By ETHAN WATTERS

After the 2004 tsunami in Asia, many mental-health experts agreed that a “second tsunami” of mental illness in the form of post-traumatic stress disorder would strike the region. Like doctors rushing to the outbreak of an epidemic, American counselors and trauma researchers soon arrived on the scene hoping to pass on useful knowledge about PTSD. A few years on, however, their efforts have raised a troublesome question: Were they bringing the wrong treatment to the wrong people?

At issue is not whether tragic events like the tsunami trigger debilitating psychological distress and even mental illness — everyone agrees that they can. The question is over the extent to which survivors’ cultural beliefs shape their symptoms. If culture has the impact that some researchers suggest, the PTSD diagnosis may be of little help (and even do potential harm) when applied wholesale in other countries.

In the last 25 years, PTSD has had a remarkable ascendancy in American psychiatry and in public consciousness. Proponents of the diagnosis assert that experiences of fear or horror often spark a cluster of 17 broad symptoms, including intrusive thoughts, memory avoidance and uncontrollable anxiety. The concept of PTSD also encompasses notions of how best to overcome the disorder, usually through measured re-exposure to the original trauma supervised by a counselor. PTSD, many Americans assume, describes the way that all humans react to trauma.

Gaithri Fernando, an expert on trauma from California State University, questions that assumption. “Researchers and counselors who came to Sri Lanka after the tsunami did find some PTSD symptoms,” Fernando says. “But it was not the nightmares or flashbacks that most of the population was concerned with. The deepest psychological wounds for Sri Lankans were not on the PTSD checklists; they were the loss of or the disturbance of one’s role in the group.”

Ken Miller, a psychology professor at Pomona College, reached similar conclusions in his work on war-related trauma in Guatemala, Bosnia and Afghanistan. His study of Afghans who experienced trauma yielded 23 symptoms, including many that were not on the PTSD symptom list and several that had no ready translation into English. There was, for instance, “asabi,” a type of nervous anger, and “fishar-e-bala,” the mental sensation of internal stress or pressure. Researchers studying other cultures have also found deviations from the PTSD symptom list. Salvadoran female refugees who endured the protracted civil war often experienced calorias, a feeling of intense heat in their bodies. When Cambodian refugees were asked about the most pressing psychological impact of trauma, they told of nighttime visits by vengeful spirits.

The simple but surprising truth appears to be that symptoms of psychological trauma can be both culturally created and utterly real to the individual at the same time. As the anthropologist Allan Young of McGill University explains, a diagnosis like PTSD “can be real in a particular place and time and yet not be true for all places and times.”

Cultural differences can also be found in the beliefs about how people heal. Many East Africans, for instance, hold that the ability not to talk about distressing experiences is a sign of maturity. This runs counter to the typical assumption of trauma counselors that a healing catharsis can be achieved through “truth telling.” In Sri Lanka, Fernando says, the idea of splitting off from the group to heal psychic wounds through individual counseling can actually exacerbate the more salient fear of social isolation. To understand how strange and disconcerting it might be to have another culture import its form of trauma healing, Miller says, you need only consider the situation reversed. “Imagine our reaction,” he says, “if Mozambicans flew here after 9/11 and began telling survivors to engage in a certain set of mourning rituals in order to sever their relationship with their deceased family members.”

Instead of imposing outside assumptions about trauma and healing, the World Health Organization has begun recommending “psychosocial support” for disaster areas. The assumption is that just as cultures have their own symptoms of trauma, they have distinct healing methods that are often tied to local rites. For every angry ghost, there is a ritual for the dead intended to lay that ghost to rest.

If we’re unaware of the local idioms of suffering, Miller and other researchers argue, our assistance is likely to be ineffective at best. The worst-case scenario is that such interventions pressure other cultures to adopt Western beliefs about the meaning and impact of trauma. “PTSD has become psychiatric Esperanto,” Young says mordantly. “It may turn out to be the greatest success story of globalization.”

Thank you, Paul, for posting this provocative article. It's very relevant to a documentary I saw earlier this week.

My husband and I watched a HBO documentary the other night, "The Greatest Silence: Rape in The Congo," which, as the name suggests, is about the systematic use of rape as a weapon used against thousands of women during the ongoing and protracted civil war in the Democratic Republic of Congo. The things they've suffered are beyond words. There are very few resources for the rape survivors, but the producer/director Lisa Jackson visited the women who were lucky enough to live in the rare women's shelters with the support of advocacy groups.

During those visits, large groups of women were gathered and individually related their stories for the cameras and for the other women residents; I can't say for sure whether this was a regular occurrence, or done solely for Jackson's camera. What strikes me is how horrible and awful it was for us to watch from the comfort of my middle-class American home, and I wonder whether it wouldn't be re-traumatizing for the survivors to hear over and over so many stories of horror, mutilation, murder, rape and isolation? Since watching the movie, my husband and I both remain deeply disturbed and saddened by what we saw and heard. I recognize the benefit of speaking out, and finding a place where others share your pain, but I know too that the re-exposure can be additionally damaging. I wonder if there are cultural differences that might make my assumption invalid. I doubt that you're an expert on Congolese culture, but I'm interested in knowing if you're aware of such differences.

