Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress, Ethnopsychology and Ethnophysiology in Alleviating Suffering and Preventing Stigma

Abstract

In the aftermath of a decade-long Maoist civil war in Nepal and the recent relocation of thousands of Bhutanese refugees from Nepal to Western countries, there has been rapid growth of mental health and psychosocial support programs, including posttraumatic stress disorder (PTSD) treatment, for Nepalis and ethnic Nepali Bhutanese. This medical anthropology study describes the process of identifying Nepali idioms of distress and local ethnopsychology and ethnophysiology models that promote effective communication about psychological trauma in a manner that minimizes stigma for service users. Psychological trauma is shown to be a multi-faceted concept that has no single linguistic corollary in the Nepali study population. Respondents articulated different categories of psychological trauma idioms in relation to impact upon the heart-mind, brain-mind, body, spirit, and social status, with differences in perceived types of traumatic events, symptom sets, emotion clusters, and vulnerability. Trauma survivors felt blamed for experiencing negative events, which were seen as karma transmitting past life sins or family member sins into personal loss. Some families were reluctant to seek care for psychological trauma because of the stigma of revealing this bad karma. In addition, idioms related to brain-mind dysfunction contributed to stigma while heart-mind distress was a socially acceptable reason for seeking treatment. Different categories of trauma idioms support the need for multidisciplinary treatment with multiple points of service entry.

Cultural logics of emotion: Implications for understanding torture and its sequelae

“…Explaining events in terms of forces or agencies like fate or "God's will" that lie beyond anyone's control may help some individuals to endure but they may also lead to ineffective coping strategies that impair functioning. On the other hand, traditions that emphasize coping by controlling one's own mind may help individuals endure experiences of loss of behavioral control and the same attitudes S C I E N T I F I C A R T I C L E may help with subsequent adaptation (Agger, 2015;Elsass, Carlsson, Jesperson, & Phuntsok, 2008;Elssass & Phuntsok, 2009;Kohrt & Hruschka, 2010). Forcing individuals to transgress cultural and religious norms and values then constitutes multiple forms of violence, causing direct injury, blocking efforts to give meaning to suffering, and damaging their social identity in ways that may lead to persistent feelings of estrangement from others (Khan, 2010;Kirmayer, 2015).…”

Strategies for assessing mental health in Haiti: Local instrument development and transcultural translation

“…One of the benefits of a focus on local perceptions, particularly in guiding instrument development, is that locally salient ways of categorizing experience are the starting point for evaluating distress and well-being (Dunn & Janes, 1986). In contrast, applying a Western psychiatric measure cross-culturally could be devoid of meaning; while indicating that an individual endorsed a certain percentage of items on a scale, that number may not map onto any discrete forms of experience such as distress versus nondistress (Kohrt & Hruschka, 2010). Instead, screening tools should identify those who have a locally salient collection of symptoms, along with functional impairment, and are suffering: in other words, those in need of care (Bolton, 2001;Bolton et al, 2003;Desjarlais et al, 1995).…”

“…However, a large literature on cross-cultural mental health research would caution that the concepts, language, and measures used by these organizations, largely from the US and Canada, cannot be expected to translate easily into other settings (Breslau, 2000;Kirmayer, 2002Kirmayer, , 2007Kohrt & Hruschka, 2010;van Ommeren et al, 1999). Recognizing these shortcomings, researchers have advocated for a more ethnographically grounded approach to assessment and care, including drawing upon local idioms of distress, adapting and validating screening tools, and examining impacts of mental distress on social and economic functioning (Bolton & Tang, 2002;Kirmayer, 2007;Kohrt & Hruschka, 2010;Nichter, 2008). Despite a shared recognition of the importance of accurate screening, there remains disagreement as to the relative utility of culturally adapted versus locally developed screening tools (Desjarlais, Eisenberg, Good, & Kleinman, 1995;Good, Subandi, & Good, 2007;Kirmayer, 2002;Mezzich et al, 1999;Miller, Omidian, Rasmussen, Yaqubi, & Daudzai, 2008;van Ommeren et al, 1999)., This paper describes research in rural Haiti using both approaches to instrument construction, ultimately demonstrating the complementary strengths of each strategy for developing ethnographically valid mental health screening tools for common mental disorders.…”

Holistic interventions to trauma management for teachers following disaster: expressive arts and integrated body-mind-spirit approaches

“…This type of approach can reinforce cultural values while reducing stigma for survivors (Kohrt & Hruschka, 2010). It is strength-based as the goal is 'not to "get rid of" the symptoms, or to simply "substitute" adaptive ways of coping, but to find and rebuild adaptive skills that the survivor possesses and values within her/himself' (Ford & Russo, 2006, p. 343).…”