially hesitated for a while when he was asked the following: ‘Where do you belong? If you were a tree, where would your roots be?’. Then he answered: ‘Tree? Tree? Hmmm… Well, I would prefer to be a rose. No, no, not even a rose. Do I need to be a plant? If I am a plant, then I would be stuck in one land. In fact, I am a human being; I would prefer to feed myself from different lands/cultures’. It was as if he was describing how all his multicultural experiences belonged to him, but he did not belong or was not rooted in any one singular ‘in-group’ or land.

A novelist with a multicultural background, Amin Maalouf, is another real example of someone who has internalised a similar approach, enjoying his multi-identity. In the words of his protagonist, Leo Africanus, ‘I come from no country, from no city, no tribe. I am the son of the road… all tongues and all prayers belong to me, but I belong to none of them’ (Maalouf 1988).

Conclusions

We are living in a world of diversity in many facets of life. The challenge is not this diversity itself, but how we maintain and handle it. Is diversity taken as grounds for segregation and discrimination, power exercise and oppression; group terror or state terror; increasing inequalities and injustice? Does diversity form a basis for traumatising the minorities? Isn’t discrimination, based on being from this or that group, the oldest and most severe psychosocial trauma for the discriminated groups, including immigrants, refugees and asylum seekers? Or, on the other hand, could diversity be used as a more solid ground from which to reap the rewards of richness and multiculturalism as part of human coexistence?

Such questions lead us to a new set of questions: What could happen when a human meets a fellow human currently designated ‘the Other’ in that society? Are stigmatisation and discrimination inevitable? Could meeting ‘the Other’ alternatively lead to human enrichment motivated by a hospitality-based acknowledgement? On the other hand, most importantly, what are the opportunities that migration offers, both to migrants and to host populations?

We do not accept the idea of cultural hierarchy; thus there is no ‘pure’ culture that is superior to other cultures. This is also why a movement of purification imposed within a cultural area cannot be legitimate. Eventually, the recognition of multicultural identity is a new dimension of human rights, in other words the right to choose one’s culture and to respect the cultural choice of others.

The focus must be on creating and improving ways of living with diversity for the unity of humanity. Living in diversity is the fact; a uniform society, free of diversity, is the illusion or the wishful thinking of some oppressors and is in its very essence pathetic. How could diversities in human existence be orchestrated de facto for the benefit of us all?

Humankind is in need of developing an integrated self; this, in turn, depends on meeting and accepting the existence of ‘the Otherness’ in ‘the Other’. We need the mirroring of Each Other.

For the immigrant, the need to develop an integrative self-image and to reconstruct an identity in order to safeguard mental health can be thwarted by stigmatisation. Stigmatisation lashes out at ‘the Other’, and in so doing, it breaks down our own mirrors. A world without mirrors is a world without selves.