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This article was downloaded by: [Radboud Universiteit Nijmegen]On: 27 October 2014, At: 04:21Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Occupational SciencePublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/rocc20
The Experience of OccupationalDeprivation in an Asylum Centre: TheNarratives of Three MenAnne-Le Morville MSc, OT Reg a b & Lena-Karin Erlandsson PhD, OTReg ca The Parker Institute, Copenhagen University HospitalFrederiksbergb Metropolitan University College, Institute of Rehabilitation andNutrition, Department of Occupational Therapy , Copenhagen ,Denmarkc Department of Health Sciences , Lund University , SwedenPublished online: 14 Jun 2013.
To cite this article: Anne-Le Morville MSc, OT Reg & Lena-Karin Erlandsson PhD, OT Reg (2013) TheExperience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men, Journalof Occupational Science, 20:3, 212-223, DOI: 10.1080/14427591.2013.808976
To link to this article: http://dx.doi.org/10.1080/14427591.2013.808976
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The Experience of Occupational
Deprivation in an Asylum Centre:
The Narratives of Three Men
Anne-Le Morville &Lena-KarinErlandsson
This article presents a study of three asylum-seeking men from Iran and
Afghanistan. It aimed to explore how and if they experienced occupations as
occupations in a Danish asylum centre and how their life experience shaped
their choice and value of current occupations. In-depth narrative interviews
explored the participants’ occupational history and its influence on their
current occupations in the asylum centre. A thematic analysis showed that the
participants had been subjected to occupational disruption and deprivation by
politically oppressive systems even before their flight. Their occupations in
Denmark were to a certain extent influenced by their earlier occupations and
the current occupational deprivation they all experienced was due to limited
possibilities in the centre. Although they tried their best to fill their days and
create structure, there was a loss of valued occupations and a profound sense
of occupational deprivation. One of the participants had been subjected to
torture and he experienced occupational deprivation to a greater extent. The
findings suggest that further research should include exposure to torture as a
key component when examining the occupational deprivation of asylum
seekers.
Keywords: Asylum seekers, Occupational deprivation, Occupational value,
Torture
In most parts of the world there has
been a significant change in migra-
tion patterns and the number of
asylum seekers worldwide increases,
due to political instability and areas
of armed conflict. In Denmark the
number of asylum seekers has
increased from 2,246 in 2007, to
6,141 in 2012 (Danish Immigration
Service, 2013). Asylum seekers are
often subjected to environments
which do not support a meaningful
daily life. The lack of occupations
and its effect on health and well-
being has been a focus for several
studies within occupational science.
One of the groups subjected to loss
of occupations due to external cir-
cumstances are asylum seekers, as
they are removed from a known
environment, and subject to legal
restrictions on their opportunities
for occupations in the centres. In
the health and occupational science
literature, distress, deprivation and
lack of occupations is in focus
(Burchett & Matheson, 2010; Coffey,
Kaplan, Sampson, & Tucci, 2010;
Martins & Reid, 2007; Ryan, Ben-
son, & Doley, 2008; Whiteford,
2004a, 2005), but less is reported
on how asylum seekers cope with
lack of occupations and restrictions
in everyday life. This study focuses
j Anne-Le Morville, MSc, OT
Reg, The Parker Institute,
Copenhagen University
Hospital Frederiksberg, and
Metropolitan University
College, Institute of
Rehabilitation and Nutrition,
Department of Occupational
Therapy, Copenhagen,
Denmark
j Lena-Karin Erlandsson,
PhD, OT Reg, Associate
Professor, Department of
Health Sciences, Lund
University, Sweden
Correspondence to:
se
– 2013 The Journal of
Occupational Science
Incorporated
Journal of Occupational Science,
2013
Vol. 20, No. 3, 212�223,
http://dx.doi.org/10.1080/
14427591.2013.808976
212 JOURNAL OF OCCUPATIONAL SCIENCE, Vol . 20 , No. 3 , 2013
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on the experience of deprivation amongst asylum
seekers and their ability to structure time in a
satisfying manner.
