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Discourses of Psychological Trauma
Nikki Kiyimba
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THE LANGUAGE OF MENTAL HEALTH
Discourses of
Psychological Trauma
Nikki Kiyimba · Christina Buxton
Jo Shuttleworth · Emily Pathe
The Language of Mental Health
Series Editors
Michelle O’Reilly, The Greenwood Institute, University
of Leicester, Leicester, UK
Jessica Nina Lester, School of Education, Indiana
University, Bloomington, IN, USA
This series brings together rich theoretical and empirical discussion at
the intersection of mental health and discourse/conversation analysis.
Situated broadly within a social constructionist perspective, the books
included within this series will offer theoretical and empirical examples
highlighting the discursive practices that surround mental health and
make ‘real’ mental health constructs. Drawing upon a variety of discourse
and conversation analysis perspectives, as well as data sources, the books
will allow scholars and practitioners alike to better understand the role
of language in the making of mental health.
We are very grateful to our expert editorial board who continue to
provide support for the book series. We are especially appreciative of the
feedback that they have provided on earlier drafts of this book. Their
supportive comments and ideas to improve the book have been very
helpful in our development of the text. They continue to provide support
as we continue to edit the book series ‘the language of mental health’. We
acknowledge them here in alphabetical order by surname.
Tim Auburn, Plymouth University, UK
Galina Bolden, Rutgers University, USA
Susan Danby, Queensland University of Technology, Australia
Debra Friedman, Indiana University, USA
Ian Hutchby, University of Leicester, UK
Doug Maynard, University of Wisconsin, USA
Emily A. Nusbaum, University of San Francisco, USA
Nikki Kiyimba · Christina Buxton ·
Jo Shuttleworth · Emily Pathe
Discourses
of Psychological
Trauma
Nikki Kiyimba Christina Buxton
School of Social Practice University of Chester
Bethlehem Tertiary Institute Chester, UK
Tauranga, New Zealand
Emily Pathe
Jo Shuttleworth Department of Psychology
Department of Psychology Glasgow Caledonian University
University of Manchester Glasgow, UK
Manchester, UK
The Language of Mental Health

ISBN 978-3-031-07710-4 ISBN 978-3-031-07711-1 (eBook)
https://doi.org/10.1007/978-3-031-07711-1
© The Editor(s) (if applicable) and The Author(s) 2022

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whether the whole or part of the material is concerned, specifically the rights of translation,
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Preface
This book has been birthed during the COVID-19 global pandemic, and
it is interesting to be writing about the topic of psychological trauma at
a time like this. We, like everyone else, have not been immune to the
destructive influence of the pandemic, often struggling throughout the
creating of this book with not just our own clinical and academic roles,
but also managing our personal and family circumstances.
In reflexively positioning ourselves as authors, we draw on Ether-
ington’s (2004) advice to be “aware of what influences our relationship
to our topic and our participants. Those influences inform personal,
cultural, or theoretical constructs that we use to guide our interactions
as we engage in the research and represent our data” (p. 46). There are
a variety of paths that have led each of us to make working with trauma
our professional focus, and within the broad topic, we have different
areas of interest. Our collaboration in working together on this book
reflects our similarities in clinical and academic experience, and our
critical social constructionist positioning in relation to the epistemics
of ‘reality’. We are all psychologists originating from different parts
of the British Isles and have been working clinically with people who
v
vi Preface
have experienced trauma as well as teaching other professionals about

trauma. Although now scattered and working in different countries and
in different contexts, we started our journey together teaching students
on the same postgraduate programmes (apart from EP who taught on a
different postgraduate programme alongside her clinical practice). Our
students were professionals who worked in a wide range of contexts
where trauma appears—prisons, schools, counselling, psychotherapy and
psychology, social work, yoga, nursing, medical, ambulance service,
working with animals, and many more. Our programmes were designed
to train and support students in understanding and working with people
who have experienced trauma in an informed and skilful way. It was
through this process that we felt we wanted to write something that
would explore the breadth and depth of psychological trauma as a
concept and an experience, and to give time to investigating the chal-
lenging dichotomy posed by the question “is it a ‘real’ thing or a social
construct?” We hope and trust that as you explore the chapters presented,
you journey with us in questioning this dichotomous way of positioning
social reality and gain a deeper and more appreciative stance in relation
to the way that we understand our own and others’ experiences of the
world.
As a fish swimming in the sea is not fully aware of the ubiquity of
the water it swims in, we know that our perspectives as white British
and Irish female heterosexual professionals position us as certain kinds
of fish. All academic endeavours towards knowledge production and
dissemination are veiled by some degree of inevitable ‘epistemological
ignorance’ which refers to a propensity towards blind spots (Ruck et al.,
2019). However, as much as our hegemonic histories allow, we seek to
turn the same lens of critical analysis on ourselves as ‘insiders’ within
those systems that we also seek to expose. As clinical academics, we
operate within the very institutions that perpetuate dominant discourses
of trauma in terms of illness and deviance. Our professional roles ensure
the need to ‘buy into’ the concept of trauma as existing in some shape
or form, and to do so make it possible to be able to operate within the
parameters of the systems of which we are part. At the same time, we also
hold the tension of deconstructing those same situated discourses. We do
not presume that our perspective is by any means the only perspective,
Preface vii
and totally accept that there are many ways of considering these topics.
We simply invite you as our reader to join us and to come also with an
open mind, willing to consider different arguments and ideas.
The important thing is not to stop questioning. Curiosity has its own
reason for existing. One cannot help but be in awe when he contemplates
the mysteries of eternity, of life, of the marvelous structure of reality. It
is enough if one tries merely to comprehend a little of this mystery every
day. Never lose a holy curiosity. (Einstein, 1955, p. 64)
As we navigate this topic together, throughout the book we pivot

