Trauma construction and traumatic events
The era of white saviourism
Content warning: This article contains mentions of mental illness and racism.
In his groundbreaking work on decolonising trauma and post-traumatic stress disorder in Palestinian territories, Dr Derek Summerfield calls for the reform of the treatment and overmedicalisation of mental health, particularly in humanitarian circumstances. The following two-part essay series understands trauma, in line with Summerfield's arguments, to be a condition manufactured by Western psychiatry, whereby the complex, unique, and often collective suffering of individuals is reframed as a technical problem to which short-term, individually-delivered solutions are applicable. In the second essay, the implications of Western framings of post-traumatic stress disorder will be explored further through the actions of non-governmental organisations such as Médecins Sans Frontières. The series concludes by suggesting ways in which decolonising psychological care can improve inequalities in access to and treatment of mental health globally, as well as raise awareness surrounding the complexity of human nature and psyche.
Image credit: Unsplash
Western social constructions of trauma and traumatic events
“despite the fact that the diagnosis of PTSD was built from the specific experiences of male American veterans, its entry into the DSM-III meant that it became the definition applied to all, irrespective of culture, experience, background, ethnicity, or gender.”
Definitions of post-traumatic stress disorder (PTSD) first appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). PTSD is described as “a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event” and is diagnosed through a series of DSM criteria, including “intrusion symptoms” like nightmares or flashbacks, and “negative alterations” in mood or reactivity like feelings of isolation and anger. The DSM-III and its subsequent versions (the DSM-5 being the most recent edition) are American-made manuals that have become used globally, supposedly offering a guide to psychiatry written in a “universal language for clinicians”. However, understandings of trauma were first premised on the early experiences of American soldiers returning from the Vietnam war in 1975. In part, the trauma experienced by these soldiers was given the label PTSD as a means to depict these soldiers as solely victims of the United States’ military establishment as opposed to individuals who had also perpetrated atrocities. In this case, the PTSD diagnosis legitimised the suffering of Vietnam veterans, and offered short-term relief to their distressing symptoms. Yet, despite the fact that the diagnosis of PTSD was built from the specific experiences of male American veterans, its entry into the DSM-III meant that it became the definition applied to all, irrespective of culture, experience, background, ethnicity, or gender.
The diagnosis of PTSD has spread to all countries subject to Western imperialism. The transition of PTSD from its localised socio-political origins into ‘objective biomedicine’ demonstrates the power of colonial channels and Western ideologies. Temporally specific diagnoses of trauma that emerged during America’s war on Vietnam have been erroneously regarded as universal and context independent, and thus applied worldwide. Suman Fernando—a lead scholar in the correlation between mental health treatment and racism—describes this as an imperialistic process: Western powers “marginalise other ways of knowing, destroy diversity, make alternatives to psychiatry vanish and create monocultures of the mind”.
“Temporally specific diagnoses of trauma that emerged during America’s war on Vietnam have been erroneously regarded as universal and context independent, and thus applied worldwide.”
How do Western conceptions of trauma engender inequality in mental health treatment?
In areas of conflict, Western non-governmental organisations distribute and deploy trained medical staff to deal with the fallout of violence and to treat early trauma signs. However, the deployment of medical staff trained in Western-centred psychiatric medicine in non-Western contexts is self-defeating. The challenge for Western medical staff is attempting to apply a ‘one-size-fits-all’ approach to mental healthcare in individuals with symptoms unexplained or not understood by Western training. In taking such an approach, ownership of what is deemed important in traumatic events is transferred from those experiencing it to Western bodies deemed to know better, those “whose knowledge carries a stamp of authority”. The understanding of Western psychiatry as a globally-applicable science implies that the vast experiences of trauma survivors can be easily reduced into a single mental illness classification of “PTSD”. Thinking of trauma in this regard is simplistic, and invalidates the experiences of trauma survivors.
“ownership of what is deemed important in traumatic events is transferred from those experiencing it to Western bodies deemed to know better”
For example, on the premise of a PTSD diagnosis, many patients receive Western treatments such as counselling or medication, which “offer little in the way of alleviating the underlying causes of collective trauma”. Collective trauma refers to the “psychological reactions to a traumatic event that affects an entire society”. Acknowledgement of collective trauma is vital to validating the stories and emotions of survivors both before and during the traumatic events. By accounting for broader frameworks of “social justice, quality of life, human rights and human security”, a more nuanced understanding of the survivors' responses within the collective memory and experiences of their society can be gained, and adequate treatment provided.
“Western narratives arguably regard sufferers of collective trauma and psychological ill-health as passive bodies in need of treatment, as opposed to survivors with valid experiences.”
Furthermore, emotional distress experienced by survivors is generally hard to empirically measure in the categoric style of Western psychiatry—a limitation further exacerbated by a lack of cultural understanding. Deployed medics’ lack of knowledge or willingness to understand local idioms of distress leads to misdiagnosis and misinterpretation, pathologising of symptoms, and prescribing medication that is in some cases unnecessary and of little effect. Western narratives arguably regard sufferers of collective trauma and psychological ill-health as passive bodies in need of treatment, as opposed to survivors with valid experiences. This narrow understanding shapes and often rewrites the ways in which people view themselves as victims, which can worsen or complicate existing experiences of psychological ill health.
The dominance of Westernised trauma narratives is contingent upon the funding of Western psychiatric research and the value attributed to the Westernised methods, with very little insight into varied cultural understandings of trauma and the local idioms in which they arise. Studies that are academically and financially valued are those which underpin Western institutions’ own understanding of trauma narratives, thereby deepening Western-centric knowledge systems, while simultaneously excluding the experiences, symptoms, and accounts of trauma globally—a symptom of the colonial legacy in scientific research. With many international organisations prioritising Western-centric understandings of psychology, along with research funding being allocated to institutes mainly in the West, culturally sensitive research is excluded from international policies.
“Studies that are academically and financially valued are those which underpin Western institutions’ own understanding of trauma narratives, thereby deepening Western-centric knowledge systems, while simultaneously excluding the experiences, symptoms, and accounts of trauma globally”
For example, in tracing the history of Palestinian mental health diagnosis and treatment, Giacaman et al. emphasise the importance of “separating clinical responses to mental illness from the public health response to mass political violation”. It must be recognised that war and violence is a collective experience. Summerfield states that when witnessing the destruction of their social world, survivors lose embodiments “of their history, identity and living values and roles”. Therefore, to exclude such experiences, and to exclude context-specific socio-political understandings of trauma, can only cause further harm to survivors. The authors emphasise the need for a shift from the individual focus of Western medical indicators to broader global factors in trauma, such as a lack of human security and human rights violations.
In sum, the trend of excluding cultural contexts of trauma sustains global hierarchies. The West and “the rest” mentality reinforces centuries-old colonial structures and channels of power that depend upon stereotypes and generalisations. Such power imbalances result in an inability to reconcile different cultures, widens racial inequalities, and limits access to proper mental healthcare in resource-poor settings.