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This book analyzes the individual and collective experience of and response to trauma from a wide range of perspectives including basic neuroscience, clinical science, and cultural anthropology. Each perspective presents critical and creative challenges to the other. The first section reviews the effects of early life stress on the development of neural systems and vulnerability to persistent effects of trauma. The second section of the book reviews a wide range of clinical approaches to the treatment of the effects of trauma. The final section of the book presents cultural analyses of personal, social, and political responses to massive trauma and genocidal events in a variety of societies.
This work goes well beyond the neurobiological models of conditioned fear and clinical syndrome of post-traumatic stress disorder to examine how massive traumatic events affect the whole fabric of a society, calling forth collective responses of resilience and moral transformation.
- Sales Rank: #1241583 in Books
- Brand: Brand: Cambridge University Press
- Published on: 2008-04-14
- Original language: English
- Number of items: 1
- Dimensions: 8.98" h x 1.22" w x 5.98" l, 1.60 pounds
- Binding: Paperback
- 548 pages
Features
- Used Book in Good Condition
Review
"... Neatly summarizes the challenges inherent in interdisciplinary integration."
--- Psychiatric Services, A Journal of the American Psychiatric Association
Understanding Trauma is an important book. Its multidisciplinary, multicultural perspectives will benefit a wide audience. It explains the complexity of trauma so eloquently that readers will see the dots begin to connect. Its successful integration of multidisciplinary research... takes the study of trauma to the next level."
- PsycCRITIQUES
This book is a must read for anyone seriously interested in the predisposition, cause, course, treatment, and outcome prognosis for people experiencing trauma and post trauma consequences... The authors have created a state-of-the-art review that is fascinating, informative, and extremely useful to all concerned with understanding trauma and its effect on all of our lives.
- Murray A. Brown, MD
About the Author
Laurence J. Kirmayer, MD, FRCPC, is James McGill Professor and Director, Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University. He is Editor-in-Chief of Transcultural Psychiatry and directs the Culture and Mental Health Research Unit at the Department of Psychiatry, Jewish General Hospital in Montreal where he conducts research on mental health services for immigrants and refugees, psychiatry in primary care, the mental health of indigenous peoples, and the anthropology of psychiatry. He founded and directs the annual Summer Program and Advanced Study Institute in Cultural Psychiatry at McGill and co-directs the National Network for Aboriginal Mental Health Research. His past research includes funded studies on the development and evaluation of a cultural consultation service in mental health, pathways and barriers to mental health care for immigrants, somatization in primary care, cultural concepts of mental health and illness in Inuit communities, risk and protective factors for suicide among Inuit youth in Nunavik (Northern Québec), and resilience among Indigenous peoples. He co-edited the volumes Current Concepts of Somatization (American Psychiatric Press), Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives (Cambridge University Press), Healing Traditions: The Mental Health of Aboriginal Peoples in Canada (University of British Columbia Press) and Encountering the Other: The Practice of Cultural Consultation (Springer SBM).
Robert Lemelson is currently a lecturer in the departments of Anthropology and Psychology at UCLA, and the president of the Foundation for Research (the FPR). He is a psychological anthropologist with a specialty in culture and mental illness. He was a Fulbright scholar in Indonesia, and is currently releasing several documentary films based on his research on culture and neuropsychiatric disorders. He has published in Culture, Medicine and Psychiatry; Medical Anthropology Quarterly; Transcultural Psychiatry and other journals.
Mark Barad is Assistant Professor of Psychiatry and Behavioral Sciences at the University of California, Los Angeles and has been the Tennenbaum Scholar from the Department of Psychiatry. His current research and writing further explores the development of adjunctive treatments to accelerate and facilitate the behavioral psychotherapy of anxiety disorders. In addition to his research and teaching, Dr Barad has supervised at the UCLA Anxiety Disorders Clinic and the UCLA General Outpatient Psychiatry Clinic. He also has a private practice as a psychiatrist.
Most helpful customer reviews
2 of 2 people found the following review helpful.
