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November 11, 2024
Western mental health discourse introduces core components of Western culture, including a theory of human nature, a definition of personhood, a sense of time and memory, and a source of moral authority. None of this is universal. DEREK SUMMERFIELD
Initially she focused on alerting the drug companies she worked with to the medical needs of the population. She then turned her efforts to alerting the Sri Lankan population about the devastating psychological impact that would soon be felt.
Although not a clinician herself, as head of a statewide association of 125 nonprofit behavioral health organizations, she had overseen several public service campaigns with the goal of lessening the stigma of mental illness and educating populations unaccustomed to seeking professional help.
“I told them that this was going to be unlike anything they had experienced before,”
problem. I told them that the impact could be multigenerational.”
She also contacted the Sri Lankan news media. In an interview that ran repeatedly on Sri Lankan national television in the days and weeks after the tsunami, Wentz told the population of how the symptoms of PTSD cluster in three different categories: avoidance, numbness, and hyperarousal. She advised everyone to be on the lookout for this pathological behavior in both adults and children. She told them that PTSD requires professional attention.
They had almost no psychiatrists, and most primary care doctors were not trained in psychiatry or mental health education.
She began to hatch a plan by which she would collect money in the United States to send American trauma experts to Sri Lanka to train local counselors how to spot and treat PTSD.
Wentz assumed, as do many Western mental health specialists who focus on trauma, that the psychological reaction to horrible events is fundamentally the same around the world.
From her own recounting of the events, it is also clear that she believed that the Western world, in particular the United States, had more and better resources than the people of Sri Lanka to both understand and respond to the coming mental health crisis.
Responding to the dire warnings, hundreds of nongovernmental organizations, universities, and private groups quickly began to gather resources and make plans to send an army of trauma counselors in teams of various sizes to the coastal areas of the Indian Ocean.
“Restore is the wrong word,” Davies was quoted as saying, “because there was nothing much there before.”
As late as the mid-1980s, in fact, the manuals for postdisaster relief focused exclusively on medicine, food, and shelter and contained no advice for treating the psychological wounds of a population.
It’s only been in the past twenty years that the diagnosis of PTSD has caught the world’s attention.
We were suddenly in a time when, as one psychiatrist put it, the concern over psychological trauma had “displaced hunger as the first thing the Western general public thinks about when a war or other emergency is in the news.”
that PTSD was becoming the way the entire world conceived of psychological trauma,”
Seldom considered in our rush to help treat the psychic wounds of traumatized people was the question of whether PTSD was a diagnosis that could be usefully applied in all human cultures.
The idea that people from different cultures might have fundamentally different psychological reactions to a traumatic event is hard for Americans to grasp.
But PTSD isn’t just a list of symptoms.
Amatruda is a BCETS, a Board Certified Expert in Traumatic Stress.
Amatruda sees trauma as forming a kind of psychic infection in the mind and the best way to drain that infection is through retelling the story.
“They may not have the words for something, but they can play out their stories with blocks or toys.”
the tradition of what has been called “psychological first aid,” or sometimes “critical incident debriefing.”
Few could comprehend the local languages, nor were they experts on the population’s religious beliefs, its grieving and burial rituals, or the country’s long and complicated history of civil war.
If you’re doing the mental health equivalent of applying a compress to someone’s injured head, why would you need to share his or her religious beliefs, traditions, or social structures?
The assumption that traumatic reactions exist outside and unaffected by culture was common among both individual trauma counselors and the relief organizations sponsoring them.
“A victim processes a traumatic event as a function of what it means,” they wrote. “This meaning is drawn from their society and culture and this shapes how they seek help and their expectation of recovery.” Trauma reactions aren’t automatic physiological reactions inside the brain, they suggested, but rather cultural communications. They have nuance and meaning that can be misinterpreted
or overlooked unless observers have a deep understanding of the culture at hand.
