Literature Review

3

Chapter 1 The Lens of Culture: Theoretical

and Conceptual Perspectives in the Assessment of Psychological

Trauma and PTSD

John P. Wilson

INTRODUCTION

The relationship between trauma and culture is an important one because traumatic experiences are part of the life cycle, universal in manifestation and occurrence, and typically demand a response from culture in terms of healing, treatment, interventions, counseling, and medical care. To under- stand the relationship between trauma and culture requires a “big picture” overview of both concepts (Marsella & White, 1989). What are the dimen- sions of psychological trauma and what are the dimensions of cultural systems as they govern patterns of daily living? How do cultures create social–psychological mechanisms to assist its members who have suffered significant traumatic events?

Empirical research has shown that there are different typologies of traumatic experiences (e.g., natural disasters, warfare, ethnic cleansing, childhood abuse, domestic violence, terrorism, etc.) that contain specific stressors (e.g., physical or psychological injuries) that tax coping resources, challenge personality dynamics (e.g., ego strength, personal identity, self- dimensions), and the capacity for normal developmental growth (Green, 1993; Wilson, 2005; Wilson & Lindy, 1994). Traumatic life events can be simple or complex in nature and result in simple or complex forms of post- traumatic adaptation (Wilson, 1989, 2005). Similarly, cultures can be simple or complex in nature with different roles, social structures, authority sys- tems, and mechanisms for dealing with individual and collective forms of trauma. For example, dealing with an accidental death of one person is

significantly different from coping with the aftermath of the worst tsunami disaster in the history of humankind (2004) that caused massive death of thousands, destruction of the environment and the infrastructure of cultures. In this regard, it is important to understand how cultures utilize different mechanisms to assist those injured by different forms of extreme stress experiences. The injuries generated by trauma include the full spec- trum of physical and psychological injuries. In terms of mental health and counseling interventions, this includes a broad range of posttraumatic adaptations that include posttraumatic stress disorder (PTSD), mood dis- orders (e.g., major depression), anxiety disorders, dissociative phenomena (Spiegel, 1994), and substance use disorders. In terms of mental health care, cultures provide many alternative pathways to healing and integra- tion of extreme stress experiences which can be provided by shamans, medicine men and women, traditional healers, culture-specific rituals, conventional medical practices, and community-based practices that offer forms of social and emotional support for the person suffering the adverse, maladaptive aspects of a trauma (Moodley & West, 2005). But how does culture influence an individual’s reaction to trauma? How do they make sense of their experiences in situations of extreme stress? In this regard, Smith, Lin, and Mendoza (1993) state: “Humans in general have an inher- ent need to make sense out of and explain their experiences. This is espe- cially true when they are experiencing suffering and illness. In the process of this quest for meaning, culturally shaped beliefs play a vital role in determining whether a particular explanation and associated treatment plan will make sense to the patient . . . Numerous studies in medical anthropology have documented that indigenous systems of health beliefs and practices persist and may even flourish in all societies after exposure to modern Western medicine . . . These beliefs and practices exert profound influences in patients’ attitudes and behavior . . .” (p. 38).

CASE HISTORY

To illustrate how culture shapes belief systems and influences the percep- tion of traumatic events and their subsequent processing and integration into cognitive structure of meaning and attribution, let us consider the following case example.

In 1985 I attended an intertribal “pow wow” on the Lakota Sioux Indian reservation in South Dakota (Sisseton-Whapeton). The pow wow was a 4-day event for Vietnam War veterans and their families. The event contained Native American ceremonies and rituals to honor the veterans for their military service and sacrifices. These ceremonies included sweat lodge purification (Lakota Warrior “sweat” for healing), the Red Feather induction ceremony, traditional communal singing and dancing, potlatch

4 John P. Wilson

sharing of gifts, and ceremonial fires with “talking circles” and communal dinner with the eating of traditional foods.

During this pow wow, I had the opportunity to meet several Lakota Sioux Vietnam combat veterans. Among them was a veteran whom I will refer to as Tommy Roundtree (not his real name). Tommy was a two-tour combat veteran who had been highly decorated for his valor and courage in combat with the 101st Airborne Brigade between 1967 and 1969. Tommy grew up on the Rosebud reservation of the Sioux Nation in South Dakota. He was an athletic, tall, handsome man with black hair and ruddy dark skin. In many respects, he had a “Hollywood” character that resembled the famous actor, Erroll Flynn.

When I met Tommy, he was dressed in traditional tribal clothing and had his face painted. Visibly noticeable were the scars on his chest and back from when he had participated in Sun Dance ceremonies in which the participants were skewered with straps to a pole located in the center of a pow wow arena. The straps are skewered into pectoral and upper back muscles by small bones or sticks. At the climax of the Sun Dance ceremony, which involves dancing and blowing through a small bone, the celebrant, at the critical time, leans back and releases himself from the straps which link him to the pole. The skewers tear the skin and cause bleeding. The Sun Dance ceremony is a physically arduous process and requires stamina, mental concentration and preparation, including a Sweat Lodge purification prior to the actual Sun Dance itself. In tradi- tional ways, it is thought that the ritual aids in the development of spiri- tual strength. When I observed Tommy’s scars, he immediately told me that he had done three Sun Dances during his life, two prior to deploy- ment to Vietnam. I told him that I had read about the ceremony and others that were part of Lakota culture. It was at this point that he said, “You know, John, I would like to talk with you about my Vietnam War experi- ences, but I am afraid that you will think I am crazy or psychotic if I tell you how I understand what happened to me there and since coming home from the war.” I responded that I have great respect for traditional Native American culture, especially Lakotan, and would like to hear his story. He smiled nervously at me as I looked at him straight in the eyes and said, “Well, okay, let’s talk.”

We found a quiet spot in the pow wow grounds and began to talk. In the background, the pulsating beat of the tom-tom drums could be heard along with the singing of traditional songs. Tommy explained that prior to his deployment to Vietnam, the tribal elders prepared him in various ways for going to war. He was taught to sing his “death song” if fatally wounded. He was instructed as to how to use his native cosmology and nat- ural connection to the earth and its creatures to help him stay alert and knowledgeable about danger and threats. Tommy said, “In Vietnam, I would ask the insects to be my eyes while I slept to look for the enemy;

The Lens of Culture 5

I asked the trees to signal me if the enemy is creeping towards me.” He continued by saying that during active combat with his M-16 automatic rifle, he would sometimes see a blue protective shield surrounding him that deflected enemy bullets away. Tommy said that other times during combat he could hear his grandmother speaking to him, saying not to worry and that he was going to live and be free from injuries or death. He added that his grandmother’s voice told him that if he did get shot, to sing his “death song” so that ancestral spirits would be with him to join him and provide care and assistance to the other world (heaven).

Tommy asked me if I thought he was psychotic or delusional. I replied that I did not believe that he was “crazy” or psychotic. However, I asked him how he dealt with his war trauma after coming home from Vietnam. Tommy said, “John, I will show you our way of healing” and arranged for me to participate in a Lakota Sweat Lodge with a sacred pipe carrier of the Sioux Nation. He also arranged for me to observe and participate in sev- eral other rituals and ceremonies for healing and well-being. Afterward, he explained to me that his perspective of the Vietnam War was different from that of the white Anglo-American culture that he volunteered for military service to honor agreements his ancestral grandfathers made about fight- ing for their “land and way of life.” He continued by saying that by keep- ing to the traditional ways, abstaining from alcohol, and working to help others who had adverse residual traumatic war injuries, he could live with harmony and balance in all his affairs in life. This he explained, was the Lakota way, the great circle of life.

