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The relationship between trauma and culture is an important one because traumatic experiences are part of the life cycle, universal in manifestation and occurrence, and typically demand a response from culture in terms of healing, treatment, interventions, counseling, and medical care. To understand the relationship between trauma and culture requires a “big picture” overview of both concepts (Marsella &White, 1989). What are the dimensions of psychological trauma and what are the dimensions of cultural systems as they govern patterns of daily living? How do cultures create social-psychological mechanisms to assist its members who have suffered significant traumatic events?

This chapter is premised on the assumption that the definition of trauma entails the cultural and ecological systems that mediate human experience and provide resources for coping and meaning making. Furthermore, the detection of traumatic stress disorder implies that the stressful event has overtaxed personal and, in some cases, community capacities. It follows that in considering cultural and ecological factors in the understanding of trauma and trauma recovery, both community resources for resilience and personal resources for coping that are appropriated from culture should be assessed. This emphasis on the cultural and the ecological is in response to the limitations of individually focused western conceptions of trauma and concerns about medicalized approaches to trauma intervention that insufficiently account for contextual factors in trauma recovery (Argenti-Pullen, 2000; Burstow, 2003; Summerfield, 2004).

This chapter argues that the contemporary practice of cultural competence falls short of ethnomedical competence. Ethnomedicine is the study of culturally embedded or alternative beliefs and practices for health care (Genest, 1978; Nichter, 1992). Interdisciplinary with medical anthropology, ethnomedical critique examines the processes by which societies abandon their culturally embedded practices in favor of modern practices.

This chapter emphasizes the time dimension in trauma assessment. As will be detailed, an approach that examines preceding generations’ trauma exposure yields the most complete assessment of an individual’s posttraumatic status. This status is best understood within my multidimensional, multidisciplinary framework. This chapter draws heavily on the International Handbook of Multigenerational Legacies of Trauma (Danieli, 1998) that the interested reader is urged to consult for further details.

Over 20 million displaced persons have relocated in Asia (49%), Europe (21%), and the Americas (10%) (UNHCR, 2003). Victimized by torture, trauma, imprisonment, and human rights violations, these unwilling immigrants are burdened by extraordinary psychological, emotional, physical, and acculturative sources of distress, resulting in an international dilemma. Resettlement in host countries may necessitate mental health services, healing of core adaptation systems, and succor for housing, employment, language, and coping skills necessary for survival and psychological well-being in unfamiliar cultures.

Being an asylum seeker in these times of increasing fear from international terrorism, mass migrations, ongoing political violence, social and economic inequity in the world and a global search for identity of large groups of people means having a very tough existence and suffering from a breakdown in different aspects of life, including psychological well-being.

A majority of trauma research has been conducted in Western nations on patients from a similar background, and its findings are typically published in English, with only 6% in languages other than English (Bedard, Greif, &Buckley, 2004). Thus, clinicians and researchers do not yet know whether people from non-Western societies have similar reactions or symptom patterns to specific trauma. This chapter aims to fill this knowledge gap by reviewing available literature on the assessment of posttraumatic stress reactions and related psychiatric disturbances in contemporary Chinese societies of Hong Kong, mainland China, and Taiwan.

Culture influences or defines youths’ characteristic reactions, methods of expressing reactions, and therapeutic needs following traumatic experiences (Nader, in press; see Box 1). Culture shapes the mediating and moderating factors –the traits, circumstances, and environmental issues that may alter outcomes –associated with traumatic response. Cultural heritage molds the family unit, which in turn helps to form a youth’s identity development (Sonderegger, Barrett, &Creed, 2004). Findings have been mixed regarding many aspects of youths’ traumatic responses. Many factors, including cultural issues, may account for these mixed findings. The norms of one culture may not apply to those of other cultures (Lee, Lei, &Sue, 2001; Rousseau &Drapeau, 1998).

After receding into relative obscurity for much of the twentieth century, there has been a vigorous renewal of interest in the role of dissociation in the understanding of human responses to catastrophic events. The theoretical contributions and clinical observations of Janet, which had been largely eclipsed by developments within modern ego psychology, self-psychology, and more recently in neurobiology, have enjoyed a resurgence of interest. Putnam (1989), and van der Kolk and van der Hart (1989a, 1989b) have provided contemporary reinterpretations of the contributions of Janet to the understanding of traumatic stress and dissociation.

Posttraumatic stress disorder (PTSD) was introduced into the world psychiatric nomenclature in 1978 (World Health Organization, 1978) with the publication of the ICD-9, documenting the cross-cultural recognition of the typical symptomatic response to exposure to traumatic life events (e.g., Horowitz, 1976). The characteristic core of the disorder includes the distressing oscillation between intrusion and avoidance. Intrusion is characterized by nightmares, unbidden visual images of the trauma or its aftermath while awake, intrusive thoughts about aspects of the traumatic event, sequelae, or self-conceptions. Avoidance is typified by deliberate efforts to not think about the event, not talk about the event, and avoid of reminders of the event. Also characteristic are more active attempts to push memories and recollections of the event or its aftermath out of mind by increasing use of alcohol or drugs, overworking, or other strategies designed to divert attention or to so exhaust someone that he or she is temporarily untouched by the intrusive phenomenology. In addition to the frank avoidance, Horowitz also described emotional numbing as a not uncommon sequel to exposure to a traumatic life event (Horowitz, 1975; Horowitz &Kaltreider, 1977). There is empirical evidence supporting three of these four phenomena.