Culture, Medicine, and Psychiatry

, Volume 39, Issue 4, pp 698–724 | Cite as

Fighting with Spirits: Migration Trauma, Acculturative Stress, and New Sibling Transition—A Clinical Case Study of an 8-Year-Old Girl with Absence Epilepsy

  • Dimitrios Chartonas
  • Ruma Bose
Clinical Case Study


In this article, we discuss the impact of migration and acculturation processes on the cultural, personal identity, and mental health of children who immigrate to a Western, multicultural environment, and the challenges clinicians in such environments face, when confronted with non-Western idioms of distress and healing practices. We do that by presenting a challenging clinical case of an 8-year-old girl who presented with very disorganized behavior, which matches a culturally accepted construct of spirit possession, in the context of migration trauma, acculturative stress, and new sibling transition. We identify cultural conflict in school and bullying as major mediators between acculturative stress and mental distress. We also aim at identifying vulnerability, risk and protective factors, and the importance of cultural coping resources. We explore in depth the patient’s cultural background and the family’s belief system and culturally shaped narratives, in order to arrive at a cultural formulation, which focuses on the significance of idioms of distress in shaping psychopathology and influencing the personal and interpersonal course of trauma- and stress-related disorders. We also call attention to the finding that in children, idioms of distress may manifest themselves in a somatic manner. We argue, together with other researchers, that spirit possession deserves more interest as an idiom of distress and a culture-specific response to traumatizing events. We finally emphasize the importance of an anti-reductionist clinical stance, that is able to use different levels of understanding processes of distress and healing, and seeks to reconciliate cultural divides and integrate different explanatory frameworks and help-seeking practices.


Migration Acculturative stress Idioms of distress Embodiment Spirit possession Dissociation Absence epilepsy 


Declaration of interests

None declared.


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Authors and Affiliations

  1. 1.LondonUK

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