THE MYTHOLOGY OF THE HERO, TRAUMATIC ENCOUNTERS, AND PERSONAL TRANSFORMATION

The mythologist Campbell (1949, 1991) researched the universality of myths in many of the world’s literature, including the myth of “the Hero” who journeyed into “zones of danger” only to emerge transformed in mind, body, and spirit. Figure 1 presents an illustration of this important myth which includes personal encounters of trauma, disaster, and war. In brief the core elements of the Hero and trauma survivor’s journey include:

! A life journey that can begin at any point in life-cycle development ! The encounter with trauma, loss, bereavement, and disaster ! The entry and exit from a zone of danger with powerful or super-

natural forces ! The four tests of the human spirit ! Trauma and the great cycle of living and dying ! The return of the Hero and the task of transformation upon re-entry

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As discussed by Campbell (1991), the mythology of the Hero concerns the travails of ordinary people through extraordinary experiences. In some cases, the myths characterize the life journey, beginning with youthful innocence and naiveté and the eventual encounter with powerful forces of seemingly insurmountable proportions. There are many variations on the themes of this myth and how the individual is transformed by the nature of his or her experience. For example, young men become war- hardened combat veterans; the apprentice shaman enters the “under- world” of spiritual entities; the knight of the king’s realm challenges dragon beasts and the search for sacred, lost objects that have secret powers. The mythological journey of the Hero is also the journey and psy- chological sequela of the trauma survivor. They both encounter dark, sin- ister, life-threatening forces and then cross a threshold to re-enter normal life and society. The power of life-threatening dark forces constitutes the nature of the Abyss Experience (Wilson, 2005). During the Abyss Experience, the individual confronts the specter of death, extreme threats, and overwhelming immersion into traumatic stressors. Upon re-entry into society after the Abyss Experience, the survivor faces the task of transformation and the psychic metabolism of these experiences. As part of this process, the mythical Hero is assisted by “helper guides” who take the form of wise old men, a spirit guide, a deceased elder relative, an

The Lens of Culture 7

Transformation and Self-Reconfiguration of Life-Journey

Life Journey

Threshold Journey of Hero (Traumatic Encounter)

Continuation of Journey Across

Threshold

Return to Society

and Re-Entry

Abyss Experience

Nurturing Aid

Zone of Danger (Trauma) Tests &

Challenges to Self, Spirit &

Life Itself

Overcoming Danger to Self & Spiritual Journey

Helpers Wise Man

World Spirit Godmother

Angel Spirit with Above Higher Power

“Tokens” / Tools Provided by Helpers

• No Reception • Seek

Approval • Develop Self

and Teach Others Lessons from Journey

• Images to Guide • Images to Meditate • Mudras – Postures of

Hand or Body • Mantras – Words or

Charts to Think on • 12 - Step Program to

Follow

Figure 1. Mythology and the journey of the Hero: the Abyss Experience and transformation of psychic trauma (Source: © Wilson, 2005)

angelic person or another person who has had a similar experience (e.g., a recovering addict, war veteran, etc.).

After the Abyss Experience, the trauma survivor (Hero) faces the arduous and painful task of re-entry where he or she is met with addi- tional stressors and psychic burdens. Contrary to expectation, the hero or survivor does not receive a warm welcome from those left behind. Campbell (1991) notes that there are three prototypical patterns: (1) no reception; (2) the search for approval, validation, and confirmation of one’s journey, travails, and suffering; and (3) the need to share his or her story of survival and teach others in generative ways (Campbell, 1991).

Upon re-entry into the culture of origin, the trauma survivor, like mythical Hero, encounters some or all of the following reactions to his or her journey and life-transforming experiences:

! The absence of recognition of the true nature of suffering, sacrifice, and survival

! The absence of recognition of the perils endured ! The absence of appreciation for personal injuries and changes ! The absence of treatments, health care, or opportunities to engage

in traditional healing rituals ! The emergent realization that meaning must be created out of the

traumatic experience

According to Campbell (1991), mythology suggests that the heroic sur- vivor seeks to find pathways to healing. Thus, we can identify six conse- quences of healing pathways within the diversity of culture: (1) restore harmony in mind, body, and spirit; (2) restore vital physical and mental energy; (3) promote well-being through mindfulness and psychic integra- tion; (4) empower personal energy for life-course development; (5) access and utilize treatments available in the culture; and (6) develop healing practices that promote resilience.

TRAUMA, CULTURE, AND POSTTRAUMATIC SYNDROMES: THE CORE QUESTIONS

The concept of traumatic stress and the multidimensional nature of cul- tures requires a conceptual framework by which to address core issues that have direct relevance to understanding the nature of trauma as embedded within a culture and its assumptive systems of belief and pat- terns of behavioral regulation. Marsella (2005) has noted that healing sub- cultures have at least five distinct elements: “(1) a set of assumptions about the nature and causes of problems specific to their world view and construction of reality; (2) a set of assumptions about the context, settings, and requirements for healing to occur; (3) a set of assumptions and

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procedures to elicit particular expectations, emotions, and behaviors; (4) a set of requirements for activity and participation levels and/or roles for patient, family, and therapist; and (5) specific requirements for therapist training and skills expertise criteria” (p. 3). These sets of assumptions are useful as they define a necessary conceptual matrix for examining how different cultures handle psychopathology, behavioral disorders, and complex posttraumatic syndromes. To be clear, I am not using the term posttraumatic syndrome as synonymous with PTSD, although it certainly includes the narrow, diagnostic definition of the disorder. Rather, post- traumatic syndromes involve a broad array of phenomena that include Trauma Complexes, Trauma Archetypes, posttraumatic self-disorders (Parsons, 1988), posttraumatic alterations in core personality processes (e.g., five-factor model), identity alterations (e.g., identity confusion), and alterations in systems of morality, beliefs, attitudes, ideology, and values (Wilson, 2005). The experience of psychological trauma can have differ- ential effects to personality, self and developmental processes, including the epigenesis of identity within culturally shaped parameters (Wilson). Given the capacity of traumatic events to impact adaptive functioning, including the inner and outer worlds of psychic activity (Wilson, 2004a), it is critically important to look beyond simple diagnostic criteria such as PTSD (Summerfield, 1999) to identify both pathogenic and salutogenic outcomes as individuals cope with the effects of trauma in their lives. As I have argued elsewhere (Wilson, 2005), the history of scientific research on PTSD is badly skewed (perhaps for reasons of historical necessity) toward the study of psychopathology rather than on human growth, self- transformation, resilience, and optimal functioning.

When we address the question of how individual cultures deal with psychological trauma in its diverse forms, it is useful to examine com- monalities and differences among approaches to counseling, healing, psy- chotherapies, treatments, and traditional practices. If traumatic stress is universal in its psychobiological effects (Friedman, 2000; Wilson, Friedman, & Lindy, 2001), are therapeutic interventions, in turn, designed in culture-specific ways to ameliorate the maladaptive consequences of dysregulated systems of affect, cognition, and coping efforts (Marsella, Friedman, Gerrity, & Scurfield, 1996; Wilson, 2005; Wilson & Drozdek, 2004)? If so, what are the differences in therapeutic approaches to dealing with trauma? To answer this question further examination of the core questions pertaining to culture and the patterns of posttraumatic adaptation is required.

