War is terrible and it has negative impacts on survivors. In addition to devastation of lives, infrastructure and economies is the anxiety and trauma which are caused by war. Atrocities, torture, disappearances and sexual crimes are intended to cause terror in the population so that they can be controlled and conquered (Summerfield 2000). These terrifying events have impacts on the mental health of the people who experienced them.
Western countries sought to help these populations with projects and programs to support mental health after war. The supports were based on western medicine and concepts with regard to war, trauma and treatment. There is a debate regarding whether PTSD and similar concepts have value in the context of war in non-western, developing nations. Further , there are ideas regarding what appropriate treatments are regarding mental health supports to populations traumatized by war (Paardekooper et. al. 1999).
American veterans returning from wars were the first evidence of specific diagnosis of stress disorders. In the world wars it was referred to as shell shock, and in Vietnam it began to be called post-traumatic stress disorder (PTSD) (Summerfield 2000). Since that time anxiety, depression, PTSD and related stress disorders have become commonplace in the western world. There are many therapies and pharmaceutical remedies intended to help persons with such problems, although there is still considerable research needed to understand and prevent it.
Anxiety and trauma are western concepts, and it is important to better understand whether these constructs are applicable to all cultures. In countries that have been ravaged by war, there is an assumption that the human population may be vulnerable to stress disorders such as violence and PTSD (Paardekooper et. al. 1999).
There has been a lot of discussion about whether PTSD and other concepts in western medicine can be applied to other cultures. On one side are those who have tried to validate western concepts of trauma and treatment, such as PTSD, cross-culturally. On the other side of the debate are those who have argued that PTSD and related trauma disorders are bound in a “cultural and moral framework” (Paardekooper et. al. 1999). Elsass (2001) conducted a qualitative analysis using interviews from his field trips to western South America. The study showed that the concept and diagnosis of PTSD is culture related, specifically with regard to collectivist versus individualist cultures and their expression of trauma after war.
Collectivist culture in Peruvian villages tended to not agree that trauma should be treated with western crisis intervention, and they also did not show the traditional signs of PTSD. Solutions that were sought were at the level of the village rather than the individual. Columbia has a less collectivist culture with more of an emphasis on the individual, in comparison to the Peruvian villages in the study. The reactions of war in this situation were relevant to concerns about shame and feelings of guilt, and the treatment that was sought was for the person experiencing those feelings (Elsass 2001). The concept of trauma differed greatly between collectivist and individualist villages, as did the expression and solutions (Elsass 2001). Jayawickreme and colleagues (2012) decides to test whether western mental health paradigms could capture and predict mental impairment in a non-western population in Northern and Eastern Sri Lanka. Self-reported questionnaires such as those used to diagnose PTSD were not found to be useful in this population in predicting dysfunction (Jayawickreme et al 2012).
Summerfield (2000) reported that there were about 1% of the world that were refugees or displaced, and 8 out of 10 were in developing countries. This is where many of the wars occurred, often over limited resources. According to this report, “There is no such thing as a universal response to highly stressful events” (Summerfield 2000). Further Summerfield saw PTSD and trauma concepts as a distorted reframing of natural distress as being psychological disturbed as a serious error. The solution, according to Summerfield, was recognizing that individual recovery in war torn regions required social recovery, as without the social recovery there were continued stressors and triggers of trauma. Knowledge and discussion of rights and social justice was part of that healing process. Clinical based samples from western medicine must be used with care in such a different context (Summerfield 2000).
Paardekooper and fellow researchers (1999) felt that war-trauma and PTSD was culturally constructed, and they stated that anthropological theories and perspectives were needed to ensure healing from the traumas of war across cultures. The World Health Organization (2013) has paid attention to such criticism, and it does not use the western clinical construct of mental health based on symptoms. Rather, it uses a holistic approach, that defines mental health as the capacity to functions social and a state of well-being (World Health Organization 2013). Western medicine and diagnostic concepts may be part of the answer; however more culturally relevant interpretations of trauma and its expression are necessary.
Elsass, P. (2001). Individual and collective traumatic memories: A qualitative study of post-traumatic stress disorder symptoms in two Latin American localities. Transcultural Psychiatry, 38(3), 306-316.
Jayawickreme, N., Jayawickreme, E., Atanasov, P., Goonasekera, M. A., & Foa, E. B. (2012). Are culturally specific measures of trauma-related anxiety and depression needed? The case of Sri Lanka. Psychological assessment,24(4), 791.
Paardekooper, B., De Jong, J. T. V. M., & Hermanns, J. M. A. (1999). The psychological impact of war and the refugee situation on South Sudanese children in refugee camps in Northern Uganda: an exploratory study. Journal of child Psychology and Psychiatry, 40(04), 529-536.
Summerfield, D. (2000). Conflict and health: War and mental health: A brief overview. BMJ: British Medical Journal, 321(7255), 232.
World Health Organisation (2013). “Mental Health: A state of wellbeing”. Retrieved from: http://www.who.int/features/factfiles/mental_health/en/