Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress, Ethnopsychology and Ethnophysiology in Alleviating Suffering and Preventing Stigma

Abstract

In the aftermath of a decade-long Maoist civil war in Nepal and the recent relocation of thousands of Bhutanese refugees from Nepal to Western countries, there has been rapid growth of mental health and psychosocial support programs, including posttraumatic stress disorder treatment, for Nepalis and ethnic Nepali Bhutanese. This medical anthropology study describes the process of identifying Nepali idioms of distress and local ethnopsychology and ethnophysiology models that promote effective communication about psychological trauma in a manner that minimizes stigma for service users. Psychological trauma is shown to be a multifaceted concept that has no single linguistic corollary in the Nepali study population. Respondents articulated different categories of psychological trauma idioms in relation to impact on the heart-mind, brain-mind, body, spirit, and social status, with differences in perceived types of traumatic events, symptom sets, emotion clusters and vulnerability. Trauma survivors felt blamed for experiencing negative events, which were seen as karma transmitting past life sins or family member sins into personal loss. Some families were reluctant to seek care for psychological trauma because of the stigma of revealing this bad karma. In addition, idioms related to brain-mind dysfunction contributed to stigma, while heart-mind distress was a socially acceptable reason for seeking treatment. Different categories of trauma idioms support the need for multidisciplinary treatment with multiple points of service entry.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

Notes

  1. 1.

    Young (1995) argues that the psychiatric lens of PTSD originally was developed primarily to understand the mental health problems and frame treatment of returning American veterans from Viet Nam. Young ties the growing interest in psychological trauma during the 1860s to increasing use of railway transport and British Parliament’s passing in 1864 of legislation to financially compensate victims of railway injury. In addition, Summerfield (2001) correlates the growing interest in psychological trauma with changes in personhood related to entitlement, expected success and absence of suffering. PTSD legitimizes victimhood, moral exculpation and disability pension. Bremner (2002) also suggests that personality has changed from a warrior class, where life was filled with violence and people endured severe hardship with great courage and strength, to a “postwarrior” class where trauma overwhelms individual resources. From automobile collisions to overhearing sexual jokes in the workplace, identifying with the psychological trauma discourse provides the foundation for compensation Summerfield (2001) views PTSD as the product of compensation pursued on the basis of individual rights: “An individualistic rights conscious culture can foster a sense of personal injury and grievances and thus a need for restitution in encounters in daily life that were formerly appraised more dispassionately.”

  2. 2.

    Argenti-Pillen (2003) describes how the new breed of “fearless women” in Sri Lanka who engage in trauma intervention programs are also the women who traveled throughout the country pursuing claims for disappeared husbands and son, thus illustrating a specific political context in which the construct becomes employed. An outspoken critic of the trauma and violence literature, Summerfield (1999) states that (1) trauma is not necessarily widespread in conflict settings, and (2) war is a social experience requiring healing through social means, not Western mental health intervention. Summerfield refers to the work of Somasundaram (1996) in Sri Lanka, which states that “none of the subjects considered themselves psychiatrically ill, and just saw their symptoms as an inevitable part of the war.”

References

  1. Argenti-Pillen, Alex 2003 Masking Terror: How Women Contain Violence in Southern Sri Lanka. Philadelphia: University of Pennsylvania Press.

    Google Scholar 

  2. Bass, J., R. Neugebauer, K. F. Clougherty, H. Verdeli, P. Wickramaratne, L. Ndogoni, L. Speelman, M. Weissman, and P. Bolton 2006 Group Interpersonal Psychotherapy for Depression in Rural Uganda: 6-Month Outcomes: Randomised Controlled Trial. Br. J. Psychiatry 188:567–573.

    Article  Google Scholar 

  3. Bennett, Lynn 1983 Dangerous Wives and Sacred Sisters: Social and Symbolic Roles of High-Caste Women in Nepal. New York: Columbia University Press.

