Trauma and Violence

Post-traumatic stress is something that can take on many forms and arise from many different circumstances. It is also known at post-traumatic stress disorder (PTSD) but sometimes the word disorder is removed to decrease the stigma surrounding it. In an article in Vanity Fair called How PTSD Became a Problem Far Beyond the Battlefield, the author, Sebastian Junger, explains that “Because PTSD is so adaptive, many have begun leaving the word “disorder” out of the term to avoid stigmatizing a basically healthy reaction.” PTSD was originally associated with combat soldiers, but has since been recognized as something that can affect anyone who faces any trauma. As Junger explains in his article, sometimes those who experience the most severe forms of PTSD are victims of rape, and those who witnessed but were not directly involved in combat, such as himself, as journalist who travelled to Afghanistan. Sharon Abramowitz explains, in her article, Searching for Normal In the Wake of the Liberian War, people are forced into a condition they are not accustomed to, where the suffering detaches them even before they have made a trial run. Abramowitz states, almost fifty percent of the population living in Liberia at the time of the Liberian war reported severe symptoms of PTSD.

Unfortunately, there is very little treatment for this and any other form of mental disorder due to many different barriers to care. Based on research for a paper I wrote discussing PTSD in American soldiers returning from war, the two biggest barriers were stigma and lack of access to care. In Farmer et al.’s book, Reimagining Global Health, one way to decrease the lack of access to care is to combine mental health care with primary health care. Many countries have found this to be more efficient and reach more people, either by having psychiatrists located in the same location as primary care physicians or having primary care providers trained in psychological health maintenance and care.

As I found in my research, the VA (Veteran’s Association) had tried to implement something similar based on survey results from soldiers saying this would be helpful. Unfortunately what this does not help is the stigma associated with any mental health diagnosis, as Farmer et al. describes as something that can greatly affect someone’s life, causing them to not be able to gain employment, and affecting the way family and friend’s view them.

Abramowitz explains that the entire mental and physical demeanor changes in people affected by PTSD, to the point that their own friends and family do not even recognize them. Because of this, often the friends and family try to get the person help before they themselves will reach out. Both in Liberia and the United States alike, many people who wish to seek treatment cannot afford the treatment they need. Farmer explains that neuropsychiatric morbidity is underdiagnosed and antidepressants are underutilized in rich and poor countries alike. In Reimagining Global Health, the DSM-V manual of mental disorders is discussed as something that can be a barrier to care because of the different forms across different cultures. The DSM-V describes PTSD and the symptoms associated with it, and is something for health care providers to use as a baseline to help diagnose different mental disorders and illnesses. Farmer et al. explains that the DSM-V is written based on American and European cultures, which may limit its use across culturally diverse populations.IMG_2374

 

Discussion Questions:

  • Do you agree that stigma is one of the biggest barriers to mental health care, especially the treatment of PTSD? What do you think might be other effective ways of dealing with stigma as a barrier to care? If you can think of any other major barriers to receiving mental health care, what are they and what might be some possible solutions?
  • Based on Farmer et al., the DSM-V can limit utility across cultures, which might reduce the diagnosing and care of mental health disorders around the world. What might be some of the cultural barriers caused by the DSM-V and what are some possible ways to address these problems? What might be some ideas for a more universal approach to mental health diagnosis and treatment?

Additional Sources:

Junger, Sebastian. “How PTSD Became a Problem Far Beyond the Battlefield.” Vanity Fair June 2015: n. pag. Web. <http://www.vanityfair.com/news/2015/05/ptsd-war-home-sebastian-junger>.

Doolin, D. T. (2009). Healing Hidden Wounds: The Mental Health Crisis of America’s Veterans. DTIC Document.

McNally, R. J. (2012). Are We Winning the War Against Posttraumatic Stress Disorder? Science, 336 (6083), 872–874. http://doi.org/10.1126/science.1222069

22 thoughts on “Trauma and Violence”

  1. I agree that there should be more cross-cultural models in the DSM-V, using clinical data/case studies from around the world. If doctors are being trained in cultural competence to improve care to all different groups, then why should their manual not reflect the same values?