Being an Asylum Seeker
People living as asylum seekers often describe
their lives as interrupted, on hold, or blown off
course (Burchett & Matheson, 2010; Quiroga,
2005). Due to geographic change, asylum seekers
often experience loss of cultural norms, religious
customs and social support systems. The resultant
loss of roles, habits and valued occupations
connected to these can lead to loss of identity
(Bhugra & Becker, 2005; Lindencrona, Ekblad, &
Hauff, 2008; Martins & Reid, 2007; Steindl,
Runge, & Winding, 2008; Whiteford, 2004a).
New circumstances in a new country may touch
aspects of daily life, from the opportunity to buy
and cook familiar foods and to express oneself in
one’s own language (Whiteford, 2004a). In short,
post migration life places enormous demands on
asylum seekers (Lindencrona et al., 2008; Ryan
et al., 2008).
According to Wilcock (2006), many people are
subjected to occupational deprivation and amongst
those are asylum seekers who, due to both legal
and local regulations and limitations of war or civil
unrest, are excluded from participating and con-
tributing to the society in which they live. In 2000,
Whiteford described occupational deprivation as:
a state in which a person or group of
people are unable to do what is necessary
and meaningful in their lives due to
external restrictions. It is a state in which
the opportunity to perform those occupa-
tions that have social, cultural and perso-
nal relevance is rendered difficult if not
impossible. (p. 200)
Occupational deprivation is more than just a
disruption but a process developing over time
(Whiteford, 2000, 2004a). However there has
been ‘‘relatively little research focused on the
occupational needs and strategies of refugees in
centres’’ (Whiteford, 2004a, p. 187). Very little
pertains to asylum seekers who have exercised
the right to seek protection under the 1951 UN
Geneva Convention (UNCHR, 2011) but have yet
to be granted refugee status. The focus has so far
been on those who already received refugee status
or are legal immigrants (Burchett & Matheson,
2010; Huot & Laliberte Rudman, 2010; Steindl
et al., 2008; Whiteford, 2004a, 2005).
In Denmark asylum seekers are required by law to
live in a centre (Danish Immigration Service,
2013; UNHCR, 2011) and have fewer legal rights
than refugees. Asylum seekers in Denmark en-
counter constraints on access to work, education,
private accommodation and regular social welfare
benefits and they have little or no say about where
they will live (Danish Immigration Service,
2013). Unlike those with refugee status, an
asylum seeker’s future is still uncertain, making
planning and productivity very challenging (Lin-
dencrona et al., 2008; Steel, Momartin, Silove,
Coello, Aroche, & Tay, 2011). Leaving parts of
one’s narratives, roles and occupations behind
might in itself have a negative effect on their sense
of identity, health and the opportunity to create a
future (Des Pres, 1980; Huot & Laliberte Rudman,
2010; Kielhofner et al., 2008; Whiteford, 2004b).
In Denmark, asylum seekers are offered few
occupations in the centres. Participation in
work-like occupations is approximately 10 hours
a week (Danish Red Cross, 2012), and they have
little or no control over the type of work to which
they are assigned. This lack of choice and control
over occupations in daily life is a condition that
most asylum seekers experience during their stay
in centres (Ryan et al., 2008; Whiteford, 2005).
Earlier studies from refugee centres and Nazi
concentrations camps (Des Pres, 1980; Horhagen
& Josephsson, 2010; Nelson & Wilson, 2011;
Whiteford, 2004a) shows that people in harsh
conditions cope through creating structure in
their everyday lives, and ‘inventing’ new occupa-
tions based on what is feasible. Even though the
occupation serves a purpose, the experience of
deprivation might still be present, depending on
earlier occupations and perceived value of the
occupation. The aim of this study was therefore to
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explore how asylum-seeking men in a Danish
asylum centre experienced occupational depriva-
tion and how prior life experience formed and
shaped their choice and value of current occupa-
tions.
Method
Research settingThis study is based on field studies, where the
first author spent 2�4 days a week over 6 months
in two Danish asylum centres, and one longer
interview with each participant. Access to the
centres was gained with the permission of the Red
Cross, in order to take part in daily life in a centre
and plan for further studies. The Danish Red
Cross runs most of the asylum centres in Den-
mark and is responsible for the administration of
daily necessities, clothes and the allowance that
all asylum seekers receive. The centres range in
size from 120 to 600 inhabitants. At the time of
the study 4,289 asylum seekers lived in an asylum
centre (Danish Immigration Service, 2013).