    Google Scholar 

  4. Bolton, Paul 2001 Local Perceptions of the Mental Health Effects of the Rwandan Genocide. Journal of Nervous and Mental Disease 189(4):243–248.

    Article  Google Scholar 

  5. Bolton, P., J. Bass, R. Neugebauer, H. Verdeli, K. F. Clougherty, P. Wickramaratne, L. Speelman, L. Ndogoni, and M. Weissman 2003 Group Interpersonal Psychotherapy for Depression in Rural Uganda: A Randomized Controlled Trial. JAMA 289(23):3117–3124.

    Article  Google Scholar 

  6. Bolton, Paul, Judith Bass, Theresa Betancourt, Liesbeth Speelman, Grace Onyango, Kathleen F. Clougherty, Richard Neugebauer, Laura Murray, and Helen Verdeli 2007 Interventions for Depression Symptoms Among Adolescent Survivors of War and Displacement in Northern Uganda: A Randomized Controlled Trial. JAMA: Journal of the American Medical Association 298(5):519–527.

    Article  Google Scholar 

  7. Bracken, P. J., J. E. Giller, and D. Summerfield 1995 Psychological Responses to War and Atrocity: The Limitations of Current Concepts. Social Science & Medicine 40(8):1073–1082.

    Article  Google Scholar 

  8. Bremner, J. Douglas 2002 Does Stress Damage the Brain? Understanding Trauma-Related Disorders from a Mind-Body Perspective. New York: W. W. Norton & Co, Inc.

    Google Scholar 

  9. Breslau, Joshua 2004 Cultures of Trauma: Anthropological Views of Posttraumatic Stress Disorder In International Health. Culture, Medicine and Psychiatry 28(2):113–126.

    Article  Google Scholar 

  10. Clifford, Terry 1990 Tibetan Buddhist Medicine and Psychiatry. York Beach, ME: Samuel Weiser.

    Google Scholar 

  11. Dahal, Kapil Babu 2008 Medical Anthropology in Nepal. The Innovia Foundation Newsletter 6: 7–9. Electronic document, www.innoviafoundation.org.

  12. Desjarlais, Robert R. 1992 Body and Emotion: The Aesthetics of Illness and Healing in the Nepal Himalayas. Philadelphia: University of Pennsylvania Press.

    Google Scholar 

  13. Desjarlais, Robert R. 2003 Sensory Biographies: Lives and Deaths Among Nepal’s Yolmo Buddhists. Vol. 2. Berkeley: University of California Press.

    Google Scholar 

  14. Dwyer, Leslie, and Degung Santikarma 2007 Posttraumatic Politics: Violence, Memory, and Biomedical Discourse in Bali. In R. Lemelson, L. Kirmayer, and A. Tobin (eds.), Inscribing Trauma: Cultural, Psychological, and Biological Perspectives on Terror and Its Aftermath. Cambridge: Cambridge University Press.

    Google Scholar 

  15. Fontana, A., L. S. Schwartz, and R. Rosenheck 1997 Posttraumatic Stress Disorder Among Female Vietnam Veterans: A Causal Model of Etiology. American Journal of Public Health 87(2):169–175.

    Article  Google Scholar 

  16. Fox, Steven H. 2003 The Mandinka Nosological System in the Context of Post-trauma Syndromes. Transcultural Psychiatry 40(4):488–506.

    Article  Google Scholar 

  17. French, Lindsay 1994 The Political Economy of Injury and Compassion: Amputees of the Thai- Cambodia Border. Pp. 69–99 in T. J. Csordas (ed.) Embodiment and Experience: The Existential Ground of Culture and Self. New York: Cambridge University Press.

    Google Scholar 

  18. Gautam, Choodamani 2001 Gautam’s Up-to-Date Nepali-English Dictionary. Biratnagar, Nepal: Gautam Prakashan.

    Google Scholar 

  19. Hinton, Devon E., and Roberto Lewis-Fernandez 2010 Anxiety Disorders and Culturally Specific Complaints (Idioms of Distress): An Analysis of Their Clinical Importance. In H. B. Simpson, Y. Neria, R. Lewis-Fernandez, and F. Schneier (eds.), Understanding Anxiety: Clinical and Research Perspectives from the Columbia University Department of Psychiatry. Cambridge: Cambridge University Press.

