The Western Concept of PTSD

I feel that, in clinical psychology, we often pay lip service to the idea that cultural factors influence mental illness, but we sometimes forget this in practice.

This article reminded me of this once again. In it, a psychiatrist named Samah Jabr suggested that PTSD statistics from Palestine are, at best, misleading, due to the questionable methodology of directly applying definitions of PTSD in a context apart from where they were developed. I would encourage everyone to read it and reflect on its application in clinical practice.

I can’t summarize Dr. Jabr better than her own words, so I’ll let her speak for herself:

PTSD better describes the experiences of an American soldier who goes to Iraq to bomb and go back to the safety of the United States. He’s having nightmares and fears related to the battlefield and his fears are imaginary. Whereas for a Palestinian in Gaza whose home was bombarded, the threat of having another bombardment is a very real one. It’s not imaginary. There is no ‘post’ because the trauma is repetitive and ongoing and continuous. I think we need to be authentic about our experiences and not to try to impose on ourselves experiences that are not ours.

Dr. Jabr also suggested that what we in the West think of as mental illness may be the result of a sick context, not a sick person.

A metaphor: if you pull a fish out of water and let it sit on the sand bank, it will flop around, and eventually suffocate and die. But we don’t characterize the fish’s flopping behaviors as “bizarre” or “maladaptive,” nor do we see them as moral failings or place blame on the fish for its condition. This isn’t some kind of malfunction of the fish, it’s a fish working perfectly well in a toxic context. The treatment for the fish isn’t to give it morphine so it stops flopping, the treatment is to get it back into the water.

In the West, we have a very individualistic, reductionist, and materialistic bias in the way we view mental illness. To co-opt a metaphor from a different context, we have swept all the apparent “problems” of mental illness into one closet, namely, the brains of individuals (or even more reductionistic, the levels of neurotransmitters within the brain). Even the phrase mental illness suggests a malfunction at the level of the brain. But we haven’t solved the problem of mental illness, we’ve just given it a location and a name.

This may lead to systematic problems in how we conceptualize and treat mental illness. For instance, it leads us to place the responsibility of fixing mental illness entirely on the individual. We may even see depressed, anxious, or self-defeating behaviors as moral failings, since in the West “moral failings” themselves are individualistic in nature.

But if a person is placed in a toxic context, she may develop what we call behavioral symptoms despite having a perfectly-functioning brain. Even behaviors that seem completely dysfunctional, such as cutting one’s self, intentionally restricting food intake, suicidal ideation, aggression, or social withdrawal, may be the result of a perfectly functional human being and brain in a toxic or dysfunctional context.

That is not to say that all mental illness is the result of context. It would be similarly wrong to sweep all the problems into a different corner of the house. Rather, I would simply encourage us as practitioners to resist simplistic models of mental illness that ignore the bigger picture.

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