I write this post as a community activist, scholar of health professional education, public health professional and second-generation Eelam Tamil, whose parents fled the armed conflict and genocide in Sri Lanka. In my career I have intentionally engaged with non-Eurocentric psychology literature, through which I’ve come to understand just how inadequate the Western model of trauma understood through a PTSD framework is to address the needs of non-Western populations with a history of colonialism and oppression.
On May 27th, 2021, I and millions of others read about the tragic finding of the unmarked buried remains of 215 children at the former Kamloops Indian Residential School. I read about how Indigenous people, even in their profound shared pain, were not surprised because communities knew about these children, and many more like them.
These discoveries highlighted a shared trauma experienced by Indigenous Peoples in Canada. Yet the way that trauma is framed in Western culture limits understanding of such collective trauma and prevents it from being adequately addressed.
In Western biomedicine ‘trauma’ is generally linked to post-traumatic stress disorder (PTSD), a psychiatric construct that has its roots in the “shell shock” and “combat fatigue” observed in World Wars I and II. Individuals diagnosed with PTSD according to the DSM-5 definition have intense, disturbing feelings and thoughts associated with witnessing or experiencing a traumatic experience. These may take the form of nightmares or flashbacks, even long after the event has ended. Yet the current operationalization of PTSD in describing and treating Indigenous and other historically & presently oppressed populations is generally deemed to be inadequate.
For example, Dr. Samah Jabr, chair of the mental health unit at the Palestinian Ministry of Health has contended that the Western-developed tools don’t work in her context and asked, “what is sick, the context or the person?”. The authors of a 2015 National Collaborating Centre for Aboriginal Health publication, Aboriginal Peoples and Historic Trauma, point out that, in addition to excluding the critical role of culture and intergenerational trauma in its definition, the DSM diagnosis of PTSD “does not connect the individual’s experience to broader, systemic conditions that perpetuate and exacerbate the individual’s experience” (citing Menzies 2010). They argue that, particularly for Canada’s Indigenous Peoples, the PTSD trauma construct fails to appropriately capture the complex, cumulative, and collective trauma across generations, and deny the presence of a necessary relationship between historical and contemporary trauma. This then in turn leads to the pathologizing, victim blaming, and stereotyping of Indigenous and historically & presently marginalized populations who express trauma. Moreover, this DSM classification individualizes the effects of political violence. Gibson and Beneduce noted that Psychiatry once served as a tool in the underlying colonial mission of “breaking and disciplining colored bodies and minds” and the individualization of the effects of political violence through the DSM framing of trauma would seem to continue this cycle.
Motivated by the desire and commitment to reduce the suffering of Indigenous Peoples and influenced by the importance of the past in shaping present reality, Marie Yellow Horse Brave Heart developed the theoretical construct of “historical trauma”. This construct aims to situate Indigenous health issues as forms of postcolonial suffering and legitimize the problematizing of structural issues in its ongoing contributions to communities’ trauma. Though described as postcolonial suffering, it is imperative to realize the ongoing reproduction of colonial institutions and systems in today’s society. Brave Heart, a member of the Indigenous community and a social worker, shares that she experienced a powerful consciousness of carrying ‘old’ grief and trauma greater than herself, her family, and her whole tribal community.
Indigenous physician, Marcia Anderson, has said, “As an Indigenous doctor, I see the legacy of residential schools and ongoing racism in today’s healthcare.” The last residential school in Canada closed 25 years ago, but the residential schools policy indisputably continues to have devastating intergenerational impacts today.
Over the past two decades, the term ‘historical trauma’ has garnered widespread attention from scholars, researchers, and community activists. Recognition that the pain and suffering experienced by one generation can persist and reproduce between and within generations has fostered transformation in ways of thinking about mental trauma. This construct of trauma captures previously missed elements around group identity, genocidal intent, collective impact, individual and communal experiences, as well as the intergenerational nature of trauma. It is described as more complex in its antecedents, evolution, and outcomes than PTSD; as a collective phenomenon rather than an individual one, in that trauma is shared by members of an identifiable group who have experienced deliberate conquest, colonization, or genocide over generations; as cumulative in its intergenerational impacts over time.
Historical trauma widens the frame of the mainstream trauma model to identify and include the legacy of colonization and unresolved collective grief. As such it opens a way to treat not just symptoms of this trauma but also to confront its sources and recognize ongoing contributors to pave a path towards sustainable healing. This framework allows health professionals to understand how this trauma can be exacerbated by communities’ current socio-politico-cultural environment. A model of trauma that can authentically speak to survivor communities can be a first step towards building trust in our healthcare systems.