Last year I was lucky enough to attend Katarina Holm-DiDio’s workshop on PTSD, at the Families in Global Transition conference in Amsterdam (I write about it more here). Katarina’s work is extensive and detailed, and you can find more about her and her current work here. She has since been generous enough to send me her thesis on the subject, in which she asks two questions
- How is post traumatic stress is manifested among people from different cultural backgrounds and regions?
- How can therapy and treatment for trauma related stress and PTSD be more culturally sensitive?
I have hesitated in writing this post – procrastinating might be more honest (!) Partly because this is a big topic that has touched many people’s lives, and partly because I would by no means count myself as an expert in it. However, I’m writing about PTSD and TCKs because I keep encountering TCK stories that feature pain and trauma, and I think that Katarina has touched on something that has wide-reaching implications for the TCK world. And this is the kind of something that needs to be heard.
Culture is defined by Katharina as:
“a shared system of meaning expressed through how we live and love, in our values and moral codes, and societal structures. How we define what is typical and healthy is cultural.”
And this is the critical point, that our experiences of trauma will be filtered through our own particular cultural lense. Our understanding of our selves, others and the world around us is influenced by our cultural world, and this in turn impacts on how we express emotional pain, and on how we heal. And this is where an understanding of culture bound syndromes can be helpful.
Culture Bound Syndromes are defined as, “recurrent, locally-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category” (American Psychiatric Association, p. 898). Bear in mind that these are considered ‘other’ simply by virtue of not being American or European. Please also bear in mind that these are not deterministic – just because you originate in these localities does not mean that you will inevitably experiences these syndromes. Katarina goes on to outline specific examples of culture bound syndromes in her work:
Kyol goeu: or othostatic panic, “sudden episode of fainting, when the individual often is unresponsive but conscious” (Boehnlein, 2001)
Mexico, Peurto Rico and other Latin American Cultures
Ataques de nervios: “episode of acute emotional upset”, “it is a cultural variation on a panic attack”
Malaysia, Laos, Philippines, Polynesia, Papua New Guinea and Puerto Rico
Amok: “a dissociative episode when the person initially broods and then explodes into aggressive or homicidal acts towards things and others”
Mexico, Central and South America, some Latinos in the UK
Susto: “soul loss”, “often preceded by a frightening event that results in sadness and being sick”, “low self-worth, dirtiness low motivation and sleep disturbances”, “traditionally healed by rituals where the soul is called back”
Hwa Byuang: “aches and pains, palpitations, anorexia, insomnia, fatigue, panic and fear of one’s death”
Malaysia, Thailand, Japan and the Philippines and some Siberian groups
Latah: “hypersensitive to sudden fright and is characterised by echolalia, being in a trance-like state and a tendency to follow commands”, “tends to be more common in middle-aged women”
Katarina concludes that a “principal question when discussing culture-bound illnesses or syndromes and how they are related to post traumatic stress is how health and illness are understood in different cultures.”
Sounds clear enough, right? Except this: TCKs grow up with multiple and at times conflicting cultural lenses. A British TCK may identify more closely with Mexican or Cambodian culture. A Cambodian may identify more closely with British culture. Will their symptoms of trauma and distress be recognised by their passport countries, when they are originate elsewhere?
When when identifying symptoms of trauma and distress in TCKs, it is not enough to be ‘culturally aware’. It is not enough to understand that a person’s cultural background impacts on experiences of both suffering and healing. Instead, the therapist needs to become fully aware of the hidden, as well as visible elements, of the TCK’s cultural history, moving beyond their current cultural identifications.
The implications of PTSD and its cultural variances are mind-blowing. Third Culture Kids are one group of many that migrate around this beautiful, and messy, globe of ours. And like others, their early cultural exposures and identifications may bear little resemblance to the cultures they move through and settle into in later life. As such, a clear and sensitive understanding of TCK life stories becomes crucial.
Therapists working with TCKs must understand ALL the “systems of meaning” and understandings about what is “typical and healthy” that play into TCKs world-views, so that we may be better positioned to better support their self-views as they move forward towards healing and wholeness.
** Holm-DiDio, K. Cultural Differences in Post Traumatic Stress Disorder Symptoms and Prevalence, Iona College
**Also at FIGT 2016, Amy Jung kindly shared some resources about complex PTSD, something that may be of interest to readers.
Complex PTSD – U.S. Department of Veterans Affairs
Complex post-traumatic stress disorder – Wikipedia