Table 1 presents 21 core questions concerning the relation of culture to traumatic life experiences. These core issues serve to frame the later discussion about the commonalities and differences in cul- ture-specific and transcultural approaches to counseling and mental health care.

The Lens of Culture 9

10 John P. Wilson

Table 1. Core Questions for Understanding Culture, Trauma, and Posttraumatic Syndromes

1. Is the experience of psychobiological trauma the same in all cultures?

2. Are the emotional reactions to trauma the same in all cultures?

3. Is the psychobiology of trauma the same in all cultures?

4. Does culture act as a filter for psychic trauma? If so, how do internalized beliefs, culturally shaped patterns of coping and adaptation govern the posttraumatic processing of traumatic experiences?

5. Are traumatic experiences universal in nature across cultures? Are traumatic experi- ences archetypal for the specter?

6. If trauma is archetypal for humankind, what are the universal characteristics across all cultures?

7. Does culture determine how individuals respond to archetypal forms of trauma? Are posttraumatic syndromes and Trauma Complexes culture specific in nature?

8. Are there cultural-based syndromes (not necessarily PTSD) of posttraumatic adapta- tion? If yes, what do they look like? What is their psychological status?

9. How do cultures develop rituals, medical–psychological treatments, religious prac- tices, and other institutionalized mechanisms to assist persons who experience psychic trauma?

10. Are there culture-specific and universal mechanisms to help persons recover from trauma?

11. What does cultural mythology tell us about the experience of trauma?

12. What are the great myths in cultural literature that concern individual and collective trauma?

13. What are the psychological and cultural functions of mythology? How do they relate to the cross-cultural understanding of trauma?

14. What is the Abyss Experience in mythology and how does it relate to the psychologi- cal study of trauma?

15. What does mythology tell us about culture-specific rituals of psychic trauma?

16. How do forms of traumatic experiences relate to the universal myth of the Hero as protagonist?

17. How does modern psychology standardize the assessment and treatment of trauma across cultural boundaries?

18. Do pharmacological treatments of posttraumatic syndromes work equally well in all cultures?

19. Is the unconscious manifestation of posttraumatic states the same in all cultures?

20. What are the mythological images of the life cycle and the transformation of consciousness by trauma?

21. What cultural belief systems underlie cultural approaches to healing and recovery from trauma?

Source: Wilson, 2005.

1. Is the experience of psychological trauma the same in all cultures? This question addresses the issues of how cultural belief systems influ- ence the perception and processing of trauma. For example, Kinsie (1988, 1993) noted that among Cambodian refugees who had suffered multiple life-threatening trauma during the Khmer Rouge regime, many who suffered from PTSD and depression understood their symptoms in the light of their Buddhist beliefs in karma as a station in life, an incarnate level of being and fate. Hence, Western psychiatric views of suffering and depression may not exist within a Buddhist ideology per se. Personal suffering may be seen from a religious–cosmological perspective of the meaning of life. If a culture does not have linguistic connotations of a pathogenic nature (e.g., PTSD), how then does the person con- strue acute or prolonged effects of extreme stress experiences? In a discussion of depression and Buddhism in Sri Lanka, Obeyesekere (1985) stated: “How is the Western diagnostic term depression expressed in society whose predominant ideology of Buddhism states that life is suffering and sorrow, that the cause of sorrow is attachment or desire or craving, that there is a way (generally through meditation) of understanding and overcoming suffering and achieving the final goal of cessation from suffering or nir- vana?” (p. 134). Hence, sorrow, suffering, depressive symptoms, traumatic memories, disruptions in sleep patterns, and other trauma-related symptoms will likely be construed in a similar manner, especially since depression is a component of PTSD (Breslau, 1999).

2. Are the emotional reactions to psychological trauma the same in all cultures? Scientific evidence, especially neurobiological studies, has documented that affect dysregulation, right hemisphere alterations in brain functioning, and strong kindling phenomena are universal in PTSD (Friedman, 2000; Schore, 2003). If there is a common set of psychobiological changes associated with either PTSD or prolonged stress reactions, is the emotional experience universal in nature (e.g., hyperarousal, startle, anger, irritability, depressive reactions) or do cultural belief systems “override” or atten- uate the magnitude or severity and intensity of dysregulated emo- tional states?

3. Is the psychobiology of trauma the same in all cultures? This question is similar to the one above. If extreme stress impacts the human organism in the same manner irrespective of culture, does the organism react in exactly the same way? Or, do cultural belief sys- tems act as perceptual filters to the cognitive appraisal and inter- pretation of traumatic stressors? For example, in the 1988 Yunnan earthquake in a rural, peasant area of China, over 400,000 people

The Lens of Culture 11

were impacted by the event which had not been previously expe- rienced by most inhabitants. However, among the common expla- nations for the earthquake was that a great dragon was moving beneath the earth because he was angry with the people (McFarlane & Hua, 1993). Does such a mythical attribution influ- ence the subsequent psychobiological responses to the disaster once it terminates? What if the dragon returns to his “rest” and “sleep”?

4. Does culture (i.e., cognitive–affective belief systems) act as a filter for psychic trauma? If so, how do internalized belief system, culturally shaped patterns coping and adaptation govern the posttraumatic process- ing of traumatic experiences? This question goes to the heart of the culture – trauma relationship. First, how does a culture define trauma? Is a trauma in one culture (e.g., natural disaster, incestu- ous relations, traffic deaths, political oppression, motor vehicle accidents, murder, etc.) necessarily viewed as a trauma in another culture? Second, what sets of expectations for resiliency in coping does the culture possess? For example, after the July 2005 terrorist bombings to transit systems in London, the general media and political leaders noted that the British people immediately returned to work the next day, rode the buses and subways, and manifest high levels of resilience. The Prime Minister, Tony Blair, made ref- erence to how British resolve was evident during the bombing raids in WWII and that in 2005 such resilient resolve was once again transparent. Is this a cultural norm or expectation? How do cultural beliefs and values influence the postevent processing and cognitive interpretation of the traumatic stressor itself?

5. Are traumatic experiences universal in nature across cultures? Are trau- matic experiences archetypal for the species? Research on PTSD has identified categories and typologies of traumatic life events and the specific stressors they contain (Green, 1993; Wilson & Lindy, 1994). While there is agreement on the nature and types of trau- matic events, a more fundamental question is whether or not they are archetypal in nature. Elsewhere, I have discussed the unique nature of Trauma Archetypes and Trauma Complexes (Wilson, 2004a, 2005) and suggested that the experience of trauma is both universal and archetypal for the human species. However, culture shapes the way that individuals form Trauma Complexes after a traumatic experience and, once formed, articulate with other psychic complexities.

6. If trauma is archetypal for humankind, what are the universal character- istics across all cultures? This question is a corollary to the one above. Given that traumatic experiences are archetypal for the species what are the defining characteristics of the Trauma

12 John P. Wilson

Archetype? I have delineated 12 dimensions (see Table 3) of the Trauma Archetype and how they influence posttraumatic person- ality dynamics and adaptive behavior (Wilson, 2005).

