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Cultural Considerations: Research On PTSD And Trauma In The Global Context — Dr. Michael Milco



MARCH 09, 2017 IN TRAUMA


Trauma is a condition that simultaneously affects our emotional and physical responses to life (Boss, 2006). Individuals can experience single trauma events and repeat trauma events. A burglary, mugging, or personal loss is an example of a single event trauma, while the ongoing effects of poverty and war are examples of repeat event traumas (Allen, 2005).


The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association [APA], 2014) specifically defines Post-Traumatic Stress Disorder (PTSD) as:


"a direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate" (Criterion A1).

Often times, therapists encounter multiple variables and cultural differences that complicate accurate measurement and interpretation of various traumas (DeVries, 1994; Tang, 2007).


Have You Ever Noticed When Traveling In Other Countries How English Speaking Tourists Commonly Ask, “Do You Speak English?”

As therapists, we are forced to confront our own inability to understand the language of life others use to interpret traumatic distress. It is important for us to understand how those from other cultures who experience traumatic events construct meaning in their lives differently from our Western way of dealing with trauma.


These are some of the issues that begin to reveal the limitations of Western-oriented trauma interventions such as talk therapy, group therapy, and medication (Lacroix & Sabbah, 2011). Our understanding of trauma not only needs to be re-defined, but put into context when working with those from non-Western cultures (Drozdek, 2007; Tankink & Richters, 2007; Wilson & Drozdek, 2007). Even though trauma affects many people around the world, how it is interpreted and processed can be uniquely different from the Western model of treatment.


The impact of colonization around the world has tried to reshape and influence cultural norms and belief systems even as they relate to trauma. Colonization was the taking of another’s land for the sake of its resources, people, and power.


As therapists, we should learn from colonial history so as not to repeat our material colonization in the form of therapeutic colonization.


Over the past decade, researchers have been more intentional at studying and identifying factors that characterize resiliency among children in order to gain insight into healthy adults and families (Turner, 1996). The frequency of trauma among children and adults has helped therapists develop assessment tools in order to better serve at-risk populations, as well as those who have experienced direct and indirect traumatic events.


Social workers working in cross-cultural settings have begun to expressed concern about the ethnocentrism (Visser, 2011) of imposing the biomedical western model of the DSM-5 as it relates those they work with in different settings. Some believe this postcolonial western model should not become the template used in understanding those suffering from traumatic events (Visser, 2011).


The literature clearly emphasizes trauma from a PTSD DSM-5 criteria based on a Western perspective (Hinton & Lewis-Fernandez, 2011). The focus from a DSM-5 perspective centers on victims of war, natural disaster, and sexual trauma.


The diagnosis should not automatically apply to those who come from other cultures, such as immigrants or refugees. This does not mean the PTSD diagnosis doesn’t reveal portions of their experience that might meet some of the criteria, but culturally their narrative bears little resemblance to the three-cluster model categorized in the DSM-5 (APA, 2014). Given all the articles surrounding trauma, there seems to be the assumption that the world has the same definition of trauma and framework for understanding it (Wong & Wong, 2006; Watters, 2010).


As Therapists, We Need To Expand Our Understanding Of Trauma In A More Comprehensive Way. When We Trivialize Trauma To A Single Event Without Understanding It From Divergent Cultural Perspectives, We Minimize The Person As Well As The Narrative That Guides His/Her Life.

The strength and influence of Western research and methodology spans the globe, including psychological diagnosis. The template for understanding cross-cultural trauma is beginning to sound like a new language. Some of the events are similar to those in other parts of the world, while others are unique.


When we give people from another culture a PTSD diagnosis, it it may minimize their experience, as it reduces the impact of political or religious violence to an individual experience exempt from their context (Wilson & Drozdek, 2007; Tang, 2007; Wilson, 2007).


The impact of war and political struggles that create trauma will impact genders, families, communities and societies as a whole and cannot be reduced to individual diagnosis (Miller & Rasco, 2004). The diagnosis minimizes societal events to a set of abnormal social conditions (Summerfield, 2008).


For individuals doing cross-cultural work, the most pressing component for good results is defining the culture. This can be done by understanding the history and culture of the people we are working with in order to interpret the data through the lens of the cultural, religious and familiar perspectives (Shalev, Yehuda, & McFarlene, 2000). In doing so, we will be serving populations with the best possible practices.


Bio: Dr. Michael R Milco earned a Master of Divinity from Trinity Evangelical Divinity School, a Master of Arts from Wheaton College Graduate School, and a Master of Social Work from Loyola University. He earned his Doctorate in Philosophy in Social Work from Loyola University in Chicago. Since 2000, he has worked with Angolan refugees in Namibia and Angola. For over 21 years, he has maintained a private practice as a licensed clinical social worker in downtown Chicago and is currently a professor at Moody Bible Institute in the counseling department. He has been married over 37 years and has two adult children.


References:

Allen, J. (2005). Coping with Trauma, 2nd ed. Arlington, VA: American Psychiatric Publishing.


American Psychiatric Association (APA). (2014). Diagnostic and Statistical Manual of Mental Disorder (5th ed.). (DSM-5). Washington, DC


Boss, P. (2006). Loss, Trauma, and Resilience, Therapeutic Work with Ambiguous Loss, New York: NY, Norton Books.


De Vries J, Van Heck GL. Quality of life and refugees. International Journal of Mental Health. 1994; 23:57–75.


Drozdek, B. (2007). The rebirth of contextual thinking in psychotraumatology in Drozdek B. & Wilson, J. Voices of Trauma, NY: Springer. pp. 1-26.


Hinton, D. & Lewis-Fernández, R. (2011). The cross-cultural validity of posttraumatic stress disorder: implications for DSM-5. Depression & Anxiety (1091-4269), 28(9), 783-801.


Lacroix, M. & Sabbah, C. (2011). Posttraumatic psychological distress and resettlement: the need for a different practice in assisting refugee families, Journal of Family Social Work, 14: 1, 43-53


Miller, K., & Rasco, L. (2004). An ecological framework for addressing the mental health needs of refugee communities in The Mental Health of Refugees. Mahwah, NJ: LEA Publishers. pp. 1-66.


Shalev, A., Yehuda, R., McFarlane, A. (Eds.) (2000). International Handbook of Human Response to Trauma, London: Plenum Publishers


Tang C. (2007). Culturally relevant meanings and their implications on therapy for traumatic grief: lessons learned from a Chinese female client and her fortune-teller in Drozdek B. & Wilson, J. Voices of Trauma, NY:Springer. pp. 127-150.


Tankink, M. & Richters, A. (2007). Silence as a coping strategy: the case of refugee women in the Netherlands for south-Sudan who experienced sexual violence in the context of war in Drozdek B. & Wilson, J. Voices of Trauma, pp. 191-210.


Visser, I. (2011): Trauma theory and postcolonial literary studies, Journal of Postcolonial Writing, 47(3), 270-282. Watters, C. (2010). Crazy Like Us. New York: NY. Free Press.


Wilson, J. (2007). Reversing cultures: the wounded teaching the healers in Drozdek B. & Wilson, J. Voices of Trauma, NY: Springer. pp. 87-104.


Wilson, J., & Drozdek, B. (2007). Are we lost in translation?: Unanswered questions on trauma, culture and post-traumatic syndromes and recommendations for future research in Drozdek B. & Wilson, J. Voices of Trauma, NY: Springer. pp. 367-386.

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