Publications

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15–24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross‐sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long‐term impacts on Inuit youth, as well as exposure to culturally meaningful activities.

International adoption is a relatively recent phenomenon and research in this field is emerging, particularly on issues of ethnic identity development and its implications for psychological adjustment and well-being. This article presents a critical review of the literature on ethnic identity in transracial adoptees as it relates to discrimination and psychological well-being. The review results show no clear evidence on the relation between a strong ethnic identity of origin, racial socialization efforts by parents and psychological adjustment in transracial adoptees. Studies investigating the effects of discrimination are too scarce to be conclusive. Results are discussed in light of future research and clinical recommendations

À l’adolescence, les enfants adoptés à l’international sont confrontés à un double défi identitaire : celui de l’adoption et celui de la négociation du statut minoritaire. S’ajoute à cette tâche complexe la possibilité que certains d’entre eux soient victimes de discrimination. Le but de la présente étude est de documenter les processus en jeu dans la négociation identitaire des adolescents adoptés à l’international en portant une attention particulière aux enjeux culturels et de discrimination. Des entrevues semi-structurées ont été menées auprès de 13 participants âgés entre 12 et 17 ans et adoptés de pays d’Asie. Une analyse par théorisation ancrée révèle l’existence d’une variation dans les stratégies identitaires bien que la majorité privilégie l’assimilation. Les expériences de discrimination poussent certains à surinvestir leur culture d’accueil au détriment de leurs origines ou, à l’inverse, rend impossible leur intégration. Les implications cliniques sont discutées en lien avec les bénéfices possibles de la socialisation culturelle.

À chaque année au Québec, un grand nombre de travailleurs reçoivent des indemnités après avoir subi une lésion professionnelle. Selon des estimations de la CSST, près de moitié des travailleurs touchés par une lésion professionnelle sur l’île de Montréal seraient issus de l’immigration. Bien que ces estimations ne tiennent pas compte du phénomène de la sous-déclaration qui touche particulièrement ce groupe, elles montrent une surreprésentation de ces travailleurs par rapport à son poids relatif dans la population montréalaise dans son ensemble. Ces travailleurs sont souvent concentrés dans des secteurs d’activité et dans des postes qui représentent de plus hauts risques en matière de santé-sécurité du travail (SST). Ils sont aussi sujets, dans le contexte de la restructuration actuelle de l’emploi, à de multiples formes de précarisation (voir Frozzini et Gratton, ce numéro). Ces travailleurs vivent plus souvent des contraintes liées au contexte de travail en plus des barrières linguistiques et culturelles qui peuvent rendre la relation thérapeutique plus difficile. À défaut d’un soutien organisationnel approprié ou adapté à la réalité des prises en charge dans les contextes de pluralité ethnoculturelle, nous découvrons que les intervenants accumulent sentiments d’échecs et d’incompétence, surcharge de travail et stress, ce qui met leur propre SST à risque. Cet article présente une réflexion sur les conditions d’inclusion dans le contexte de la réinsertion professionnelle en soutenant qu’il n’est pas possible de penser l’inclusion des personnes issues de l’immigration sans penser aussi aux conditions dont ont besoin
les intervenants, les ressources et les formes d’organisation nécessaires pour optimiser les prises en charge.

The use of the category “race/ethnicity” intensified in the field of U.S. Public Health following the Clinton administration’s announcement of a budget increase for research focusing on ethnic and racial disparities in health. This article discusses the ways in which racialized difference is produced and represented as an object of knowledge and regulated by discursive practices in public health documents from U.S. federal government offices and a major public health journal published between 2001 and 2013. Races are approached, following Foucault’s proposition, as the product of racism, a technology of power of the modern State that consists of fragmenting humanity to permit colonizations. Thus, “race” has been established within the discourse to mark difference. Racism has developed concomitantly with the affirmation of power over life aimed at ruling out bodies and populations through public health practices, among others. The results suggest that the discourse on race varies throughout time. They indicate the relative permanence of a racialized regime of representation that consists of identifying, situating, and opposing subjects and groups based on standardized labels. This regime constitutes an ensemble of representational practices, which, together with disciplinary techniques and the use of culture as an idea, lead to the characterization and formation of racialized objects and stereotypes. These operations tend, together with medicalization and culturalization, to naturalize difference and constitute racial identities.

