Cultural Aspects of Post-Traumatic Stress Disorder: Thinking on Meaning and Risk

Over the past year and a half, I have been conducting research among male U.S. veterans who have served combat tours in Iraq and Afghanistan, most of whom have been diagnosed with Post-Traumatic Stress Disorder (PTSD). An anthropologist myself, I planned to follow the trail originally blazed by Victor Frankl and Robert Jay Lifton, psychotherapists who wrote a great deal about meaning in their descriptions of trauma and PTSD.

Early on, however, a psychiatrist whose work on trauma I admire opined to me that crises of meaning belong to the realm of depression rather than PTSD. He suggested that combat PTSD was best thought of as the physiological effects of living under conditions of extreme stress, while more meaning-related struggles were best understood as a symptom of depression. Given the frequency of comorbidity between PTSD and depression, I was for some time inclined to go along with his analysis.

Then two things happened. First, I began the work of talking with veterans themselves about their stories of trauma and PTSD, listening to how they describe their own experiences. And second, I began to explore the increasingly dominant Prolonged Exposure model of PTSD, which views the disorder as a pathology that develops when individuals fail to process their traumatic memories in the normal way.

Some background is important here. A recent RAND report suggests that as many as 18.5% of combat troops have gone on to develop PTSD after serving in Iraq or Afghanistan; alarming as that number is, it nonetheless demonstrates that the vast majority of combat-exposed individuals do not develop PTSD. However, most of the veterans I’ve spoken with – even those without a formal PTSD diagnosis – report experiencing some PTSD symptoms for a period of time following their combat deployment. Many of them dealt with such symptoms for a while – a month, three months, a year – before passing through this period of processing their memories and going on with their lives. They may be changed by their experiences in the war zone, but they are not broken by them, and may even describe them as resulting in personal growth and other positive effects.

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CeaseFire: Violence Prevention and Why Gary Slutkin Is An Anthropologist

Gary Slutkin, an epidemiologist and physician at the University of Illinois at Chicago, is treating violence like an infection. Stop its transmission; get at the highest risk cases. And he’s doing that by acting like an anthropologist, using experiences and ideas culled from years working on public health projects in immigrant communities in the United States and in several countries in sub-Saharan Africa. I just wish more anthropologists would act like him!

CeaseFire, a Chicago-based violence prevention program started by Slutkin, was featured in the New York Times Magazine yesterday, covered by Alex Kotlowitz in his excellent “Blocking the Transmission of Violence.” Kotlowitz focuses on the core feature that makes CeaseFire a different sort of program: the use of “violence interrupters.” These are men who have been through the streets, who have the contacts and know the code. They are men like Zale Hoddenbach, thirty eight, once active in gangs, then eight years in prison, now a fervent interrupter. These “hardened types” form the core of CeaseFire, living proof of change as well as men who can go places and talk to people that no public health PhD could ever imagine doing.

So why do I say he’s an anthropologist? Three reasons, really. First, Slutkin is critical of received ideas, in this case that punishment drives behavior: “He was convinced that longer sentences and more police officers had made little difference… ‘Copying and modeling and the social expectations of your peers is what drives your behavior’.” He sees this approach as more akin to stigmatization and moral punishment than effective policy: people are afraid, so they turn to old reactions “like putting people away, closing the place down, pushing the people out of town.” This combination of a critical cultural take on present practices, and an informed social perspective, makes his approach inherently anthropological.

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