Trauma doesn't cause PTSD in all cultures

One of the real problems when  dealing with trauma such as child abuse or rape or war - is the assumption that there is a universal scientific model of psychological trauma. "Trauma in - PTSD out." The traumatized individual is assumed to have been betrayed, his/ her personal boundaries crossed, felt helpless, experienced depression, lost self-esteem and ability to trust others. The intrapsychic needs to be dealt with, understood and repaired when a wide variety of trauma occurs. In fact, however, in non-Western societies trauma might be not even be experienced or is manifest primarily in somatic symptoms or rejection by family and society resulting more in shame than personal degradation. Torture in some communities is best understood by reference to political or social concepts rather than psychological ones. This is I believe the major cause of dissatisfaction of Modern Western educated observant Jews who are embarrassed to find that the "obvious" traumas of child abuse, rape and other indignities - are apparently not a significant concern in the traditional Jewish literature. They readily assume that there is a coverup and ignoring or ignorance of PTSD resulting from various traumatic situation- or that G-d or rabbis don't care. In fact it seems that much of the trauma in traditional Jewish society was damage to social status or betrayal of religious norms of either the victim or perpetrator - rather than to the psyche. This is a major topic and one that Western mental health workers have trouble accepting or even understanding.

 The issue is what is the trauma? If it primarily comes because of psychological damage- then an event such as abuse or rape will have a wide range of consequences in different cultures - especially ones in which the psychological dimension is relatively small.

See Victor Frankl who was shocked to discover that the impact of being in a concentration camp varied greatly - depending on how the events were perceived. See Gail Sheehy's book  Spirit of Survival (1987) about her adopted Cambodian daughter - who experienced the horror of the "killing fields" and yet didn't seem to have been traumatized by the events.

The article is saying to stop viewing certain events as if they were objective and clearly defined forces. The impact of these events is mediated by the victims perception and it is not a mechanical cause and effect paradigm. This is a major theme in Jewish writings about suffering

To put it another way - should rape and war be viewed as being equivalent to being beaten. Depending upon where the blows fall and the person's strength - a particular blow will have varying effects. However  for the same blow in the same spot and the same personal strength - there will be a high degree of consistency of damage.

This other model says that the impact of rape or abuse is largely determined by how it is viewed in a particular culture by a particular individual. For some it will be totally devastating but for others the impact will be minimal.

There is also a consequence for therapy. A mechanical model says that all traumatic events produce serious damage. Therefore the therapy looks for and encourages acknowledgement of this damage - catharsis.

The other model says that the main focus should be on developing cognitive frames that minimize the impact of these events and that it is possible that little or no damage has actually occurred and therefore encourage catharsis or talking about these events actually is more damaging than the original events.

There is evidence that the cathartic focus in catastrophe counselling is actually counterproductive - even in Western society.

 
The following article just provides a brief - but very intelligent - introduction to the topic.

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Psychological Responses to War & Atrocity

Psychotherapy, as practiced in western countries, largely takes the form of an individual client consulting a therapist. In Africa and other Third World settings most therapy directly involves other family members and sometimes the wider community. When it comes to responding to the effects of violence western style psychotherapy can have the effect of 'individualising' the suffering of the person involved. Psychotherapy of this mode might be inappropriate and indeed harmful in more "sociocentric" societies where the individual's recovery is intimately bound up with the recovery of the wider community. This is true for individuals and communities still living in the Third World but also for refugees who are living in western countries. 

Thus it is apparent that what will be effective healing healing for victims of violence, will be largely determined by the cultural and social context. Such factors will also determine what types of healing are available. Indeed Herman makes the point that the therapeutic strategies associated with the western discourse on trauma have only become available because of particular political developments during the past 20 years:

The systematic study of psychological trauma therefore depends on the support of a political movement. Indeed, whether such study can be pursued or discussed in public is itself a political question. The study of war trauma becomes legitimate only in a context that challenges the sacrifice of young men in war. The study of trauma in sexual and domestic life becomes legitimate only in a context that challenges the subordination of women and children 

Conclusion

All scientific approaches to understanding use metaphors at a very basic level. Certain metaphors underlie the approaches of modern biomedicine and psychiatry. Even though these metaphors may be the source of problems for the conceptualisation of psychiatric illness in the West, at least in this part of the world they are metaphors widely used and endorsed by society. In parts of the world where such forms of understanding are not the norm the introducing of concepts such as PTSD based as it is on a likening of the mind to an 'information processing instrument' may be at best confusing. Fear and suffering are facts of human life that belie simple explanatory models, and attempts to account for them in terms of such models have to be, at most, tentative.

If we ignore these problems, we are at risk of introducing inappropriate treatment models and strategies in our attempt to help the rehabilitation of individuals and communities who are the victims of violence and trauma. In addition, because such models of therapy involve expertise, training and a new 'language', the possibility of creating a new 'expert syndrome' arises and with it the possibility of undermining already existing medical and non-medical approaches to the alleviation of distress caused by organised violence. This in turn may have the effect of undermining local community structures, the very forces which act as 'protective' elements with regard to the effects of trauma and the very structures which need to bear testimony in their own terms.