The drawbacks of applying a Western lens to the trauma of South Asian immigrants
This piece is in response to the following essays in the Keppel Health Review for the issue ‘Gradients’: ‘Trauma construction and traumatic events’ and ‘Western conceptions of trauma’.
Content warning: This piece discusses mental illness and racism.
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In the two essays ‘Trauma construction and traumatic events’ and ‘Western conceptions of trauma’ published in ‘Gradients’, the authors discuss the colonisation of mental health. In particular, they argue that the use of a singular definition for post-traumatic stress disorder (PTSD) limits the scope of human suffering through narrow predetermined criteria. The authors’ conceptual framework was one that I wanted to explore in relation to a community that I am a member of. Thus, in response to these essays, I will delve into the definition of PTSD and its inadequacy in understanding the trauma of the South Asian (SA) diaspora, specifically in the United States.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) guidelines for PTSD are based on the experiences of male veterans of the Vietnam War. According to these guidelines, a diagnosis of PTSD requires experiencing or witnessing a traumatic event. However, recent pushes for more “trauma-informed care” widen this definition substantially. When providing trauma-informed care, trauma is understood as stemming from exposure to a single or series of emotionally disturbing events that result in sustained adverse effects. The struggles of the SA immigrant community are more readily understood within this framework. The trauma of the diaspora comes with immigration to a new country and arises from grappling with racism and a variety of other acculturative stressors—none of which would be recognised within the aforementioned PTSD paradigm.
The symptomatology associated with PTSD includes intrusive thoughts, avoidance behaviour, and alterations in cognition and mood. These phrases and descriptions may indeed represent the 'idioms of distress' used in Western culture. Yet they are not necessarily the ways in which other groups, societies, and cultures display their suffering. For example, in many SA communities, common somatic symptoms of distress include chronic pain and fatigue. These are seen as culturally appropriate ways to express depression or anxiety.
Currently, the recommended treatments for PTSD include a variety of talking therapies, such as group or cognitive restructuring, as well as medications, such as antidepressants or anxiolytics. But within the SA community, speaking to an outsider regarding one’s psychological distress is at odds with extant mental health stigma, and compliance with psychotropic medications is often undermined by ambivalence towards Western medicine. Traditional healing and wellness modalities used by this community are not widely recognised by the biomedical field. Yet, there is growing evidence, including a randomised controlled trial by Bessel van der Kolk—a world renowned trauma expert and author of The Body Keeps the Score—that yoga, a SA spiritual and healing practice, is an effective way to address the symptoms of PTSD.
“But within the SA community, speaking to an outsider regarding one’s psychological distress is at odds with extant mental health stigma, and compliance with psychotropic medications is often undermined by ambivalence towards Western medicine”
As clinicians, we are in positions of privilege. We have access to information, resources, and discourse that many of our patients do not. Thus, it is our responsibility to meet them where they are. In the case of an SA immigrant woman suffering from post-traumatic stress, imagine her doctors and therapists recognising that she not only had to overcome American stigma towards mental health, but also barriers unique to SA immigrants in order to initiate care. Imagine her therapists understanding that her trauma may not stem from one single event, but rather from multiple intertwining sources. Let us be so bold as to imagine that her process of healing incorporates the language and practices of her own culture.