Résumé Cet article présente l’évaluation en méthode mixte d’une formation-accompagnement en santé mentale à l’école, proposée aux enseignants, aux équipes-écoles et à leurs partenaires des Centres de santé et des services sociaux (CSSS). Les résultats démontrent que la formation a augmenté le sentiment de compétence des participants quant à leurs interventions, leur confort par rapport aux décisions partagées avec leurs partenaires et leur motivation face aux collaborations interdisciplinaires. Ces résultats suggèrent que cette formation peut améliorer l’arrimage entre les milieux de l’éducation et de la santé face aux problèmes de santé mentale des jeunes à l’école.

For social workers striving for cultural competency and strength-based approaches with refugees resettled in the West, attention to the role of religion and faith as potential resources is particularly vital. With rising numbers of refugees fleeing from Islamic societies to Western host countries over the past two decades, social work research has articulated Islam as a source of strength and group solidarity, as well as the trigger for anti-Islam bias and discrimination. However, Muslims are not a monolithic group. This article reports on a qualitative study with fourteen Muslims seeking US asylum due to persecution based upon their gender role non-conforming behaviours.

Findings suggest that, for persons in this category, relationships to religion and faith may be complex, and potentially traumatic. Creating opportunities for gender role non-conforming refugees from Islamic societies to discuss religion and spirituality, with appropriate psychological support and without judgements from co-ethnic others or service providers, is an important clinical intervention for social workers to consider.

Comment ça se passe quand on est lesbienne, gai, bisexuel, transsexuel, queer (LGBTQ), mais aussi immigrant, réfugié, demandeur d’asile? Quelles sont les conséquences de cette double appartenance sur le parcours migratoire? Sur l’affirmation identitaire? Les services offerts à cette population prennent-ils en compte leur réalité?

Cette publication présente les résultats d’une recherche réalisée par Habib El-Hage, sociologue, et Edward Ou Jin Lee, candidat au doctorat en travail social, à l’Université McGill. Des personnes LGBTQ issues de l’immigration ont été rencontrées, ainsi que des intervenants sociaux et des gestionnaires d’organismes qui offrent des services à cette population.

Au Québec et au Canada, les politiques d’immigration visent à attirer « les meilleurs et les plus brillants ». Les médecins font partie de cette élite transnationale et leur « fuite » soulève des enjeux éthiques dans les zones mal desservies. Or, un second enjeu éthique apparaît au pays hôte : leur reconnaissance professionnelle parcellaire. Elle soulève là encore de nombreux défis pour ces médecins, dont celui d’une identité professionnelle malmenée, qui reste pourtant peu documentée. Le caractère dynamique et relationnel de l’identité professionnelle est mis en relief, mais surtout, la puissance des conditions d’appartenance qui oblige à une flexibilité professionnelle et parfois au retrait de la profession ou du pays ; la notion de pouvoir et celle de reconnaissance sont au cœur de ces processus identitaires. Dans cet article les auteurs posent un regard critique sur les approches centrées sur l’individu qui ignorent les normes et les contraintes sociales.

Background: Substance abuse is a worldwide public health concern. Extensive scientific research has shown that screening and brief interventions for substance use disorders administered in primary care provide substantial benefit at relatively low cost. Frontline health clinicians are well placed to detect and treat patients with substance use disorders. Despite effectiveness shown in research, there are many factors that impact the implementation of these practices in real-world clinical practice. Recently, the Ministry of Health and Social Services in Quebec, Canada,issued two policy documents aimed at introducing screening and early intervention for substance abuse into frontline healthcare clinics in Quebec. The current research protocol was developed in order to study the process of implementation of evidence-based addiction treatment practices at three primary care clinics in Montreal (Phase 1). In addition, the research protocol was designed to examine the efficacy of overall policy implementation, including barriers and facilitators to addictions program development throughout Quebec (Phase 2). Methods/Design: Phase 1 will provide an in-depth case study of knowledge translation and implementation. The study protocol will utilize an integrated knowledge translation strategy to build collaborative mechanisms for knowledge exchange between researchers, addiction specialists, and frontline practitioners (guided by the principles of participatory-action research), and directly examine the process of knowledge uptake and barriers to transfer using both qualitative and quantitative methodologies. Evaluation will involve multiple measures, time points and domains; program uptake and effectiveness will be determined by changes in healthcare service delivery, sustainability and outcomes. In Phase 2, qualitative methods will be utilized to examine the contextual facilitators and barriers that frontline organizations face in implementing services for substance dependence.
Phase 2 will provide the first study exploring the wide-scale implementation of frontline services for substance dependence in the province of Quebec and yield needed information about how to effectively implement mandated policies into clinical practice and impact public health.Discussion: Findings from this research program will contribute to the understanding of factors associated with implementation of frontline sevices for substance dependence and help to inform future policy and organizational support for the implementation of evidence-based practices.

