Wednesday, November 23, 2005

Cultural Perspectives on Trauma and Critical Response

Adapted by Kris Sieckert, NCSP, NEAT Central Region Facilitator
This article is a condensed version of Chapter 7 of the National Organization for Victim Assistance (NOVA) Community Response Team Training Manual. It was written by Kris Sieckert with the permission of Dr. Marlene Young, NOVA Executive Director.
Using the American Heritage Dictionary of the English Language to define culture, we find the following: "The totality of socially transmitted behavior patterns, arts, beliefs, institutions and all other products of human work and thought characteristic of a community or population." In other words, cultures are a means for sharing wisdom and skills that are necessary to the survival of the community, the individual and the community area of humanity. Therefore, our culture shapes how we identify and interpret the threat of traumatic events and how we manifest our distress in response to these events.
Cultural IdentitiesIt is important that crisis responders attempt to understand their own cultural identities as they reach out to serve others. NOVA identifies the following as sources of cultural identities:
Nationality ReligionIncome AgeEducation Sexual OrientationRural/Urban Mental/Physical AbilitiesGender ProfessionEthnicity "Location in Life"
NOVA also identifies the following concepts and attitudes shaped by culture:
Birth CommunitarianismMarriage AmbitionDeath AcquisitionsMale/Female PowerLanguage/Dialect WealthSpirituality ChildrenIndividualism ElderlyHomosexuality Dress"Differentness"
Crisis responders are encouraged to use the lists to identify important sources of cultural identity in their lives, to initially access the cultural backgrounds of individual victims or groups they serve, and to find significant commonalities in order to establish a basis of communication.
Interpreting Traumatic EventsCulture influences what type of threat is perceived as traumatic and how we interpret the meaning of the traumatic event. Culture also influences how individuals and communities express traumatic reactions. While reactions to trauma seem to be common throughout all cultures and based in the physiology of human beings, manifestations of responses may differ significantly. Culture forms a context through which the traumatized individuals or communities view and judge their own response. If people think that the society around them will not accept them as victims, there is a tendency to withdraw and be silent. Culture may affect the response of immediately "non-traumatized to trauma" and the traumatized. This is a critical issue for many people who are victims. Their own culture or the culture in which they exist may reject or stigmatize them and may be perceived as an additional injury. Cultures may help define healthy pathways to new lives after trauma. The routines and traditions may aid survivors of a tragedy in feeling re-oriented or rendering life predictable.Trauma and culture are particularly complicated today. Multiple identifications require complex reasoning for negotiating the environment. With an increase in life stress and a decrease in the capacity to screen and moderate the impact of a trauma, cultural traumas can be transmitted across time and generation as a bond for survival.
Accommodating and Integrating Cultural StandardsPrior to cross-cultural work, education is needed about a culture's routines, traditions and impact of family relationships. Be prepared to accommodate and integrate such cultural standards into crisis response work. Attention should be paid to the following issues:
Geography, climate and environmentHistory of a cultureLanguage of cultureRoutines and rituals of culture
No matter what the preconditions to introduction to other cultures, caregivers should be prepared to convey respect and good will:
Say "Hello" and request the opportunity to talk with people.
Acknowledge differences and apologize for discrepancies between your behaviors and the people with whom you are talking.
Be aware of your own cultural biases and try to be non-judgmental with those with whom you interact.
Always say "please" and "thank you" when appropriate; always request permission to do things.
Protocol for Crisis Work Across CulturesOrientation to caregiving interventions:• Participate in access rituals. These often involve ceremony, food and expressions of good will.
• Explain purpose of intervention and the need for reciprocal questions. Many cultures find questions intrusive. Yet, for the caregiver, they may be essential in the establishment of understanding. Questions and answers are often the only way to clarify differences in language, customs and unconscious behaviors.
• Express an appreciation and respect for the culture's strengths in coping with trauma. Every culture has means to deal with trauma and can explain those means. Their understanding of trauma and its implications is inherent in their eventual integration of a tragedy into their lives.
• Express a willingness to learn about the ethnic group involved. One method to convey this is to ask, "If I were a victim of this trauma, how would you expect me to deal with it?"
• Acknowledge your limitations and differences. These may include the inability to speak or understand the language, confusion over certain customs or rituals or spiritual understandings.
• Establish your competence in understanding trauma's impact whether or not you understand the traumatic impact of an event or the meaning of that impact.
Practical Problems:• Deal with immediate environmental problems such as financial loss, secure shelter, family conflict, etc. that the individual is having difficulty handling by himself.
• Build trust.
• Assist the survivors or victims with financial resources or compensation, if possible.
• Help the survivors focus on something tangible that they can accomplish over the next few days.
Crisis Intervention with Cultural Focus:• Search for the meaning of suffering and pain relevant to the dominant cultural group involved.
• Search for the meaning of death in the culture.
• Search for the meaning of life in the culture.
• Make an effort to acknowledge your limitations with language or other communication concerns, and ask the survivors to tell you if you say something wrong or do something offensive.
• Ask survivors to tell their story and talk to them about the crisis reaction.
• Ask survivors if their families should be present during discussions or if they would like to have clergy members present.
• Ask survivors if they would like to go to a place of worship or if there are any ceremonies or rituals that are particularly directed at crisis in their culture.
• Ask survivors to describe what they would like you to do to be of assistance to them and then tell them truthfully what you can or can't do.
• Useful cross-cultural interventions include: reduction of isolation, relaxation techniques, meditation, education about crisis in culturally relevant terms, helping individuals to develop control, increase self-esteem and self-regulation.
• Be aware of culturally specific communication techniques such as the use of eye contact, the integration of food and drink in discussions, the pace of conversation, body language and so forth.
Hints for Helping:• Dress appropriately: Men should wear suits and women should wear dresses in most cultures. An outside team of crisis responders may convey their respects through respectful clothes.
• Establish commonality with survivors through access rituals and mutual interests: Eat what is offered; drink what is offered. Ask about family, friends, pets, plants and loved ones.
• Search for linguistic equivalency even if you do not know the language of the culture.
• Greet and say good-bye to survivors in their own language.
• Allow survivors to direct you through cultural protocols and follow their directions.
• Participate in defined ritual, as allowed or requested.
• Apologize when you do something wrong.
• Clearly define your objectives and give references of specific other situations that are similar to this one in which you were helpful.
• Find out and use appropriate body language.
• Bring a gift of commemoration.
• Be aware of spiritual beliefs in the culture.
• Ensure that written communications are either in the appropriate language or are linguistically and structurally correct to facilitate translation.SourceYoung, M. (1998). Community response team training manual (second edition). NOVA: Washington, DC.