Document Actions
  • Print
You are here: Home Research Resources Expert Guides Psychosocial Issues Cultural and anthropological studies

Cultural and anthropological studies

Cultural and anthropological studies

The study of armed conflict distress has not only been the concern of psychology and psychiatry but has also been researched by anthropologists and sociologists. Their approach has been to take local understandings and perspectives as a starting point, based on the belief that the political, historical social, cultural, and economic contexts play a central part in how armed conflict is perceived and how subsequent distress is dealt with.

Understandings of distressing events vary between situations, and these variations are very important as to how people themselves perceive and cope with these events. For example, experiences of young people in armed conflict in the DRC (Democratic Republic of Congo) will differ from those of young people involved in armed conflict in Palestine, which in turn differ from the experiences of young people in Kosovo. The political situations differ; the historical reasons for the conflict differ; the social and communal situations differ; economic factors play different roles; and cultural understandings of the situations differ. These will all affect how young people view themselves and their communities, and how they view their own actions and those of people against whom they are fighting. This in turn will influence how they and their communities deal with the distressing events. Most scholars advocating for a cultural approach to war-related distress are therefore sceptical of the claims of trauma professionals that trauma is a universal phenomenon, and question whether Western systems adequately reflect experiences of people in other cultures.

Culture: definition

People use the word 'culture' in many ways and to mean very different things. In the West, researchers have in the past viewed 'culture' as referring to something that other people have in other parts of the world, without taking into account that every society and community is influenced by culture or cultures (Chakraborty 1991) . As Clifford Geertz observes: no human community is 'culture-free' (1973).

The term has often been understood to refer only to specific customs, practices, food. or ways of dressing. However, this definition is too narrow. Culture is about ways of thinking and living. Culture influences the meanings we attach to issues and events, relationships, and interactions, ways of feeling and being in the world.

A useful definition is given by Helman (1994: 2-3) , who defines culture as a set of guidelines (both explicit and implicit) which individuals inherit as members of a particular society, and which tells them how to view the world, how to experience it emotionally, and how to behave in it in relations to other people, to supernatural forces or gods, and to the natural environment. It also provides them with a way of transmitting these guidelines to the next generation - by the use of symbols, language, art and ritual.

Culture and distress

This section briefly describes some of the central concepts that have been used by medical anthropologists, and cultural psychologists and psychiatrists to understand how culture influences how people understand and respond to distressing events such as armed conflict and displacement.

Etic and emic perspectives

These refer to whether one adopts an 'outsider' or 'insider' view of an illness or problem.

The etic perspective imposes a way of viewing the world on the illness. Usually this is a Western, biomedical view that tries to make an illness fit a prescribed biomedical category. Behaviour and illnesses are examined from a position outside the social or cultural system in which they take place.

The emic approach is the 'insider' perspective, in which the world-view of the people who are ill or distressed is adopted. The cultural and social system in which the people find themselves is seen as central to understanding the illness (Berry et al. 1992) .

Explanatory models

Arthur Kleinman (1978) , psychiatrist and medical anthropologist, uses the term 'explanatory model' to explain that the patient and the healer may have very different conceptual understandings of the nature of the illness, its cause, and its treatment. For example, the experiences of a returning soldier may be seen by a psychiatrist as symptoms of PTSD. To the soldier and their family, these symptoms may be signs that vengeful spirits of civilians they have unjustly killed may be disturbing them. Whereas the psychiatrist may recommend some form of therapeutic intervention, the family may believe a purification ritual to appease the spirits to be the most effective remedy. The psychiatrist and the family hold different explanatory models of the problem and conflict may arise when communication across these different models does not occur.

Somatization and idioms of distress

Distress is not expressed in the same way in all cultures or communities. Some symptoms seem to be common to people who have experienced or witnessed armed conflict (sleep disturbance, concentration problems, disturbing memories). Other symptoms vary and are frequently complex. Some have argued that the imposition of a PTSD framework results in the loss of important variations in the way in which distress is expressed.

A common way in which distress is expressed in many parts of the world is somatization: people complain of physical symptoms which are mainly caused by emotional or mental worry, anxiety, or stress. Common complaints are vague aches and pains, headaches, palpitations, dizziness, and weight loss (Swartz 1998) .

The term 'idioms of distress' has been used to describe specific illnesses that occur in some societies and that are recognized by members of those societies as expressions of distress. An example that illustrates both 'somatization' and 'idioms of distress' is the term 'nerves'. It is used in many parts of the world to describe bodily pain and emotions: insomnia, fatigue, restlessness, etc., as well as feelings of sadness, tension, and weepiness (Scheper-Hughes 1992) . In South Africa people suffering from nerves associated it with poor economic conditions, worries, bad feelings, and interpersonal conflicts (Swartz 1998) . Nerves refer to matters of mind, body, and spirit ,and no one medical explanation can ever convey the multiple meanings of this illness.

