Culture shock

Neuroanthropology has an excellent article on how culture influences the experience of trauma, particularly in light of soldiers returning from Iraq and Afghanistan diagnosed with post-traumatic stress disorder.

We tend to think of trauma as being similar across cultures. Something awful happens, we have ‘trauma’. In actual fact, both the experience and expression of trauma are heavily culturally influenced.

The Neuroanthropology piece makes the point that what counts as traumatic differs between individuals because not all dangerous situations are perceived as traumatic whereas some have a deeply personal and disturbing effect.

The author is apparently doing research on US combat veterans and has noted a common element in his interviews:

The classic example of this, and a running theme in [non-commissioned officers’] trauma stories, occurs when a lower-ranking soldier is hurt while following orders to which the NCO personally objects. For example, one veteran told me about the day when one of ‚Äúhis‚Äù soldiers was wounded while following the unnecessarily risky orders of his superior, orders that he protested at the time but ultimately felt compelled to obey.

His story, and others like it, reveal that the trauma of these events lies not only in the wounding of a fellow soldier, but in the inability to protect a subordinate for whom one feels deeply responsible, and the sense that the damage might have been prevented. Thus the meaning of events creates much of their resonance, and their cultural embeddedness – e.g. in the communal socialization and strict power structures of the military – is partially responsible for the emotional overload that defines trauma.

The expression of trauma is also culturally influenced as can be seen in the differing presentation of combat stress in Western soldiers during the last 150 years.

During the American Civil War and the Boer War, most expressions of trauma took the form of heart troubles and were diagnosed as ‘soldier’s heart’, ‘effort syndrome’ or Da Costa’s syndrome.

However, it quickly became clear that the majority of affected soldiers had no physical problems with their hearts, and seemed to be expressing their psychological stresses as physical problems.

During these wars, trauma seemed most commonly expressed as problems with the autonomic system (heart function, breathing, blood pressure etc), while by the time the First World War came round, the expression seems to have largely shifted to problems with motor function and the senses.

Labelled ‘shell shock’, film footage shows that the effects were dramatic, but despite early theories of brain disturbance caused by ‘concussion’, no neurological damage could be detected in most cases.

The UK government quickly banned military psychiatrists from diagnosing ‘shell shock’, and as as World War Two approached combat stress was labelled as ‘psychoneurois’, ‘neuraesthenia’ and a number of other non-specific labels instead.

It wasn’t just the labels that changed though. Dramatic ‘shell shock’ presentations were rarely seen during the Second World War, with the effects of trauma more commonly resembling how we think of it today: intrusive memories, intense anxiety, disrupted sleep.

The Vietnam War was a turning point for the diagnosis of trauma, as veteran’s pressure groups, not unreasonably, wanted, medical care for psychological problems when they returned from service.

They successfully lobbied to have a new disorder included in the diagnostic manuals so the problems could be officially diagnosed and treatment funded. Originally called ‘post-Vietnam syndrome’ in the literature it was quickly renamed to post-traumatic stress disorder or PTSD for its official diagnosis.

For many people today, including clinicians, PTSD is trauma, but its construction owed as much to political expediency than cut-and-dry scientific evidence.

That’s not to say that traumatised people aren’t suffering or don’t exist, just that our ideas about trauma are fluid, malleable and culturally influenced.

Indeed, a recent review of the assumptions behind the definition of PTSD concluded that “virtually all core assumptions and hypothesized mechanisms lack compelling or consistent empirical support”.

When watching the debate unfold over trauma and mental health in the current wars, it’s possible to see some striking parallels in the push and shove of cultural influence.

In 1922 the UK government stopped doctors diagnosing ‘shell shock’ to reduce war pension costs. A recent leaked email from the US Veterans Administration advised doctors to avoid diagnosing PTSD to reduce disability payment costs.

World War One ‘shell shock’ was originally thought to arise from concussion from nearby explosions but was later attributed largely to trauma. Physical problems after mild traumatic brain injury in Iraq have been attributed to nearby explosions but are largely explained by depression and PTSD.

One of the most powerful things to come out of both a historical view and contemporary research is that our beliefs about how should trauma affect us, partly dictates how it does.

In other words, our bodies, beliefs and culture are bound together and when damaged, each contributes to how disability expresses itself.

Needless to say, with this much diversity from a relatively short space of time in similar Western cultures, the difference across cultures can be even more striking.

While being traumatised is a universal experience, the experience of trauma is not, and our expression of distress is a reflection of both our common humanity and our cultural diversity.

Link to Neuroanthropology on Cultural Aspects of PTSD.

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