    Some cultural barriers caused by the DSM-V could involve the manual not including certain customs that are common indicators of trauma/PTSD in certain cultures. Another possible example could be the distinguishing of traumatic, conflict-related nightmares (related to PTSD) and ordinary jin-inspired nightmares in Aceh, as mentioned in the Grayman paper. It seems that that the only way to make a comprehensive manual would be to involve people of many different cultures (or people who have done significant ethnographic research into these cultures) in writing the symptoms of different diseases – which seems like a very extensive task and a lofty goal to accomplish.

    1. – I would have to disagree Sebastian Junger when he says that PTSD is a “healthy reaction.” There is nothing healthy about the reactions that these people are encountering after traumatic events. These reactions feel “normal” to the individual, but they are most certainly are not, and they need to seek help.
      – I agree with Methma’s comment above. Doctor’s should diversify their training to adapt to cultural differences. Otherwise this could lead to misdiagnosis. Expanding and diversifying training will allow for doctor’s to get a better understanding of why a person reacts the way they do to a certain “normal” event. Normal practices could be seen as abnormal in another country. It depends on the cultural context of the situation. In order to address these problems, I think it would be helpful for psychiatrists and doctors to attend informational sessions and take extra classes in cultures where they will be traveling to. There are many mental illnesses, which can make it difficult to distinguish certain behaviors if they appear “normal” to us, but “abnormal” to someone else. Like the example we discussed in class where people in Japan didn’t recognize that menopause was actually a thing. No one knew because no one had discussed it, but in the US it had been well defined as a common event when women reach a certain age. In general, I think it is important for people to be cognizant and well-aware of different cultures ESPECIALLY if they are traveling to a different country and are supposed to be treating people. If you know nothing about them, how can you gain trust, loyalty, relationships, and an understanding of your patient?
      I also agree with Methma’s approach to writing different down symptoms of different diseases, but this would be a tedious and time-consuming task. I don’t know though, it’s never really been researched in-depth to know how helpful it could be!

    2. Methma, thank you for your idea of including people of different cultures to write down the symptoms. While this does seem like a very extensive task, I think there could be some alternatives. Currently the DSM is basically viewed throughout the world as a universal manual. If individual countries wrote their own DSM manuals or something like it, that could be much less time consuming and complicated. While maybe it isn’t realistic for individual countries to each write their own, maybe countries with similar cultures could write one because people of similar cultures will experience similar symptoms. Just an idea that could be an inclusion of your thoughts, while also expanding upon it.

  2. Kelly,

    I think you brought up some great points about the usefulness of the DSM on a global scale. As it was written according to Western ideology, experiences, and manifestations of illness, its generalizability to other contexts and cultures is mostly likely overstated. As we discussed in class, Kleinman found that depression as experienced in China had a completely different symptomology than depression as experienced by Westerners. Indeed, it was not that depression was absent from China, but that the illness manifested itself differently. While it is clear then that in many cases mental health diagnosis based off of a specific set of criteria is not generalizable in other contexts, it begets the question of whether or not this same principle applies to mental health treatments. For example, if depression manifests itself in accordance to cultural context, what does this mean for the treatment of depression in varying cultural settings? Are the same treatments (medication, psychotherapy, etc.) effective in every context, or does more research need to be done to ensure that people experiencing mental illness in a distinct biosocial context are receiving beneficial care? I’m not sure if research has been done in this area, but if not I think that it is definitely a question worthy of exploration.