Upon arrival all asylum seekers are interned at a
centre and after primary evaluation they are
moved to other centres, where they remain until
they gain status as refugees or are expelled from
the country. During their stay in a centre, asylum
seekers are free to come and go as they please.
However, if they do not show up at appointed
times, they are not eligible for their allowance,
which is t200 a month for food and other
necessities for a single living person. Most of
the asylum seekers receive money for food from
the Red Cross and do their own cooking, but
others are obliged to eat in the canteens. The
average stay in an asylum centre is 600 days
(Danish Red Cross, 2012), but can range from a
few months to years. About two thirds of the
asylum seekers in Denmark are men, most of
them single or having left their families behind,
whereas women who seek asylum are often
together with their family (Danish Immigration
Service, 2013).
The centres are former military barracks, located
in rural areas and with limited transport to the
nearest small provincial towns. Transportation to
larger cities is costly and time-consuming. The
rooms hold two to four beds, some with a private
kitchenette and a bathroom. Others have com-
munal kitchens, toilets and baths located on each
floor. At the time of the study all food was
prepared by the canteen in one of the centres,
and in the other centre the asylum seekers were
allowed to buy and cook their own food.
ParticipantsThis study focuses on the men, as their loss or
changes in daily life might be bigger than for the
women (Martins & Reid, 2007; Ryan et al.,
2008). Most of occupational science research
with refugees and asylum seekers has focused
on women (e.g., Burchett & Matheson, 2010;
Martins & Reid, 2007; Steindl et al., 2008;
Whiteford, 2004a), but as most asylum seekers
in Denmark are men it seemed warranted to look
at the male experience. The participants were
chosen based on the first author’s knowledge from
earlier informal conversations and observations of
their occupations in the centre. The inclusion
criteria were that they were male and able to
speak English on a level similar to college level, in
order to have a fluent conversation.
EthicsThe study was approved by a local ethical com-
mittee and the Danish Data Protection Agency.
According to ethical guidelines (Kvale & Brink-
man, 2009) prospective participants were provided
written information in their first language about
voluntary participation, anonymity, and confiden-
tiality of data collected. Of the six men initially
invited to participate, one declined, five agreed to
participate, but two were moved before the inter-
views could take place. Those who were interested
received additional information and if they wished
to participate, they gave their written informed
consent. Data were collected through narrative
interviews, observations and everyday conversa-
tions. To introduce the participants, Alireza,
Mohammad and Ali, some brief background
information is provided for each in Table 1. Names
given to participants are fictional.
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Data collectionData consisted of interviews, field notes and
reflections written after each visit or encounter.
The first author was one of the health personnel
at the centre. Contact with the asylum seekers
was made through the initial medical screening
performed by nurses. If the asylum seeker was
interested, the first author followed their every-
day life over a few weeks in order to gain insight
into their occupations. In this part of the study
the observer did not ask for personal information,
but followed the issues that the participants
presented.
Two pilot interviews were performed, but due to
loss of information, even with a conscientious
interpreter, the data from the interpreted inter-
view were found to be very sparse compared to
the interview being performed in English. The
ability to speak English was therefore made an
inclusion criterion. The pilot interviews are not
part of this study. The interviews were conducted
by the first author, in an undisturbed office in the
centres. As people use narratives not only to
understand their everyday lives in retrospective,
but also to guide or create a framework for
the future (Kielhofner et al., 2008) a narrative
approach was used. Narratives can be told as
stories that have a natural timeline, or as several
stories with no specific timeline, which can then
be pieced together in a temporal order by the
researcher (Riessman, 2005). Data collection in
this study consisted of narrative interviews,
everyday conversations over time and field notes
based on observations.
The interviews lasted from 90 to 120 minutes
each. The interview guideline was relatively brief
and the interviewer improvised comments and
questions within the framework of the guidelines,
keeping questions and probes open-ended in
order for the narrative to develop (Cresswell,
2007; Kvale & Brinkman, 2009). Consistent with
the aim, the guidelines included past and present
occupations on a daily, weekly, monthly basis,
and wishes for the future, as told from that parti-
cipant’s perspective. All interviews were digitally
recorded and transcribed verbatim, and field
notes were recorded in a dairy at the end of
each day.
