14

Click here to load reader

The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

Embed Size (px)

Citation preview

Page 1: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

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

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoeveror howsoever caused arising directly or indirectly in connection with, in relation to orarising out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &

Page 2: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014

Page 3: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

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:

[email protected]

[email protected].

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

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014

Page 4: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

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

ANNE-LE MORVILLE & LENA-KARIN ERLANDSSON

JOURNAL OF OCCUPATIONAL SCIENCE, Vol . 20 , No. 3 , 2013 213

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014

Page 5: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

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.

ANNE-LE MORVILLE & LENA-KARIN ERLANDSSON

214 JOURNAL OF OCCUPATIONAL SCIENCE, Vol . 20 , No. 3 , 2013

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014

Page 6: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

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

ANNE-LE MORVILLE & LENA-KARIN ERLANDSSON

JOURNAL OF OCCUPATIONAL SCIENCE, Vol . 20 , No. 3 , 2013 215

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014

Page 7: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

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

ANNE-LE MORVILLE & LENA-KARIN ERLANDSSON

216 JOURNAL OF OCCUPATIONAL SCIENCE, Vol . 20 , No. 3 , 2013

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014

Page 8: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

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

ANNE-LE MORVILLE & LENA-KARIN ERLANDSSON

JOURNAL OF OCCUPATIONAL SCIENCE, Vol . 20 , No. 3 , 2013 217

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014

Page 9: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

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.

ANNE-LE MORVILLE & LENA-KARIN ERLANDSSON

218 JOURNAL OF OCCUPATIONAL SCIENCE, Vol . 20 , No. 3 , 2013

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014

Page 10: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

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-

ANNE-LE MORVILLE & LENA-KARIN ERLANDSSON

JOURNAL OF OCCUPATIONAL SCIENCE, Vol . 20 , No. 3 , 2013 219

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014

Page 11: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

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.

ANNE-LE MORVILLE & LENA-KARIN ERLANDSSON

220 JOURNAL OF OCCUPATIONAL SCIENCE, Vol . 20 , No. 3 , 2013

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014

Page 12: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

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.

REFERENCES

Amris, K. W. (2007). Chronic pain in survivors of

torture. Pain, XV(7), 1�6.

Bhugra, D., & Becker, M. A. (2005). Migration,

cultural bereavement and cultural identity.

World Psychiatry, 4(1), 18�24.

Burchett, N., & Matheson, R. (2010). The need

for belonging: The impact of restrictions on

working on the well-being of an asylum seeker.

Journal of Occupational Science, 17(2), 85�91.

doi:10.1080/14427591.2010.9686679

ANNE-LE MORVILLE & LENA-KARIN ERLANDSSON

JOURNAL OF OCCUPATIONAL SCIENCE, Vol . 20 , No. 3 , 2013 221

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014

Page 13: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

Coffey, G. J., Kaplan, I., Sampson, R. C., & Tucci,

M. M. (2010). The meaning and mental health

consequences of long-term immigration deten-

tion for people seeking asylum. Social Science

and Medicine, 70(12), 2070�2079. doi:10.1016/

j.socscimed.2010.02.42

Cresswell, J. W. (2007). Qualitative inquiry and

research design: Choosing among five different

approaches. London: Sage.

Danish Immigration Service (Udlændingeser-

vice). (2013). Coming to Denmark. Retrieved

February 5, 2013 from https://www.nyidan-

mark.dk/en-us/coming_to_dk/asylum/asylum.

htm

Danish Red Cross (Dansk Røde Kors). (2012).

Røde Kors og arbejdet med asyl ansøgere. [In

Danish: Red Cross and the work with asylum

seekers]. Retrieved August 9, 2012 from http://

www.rodekors.dk/det�g%C3%B8r�vi/asyl

Des Pres, T. (1980). The survivor: An anatomy of

life in the death camps. Oxford: Oxford Uni-

versity Press.

Erlandsson, L., Eklund, M., & Persson, D.

(2011). Occupational value and relationships

to meaning and health: Elaborations of the

ValMO-model. Scandinavian Journal of Occupa-

tional Therapy, 18, 72�80. doi:10.3109/11038

121003671619

Horghagen, S., & Josephsson, S. (2010). Theatre

as liberation, collaboration and relationship for

asylum seekers. Journal of Occupational Science,

17(3), 168�76. doi:10.1080/14427591.2010.96

86691

Huot, S., & Laliberte Rudman, D. (2010). The

performances and places of identity: Concep-

tualizing intersections of occupation, identity

and place in the process of migration. Journal of

Occupational Science, 17(2), 68�77.

doi:10.1080/14427591.

2010.9686677

Kielhofner, G., Borell, L., Holzmueller, R., Jonsson,

H., Josepsson, S., Keponen, R., & Nygard, L.

