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.
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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.”
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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.
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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
- Posttraumatic stress disorder