Comment by philwelch | Hacker News Reader

Comment by philwelch | Hacker News Reader

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This is a really good comment that touches on some thoughts I’ve been pondering for awhile now.

In psychology, there is a concept of “culture-bound disorders”. Traditionally, these seem to be very unusual disorders that are extremely common in some cultures but not in WEIRD cultures. I think maybe the psychologists are getting this backwards; maybe some of the proper disorders in the DSM are actually culture-bound to WEIRD culture, and I think the specific way PTSD is normally described may be one of these. This isn’t to say that other cultures don’t have stress reactions, but they have different stress reactions that crystallize in forms that are more “normal” to their cultures, the way textbook PTSD is effectively “normal” to our culture. I’ve read about cases where well-meaning Western counselors show up to natural disasters expecting the survivors to have textbook PTSD symptoms. At first, people hear these counselors asking about PTSD symptoms and are genuinely confused, but apparently with enough contact, the suggestion from an authoritative sounding western medical practitioner implying that this is how they should be feeling in that situation can end up inducing those very symptoms.

> I think the specific way PTSD is normally described may be one of these

I'm not sure I understand: Are you saying that there is research that says PTSD is WEIRD? Or is this your idea?

One common feature of Western culture, or at least US culture, is to play down PTSD (and other psychological conditions). Suicide rates among veterans is sky-high, in part because PTSD is treated as dubious. Let's be careful about what we say.

There's a common thread in the comment you're replying to and another comment made by the same author, in which they appear to quietly suggest that perhaps it's just TBIs and sleep deprivation. I get the sense it's a theme.

> One common feature of Western culture, or at least US culture, is to play down PTSD

Yes indeed!

I’m suggesting that TBI’s and sleep deprivation probably make things worse instead of better. Would you seriously argue the contrary?

Broader culture plays down all the atrocities and sheer waste of war for its own psycological purposes. Treating PTSD as dubious is simply collateral damage when it comes to pretending that war means anything but exploding living humans over dirt / oil / religion / money / power.

> I'm not sure I understand: Are you saying that there is research that says PTSD is WEIRD? Or is this your idea?

I’m saying that the specific features and symptoms are not necessarily universal across cultures and that we don’t have anything close to a full understanding of the underlying psychology. All people react to stress, but the specific ways they react to stress might be more culturally bound than we expect. It’s hard to tell because our understanding of PTSD is almost entirely based on cases observed inside of WEIRD cultures.

> One common feature of Western culture, or at least US culture, is to play down PTSD (and other psychological conditions).

This was obviously very much the case for some time. I think we’ve made some laudable efforts to improve on this in recent years.

> Suicide rates among veterans is sky-high, in part because PTSD is treated as dubious.

I agree that veteran suicide is a major problem. I also agree with the desire to avoid stigma. That’s actually why I am skeptical about the impulse to address veteran mental health, for lack of a better terminology, almost entirely within a medical and clinical frame. That carries the implication that our culture is completely healthy and it’s only our returning warriors who are sick and mentally unwell. On the contrary, I think our culture is deeply sick and atomized, and that our warriors are more alienated from civil society than ever before.

It’s not just arrogant but outright laughable to assume we have all of this figured out. If we had it all figured out, we would have solved the problem.

> Let's be careful about what we say.

I am. Let’s be careful about making a good faith effort to actually understand and respond to what’s being said instead of misrepresenting it and trying to shut down the conversation.

It's really hard to read this comment as anything but a quiet suggestion that perhaps PTSD is a result of mental health workers and not the result of trauma. What seems far more likely is that people trapped in cultures that have not really developed a strong mental health response (e.g., 20th century America) have few if any resources available to help people with their literally invisible condition, and they have been trained through stigma and other "culture-bound" behaviours to keep their problems to themselves and show that stiff upper lip.

> It's really hard to read this comment as anything but a quiet suggestion that perhaps PTSD is a result of mental health workers and not the result of trauma.

I’m sorry you struggled and ultimately failed to understand what I was saying, because I actually clarified this specific point:

> This isn’t to say that other cultures don’t have stress reactions, but they have different stress reactions that crystallize in forms that are more “normal” to their cultures, the way textbook PTSD is effectively “normal” to our culture.

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