    1. Sabrina,
      In order to discuss your question about the appropriate treatment of mental illnesses in different cultures, I think about a movie I just watched last week entitled “Hidden Pictures.” The movie discusses mental illness in other countries and the care that people in these countries receive. Much to my surprise, much of the care in these countries is very similar to that of the United States. The difference is that in these countries, the care often starts off with homeopathic remedies, and certain rituals, such as African rituals to try to rid the person of the evil curse that was put on them. However, once you dig deeper and go beyond this, you find that in the places where there is regular health care, treatment is comparable to that of the United States. As we have learned through discussions about pharmaceutical companies, these companies do distribute drugs to the developing world. Because of this, people do have access to the same treatment that people in the United States are getting. While the care is probably not as regular and does not involve monitoring of patients and changing of drugs, the drugs they receive are often the same. This is not to say treatment in these areas is the same, just to show that the same drugs do work to treat a lot of the same illnesses even though they manifest with different symptoms. It is also important to note that there are much fewer psychiatrists and people to diagnose mental illness in these places; as well as there being only a few facilities for people to seek care at, that are often very far away from their homes. So while care is certainly much harder to get, and probably less sought after for that reason, it still appears that many of the actual medications are the same. One other treatment option that can be compared to earlier days in the United States is that of treatment in South Africa. In South Africa, as is apparently the case in much of the world, people are involuntarily hospitalized and have no right to appeal that. The doctors cannot even discharge these people when they think they are healthy enough to live out in the world. Whoever put this person in the hospital, often parents, have to sign the person out in order for them to leave. While there used to be similar situations to this in the United States, today even those who should be hospitalized cannot be because there are not enough mental hospitals and psychology wards at hospitals to accommodate them. Still, many similarities can be seen in mental health care between the United States and other countries.

      1. Hey Kelly and Sabrina,
        I just wanted jump into your conversation as I was intrigued by some of the ideas you brought up. I like that you both addressed that mental health has very different stories depending on its contexts in various countries. Sabrina you brought up a great point about context specific treatment, and as Kelly said, understanding cultural beliefs and homeopathic medicine can enlighten how mental health might manifest in particular societies. Additionally, I would add that we shouldn’t just really on our foreign methodology and pharmaceuticals as the only acceptable treatment. We need to consider domestic health practices as probable solutions as well. Just like in the U.S. where there is a push to combine primary care and mental health services, global work can combine domestic practices with mental health treatment. For example, many practices from Asia such as herbal medicine and energy therapy have recently become part of an integrative method of addressing health known as CAM (complementary and alternative medicine). Even beyond treatment, acknowledging local practices can lead to cultural ownership of mental health illness.

  3. Kelly,

    Thank you for your post. I believe that you brought up several important topics for discussion. In regards to your first question, I do believe that stigma is the biggest barrier for those sufferering from mental health problems to receive help. This is due in my opinion to both how they believe they will be perceived and because of the lack of awareness in this country around mental health. Due to the stigma attached to it, mental health is hardly ever talked about in our society. On tv you can see advertisements offering medicines to help with every physical ailment, but not once can I remember seeing an advertisement offering medicine for mental ailments. Due to the lack of conversation surrounding mental health, those who are suffering are bound to believe that they are alone in their struggle. Through your own research I am sure that you can attest that there are many individuals suffering in very similar ways, however, because of the stigma surrounding this topic, these stories will likely never get heard.

    1. Steven,
      To add to your comment, I have support from a movie I just watched last week with Active Minds, a club I am part of. The movie was called “Hidden Pictures,” and shared the stories of people from other countries with mental illness. It supports your last statement about people with mental illness never being able to share their stories because of the stigma surrounding it. When Delaney Ruston, the filmmaker traveled to India, she spent two weeks trying to find one family that would talk to her about mental illness. She traveled the streets, asking people if they had anyone in their family with a mental illness that she could talk to. For two weeks she went with nothing, when finally through a connection at the hospital, she was introduced to a girl who was being treated who agreed to talk to her. When she went for the interview, the mother would not let the girl face the camera so as to keep her identity hidden, and would not let the girl talk. Ruston decided this interview would not work. But this shows how stigma can be even more powerful in foreign countries. Where in India, a mother will not even let her child speak or be seen because they are embarrassed of the mental illness. Ruston also finds from another family in India, that the family hides their daughter away to avoid telling people of her illness. The young woman is in her early twenties and suffers from bipolar mood disorder. She lives with her parents who take care of her and drive her 2 hours each way to seek care. When she is not traveling to see the psychiatrist, she spends the rest of her time at home with her dog. Her parents do not allow her to go anywhere other than the doctor because of the fear that she will embarrass them. They do not even go out because of the inevitable question about how their daughter is doing. This family is so confined by their daughters’ disability it’s a shame. While yes, these people do receive treatment, the stigma surrounding the mental illness that allows it to control the rest of their lives is the biggest barrier. Even when it is not a barrier to care as you brought up and I discussed originally, it is a barrier to social life. We thought the United States had a society that stigmatized mental health, but from this film it is clear that the United States almost does not compete with other countries around the world.

