Trauma and Disasters in Social and Cultural Context

Kirmayer, Laurence J.; Kienzler, Hanna; Afana, Abdel Hamid; Pedersen, Duncan

doi:10.1002/9780470684214.ch13

Cited by 79 publications

(46 citation statements)

References 118 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1 Of course, models based on studying the impact of acute stressors and discrete traumatic events also must be expanded to account for the range of symptoms and suffering seen among refugees or other survivors of massive violence who have endured multiple losses and profound disruptions of the fabric of social life (Kirmayer, Kienzler, Afana, & Pedersen, 2010;Silove, 2007).…”

mentioning

confidence: 99%

Local responses to trauma: Symptom, affect, and healing

Hinton

Kirmayer

2013

Transcult Psychiatry

Self Cite

View full text Add to dashboard Cite

This article provides an introduction to the thematic issue of Transcultural Psychiatry on local responses to trauma. To illustrate how local responses to trauma may be therapeutic, we consider the multiple dimensions or domains that may be targeted by healing rituals and interventions. We then outline a theoretical model of the generation of trauma-related symptoms and distress. We present the multiplex model of symptom generation which posits multiple cognitive, social, and physiological mechanisms by which various triggers can lead to severe distress among trauma victims in acute episodes, and which may be targeted in treatment. More persistent forms of distress can be explained in terms of the effects of persistent mood states and associated modes of cognitive processing and behavior that render individuals vulnerable to chronic symptoms and acute exacerbations. The beneficial effects of healing rituals and interventions may occur, in part, by inducing positive affective states associated with a flexible mindset. We conclude by summarizing some of the contributions of the papers in this issue to understanding local therapeutic processes of healing.Keywords affect, flexibility, healing, mood, PTSD, psychotherapy, ritual, symptom amplification, trauma This issue of Transcultural Psychiatry examines local attempts to cope with and recover from trauma. In every cultural context and community, there will be particular ways to respond to the effects of trauma, some more effective than others. Clinically, these responses, practices and techniques are important to assess for Corresponding author: Devon E. Hinton, Harvard University, 15 Parkman Street, WACC 812, Boston, MA 02114, USA. Email: devon_hinton@hms.harvard.edu several reasons. First, they provide a view of how trauma and its effects are understood in specific socio-cultural contexts, which is important for clinical engagement and diagnosis. Second, attention to local approaches to trauma can provide guidance on how to adapt Western treatment interventions to support local modes of coping, strength, and resilience. Finally, the diversity of responses can provide key insights into therapeutic processes and universal aspects of healing that may have applicability across cultural groups.Although the contributors to this issue consider a broad range of local responses to trauma that include interpretive practices based on local ethnopsychologies, for many the focus is on ritual healing and religious practices. There are several theories of how ritual may bring about healing (

show abstract

mentioning

confidence: 99%

Local responses to trauma: Symptom, affect, and healing

Hinton

Kirmayer

2013

Transcult Psychiatry

Self Cite

View full text Add to dashboard Cite

show abstract

“…The egocentric view of self has also been implicitly taken to be universal nature of human beings within biomedicine and psychiatry and psychiatrists and social scientists have voiced their concern for incorporating a culturally contextualized understanding of self (such as the one offered by Shweder and Bourne 1984) in order to explore meaningfully the mental health problems, trauma, or distress (Gaines 1982a, b;Kirmayer 2004;Kirmayer et al 2010;Kleinman et al 1978). Thus, the social constructionist approach to trauma-related distress closely follows the relativist approach to self and a potential threat to its coherence caused by the traumatic event.…”

Section: Why a Social Constructionist Approach To Study Trauma?mentioning

confidence: 99%

On the Social Constructionist Approach to Traumatized Selves in Post-disaster Settings: State-Induced Violence in Nandigram, India