    Google Scholar 

  20. Hinton, Devon E., and Susan Hinton 2002 Panic Disorder, Somatization, and the New Cross-Cultural Psychiatry: The Seven Bodies of a Medical Anthropology of Panic. Culture, Medicine and Psychiatry 26(2):155–178.

    Article  Google Scholar 

  21. Hinton, Devon E., Vuth Pich, Steven A. Safren, Mark H. Pollack, and Richard J. McNally 2006 Anxiety Sensitivity Among Cambodian Refugees with Panic Disorder: A Factor Analytic Investigation. Journal of Anxiety Disorders 20(3):281–295.

    Article  Google Scholar 

  22. Hinton, Devon E., Andrew Rasmussen, Leakhena Nou, Mark H. Pollack, and Mary-Jo Good 2009a Anger, PTSD, and the Nuclear Family: A Study of Cambodian Refugees. Social Science & Medicine 69(9):1387–1394.

    Article  Google Scholar 

  23. Hinton, Devon E., Alexander L. Hinton, V. Pich, J.R. Loeum, and M.H. Pollack 2009b Nightmares Among Cambodian Refugees: The Breaching of Concentric Ontological Security. Culture, Medicine and Psychiatry 33: 219–265.

  24. Hruschka, Daniel J., Lynn M. Sibley, N. Kalim, and J. K. Edmonds 2008 When There Is More Than One Answer Key: Cultural Theories of Postpartum Hemorrhage in Matlab, Bangladesh. Field Methods 20(4):315–337.

    Article  Google Scholar 

  25. Human Rights Watch 2007 Children in the Ranks: The Maoists’ Use of Child Soldiers in Nepal. Kathmandu, Nepal: Human Rights Watch.

    Google Scholar 

  26. IASC 2007 Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Geneva: Inter-Agency Standing Committee.

    Google Scholar 

  27. INSEC 2008 Fact Sheet: Number of Victims Killed by State and Maoist in Connection with the “People’s War” (12 Feb 1996–31 Dec 2006). Informal Sector Service Center (INSEC), Kathmandu. http://www.inseconline.org/. Accessed 1 April 2009.

  28. Janes, Craig R. 1999 Imagined Lives, Suffering, and the Work of Culture: The Embodied Discourses of Conflict in Modern Tibet. Medical Anthropology Quarterly 13(4):391–412.

    Article  Google Scholar 

  29. Johnson D. R., H. Lubin, R. Rosenheck, A. Fontana, S. Southwick, D. Charney (1997) The Impact of the Homecoming Reception on the Development of Posttraumatic Stress Disorder. The West Haven Homecoming Stress Scale (WHHSS). Journal of Traumatic Stress 10(2):259–277.

    Google Scholar 

  30. Jordans, Mark J. D., Annalise S. Keen, Hima Pradhan, and Wietse A. Tol 2007 Psychosocial Counselling in Nepal: Perspectives of Counsellors and Beneficiaries. International Journal for Advancement of Counseling 29:57–68.

    Article  Google Scholar 

  31. Jordans, Mark J.D., Wietse A. Tol, Ivan H. Komproe, and Joop T.V.M. De Jong 2009 Systematic Review of Evidence and Treatment Approaches: Psychosocial and Mental Health Care for Children in War. Child and Adolescent Mental Health 14(1): 2–14.

  32. Kenny, Michael G. 1996 Trauma, Time, Illness, and Culture: An Anthropology Approach to Traumatic Memory. Pp. 151–171 in P. Antze and M. Lambek (eds.), Tense Past: Cultural Essays in Trauma and Memory. New York: Routledge.