Data analysisData from narrative interviews can be analysed
either with the purpose of constructing a story-
line or using a phenomenological approach to
find hidden meanings and themes in the dataset
(Cresswell, 2007; Riessman, 2005). The authors
analysed the data using a thematic analysis
approach, which is useful for finding common
thematic elements across the participants and
their stories, focusing on meaning.
The analysis of the narrative interviews and field
notes consisted of the following steps. Before
analysis, the language in the transcripts was
structured in order to make them more readable,
but kept true to the original wording in the
transcript (Whiteford, 2005). In order to enhance
the readability in the quotes provided below, the
actual wording has been edited to reduce length,
improve grammar, and in a few quotes, link
sections for continuity, while maintaining the
original meaning (Whiteford, 2005). Being true
to the narrative outline and aim of the study, the
statements about the participants’ occupations
and experience of occupational deprivation were
identified and categorised into past, present and
future. This created a pattern of themes in the
Table 1: Demographic Data
Pseudonyms Age Nationality Education Work history Family in the homeland Religion
Ali 25 Iran Literature student at
university
Antique book seller
& Student
Parents, brother and his
family
None
Mohammad 30 Iran MSc sports sciences Teacher & Journalist Parents, brothers and sister
and their families
None
Alireza 28 Afghanistan Doctor Translator & Teacher Uncle and aunt None
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narratives about occupations. In line with the
study aim, all statements pertaining to depriva-
tion were selected and reread in order to freely
categorise the data, while still using the state-
ments about occupational deprivation and occu-
pations in the context in which they were uttered.
Theory was not consciously used during the
analytic process.
If a statement or field note expressed more than
one aspect, it could be placed in several relevant
categories and eventually the unfolding categories
were structured into three themes: Past: Playing
and going to school, university years, fleeing your
homeland; Present: The distress and motives,
daily occupations in a centre; Future: ‘‘I want
to . . .’’, wishes for the future.
Findings
Each participant’s narrative was imprinted by
experiences of a problematic past, of having to
flee from his homeland, and being caught in a
very difficult and transitory ‘present’ with no way
of shaping a definite future. They described their
childhood and youth as being in a more or less
constant state of occupational deprivation, caused
by suppressive systems based on fear and retribu-
tion, and where mean, degrading treatment and
torture were widespread. Further deprivation and
several occupational disruptions occurred, such
as suicide bombings, prison, torture and finally
the escape, which lead to another situation of
occupational deprivation, i.e. life in an asylum
centre. Yet, somehow they managed to structure
their days, with the clear purpose of maintaining
well-being.
PastPlaying and going to school
All three men grew up in areas affected by war or
civil unrest. They described societies where, even
as small children, they could not speak freely for
fear of retribution from the government or
Taliban: ‘‘You don’t know who you can trust’’.
Many of their occupations related to what could
be labelled normal childhood, such as playing
with siblings, playing football, and having stories
read to them by parents. The occupations were
described as being primarily games played out-
side, like football and ‘‘running around’’.
They experienced their possibilities for playing as
limited, though in Afghanistan the limitations
were less severe than in Iran, where ‘‘we have
nothing, no schools, and no fun places. We must stay
home, play football or go to the mosque’’. Even so
they experienced their childhood as happy times.
Alireza described his opportunities for play as
good, or as he said ‘‘When I was a child I played
everything, kiting, skiing and skating, but then the
Taliban closed schools, cinemas, theatres etc.’’ Trips
with the family were rare, mostly in relation to
the official holidays. They described going on
picnics and making bonfires as something enjoy-
able, but other celebrations were only allowed if
they related to specific Islamic holidays or
anniversaries. They experienced going to school
as positive, but outside school the possibilities
were limited. Even so Mohammad became cap-
tain of his team, Alireza started doing Taekwondo
and Ali started played piano and took dance and
swimming classes. They mentioned friends rarely
when they talked about this period, but often
mentioned lack of opportunity to spend time with
girls, except for female relatives, as a negative
experience.
Alireza experienced a severe occupational disrup-
tion as he, at age 16, was forced to flee to a
neighbouring country, leaving school, Taekwondo
and his friends behind. Though the rest of his
family could not return to Afghanistan, remaining
in exile, he went back after 4 years to study
medicine in his hometown.