L’embauche des travailleurs étrangers temporaires (TET) a des impacts sur  la cohabitation résidentielle et sur la cohabitation des métiers dans lescommunautés rurales. Cette étude repose sur le discours des chefsd’entreprises (n=17) et d’informateurs-clés (n=23) des secteurs agricole,horticole et de l’aménagement paysager au Québec. Ce type d’embauche aincité différents acteurs à reconsidérer leurs pratiques de gestion pour recréerun équilibre dans des petites communautés déstabilisées par l’apportdémographique saisonnier entraîné par l’arrivée des TET. De l’analyse dediscours a émergé un modèle de gestion de la diversité qui rend compte desdéfis de cohabitation pour les employeurs et les TET.

The Canadian government’s recent cuts to healthcare coverage for refugee claimants has rekindled the debate in Canada about what medical services should be provided to individuals with precarious immigration status, and who should pay for these services. This article further explores this debate, focussing on the perceptions of healthcare workers in Montreal, a large multiethnic Canadian city. In April–June 2010, an online survey was conducted to assess how clinicians, administrators, and support staff in Montreal contend with the ethical and professional dilemmas raised by the issue of access to healthcare services for pregnant women and children who are partially or completely uninsured. Drawing on qualitative analysis of answers (n = 237) to three open-ended survey questions, we identify the discursive frameworks that our respondents mobilized when arguing for, or against, universal access to healthcare for uninsured patients. In doing so, we highlight how their positions relate to their self-evaluations of Canada’s socioeconomic situation, as well as their ideological representations of, and sense of social connection to, precarious status immigrants. Interestingly, while abstract values lead some healthcare workers to perceive uninsured immigrants as “deserving” of universal access to healthcare, negative perceptions of these migrants, coupled with pragmatic considerations, pushed most workers to view the uninsured as “underserving” of free care. For a majority of our respondents, the right to healthcare of precarious status immigrants has become a “privilege”, that as taxpayers, they are increasingly less willing to contribute to. We conclude by arguing for a reconsideration of access to healthcare as a right, and offer recommendations to move in this direction.

Services that are designed by, and for, the host society majority group may be inadequate or inappropriate for ethnic minority or immigrant families. These issues are relevant to cultural consultants who are asked to provide advice to a variety of social service and institutional settings, including youth protection as well as legal and family services. Those who work within these agencies must be assisted to understand the difficulties encountered by migrant families during the process of resettlement, including separation and reunification, cultural variations in discipline and physical punishment, and the important roles of identity and intergenerational conflicts as well as distinguishing between situations of dysnormativity and dysfunctionality. Given that intimate partner violence is one of the challenges that institutional agencies face when assisting families, it is imperative that staff members be provided with the training necessary to adequately assist families confronted by these difficulties. The enormous power vested in these institutions and their representatives must also be considered when creating training strategies to assist workers. Finally, special attention must also be given to the challenges of migration and resettlement which can result in the destabilization of families, interrupt the transmission of traditional values from parents to children, diminish parental authority, and lead to the break-down of family structures which could result in the inappropriate removal of children from the parental home. Case vignettes and examples training programmes are used to demonstrate how cultural consultants can assist in the development of culturally safe spaces for families interacting with societal institutions.

