“The Stress Along the Way”: Medicalization and Transit Migration

by Kristin Yarris and Heide Castañeda

This month, Youth Circulations features a series of conversations between two migration scholars, Heide Castañeda (University of South Florida) and Kristin Yarris (University of Oregon). In this series, Drs. Castañeda and Yarris creatively and critically examine representations of the circulation of Central American and Mexican migrants through what they describe as "a zone of transit" in Western Mexico. Their research is funded by The Wenner Gren Foundation for Anthropological Research, and is a collaboration with Dr. Juan Manuel Mendoza of the Universidad Autonoma de Sinaloa.

Kristin Yarris: 

Several participants in our project on Transit Migration through Mexico’s Pacific Route recently attended a workshop offered by two organizers with Doctors without Borders-Mexico (Médicos sin Fronteras, or MSF). While MSF doesn’t have a field site where we work, they do partner with migrant shelters--particularly those in the south and north of Mexico-- where they attend to the physical and mental health needs of migrants traveling through Mexico to “El Norte,” or the USA. In our field site, during this workshop, MSF was seeking to train local NGO staff and others working to protect the health and safety of migrants in transit, teaching people to recognize the signs of mental distress, and discussing appropriate responses.

Unlike the rhetoric dominating U.S. media during the current political cycle, which portrays migrants as criminals, “rapists” and drug traffickers, anthropological fieldwork shows that Central Americans traveling north through Mexico are highly vulnerable. These are people fleeing extreme conditions of poverty, violence and failed states and traveling with few possessions other than the clothes they are wearing and the few pesos they manage to carry in their pockets (Vogt 2013). MSF’s humanitarian assistance thus becomes essential and life-saving for migrants in transit through Mexico-- especially along the tracks of freight trains used as transportation, where migrants suffer traumas including falls, limb loss, rape and sexual assault, robbery, and extortion.

The images here are from a brochure distributed during the MSF workshop described above, which was held in August, 2015. What I find provocative in these images is the way the pamphlet transforms the violence and extremity of transit into a medicalized version of suffering: “estrés” (stress). My concern is that medicalizing transit violence and its mental health effects as “stress" risks shifting our gaze away from the sociopolitical dimensions of migrant suffering. Further, medicalization individualizes both psychosocial distress and the responsibility to respond to it. “Stress”, in particular, whether in U.S. or Mexican popular discourse, also implies an orientation to the individual sufferer, who must “manage stress”, as part of our responsibilities as neoliberal subjects.

These critiques of the medicalization of suffering are not new. Indeed, medical anthropologists have exposed how the individuation of harm reduction responses may save lives but do little to alleviate social suffering (Garcia 2010) and may exacerbate conditions of extremity (Jenkins 2015).  When I look across the images in MSF’s brochure– of migrants jumping across moving train cars, lying on the side of train tracks, or sharing a cigarette while ostensibly waiting to jump onto a moving train – and compare these images of danger and risk to the professionalized stress language contained in the bullet-points of text – “What is Stress? A physiological response we have when we perceive life’s demands as overly-difficult” – I perceive a troubling disconnect between medical discourse and migrant reality. And yet, I am able to critique this brochure from an academic distance, as I’m not currently in the field but instead sitting comfortably behind my laptop screen, analyzing images. So, I’m left with an unsettled feeling, both troubled by medicalization but also mindful of the crucial role MSF and similar humanitarian NGOs play in providing “primeros auxilios psicológicos” (“psychological first aid”) to migrants in transit, which can indeed be essential to migrants’ survival through a perilous journey.  

Heide Castañeda:

As Kristin points out, the images and text in the MSF pamphlet medicalize the violence and extremity inherent in the migrant journey, transforming it into a form of suffering called “estrés” (stress).  This occurs not only in the Mexican context; we have seen similar discourses about the mental health consequences of migratory transit in relation to Syrian refugees entering Europe. For the non-migrant viewer of the images, the individualization of this psychosocial distress onto migrant bodies works to remove any political imperative or ethical responsibility to respond. 