Exhaustively convincing
By Umbra Carmine Dobbin
The book Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives is a deep and broad exploration of the causations and effects of, and various treatments for, trauma-induced stress. From sections on in vitro laboratory experimentation, and clinical philosophies wrought from human patient observation, to on-the-ground realities of posttraumatic stress, editors Kirmayer, Lemelson, and Barad (2007) poignantly paint a picture of PTSD diagnosis with the medium of myriad contributing authors’ treatises, as being one (1) with some universality but with a risk factor that is dependent upon individual biology and upbringing, and (2) that is, in humans, experienced and handled differently due to particular cultural worldviews and social circumstances. I agree with their concluding comments that especially in regards to psychiatric intervention for the displaced and disaster-stricken (by natural or anthropogenic forces) people around the world, post-traumatic stress should be treated (or not at all) through a biopsychocultural frame. I will now give examples to iterate why I am so convinced, from select chapters out of each pertinently discipline-specific section in the book.
For mice that experience panic from a traumatizing unconditioned stimulus (US) after classic conditioning, such panic can be duly titrated with repeated conditioning that simply excludes that stressor (Bouton and Waddell 2007:42), the conditioned stimulus (CS). It appears that this fear extinction is not fear erasure but rather a situational re-learning process (Quirk et al. 2007:60) that can in fact be disrupted in the future (leading to recurrence) with exposure to the original US alone or to the CS in a different context than extinction took place in. It can also come back in short time without any evocation at all. I offer an analogical human experience: a Vietnam militiaman is in a helicopter when it is shot down and his friends all die, and, as he is later exposed to tens of other situations with military helicopters and no disaster, his trauma subsides, but in situations wherein he hears random news helicopters outside of the military setting he experiences full-blown panic which begs recourse. This leads to a perplexing problem for rehabilitation efforts centered on conditioned fear extinction.
Not all people in this militiaman’s position would have this problem, however. “While 75% of adults have had a traumatic experience fulfilling current DSM-IV criteria as potential factors in the development of PTSD, only 12% actually developed PTSD” (Quirk et al. 2007:60). A larger hippocampus could have made him less vulnerable (Bremner 2007:119-120, 132), but there is more to that than simple genetic predisposition. Rodent models show that “variations in mother-infant interactions over the first week of life stably alter the development of neural systems involved in botho cognitive-emotional responses to stress and spatiotemporal information processing” (Bagot et al. 2007:98). Such interactions in humans may lend to the “combination of biological and biographical factors, such as inheritance [...], child abuse, lower education, lifetime occurrence of mental disorders, and so forth [that] contribute to individual [PTSD] vulnerability” (Shalev 2007:207). If the militiaman were born into different conditions, in other words, he might have had better developed physiological and social defenses, and hence been fortunate enough to not end up with PTSD. It takes a merging of biomedical and social sciences to discern how this might be the case, and offer the possibility that PTSD is not inevitable for someone in his position. Indeed, as sensation seekers, “some men speak of their combat experiences in strangely positive terms, as the time in their past when they felt most alive, or even as the best time” (Konner 2007:305). Also, if he were a more desensitized soldier as some training can produce, he may not perceive the traumatizing event as grotesque or “strange, disturbing, or distorted – a type of experience akin to violation of norms for wholeness, bodily integrity, and species-specific survival schemata” (Shalev 2007:211), a requirement for PTSD – and may therefore move on (perhaps with psychic and physical scars, but not with PTSD).
So apart from grotesqueness or violation as requisite for PTSD, it is apparent that PTSD (a) is not inevitable since individual differences can lessen the risk for it, and (b) fear extinction is complex in that it may require (1) either frequent exposure to plentiful contexts with the CS exclusively, (2) deep psychodynamic therapy, or (3) something entirely different, and, that it (c) is actually unwantedly interrupted with supposedly ameliorative prescription medications (Bouton and Waddell 2007:44). Post-traumatic stress can bring resolution, or at least bring about positive effects, in unexpected ways. It is the case that “little attention is paid to the individual and collective strengths that can come out of terrible experiences,” which “are usually treated as anecdotal observations, as if they were individual exceptions to the rule” (Rousseau and Measham 2007:278). Quirk et al. (2007) have shown this to be false, as noted earlier, corroborated by yet other researchers in the book. Lessened risk behaviors, solidarity with other victims, tenderness, pride from both survival and preserving identity, and increased altruism as well as planning behavior and positive self-images can all come from trauma (Rousseau and Measham 1007:278-279). One example is how “a self-report on-line questionnaire based on the Values in Action Classification of Strengths was completed by 4,817 Americans in the two months following [9/11], and showed increases in gratitude, hope, kindness, leadership, love, spirituality, and teamwork” (Konner 2007:314).
