of some cultural groups (also known as historical trauma; e.g., African Americans and the violent history of slavery). Although culture is not always easily discernible, it influences the experience and presentation of trauma in a multitude of ways. Culture acts to filter perceptual reality and may influence interpretations and meaning-making during and after a traumatic experience (Hinton & Lewis-Fernandez, 2019; Schnyder et al., 2016). That is, even if the human biological response to trauma is relatively unchanged across cultural groups, vulnerability to trauma varies based on variables such as levels of stress and local means of the trauma (Hinton & Lewis-Fernandez, 2019). Cultural beliefs can affect individuals’ appraisal systems, including what they deem to be stressful or not stressful (Schnyder et al., 2016). Additionally, the meaning and implication of trauma sequelae, such as traumatic nightmares, may be construed in a number of ways, depending on cultural beliefs about the interpretation and relevance of dreams (Hinton & Lewis-Fernandez, 2019; Schnyder et al., 2016). An individual’s cultural beliefs about destiny or fate (e.g., a belief that everything happens for a reason) may also mitigate the perception of a traumatic event (Marsella, 2010). Additionally, the lesser emphasis that collectivistic cultures place on factors such as personal agency, control, and responsibility may influence the personal appraisals made following trauma and subsequent PTSD symptoms (Bernardi & Jobson, 2019). If an individual perceives an event as traumatic and potentially develops a pattern of posttraumatic stress—that may or may not fit PTSD criteria—the presentation of symptoms is likely to be mediated by culture. The symptoms and the cultural attributions of those symptoms can influence many areas, including stigma, social network effects, economic effects, help-seeking, and treatment in the healthcare system (Hinton & Lewis-Fernandez, 2019). Patterns of symptom onset and the idioms used to describe distress (e.g., somatic complaints that are delineated from psychological processes) may also vary by culture (Marsella, 2010). For instance, in some Asian cultures, PTSD symptoms may be identified as somatic complaints (Yap et al., 2021). Across many cultures, the distress of intrusive thoughts often associated with traumatic experiences may be described as “thinking too much” (Hinton & Lewis-Fernandez, 2019). Whether or not a culture is primarily collective or individualistic may also dictate symptom expression. In individualistic cultures, some people may develop feelings of diminished self-worth or personal vulnerability—symptoms rooted in the individual self (Bernardi et al., 2019). Conversely, in collective cultures, individuals may struggle with how their trauma has affected their social functioning and standing within the group (Bernardi et al., 2019). With this understanding, it becomes obvious that knowledge and practices sensitive to multiculturalism are required to adequately assess trauma symptoms. Professionals need to be knowledgeable of the ways in which cultural differences may mediate or moderate the experience and response to overt traumatic events (e.g., natural disasters, assaults), but they also must consider the existence of covert, culturally specific traumas that are less recognizable in common diagnostic literature. Marginalization, oppression, and racism can act as traumatic stressors. These stressors can range from chronic, long-standing racist institutional and societal practices, to “blatant hate crimes,” to subtle microaggressions (Williams et al., 2014, p. 104). Microaggressions may take the form of “vague insults or non-verbal exchanges” that may appear benign to more privileged individuals, but they can contribute to justifiable and relentless vigilance and paranoia from the individual against whom they are perpetrated, “resulting in PTSD symptoms over time” (Williams et al., 2014, p. 104). For marginalized individuals, these are adaptive responses to harmful institutionalized societal practices and discriminatory actions that may or may not become maladaptive (Williams et al., 2014). Historical trauma is another culturally specific traumatic experience that deserves increased recognition. According to
Kirmayer, Gone, and Moses (2014, p. 300), “Recent years have seen the rise of historical trauma as a trope to describe the long- term impact of colonization, cultural suppression, and historical oppression.” “Massive group trauma experiences” result in cumulative suffering across generations that, if unaddressed, will shape the way people respond to current traumas (Jackson, 2013, p. 1). Dupuis-Rossi and Reynolds (2018) describe dissociation within Indigenous nations as analogous to settlers’ attempts to disconnect Indigenous peoples from their culture/ land. Some of the atrocities that may contribute to historical trauma are the Holocaust, Japanese internment camps, the genocide and disenfranchisement of Native people and tribal communities, and slavery. The individual who experienced the initial trauma may encounter triggering events decades later. Jackson (2013) offers the example of Japanese Americans witnessing calls to round up Muslim Americans after the 9/11 attacks—calls that were eerily similar to their experience after the Pearl Harbor bombings. Although the initial victim of historical trauma may experience long-lasting symptoms, the insidious aspect of historical trauma is its ability to affect multiple generations. This impact is unintentional and often without awareness of the influence of the original trauma (O’Neill et al., 2018). For example, the offspring of individuals who experienced historical traumas often exhibit higher thresholds for trauma perception and arousal and often fail to meet diagnostic criteria thresholds for PTSD, despite experiencing trauma symptoms (Jackson, 2013; Marsella, 2010). Descendants of historical trauma survivors may come to believe that their traumas are arbitrary or ordinary in comparison to the experiences of their ancestors. For this reason, they may minimize their own experiences in their reporting to professionals (Jackson, 2013), which can result in continued suffering. In other instances, descendants may experience “ever-present anger” toward the institutions that enacted the traumas and this may “serve to undermine their ability to be successful” or heal from future traumas (Jackson, 2013, p. 2). Additionally, attachment may mediate intergenerational trauma transmission (Isobel et al., 2019). However, many cultural groups have responded to their historical traumas with growth and advanced coping/healing practices that have been honed over generations. Professionals should be mindful of these practices that may not fit traditional medical practices (e.g., tribal healing practices; Jackson, 2013). Awareness of the impacts of trauma can allow families to take steps to break historic patterns of interactions and cope with the burdens of an intergenerational trauma legacy (O’Neill et al., 2018). Trauma and psychological suffering are mediated by culture and historical experiences (Jackson, 2013). Clinicians must be mindful and develop cultural humility, responsiveness, and competence to effectively “understand, assess, diagnose, communicate, and treat patients from different ethnocultural traditions” (Marsella, 2010, pp. 17–26). Clinicians should (Marsella, 2010, p. 17): ● Ask about cultural coping practices ● Attend to the collective or individualistic nature of an individual’s culture ● Consider if individual therapy is appropriate or if treatment should include an ecological approach that addresses the larger cultural community as a coping resource ● Assess historical perspectives and intergenerational familial experiences ● Be aware of subtle traumatic experiences for marginalized groups and how those experiences may impact people’s worldview and response to trauma ● Recognize that cultural specifics, such as intrafamilial boundaries, shame in discussing negative affect, and fear of involvement with services may require nuanced and alternative treatment options ● Self-assess clinician cultural competence and search for cultural blind spots; perfection in cultural competence is “never attainable,” and it should remain an ongoing practice
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Book Code: PYFL4024
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