University years
The participants experienced their university
years as being very restrictive and with limited
possibilities for visiting bars, cafes or going to the
cinema or a concert, as these were rare pleasures
in both Iran and Afghanistan. Drinking alcohol or
celebrating a wedding was restricted if not
forbidden, holding the risk of being arrested.
Free time was spent with friends at fitness centres,
playing on the computer, going for walks in the
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city or playing board games. Their experiences
during this time differed. Ali went to a university
for Islamic radicals, which he disliked, whereas for
Mohammad and Alireza it was a new and pleasant
experience, and for a period girls and boys were
allowed to mingle during class and went on trips
together. Even so they experienced being at the
university as interesting, time consuming and in
general enjoyable and they held in common a love
of language, reading and writing. They continued
earlier leisure occupations, such as Taekwondo for
Alireza, football and sports for Muhammad and
dance, music and swimming for Ali.
Fleeing your homeland
In general, the participants were reluctant to
discuss the experience of fleeing during the inter-
view, but in the informal conversations bit and
pieces were revealed. Ali ran a business installing
TV-satellite dishes, which was illegal, but he said
‘‘people need to know what is going on in the world
and take a stand against the government’’. He was
caught by the police and eventually imprisoned
and tortured. Ali had paid smugglers to take him to
Canada, but ended up in Denmark, as the
smuggler ‘‘disappeared’’. Mohammad and Alireza
both earned their masters degrees. Afterwards
Mohammad tutored students, while writing arti-
cles for a civil rights movement. He was warned
that the police wanted to arrest him, but he was
able to flee and managed to get to Iraq and then to
Denmark with a friend. Alireza did not want to
work as a doctor after his experience dealing with
victims from suicide bombings. Afterwards he
worked as teacher/trainer in basic and advanced
medicine, educating the Afghani forces. Due to his
work he was assaulted twice by the Taliban and
again had to flee. He got as far as Teheran with the
money his family gave him, and in order to go to
Denmark he worked illegally on his way through
Europe, living on the streets for 6 months.
Present occupations: The distress and motivesIn general the participants expressed satisfaction
with being in Denmark, since it provided a safe
place with no danger of persecution and arrest,
but they were unable to feel sure about their
future. Waiting, maybe for months, for an answer
from the Immigration Service was experienced as
demanding and they stated that their well-being
was compromised by the long application pro-
cess. An expressions typically used was ‘‘you can’t
stop thinking about it’’. They described anxiety
about whether the Immigration Service believed
them and especially Ali expressed that he felt
unhappy, due the uncertainty of the situation and
nightmares about the torture. Mohammad and
Alireza were less explicit, but when describing
their current stressful situation, they often used
the sentence ‘‘if I don’t do something, I will go
crazy’’. They expressed lack of trust in both the
staff and the other residents and Ali in particular
was reluctant to speak to other asylum seekers or
discuss his problems with the staff. In addition,
they experienced the multi-national environment
as creating an atmosphere of latent aggression.
Mohammad stated: ‘‘There’s always violence,
because of this cocktail of several cultures and
languages.’’
The participants’ motives for participating in
occupations were related to their experience of
distress and knowledge of the effects of insuffi-
cient occupations. They stated that they used
occupations as diversions, and tried to keep busy
to avoid falling into depression. The participants
all shared an interest in being helpful to others
and Mohammad and Alireza remarked on the
general importance of getting up and being active
every day. Alireza took a hands-on approach by
starting a volleyball team for the young boys in
the centre.
They experienced their need to cope in a new
environment as a strong motive for building a
structured everyday life. This served the purpose
of keeping busy and not thinking about their
pending cases. The participants mentioned the
lack of family and friends and though Alireza
talked with many people during the day, he said:
‘‘they are not friends. They are someone you help’’.
He was the only one with family in Denmark, but
they were not part of his daily life. Mohammad
came to Denmark with a friend and mentioned
missing his family, but not a lack of friends. Ali
was very explicit about missing his family and
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though he chatted with his brother on the
internet, he could not phone as the lines were
tapped, and he was afraid that his family would be
hurt.