Perhaps most importantly, post-traumatic stress is experienced and handled in different ways from culture to culture and symptoms may not exactly fit the PTSD criteria. In the case of the !Kung San bushmen who deal with perpetually intense and extensive trauma from nature, society, and disease, and who may represent a culture similar to what myriad industrial cultures diverged from, such stress can cause a people overall to adaptively thrive whether or not there are outliers of psychiatric disorder (Konner 2007:304-305), which may not actually be precipitated but rather exacerbated by traumatic stress, in parallel to priorly mentioned susceptibilities as risk factors. For some cultures such as theirs, the traumatic barrage of constantly changing threats is intergenerational in duration but “social and political circumstances determine the temporality of trauma and may not allow the “post” of PTSD to emerge” (Lemelson, Kirmayer, and Barad 2007:466). In the case of Balinese genocide and living life in the shadow of oppressive government and vile neighbors, e.g., culturally normal acts of withdrawal – called ngeb (Dwyer and Santikarma 2007:422) – and rarer developments of delusions of spiritual counselors/friends may actually be duly adaptive and psychotic (ibid:453-455), but simple social assurance from medicine men can ensure their comfort and continued active place in society. For other Balinese, dependent upon tourism, after a recent local bombing they were less traumatized by the hundreds of deaths than by the economic disruption to their livelihoods from hesitant tourists (Dwyer and Santikarma 2007:412). They were ignorantly entreated to believe in PTSD and to learn how to forget about their trauma rather than address the ever-present economic problems (ibid:414-416). This is especially impactful for them because they already live under a regime that is trying to bury its genocidal acts from decades prior, and the people have come up with new and effective ethnopsychiatric practices to manage their losses and psychically undermine the regime (ibid:420) – an empowering rather than problem-masking course of healing (that is, better than PTSD counseling). A murderous Javanese government affected one young girl (after killing her father) in a manner similar to PTSD but, without much worry directed at her, she began growing tough and responsible for family, and then had ecstatic visions that healed her further by bringing her to religion and thenceforth to founding a religious center (Kirmayer, Lemelson, and Barad 2007:461). She accomplished this without ever leaving the traumatic environment.
These latter examples show us resiliency when and where we might least expect it, and that posttraumatic stress is not universally expressed. PTSD-related neurobiological models of hippocampus size and mother-infant interactions (as well as others) offer humanity an understanding of where posttraumatic stress reaction universality may exist, and offer parents of many cultures a path of preparation and/or prevention. But “trauma is always more than a biological state,” in that “it emerges and takes on force and meaning in dialogue with a host of cultural, ethical, and political discourses that address what it means to suffer and what – and whose – pain should be ameliorated” (Dwyer and Santikarma 2007:405). Work in Western clinical settings shows us how some Westerners are affected and others are not, and how mimesis – “a general term for the processes by which we construct representations that mimic or stand in for reality [...] reconstructing and reorganizing experiences according to cultural models or templates” (Kirmayer, Lemelson, and Barad 2007:296) – should not necessarily be considered self-endangering avoidance but rather a self-fortifying method of recovery. In other words, imagination helps the healing process. PTSD in Westerners can in many cases be effectively treated with psychiatric intervention (Yadin and Foa 2007:181-184), but psychiatrists’ who intervene in the non-Western world are so rife with failures of imagination (Kirmayer 2007:363-379) that many refugees are misunderstood and mistreated, often in ways that make asylum an out-of-reach state instead of promised land, making rehabilitation efforts obstacles rather than triages. People whose cultures do not raise them to think that they will have PTSD after trauma may not exhibit the disorder at all, or they may but only partially or briefly, and, if trauma is constant they may never react in a non-adaptive way. I am influenced by these authors in my thinking that, in those cases, (1) intercultural collaboration rather than assumptive and imposed intervention may be the best humane response and (2) that more upbringing-focused assistance (perhaps carefully aiding in the mimetic process) be given to those who truly cannot take care of themselves or their dependents. No less, Westerners could learn from other cultures how trauma can be socially managed, from circumstance to circumstance. This may altogether best exemplify a conscious biopsychocultural approach to cognitive therapy, and the editors of this book illustratively nailed it.
