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1. Cultural aspects
1. Cultural aspects
Aim. To review the interpretation of trauma-disorders and their symptoms in different parts of the world. Some cultural factors to consider when you work with survivors.
Physiologically, human beings respond to danger and shock in more or less the same way everywhere, regardless of their culture. Someone who has just been robbed in France, caught up by war in the Congo, or devastated by a tsunami in Thailand, will display similar physical responses, based on human physiology and the reflexes associated with it. Under the influence of culture, however, the way people express and interpret their behaviour may differ considerably.
PART I: POINTS OF DEPARTURE
Culture makes it possible for people to create communities with others. Through culture, we transfer ideas, values, and ways of living, and communicate knowledge and skills, all the‘ wisdom’ that communities need to survive and flourish over generations.
When we meet survivors of trauma, the bodily reactions that they display may be common to most persons exposed to traumatising events; and at the same time, survivors may understand and express these reactions in many different ways. We who are helpers should understand and deal with these cultural interpretations – and do so while taking into account our own beliefs, because of course we too have cultural values and assumptions.
The international diagnostic manual DSM-IV discusses so-called‘ culture bound syndromes’( CBS). It lists many syndromes in specific societies or culture areas, and underlines that different societies and cultures have different ways of interpreting similar forms of trauma-events and responses to them. The diagnostic manual( APA 2002) discusses five elements of cultural formulation: the cultural identity of the individual; cultural explanations of the individual’ s illness; the influence of the patient’ s psychosocial environment and functioning within it; cultural elements in the patientprofessional relationship; the use of cultural assessment to decide diagnosis and care.
For our purpose, it is important to bear in mind that people may judge mental illness morally. They may consider that it is the result of character weakness and may not recognise that it can be caused by trauma. It may be associated with shame and lead to exclusion.
It is therefore important to adopt a sensitive approach to survivors of severe trauma, because different cultural backgrounds may require different approaches. At the same time, one must never jump to conclusions based on knowledge about a given culture, but be open and sensitive to meaning and values.
This manual will be used in different parts of the world, so it is important to bear in mind that cultural aspects vary and that cultural differences may influence the reactions and behaviour of survivors as well their social environment. At the same time we want to highlight that many physical and psychological responses to danger and threat are shared by every human being.