Daily occupations in a centre
The participants complained about the lack of
‘‘real work’’ and opportunities for education. They
spoke fairly fluent English and were asked to act
as interpreters at the Red Cross office. This was
not on a regular basis and Alireza and Ali were on
standby, not knowing when they would be
needed. Even so they did not like to interpret,
as they experienced their countrymen as rude,
impolite and aggressive and Mohammad even
declined working as an interpreter after a while.
The participants had taken part in a compulsory
introduction course and Danish language classes,
but the number of classes was limited. This lack
of occupations was evident through all three
interviews, or, as Mohammad stated:
We haven’t any work to do. My time is spent
on cooking, talking with my friend, work at
the computer and go shopping for food. Two
times a week we clean the kitchen and the
bathrooms. Nothing else. It is not occupa-
tions that can fill the week.
They stated that to cope with the lack of
occupations at the centre they had to build a
structured routine in order to keep distress at bay.
The experience of limited possibilities influenced
their occupations, as they stated that they would
like to do something other than what they
actually did. They tried to keep their minds and
bodies occupied and valued their occupations,
but only as diversion.
Daily structure
Alireza described how he would get up at 7 am,
go for a run and come back to eat breakfast.
Afterwards he reported to the office and went on
with his interpretation tasks. He used his med-
ical background to assist at the medical clinic, as
he could explain medical terms to his countrymen:
‘‘I interpret the medical words. You know, Afghan
people are not well educated, they don’t know the
words or the meaning’’. During the day, he would
help out at the fitness centre, or take a walk
through the centre: ‘‘Just walking and talking’’. He
was known to many of the residents, who would
ask for help. Though he ended up with a weekly
amount of work of about 25 hours, this was not
enough and he started the volleyball team.
Ali took the bus to another centre every morning,
in order to report at the office and offer his skills as
an interpreter. He then proceeded to work at the
hairdressing salon, with the specific goal of
forgetting his pending case: ‘‘Boss, I’m boss of the
hairdresser, so it is a nice place . . .but just to laugh
and talk to people, so I don’t think about my case’’.
This was at the most about 10 hours a week, and he
spent another 2�10 hours on interpreting if
needed. Ali had trouble doing something related
to his former occupations as a student and
mentioned his decrease in status: ‘‘Before I had a
life like a prince. And now I just come here.’’ He wrote
poems and stories by hand, as he could not use the
computers as they lacked the programs to write in
Farsi. Ali had been a keen swimmer and dancer,
but due to torture and subsequent operations, he
could not endure physical activity. He enjoyed
music and used music as a tool to adjust his moods.
Mohammad maintained his earlier occupations
and spent time writing articles for the centre’s
weekly paper, and other media about the situa-
tion in the centres and in his homeland. He
considered it important and a continuation of his
work against the dictatorship in Iran. He de-
scribed how he followed the news and then
analysed it in order to decide which perspective
to take before writing. But Mohammad did not
follow the structure of the centre and said:
My working day starts late here. It is not
important when you wake up or go to sleep.
I just eat breakfast, check my mail and talk
about the Immigration Service, and so on.
Sometimes I go to the gate and check the
post. Every other day, I and my roommate go
to the gym for one hour. Afterwards we cook
dinner and that’s it.
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Although they had different stories and differed in
number and type of occupations, all talked about
the experience of a profound occupational depri-
vation and though they had occupations, they
were experienced not as adding meaning to life,
but only enabling life.
‘I want to . . .’ Wishes for the futureThe participants’ former occupations reflected
their desires for the future. Alireza wanted to
continue learning or as he said: ‘‘I want to know
things, to be better educated. I want Danish friends
and to be Danish, so I go to school and classes, but
I want to know more . . . I need to know’’. Even
though Alireza did not want to work as a doctor,
he still wanted to ‘‘lecture and teach medicine . . .but
maybe Denmark is different, maybe I will be a doctor
here.’’ After a brief pause he said: ‘‘I want to stay here
and work, get a job . . .any job I could get’’. Alireza’s
emphasis on being Danish was not as clearly
expressed by the others, but as Alireza had family
in Denmark this might have affected his feelings.
Mohammad wanted to do research within his field:
‘‘It is my dream to do research in sports physiology. I
have many ideas and I would like to work with this’’.