7. Does culture determine (i.e., shape, influence, design) how individuals respond to archetypal forms of trauma? Are posttraumatic syndromes and Trauma Complexes culture specific in nature? Culture serves as a powerful socializing force, creating and shaping beliefs and regu- lating patterns of behavior and adaptation. For example, among many Native American people a “good world” is one defined by harmony and balance in “all things” and “all relations” in the environment and amongst people (Mails, 1991). Illness is thought to result from imbalance, loss of harmony, and being dispirited within oneself due to a loss of vital connectedness. Among some aboriginal native people, trauma is simply defined as that which causes one to lose balance in living with positive relations with nature and the human-made world. Moreover, within this cos- mology, it was well known that certain events, such as warfare, could cause profoundly altered states of well being (i.e., dispirit- edness) and necessitated healing rituals for the restoration of wholeness (Wilson, 1989, 2005).

8. Are there cultural-based syndromes (cf. not necessarily PTSD) of post- traumatic adaptation? If yes, what do they look like? What is their psy- chological structure? This core issue is among the most fascinating to consider and interesting to conceptualize since there may be unique ways that posttraumatic adaptations occur within a cul- ture or subculture (e.g., trance states, dissociative phenomena, somatic illnesses, mythical attributions, etc.). How does culture provide awareness for posttraumatic syndromes to exist and be expressed? Are these forms of adaptation pathogenic or saluto- genic in nature (Marsella, 1982)? What are the implications of culture-specific posttraumatic adaptations for culture-specific interventions?

9. How do cultures develop rituals, medical–psychological treatments, reli- gious practices, and other forms of institutionalized mechanisms to assist persons who experience psychological trauma? This question attempts to identify the specific ways that cultures evolve and develop institutionalized and noninstitutionalized mechanisms and treat- ments for victims of trauma. This question is of significant research interest as it defines the areas in which commonalities overlap and in which culture-specific differences exist. As I will discuss later, it is my belief that each person’s posttraumatic syndrome is a variation on a culturally sanctioned modality of adaptation which can then be “treated” by either generic or culturally specific practices.

The Lens of Culture 13

10. Are there culture-specific and universal mechanisms to help persons recover from psychological trauma? How have cultures evolved spe- cific rituals, treatments, or ceremonies to facilitate recovery from psychic trauma? For example, most Native American nations use the Sweat Lodge Purification Ceremony to “treat” states of dispiritedness, mental illness, alcohol abuse, depression as well as to instill spiritual strength (Wilson, 1989). The Sweat Lodge purifi- cation ritual has a unique structure and process and is embedded within the traditional cosmology of a tribe (e.g., Lakota Sioux). Under the guidance of a trained and experienced medicine person, the Sweat Lodge is used to restore “balance” through purification, sweating, and emotional catharsis (Mails, 1991; Wilson, 1989). This is just one example of many that exist among and between cul- tures to facilitate “stress reduction” and to alleviate suffering, including prolonged stress reactions after traumatic life events.

11. What does cultural mythology tell us about the experience of trauma? The discovery of how cultures deal with trauma can be found in the great mythologies of the world (Campbell, 1949, 1992). Mythology con- tains themes which converge across cultures, literary forms (e.g., epochs), and style. While it is the case that modern science, especially in the study of PTSD, has generated an impressive body of knowl- edge, it lacks carefully crafted cross-cultural studies of trauma, heal- ing, and human adaptation (Wilson, 2005). However, from the pre-Greeks to the middle ages to our present time, the great mytholo- gies of the world have chronicled the trials and tribulations of simple, ordinary, “heroic” figures and their individual journey which present profound challenges to life, spirit, body, and human integrity. Joseph Campbell’s (1949) study of mythology has identified universal themes of the heroic figure whose journey of self-transformation in the life cycle is also about the universal stories of the trauma sur- vivors. Analysis of the great mythologies is a rich source of inquiry as to the interplay between culture, traumatic events, and their trans- formation by facing challenges to existence itself.

12. What are the great myths in cultural literature that concern individuals and collective trauma? There are many great mythologies in cultures throughout the world (Campbell, 1991). The Great Mythologies are themes and stories about the human condition: adversity, jealousy, confrontation with powerful “zones of danger,” the prospect of death, the process of individual transformation by confrontation with unconscious and external forces, and the difficult task of re- entry into society after an adverse journey into the abyss of trauma (Wilson, 2005). Analysis of these myths thus illuminates the arche- typal nature of trauma and the challenges it sets up for human development, healing, and the maintenance of personal integrity.

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13. What are the psychological and cultural functions of mythology? How do they relate to the cross-cultural understanding of trauma? In his book, Pathways to Bliss (1992), Joseph Campbell outlines the four func- tions of mythology as (a) spiritual–mystical; (b) cosmological; (c) sociological; and (d) psychological. Each of these functions is revealed within mythology and has direct parallels to the nature of psychological requirements in dealing with the impact of trauma to self and psychological functioning. For example, trauma and traumatic life experiences form a reconciliation with unconscious- ness and the meaning of life. This issue concerns directly the mythology of one’s own life and the role trauma has played in it. For example, novels and autobiographies of war trauma of former combat soldiers typically characterize the horrific encounter with death, the existential questioning of the purpose of war and how such experiences subsequently shape life-course trajectory (Caputo, 1980). Traumatic experiences often force a self-effacing look at personal identity and consciousness. Trauma serves to put the individual in touch with their unconscious processes, includ- ing the disavowed, dark or “shadowy” side of personality. By carefully analyzing the functions of mythology within a culture we can identify how it is that culture shapes posttraumatic adap- tation, growth, and the challenges of self-transformation.

14. What is the abyss experience in mythology and how does it relate to the psychological study of trauma? The Abyss Experience is a term I have coined to describe the “black hole” of psychological trauma – a vast chasm of dark, empty space in which terror and fear of annihilation exist (Wilson, 2004a, 2005). There are five dimensions of the Abyss Experience which include: (1) the confrontation with evil and death; (2) the experience of soul death with nonbeing; (3) a sense of abandonment by humanity; (4) ultimate loneliness and despair; and (5) cosmic challenge of meaning. For each of these five dimen- sions there are corresponding posttraumatic phenomena: (i) the trauma experience; (ii) self/identity; (iii) loss of connection; (iv) sep- aration and isolation; and (v) spirituality and numinous sense. In the mythology of culture, these themes and aspects of the Abyss Experiences are always present and yet played out within the unique tapestry of a particular culture.

15. What does mythology tell us about culture-specific rituals for psychologi- cal trauma? The awareness of the Abyss Experience and the zones of danger through which the mythical hero figure traverses suggest that upon return to society from the zone of danger (i.e., trauma) the individual crosses a threshold of re-entry that often includes being ignored or rejected because of the overwhelming and often horrifying nature of his experience. Mythology suggests

The Lens of Culture 15

that there may exist a “guide” or nurturant person, who helps a “cast light” as to the meaning of the traumatic experience and clues as to how to recover and integrate the experience without prolonged suffering or maladaptive avoidance behaviors (e.g., excessive drinking, alienation, anomie, emotional detachment, and numbing). It can be seen that culture has to have built-in wis- dom as to the pathways to healing and the literature of mythology describes the nature and character of these life pathways.

16. How do forms of traumatic experiences relate to the universal myth of the hero as protagonist? The mythical hero traverses a journey and encounters powerful forces (e.g., trauma) which challenge mind, spirit, body, and sense of personhood. The travails of the protago- nist are universal images of how psychic trauma creates hurdles in the process of living and finding meaning in life.