    Google Scholar 

  33. Kinzie, J. D., J. K. Boehnlein, P. K. Leung, L. J. Moore, C. Riley, and D. Smith 1990 The Prevalence of Posttraumatic Stress Disorder and Its Clinical Significance Among Southeast Asian Refugees. American Journal of Psychiatry 147(7):913– 917.

    Google Scholar 

  34. Kleinman, Arthur, and Robert R. Desjarlais 1995 Violence, Culture, and the Politics of Trauma. Pp. 173–192 in A. Kleinman (ed.), Writing at the Margin: Discourse Between Anthropology and Medicine. Berkeley: University of California Press.

    Google Scholar 

  35. Kohrt, Brandon A. 2006 A Brief Report on Psychological Trauma and Psychosocial Services in Kathmandu, Nepal—a Distributed Report. Kathmandu.

  36. Kohrt, Brandon A. forthcoming The Role of Traditional Rituals for Reintegration and Psychosocial Wellbeing of Child Soldiers in Nepal. In Rethinking Trauma: Memory, Symptom, and Recovery after Genocide and Mass Violence. A.L. Hinton and D.E. Hinton, eds. New Brunswick, NJ: Rutgers University Press.

  37. Kohrt, Brandon A., and Ian Harper 2008 Navigating Diagnoses: Understanding Mind-Body Relations, Mental Health, and Stigma in Nepal. Culture, Medicine and Psychiatry 32(4):462–491.

    Article  Google Scholar 

  38. Kohrt, Brandon A., and Robert A. Koenig 2009 Child Soldiers After War. Anthropology News 50(5):27.

    Article  Google Scholar 

  39. Kohrt, Brandon A., and Carol M. Worthman 2009 Gender and Anxiety in Nepal: The Role of Social Support, Stressful Life Events, and Structural Violence. CNS Neuroscience & Therapeutics 15:237–2248.

    Article  Google Scholar 

  40. Kohrt, Brandon A., Daniel J. Hruschka, Holbrook E. Kohrt, Nova L. Panebianco, and G. Tsagaankhuu 2004 Distribution of Distress in Post-Socialist Mongolia: A Cultural Epidemiology of Yadargaa. Social Science & Medicine 58(3):471–485.

    Article  Google Scholar 

  41. Kohrt, Brandon A., Richard D. Kunz, Jennifer L. Baldwin, Naba R. Koirala, Vidya D. Sharma, and Mahendra K. Nepal 2005 “Somatization” and “Comorbidity”: A Study of Jhum-Jhum and Depression in Rural Nepal. Ethos 33(1):125–147.

    Article  Google Scholar 

  42. Kohrt, Brandon A., Wietse A. Tol, and Ian Harper 2007 Reconsidering Somatic Presentation in Nepal. Journal of Nervous & Mental Disease 195(6):544.

    Article  Google Scholar 

  43. Kohrt, Brandon A., Mark J. D. Jordans, Wietse A. Tol, Rebecca A. Speckman, Sujen M. Maharjan, Carol M. Worthman, and Ivan H. Komproe 2008 Comparison of Mental Health Between Former Child Soldiers and Children Never Conscripted by Armed Groups in Nepal. JAMA: Journal of the American Medical Association 300(6):691–702.

    Article  Google Scholar 

  44. Kohrt, Brandon A., Wietse A. Tol, Judith Pettigrew, and Rohit Karki 2010 Children and Revolution: The Mental Health and Psychosocial Wellbeing of Child Soldiers in Nepal’s Maoist Army. In: M. Singer and G. D. Hodge (Eds.), The War Machine and Global Health. Lanham MD: Altamira Press Rowan & Littlefield.

    Google Scholar 

  45. Layne, C.M., W.R. Saltzman, G.M. Burlingame, R.F. Houston, and R.S. Pynoos 2000 Evaluation of Program Efficacy UNICEF School-based Psychosocial Program for War-Exposed Adolescents as Implemented During the 1999–2000 School Year. UNICEF.

