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In the present chapter, we will give an account of the culture-specific facets of traumatic stress and of posttraumatic symptomatology in their respective societal contexts as they have been reported by asylum seekers belonging to different ethnic groups. We also intend to highlight the multiple and culture-dependent strain, asylum seekers are suffering from while trying to adjust to a foreign society and while being left in uncertainty about being granted asylum. We will also examine the pathogenetic impact that societies can have on individuals as well as the differential coping styles, resulting from divergent evaluations of traumatic events by people stemming from various parts of the world. From these findings, we will derive recommendations for diagnosing posttraumatic stress and for developing culturally sensitive treatment concepts when dealing with asylum seekers and refugees from non-Western societies. Special emphasis will be laid on differences between the three cultures under consideration.

Dissociation is a human capacity that can fulfill an adaptive or maladaptive function in specific circumstances, and which appears to be particularly recruited as a response to trauma in most cultural settings around the world. Although much of the initial work on dissociation was done in Europe and the United States, recent expansion of research on this topic in other cultural regions has led to welcome progress toward a more global understanding of dissociation. This progress is reflected in a greater ethno-cultural diversity of populations under study, expansion of the known phenomenology of dissociation and thus the conceptualization of the construct, creation of new assessment instruments, and renewed debate over existing diagnostic categories. This chapter reviews current understandings of the phenomenology and classification of dissociation from a cross-cultural perspective, including its relationship to trauma, with a focus on current assessment methodologies. These topics are illustrated with recent dissociation research from two non-US, non- European cultural settings, Puerto Rico and Turkey.

In recent years, leading medical journals have published a series of commentaries (Bracken, 2001; Bracken, Giller, &Summerfield, 1995; Summerfield, 1998; Van Ommeren, Saxena, &Saraceno, 2005) challenging the notion that mass trauma exerts an adverse effect on the mental health of populations from non-Western cultures. The diagnostic category, posttraumatic stress disorder (PTSD), has attracted particular criticism, the key issue being the nosologic validity of that diagnosis when applied across cultures (Summerfield, 1999, 2001; Terheggen, Stroebe, &Kleber, 2001).

Psychological trauma is pervasive for Aboriginal Australians, both in its impact on individuals and their families through the earlier processes of colonisation, and in ongoing ways through disadvantage, experience of violence, illness, injury and premature mortality. Traumatic experiences have impacted on individuals, families and communities and on culture. And these experiences continue. As Ober, Peters, Archer, &Kelly (2000) cogently argue “understandings and responses to acute trauma in Aboriginal settings today” need to be understood “within a framework of collective and cumulative traumatisation over several generations” (p. 242).

The cross-cultural treatment of traumatized refugees is complicated and difficult. The cross-cultural issues of language and values expectations of treatment add to the already difficult task of treating PTSD, depression, and other psychiatric disorders among the refugees. Treatment has usually been suggested with psychosocial therapeutic approaches. These have included psychoanalytic approaches (De Wind, 1971; Varvin &Hauff, 1998), behavioral and cognitive approaches (Basoglu, 1998), testimonial therapy (Cienfuegos &Monelli, 1983), and trauma-focused treatment techniques (Drozdek &Wilson, 2004). Research into the effectiveness of these techniques has been few, undoubtedly because of the large problems of psychotherapy outcome studies across both trauma and cultures. Arecent report found that after nine months in a psychotherapy program, the torture survivors showed little improvement (Carlsson, Mortensen, &Kastrup, 2005).

The Hmong in Asia comprise a large, distinctive ethnic group that inhabits the countries of China, Vietnam, Laos, Burma, and Thailand. Although they do live in lowland areas of even islands of the South China Sea, they are widely known as “mountain people” who dwell in the Annamite Chain of mountains, several thousand feet above sea level (Geddes, 1976). The Hmong, whose name for themselves means “free [people],” possess a long tradition of self-sufficiency and resistance to outside interference or domination (Lemoine, 1972). Throughout the twentieth century, national, regional, and even international forces have challenged their traditions, world views, and sociopolitical roles in Southeast Asia (Yang, 1974).