“Dunki” and Sexual Health: The Missing Link

The recently released Bollywood movie “Dunki,” starring Shahrukh Khan, has brought the issue of illegal immigration into the public eye. The same issue formed the theme of the Pakistani movie, “Zinda Bhaag,” released in 2013, the country’s first entry for the coveted Academy Awards in the “Best Foreign Language Film” category, in over 50 years.

The issue, however, is, by no means, a new entity in the sociocultural fabric of this part of the world. Immigration to the United States, for instance, began in the 17th century, and ever since, the country has been the destination for millions of people as they search for a better life. ¹

Socioeconomic Compulsions

The word “Dunki” comes from “Donkey,” and denotes the quintessential hop and jump of the animal, which draws close parallels to the hop of the illegal immigrants from their homeland in Southeast Asia across the oceans in ramshackle boats, across the forests with no expert guidance and across the deserts with little or no supplies, to clandestinely enter the “dream countries” like the USA, the UK, or the European Union. Often, the “Dunki” route is fraught with dangers at every step. The unscrupulous “agents” and the adverse and unpredictable terrain are the prime adversaries, not to forget the fellow denizens also taking the “Dunki” route, as a bigger group is more likely to be caught at the time of border crossings. What is worse is the grave truth that any loss of life along this illegal path is never accounted for. The mortal remains seldom find their way back home.

The cost incurred varies from 25 lac to 50 lac rupees, depending on the anticipated dangers and the final destination.

The decision to take the “dunki” route is based on extreme socioeconomic compulsions in the backdrop of dwindling land holdings, rising debt, and limited job opportunities contrasted with the guaranteed returns in foreign currencies if the calculated risk succeeds.

The Magnitude of the Problem

The problem of illegal immigration is huge, especially, in the North Western Indian states of Punjab and Haryana as well as the western state of Gujarat. The most telling evidence comes from the crowds that one sees outside the visa offices there. There have been media reports of village after village inhabited only by senior citizens and women, while the young men have immigrated in search of greener pastures, either legally or illegally.

The only statistical data available comes from the US Customs and Border Protection (UCBP), according to which a record 96,917 Indians were arrested while crossing illegally into the USA between October 2022 and September 2023. Not just that, the number of Indians arrested has risen fivefold since 2019. ² This is just the tip of the iceberg. The number of Indians who succeeded in clandestinely crossing the borders to reach their country of choice is almost impossible to determine and so is the number of Indians who lost their lives in their desperate attempt to reach their “dream country.”

Similar data related to the UK and the European Union is scanty and hard to find.

The Focus of Research to Date

The research carried out to date on this highly vulnerable subset of the population has largely focused on the psychological trauma faced by immigrants when they land on foreign shores. This includes social exclusion, exploitation, and sexual abuse.

It has been found that migrants, applicants for international protection, and refugees (collectively labeled as “MARs”) are especially vulnerable to sexual violence. ³

Various mental health outcomes explored include psychological distress, depression (i.e., depressive symptoms, major depressive disorder [MDD]), anxiety (i.e., anxiety symptoms, generalized anxiety disorder [GAD], panic disorder [PD]), trauma- and stressor-related disorders (i.e., post-traumatic stress disorder [PTSD], adjustment disorder, acute stress disorder [ASD]), substance use/abuse (i.e., alcohol and drug use), stress, and sleep problems.^4,5

Other mental health outcomes explored were satisfaction with life, flourishing, sense of safety, fear, despair, anger, shame, health-related quality of life, self-reported health, sleep difficulties, general well-being, and resilience.

The Phenomenon of Immigration and Sexual Health: The Overlooked Connection

The connection between sexual health and the phenomena of immigration, legal or otherwise, seems far-fetched at first sight. The following two clinical vignettes underscore the often-overlooked link.

Case Vignette 1

Mr. A, a 24-year-old man, presented with a poor erection ever since he got married a week back. He reported feeling jittery at the very thought of intimacy with his wife and was unable to sleep for the last five days. His parents implored me to do something very quickly as they were planning to send him to the USA by the “dunki” route within the next few days and that the call from the travel agent might come anytime. They had decided to marry Mr. A before his departure so that he might not “go astray” in the USA. The families of both the patient and his newlywed wife were very eager for the marriage to be consummated before his “hop” to the USA. Herbal treatment from a “sexologist” had not yielded any results thus far.

Case Vignette 2

Mr. B, 30 years of age, presented with complaints of poor erection and early ejaculation ever since he returned home, after spending three years in the UK. He disclosed that he had never experienced such symptoms before. He reported feeling very anxious since he was staying in India only for fifteen days during which the couple planned to conceive a baby. Now that only two days remained, his anxiety, and that of his wife, was becoming unbearable.

The thread that binds these two fairly common clinical scenarios together is the extreme form of performance anxiety stemming from the situation the two couples find themselves in.

The backdrop of a difficult economic situation of the family which drove the patient to choose the option to immigrate no matter what, and the associated sociocultural compulsions, form the perfect bedrock for the problems related to sexual health. The anxiety is heightened by the fact that an illegal immigrant may not be able to come back home for months together as he would not have the legal documents required to make a legal journey. The situation for a legal immigrant is only slightly better as he may not be able to come back for one year or more, given the stringent job conditions that the immigrants are subjected to.

This is an under-researched area wherein the social, cultural, and economic factors unique to a particular region give rise to a different nuance of a common psychiatric problem.

Conclusion

Problems related to sexual health can have varied underpinnings that are colored by sociocultural factors unique to a region and the approach to treatment must consider these for satisfactory results.

Many such patients may not qualify for a standardized ICD-11 or a DSM-5 diagnosis though they still need specialized help.

This underscores the need to develop an inclination to go beyond the standard textbooks of psychiatry. The problems discussed in the article are an example of what modern-day psychiatry is all about.