I appreciate your feedback.

 There are that I know two centers for treating torture victims in the world and one is in Minneapolis St Paul the other one is in Europe.

In our Western culture researchers and psychiatrist have found that the patient repeating and explaining what occured to him or her during a traumatic experience experience is of considerable help for victims of torture.  Usually this talk takes place with the psychiatrist and the patient alone and some have found that recording  what the patient says could be benefitial too. Talking in front of a group depends on the believe system of the patient, on the nature of the traumatic experience and on the kind of relationship that she(the patient) has develop with the support group that she is working with.

There are cultural differences concerning perceptions of traumatic experiences and also of patient's symptoms and there is a branch of anthropology called Medical Anthropology dedicated to research in this area.  

Among the Aztecs some offered themselves to be sacrificed and had their heart taken out by a priest  as a privilege. In some Asian countries a characteristic of depression known as anhedonia, which is the lost of capacity to experience pleasure, is welcome because it helps the individual to reject the outside world and to look for comfort in the inner world of meditation.       

Thanks for your response, Paul. I'm about half way through a book on neuroplasticity, "Train Your Mind, Change Your Brain." It's fascinating stuff, written by Sharon Begley, the science writer from Newsweek and Wall Street Journal. I highly recommend the book to anyone with any interest at all in brain function.

Before long, I should be to the section of the book that discusses the PET-scan findings when examining the brains of Buddhist monks, and how their brains have been re-shaped by tens of thousands of hours of meditation. (The forward to the book is by the Dalai Lama.) So far, the scientists cited have determined that people born blind really do have better hearing thanks to activity in the visual cortex; people born deaf really do have better vision thanks to activity in the auditory cortex; dyslexia can be cured by stimulating the specific region of the auditory cortex that processes the fast, explosive phonemes "b" "d" "g" and "t." You read it right: people can hear through their visual cortex, and see through their auditory cortex.  The brain just won't let all that prime real estate go to waste!

There is so much promise for us as we learn more about developing our brains through targeted stimulation. With even my crude understanding of neuroplasticity, I can grasp how PTSD can be caused, and the neuromechanics of its development because of trauma. I hope someone with a better brain that my own can find an application for neuroplasticity in its treatment. 

 Yes the brain is amazing a person can live with half a brain specially if the other  half is taken away when they are very young

 Phantom limbs also demonstrate how neurons from a certain area that no longer receive input from an extremity can have their dendrites connect to an adjacent area and trigger feeelings of an extremity that is no longer there.

Some books I highly recomend are the following:

THE FEELINGS OF WHAT hAPPENS AND DECARTE'S ERROR  BY ANTONIO DAMASIO THESE ARE TWO GREAT BOOKS BY PERHAPS THE BEST NEUROLOGIST IN THE WORLD.

THE SYMBOLIC SPECIES  BY TERRENCE W. DEACON (AN AMAZING BOOK) one of the very best

PHANTOMS IN THE BRAIN BY V.S RAMACHANDRAN ALSO AMONG THE WORLD GREATEST NEUROLOGIST fantastic book

AND FINALLY A CLASSIC THE MAN WHO MISTOOK HIS WIFE FOR A HAT BY OLIVER SACKS

THIS BOOKS ARE THE BEST STUFF YOU CAN BUY GREAT READING  

Just last night I read about the phantom limb studies by Ramchandran, and I read the Sacks book some years ago. There is also a book, (The Echo Maker, by Richard Powers) that tells the story of a man with Kapgras Syndrome, a bizarre phenomenon following head trauma that makes the patient unable to recognize someone close, like family; they'll acknowledge that the pseudo-family member looks, talks, dresses, walks...exactly like the real family member, but perceives them as an imposter. Though this is a piece of fiction, it is extensively researched.

Thanks for the recommendations; I'll add your books to my list at Amazon.com. (I'm so compulsive about bookstores that when I make a detour after work and get home late, I lie to my husband and tell him I've been at a bar! He's wise to me, though; he sniffs my breath and tells me he smells ink!)

I'm just now starting to read some of your earlier posts.

I am so glad you are interested in this things I also have read about Capgras(Ramachandran believe that the amygdala is damage) that sometimes is refer to as Kapgras syndrome

I also love bookstores and libraries  and my main hobby is the study of consciousness The brain is definetly a fascinating and mysterious organ.

RE: "I wonder whether it wouldn't be re-traumatizing for the survivors to hear over and over so many stories of horror, mutilation, murder, rape and isolation?" by Writer Lady

I don't know the specifics of when it works, why it works, and how to finesse it so that it works, but I've heard of the concept of "desensitization" as a way of healing (as opposed to as a way of coping) for survivors of violence and other traumas. Does anyone know any of the specifics behind this and/or criticisms of this? I can only hope these survivors benefited by hearing that they weren't alone and by refuting any "shame" they may have felt by speaking out.

On a more personal note, thanks, Writer Lady, for sharing the impact this documentary had on you personally. I can relate to learning about something outside of my own life and feeling at a loss to deal with the grim reality that others live through.