Culture and PTSD: Trauma in Global and Historical Perspective ed. by Devon E. Hinton and Byron J. Good (review)

Culture and PTSD: Trauma in Global and Historical Perspective is a collection of essays in cultural psychology, specifically examining the juncture between posttraumatic stress disorder (PTSD, as defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, or DSM) and different cultural connotations and practices. Edited by Devon E. Hinton and Byron J. Good, professors of psychiatry and the anthropology of mental illness, respectively, the book brings together eleven essays on trauma, leveling a challenge to the established definition and treatment of PTSD. These essays critically examine the relative strengths and weaknesses of common DSM style PTSD diagnoses, the relative cultural understanding of PTSD in terms of diagnostics and treatment, and ask whether the over-prevalence of PTSD is a possibly pernicious kind of diagnosis, one that is harmful to patients and the mental health field as a whole.

After their introductory chapter, Hinton and Good's second section provides three chapters on the historical background on PTSD. This part of Culture and PTSD provides a strong foundational knowledge for the reader on the history of PTSD as a diagnosis and, perhaps more importantly, the debates surrounding the concept of PTSD among the professional community. The third, and final, section is much larger than the first two. Consisting of eight chapters, it comprises the majority of the book. Each chapter is an essay examining trauma and treatment in radically different sociocultural contexts around the world. The third section is wide ranging, by necessity, and the chapters are quite disjointed as a result. This does not, however, detract from the quality of the book, and if anything, the highly varied nature of the case studies adds validity to the importance of part of the author's argument: that PTSD ought to be better understood in individual cultural contexts.

While all of the chapters in the final section are worthwhile, several stand out. Ball and O'Neill's chapter on historical trauma among Native Americans, for example, is a much needed examination of an under-looked group. Ball and O'Neill argue that PTSD is an unsuitable diagnosis for the trauma that Native American groups face because their experiences have a much longer cultural time frame, one wrapped up in continuous genocide and persecution. Historical trauma, they argue, is a better fitting framework for understanding the kind of epochal suffering that groups like Native Americans face, as it ignores the complex socioeconomic and historic reasons for depression and disaffection found in many Native American communities. Given the amount of recent attention being paid toward the rash of suicides in Canadian Native American communities, Ball and O'Neill's chapter is quite timely.

The chapters on Latin America are also noteworthy. Duncan, for example, looks at the differences between what constitutes traumatic experiences in Oaxaca, Mexico. For this region, the high prevalence of women seeking mental health assistance has led to a high rate (20 percent) of PTSD diagnoses within the population. Duncan argues that because domestic abuse is not considered to be a traumatic experience by local professionals, unlike factors such as poor socioeconomic conditions or forced migration, professional services have created a climate in which things that are normally associated with trauma are divorced from it diagnostically. Pendersen and Kienzler's chapter on the Quechua speakers of Peru illustrates the different ways that these people understand and express traumatic experiences, and how their unique ethnopsychological conceptions of what trauma and stress can do to people correlates to DSM type diagnoses. Ultimately, Pendersen and Keinzler show how local idioms can be understood in a DSM (and by extension, Western) framework.

Pendersen and Kienzler's efforts to bridge the gap between the DSM and local ethno-psychologies is a kind of microcosm of the most important parts of Culture and PTSD. Hinton and Good have created a relevant and understandable collection of essays, each backing their ultimate...