  4. As an addition to my original post, I thought I would let everyone know about world mental health day. The World Health Organization (WHO) as is often discussed surrounding mental health care is actually a huge advocate for decreasing stigma and providing equal mental health care to all. This year’s annual World Mental Health Day is on October 10th. The theme this year is “Dignity in mental health.” The WHO explains that this year they “will will be raising awareness of what can be done to ensure that people with mental health conditions can continue to live with dignity, through human rights oriented policy and law, training of health professionals, respect for informed consent to treatment, inclusion in decision-making processes, and public information campaigns.” The WHO explains that in other countries, people are deprived of their human rights as they are discriminated against, stigmatized, and marginalized. In addition, they are subject to emotional and physical abuse in both mental health facilities and the community. The WHO aims to bring recognition to the poor mental health care around the world and find ways to add equality to treatment everywhere.

    I have also added a very telling cartoon to my original post because I could not figure out how to add it to a comment.

  5. Hey Kelly! In terms of your second discussion question, I agree that the DSM is limited by its cultural specificity, both in terms of what it defines as causes as well as symptoms for PTSD. In terms of symptoms, as illustrated by the Grayman, Good, and Good paper we read talked about, in Aceh there has certainly been trauma and cause for PTSD to develop – but no word for one of the major signifiers of PTSD, “nightmare.” With other mental illnesses, symptoms have been proven to vary based on culture and location (e.g. somatic symptoms for depression in China), and the same is likely true with PTSD. However, the question we face then is whether these distinct symptoms can and should be considered under the umbrella of the same disorder, and treated as such. We don’t want to exclude people from potential help by basing our criteria on a Euro-centric list of symptoms; on the other hand, I’m not convinced that the way we deal with mental illness in this country is that great either. There has recently, as well, been evidence for the exporting of mental illness; traditional diagnoses of depression in China, for example, have increased substantially since the introduction of the DSM to the country. I’m still pretty conflicted about this, and want to be wary of forcing our social constructions onto other countries. Secondly, I think that the way PTSD is defined as caused by a specific instance of trauma is problematic, as we discussed in class. What about constant micro-agressions? Wars that last for years, becoming almost like a new “normal”? We need, too, to look into the differences in the ways this type of differing circumstance affects survivors’ psychology as well.

    1. Allison thanks for your comment. In response to your first question about whether we should place these symptoms under the same umbrella and treat them the same elsewhere, I would tend to say yes we probably should. While yes, the symptoms of PTSD and other mental illnesses might manifest themselves in different ways depending on what part of the world you live in, if we look at the underlying factors, they are still very similar regardless of where you are. Because of this, I believe that the disorders can be treated the same, as long as we can differentiate diagnoses based on the way they present themselves in whatever part of the world is in question. While yes, I would agree that the way we treat mental illness in the United States isn’t that great either, it is still much better than it is in many different regions.

      For one of my other classes, I watched a video about a lady who traveled from country to country, looking at the way people with mental illness were treated and what methods they had of getting help. Every other country that she went to, had much worse mental health treatment than we do. Some countries would chain people with disabilities to posts so that they could not “escape,” other countries would hide those with schizophrenia, depression, etc. away from the world. In other countries, mostly in Africa, mental illnesses were viewed as a curse that somebody put on you. For this you went to a spiritual healer to get the demons out of you. When this didn’t work, you were just written off. One major thing all of these countries had in common is that most of the people who actually were able to get real care from a psychiatrist, had to drive two or three hours each way to get that care. While yes, the US doesn’t have the greatest care, we are working on it, and we arguably have much better care than most other countries in the world.

