Perspectives on trauma and healing from anthropology and social and affective neuroscience

Socio-political interpretations among healing modalities

Let me begin with the three articles on trauma and healing in North American society and address the political dimensions within each of these works. Joseph Gone’s Redressing First Nations Historical Trauma draws from his research in Canada among First Nations peoples as well as from his academic and scientific research, from advocacy as well as personal experiences in the United States. Gone opens with a quote from a spiritual leader, from his own home reservation in Montana, who was speaking about cultural and spiritual ways to deal with the historical trauma (HT)—“the devastating legacy of Euro-American and Euro-Canadian settler colonialism” (Gone, 2013). Gone argues for indigenous cultural participation as an important therapeutic mechanism and draws from his research with a Manitoba First Nations treatment program. He goes to the heart of emotional and social devastation of collective historical and contemporary trauma, documenting too the current shockingly high rates of Native Americans’ exposure to poverty, violence, and substance use. As we read Gone, we are drawn into a compelling political argument for culture-as-treatment, one which addresses historical trauma, illustrated through a vivid account of one woman’s stigmatizing experiences at a residential school. Gone's arguments recall Teresa O’Nell’s (1992, 1996) research on the Pine Ridge and Flathead reservations, and her more recent work in tribal communities in Oregon (Ball & O’Nell, in press) on the links between collective depression, contemporary racism, and historical trauma (O’Nell, 1992, 1996). Within this work on historical trauma and culture-as-treatment are nested policy and thus political arguments, as well as a social and historical, relational and collective perspective. Although my own research in metropolitan Boston suggested the flexibility of boundaries of identity for patients and a range of positions on “cultural matching” (Good, Willen, Hannah, Vickery, & Park, 2011; Willen, 2011), Gone’s argument is compelling for cultural and political advocacy built into therapeutics and local healing practices for historical trauma. Our work also supports the role of advocacy, a view that “culture counts” in collective as well as individual therapeutics. Gone’s work is situated in the literature and policy work that seeks to redress “disparities and inequalities” in mental health care and is a prime example of the position taken by the Surgeon General on “culture counts” and the Institute of Medicine’s “Unequal Treatment” (Chang et al., 2003; Good & Good, 2003; Good, James, Good, & Becker, 2003; Good et al., 2011; Smedley, Stith, & Nelson, 2003).

Tanya Luhrmann’s essay Making God Real and Making God Good is provocative for a number of reasons. She calls out academics and mental health professionals for being “notoriously secular” (Luhrmann, 2013), suggesting that “clinicians consider the possibility that a relationship with God may be a response to their trauma and [that] it is sometimes quite effective.” Luhrmann’s review of the literature found studies indicating that engagement with a close and loving God, one who is approving and forgiving, is far better for mental health than a relationship with a judgmental God or no relation at all. Her own research program in Chicago with homeless women raises questions about how these women—allowed daily into a “shelter,” a place of supposed “safety”—might actually experience a loving God. Her accounts of women who pray to God nearly every day, and have “transformative moments” in talking to God, draw our attention to the clinical versus the mundane. She gives us an “imagination rich” essay. Prayer may indeed be related to politics. If one is deprived of a home or safe haven not just over night but for lived time, for whatever reasons, would that not drive one to be anxious, paranoid, or mad? When God Talks Back, as Luhrmann titled her recent book (2012), may in fact be one way to find a home for the heart and one’s inner self. Luhrmann’s (2011) work with women who live on the street and in shifting available shelters is a blistering critique of American social policy. The therapeutic politics here concern not just how clinicians distinguish between imaginal dialogues and psychotic symptoms—e.g., deciding whether talking with God is madness or just religiosity—and whether the homeless women of Chicago find talking to God as comforting and calming. More importantly, they raise the question of why we have transient shelters and not safe and secure “homes,” where people can talk to and with God without fear of the insecurity of the streets. Is “experiencing a loving God” all there is to therapy when one returns to the streets once daylight comes?

Underlying Luhrmann’s work is a marvelous elaboration of modes of emotional absorption and imagination involved in talking with and being spoken to by God, and within this a critique of symptom measures and marks of danger and the trauma of homelessness and being on the streets. As a side note on talking to God, people with whom we spoke in Aceh, Indonesia, after the tsunami and after a harsh civil conflict between the Acehnese and the Indonesian military spoke about coping with both the trauma inflicted by decades of complex and chronic conflict as well as the acute trauma of the massive tsunami (which killed over 160,000 people with an onslaught of three waves, the last reaching 100 meters in height), and said they found solace through prayer and “talking with God” (Good, Good, Grayman, & Lakoma, 2007; Grayman, Good, & Good, 2009).

