3Chapter 1The Lens of Culture: Theoreticaland Conceptual Perspectivesin the Assessment of PsychologicalTrauma and PTSDJohn P. WilsonINTRODUCTIONThe relationship between trauma and culture is an important one becausetraumatic experiences are part of the life cycle, universal in manifestationand occurrence, and typically demand a response from culture in terms ofhealing, treatment, interventions, counseling, and medical care. To under-stand the relationship between trauma and culture requires a “big picture”overview of both concepts (Marsella & White, 1989). What are the dimen-sions of psychological trauma and what are the dimensions of culturalsystems as they govern patterns of daily living? How do cultures createsocial–psychological mechanisms to assist its members who have sufferedsignificant traumatic events?Empirical research has shown that there are different typologies oftraumatic experiences (e.g., natural disasters, warfare, ethnic cleansing,childhood abuse, domestic violence, terrorism, etc.) that contain specificstressors (e.g., physical or psychological injuries) that tax coping resources,challenge personality dynamics (e.g., ego strength, personal identity, self-dimensions), and the capacity for normal developmental growth (Green,1993; Wilson, 2005; Wilson & Lindy, 1994). Traumatic life events can besimple or complex in nature and result in simple or complex forms of post-traumatic adaptation (Wilson, 1989, 2005). Similarly, cultures can be simpleor complex in nature with different roles, social structures, authority sys-tems, and mechanisms for dealing with individual and collective forms oftrauma. For example, dealing with an accidental death of one person issignificantly different from coping with the aftermath of the worst tsunamidisaster in the history of humankind (2004) that caused massive deathof thousands, destruction of the environment and the infrastructure ofcultures. In this regard, it is important to understand how cultures utilizedifferent mechanisms to assist those injured by different forms of extremestress experiences. The injuries generated by trauma include the full spec-trum of physical and psychological injuries. In terms of mental health andcounseling interventions, this includes a broad range of posttraumaticadaptations that include posttraumatic stress disorder (PTSD), mood dis-orders (e.g., major depression), anxiety disorders, dissociative phenomena(Spiegel, 1994), and substance use disorders. In terms of mental healthcare, cultures provide many alternative pathways to healing and integra-tion of extreme stress experiences which can be provided by shamans,medicine men and women, traditional healers, culture-specific rituals,conventional medical practices, and community-based practices that offerforms of social and emotional support for the person suffering the adverse,maladaptive aspects of a trauma (Moodley & West, 2005). But how doesculture influence an individual’s reaction to trauma? How do they makesense of their experiences in situations of extreme stress? In this regard,Smith, Lin, and Mendoza (1993) state: “Humans in general have an inher-ent need to make sense out of and explain their experiences. This is espe-cially true when they are experiencing suffering and illness. In the processof this quest for meaning, culturally shaped beliefs play a vital role indetermining whether a particular explanation and associated treatmentplan will make sense to the patient . . . Numerous studies in medicalanthropology have documented that indigenous systems of health beliefsand practices persist and may even flourish in all societies after exposureto modern Western medicine . . . These beliefs and practices exertprofound influences in patients’ attitudes and behavior . . .” (p. 38).CASE HISTORYTo illustrate how culture shapes belief systems and influences the percep-tion of traumatic events and their subsequent processing and integrationinto cognitive structure of meaning and attribution, let us consider thefollowing case example.In 1985 I attended an intertribal “pow wow” on the Lakota SiouxIndian reservation in South Dakota (Sisseton-Whapeton). The pow wowwas a 4-day event for Vietnam War veterans and their families. The eventcontained Native American ceremonies and rituals to honor the veteransfor their military service and sacrifices. These ceremonies included sweatlodge purification (Lakota Warrior “sweat” for healing), the Red Featherinduction ceremony, traditional communal singing and dancing, potlatch4 John P. Wilsonsharing of gifts, and ceremonial fires with “talking circles” and communaldinner with the eating of traditional foods.During this pow wow, I had the opportunity to meet several LakotaSioux Vietnam combat veterans. Among them was a veteran whom I willrefer to as Tommy Roundtree (not his real name). Tommy was a two-tourcombat veteran who had been highly decorated for his valor and couragein combat with the 101st Airborne Brigade between 1967 and 1969.Tommy grew up on the Rosebud reservation of the Sioux Nation in SouthDakota. He was an athletic, tall, handsome man with black hair andruddy dark skin. In many respects, he had a “Hollywood” character thatresembled the famous actor, Erroll Flynn.When I met Tommy, he was dressed in traditional tribal clothing andhad his face painted. Visibly noticeable were the scars on his chest andback from when he had participated in Sun Dance ceremonies in whichthe participants were skewered with straps to a pole located in the centerof a pow wow arena. The straps are skewered into pectoral and upperback muscles by small bones or sticks. At the climax of the Sun Danceceremony, which involves dancing and blowing through a small bone,the celebrant, at the critical time, leans back and releases himself from thestraps which link him to the pole. The skewers tear the skin and causebleeding. The Sun Dance ceremony is a physically arduous process andrequires stamina, mental concentration and preparation, including aSweat Lodge purification prior to the actual Sun Dance itself. In tradi-tional ways, it is thought that the ritual aids in the development of spiri-tual strength. When I observed Tommy’s scars, he immediately told methat he had done three Sun