Kumari

2015

Cult Med Psychiatry

View full text Add to dashboard Cite

Through the use of concepts such as traumatization and posttraumatic stress disorder (PTSD), the distressing experiences of survivors are understood in psychology and psychiatry primarily as the behavioural symptoms resulting supposedly from an incomplete emotional and cognitive processing of traumatic events. Due to such an exclusive focus on the intra-psychic processes, besides the survivors' healing facilitated by cultural beliefs and symbols, their trauma-related distress associated with the cultural interpretation of loss is also generally ignored. This paper illustrates the utility of the social constructionist paradigm in understanding the survivors' experiences of suffering and healing within the cultural and socio-political context of violence through an ethnographic study among the poor farmers of Nandigram, India, inflicted by violence from the state government as it tried to forcibly acquire their land to build a chemical factory. How the traumatized selves experience intense distress resulting from disruptions to a sense of wholeness and how this wholeness may be reformulated through culturally valued beliefs are highlighted in the themes of suffering ('experience of PTSD symptoms', 'betrayed self', 'overwhelmed by loss', and 'biographical disruption') and healing ('moral re-affirmation', 'sense of togetherness', 'sense of security due to change in political environment') presented in the vignettes.

show abstract

“…However, psychiatrists, psychologists, anthropologists, and other health professionals working in war-afflicted communities have attempted to broaden the focus of mental health studies beyond the individual’s experience to include socio-cultural determinants of collective suffering [18-23]. Furthermore, it is critical to look beyond DSM causal definitions and explore the mechanisms of human growth, self-transformation, and resilience affecting individual mental health outcomes [24-26].…”

Section: Introductionmentioning

confidence: 99%

Trauma and mental health of medics in eastern Myanmar’s conflict zones: a cross-sectional and mixed methods investigation

Lim

Stock

Oo³

et al. 2013

Confl Health

View full text Add to dashboard Cite

BackgroundIn conflict and disaster settings, medical personnel are exposed to psychological stressors that threaten their wellbeing and increase their risk of developing burnout, depression, anxiety, and PTSD. As lay medics frequently function as the primary health providers in these situations, their mental health is crucial to the delivery of services to afflicted populations. This study examines a population of community health workers in Karen State, eastern Myanmar to explore the manifestations of health providers’ psychological distress in a low-resource conflict environment.MethodsMental health screening surveys were administered to 74 medics, incorporating the 12-item general health questionnaire (GHQ-12) and the posttraumatic checklist for civilians (PCL-C). Semi-structured qualitative interviews were conducted with 30 medics to investigate local idioms of distress, sources of distress, and the support and management of medics’ stressors.ResultsThe GHQ-12 mean was 10.7 (SD 5.0, range 0–23) and PCL-C mean was 36.2 (SD 9.7, range 17–69). There was fair internal consistency for the GHQ-12 and PCL-C (Cronbach’s alpha coeffecients 0.74 and 0.80, respectively) and significant correlation between the two scales (Pearson’s R-correlation 0.47, P<0.001). Qualitative results revealed abundant evidence of stressors, including perceived inadequacy of skills, transportation barriers, lack of medical resources, isolation from family communities, threats of military violence including landmine injury, and early life trauma resulting from conflict and displacement. Medics also discussed mechanisms to manage stressors, including peer support, group-based and individual forms of coping.ConclusionsThe results suggest significant sources and manifestations of mental distress among this under-studied population. The discrepancy between qualitative evidence of abundant stressors and the comparatively low symptom scores may suggest marked mental resilience among subjects. The observed symptom score means in contrast with the qualitative evidence of abundant stressors may suggest the development of marked mental resilience among subjects. Alternatively, the discrepancy may reflect the inadequacy of standard screening tools not validated for this population and potential cultural inappropriateness of established diagnostic frameworks. The importance of peer-group support as a protective factor suggests that interventions might best serve healthworkers in conflict areas by emphasizing community- and team-based strategies.

show abstract

Trauma and Disasters in Social and Cultural Context

Cited by 79 publications

References 118 publications

Local responses to trauma: Symptom, affect, and healing

Local responses to trauma: Symptom, affect, and healing

On the Social Constructionist Approach to Traumatized Selves in Post-disaster Settings: State-Induced Violence in Nandigram, India

Trauma and mental health of medics in eastern Myanmar’s conflict zones: a cross-sectional and mixed methods investigation

Contact Info

Product

Resources

About