One of the main functions of idioms of distress and somatization is that they convey a wide range of personal and social concerns in a way easily recognizable by other people, who are then alerted that the sufferer may need help.

Local resources and strategies

All communities have resources for dealing with difficulties, illness, and distress. Practitioners who place culture at the centre of their work with war-affected communities believe that the starting point for any intervention or assistance offered must be an understanding of what these resources are. Efforts by 'outsiders', i.e. people who do not belong to he communities they seek to assist, should be aimed at

establishing the resources available

determining to what degree they have been disrupted

providing assistance to re-establish these, or facilitating processes for strengthening these.

Local resources and strategies for dealing with distress may vary. One of the most common ways in which people around the world respond when they are distressed is to turn to those around them for advice (Kleinman 1980) . Practical advice will often be given about how the problem or illness can be resolved, for example by seeking out a healer, priest, or nurse. Moral support may be given to the person and practical help for overcoming periods of illness may be provided.

Other resources that people draw on may be indigenous healer, diviners, priests, or prophets. Honwana (1999) describes how healers and diviners are consulted by people in Mozambique troubled by spiritual problems related to the killing of innocent civilians and to the neglect of the performance of proper burial rites. Reynolds (1996) reports that children who were disturbed by nightmares following the civil war in Zimbabwe were taken to indigenous healers by their parents, and Eisenbruch (1992) observed similar ways of coping with distress amongst Cambodian refugees in the USA. In Angola the churches play an important role in helping people with distress, with priests of independent, prophetic, charismatic, and established churches providing prayers, advice, and faith healing (Eyber 2001) .

Rituals form an important part of healing in some communities. Wessells and Monteiro (1999) provide examples from Angola where communities use rituals to reintegrate young returning soldiers who were demobilized during a brief period of peace in the country. These rituals were effective in helping most of the youngsters make the transition to civilian life and in facilitating community acceptance of the youth.

Practitioners and scholars who study the local resources and strategies of war-affected communities report that people deal with the realities of their experience in a dynamic way, constantly negotiating their survival and simultaneously rebuilding their lives. Nordstrom (1997: 189) , researching the way in which Mozambicans responded to the destruction of their homes and lives, calls this engagement in 'world-making', where people 'seek new sources of survival; they seek to understand what it is they need, and how they are to go about getting it', creatively and actively forging new identities, reinventing homes, and revitalizing the world with significance. Nordstrom reported that during her extensive research in many parts of Mozambique over a period of many years she saw no community that had succumbed to chaos, inertia, or destructiveness. Some individuals had, but they were in the minority.

Websites
Eisenbruch 1992 http://216.239.35.100/search?q=cache:lzCNbuJucm8C:www.dinarte.es/salud-mental/pdfs/Eisenbruch-From%2520PTSD%2520to%2520cultural%2520bereavement.pdf+Maurice+Eisenbruch+cultural+bereavement&hl;=en&ie;=UTF-8
Honwana 1999 http://ccrweb.ccr.uct.ac.za/archive/two/8_1/p30_collective_body.html

Criticism of the cultural approach

Criticism has been expressed of the cultural approaches to providing psychosocial assistance:

Cultural approaches provide information about one specific community which cannot be generalized to other communities. It has been argued that this approach has limited practical value as the information gathered cannot be applied to inform a broader approach.

There is a danger that local culture and local resources may be romanticized and seen as the solution to all problems. This is often not the case as resources have been destroyed, healers may not be available, and the performing of rituals may not be possible in locations to which people have been displaced. There is a need to be aware of not romanticizing local culture.

Some advocates of a cultural approach view 'culture' as static entities rather than as constantly changing dynamic systems. There is a danger that people seek to identify certain characteristics of cultures (e.g., 'Cambodians believe in spirit possession') without taking into account variation within the population, as well as the changing nature of beliefs, lifestyles, and ways of thinking.

Issues of power between individuals and groups are present in all communities. The emphasis on taking local practices as a starting point may contribute to maintaining unequal power structures in communities.

Key readings on cultural and anthropological studies:
Honwana, A., 'Non-western Concepts of Mental Health'. In M. Loughry and A. Ager (eds), The Refugee Experience. Psychosocial Training Module (rev. edn). Oxford: Refugee Studies Centre. 2001 http://earlybird.qeh.ox.ac.uk/rfgexp/rsp_tre/student/nonwest/toc.htm
Nader, K., Dubrow, N., and Stamm, H., Honoring Differences: Cultural Issues in the Treatment of Trauma and Loss. Philadelphia: Bruner/Mazel, 1999.
Nordstrom, C., A Different Kind of War Story. Philadelphia: University of Pennsylvania Press, 1997
Swartz, L., Culture and Mental Health. A Southern African view. Cape Town: Oxford University Press, 1998.
Last updated Aug 17, 2011