Impact of Culture on PTSD in the Middle East Essay

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PTSD in the Middle East



Post-Traumatic Stress Disorder (PTSD) is one of the most common mental health or psychological disorders facing people in the Middle East region. This condition emerges from episodes of social upheaval, combat, and violence that have become common in the Middle East over the past few years. Some of the major areas in the Middle East that have been characterized by increased conflicts in recent years include Palestine, Iraq, and Lebanon. Given increased conflicts and combat in the Middle East, PTSD and other trauma-related mental health conditions are expected to become public health crisis in the Arab world (Suto, 2016). Therefore, public health professionals in the Middle East face the need to develop appropriate measures for diagnosis and treatment of PTSD and other trauma-related disorders. However, the treatment of this condition and other traumatic mental health disorders is significantly affected by culture. This paper examines how culture in the Middle East affect

diagnosis and treatment of Post-Traumatic Stress Disorder.



Prevalence of PTSD in the Middle East



The Middle East in one of the regions in the world that has experienced increased cases of violence, combat, and conflict. According to Neria, Bravova & Halper (2010), civilians in the Middle East have experienced frequent episodes of natural disasters, violence, and intra- and inter-group conflicts. These episodes have in turn generate psychological distress among civilians, particularly because they are extreme forms of psychological trauma. Since civilians in this region are repetitively exposed to these incidents, a significant portion of them are vulnerable to trauma-related psychopathology. Existing studies have established a strong link between Post-Traumatic Stress Disorder and repetitive exposure to violence, conflict, and natural disasters. PTSD is strongly linked to such incidents on the premise that they are extreme forms of psychological distress with tremendous negative impacts on an individual’s mental health and psychological well-being.



Since the Middle East has been characterized by increased episodes of conflicts, violence, and natural disasters in recent years, several studies have been carried out to examine the prevalence of PTSD on the general population in this region. Afana (2012) states that these studies have reported a wide range of prevalence rates for PTSD since they utilized different research instruments and were carried out in different countries. For example, a survey on Palestinian territories reported 34% prevalence rates of PTSD, while Lebanon is reported to have 29.3% PTSD prevalence rates (Afana, 2012). Generally, the overall general-population prevalence of Post-Traumatic Stress Disorder in the Middle East varies depending on the research instrument and the population’s exposure to extreme forms of psychological distress.



Neria, Bravova & Halper (2010) reports that higher rates of prevalence of PTSD in this region are reported among children and in areas with recent or ongoing conflict, violence, war or natural disasters. According to Afana (2012), the most common PTSD cluster in the Middle East is enhanced arousal in the aftermath of experiencing traumatic events or exposure to incidents with extreme forms of psychological distress.



In light of the increased episodes of traumatic events in the Middle East, Suto (2016) argues that PTSD is and will be a public health crisis in this region and the entire Arab world. Large portions of populations in the Middle East are continually exposed to torture, witnessing murder, political/religious discrimination and oppression, and displacement. This contributes to increased vulnerability to PTSD, which is in turn a major public health issue. As these episodes continue to be prevalent, there have relatively minimal efforts by public health professionals in the Middle East to deal with this public health issue/concern.



Diagnosis and Treatment of PTSD in the Middle East



PTSD is an established diagnostic category that is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, the conceptualization and diagnosis of this condition needs to be revisited given the widespread episodes of natural disasters and other traumatic events (Nicolas, Wheatley & Guillaume, 2014).

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Most of the existing research and diagnosis of PTSD in the Middle East focuses on the aftermath of isolated, single traumatic events for individual civilians such as violence and conflicts. While this framework is suitable for diagnosis of the condition, Nicolas, Wheatley & Guillaume (2014) argue that its important to place PTSD in a social and cultural context. The integration of a social and cultural context helps to generate a suitable diagnosis of this condition and plays a major role in the development of an effective treatment technique or approach.

In the Middle East, diagnosis and treatment of PTSD is based on the symptom clusters classified in the Diagnostic and Statistical Manual for Mental Disorders (DSM). However, the use of these clusters is characterized with some challenges since they are based on an unproven belief that they are conceptually and culturally valid across different sociocultural settings (Afana, 2012). The clusters listed in DSM are based on conceptualizations developed in the United States, which may not represent the sociocultural context of a different country even when translated into the local language. Additionally, the use of these clusters does not imply that civilians in different sociocultural settings such as the Middle East will experience similar symptoms and mental illnesses.