      As for your comment about the way PTSD is described as an acute instance of trauma, I would agree with you that it is problematic. As I stated in my original post, PTSD is starting to be viewed differently, and diagnosed in people who have many different experiences of trauma. I did not, however discuss those people who have experienced constant violence for years, making it kind of a social construction of reality. I agree that these people do need to be paid more attention, and their symptoms should be taken seriously as well. If I am not mistaken, I believe the DSM-V may have actually revised some of their symptoms checklist to include those who have experienced any type of violence, whether acute or chronic. If this is not the case, I do hope that that is changed in the next revision of the DSM.

  6. Hi Kelly,
    Thank you for your post!
    In regards to your first question, I do think that stigma, in addition to lack of access to care, is a great barrier to mental health. I think in general, there’s this perception that mental health ‘disorders’ are less burdensome than physiological diseases (malaria, TB, HIV/AIDS, etc.). This perception is largely internalized in those suffering from mental disorders, which therefore discourages them from seeking necessary help. Furthermore, this points to a larger issue of the separation between mental health and biological health. While many may view these two separately, we have learned in class that they are highly intertwined and must both be treated. Then again, this leads to the question of whether mental health should be treated separately or whether it should be treated in conjunction with physiological diseases. What do you think?

    As for your second question, I think that a limitation of the DSM-V stems from ‘local biologies’ (which we discussed in class), or the fact that symptoms for the same disease are going to vary from country to country. This means that cultural barriers blur not only actual diagnoses of a disease, but also their corresponding treatments.

    1. Diem-Khanh, thank you for your participation in my post. As an answer to the question you posed, I think mental health disorders should be treated separately from physiological diseases. Just to play devil’s advocate, earlier in your comment you referred to mental health and biological health. Some would argue that much of mental health is biological as well. Most mental disorders are caused by imbalances in the brain. which is why there is medication that can treat them. While I knew what you meant, I just wanted to comment on it to make sure you realized that as well. As far as treating the two together, I would argue that you need to figure out the underlying problem, meaning whether there is a physiological problem causing a psychological problem, or if it is the other way around. Similarly to medicalization of social suffering, we also do not want to give medication to people for things that they may not need, or for something that is going to treat one problem, but still leave the underlying problem untreated. Although, I also think in some cases this may be the only approach to providing mental health care. Because of the stigma associated with mental health, many people will not seek care if it is provided separately. Time is also a major issue, from research I have done for a different class, soldiers explain that one of their big barriers is getting time of work. If mental and physical health were treated at the same time, maybe this would not be so much of an issue for as many people. I think though, that I would need to do more research to determine what my final answer would be. Thank you for making me think about that possibility of care though.

      1. Hey Kelly,
        Thanks for your opinion! And of course, as you pointed out, much of mental health is biological. (I was more referring to this general idea that 1) they are separate and 2) “physical” diseases are more burdensome than “mental” diseases.) But I think that is why I’m curious as to whether the two should be treated as completely separate or whether separate treatment is even possible. Like you suggested, often physiological problems cause psychological problems (and vice versa). By treating both problems together, would we be undermining the single burden of mental health?

        1. Also, thank you for bringing up the point about time. That isn’t something I’ve considered before.

  7. Hey Kelly!

    Thank you for your post! I think you brought up some great points about the need for some cross-cultural nature of mental illness and the need to expand the DSM definitions of PTSD.

    To try to answer your first question, I think that stigma is a huge factor in the barriers to mental health. I think it can be problematic however to put too much of the burden on “stigma”. I think it can become a problem if we place too much of the blame on “culture” and don’t worry about the lack of resources and access to treatment options available. Even with a complete eradication of stigma, if there are no options for treatment for people with mental illness, they are not going to be getting any better. While, I do not suggest we ignore the issue, I think we must be careful o get caught up the issue of stigma so much so that we stop acknowledging the other factors such as lack of access to care.

