MSW 521 (Discussion -1) Module 6 Understanding Intergenerational Transmission of

Welcome to Module 6!

This week, one focus is on understanding the intergenerational transmission of trauma the results from mass violence events and how trauma is transmitted from one generation to other generations. In this regard, we explore the storytelling interventions that social workers might use if they see trauma in a second or third generation. We also examine the narrative exposure therapy as a means of addressing the trauma that youth experience with exposure to armed conflict. Both discussions this week focus on intergenerational transmission of trauma and how social workers might assist a selected population that survives a mass violence event. At the end of the week, consider how social workers might recognize the transmission of trauma in families, particularly in families that come to the United States from war-torn countries or in families of indigenous populations within the United States.

Ray, L., Outten, B., Andrew, P., & Gottlieb, K. (2019). Disrupting the intergenerational transmission of trauma among Alaska Native people: A conceptual model for Family Wellness Warrior Initiatitve. Journal of Health Disparities Research & Practice, 12(2), 40-68.

Kangaslampi, S., Garoff, F., & Peltonen, K. (2015). Narrative exposure therapy for immigrant children traumatized by war: Study protocol for a randomized controlled trial of effectiveness and mechanism of change. BMC Psychiatry, 15(1), 1-14.

Module 6: Intergenerational Transmission of Trauma

Transgenerational Trauma or Intergenerational Trauma Transgenerational trauma is a conceptual framework for explaining how the effects of trauma can be transferred from one generation to another (Dekel & Goldblatt, 2008; Fossion, Rejas, Servais, Pelc, & Hirsch, 2003). As such, the proposition in the framework is that a survivor(s) who experience a traumatic event transfer the trauma effects to the next generation, and in some cases, subsequent generations. Similarly, historical trauma occurs when a group or population experiences trauma wherein the trauma was widespread, affected the group as a whole, and there was intent to traumatize as many members of the group as possible (Oneill, Fraser, Kitchenbaum, & McDonald, 2018). For example, historic trauma has been documented among Holocaust survivors, Native Americans, descendants of slaves, and other survivors of war conflicts.

Symptoms of transgenerational trauma may vary by group and include a variety of symptoms that present in families, i.e. communication, family conflict, and other family- related issues. The first generation of survivors likely experience posttraumatic stress disorder (PTSD), and subsequent generations may experience any number of symptoms depending on group membership and the degree of dysfunction in the family. Within this context, family work and intervention in some form seem needed to prevent the transmission from one generation to others.

How Trauma Is Transferred Generationally Early research on the transmission of trauma seemed to suggest that the intergenerational transmission of trauma was primarily a result of social learning. However, more recent research suggests that the study of epigenetics may further explain transgenerational trauma, as well as its reversal (Yehuda & Lehrner, 2018). By definition, epigenetics is the study of heritable changes in gene function that do not involve changes in DNA sequence (Merriam-Webster, 2020). Cloud (January 18, 2010) noted that "at its most basic, epigenetics is the study of changes in gene activity that do not involve alterations to the genetic code but still get passed down to at least one successive generation."

Nolan-Hoeksema (2006) noted that women's endocrine system may become overactive and dysregulated in response to stress related to trauma via the hypothalamic-pituitary- adrenal feedback system (HPA). In this context, Baker (2018) explored the possibility that the musculoskeletal pain many Maori people experience in New Zealand may also be a dysregulated response to internal and external stressors they have experienced in trying to acculturate into the European New Zealand culture, i.e. social inequities. Based on the findings of a phenomenological study, Baker concluded that the musculoskeletal pain among Maori people may be a result of historical trauma and acculturation stress. As such, treatment is needed that addresses the emotional and social health in order to address the physical pain that Maori and reverse the trauma affect.

Native Americans and Historic Trauma Cromer, Gray, Vasquez, and Freyd (2018) highlighted that historical trauma impacts a large group of individuals who identify with each other in particular ways, and unlike intergenerational transmission of trauma, results from institutional betrayal. Institutions can be governments, and in the case Native American populations, it is well documented that the United States government betrayed Native Americans in a variety of ways that reflect genocide or ethnic cleansing, particularly in the attempt to Americanize Native American children and take the land of Native America people. It is noteworthy, however, that Native Americans also experience transgenerational trauma within families across generations, i.e. possibly via parenting.

Native females have been especially vulnerable to the institution's betrayal, primarily via the Indian Health Service (IHS). Smith (2005) highlighted that native women were raped, children were removed from the care of their mothers for the purpose of making children American, and sterilizations were performed without informed consent to control the growth of the Native population. Smith shared data that showed the

sterilization policies in the 1970s. In 4 of 12 areas that the IHS served (Albuquerque, Phoenix, Aberdeen, and Oklahoma City), 3001 native women of the age to bear children were sterilized between 1970 and 1973, which was 5% of all Native women who could bear children (General Accounting Office, 1976). The speculation is that there were many more unreported and undocumented sterilizations in all areas (Smith, 2005, p. ).

There are far too many examples of how Native people have been marginalized and oppressed to address in this lesson. However, Cromer et al. (2018) noted in order to address the historic trauma and institutional betrayal, the "historic losses" could potentially be healed through the grief process. By comparison, the intergenerational transmission of trauma in families will likely warrant various therapeutic approaches that focus on families. Both approaches may be needed to address the homicide, suicide, domestic violence, and substance abuse rates in the Native communities that are likely outcomes of some combination of both historic and transgenerational trauma.

Social Work Response Social workers are challenged to address the trauma that Native peoples have experienced over many years, especially Native women. In this case, social workers must be culturally aware of the trauma that Native people have experienced and be especially patient in recognizing tribal culture relative to their own culture. This means being accomplished in many areas wherein traveling social workers (TSWs) are contracted to provide service to Native populations. In these areas, it will be helpful for social workers to have a compassionate understanding of historic trauma and losses in order to provide services that focus on helping Native populations grieve their losses.

In addition, those social workers who work with Native families should be competent in implementing interventions that allow family members to tell their stories and provide narratives within and across generations. In this regard, the ability to implement narrative family therapy will be particularly helpful. This approach takes on salience in allowing members of families in each generation to provide the family narrative/story over several generations. In doing so, it will be important for social workers to respect tribal culture and normative practices that often warrant special awareness and attention in providing services.

Summary This lesson focused specifically on intergenerational transmission of trauma, or transgenerational trauma and/or intergenerational trauma. How trauma is transferred from one generation to others was discussed, especially how epigenetics, or how trauma my result in changes in gene activity in some way that is transferred to other generations. Epigenetics may explain how the stress of social inequities the Maori population has experienced in New Zealand may result in trauma expressed as musculoskeletal pain. Last, historic trauma that results when an institution, such as a government, betrays an entire group of people as was the case in Native American peoples.