Ali wanted to continue his university studies. As
the only who had experienced torture and prison,
he emphasized the need for a stable life and said: ‘‘I
want to stay here and live a normal life, like others. I
want to be sure that I’m in a safe place. I want peace
and quiet now. This is all I want.’’
Discussion
The aim was to explore how asylum-seeking men
in a Danish asylum centre experienced occupa-
tional deprivation and how their life experience
shaped their choice and value of current occupa-
tions. The findings showed that they experienced
occupational deprivation, even though they did
have occupations. Their occupations were to
some extent based on earlier occupations, but
seemed to be used as a coping tool more than
being a meaningful way to fill time. The state-
ments showed that they were unable to do
something meaningful in their lives due to the
restrictions imposed on them in the asylum
centres. Their experience of meaningful time
use is consistent with other research concerning
internees, refugees and asylum seekers living
under conditions that do not support valued
occupations (Des Pres, 1980; Nelson & Wilson,
2011; Whiteford, 2005).
Feelings of distress and worry about their cases,
the lack of occupations and loss of roles, habits,
friends and family are well-known themes within
the literature (Bhugra & Becker, 2005; Martins &
Reid, 2007; Ryan et al., 2008; Whiteford, 2004a).
Yet the participants managed to build a structure
and tried to cope by using occupations as a
diversion and a way to maintain an identity. Their
ability to do so might be due to their level of
education and awareness of keeping themselves
occupied. The feeling of control, along with
education, is one of the most important features
when discussing the social determinants of health
(Marmot, 2006). Feeling in control plays a major
part in coping with being an asylum seeker
(Quiroga, 2005), as studies have shown that those
who cope with exposure to torture and/or perse-
cution are the ones who, like the participants, have
consciously entered into illegal or otherwise
dangerous occupations (Amris, 2007; Quiroga,
2005). However, when discussing these factors it
is important to remember that Ali had not finished
his education, he did not have friends or relatives
close by and had sequelae from torture which
might limit his capacity to perform previously
valued occupations.
Though the conditions in a Danish asylum centre
are a far cry from a Nazi concentration camp,
some of the same ‘survival’ techniques are utilised
by the participants (Nelson & Wilson, 2011) who
showed compassion for others and tried to
help by using the different means at their
disposal. They did this with the personal purpose
of retaining a structure, building a network and
maintaining an occupational identity, as they tried
to avoid isolation and de-humanisation (Des Pres,
1980; Nelson & Wilson, 2011; Whiteford, 2005).
Despite the positive effects of this, there are some
interesting perspectives in relation to occupa-
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tional deprivation. Even though they lost roles
and identities Muhammad kept the role as friend,
Alireza had family in Denmark, whereas Ali had
neither. According to Kielhofner et al. (2008),
loss of roles might indicate that social status and
identity changes. Even though Ali’s days were
structured, the occupations were markedly dif-
ferent from before and he was very explicit in
expressing his loss of occupational identity and
status. The others kept occupations that were
closer to their former occupations, though their
days were not as structured. Even though they
tried to keep a sense of control and managed to
fill their days, their statements show that many of
their roles, habits, and subsequent occupations
were lost. The feeling of control and indepen-
dence is questionable for the participants, since
their occupations did not add meaning and value
to their lives, despite helping to enable a life.
The participants were unable to use their compe-
tencies and capacities to their full extent, and
their occupations did not present a challenge that
could be of any future value. Not being able to
perform occupations that gave a sense of personal
relevance, competence and using their capacities
influenced the distress and might lead to loss of
abilities and capacity over time, though this has
yet to be researched within this population. So
even though structure and occupations are pre-
sent, and the performer finds an immediate value
and purpose with the present occupations, the
importance and value is debatable if the occupa-
tions and their perceived status are lower. Despite
that the occupations had some value, the findings
suggest that the value of an occupation is some-
thing that is meaningful in its context. None the
less, the relationship between the concrete, sym-
bolic and self-reward value (Persson, Erlandsson,
Eklund, & Iwarsson, 2001) was not evident in
their daily occupations, perhaps because their
occupations were essentially means to forget and
cope with distress, and not valued and mean-
ingful in themselves.