17. What are the mythological images of the life cycle and the transformation of consciousness by trauma? In mythology, the challenges of trauma can occur anywhere in the life span, from infancy to old age. However, no matter where trauma occurs in epigenetic develop- ment, it can influence the configuration of ego identity and trans- form personal consciousness about oneself, others, the meaning of death and the task of self-transformation. Elsewhere, I have described in detail the process of traumatogenic experiences with an ontogenetic framework of self-metamorphosis (Wilson, 2005). Understanding mythological and epigenetic frameworks of how trauma alters the trajectory of the life cycle has important implica- tions for counseling and psychotherapy.

18. How does modern psychology standardize the assessment and treatment of trauma across cultural boundaries? This is a core issue in terms of the “globalization” of knowledge about the relation of trauma to cul- ture. At present, we have no standardized ethic (universal) meas- urements of trauma and PTSD (Dana, 2005). Similarly, we do not have standardized cross-cultural treatment protocols for persons suffering from posttraumatic syndromes. There exist empirical and clinical voids in the knowledge base as to what “treatments” work best for what kinds of person and under what set of circumstances.

19. Do pharmacological treatments of posttraumatic syndromes work equally well in all cultures? This question is intriguing because it posts the controversy as to whether or not the psychobiology of trauma is the same across cultures and therefore treatable by pharmacologi- cal agents designed to stabilize the dysregulation in neurobiological functioning caused by extreme stress experiences. However, to date, there are a few comparative randomized clinical trials (RCT) of medications to treat PTSD in culturally diverse populations (Friedman, 2001). Yet, studies have shown that some antidepressant

16 John P. Wilson

medications are more efficacious in symptom reduction than oth- ers for non-Western populations with severe PTSD (Kinsie, 1988; Lin, Poland, Anderson, & Lesser, 1996).

20. Is the unconscious manifestation of posttraumatic states the same across cultural boundaries? This core question is complex and fascinating because it demands a method to assess unconscious processes cross-culturally (Dana, 1999) and to discern if unconscious mem- ory encodes traumatic experiences in similar ways, perhaps in Trauma Complexes that are, in turn, shaped by cultural factors (Wilson, 2005).

21. What conceptual belief systems underlie cultural approaches to healing and recovery from trauma? In many respects, this issue deals with the most “pure” consideration of the trauma–culture relationship. How does the culture view “trauma” and employ methods to facilitate healthy forms of posttraumatic adaptation? What set of assumptive beliefs does the culture “bring” to the understanding of trauma? Within a culture, is trauma idiosyncratic or synergistic in nature? Are there differences between individual and cultural trauma? What does damage to the structure of a culture mean in terms of posttraumatic interventions? For example, Erikson (1950) noted that among the Lakota Sioux Indians in the United States, the loss of their nomadic mystical culture oriented around the Buffalo meant a loss of historical continuity and collective identity which was profoundly traumatic once the Lakota were interned on federal reservation lands that deprived them of their cherished patterns of living (Wilson, 2005).

CULTURE AND TREATMENT FOR POSTTRAUMATIC SYNDROMES

The ubiquity of traumatic events throughout the world has raised global awareness of PTSD as an important psychological condition that results from a broad range of traumatic experiences (e.g., war, ethnic cleansings, terrorism, tsunamis, catastrophic earthquakes, etc.). Economic globaliza- tion has “flattened the world” (Friedman, 2005) as technologies have changed the face of commerce and international marketplace. In a real sense, globalization has generated trends toward the homogenization of cultures and at the same time heightened awareness of distinct cultural differences. However, when it comes to the issue of cultural differences and posttraumatic syndromes (e.g., PTSD) it cannot automatically be assumed that advances in Western psychotherapeutic techniques can be exported and applied to non-Western cultures (Summerfield, 1999). Further, the literature on cultural competence has brought awareness of

The Lens of Culture 17

the need for knowledge, sensitivity, and innovation when it comes to mental health treatment in non-Western cultures (White & Marsella, 1989). More recently, Moodley and West (2005) discussed the limitations of verbal therapies and presented a rationale for the integration of traditional healing practices into counseling and psychotherapy. While a discussion of the types of traditional healing practices (e.g., shamanism, medicine healing in aboriginal nations) is beyond the scope of this article, it is worthwhile to point out that there are culture-specific healing practices as well as overlaps in conceptual viewpoints about the assumptions that underlie traditional healing practices across different cultural groups. Let us consider for a moment four very different cultural views of healing: Native American; African (Zulu); Indian (Ayurveda), and traditional Chinese medicine (TCM) (Table 2). What do these Western, African, and Asian cultures assume about traditional healing and the cosmological (cf. one could also say mythological) assumptions they hold about physical and mental health?

Native American

In most North American aboriginal nations, healing is considered from the perspective of relations – balanced relations – between individuals and environment and the world at large (Mails, 1991). When sickness occurs it is generally assumed that there is an imbalance in the nature of “relations to all things” – that a loss of balance and harmony has occurred within the person and illness follows. Healing, then, is the empowerment

18 John P. Wilson

Table 2. Cultural Convergence: Similar Principles?

Native African Indian Chinese Principle/Assumption American (Zulu) (Ayurveda) (TCM)

1. Harmony in relations Yes Yes Yes Yes (earth, people, society)

2. Vulnerability within Yes Yes Yes Yes person

3. Balance of biological Yes Yes Yes Yes and mental forms

4. Illness is imbalance, Yes Yes Yes Yes loss of harmony

5. Health is restoration of Yes Yes Yes Yes balance, harmony

6. Healing empowers Yes Yes Yes Yes vital energy

Source: Wilson, 2005.

of the individual spirit with the great circle of life to restore balance and harmony with nature, others, and the Great Spirit (God). The medicine wheel and traditional shamanic (i.e., medicine) practices are used as a guide to understanding. Through traditional healing practices, rituals and ceremonies, the designated “medicine” person facilitates the restoration of a person’s spirit and inner strength in order to restore their vital power to be in good balance, i.e., to have good relations of balance and harmony. More specifically, trauma can cause a loss of centeredness in the person and lead to a loss of “spirit,” resulting in various forms of “dispirited- ness,” which includes depression, PTSD, dissociation, and altered maladaptive states of consciousness and being (Jilek, 1982; Mails, 1991; Poonwassie & Charter, 2005; Wilson, 1989).

South African (Zulu)

The Zulu culture in South Africa employs a view of mental and spiritual life that is intricately interconnected. Bojuwoye (2005) states: “The inter- connectedness of phenomenal world and spirituality are two major aspects of traditional African world views. The world view holds that the universe is not a void but filled with different elements that are held together in unity, harmony, and the totality of life forces, which maintain firm balance, or equilibrium, between them. A traditional Zulu cosmology is an individual universe in which plants, animals, humans, ancestors, the earth, sky and universe exist in unifying states of balance between order and disorder, harmony and chaos” (p. 63). In Zulu culture, then, tradi- tional healing practices have respect for this view and attempt to facilitate the restoration of a harmonious state of being in relation to these dimen- sions of the person’s phenomenal world.