  46. Lemelson, Robert, Laurence J. Kirmayer, and Mark Barad 2007 Trauma in Context: Integrating Cultural, Clinical and Biological Perspectives. In R. Lemelson, L. Kirmayer, and A. Tobin (Eds.), Inscribing Trauma: Cultural, Psychological, and Biological Perspectives on Terror and Its Aftermath. Cambridge: Cambridge University Press.

    Google Scholar 

  47. Lopes Cardozo, B., A. Vergara, F. Agani, and C. A. Gotway 2000 Mental Health, Social Functioning, and Attitudes of Kosovar Albanians Following the War in Kosovo. JAMA: Journal of the American Medical Association 284(5):569–577.

    Article  Google Scholar 

  48. Lopes Cardozo, B., R. Kaiser, C. A. Gotway, and F. Agani 2003 Mental Health, Social Functioning, and Feelings of Hatred and Revenge of Kosovar Albanians One Year After the War in Kosovo. Journal of Traumatic Stress 16(4):351–360.

    Article  Google Scholar 

  49. Lopes Cardozo, B., L. Talley, A. Burton, and C. Crawford 2004a Karenni Refugees Living in Thai-Burmese Border Camps: Traumatic Experiences, Mental Health Outcomes, and Social Functioning. Social Science & Medicine 58(12):2637–2644.

    Article  Google Scholar 

  50. Lopes Cardozo, Barbara L., O. O. Bilukha, C. A. Crawford, I. Shaikh, M. I. Wolfe, M. L. Gerber, and M. Anderson 2004b Mental Health, Social Functioning, and Disability in Postwar Afghanistan. JAMA: Journal of the American Medical Association 292(5):575–584.

    Article  Google Scholar 

  51. Lutz, Catherine 1988 Unnatural Emotions: Everyday Sentiments on a Micronesian Atoll & Their Challenge to Western Theory. Chicago: University of Chicago Press.

    Google Scholar 

  52. Marsella, Anthony J., Matthew J. Friedman, Ellen T. Gerrity, and Raymond M. Scurfield 1996 Ethnocultural Aspects of PTSD: Some Closing Thoughts. Pp. 529-538 in A. J. Marsella, M. J. Friedman, E. T. Gerrity, and R. M. Scurfield (eds.), Ethnocultural Aspects of Posttraumatic Stress Disorder: Issues, Research, and Clinical Applications. Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  53. Maskarinec, Gregory G. 1992 A Shamanic Etiology of Affliction from Western Nepal. Social Science & Medicine 35(5):723–734.

    Article  Google Scholar 

  54. Maskarinec, Gregory G. 1995 The RULINgs of the Night: An Ethnography of Nepalese Shaman Oral Texts. Madison: University of Wisconsin Press.

    Google Scholar 

  55. McHugh, Ernestine L. 1989 Concepts of the Person Among the Gurungs of Nepal. American Ethnologist 16(1):75–86.

    Article  Google Scholar 

  56. McHugh, Ernestine L. 2001 Love and Honor in the Himalayas: Coming to Know Another Culture. Philadelphia: University of Pennsylvania Press.

    Google Scholar 

  57. McKenzie, Kwame, Vikram Patel, and Ricardo Araya 2004 Learning from Low Income Countries: Mental Health. BMJ: British Medical Journal 329(7475):1138–1140.

    Article  Google Scholar 

  58. McNally, Richard J. 2003 Progress and Controversy in the Study of Posttraumatic Stress Disorder. Annual Review of Psychology 54:229–252.

    Article  Google Scholar 

  59. Miller, Ken 2009 Unholy Ground. Sri Lanka (documentary film).

  60. Mohlen, H., P. Parzer, F. Resch, and R. Brunner 2005 Psychosocial Support for War-Traumatized Child and Adolescent Refugees: Evaluation of a Short-Term Treatment Program. Australian & New Zealand Journal of Psychiatry 39(1-2):81-87.