Refugees and refugee claimants are faced with the task of rebuilding their lives in an unfamiliar environment, while having to deal with past trauma and multiple ongoing stressors. As part of the clinical intervention with this population, it is important to understand and act on the social determinants of health, which may maintain or exacerbate mental health problems and impede integration. In this chapter, we summarize the legal rights of refugees and refugee claimants, with a strong focus on the criteria that a refugee claimant must meet in order to be accepted as a refugee according to international and Canadian law. We then examine some of the main stressors that refugees and refugee claimants may face during the premigratory, transit and postmigration phase, and discuss in greater depth the impact of immigration detention in the host country and of family separation and reunification. This is followed by a discussion of the clinical assessment and treatment of refugees who have experienced trauma and forced migration. Finally, we provide guidance on writing reports assessing refugee claimants’ mental health in the context of refugee status determination proceedings. To conclude, we briefly examine the relevance for clinicians to engage in advocacy on behalf of this population.

Most models of mental health services have been developed in urban centres, with large populations and many specialized resources. Rural and remote communities pose challenges to these models for reasons of geography, social structure and culture. In Canada and other countries, rural and remote communities include a high proportion of Indigenous peoples, with important cultural differences from the urban population. In this chapter, we discuss the role of cultural consultation in providing mental health services for remote and rural communities, with an emphasis on the mental health of Indigenous peoples in Canada. The authors have worked as psychiatric consultants to First Nations and Inuit communities in Northern Quebec and draw from this experience and the work of the CCS to outline key issues for cultural consultation in this setting. The major social determinants of health and contextual factors that are distinctive for remote communities and Indigenous populations are reviewed. Models of service discussed include: onsite delivery of mental health services through collaborative care models; itinerant consultants; telepsychiatry; and satellite services. Mental health services for Indigenous communities need to be provided in culturally appropriate ways, both through supporting the use of traditional healing approaches and ensuring that mainstream mental health services are culturally safe and competent.

This chapter describes principles of collaborative care in mental health and how this model, based on strong partnership between primary care and mental health professionals, can be adapted to provide culturally sensitive services. The patient-centred model of collaborative care aims at decreasing barriers to accessing mental health care, which are particularly tangible for ethnocultural minorities and marginalized groups. It recognizes the major role played by primary care professionals in delivering mental health services and the benefit of comprehensive networks of professionals and community partners. The chapter discusses necessary conditions for implementing such initiatives, describes the benefits of multidisciplinarity, which goes beyond a medically centred model, and addresses issues of power. It then considers the adaptation of collaborative care to address the cultural specificities of communities. It reviews the recommendations of the Canadian Collaborative Mental Health Initiative (CCMHI) Toolkit for Ethnoculturally Diverse Populations and of the Canadian Collaboration for Immigrant and Refugee Health (CCIRH), and then focuses on two key areas identified by these recommendations: partnership with communities and awareness of historical and cultural specificities. The chapter then describes a youth mental health care project in a multiethnic neighbourhood to illustrate how collaborative care can be adapted to local constraints, while fostering attention to cultural diversity in mental health. Finally, the chapter addresses training methods appropriate to support collaborative care and proposes a continuing education program based on the synergy of seminars, supervisions, and didactic teaching.

Issues of gender, ethnicity, power and position not only influence the identity and social suffering of the patient, but shape the clinical encounter influencing therapeutic alliance, transference, countertransference and the process of assessment and treatment. This chapter uses case material from the work of South Asian cultural consultants to illustrate how the identity of the consultant influences clinical encounters with patients from the Indian subcontinent, with particular attention to gender and power issues. The cultural or racial similarities or differences in the identity of consultant and patient, or referring clinicians, raise complex issues encompassing institutional, familial, and individual dynamics. These issues may have positive effects on the clinical alliance, or create excessive ambivalence and negative responses that undermine therapeutic work. Mirroring of gender and power attributes can position the therapist as someone who shares vulnerabilities and strengths with minority patients. This can cause impediments to clinical work, with resistance, scotomas or excessive identifications. The intrapsychic, intra-familial and socio-political implications are explored using a case examples as well as reference to current literature on gender, migration and identity. As the cultural consultation strives to promote cultural safety as the primary basis of engagement, therapist and patient identity issues must be acknowledged and conflicting agendas of gender, power, ethnicity, as well as cultural dissonance and prejudice must be negotiated by consultants and clinical teams.

