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Recognizing Historical Trauma’s Role in Cross-Cultural Psychiatry

As a first-generation Singaporean American, I sometimes think about the stark contrast in richness between the age-old historical narratives of Asian countries and those of acculturated Asian Americans. Identifying more with the latter, I realize how the absence of an inspiring historical narrative has left some of my second- and third-generation peers susceptible to absorbing their stereotyped misrepresentations in media and with reduced self-esteem. Yet I also suspect this ignorance of historical memory has benefits for one’s psyche. My parents, as immigrants who feel tied to a millennia-old Chinese historical-cultural tradition, may take vague pride in the many achievements it has produced, but may also harbor pessimism. After all, out of many millennia, the same historical tradition within merely the last eighty years has seen cataclysmic Japanese invasion, civil war and famine, along with senseless judicial and even violent stifling of free speech. Collective historical identity obviously needs not define a person; however, it can subtly erode at one’s mental well-being.

Stress resulting from historical consciousness is by no means isolated to Asian Americans. In Black Skin, White Masks, Frantz Fanon described psychiatric stresses specific to citizens of African ancestry in the West at the time. He noted how collective memory of African culture and achievement had long disappeared, but historical trauma and cruel portrayal by media within the “mother country” insidiously ravaged one’s self-esteem. Even today, even ignoring ongoing injustices that cause stress, it should surprise none that repeatedly hearing, starting from elementary school, about the horrific enslavement of and discrimination towards one’s ancestors could contribute to mental trauma.

Joy DeGruy proposed a term for the results of such historical trauma: “post-traumatic slave syndrome” (PTSS). According to DeGruy, a collective memory of centuries of slavery, Jim Crow laws and unwarranted mass incarceration aggravates maladaptive behaviors among many African Americans. Today, widespread sentiments of victimization persist. Older generations, who experienced and vividly remember acute racism, may indoctrinate their children into anti-authority cynicism and aggression. Despite policy and society’s roles in perpetuating PTSS, there exists an enormous opportunity for psychiatrists to help patients identify and defuse their maladaptive mechanisms.

At times, psychological impacts of historical consciousness are so strong that cultures have well-established terms for them. Such terms abound today for Korea, which historically had little power to resist brutal interference from militaristic giants: invasion by nomadic Mongols and Jurchens, colonial exploitation by the Japanese, and an indefinite fratricidal divide since the internationally-fought Korean War. Furthermore, domestic oppression historically persisted through a caste system dominated by the hereditary yangban aristocracy, and ranking down to deprived cheonmin commoners and slaves. Connecting all this to psychiatry, palja (literally, “destiny”) denotes a sort of fatalistic, helpless attitude: an acceptance of lack of control over one’s life course that stems from folk memory of invasions as well as unfair hierarchy that pervaded throughout Korean history, even to this day. Even more prominent, han describes an unresolved and distress-inducing feeling of unjust victimization among many Koreans, often strong enough to elicit somatic pain. A lifelong internalization of memories of unaddressed oppression no doubt contributes immensely.

All of these examples relate to Arthur Kleinman’s term “cross-cultural psychiatry,” which first described a tendency towards somatization of depression among patients of native Chinese cultural background. Fanon’s observations, PTSS, and han could be categorized into a new “collective history-bound” subfield within cross-cultural psychiatry. Much of psychiatry and, especially, psychoanalysis tries to alleviate latent tension in part by bringing buried, uncontemplated stressors into conscious processing. These stressors arise not only from a person’s life events, or events involving their close friends and family, but also from their ethno-cultural community. This, discussing historical traumas relevant to an entire culture could benefit certain patients.

A more immediate priority, however, is public awareness of cross-cultural psychiatry. In 2016, some psychiatric morbidities allotted the greatest federal funding for research included acquired cognitive impairment ($1.132 billion) and depression ($410 million). Few would argue against such conditions receiving major attention in research, due to their prevalence and universality across demographic lines. Yet mental stress arising from historical collective memory, including culture-specific sources of burdens, receives very little attention from American psychiatric research.

The gap in research funding for cross-cultural psychiatry has two causes. First, the United States is relatively young among civilizations and the dominant historical narrative we do have about our last 241 years almost close-mindedly emanates optimism. The national narrative is easily replete with heroic figures such as George Washington and Abraham Lincoln and achievements like our contribution towards an Allied victory in both world wars. However, it may not show a more rounded picture with the darker undertones of history, such as the fairly recent extensive de facto racism depicted by Fanon. Thus, researchers may not perceive historical consciousness as a stressor.

Second, there is a lack of diversity among academicians. Trends at any academic center will likely be influenced by issues about which its researchers feel most aware. More ethno-cultural diversity among research psychiatrists would likely lead to increased academic interest in the impact of culture on mental health. Inadequate representation in academic psychiatry alienates ethnic groups that have unique culture-bound and minority status-related psychiatric stressors. Hence, advocates for psychiatry and other mental health care training programs should intensify their current academic diversity initiatives. When demographic diversity among trainees cannot be easily obtained, more psychiatry residency programs should adopt training initiatives surrounding culture-bound mental illness, such as those that at Yale and George Washington University. Furthermore, more programs could train all residents to be aware of, and thus sensitively screen for, history-bound conditions such as PTSS and han, especially in and near large cities.

Finally, cross-cultural psychiatry as a whole deserves stronger advertising among medical students and psychiatry residents. Long-term solutions include the addition of several pertinent lectures to medical school curricula and the creation of clinical rotations in cross-cultural psychiatry. Immediately, psychiatry clerkship preceptors could encourage trainees to ask about cross-cultural concerns when giving psychiatric evaluations among diverse patients. Advocates can also write and speak about cross-cultural psychiatry’s relevance not only to academic centers but also to community practices. In turn, psychiatrists would pay more attention to distress specifically related to historical trauma.

Identifying with one’s cultural history may enhance resilience but may also generate distress. A traumatic collective history can certainly aggravate the latter, justifying a greater awareness of the effects of historical narratives on mental health when evaluating diverse patients. Mental health advocates can promote awareness of, and encourage research on, culture-bound psychiatric stressors. In turn, by also acknowledging the currently limited attention on the role of historical trauma as a stressor, we can promote a new “collective history-bound” field of discussion within psychiatry. Such a field would help psychotherapy patients transcend trauma from not only their individual pasts but also from a far larger collective past.

Richard Zhang Richard Zhang (1 Posts)

Contributing Writerr

Sidney Kimmel Medical College at Thomas Jefferson University

I am a second year medical student at Sidney Kimmel Medical College, in Philadelphia. When I am not dressed in a white coat or poring over lecture notes, you can often find me pursuing my passions in history, digital art, running, and lifting weighted disks.