Download Name: Block:______ Hanscom 2001 Cultural differences in PTSD

Name:_________________________________
Block:____________
Hanscom 2001 Cultural differences in PTSD reporting
In 2001 Karen Hanscom conducted field work with women in Guatemala. These women were survivors of
rape and torture during a Guatemalan civil war. Hanscom started the Puentes de Paz health project in
Guatemala to help these women cope with their ordeal. She found that the majority of them suffered
Post-Traumatic-Stress disorder, but discovered that the symptoms they reported were very different from
what the DSM-IV describes in western culture as being symptoms. Because of that, she published her
findings in order to alert other psychologists of the symptoms these women would be describing. In order
for treatment to begin, and healing to start, she argued that psychologists must first be able to make an
accurate diagnosis. Below is an excerpt from a paper she published teaching other psychiatrists what
symptoms they should be looking for. Hanscom’s training programs have helped survivors all over the
world get the help they need.
A- ASKING Questions about Symptoms
The goal of the third part of treatment is to assess the individual’s current feelings and
behaviors. While a full discussion of the various symptoms seen in post-trauma and torture are beyond
the scope of this presentation, doctors in Guatemala and in the United States are in fact trained in the
identification of clusters of symptoms commonly found in survivors… Symptoms that are indicative of a
diagnosis such as Major Depression, Anxiety, or Post Traumatic Stress Disorder – but may not be
referred to as such in Guatemalan culture and vocabulary – are taught through spontaneous casepresentations provided by the doctors. Within the framework of the model, the doctors are familiar
with asking questions and describing cases of individuals with whom they are working. Local remedies
such as rituals and the use of local medicinal herbs are collected by the doctors as they assist each other
by sharing their personal knowledge and expertise. Site three, for example, is actively engaged in
preparing a booklet of drawings and samples of herbs used in their communities which they can then
use for symptoms which they refer to as “fear,” “hysteria,” and “deep sadness.”
Doctors in the United States are instructed using DSM4 classifications. Discussions are
encouraged regarding such classifications as Post Traumatic Stress Disorder which, while coming close to
describing the symptoms seen in survivors of torture and trauma, does not fully define the problem. In
the U.S., as in Guatemala, the elements of the three categories that comprise the diagnosis of Post
Traumatic Stress Disorder (PTSD) are stressed: persistent re-experiencing, persistent avoidance, and
persistent arousal and treatment options discussed. Doctors are encouraged to use their personal
therapy style to discover the survivor’s current symptoms and use available resources (hospitals,
psychiatry, etc). The importance of psychological symptoms is stressed. While it appears inherent to the
Guatemalan women to understand the use of physical symptoms to express distress, doctors in the U.S.
often need further explanation about the way in which individuals of many cultures will speak freely of
physical symptoms when beginning work with a clinician. In many cultures, diffuse somatic complaints
are the primary concern of survivors. Survivors will report both clear, physical symptoms that have
resulted from specific forms of torture (for example, burns on the wrists from electric shock), or broad
non-specific symptoms (“my whole body hurts”) that represent the emotional wounds of trauma and
torture. Body memory symptoms are also discussed and included such symptoms as the symptom of
dizziness experienced by one woman which was found to be a body memory of her repeated experience
of being forced to drink large amounts of alcohol and then being raped and tortured. In either case,
admitting to such physical problems may be a more culturally “acceptable” means of getting both
medical and psychological assistance and must be recognized by the professional.
R- Explaining the REASONS for Symptoms
This element of treatment refers to the counselor’s need to assist survivors in understanding
and “making sense” of their symptoms. A survivor often states that he or she is “loosing my mind” or
states that “my spirit has left me”. With this come feelings of powerlessness, helplessness, vulnerability
and doom. Thus, this element of treatment involves assisting the survivor in understanding that there
are physical and psychological reasons why specific symptoms are occurring. They learn that these
symptoms are the result of their trauma and torture and that these symptoms constitute a “normal”
reaction that “normal” people have to an “abnormal” event such as war trauma and torture. This
educational component is essential and produces a sense of self-control.
In both Guatemala and the U.S. a discussion of “stress” is important to this element of
treatment. Stress is, of course, not part of the regular vocabulary of Mayan village women. At one site, I
was speaking about stress while spontaneously demonstrating emotions that I feel while stressed. I was
met with nodding heads and agreement as women expressed to me that “a las tres” (3:00 in the
morning) happens to them as well! They spoke of waking up in the night tense and anxious with worry
and unable to resume sleep. They acknowledged that they often get this feeling at other times of the
day as well. “A las tres” continues to be the term used to mean “stress” at that project site.
Questions
Directions: Answer on a separate sheet of paper
1. Are treatments for PTSD in the United States and Guatemala different? How are they different?
2. What symptoms of PTSD are typically reported in the United States? What does the DSM
primarily report (What kind, affective, behavioral, cognitive, somatic)?
3. What types of symptoms do Guatemalan women seem to report? Give examples.
4. Define Body Memory Symptoms
5. What problems does this pose to the US doctors who are volunteering to help the Guatemalan
survivors?
6. Why does Hanscom believe the Guatemalan women are suffering from their symptoms, what
are the reasons?