Archive for April, 2014

Publication: Review of posttraumatic cultural concepts of distress

Although not every human culture would recognize psychological terms as we use them in North America and Europe, every culture has ways of talking about how individuals feel, and every culture has terms that describe extreme and abnormal versions of these feelings. Cultural concepts of distress are those culturally-specific ways that people from within a given group express their psychological distress. For example, Cambodians talk about a khyal attack” as an experience whereby “wind” that flows naturally through the body (akin to chi in Chinese medicine) is blocked from exiting, causing problems that Western psychologists would call symptoms of panic attack (if you’re at all curious, you really should visit the website dedicated to explaining khyal attack).

A couple of colleagues and I recently published a review in Social Science and Medicine of the symptoms that are included in the various ways that different cultures think about the emotional distress following trauma. Our review included 55 studies and identified 116 different cultural concepts of distress. We categorized these concepts based on their symptoms (using hierarchical cluster analysis), and found that the 116 concepts could be described in four basic categories: (1) somatic dysphoria, which largely concerned bodily complaints; (2) behavioral disturbances, “odd” behavior (relative to cultural norms), (3) anxious dysphoria, which as its name implies included lots of anxiety; and (4) depression, which was surprisingly similar to depression as it appears in North American and European medicine. Notably, none of these groups of concepts looked like the psychological disorder that most mental health professionals in North America and Europe think of when they think about trauma — posttraumatic stress disorder, or PTSD.

Of course there are all sorts of limitations to our review, and some would argue that the way we categorized cultural concepts of distress using symptoms alone misses the point of the diversity of these concepts globally (which is broader concerning explanations for distress than it is concerning symptoms). Others would argue that PTSD is actually somewhere in the mix of concepts we reviewed. I’d like to think our review is a starting point for discussion of these issues, rather than a definitive answer to any of these questions.

You can find a link to the publication in Social Science and Medicine here.

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One million Syrians in Lebanon: A portrait of daily stressors

The one millionth Syrian refugee in Lebanon was registered recently, and the United States’ National Public Radio commemorated the moment with a illuminating profile of life for Syrian refugees in Lebanon. Reporting from Beirut, NPR’s Alice Fordham reports that Syrians are struggling with multiple daily stressors — those stress-inducing events and conditions of varying degrees of severity that result in large negative effects on mental health.

Notably, of this four-minute radio piece it is not until the second half that Ms Fordham refers to trauma as a problem. Of course, for many Syrian refugees trauma and the emotional consequences of trauma are without a doubt a problem — but they are not the only problem. For psychologists and other mental health professionals the (mostly academic) debate surrounding the roll of common stressful events and conditions is still an unsettled question. For displaced persons, there is no debate at all.

In the interest of disclosure, I come to this debate not exactly as a neutral party: Ken Miller and I proposed a model for integrating daily stressors into conflict and post-conflict research a few years ago. For an alternative viewpoint, see the debate that followed.


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