Indian (Ayurveda)

Indian healing, in the Ayurvedic tradition, views restorative practices as uni- fying mind, body, and spirit within the context of social conditions. Kumar, Bhurga, and Singh (2005) state: “According to Ayurvedal principles, perfect health can be achieved only when body, mind and soul are in harmony with each other and with cosmic surroundings. The second dimension in this holistic view of Ayurveda is the social level, where the system describes the ways and means of establishing harmony within and in the society. Mental equilibrium is sought by bringing in harmony three qualities of the mind in sattva, vajas and tamas” (p. 115). Thus, traditional Indian healers use time- honored practices (e.g., touching, laying of hands) to facilitate helping a person restore unity in the psyche. After the 2004 tsunami, such practices were used with success by local healers to aid victims who suffer from the stress-related effects of the disaster in India (Siddarth, in press).

The Lens of Culture 19

Traditional Chinese Medicine

In traditional Chinese medicine, “mental illnesses are said to result from an imbalance of yin and yang forces, a stagnation of the qi and blood in various organs, or both” (So, 2005, p. 101). He further elaborates that “the driving forces behind this relationship are the entities of qi (virtual energy) and li (order). The oft-cited concepts of yin and yang, opposi- tional yet complementary in nature, are characteristics along the meridian channels of that compound to the specific organ of the body” (p. 101). Thus, TCM views health and illness as related to a balance of vital forces and that disruptions which effect their critical balance can result in physical or mental illnesses.

CULTURAL CONVERGENCE IN TRADITIONAL HEALING

Table 2 compares the different cultural approaches to healing across five basic dimensions that represent assumptions about the nature of illness and health: (1) harmony in relations (e.g., with earth, others, nature, society; (2) personal vulnerability within the person due to imbalance caused by external forces or inner conflict; (3) the importance of balance in biological and mental processes; (4) illness results from imbalance and loss of har- mony; and (5) health is the restoration of balance and harmony in mind, body, and spirit. Thus, healing empowers vital energies contained within the person. By comparing different traditional cultural views and assump- tions that underlie we can go further and ask how it is that culture deals with those who are severely traumatized by events of human design or acts of nature.

THE TREATMENT OF TRAUMATIC STRESS SYNDROMES IN CULTURAL CONTEXTS

In an influential and important critique of mental health programs in war- affected areas (e.g., Bosnia, Rwanda, etc.), Summerfield (1999) explicated seven fundamental assumptions that many of these programs embrace as justifications for interventions with programs derived from clinical efforts and research on psychotherapy in Western cultures, primarily the United States and Western Europe. These seven assumptions are as follows: “(1) experience of war and atrocity are so extreme and distinctive that they do not just cause suffering, they ‘cause’ traumatization; (2) there is basically a universal human response to highly stressful events, captured by Western psychological framework [cf. PTSD]; (3) large numbers of

20 John P. Wilson

victims traumatized by war need professional help; (4) Western psychological approaches relevant to violent conflict worldwide victims do better if they emotionally ventilate and ‘work through’ their experi- ences; (5) there are vulnerable groups and individuals who react to a specific target for psychological help; (6) wars represent a mental health emergency: rapid intervention can prevent the development of serious mental problems, as well as subsequent violence and wars; and (7) local workers are overwhelmed and may themselves be traumatized” (pp. 1452–1457). This same set of assumptions could safely be generalized to non-war zone countries in which there are catastrophic natural disasters (e.g., tsunami, earthquake) or other conditions of human rights violations by political regimes: “the humanitarian field should go where the concerns of survivor groups direct them, towards their devastated com- munities and ways of life, and urgent questions about rights and justice” (p. 1461). Moreover he notes that “the medicalization of distress, a signif- icant trend within Western culture and non-globalizing, entails a mined identification between the individual and the social world, and a ten- dency to transform the social into the biological . . . consultants . . . have portrayed war as a mental health emergency writ large, with claims that there was an epidemic of `posttraumatic stress’ to be treated, and also that early intervention could prevent mental disorders, alcoholism, criminal and domestic violence, and new wars in subsequent generations by nipping brutalization in the bud” (p. 1461). This conclusion by Summerfield raises a number of critical questions when it comes to the proper and efficacious treatment of posttraumatic syndromes in simple and complex cultures in the world.

POSTTRAUMATIC INTERVENTIONS: WHAT WORKS BEST FOR WHOM UNDER WHAT CONDITIONS?

To focus the central issues rather sharply, what types of counseling, inter- ventions, treatments, practices, rituals, medicines, ceremonies, and thera- pies work best for whom and under what set of conditions? This seemingly simple and straightforward question turns out to be extraordi- narily complex and multifaceted for several key reasons. First, we do not have sufficient scientific studies across cultures to begin to answer this question. Second, cultural competence has shown the need to explore assessment, diagnosis, and treatment within a sensitive cultural frame- work that reflects knowledge and understanding of a culture. Indeed, the World Health Organization (WHO) published a global plan for culturally competent practices that included mandates to insure the availability of traditional and alternative medical practices in safe and therapeutically useful ways (World Health Organization, 2002). Third, it cannot be

The Lens of Culture 21

assumed that well-documented Western psychotherapies for PTSD, for example, are necessarily useful in non-Western cultures, especially thera- pies that rely heavily on verbal self-reports (e.g., CBT, psychodynamic). Fourth, there are a broad range of individual responses to traumatic events. It cannot be assumed “a priori” that PTSD is an inevitable outcome of exposure to extremely stressful life events. It is entirely possible that the concept of PTSD (cf. Western in conceptualization) is foreign and not read- ily understood in many cultures that do not utilize psychobiological expla- nations of illness or human behavior. Fifth, to understand “maladaptive” behavior consequences of trauma (and therefore traumatization) can only be meaningfully defined by cultural norms and expectations about “normal” and “abnormal” behavior. Human grief reactions are universal to death and loss but that does not make them pathological (Raphael, Woodling, & Martinale, 2004). Acute adjustment reactions for a short period of time are entirely expectable after the 2004 tsunami that destroyed towns, cities, even cultures and more than 250,000 people. But that does not make adaptational requirements pathological or PTSD symptoms an illness per se for the survivors. Sixth, it can be justifiably assumed that throughout centuries of human evolution, adaptive mechanisms, that wis- dom exists in culture to deal with the human effects of extreme trauma. As noted earlier, the great mythologies of the world chronicle such events and the adaptational dilemmas they present for survivors. Such mythical themes point to the necessity of framing culture-sensitive perspectives on human resilience versus psychopathology (Wilson, 2005). These consider- ations allow us to now explore ten hypotheses about the relation of trauma to culture to posttraumatic adaptations and how mental health “treatments” can be construed in culturally competent ways.

TEN HYPOTHESES CONCERNING TRAUMA, CULTURE, AND POSTTRAUMATIC

MENTAL HEALTH INTERVENTIONS

1. Each person’s posttraumatic syndrome, state of psychological dis- tress, or adaptational pattern is a variation on culturally sanctioned modalities of behavioral–emotional expression.

2. Healing and recovery from psychic trauma is person specific. There are multiple pathways and forms of treatment within a culture.

3. Each culture develops specific forms and mechanisms for posttraumatic recovery, stabilization, and healing (e.g., rituals, counseling practices, treatment protocols, medications, etc.). At any given time, cultures may not have available certain types of treatments that would be beneficial to people. These will either evolve in time or be adapted from other cultures.