    Google Scholar 

  61. Mollica, R. F., G. Wyshak, and J. Lavelle 1987 The Psychosocial Impact of War Trauma and Torture on Southeast Asian Refugees. American Journal of Psychiatry 144(12):1567–1572.

    Google Scholar 

  62. Mollica, R. F., G. Wyshak, J. Lavelle, T. Truong, S. Tor, and T. Yang 1990 Assessing Symptom Change in Southeast Asian Refugee Survivors of Mass Violence and Torture. American Journal of Psychiatry 147(1):83–88.

    Google Scholar 

  63. Moore, C. C., A. K. Romney, T. L. Hsia, and C. D. Rusch 1999 The Universality of the Semantic Structure of Emotion Terms: Methods for the Study of Inter- and Intra-cultural Variability. American Anthropologist 101(3):529–546.

    Article  Google Scholar 

  64. Neuner, Frank, Claudia Catani, Martina Ruf, Elisabeth Schauer, Maggie Schauer, and Thomas Elbert 2008 Narrative Exposure Therapy for the Treatment of Traumatized Children and aAdolescents (KidNET): From Neurocognitive Theory to Field Intervention. Child & Adolescent Psychiatric Clinics of North America 17(3):641–664.

    Article  Google Scholar 

  65. Nichter, Mark 1981 Idioms of Distress: Alternatives in the Expression of Psychosocial Distress: A Case Study from South India. Culture, Medicine and Psychiatry 5:379–408.

    Article  Google Scholar 

  66. Nicoletti, Martino 2004 Shamanic Solitudes: Ecstasy, Madness and Spirit Possession in the Nepal Himalayas. Kathmandu: Vajra Books.

    Google Scholar 

  67. Peters, Larry 1981 Ecstasy and Healing in Nepal: An Ethnopsychiatric Study of Tamang Shamanism. Malibu, CA: Udena.

    Google Scholar 

  68. Pettigrew, Judith, and Kamal Adhikari 2009 Fear and Everyday Life in Rural Nepal. Dialectical Anthropology 33(3–4):403– 422.

    Article  Google Scholar 

  69. Physicians for Human Rights 1996 Torture in Turkey and Its Unwilling Accomplices. Boston: Physicians for Human Rights.

    Google Scholar 

  70. Physicians for Human Rights 2001 Examining Asylum Seekers: A Health Professional’s Guide to Medical and Psychological Evaluations of Torture. Boston: Physicians for Human Rights.

    Google Scholar 

  71. Physicians for Human Rights 2008 Broken Laws, Broken Lives: Medical Evidence of Torture by the U.S. Cambridge, MA: Physicians for Human RIghts.

    Google Scholar 

  72. Romney, A.K., C.C. Moore, and C.D. Rusch 1997 Cultural Universals: Measuring the Semantic Structure of Emotion Terms in English and Japanese. Proceedings of the National Academy of Sciences of the United States of America 94(10): 5489–5494.

  73. Romney, A.K., C.C. Moore, W.H. Batchelder, and T.L. Hsia 2000 Statistical Methods for Characterizing Similarities and Differences Between Semantic Structures. Proceedings of the National Academy of Sciences of the United States of America 97(1): 518–523.

  74. Rubel, Arthur J., C. W. O’Nell, and R. Collado 1984 Susto: A Folk Illness. Berkeley: University of California Press.

    Google Scholar 

  75. Schmidt, Ruth Laila, ed. 2000 A Practical Dictionary of Modern Nepali. 5th ed. Delhi: Ratna Sagar.

    Google Scholar 

  76. Sharma, Bhogendra, and Mark Van Ommeren 1998 Preventing Torture and Rehabilitating Survivors in Nepal. Transcultural Psychiatry 35(1):85–97.