Douglas Hollan, in Coping in Plain Sight, brings us to reflect on psychological anthropology’s foundational theorists. Drawing on leading theorists from Devereux to Obeyesekere and Spiro and most recently to Veena Das, Hollan argues that “much of coping occurs in plain sight, in efforts to reclaim and enact everyday routines and practices” (Hollan, 2013). He argues for a culturally local interpretation of trauma and coping, and illustrates with cases from his own psychotherapeutic practice the uniqueness of individual traumatic experiences and ways of coping. But in American society, work can be a haven from trauma, as Hollan illustrates, and a way to respond to personal and familial distress. Hollan’s piece resonated powerfully with me. Years ago I worked on a chronic pain project with a Harvard medical anthropology group led by Arthur Kleinman and found that work was profoundly important as a way to cope with chronic pain among the largely middle-class people we interviewed for the project (Good, Brodwin, Good, & Kleinman, 1992). Physical pain was deeply entwined with psychic pain, grief, and loss. Today, one might speak of some of those losses as “traumatic.” Of individuals with chronic pain that we interviewed, the great majority (over 80%) had suffered a loss of one or more family members, often during their own childhood, or loss of their own children, through abandonment or illness or simply unexplainable disappearance. Work became a means to remake their life worlds and to work through personal sources of suffering. I characterized the themes in the narratives of chronic pain patients, who also suffered from intermittent depression, as “work as a haven from pain and loss, work as an arena for self-realization and effective performance, and work as a vehicle for control over the intrusiveness and daily disruptiveness of pain” (Good, 1992, p. 50). Several of the cases Hollan presents are very similar to those in our study in the mid to late 1980s, and reading his essay is haunting. Work in American society at that time was described by Studs Terkel as a search “for daily meaning as well as daily bread” (1972, p. xiii). Hollan has given this search for meaning a new twist in his essay—highlighting the importance of the ordinary routines of daily living for bringing a sense of control. Yet the themes are remarkably similar, emphasizing work as a means of control and working through the trauma of earlier life experiences. One wonders how many chronic pain patients suffer from family-related chronic trauma of the sort that Hollan elaborates. Work as a culture of healing and treatment is a compelling concept not only in the United States but in many places around the world.

Hollan’s essay offers subtle political, as well as therapeutic, questions. Without work can one be healed in a society whose main mode of healing is in fact meaningful work (in whatever way)? What happens to those who are caught in a low wage, high unemployment segment of society? This brings us back to the social situation of the First Nations peoples and Gone’s studies of historical trauma, as well as to Luhrmann's women of the street.

Collective trauma and political healing

I turn now to the article by Joop de Jong and Ria Reiss. In their joint paper on Collective Trauma Resolution, de Jong and Reiss (2013) tell the story of Kiyang-yang in Guinea Bissau and introduce the notion of “collective trauma processing” through a local form of dissociation, which became a collective political movement and popular cult spreading throughout the country in the 1980s and into Senegal in the 1990s. They characterize this movement, known as KYY, as using a local idiom of distress to process the traumatic experiences of protracted and widespread political violence. They compare this exceptional political movement and its ability to foster collective trauma processing (even though it was so socially and politically threatening to governing powers that it was suppressed) to psychology and psychiatry. They argue that KYY was able to address the Balanta’s deeply felt economic and political aspirations, as well as offering modes of transforming identities, through education and re-identification, from sufferer to healer engaged in the modernizing economy.

Ria Reis’s (2013) article on cultural idioms used by children in Africa to make sense of their social suffering also examines the possibility of therapeutic mechanisms arising from these idioms. She focuses on haunting spirits and child witches. In particular, her work with the child soldiers of Lord’s Resistance Army (LRA), who were often forced to kill, brings us into a very complex and disturbed world. Sedatives and sleeping pills, as well as herbal remedies, are widely used among children, as are local cleansing and welcoming rituals, which appear as part of “reintegration.” But the youth are often feared, possessed by cen (jinn?). Reis’s essay raises many questions about the variable affect of the youth who were the victims and the perpetrators of the LRA. Her essay leads us to wish for more to understand this dense complexity of child soldiers and abandoned youth in conflict and postconflict societies. We want to know how societies whose social fabric ruptures recover over time. There is obviously more to document to deepen our understanding through ethnographic study.

