Traumatic Amputation: A Case of Laotian Indignation and Injustice

Abstract

Culture is an essential variable of diagnosis and treatment. A cultural perspective draws attention to the social context within which symptoms arise, are given meaning, and are managed. Ethno-cultural work on illness narratives suggests that most people can provide culturally-based explanations for their symptoms. While these explanations are inconsistent with biomedical theory, they relieve patient distress by allowing the patient to create meaning for symptoms. Exploring the characteristics, context, and antecedents of the symptoms enables the patient to convey them to the clinician who may have a divergent explanation of sickness. This case study uses the Outline for Cultural Formulation of the DSM-IV created for clinicians to elicit a narrative account of the illness experience from the patient. Our study examines how the patient, a Laotian used social indignation ("Kwam khem keuang") as an explanatory model for his ailment. He was diagnosed with post-traumatic stress disorder after having undergone a traumatic amputation. In the process of explaining his illness through a cultural idiom, the patient was able to reveal both personal and collective meaning of repressed anger and frustration, expressing them in a context that was acceptable to him. This cultural idiom allowed the patient to reflect upon the structure of the health care system and the specific context in which symptoms and their possible origins are recounted and explored. It also clarified to the treating clinicians some categories of experience and causal explanations that did not fit easily with western biomedical and psychiatric understanding. The case study illustrates how a cultural approach to illness from the patient's perspective offers a reflexive stance on the clinician-patient interaction that allows for better patient care.

Culture and Psychiatric Evaluation: Operationalizing Cultural Formulation forDSM-5

“…Cultural norms affect patient communication with providers, family, and friends (Browne, 2001; Dinh & Groleau, 2008). Eliciting illness representations of the patient's family members, friends, or close associates can clarify the range of views influencing the illness experience (Kirmayer et al, 2014).…”

“…In most published case reports, the treating clinician was the interviewer. However, the OCF may also be used by adjunctive personnel, such as a culture broker or anthropologist (Dinh & Groleau, 2008; Groen, 2009a; Kirmayer, Thombs et al, 2008c; Miklavcic & Leblanc, 2014; Rohlof et al, 2009) to integrate OCF data with routine clinical findings. In Montreal's CCS, the perceived utility of the OCF did not differ between clinicians and non-clinicians (e.g., culture brokers), though psychologists found it more useful than did physicians (Kirmayer, Thombs et al, 2008c).…”

A qualitative study of the perceived effectiveness of refugee services among consumers, providers, and interpreters

“…Individuals experiencing trauma may find resettlement even more stressful, learning a new language especially difficult, and managing chronic illness more challenging (Bakker, Dagevos, & Engbersen, 2016;Boucher, 2009;Myers, 1997). There is debate in the literature regarding the prevalence of PTSD in this population, as well as on the accuracy or helpfulness of the DSM criteria in assessing traumatic stress in individuals from non-Western cultures (Dinh & Groleau, 2008;Saya, Aung, Gast, & Lewis, 2016). Dinh and Groleau (2008) argue that PTSD is a cultural construction by Western-trained mental health providers and may not reflect the cultural interpretation of symptoms by non-Western individuals.…”

“…There is debate in the literature regarding the prevalence of PTSD in this population, as well as on the accuracy or helpfulness of the DSM criteria in assessing traumatic stress in individuals from non-Western cultures (Dinh & Groleau, 2008;Saya, Aung, Gast, & Lewis, 2016). Dinh and Groleau (2008) argue that PTSD is a cultural construction by Western-trained mental health providers and may not reflect the cultural interpretation of symptoms by non-Western individuals. These cultural differences can interfere with refugees' access to mental health services, the effectiveness of providers' treatment approach, and the perceived helpfulness of interventions.…”

Decades after Resettlement

“…Future studies need to focus in detail on the factors that precipitate the reappearance of psychic disorders years after settling down and how best to rehabilitate people so affected into normalcy. Understanding the cultural factors that hold the key to the ''essential variables of diagnosis and treatment'' is significant, as it would draw attention to the ''social context within which symptoms arise, are given meaning and are managed'' (Dinh and Groleau 2008). Understanding these cultural and social variables can be instrumental in formulating programs useful to agencies and people responsible for delivery of care not only to a specific ethnic group, such as the Cambodian refugees, but also to a larger audience of other aging ethnic populations.…”