    Article  Google Scholar 

  77. Shrestha, Nirakar Man, Bhogendra Sharma, Mark Van Ommeren, S. Regmi, R. Makaju, Ivan H. Komproe, Gyanendra B. Shrestha, and Joop T. V. M. de Jong 1998 Impact of Torture on Refugees Displaced Within the Developing World: Symptomatology Among Bhutanese Refugees in Nepal. JAMA: Journal of the American Medical Association 280(5):443–448.

    Article  Google Scholar 

  78. Silove, D. 2002 The Asylum Debacle in Australia: A Challenge for Psychiatry. Australian & New Zealand Journal of Psychiatry 36(3):290–296.

    Article  Google Scholar 

  79. Singh, Chandra Lal, and Matshyendra Lal Singh 1991 Nepali to English Dictionary. 4th ed. Kathmandu, Nepal: Educational Enterprises.

    Google Scholar 

  80. Singh, Sonal, Sharan Prakash Sharma, Edward Mills, Krishna C. Poudel, and Masamine Jimba 2007 Conflict Induced Internal Displacement in Nepal. Medicine, Conflict & Survival 23(2): 103–110.

  81. Smith Fawzi, M. C., E. Murphy, T. Pham, L. Lin, C. Poole, and R. F. Mollica 1997 The Validity of Screening for Post-Traumatic Stress Disorder and Major Depression Among Vietnamese Former Political Prisoners. Acta Psychiatrica Scandinavica 95(2):87–93.

    Article  Google Scholar 

  82. Somasundaram, Daya 1996 Post-traumatic Responses to Aerial Bombing. Social Science & Medicine 42(11):1465–1471

    Article  Google Scholar 

  83. Summerfield, Derek A. 1999 A Critique of Seven Assumptions Behind Psychological Trauma Programmes in War-Affected Areas. Social Science & Medicine 48(10):1449–1462.

    Article  Google Scholar 

  84. Summerfield, Derek A. 2001 The Invention of Post-Traumatic Stress Disorder and the Social Usefulness of a Psychiatric Category. BMJ 322(7278):95–98.

    Article  Google Scholar 

  85. Summerfield, Derek A 2002 Effects of War: Moral Knowledge, Revenge, Reconciliation, and Medicalised Concepts of “Recovery.” British Medical Journal 325(7372):1105–1107.

    Article  Google Scholar 

  86. SYSTAT 2007 SYSTAT Software. Chicago: Systat Software.

    Google Scholar 

  87. Thapa, Suraj Bahadur, and Edvard Hauff 2005 Psychological Distress Among Displaced Persons During an Armed Conflict in Nepal. Social Psychiatry and Psychiatric Epidemiology 40(8):672–679.

    Article  Google Scholar 

  88. Thienkrua, W., B. L. Cardozo, M. L. S. Chakkraband, T. E. Guadamuz, W. Pengjuntr, P. Tantipiwatanaskul, S. Sakornsatian, S. Ekassawin, B. Panyayong, A. Varangrat, J. W. Tappero, M. Schreiber, and F. van Griensven 2006 Symptoms of Posttraumatic Stress Disorder and Depression Among Children in Tsunami-Affected Areas in Southern Thailand. JAMA: Journal of the American Medical Association 296(5):549–559.

    Article  Google Scholar 

  89. Tol, Wietse A., Mark J. D. Jordans, Sushama Regmi, and Bhogendra Sharma 2005 Cultural Challenges to Psychosocial Counselling in Nepal. Transcultural Psychiatry 42(3):317–333.

    Article  Google Scholar 

  90. Tol, Wietse A., Ivan H. Komproe, Suraj B. Thapa, Mark J. D. Jordans, Bhogendra Sharma, and Joop T. V. M. De Jong 2007 Disability Associated with Psychiatric Symptoms Among Torture Survivors in Rural Nepal. Journal of Nervous & Mental Disease 195(6):463–469.

    Article  Google Scholar 

  91. Tol, W. A., I. H. Komproe, D. Susanty, M. J. D. Jordans, R. D. Macy, and Jtvm De Jong 2008 School-Based Mental Health Intervention for Children Affected by Political Violence in Indonesia—A Cluster Randomized Trial. JAMA: Journal of the American Medical Association 300(6):655–662.