22 John P. Wilson

4. Based on Trauma Archetypes, cultures contain the wisdom to develop mechanisms to facilitate the processing and integration of psychic trauma. Empathy, as a universal psychobiological capacity, underlies the development and evolution of culture-specific forms of healing (Wilson & Drozdek, 2004; Wilson & Thomas, 2004).

5. The concept of “mindfulness” in states of consciousness (tradi- tionally associated with Buddhism) is a key mental process to self- transcendence and the integration of extreme psychic trauma into higher states of consciousness and personal knowledge. Mindfulness, in this regard, is personal awareness of the impact of trauma to liv- ing in one’s culture of origin and how trauma has impacted the quality of life.

6. There is no individual experience of psychological trauma without a cultural history, grounding or background. Similarly, there is no individual sense of personal identity without a cultural reference point. Anomie and alienation are commonly produced by severely traumatizing experiences and are associated with forms of anxiety, distress, and depression (Wilson & Drozdek, 2004).

7. The rapid growth of globalization in the twenty-first century is cre- ating new evolutions in a “world-universal” culture and the possi- bility of fusing cross-cultural modalities of treatment and recovery.

8. Posttraumatic therapies and traditional healing practices, in culturally specific forms, can facilitate resilience, personal growth, and self-transcendence in the wake of trauma (Wilson, 2005).

9. The pathways to healing are idiosyncratic and universal in nature. The pathways of healing vary in nature, purpose, duration, social complexity, and utilization by a culture.

10. Healing rituals are an integral part of highly cohesive cultures. Healing rituals evolve in situations of crisis, emergency, and threat to the social structure of society and culture. Healing rituals demand special roles and skills (e.g., shaman, crisis counselor, psychologist, medicine person, priest, etc.) to facilitate efforts for recovery and the psychic metabolism of trauma.

The ten hypotheses concerning the relationship of culture and trauma provide a framework for understanding the diversity of posttraumatic psychological outcomes. As Summerfield (1999) noted, it is prejudicial and scientifically unwarranted to assume that traumatic events at the individual or cultural (collective) level will always produce PTSD and the clinical need to intervene with programs and procedures developed pri- marily in Western cultures. For example, cognitive behavioral therapy (CBT) is the most validated psychotherapy for PTSD in the USA (Foa, Keane, & Friedman, 2000). But is CBT applicable to assisting victims of the 2004 tsunami who live in a non-English speaking culture in Aches,

The Lens of Culture 23

Indonesia? Or, the survivors of the 2003 catastrophic earthquake in Bam, Iran, which killed over 30,000 people? Or, the mothers of genocidal war- fare in the Sudan in 2005 whose children were murdered or starved to death? Or, Native American Vietnam war veterans living in traditional ways on the Navajo reservation in Arizona? These questions bring into focus critical assumptions that each person’s posttraumatic adaptational pattern is a variation on culturally sanctioned modalities of coping with extreme stress experiences that impacts the psychobiology of the organ- ism. Clearly, posttraumatic adaptations fall along a continuum from pathological to resilient (Wilson, 2005). At the pathological end of the con- tinuum we find PTSD, dissociative reactions, brief psychosis, depressive disorder, and disabling anxiety states. In contrast, the resilient end of the continuum includes optimal forms of healthy adaptation, manifestations of behavioral resiliency in the face of adversity, and the resumption of normal psychosocial functioning (Wilson, 2005).

By examining the continuum of culturally sanctioned modalities of posttraumatic adaptation, the second and third hypotheses can be under- stood more precisely. Healing and recovery is person specific and there are multiple pathways to posttraumatic recovery, if they are needed. Considered from an evolutionary and adaptational perspective, cultures develop rituals, helper roles (e.g., shamans, mental health specialists, herbalists, medicine persons, physicians), ceremonies, and other modali- ties to facilitate recovery from distressing psychological conditions, including those produced by trauma (Moodley & West, 2005). Where such modalities of treatment do not exist or are inadequate, they will be devel- oped and implemented as it is critical to culture to have functional and healthy members to carry out the critical day-to-day activities necessary to sustain commerce, family life, and the functions that define the identity and essence of the culture itself. For example, a culture that is sick, self- destructive, and dissolving due to warfare, political conflicts and revolu- tion, and massive natural disaster or illness, will not thrive or maintain itself in a viable way.

The viability of culture in the face of collective trauma illustrates the sixth assumptive principle that there can be no experience of psychologi- cal trauma without a cultural history, grounding, or continuity of back- ground. There is no individual sense of personal identity without a cultural reference point (Wilson, 2005). Personal identity within a cultural context includes a sense of continuity and discontinuity in life-course development which shapes personality and the coherency of the self- structure. Thus, there is no sense of personal identity without a cultural reference marker to counterpoint and define those events which seem to shape the formation of identity for the person. As an extension of this viewpoint, it can readily be seen that anomie and alienation (e.g., feeling

24 John P. Wilson

detached, separate, cut off, divorced, estranged, distanced, removed) from mainstream cultural processes is a potential consequence of severely trau- matizing experiences and typically associated with anxiety, distress, and depression since the traumatic experience can “push” the person “out- side” the customary boundaries of daily living. The potential of trauma to dysregulate emotions and set up complex patterns of prolonged stress can- not be dismissed as statistically infrequent (Kessler, et al., 1995). As Wilson and Drozdek (2004) have noted, this is particularly true when: (1) the trauma is massive and damages the entire culture; (2) the nature of trauma causes the person to challenge the existing moral and political adequacy of prevailing cultural norms and values; and (3) the trauma causes the indi- vidual to become marginalized within the culture and to be viewed as problematic, stigmatized, “damaged goods,” or tainted by their experi- ences or posttraumatic consequences (e.g., physically disabled, disease infected, atomic radiation exposure; mentally ill, etc.).

The nature of how cultures deal with the social, political, and psy- chological consequences of trauma raises the issue of the availability of therapeutic modalities of healing and recovery. Stated simply, what does the culture provide to assist persons recover from different types of trauma? Examining this question is instructive since one can analyze the nature of formal, organized, and institutionalized mechanisms for recov- ery from trauma as well as informal, noninstitutionalized, or officially sanctioned modalities of care and service provisions. While a detailed analysis of these issues is beyond the scope of this article, it is nonetheless important when using a “crows nest” or “helicopter aerial” view of how cultures deal with those who suffer significant posttraumatic conse- quences of trauma, which include being displaced, homeless, unem- ployed, physically injured, and emotionally traumatized. Clearly, there are levels of posttraumatic impact to the social structures of culture and to the inner-psychological world of the trauma survivor. There are primary, secondary, and tertiary sets of stressors associated with trauma. In the “big view” of traumatic consequences, they intersect to varying degrees in affecting the patterns of recovery, stabilization, and resumption of nor- mal living (Wilson, 1994).

A further understanding of the relation of culture and trauma can be analyzed from knowledge of the Trauma Archetype (Wilson, 2004a, 2005). The Trauma Archetype represents universal forms of traumatic experi- ences across time, space, culture, and history.

