Don is a 45-year-old, full-blood Indian who is married and has five children. The family lives in a small, rural community on a large reservation in New Mexico. Don was sent to boarding school for high school, and then he served in the war. He recently was treated through Veterans Affairs (VA), which is where he participated in a posttraumatic stress disorder (PTSD) support group. Don suffers from alcoholism. It began soon after his initial patrols in the war, which involved heavy combat and, ultimately, physical injury. He exhibits the hallmark symptoms of PTSD, including flashbacks, nightmares, intrusive thoughts on an almost daily basis, marked hypervigilance, irritability, and avoidant behavior.
Don is fluent in English and his native language, which is spoken in his home. He is the descendant of a family of traditional healers. Consequently, the community expected him to assume a leadership role in its cultural and spiritual life. However, boarding school interrupted his early participation in important aspects of local ceremonial life. His participation was further delayed by military service and then forestalled by his alcoholism. During boarding school, Don was frequently harassed by non-Indian staff members for speaking his native language, for wearing his hair long, and for running away. Afraid of similar ridicule while in the service, he seldom shared his personal background with fellow infantrymen. Don was the target of racism and was called “Chief” and “blanket ass.”
Some 10 years after his return from the war, Don began cycling through several periods of treatment for his alcoholism in tribal residential programs. It was not until one month after he began treatment for his alcoholism at a local VA facility that a provisional diagnosis of PTSD was made. Upon completing that treatment, he transferred to an inpatient unit that specialized in combat-related trauma. Don left the unit against medical advice, sober but still experiencing significant symptoms.
Don’s tribal members frequently refer to PTSD as the “wounded spirit.” His community has long recognized the consequences of being a warrior, and indeed, a ceremony has evolved over many generations to prevent as well as to treat the underlying causes of these symptoms. Within this tribal worldview, combat-related trauma upsets the balance that underpins someone’s personal, physical, mental, emotional, and spiritual health. Don did not participate in these and other tribal ceremonies until after he was diagnosed at the VA with PTSD. His sobriety has been aided by involvement in the Native American Church, with its reinforcement of his decision to remain sober and its support for positive life changes.
Though Don has a great deal of work ahead of him, he feels that he is now ready to participate in the tribe’s major ceremonial intended to bless and purify its warriors. His family, once alienated but now reunited, is excited about that process.
Culture and PTSD examines the applicability of PTSD to other cultural contexts and details local responses to trauma and the extent they vary from PTSD as defined in the American Psychiatric Association’s Diagnostic and Statistical Manual. Investigating responses in Peru, Indonesia, Haiti, and Native American communities as well as among combat veterans, domestic abuse victims, and adolescents, contributors attempt to address whether PTSD symptoms are present and, if so, whether they are a salient part of local responses to trauma. Moreover, the authors explore other important aspects of the local presentation and experience of trauma-related disorder, whether the Western concept of PTSD is known to lay members of society, and how the introduction of PTSD shapes local understandings and the course of trauma-related disorders. By attempting to determine whether treatments developed for those suffering PTSD in American and European contexts are effective in global settings of violence or disaster, Culture and PTSD questions the efficacy of international responses that focus on trauma.
As a result of culture-specific individual and collective meanings linked to trauma and trauma-related disorders survivors may be exposed to (self-)stigma in the aftermath of trauma. Patients who are reluctant to talk about their traumatic experiences may instead be willing to write or use other ways of accessing the painful memories such as drawing. In other cultures, community and family cohesion are crucial elements of recovery. While awareness of culture-specific aspects is important, we also need to beware of premature cultural stereotyping. When disseminating empirically supported psychotherapies for PTSD across cultures, a number of additional challenges need to be taken into account: many low and middle income countries have very limited resources available and suffer from a poor health infrastructure.
Cultural sensitivity is required to successfully treat trauma survivors.
Empirically supported treatments may need to be modified depending on the patient’s cultural background.
In addition to talking, patients may write or use other ways of accessing the traumatic memories such as painting, dancing, or singing.
In low and middle income countries, dissemination of evidence-based treatments is frequently impeded by limited resources and poor health infrastructure.
Beware of cultural stereotyping!
The steps helps to prevent don's alcohol problem are
1)Treatment for co-occurring disorders including PTSD
2)Finding like-minded peer groups for connection
3)Access to spiritual-based treatments like meditation
4)Cognitive behavioral therapy to explore solutions to behavioral challenges
5)Access to therapists to discuss underlying life challenges for alcoholism
6)Treatment for other substances abused with alcohol
7)Access to 12-Step groups
8)Safe detox for expecting mothers struggling with alcohol addiction.
Don is a 45-year-old, full-blood Indian who is married and has five children. The family lives...