References
Bagot, Rosemary, Carine Parent, Timothy W. Bredy, Tieyuan Zhang, Alain Gratton, and Michael J. Meaney
2007 Developmental Origins of Neurobiological Vulnerability for PTSD. In Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. Kirmayer, Laurence J., Robert Lemelson, and Mark Barad, eds. Pp 98-117. Cambridge: Cambridge University Press.
Bouton, Mark E., and Jaylyn Waddell
2007 Some Behavioral Insights into Persistent Effects of Emotional Trauma. In Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. Kirmayer, Laurence J., Robert Lemelson, and Mark Barad, eds. Pp 41-59. Cambridge: Cambridge University Press.
Bremner, J. Douglas
2007 Does Stress Damage the Brain? In Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. Kirmayer, Laurence J., Robert Lemelson, and Mark Barad, eds. Pp 118-141. Cambridge: Cambridge University Press.
Dwyer, Leslie, and Degung Santikarma
2007 Posttraumatic Politics: Violence, Memory, and Biomedical Discourse in Bali. In Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. Kirmayer, Laurence J., Robert Lemelson, and Mark Barad, eds. Pp 403-432. Cambridge: Cambridge University Press.
Kirmayer, Laurence J.
2007 Failures of Imagination: The Refugee’s Predicament. In Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. Kirmayer, Laurence J., Robert Lemelson, and Mark Barad, eds. Pp 363-381. Cambridge: Cambridge University Press.
Kirmayer, Laurence J., Robert Lemelson, and Mark Barad
2007 Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. Kirmayer, Laurence J., Robert Lemelson, and Mark Barad, eds. Cambridge: Cambridge University Press.
Lemelson, Robert, Laurence J. Kirmayer, and Mark Barad
2007 Trauma in Context: Integrating Biological, Clinical, and Cultural Perspectives. In Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. Kirmayer, Laurence J., Robert Lemelson, and Mark Barad, eds. Pp 451-474. Cambridge: Cambridge University Press.
Konner, Melvin
2007 Trauma, Adaptation, and Resilience. In Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. Kirmayer, Laurence J., Robert Lemelson, and Mark Barad, eds. Pp 300-338. Cambridge: Cambridge University Press.
Quirk, Gregory J., Mohammed R. Milad, Edwin Santini, and Kelimer Lebrón
2007 Learning Not to Fear: A Neural Systems Approach. In Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. Kirmayer, Laurence J., Robert Lemelson, and Mark Barad, eds. Pp 60-77. Cambridge: Cambridge University Press.
Rousseau, Cécile, and Toby Measham
2007 Posttraumatic Suffering as a Source of Transformation. In Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. Kirmayer, Laurence J., Robert Lemelson, and Mark Barad, eds. Pp 275-294. Cambridge: Cambridge University Press.
Shalev, Arieh Y.
2007 PTSD: A Disorder of Recovery? In Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. Kirmayer, Laurence J., Robert Lemelson, and Mark Barad, eds. Pp 207-223. Cambridge: Cambridge University Press.
Yadin, Elna, and Edna B. Foa
2007 Cognitive Behavioral Treatments for Posttraumatic Stress Disorder. In Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives. Kirmayer, Laurence J., Robert Lemelson, and Mark Barad, eds. Pp 178-193. Cambridge: Cambridge University Press
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