Table 3 presents a summary of the dimensions of the Trauma Archetype which has 11 separate but interrelated dimensions. The Trauma Archetype is a primordial type of human experience in which a psychological experience is encoded into personality dynamics. The Trauma Archetype gives birth to Trauma Complexes which, in turn, represent

The Lens of Culture 25

how traumatic experiences are encapsulated in individualized ways in the psyche. Moreover, Trauma Complexes: (1) develop in accordance with the Trauma Archetype; (2) are comprised of affects, images, and percep- tion of the trauma experience; (3) are mythological in form, symbolic in nature, and shaped by culture; (4) contain the specter of the extreme threat of annihilation; (5) articulate with other psychological complexes; (6) may become central in the self-structure; (7) contain motivational power; (8) are expressed in personality dynamics; (9) are primarily unconscious phe- nomena; and (10) contain forms of prolonged stress reactions, such as PTSD, dissociative, and anxiety disorders (Table 4).

The conceptualization of Trauma Archetypes and Trauma Complexes has much utility when looking at trauma and culture, since these concepts

26 John P. Wilson

Table 3. Trauma Archetype (Universal Forms of Traumatic Experience)

Dimensions

1. The Trauma Archetype is a prototypical stress response pattern present in all human cultures, universal in its effects and is manifest in overt behavioral patterns and internal intrapsychic processes, especially the Trauma Complex

2. The Trauma Archetype evokes altered psychological states, which include changes in consciousness, memory, orientation to time, space, and person, and appear in the Trauma Complex

3. The Trauma Archetype evokes allostatic changes in the organism (posttraumatic impacts, e.g., personality change, PTSD, allostatic dysregulation) which are expressed in common neurobiological pathways)

4. The Trauma Archetype contains the experience of threat to psychological and physical well-being, typically manifest in the Abyss and Inversion Experiences

5. The Trauma Archetype involves confrontation with the fear of death

6. The Trauma Archetype evokes the specter of self-de-integration, dissolution, and soul (psychic) death (i.e., loss of identity), and is expressed in the Trauma Complex

7. The Trauma Archetype is a manifestation of overwhelmingly stressful experience to the organization of self, identity, and belief systems, and appears as part of the structure of the Trauma Complex

8. The Trauma Archetype stimulates cognitive attributions of meaning and causality for injury, suffering, loss, death (i.e., altered core beliefs), which appear in the Trauma Complex

9. The Trauma Archetype energizes posttraumatic tasks of defense, recovery, healing, and growth, which include the development of PTSD as a Trauma Complex

10. The Trauma Archetype activates polarities of meaning attribution; the formulation of pro-social – humanitarian morality versus abject despair and meaninglessness paradigm

11. The Trauma Archetype may evoke spiritual transformation: individual journey/encounter with darkness: return/transformation/re-emergence, healing (Campbell, 1949). The evocation of a “spiritual” transformation is manifest in the Trauma Complex as part of the Transcendent Experience and the drive toward unification

Source: © Wilson, 2004.

are universal in nature and not “wedded” to the concept of PTSD per se or Western perspectives of psychiatric illness. While a more extensive analysis of Trauma Archetypes and Complexes is not possible here due to page limitations, their relevance to the other assumptions about healing, recovery, and culture-specific forms of counseling, psychotherapy, or treatment is transparent and critical (Wilson, 2005).

First, it is necessary to understand, in culture-specific ways, the phe- nomenal reality of person. Wilson & Thomas (2004) have presented evi- dence that sustained empathy, as part of any treatment modality, is essential to facilitate posttraumatic recovery. Among other consequences of sus- tained empathic attunement, it helps the individual develop states of “mindfulness” as self-awareness of how a traumatic experience has impacted all levels of functioning, especially affect dysregulation (Schore, 2003). Mindfulness as a process of meditation is facilitative of higher states of consciousness and personal awareness of how a traumatic event may have impacted pre-existing beliefs about self, others, and nature. We can consider posttraumatic interventions, treatment, traditional healing practices, etc., as culture-specific forms designed to facilitate recovery, resilience, and the resumption of healthy living. The pathways to healing

The Lens of Culture 27

Table 4. The Trauma Complex

1. The Trauma Complex is a feeling-toned complex which develops in accordance with the Trauma Archetype

2. The Trauma Complex comprises affects, images, perceptions, and cognitions associated with the trauma experience

3. The Trauma Complex is mythological in nature and takes form in accordance with culture and symbolic, mythological representations of reality

4. The Trauma Complex contains the affective responses of the Abyss Experience: fear, terror, horror, helplessness, dissociation

5. The Trauma Complex articulates with other psychological complexes and innate archetypes in a “cogwheeling,” interactive manner. This includes the Abyss, Inversion, and Transcendent forms of traumatic encounters

6. The Trauma Complex may become central in the self-structure and reflect alterations in identity, ego processes, the self-structure and systems of personal meaning

7. The Trauma Complex contains motivational power and predisposition to behavior

8. The Trauma Complex is expressed in personality processes (e.g., traits, motives, altered personality characteristics, memory and cognition, etc.)

9. The Trauma Complex is primarily unconscious but discernible by posttraumatic alterations in the self and personality

10. The Trauma Complex contains the polarities of the Abyss Experience: diabolic versus transcendent which are universal variants in the search for meaning in the trauma experience

Source: © Wilson, 2004a, 2004b.

are idiosyncratic and universal in nature and may vary greatly in their contexts, purpose, length, social desirability, and utilization within the culture. In highly cohesive cultures, there will be the use and prescription of rituals, practices, traditional methods of healing, etc. as they reflect archetypal forms of healing. Where such rituals and treatments do not exist, they will be developed by the culture in response to crises and threats to social structures vital to cultural continuity; hence the need for multiple modalities of treatment and specialists (e.g., counselor, shaman, medicine person, priest, doctor, etc.), who, “through the lens of culture,” can assist in recognition of how a person has been changed, if at all, by psychological trauma.

So what does globalization portend for trauma treatment in the twenty-first century as the world “flattens” due to technological advances and commercial homogenization? In brief, the ready availability of scien- tific data on international databases for PTSDs (e.g., P.I.L.O.T.S. @ncptsd.org) enables clinicians, researchers, and patients to have instant access to information about PTSD, complex PTSD, treatment advances, pharmacotherapies, and much more. Second, the spread of knowledge has spurned unprecedented levels of international cooperation and the formation of international professional societies (e.g., ISTSS, International Society for Traumatic Stress Studies in 1985; Asian Society for Traumatic Stress in 2005) to share scientific data and clinical wisdom and to lobby for political and legislative changes on behalf of trauma victims. Third, glob- alization, to a certain extent, allows for homogenization, fusion, and experimentation with different modalities of counseling, psychotherapy, traditional healing practices, and modern medicine (e.g., traditional Chinese medicine). In a related way, globalization, driven by economic and political forces, is creating the emergence of “global culture” which enables the prospect of fusing cross-cultural modalities of treatment and subjecting them to scientific measures of efficacy. As this occurs, the answer to the question, “What works for whom and under what condi- tions?” will take on new meaning in terms of how we conceptualize the prolonged effects of extreme stress experience to the human psyche and as a holistically integrated organism. Beyond doubt, nineteenth- and twentieth-century conceptualizations of counseling and psychotherapy are cultural bound in nature and origin. The twenty-first century will witness the development and emergence of global conceptualizations of what constitutes trauma and how it gets healed. There will be developed a matrix of databases which cross-list cultures and the diversity of tech- niques employed to cope with states of traumatization. Moreover, as this convergence begins to occur, the scientific “gold standards” of what works for whom under what circumstances will take on meaning that transcends culture but not persons whose human suffering impels humanitarian care.

28 John P. Wilson

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