When looking at the participants’ occupations, the
discrepancy between what they do and what they
want to do suggests that they do not enjoy and
positively appraise their present occupations. Even
though they have a minor self-reward value, the
occupations align with what they personally value
and as the symbolic value is person and culture
bound, the symbolic value might even be negative
(Persson et al., 2001). Experiencing low self-
reward and negative symbolic value in occupations
implies a risk of lack of meaning, which in the long
run might be a risk factor for ill health (Erlands-
son, Eklund, & Persson, 2011). In this study there
was no specific emphasis on torture, but the
findings suggest that it might have an influence
on the ability to find valued occupations. Addi-
tionally the consequences of time spent in a centre
and the experience of occupational deprivation
could negatively influence the possibility of transi-
tion back to a balanced and satisfying daily life.
Methodological considerationsThere is a risk of instability in designs in which
open questions are asked (Cresswell, 2007; Kvale
& Brinkman, 2009). To strengthen the analysis,
the authors individually listened to and read the
transcripts of the interviews before commencing
analysis. After the initial independent analysis,
the authors compared and discussed the findings,
before analysing the data into categories and
themes. The first author had experience with
interviewing in relation to therapeutic interven-
tion and in connection with research and devel-
opment projects but the fact that the interviewer
is female and has grown-up children of the same
age as the participants should be noted. The three
men did not practice Islam or any other religion,
but growing up in Islamic societies might influ-
ence their views on women and attitude towards
being interviewed by a woman. Furthermore, as
many asylum seekers are guarded and do not
trust others, the time spent with the participants
before the interviews might have helped develop
a trusting relationship. This strategy has probably
influenced the interviews, but it could also be a
factor in creating an open and inviting atmo-
sphere and providing more substantial informa-
tion. The established relationship was valuable in
overcoming language and cultural barriers and
helped in interpreting data.
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The narrative method was founded on the focus
on their stories and its influence on choice of
occupations, i.e. the lived experience over time
(Mattingly & Lawlor, 2000; Riessman, 2005). The
choice of individual interviews was based on
the notion that individuals have their own sub-
jective narrative about a series of incidents and to
ensure that the individual narrative of the parti-
cipants’ experience could unfold. The interviews
were conducted in English which might have
influenced the results. This excluded the majority
of asylum seekers, but it was felt that data from
the interviews would be seriously limited and less
rigorous if they had to be done through an
interpreter. Thus, even though English was a
well-known language for both parties, it has
possibly limited the vocabulary on both sides
and given less substantial information than if
performed in first languages. Additionally
although the authors have been conscientious in
their transcription and analysis, these factors
should be considered when looking at the results.
The homogeneity of the participants’ background
should be noted as a limitation in this study.
Additionally, due to the sometimes disturbing
content of the conversations and interviews, peer-
debriefing has been of particular importance and
value for the interviewer as a coping mechanism,
along with the written reflections. The disturbing
content in the data were fully experienced during
analysis, due to the different methods of collect-
ing data over time.
Conclusion
This study revealed that the participants
experienced a profound externally imposed
occupational deprivation due to lack of meaning
and relevance in their present occupations. It also
suggests that being well-educated assisted the
participants to build a structure around the
routines and opportunities in the centre, whereby
they used their occupations as diversions and a
way to enable life. However having some value in
the immediate context in which they are per-
formed does not necessarily mean that daily
occupations provide meaning in the longer term
and the absence of valued occupations might lead
to ill health. Thus, future research into the
occupations of asylum seekers and refugees might
usefully focus on meaning and value in their
occupations in order to understand the impact of
the specific situation on health and well-being.
Additionally one of the participants was a torture
survivor and his narrative showed that he was
exposed to the greatest loss of valued occupa-
tions. In order to understand the impact of
torture on human occupation and the role it
might play in the subsequent occupational depri-
vation, further research should include torture as
a key component in understanding the experi-
ences of asylum seekers and refugees.
Acknowledgements
This study was supported by The Metropolitan
University College, Copenhagen; The Parker
Institute, Copenhagen; The Danish Association
of Occupational Therapists and Lund University.
Also thanks to the personnel at the Red
Cross Health Services, and to Professor Bente
Danneskiold-Samsøe, MD, for making this study
possible and Professor Mona Eklund for valuable
advice during the writing process.
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