This chapter addresses cultural consultation in child psychiatry. The mental health needs of immigrant and refugee youth are outlined, and different models of mental health services for immigrant and refugee children and their families are described. The work of two transcultural child psychiatric teams, one in Canada and one in France, are presented in order to illustrate the practice of transcultural child psychiatry. The aim is to outline practical strategies for consultation and intervention, and also to show how specific institutional, social and political contexts influence how clinicians address issues associated with minority status and culture in their cultural consultation work. The chapter concludes with some reflections on how sociocultural context influences the practice of transcultural child psychiatry in these two models of care.

In this chapter, we describe the development, implementation and evaluation of the cultural consultation service (CCS). We begin with some background on the development of intercultural services in Montreal. The next section describes the rationale for the CCS approach and the steps involved in setting up the service. The third section provides an overview of the cases seen by the service in the first decade of its operation, including sources and reasons for referral, as well as socio-demographic and clinical characteristics. This provides a sense of the portfolio of cases from which vignettes are drawn throughout this book to illustrate key issues in cultural consultation. The remaining sections summarize findings from qualitative process and outcome evaluations of the service. The analysis of cases seen in the CCS and transcultural clinics indicates that access to mental health care varies widely by linguistic and cultural background. In a significant number of cases, language barriers and the cultural complexity of the cases had prevented adequate assessment in conventional mental health care settings. The CCS was able to provide clinical reassessment and redirection of treatment in a substantial proportion of cases and these interventions have been well received by referring clinicians. Although cultural consultations require substantial resources, in terms of specific expertise in cultural psychiatry as well as interpreters and culture brokers, the result of this intensive process is often a change in diagnosis and treatment plan with significant immediate and long-term consequences for patients’ functioning, use of services, as well as clinician satisfaction.

Cultural diversity presents an important challenge for health care services in every society around the world. In this introductory chapter, we consider the changing meanings of culture and the ways in which different societies have responded to cultural diversity in mental health services. We show how these approaches reflect local patterns of migration and demography, ideologies of citizenship and theories of the place of culture in mental health. We outline the rationale and key principles of the cultural consultation approach: focusing on social and cultural contexts in assessment; recognizing the ubiquity of culture in the experience of patients and clinicians; understanding culture not simply as mental representations but as embodied and enacted; using systemic, interactional and self-reflexive views; emphasizing problems of power, position and communication; approaching culture and community as resources for healing, adaptation and recovery; and working within health care systems to foster change. We illustrate what culture adds to clinical care including diagnostic assessment and treatment through the contextual framing of psychiatric disorders. Social and cultural processes shape the mechanisms of disease, the symptoms of distress, and subsequent ways of coping or help-seeking. Systems of healing reflect cultural models of body, self and person that are grounded in distinctive ontologies or notions of what constitutes the individual and the world. Finally, we consider the importance of understanding culture and context for clinical empathy.

Cultural diversity is a global challenge for mental health services. The changing demography of communities requires rethinking approaches to cultural competence for health professionals and institutions. Cultural consultation is a way to improve the quality of mental health care by providing a nuanced understanding of the predicaments that prompt diverse clients to seek help, and the social contexts of their mental health problems, to guide clinical assessment and intervention.

Cultural Consultation explores the practice of cultural consultation as a strategy to improve the quality of mental health care for diverse populations. The contributors, who have worked together at an innovative clinical service, frame best practices in psychiatry clinical psychology, and social work in relation to empathy, human rights, and culturally responsive and ethically sound care. A detailed model of the process of cultural consultation, from initial intake, through assessment, to recommendations and referrals, provides guidelines for clinical practice. Expert contributors examine specialized settings (medical, psychiatric emergency, inpatient, social/legal services), populations (remote, indigenous, child and youth), and contextual issues in the care of people with a wide range of mental health problems. Numerous case examples, charts, and tools add depth for readers interested in developing similar services or enhancing existing practice. Among the key areas covered: 

• Working with interpreters and culture brokers.
• Family systems in cultural consultation.
• Gender, power, and ethnicity in cultural consultation.
• Consultation and mediation with racialized and marginalized communities.

Collaborative care and primary care consultation.

• Cultural consultation with refugees.

A unique guide to challenges and opportunities in contemporary practice, Cultural Consultation will be immediately useful for health care professionals, clinical psychologists, and cultural consultants and provide a versatile knowledge source for years to come.

