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PART III: THEORY
3. Culture and understandings of trauma
Theoretical approach
In Part I and in Part II we discussed the psychological and physical symptoms that traumatised people may present, and some of the ways in which survivors can be helped to manage their suffering.
Here we look at different attitudes to psychological trauma that we might meet in different countries and settings around the world. Physiological reactions to traumatic events are everywhere the same but cultural responses differ widely. It is therefore essential to understand the influence of culture on the survivors we seek to help, and recognise that our own attitudes also influence how we feel and think.
Why do people react differently because of their‘ culture’?
The American Heritage Dictionary of the English Language defines culture as:“ The totality of socially transmitted behaviour patterns, arts, beliefs, institutions and all other products of human work and thought characteristic of a community or population”.
According to another definition, culture is“ an integrated system of learned behaviour patterns which are characteristic of the members of a society and which are not a result of biological inheritance”( Hoebel 1966).
Culture enables people who can empathise to relate to each other, to form communities, and transfer ideas, values, and ways of living down the generations. It“ communicates the knowledge and skills a community needs to survive over time”. By means of our culture and cultural language, we‘ learn’ how to interpret different social situations, including our reactions to traumatic events and how to cope with them.
One therefore has to keep in mind that what is considered healthy in one society may be thought harmful in another. The American Psychiatric Association has defined what it calls‘ Culture-Bound- Syndromes’ or CBS( American Psychiatric Association 1994, DSM-IV Text Revision, appendix I). These are generally folk diagnostic categories in specific societies or culture areas that aim to explain the meaning of certain repetitive, patterned, or troubling experiences and observations( American Psychiatric Association 1994). It is characteristic of such syndromes that they cannot be defined in terms of objective changes in body organs or functions, and that they are not found in other cultures. These illnesses tend to carry psychological or religious overtones.
The term CBS is controversial, because it might imply that‘ culture bound syndromes’ are confined to societies that are the object of ethnographic study( normally indigenous communities), as if those(‘ us’) who study those societies are‘ culture-free’( Guarnaccia and Pinkay 2008). Western societies are not, of course, culture-free. In recent years, researchers have become more aware that PTSD and other stress-disorders vary widely across different cultures.
Many of the examples of CBS that have been studied involve dissociative or somatic syndromes( in western terms), frequently linked to trauma histories. The Nervios in Latin America, Spell in the Southern United States, Zar in North Africa, and qi-gong psychotic reactions in China all share cross-cultural similarities. In so-called Possession Trance Disorders one person’ s identity is replaced by another’ s.