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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 .