    I think your second question is a very interesting albeit complicated one. I agree with Diem-Khanh that the problem with using the DSM-V in all cultural contexts stems from local biologies. I do believe that PTSD manifests itself differently in different social environments. We need a different manual in order to diagnose it and we definitely need to rethink the methods to treat it. We like the DSM-V because it provides simplicity and universality. I think it is important to create a model that is specific to each local, cultural context. This may not be as popular a model because it cannot be universally applied and would have to be redone in each new place, but I would argue that a model based of American and European cultures cannot be universally applied either.

    1. Yilena, thank you for your insight. I never really thought about the possibility that people put too much blame on stigma without addressing the other problems. That is a very good point. Looking at it as a big picture, that definitely seems like a problem. While I do still believe that stigma is the biggest barrier to care, that does mean that it is the only barrier. A lot of research actually shows that second to stigma, the next biggest barrier to care is the lack of care available. Another thing that I think we need to consider as part of the lack of access to care is the lack of money to pay for it. While medical insurance companies cover a lot of medical expenses, usually mental health care is not one of those. Mental health is just as expensive as other health care, and yet people are expected to pay for it out of pocket. For many people this just isn’t possible. Even for people who can find a provider, they still can’t get help anyway.

  8. Do you agree that stigma is one of the biggest barriers to mental health care, especially the treatment of PTSD? What do you think might be other effective ways of dealing with stigma as a barrier to care? If you can think of any other major barriers to receiving mental health care, what are they and what might be some possible solutions?
    Hi Kelly,

    Thanks for the post! With regard to the first question, I do agree that stigma is one of the largest barriers to mental health care. In fact, I think there’s a stigma associated with every form of illness, albeit mental or physical, because doing asking for help in any capacity can be perceived as an inability to cope with your surroundings. However, because mental illness isn’t a visual marker that can be identified easily, the stigma persists because it can be covered up. In order to reduce the stigma, mental illness awareness has to be normalized. It needs to be embraced and integrated into a society.
    That said, there are definitely other barriers. Money is perhaps the most formidable. Many of the war-torn countries populated with individuals suffering from mental illness are not in a position to offer mental health care to its people. They cannot afford to do so.
    With regard to the second question, some of the cultural barriers caused by the DSM-V may include the deliberateness with which we address mental health care. It’s more acceptable in European and American society to admit to suffering from trauma, or to even know what trauma is in the first place. If these terms aren’t explained and broached carefully, the individuals being asked to answer these questions will not be willing nor able to. You ask for a more universal approach to solving this? Well, I don’t think there is one. As long as cultures differ, you cannot approach this topic universally. I’d advise that those looking to treat mental illnesses abroad need to first understand their cultural views toward mental illness.

  9. Chad, thank you for your post, it has really got me thinking. In regards to the money part, you are very right. While we can say all we want that we will send missionary psychiatrists just like we send missionary doctors to war-torn countries, this does not work out the same. I think first of all, there are not as many psychiatrists as there are doctors, so if we do not even have enough to treat our own people in the Western world, how could we ever hope to send anyone with any sort of knowledge to another country. On top of that, medicine costs money. So even if we could hypothetically send psychiatrists to these countries, that does not solve the problem of medication to treat those who really need it. Medicine will always cost money, so even with volunteer workers, there is still a major problem with being able to afford medication for these people because we know that they will not be able to afford it for themselves. Thinking about the United States, many people in the United States cannot even afford mental health care; and although there are insurance companies for that, many insurance companies are very difficult in paying for psychiatric treatment. While they are slowly improving, if people in the United States cannot even afford care, how could we ever think that people in war-torn countries could afford care?

