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To understand trauma, we must consider not only different‘ interpretations’ of trauma-reactions but how the mind and the body are understood and interpreted in given cultural contexts. It is acknowledged that the West dichotomises the mind and the body, whereas many other cultures( in Asia for example) consider mind-and-body as a whole, which causes mental symptoms to appear as somatic sensations. Survivors who are unable to articulate their trauma or mental distress will often describe their symptoms in terms of pain. Somatisation is common among survivors from non-Western countries. Dissociation is also a frequent symptom of post-traumatic distress in non-Western societies, alongside depression, mood disorders and anxiety, with which the West is more familiar.
PART III: THEORY
In many places a mental illness is considered stigmatising or a character weakness. Sometimes a mental affliction is thought to be passed on genetically, leading to the belief that a survivor who displays symptoms of trauma puts the whole family at risk. Elsewhere, the disorganised, disruptive, impolite behaviour of a mentally ill person shames the family. In some Asian cultures, mental distress or illness are considered to be caused by loss of one’ s soul or possession by evil or vengeful spirits. By Buddhists, suffering is often understood to be caused by fate( karma), itself the result of actions taken in a past life.
When we meet survivors we therefore have to deal with numerous interpretations or understandings of essentially identical bodily reactions to trauma. When addressing survivors who have a different cultural background, we have to be aware of our own cultural assumptions and values, and also of the possible presence of culture-bound syndromes. This means that helpers must be unusually sensitive to culture when they observe the behaviour of survivors, and must distinguish between culture and pathology as far as possible. Accurate and neutral observation is an essential skill. An ability to make sensitive inquiries about survivors’ cultural routines and traditions, and family relationships, is another.
Often it is not possible to learn enough about the social culture and environment. Where this is so, helpers can enlist local people to explain and‘ translate’ local cultural practices and‘ codes’. It is important to be sensitive about these relationships too, because mediators may themselves be survivors of traumas, which assisting the helper may reawaken.
Some practical issues
Most humanitarian helpers lack wide international experience because they work in their own country and within their own culture. In terms of general advice, one should make sure that helpers:
• Are fully aware at all times of the cultural implications of interpreting trauma.
• Monitor for traumatic symptoms in the local people who help them.
• Monitor their own reactions.
• Are prepared for the possibility that they may be re-traumatised, or indirectly traumatised, when they listen to the stories of survivors they help. Training here might be especially important for local helpers.
The following advice may assist helpers to explore and manage the cultural dimensions of trauma
• Explore understandings of suffering and pain, and death and life, in the dominant local cultural group.
• If you do not speak the language fluently, acknowledge your limitations and ask survivors to tell you if you speak inappropriately or do something offensive.
• Be aware of culturally specific communication techniques( eye contact, the integration of food and drink in discussions, the pace of conversation, body language, etc.).