Vivetha Thambinathan is a doctoral candidate in the Faculty of Health Sciences at Western University in Ontario.
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.
Hello Vivetha Thambinathan, Excellent article. I am a retired trauma therapist who also has a different take on treating trauma. In the July 2 issue of the online Newsletter, madinamerica.com is a featured article titled, “A Self Help Version of EMDR Could Make Healing from Trauma Easier”. The program, Se-REM (Self effective – Rapid Eye Movement) does not address generational, systemic or historical trauma, but still, it is revolutionary in its potential to help others. If you would like to explore it, the website is: Se-REM.com. If you would like to give feedback, share your thoughts or correspond, please write to me at: firstname.lastname@example.org.
Take care, David Busch, (LCSW, retired trauma therapist).
I saw a number of patients who survived the Holocaust. They were complaining of nightmares,headaches,generalized pain,etc. At least six were hospitalized,some received ECT,antidepressants, councrlling etc. Their worst remembrances was the death of their children .At least three million children were killed by the Germans. I passed my fellowship because I picked up the tattoo on her arm,missed by her physicians! She had all the criteria of shell shock,now labeled PTSD.
Harry Jeffrey Zeit
I remember visiting this memorial, to 50,000 of those 3 million murdered children you mention, on the same day I visited Ninth Fort, in Kaunas Lithuania. What a bleak and haunting day in 1997 – a woman from Napa (Jewish, born in Berlin and left in 1936, in the nick of time), a local taxi driver (with written instructions in Lithuanian provided by an Israeli tour guide fluent in the language of tragedy and irony – we’d met in one of those crazy Eastern European bars filled with post-Glasnost denizens) and me. There was nothing there but these barely visited and unadorned monuments to unimaginable atrocities, and that’s one reason why we must never permit human suffering and degradation to hide behind an overmedicalized and dehumanized constructs.
Malcolm M MacFarlane
Excellent article. Another useful lens for understanding these issues and the impact of residential schools on their inmates is Canadian sociologist Erving Goffman’s concept of Total Institutions. This concept has been applied to residential schools by Julia Rand in her paper Residential Schools; Creating and Continuing Institutionalization Among Aboriginal Canadians https://fpcfr.com/index.php/FPCFR/article/view/105/169
This is a paper well worth reading as it clearly illustrates the trauma to self and culture associated with being the victim of the societal and cultural phenomenon of a total institution.
In N. Ireland we saw very good results (in all areas of the patient’s life) with trauma-focused CBT for PTSD. Even very complex cases eg members of the security forces who had been multiply traumatised and who were in constant fear of violent death for many years. The socio-cultural and historical contexts of the N Ireland conflict have their roots centuries back and many people do not know, for example, that 1.5 million Irish people, at a conservative estimate, lost their lives in the famine of the 1840s–a famine which was a direct result of crop diversion by the British rulers. Genocide would be an appropriate descriptor for this. Given this history, we would not have expected a specific CBT routine to work and certainly not work as well as it did. In any discussion of any type of PTSD, we need to consider carefully what sort of treatment has been used and the N Ireland work, using the CBT routine developed by Professors Ehlers and Clark, shows that it is possible to relieve suffering even in the context of centuries of oppression of Irish people and more recently, decades of oppression of the Catholic minority in N. Ireland.
Sometimes we overvalue the model and undervalue the people delivering the model. In my experience, a very special breed of psychotherapist chooses to work specifically we trauma, and we would do well to put the spotlight on them (or at least share it with the many good trauma therapy models currently available to us.
Harry Jeffrey Zeit MD
Thank you for this important article and I do hope it inspires curiosity and dialogue within medicine.
There are so many areas in which we can expand on your ideas. For one, we could see that not just PTSD but every diagnosis in the DSM ignores the web of community and culture as well as historical and generational trauma. How many times have we heard psychiatrists dismissing the developmental trauma disorder because this would encompass too many of our patients? This then becomes a path to turning our back on trauma and suffering, concealing it with a host of different medicalized diagnoses.
I’ve also been inspired by Janice Haaken PHD’s work, including her recently published “Psychiatry, Politics and PTSD: Breaking Down.” One idea she elaborates is how the PTSD construct (and that’s all it is) has created a disconnect between human suffering and an insulated and insular psychiatry. The upcoming Complex PTSD diagnosis coming to the ICD classification in January, 2022 is a step forward, although it still comes with many compromises and a focus on the individual.
The more we explore trauma, the more we see it everywhere, and our own profession is filled with its paradoxes and perpetrator/victim splits and their devastating impact. Any movement to better understand trauma and to understand how deeply it is enfolded into history and oppression and the traumatizing nature of our current society (inordinately expressed against minorities) and power structures will be a step forward for us in medicine.
Thank you for assisting & guiding us on that path.