These essays made me reflect on the post-conflict period in Aceh Indonesia, where open engagement in politics was ritualized as people were able to fly the Party Aceh flags and to speak enthusiastically about their political party without threat of jail or death. The politics of peace and the politics of identity were made possible by successful negotiation of an MOU between the Free Aceh Movement and the Indonesian central government. One outcome was the legitimization of local political parties, including Party Aceh, which were authorized by the central government to run candidates for national as well as local offices. These political activities held great therapeutic value for many men and women in Aceh, who had suffered chronic trauma and violence from the protracted war, which pitched the Free Aceh Movement and much of the Acehnese population against Indonesian government forces (Good et al., 2011; Good, 2011; Good & Good, 2013). People laughed and were gleeful when putting up their political party flags and when talking politics. They were energetically high, filled with positive affect and often madly engaged in campaigning and voting. For some, it was a kind of cleansing of depression and oppression. Clearly, successful political movements, whether or not they involve dissociative behavior, can be viewed as potentially therapeutic modes of local healing, reenergizing a population, bringing a kind of political high and a sense—even if but momentary—of collective and personal efficacy. Politics, including DDR (“Demoblization, Demilitarization, Reintegration”) rituals and other community healing rituals for traumatic experiences, are worth further exploration.

Soured politics or political and social movements, such as the cleansing rituals of the reintegration process for the child soldiers of the former LRA, can lead to more negative consequences, rejection and isolation, jail and a failure of reintegration (70% in one study ended up jailed within three months of their ritual), rather than healing. This raises questions for further research on the range of value of local rituals. What is the source, we wonder, of the local ritual that Reis describes? It sounds very much like a ritual developed by humanitarian organizations, perhaps one designed in Geneva rather than Uganda? Her essay raises many questions about the negative and positive or therapeutic qualities of local rituals. When are medicalized or Western-designed therapeutics more helpful in providing exit strategies from military life, such as for the child soldiers? Are economic interventions, including work and livelihood programs, therapeutic? Are they more therapeutic if they are offered together with more traditional trauma therapeutics? Are they more therapeutic than ritual activities regardless of cultural content (psychotherapy and psychiatry or local rituals ridding one of cen (jinn) or appeasing haunting ghosts)? These are important questions for humanitarian organizations, as well as for anthropologists.

Local moral worlds and the politics of public health

Marilyn Nation’s (2013) ethnographically rich essay, Dead-baby Dreams, Transfiguration and Recovery from Infant Death Trauma in Northeast Brazil, resumes a debate begun when Nancy Scheper-Hughes published Culture, Scarcity and Maternal Thinking: Maternal Detachment and Infant Survival in a Brazilian Shantytown (1985), in which she argued that mothers’ detached concern from weak infants led to higher rates of death and that the detached concern was evidenced by no apparent emotive grief. In an ethnographically dense essay rebutting Scheper-Hughes’ position, Nations and Rebhun (1988) argued that the reason mothers did not cry was that they believed their children would not be able to fly to heaven if laden with tears. Nations’ article for this collection elaborates her initial attempt to refute Scheper-Hughes, as she returns to analyze interviews which she calls death narratives collected during the same period and in the same place in Northeast Brazil. The ethnographic accounts are compelling illustrations supporting Nations’ argument, in all its nuanced facets, that dead baby dreams are a “cultural armament to preserve their mental sanity and recover from death’s traumatic aftermath” (Nations, 2013). It would be worth exploring the change in the way mothers dream today compared to the 1980s when infant death rates were higher and poverty more extreme.

Cultures of dreaming as therapeutic are found also in Aceh “as pleasant visits with the deceased” (“I dream most often that my husband comes to visit”), but they are also compared to dreams that are not pleasant (“I saw it all over again, my son being torture by them”). Thus the local cultural modes of dealing with traumatic loss of family members (in the Aceh case through the conflict) may or may not be therapeutic. Yet, does an unpleasant dream of conflict-related loss mean it is not therapeutic—perhaps as part of a psychological working through of loss? In our experience, recollection and recall may be traumatic to those who respond when asked about dreams with stories of recurring and intrusive nightmares that are rarely spoken of—they respond “saya masih trauma” (“I am still suffering from trauma”) (Grayman et al., 2009).

In sum, further analysis of these cultural modes of healing and therapeutics along the domains identified by Hinton and Kirmayer, attending to social and affective neuroscience, appears a project worthy of additional pursuit. These essays broaden the scope of anthropological discussions of trauma treatment and ritual value. They begin to broaden too explorations of different forms of affect. The articles by Luhrmann, Gone, and Nations open up this dimension through their ethnographic and other empirical work. Looking at how positive affect is induced and enhanced both in collective groups and individuals who have suffered or are suffering traumatic experiences is particularly intriguing. Examining not only designated healing rituals but also affect-elevating activities such as positive political and economic activities would warrant additional attention through a comparative and historical perspective. And bringing social and affect neuroscience to bear on such analyses would be most intriguing and appears as a promising avenue to add to the armament of interventions and ways of coping with traumatic experience from HT to PTSD and other forms of chronic and complex trauma.