(2008). Crafting occupational life. In G. Kielhof-

ner (Ed.), Model of human occupation: Theory and

application (4th ed., pp. 110�125). Baltimore,

MA: Lippincott Willimas & Wilkins.

Kvale, S., & Brinkmann, S. (2009). Den kvalita-

tiva forskningsintervjun. [In Swedish: Qualitative

research interviews]. Lund: Studentlitteratur.

Lindencrona, F., Ekblad, S., & Hauff, E. (2008).

Mental health of recently resettled refugees

from the Middle East in Sweden. The impact

of pre-settlement trauma, resettlement stress

and capacity to handle stress. Social Psychiatry

Epidemiology, 43, 121�131. doi:10.1007/s00127-

007-0280-2

Marmot, M. G. (2006). Introduction. In M. G.

Marmot & R. G. Wilkinson (Eds.), Social

determinants of health (2nd ed., pp. 1�14).

Oxford: Oxford University Press.

Martins, V., & Reid, D. (2007). New-immigrant

women in urban Canada: Insights into occupa-

tion and sociocultural context. Occupational

Therapy International, 14(4), 203�220. doi:10.

1002/oti.233

Mattingly, C., & Lawlor, M. (2000). Learning

from stories: Narrative interviewing in cross-

cultural research. Scandinavian Journal of Occu-

pational Therapy, 7, 4�14. doi:10.1080/11038

1200443571

Nelson, A. M. P., & Wilson, L. H. (2012).

Occupational understandings from the experi-

ence of holocaust survivors. Journal of Occupa-

tional Science, 19(2), 178�190. doi:10.1080/

14427591.2011.595892

Persson, D., Erlandsson, L-K., Eklund, M., &

Iwarsson, S. (2001). Value dimensions, meaning

and complexity in human occupation: A tenta-

tive structure for analysis. Scandinavian Journal

of Occupational Therapy, 8, 7�18.

Quiroga, J. J. (2005). Politically-motivated torture

and its survivors: A desk study review of the

literature. Torture, 16(2�3), 3�101.

Riessman, C. K. (2005). Narrative analysis. In N.

Kelly, C. Horrocks, K. Milnes, B. Roberts, D.

Robinson (Eds.), Narrative, memory & everyday

life (pp. 1�7). Huddersfield: University of

Huddersfield.

Ryan, D. A., Benson, C. A., & Dooley, B. A.

(2008). Psychological distress and the asylum

process: A longitudinal study of forced migrants

in Ireland. Journal of Nervous and Mental

Disease, 196(1), 37�45. doi:10.1186/1471-

2458-9-214

ANNE-LE MORVILLE & LENA-KARIN ERLANDSSON

222 JOURNAL OF OCCUPATIONAL SCIENCE, Vol . 20 , No. 3 , 2013

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014

Page 14: The Experience of Occupational Deprivation in an Asylum Centre: The Narratives of Three Men

Steel, Z., Momartin, S., Silove, D., Coello, M.,

Aroche, J., & Tay, K. W. (2011). Two year

psychosocial and mental health outcomes for

refugees subjected to restrictive or supportive

immigration policies. Social Science & Medicine,

72(7), 1149�1156.

Steindl, C. W., Runge, U., & Winding, K. (2008).

Occupation and participation in everyday life:

Women’s experiences of an Austrian refugee

camp. Journal of Occupational Science, 15(1),

36�42. doi:10.1080/14427591.2008.9686605

United Nations High Commissioner for Refugees.

(2011). Convention and protocol relating to the

status of refugees. Retrieved October 27, 2011

from http://www.unhcr.org/3b66c2aa10.html

Whiteford, G. (2000). Occupational deprivation:

Global challenge in the new millennium. British

Journal of Occupational Therapy, 63(5), 200�204.

Whiteford, G. (2004a). Occupational issues of

refugees. In M. Molineux (Ed.), Occupation for

occupational therapists (pp. 183�199). Oxford:

Wiley-Blackwell.

Whiteford, G. (2004b). When people cannot parti-

cipate: Occupational deprivation. In C. H. Chris-

tiansen & E. A. Townsend (Eds.), Introduction

to occupation: The art and science of living

(pp. 221�242). Upper Saddle River, NJ: Prentice

Hall.

Whiteford, G. (2005). Understanding the occupa-

tional deprivation of refugees: A case study

from Kosovo. Canadian Journal of Occupational

Therapy, 72(2), 78�88.

Wilcock, A. A. (2006). An occupational perspective

of health (2nd ed.). Thorofare, NJ: Slack.

ANNE-LE MORVILLE & LENA-KARIN ERLANDSSON

JOURNAL OF OCCUPATIONAL SCIENCE, Vol . 20 , No. 3 , 2013 223

Dow

nloa

ded

by [

Rad

boud

Uni

vers

iteit

Nijm

egen

] at

04:

21 2

7 O

ctob

er 2

014