What strikes me also is that pathologizing the suffering that accompanies transiting from one place to another assumes that there is something abnormal about migration, or that it is somehow a new phenomenon. In fact, mobility has been a recurring feature of human populations across time and space, yet migration is still often discussed as if it were unusual. Time and again we encounter political and public debates that rely on an understanding of migration as abnormal. That migration is strange becomes “common sense.”

 At the same time, we of course recognize that this particular migration through Mexico – often but not always by Central Americans fleeing economic and political insecurity and underdevelopment – is particularly extreme. Not only are people migrating after having already suffered violences in their place of origin, but also travel along these routes is especially risky amidst harsh environmental conditions, dangerous modes of transportation, and interpersonal aggressions. In this case, MSF steps in where states fail and “do their best” despite the many critiques of short-sighted and depoliticized humanitarian aid. Indeed, MSF is among the few organizations that, despite observing neutrality and impartiality in the name of universal medical ethics, has also explicitly chosen to take a political stand for victims as part of their humanitarian efforts. 

Many of the images here show the dangers of travel (by train or by flimsy raft). One interesting photo shows two men sharing a smoke – is this supposed to indicate tobacco or marijuana use, to cope with estrés?  Perhaps, but I also see in the image camaraderie, solidarity, and the opportunity to share about one’s experiences. Maybe I am too optimistic, but this underscores that a migratory journey is not always a negative thing, nor really a “thing” at all. It is instead a social process. 

Kristin Yarris:

I agree that we need to be cautious about the tendency to medicalize migration-related stress or pathologize migration itself. As Heide rightly points out, migration is a social process and has always been one. Yet, I am also mindful of the very real violence of the journey that undocumented Central Americans make through Mexico on their way (usually) to the U.S., what Janis Jenkins (2015) might call a condition of extremity. Where the Mexican and U.S. states fail to protect migrants, NGOs like MSF respond by providing medical services and care at various points along transit routes through Mexico. This work is vital, often life-saving, and I value and respect our MSF colleagues in the field. Still, the tone and message of the brochure is unsettling to me, both for the brochure's ambiguity and for the ambivalence I feel about medicalizing migrant stress.

One area of ambiguity regards the target audience of the brochure - who is meant to receive these messages and what action(s) are the messages meant to provoke? At first glance, the pamphlet seems directed towards migrants themselves, given the tone, language, and how-to type instructions. On one hand, it is difficult to imagine migrants sitting down and reading such a brochure, given the instability and insecurity of their journeys. However, we have indeed encountered Central American migrants as far north as Sinaloa clutching onto the maps and printed guides that NGOs distribute in the South of Mexico, in shelters in Chiapas and Oaxaca. During interviews with migrants in a shelter in Sinaloa, I have witnessed travel-tired men and women pulling folded pieces of glossy paper from their jeans pockets; their edges worn and tattered from weeks of transit, the brochures and maps still serve as helpful guides for migrants making crucial decisions about their next northward steps. I am made to wonder if the benefit of this type of brochure lies well beyond the content of the message it contains. In other words, I am coming to see how such brochures become material instantiations of humanitarian aid, small tokens of social support – reminding migrants that, despite the dangers and marginalities of transit, they matter, they are cared for, and their lives have value. 


Works Cited

Garcia, A., 2010. The pastoral clinic: Addiction and dispossession along the Rio Grande. University of California Press.

Jenkins, J.H., 2015. Extraordinary conditions: Culture and experience in mental illness. University of California Press.

Vogt, W.A., 2013. Crossing Mexico: Structural violence and the commodification of undocumented Central American migrants. American Ethnologist, 40(4), pp.764-780.

Kristin Yarris is Assistant Professor of International Studies at the University of Oregon. Her research and teaching focus on global health, global mental health, migration, kinship and care.

Heide Castañeda is Associate Professor in the Department of Anthropology at the University of South Florida. Her research lies at the intersection of cultural and medical anthropology and focuses on migrant health, constructions of citizenship, and how policy and legal institutions shape everyday experiences of immigrant communities. Current projects focus on: mixed-status families along the US/Mexico border; transit migration in Sinaloa, Mexico; effects of healthcare policies on immigrant communities; and immigrant youth movements in Texas and Florida.