Given these factors, a sociocultural conceptualization of mental health condition is critical towards effective diagnosis and treatment of PTSD and other trauma-related conditions in the Middle East. The use of symptom clusters derived from U.S. scales without integration of culturally relevant local idioms and social representations of psychological distress contributes to complexities in appropriate diagnosis and treatment of PTSD. Afana (2012) contends that local or sociocultural idioms of distress are culturally-specific measures of showing distress. Therefore, these factors play a critical role in appropriate diagnosis and treatment of trauma-related disorders like Post-Traumatic Stress Disorder as well as other mental health conditions.

According to Suto (2016), the diagnosis and treatment of Post-Traumatic Stress Disorder in the Middle East has been affected by the increased episodes of violence and other traumatic events. Public health officials in different countries in the Middle East region have experienced tremendous challenges in their efforts to diagnose and treat PTSD because of increased episodes of traumatic events. Rewar (2015) concur by stating that high rates of exposure to traumatic events has limited mental health care provision in the Middle East despite increased need for such healthcare services. Therefore, ongoing traumatic events have significantly affected the provision of mental health care for treatment of PTSD.



Role of Culture in Diagnosis and Treatment of PTSD in the Middle East



Existing literature has established the case for culturally-specific ways of diagnosis and treatment of PTSD. Skinner & Kaplick (2017) state that while PTSD is an established diagnostic category, culture is an essential factor in the symptom manifestation, diagnosis, and treatment of this condition. Over the past two decades, there has been increased interest in consideration and examining the role culture plays in diagnosis and treatment of PTSD. This is largely because culture has been identified as an influential factor in how mental illnesses like PTSD forms, manifests itself, and is treated.



In the Middle East, culture influences how civilians respond to various forms of psychological distress in light of the increased episodes of traumatic events. Additionally, culture determines social representations of trauma and meanings associated with it. Unlike the western world, trauma in the non-western world such as the Middle East is presented using culturally-appropriate metaphors that have not been embraced in psychiatric nosology. For instance, in Palestine, trauma is presented using three metaphors i.e. sadma, faji’ah, and musiba. While sadma is used to refer to sudden painful events, faji’ah is used to refer to response to an extraordinary event or tragedy and musiba is used to refer to persistent traumatic events with long-term consequences (Afana, 2012). In the Arab culture in the Middle East, anxiety and.....

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References

Afana, A. (2012). Problems in Applying Diagnostic Concepts of PTSD and Trauma in the Middle East. The Arab Journal of Psychiatry, 23, 28-34.

Davey, C., Heard, R. & Lennings, C. (2018, January 28). Development of the Arabic Versions of the Impact of Events Scale-Revised and the Posttraumatic Growth Inventory to Assess Trauma and Growth in Middle Eastern Refugees in Australia. Clinical Psychologist, 19(3), 1-9.

Ibrahim, H. & Hassan, C.Q. (2017, February 20). Post-traumatic Stress Disorder Symptoms Resulting from Torture and Other Traumatic Events Among Syrian Kurdish Refugees in Kurdistan Region, Iraq. Frontiers in Psychology, 8, 241. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5316552/

Kizilhan, J.I. (2017, December 28). Trauma and Pain in Family-Orientated Societies. International Journal of Environmental Research and Public Health, 15(44), 1-7.

Neria, Y., Bravova, M. & Halper, J.M. (2010). Trauma and PTSD Among Civilians in the Middle East. PTSD Research Quarterly, 21(4), 1-8.

Nicolas, G., Wheatley, A. & Guillaume, C. (2014, March 26). Does One Trauma Fit All? Exploring the Relevance of PTSD Across Cultures. International Journal of Culture and Mental Health, 8(1), 34-45.

Norris, A.E. & Aroian, K.J. (2008, October). Avoidance Symptoms and Assessment of Posttraumatic Stress Disorder in Arab Immigrant Women. Journal of Traumatic Stress, 21(5), 471-478.

Rewar, S. (2015, May-June). Diagnosis, Prevention & Treatment of PTSD. Indian Journal of Research in Pharmacy and Biotechnology, 3(3), 204-209.

Skinner, R. & Kaplick, P.M. (2017, December 4). Cultural Shift in Mental Illness: A Comparison of Stress Responses in World War I and the Vietnam War. Journal of the Royal Society of Medicine Open, 8(12), 1-5.

Suto, R.J. (2016, November 4). Mental Health as Foreign Policy: Trauma in the Arab World. Retrieved June 8, 2018, from https://www.fairobserver.com/region/middle_east_north_africa/mental-health-ptsd-middle-east-health-news-78002/
 

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