    As far as a universal approach, as we have gotten farther in the class, I would now tend to agree with you that there is no such thing as a universal approach. We have discussed extensively in class that in order for any programs to succeed in other countries we need to know the culture of that county. We even discussed it in regards to vaccination programs, such as the WHO’s global smallpox eradication program. We read that many people did not want to get the vaccinations, part of this being due to that fact that the people sent there to give the vaccinations had no regard for their culture, they were just there to force the vaccine on everyone. If the same thing were to happen with mental health initiatives, I can imagine that it would be exponentially worse because the patients are already mentally unstable. To have someone in who is supposed to help them, but turns their world upside down, not having any regard for the person’s culture, that could be a very extreme trigger, and probably make people even worse instead of helping them.

  10. Looking back on what we have learned this semester, I think it is important to add something about medication to my post. While my post primarily discusses PTSD and the reason why people do not seek care, I think medication is important to add in here. As we learned from Jeremy Greene in his 2011 article, pharmaceuticals have relatively recently become a central theme in global health. Pharmaceutical companies start sending medicines to other countries, and making themselves seem so high and mighty because they improving the lives of so many people who cannot afford the care they need. However, the other side to this that we learned about is the medicalization of social suffering. In class we discussed the case of Chile where 57% of people seen for primary care visits were found to have mood disorders. In order to fix this, western countries and pharmaceutical companies starting throwing anti-depressants and anti-anxiety medication on these people. By doing this, it helped to make these people suffer a little less and be more productive, but on the other hand it did not address the underlying problems causing the mood disorders. People will only be able to stay on these drugs for so long and once they will likely go right back to the way they were without the underlying issues being addressed.

    I think that this is important to discuss, especially relating to PTSD. People who have PTSD, while there are medications to take, it is extremely necessary for them to have counseling as well. These people have issues with what they have seen and experienced that causes them often to relive those experiences. While medication can definitely be helpful to curb those reactions, if they do not receive counseling to address the trauma they have experienced and teach them how to move past it and cope with it, they will never be able to function without the medication. It then becomes another problem all together of people being on medications for their whole life that was only meant for a short period of time. I think that with all of our discussions about medicalization of global health and the aspect of underlying social conditions causing mental problems, it is very important to incorporate this into my original post.

  11. I like your discussion of Abramowitz’s observation: “Abramowitz explains that the entire mental and physical demeanor changes in people affected by PTSD, to the point that their own friends and family do not even recognize them. Because of this, often the friends and family try to get the person help before they themselves will reach out.” This opens up a whole new concern about agency and mental health problems, and how patients who are suffering from severe psychological pain and illness are sometimes stripped of their autonomy because of the way their detachment from identity, ‘normalcy,’ and perceived functionality in the community through the enactment of their identity (I believe Abramowitz discusses this as well) evokes fear, dissonance in one’s social body, and can manifest as a point of social suffering.

    To answer your first question, I would imagine that stigma is one barrier to seeking mental healthcare for symptoms of PTSD, especially in cases where individuals feel as though their experiences or actions in which their trauma is rooted is somehow “their fault” or warrants the pain that they endure from their subsequent trauma. I don’t know if stigma is the largest obstacle that stands between victims of PTSD and trauma and the care they deserve, but I strongly believe that, if uniform, easy access to affordable and quality mental healthcare were available to everyone on the planet, there would still be discrepancies in the efficacy with which victims of trauma find treatment and healing. I believe a shift in cultural paradigms that characterize the mentally ill as incompetent should they require/seek help or that demonize them towards a blame-free, open, and compassionate attitude toward health for all is a fundamental step in creating universal access to resources and health solutions overall.

  12. Hi Kelly,
    Thanks for your thoughtful post! In regards to your first question I think that the stigma associated with mental illness is one of the largest barriers that NGOs and governments face in attempting an intervention. The access to mental health care treatment is already much lower than is needed and the stigma associated with mental illness further limits access to treatment. Educating individuals and families on mental illness is probably the most effective ways of reducing social stigma. Sensitivity training can do a lot to make mental illness something not to be ashamed of. Overcoming cultural barriers during interventions is something that needs to be addressed in order to make people feel comfortable enough to seek help without facing the shame that is often attributed to illness.

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