    Article  Google Scholar 

  92. Tol, Wietse A., Brandon A. Kohrt, Mark J. D. Jordans, Suraj B. Thapa, Judith Pettigrew, Nawaraj Upadhaya, and Joop T. V. M. de Jong 2010 Political Violence and Mental Health: A Multi-disciplinary Review of the Literature on Nepal. Social Science & Medicine 70(1):35–44.

    Article  Google Scholar 

  93. Turner, Ralph Lilley 1931 A Comparative and Etymological Dictionary of the Nepali Language. London: K. Paul, Trench, Trubner.

    Google Scholar 

  94. Udomratn, Pichet, and Devon E. Hinton 2009 Gendered Panic in Southern Thailand. Pp. 183–204 in D. E. Hinton and B. J. Good (eds.), Culture and Panic Disorder. Stanford, CA: Stanford University Press.

    Google Scholar 

  95. Verdeli, Helen, Kathleen Clougherty, Grace Onyango, Eric Lewandowski, Liesbeth Speelman, Teresa S. Betancourt, Richard Neugebauer, Traci R. Stein, and Paul Bolton 2008 Group Interpersonal Psychotherapy for Depressed Youth in IDP Camps in Northern Uganda: Adaptation and Training. Child and Adolescent Psychiatric Clinics of North America 17(3):605–624.

    Article  Google Scholar 

  96. Weiss, Mitchell G., Jayashree Ramakrishna, and D. Somma 2006 Health-Related Stigma: Rethinking Concepts and Interventions. Psychology Health & Medicine 11(3):277–287.

    Article  Google Scholar 

  97. White, Geoffrey M. 1992 Ethnopsychology. In New Directions in Psychological Anthropology. Publications of the Society for Psychological Anthropology No. 3. C. Lutz, G.M. White, and T. Schwartz, eds., pp. 21–46. New York: Cambridge University Press.

  98. Wikan, Unni 1989 Illness from Fright or Soul Loss: A North Balinese Culture-Bound Syndrome? Culture, Medicine and Psychiatry 13(1): 25–50.

  99. Wikan, Unni 1990 Managing Turbulent Hearts: A Balinese Formula for Living. Chicago: University of Chicago Press.

    Google Scholar 

  100. Young, Allan 1976 Internalizing and Externalizing Medical Belief Systems: An Ethiopian Example. Social Science & Medicine 10(3–4):147–156.

    Google Scholar 

  101. Young, Allan 1995 The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton, NJ: Princeton University Press.

    Google Scholar 

Download references

Acknowledgments

The authors thank all of the participants and organizations who took part in the study. Srijana Nakarmi was the lead research assistant for the study. We also thank the individuals who contributed to discussions in preparing the manuscript: Nanda Raj Acharya, Ganesh Bhatta and his family, Peter Brown, Christina Chan, Tulasi Ghimirey, Ian Harper, Mark Jordans, Suraj Koirala, Geeta Manandhar, Mahendra Nepal, Judith Pettigrew, V. D. Sharma, Damber Timsina, Wietse Tol, Lotje van Leeuwen and Carol Worthman. Special thanks go to Devon Hinton and Roberto Lewis-Fernandez for their insight and thoughtful suggestions in revising the manuscript. The first author was funded by an NIMH National Research Service Award, the Wenner-Gren Foundation and the Emory University Graduate School of Arts and Sciences.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Brandon A. Kohrt.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kohrt, B.A., Hruschka, D.J. Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress, Ethnopsychology and Ethnophysiology in Alleviating Suffering and Preventing Stigma. Cult Med Psychiatry 34, 322–352 (2010). https://doi.org/10.1007/s11013-010-9170-2

Download citation

Keywords

  • Posttraumatic stress disorder
  • Trauma
  • Psychosocial
  • Stigma
  • Nepal