Mark Barad

Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives

Foreword Robert Jay Lifton 1. Introduction: inscribing trauma in culture, brain and body Laurence J. Kirmayer, Robert Lemelson and Mark Barad Part I. Biological Perspectives on Trauma: Introduction Mark Barad 2. Neurobiological and neuroethological perspectives on fear and anxiety Vinuta Rau and Michael S. Fanselow 3. Some biobehavioral insights into persistent effects of emotional trauma Mark E. Bouton and Jaylyn Waddell 4. Learning not to fear: a neural systems approach Gregory Quirk, Mohammed R. Milad, Edwin Santini, and Kelimer Lebron 5. Mechanisms of fear extinction: towards improved treatments for anxiety Mark Barad and Chris K. Cain 6. Developmental origins of neurobiological vulnerability for PTSD Rose Bagot, Carine Parent, Timothy W. Bredy, Tie Yuan Zhang, Alain Gratton and Michael J. Meaney 7. Somatic manifestations of traumatic stress Emeran A. Mayer 8. Does stress damage the brain? J. Douglas Bremner Part II. Clinical Perspectives on Trauma: Introduction Laurence J. Kirmayer 9. Cognitive behavioral treatments for PTSD Elna Yadin and Edna B. Foa 10. PTSD among traumatized refugees J. D. Kinzie 11. PTSD: a disorder of recovery? Arieh Y. Shalev 12. The developmental impact of childhood trauma Bessel A. van der Kolk 13. Adaptation, ecosocial safety signals and the trajectory of PTSD Derrick Silove 14. Religion and spirituality after trauma James K. Boehnlein 15. Post-traumatic suffering as a source of transformation: a clinical perspective Cecile Rousseau and Toby Measham Part III. Cultural Perspectives on Trauma: Introduction Robert Lemelson 16. Trauma, adaptation, and resilience: a cross-cultural and evolutionary perspective Melvin Konner 17. Bruno and the holy fool: myth, mimesis, and the transmission of traumatic memories Allan Young 18. Failures of imagination: the refugees predicament Laurence J. Kirmayer 19. Trauma, culture and myth: narratives of the Ethiopian Jewish exodus Gadi BenEzer 20. Post-traumatic politics: violence, memory and biomedical discourse in Bali Leslie Dwyer and Degung Santikarma 21. Terror and trauma in the Cambodian genocide Alexander Hinton 22. Trauma in context: integrating biological, clinical and cultural perspectives Robert Lemelson, Laurence J. Kirmayer and Mark Barad Epilogue: trauma and the vicissitudes of interdisciplinary integration Laurence J. Kirmayer, Robert Lemelson and Mark Barad Index.

The Developmental Impact of Childhood Trauma

Childhood trauma, including abuse and neglect, is probably the single most important public health challenge in the United States – a challenge that has the potential to be largely resolved by appropriate prevention and intervention. Each year over 3 million children are reported for abuse and/or neglect in the United States (Wang & Daro, 1997). The effects of abuse and neglect are well documented to persist over time. Although posttraumatic stress disorder (PTSD) has received much attention in the research and clinical literature, it is not the most common psychiatric diagnosis in children with histories of abuse and neglect (Putnam, 2003).Separation anxiety disorder, oppositional defiant disorder, and phobic disorders may all be more frequent diagnoses than PTSD in abused children, and attention-deficit hyperactivity disorder (ADHD) is common as well (Ackerman, Newton, McPherson, Jones, & Dykman, 1998). Because there is only one trauma-related diagnosis in the fourth edition of the Diagnostic and Statistical Manual ( DSM–IV ), the effects of trauma on children are generally described under the rubric of PTSD, with numerous additional comorbid diagnoses to describe the many other psychological and biological functions that are disturbed by life experiences that may overwhelm the coping mechanisms of the growing human organism. When the DSM–IV was under development, extensive research was conducted to support the introduction of complex PTSD or disorders of extreme stress not otherwise specificed (DESNOS) as an extended diagnosis for children and adults who were victims of prolonged interpersonal abuse (Herman, 1992; van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005).

Understanding Trauma: Introduction: Inscribing Trauma in Culture, Brain, and Body

INTRODUCTION We live in a world torn and scarred by violence. Globalization has increased the speed and scale of conflicts and catastrophes, but violence has been integral to the human condition from our earliest origins. We should expect, therefore, to find its traces in the design of our brains and bodies no less than in the weave of our communities. Trauma has become a keyword through which clinicians and scholars from many disciplines approach the experience of violence and its aftermath. The metaphor of trauma draws attention to the ways that extremes of violence break bodies and minds, leaving indelible marks even after healing and recovery. But the notion of trauma has been extended to cover a vast array of situations of extremity and equally varied individual and collective responses. Trauma can be seen at once as a sociopolitical event, a psychophysiological process, a physical and emotional experience, and a narrative theme in explanations of individual and social suffering. Within psychiatry, much recent work on the psychological impact of trauma has focused on the diagnostic construct of posttraumatic stress disorder (PTSD). The diagnostic criteria for PTSD include a history of exposure to a traumatic event and symptoms from each of three groups: intrusive recollections of the trauma event, avoidance of reminders of the event and emotional numbing, and hyperarousal (American Psychiatric Association [APA], 2000).