Many migrants do not speak the official language of their host country. This linguistic gap has been found to be an important contributor to disparities in access to services and health outcomes. This study examined primary care mental health practitioners’ experiences with linguistic diversity. 113 practitioners in Montreal completed a self-report survey assessing their experiences working with allophones. About 40 % of practitioners frequently encountered difficulties working in mental health with allophone clients. Few resources were available, and calling on an interpreter was the most common practice. Interpreters were expected to play many roles, which went beyond basic language translation. There is a clear need for training of practitioners on how to work with different types of interpreters. Training should highlight the benefits and limitations of the different roles that interpreters can play in health care delivery and the differences in communication dynamics with each role.

An analysis of worker participation was carried out as part of a larger study on strategies for managing occupational safety and health in small businesses that hire immigrant workers. This analysis was based on the triangulation of three data sources: interviews with those who answered the questions on behalf of the small business owners or managers (n = 28); occupational health professionals who gave advice to the same small businesses (n = 26); and questionnaires completed by the immigrant workers (self-administered, n = 181). The results converged in that immigrant workers, compared to workers of Canadian origin, received less initial training when hired and were less able to identify risks. Immigrant workers informed their employer less often when they were injured and participated less in investigations following an accident. Many did not have protective equipment and, where the employer did provide it, they were less inclined to wear it. Generally, insufficient effort was made by small businesses to protect or inform immigrant workers of their rights and obligations, or to integrate them into the workplace. The study shows that it would be useful if company directors provided support to manage the occupational safety and health of immigrant workers and compliance with regulations, as well as endeavouring to understand the issues underlying equal labour and management representation in occupational safety and health.

On connait peu de choses sur la vie des immigrants sans papiers au Canada, et encore moins lorsqu’ il s’agit des jeunes. À partir d’ un terrain ethnographique, cette thèse examine les interactions complexes entre les politiques d’ immigration et les vies de jeunes migrants (14-20 ans) sans papiers, issus de pays latino-américains ou caribéens et vivant à Montréal. Cette thèse a deux objectifs principaux. Premièrement, à partir de l’étude des lois et décisions juridiques de la dernière décennie au Canada, cette thèse vise à explorer comment les politiques d’immigration construisent des jeunes migrants simultanément comme des Autres menaçants et comme des êtres vulnérables, leur enlevant ainsi leur voix. Ces politiques d’ exclusions sociales transforment dramatiquement la vie de ces jeunes en limitant les possibilités de leurs interactions quotidiennes et en restreignant leur accès à des services sociaux. Deuxièmement, à partir d’un terrain ethnographique réalisé auprès de jeunes migrants sans papiers, cette thèse a comme objectif de comprendre comment ces sujets réinterprètent activement leur position sociale subordonnée et affirment leur pouvoir d’agir. La thèse postule que la multiplicité des stratégies développées par les jeunes migrants pour faire face aux incertitudes et à la liminalité découlant de leur statut migratoire est ancré dans de complexes relations d’interdépendance et dans des sentiments ambivalents d’appartenance. Comme cette étude le montre, la vie de ces jeunes et les façons dont ils conçoivent leur existence ne devraient pas être interprétées comme des récits de victimisation ou de résistance. Les jeunes ont plutôt des façons multiples, complexes et parfois paradoxales de (re)prendre parole, en se situant de façon ambivalente et ambigüe comme étant “présents”. Ce n’est qu’à travers l’examen du pouvoir d’ agir et des appartenances ambivalentes des jeunes ainsi qu’à travers des recherches empiriques que nous pourrons améliorer notre capacité à répondre aux besoins des jeunes migrants sans papiers et comprendre l’impact des politiques migratoires sur leurs vies.

L’ouvrage s’adresse à tous ceux qui s’intéressent aux médecines traditionnelles, particulièrement au public marocain mais aussi ailleurs puisque il est situé, bien que brièvement, au sein d’un contexte global et en parallèle à d’autres notions comparables à la baraka au sein de d’autres peuples et religions. Une fenêtre sur un islam fort méconnu en Occident. En réussissant à dégager, au-delà de la quête du sens de la maladie et des soins, la quête du sens du monde, le livre contribue à un renouvellement et à un enrichissement de la connaissance de l’«islam populaire».