Ambiguous loss in the current migration crisis: A medico-legal, psychological, and psychiatric perspective

Abstract

Ambiguous loss is a condition of uncertainty experienced following the disappearance of a person or following the psychological absence of a loved one. It generally has psychological and psychosocial repercussions, in addition to economic and administrative consequences. In the current Mediterranean migration crisis, this condition affects families and persons who have remained in the country of origin or are waiting for the arrival of the person in the host country. In the literature few studies have analysed the psychological state of these persons and who they are, especially those who managed to reach the European coasts, and in particular no one has highlighted the desire to know which accompanies the families of the missing. The present study begins to fill this gap by analysing data collected from the families and friends of the missing who disappeared during the crossing of the Mediterranean; it aims to begin to discuss a little known issue, well visible to forensic scientists and psychiatrists and very likely relevant for clinical purposes. To this end, 340 ante mortem forms containing the information collected during interviews of the living to identify the victims were analysed, focusing especially on the data useful to trace a profile of relatives who seek their missing loved ones. Since, for these relatives, the information needed to investigate the emotional and behavioural trends of ambiguous loss was lacking, a different sample of ten patients from the Ethnopsychiatry Department of the Grande Ospedale Metropolitano Niguarda (Milan, Italy) who had recently lost a loved one was also included in the study. The results suggested that the living do not forget those who left and continue to seek their loved ones, even six years after the last contact, some investing economically in their travels. The number of persons looking for the missing supported this, underlining the great number of potential victims of ambiguous loss caused by the migration disasters and lack of identification of the dead. From a psychological point of view, comparisons were identified with post-war victims, highlighting that similar clinical consequences occur regardless of different cultural contexts and modalities of loss. Differences were also identified, especially concerning the tensions that the journey could have caused to the identity of the patients and the loneliness experienced where these persons live, making the cause of the malaise ascribable to the emotional and psychological repercussions of ambiguous loss. In such a situation the identification of a body may represent the way to find one's own roots, to facilitate the end of ambiguity, and to mark the point where they can start rebuilding a life. In conclusion, migrants should not only be included in the group of victims of ambiguous loss, but they should be ensured an integrated health path that takes into account their psychological and social conditions, remembering that the recovery and identification of a body or of an emotional bond may ameliorate mental health concerns.