between our respective positions as human beings, as therapists, and as
academic researchers. Each of these positions brings a different lens to the
subject. Whilst, as academics, we value the rigour of researching the liter-
ature and considering the empirical evidence, we also know as therapists
that there is always a ‘so what?’ to be considered. We expect, like us, you
will be keen to evaluate how the information we critically examine will
make a difference to your professional practice or to your approach and
perspective in your work. To that end, we have sought to pull together
the threads and strands of the arguments presented in each chapter into
a final section entitled ‘applications’. Here, we reflectively turn to our
attention to our shared humanity and to our awareness of the pragmatic
need to bring these ideas into a semblance of order that can make sense
in the real world of our everyday lives. Sometimes, there is no concrete
answer or solution, but we invite you to stand with us in the place of ‘not
knowing’ with at least a little broader perspective on perhaps previously
taken-for-granted assumptions about how things just ‘are’.
One of the positions that we take is an appreciative affinity with
Claudia Brunner’s work on epistemic violence (2007, 2010, 2016,
2021). Epistemic violence is defined as “violence exerted against or
through knowledge” (Galván-Álvarez, 2010, p. 11). We argue along with
Coronil (1996) that what constitutes knowledge per se is a contested area
and is not only an academic concern but a political reality. In this context
of ‘political epistemics’ (Coronil, 1996), epistemic violence is “one of
the key elements in any process of domination” (Galván-Álvarez, 2010,
p. 11). We acknowledge therefore that the predominantly Eurocentric
viii Preface
realm of scholarly activity that values the production of books such as

this is arguably one of the ways in which we co-create, position, and
perpetuate dominant discourses. In choosing the word Eurocentric as a
reference point for describing this prevailing privileged perspective in the
so-called global epistemological hierarchy, we are doing so with consider-
ation of the various ways in which the “the West is often identified with
Europe, the United States” (Coronil, 1996, p. 52). We could equally
therefore have used the term ‘West’ in the same way, and in places may
do so, as we perceive that these terms are “frequently interchangeable or
synonymous” (ibid.).
The widespread global dominance of valuing certain kinds of knowl-
edges and knowledge production is an indication of the ways in which
cultural preferences have usurped those of other cultures. Brunner (2016)
draws on the idea of epistemic violence to highlight the ways in which
‘scholarly expertise’ can often be the vehicle for the “perpetuation of
globally asymmetric relations between knowledge and power” (p. 5).
Thus, the radical elimination of certain epistemic traditions through
colonisation is also a matter of importance in any reflexive consideration
of academic accountability. With reference to these kinds of concerns,
Quijano (2010) states that:
colonialism was a product of a systematic repression, not only of the

specific beliefs, ideas, images, symbols or knowledge that were not useful
to global colonial domination” but “above all, over the modes of knowing,
of producing knowledge, of producing perspectives, images and systems
of images, symbols, modes of signification, over the resources, patterns,
and instruments of formalized and objectivised expression, intellectual or
visual. (p. 23)
It is thus, in exercising ‘strong reflexivity’ (Harding, 1993), with as much

awareness as we are capable, that we seek to navigate the tension of
honouring and owning our respective backgrounds and education that
privilege certain kinds of knowing, with a respect and valuing of alter-
native ‘modes of knowing’. In other words, we accept that “knowledge
producers (i.e., scientists) must actively work to become aware of how
their social location impedes their ability to perceive aspects of social
Preface ix
reality that are accessible to others” (Ruck et al., 2019, p. 6). It is some-
what paradoxical that in writing an academic text as authors who are
inhabitants of a dominant Western paradigm that asserts a particular
epistemological privilege, we draw upon the conceptual framework of
epistemic violence to do so. However, we hope that we do so in as
reflexive way as possible, simultaneously cognisant that there will be
inevitable epistemic blind spots that we are unaware of, and equally
reaching for the light switch for both ourselves and our readers to
recognise and embrace a wider epistemic horizon than before.
To achieve this widening of narrow perspectives, the visionary Frantz
Fanon references Coronil (1996/2019) who speaks of writing “poetry
from the future”, a moving and powerful concept that he engaged in
as a means “to liberate both colonizer and colonized from the night-
mare of their violent history” (p. 51). We turn our attention, particularly
in Chapters Six and Seven, to this endeavour by critically exploring the
notion of universality as a starting point for what Quijano (2010) refers
to as “epistemological decolonisation” (p. 31). A helpful phrase that
encapsulates the problem that epistemological decolonisation seeks to
retrieve is that of ‘Occidentalism’, which is defined as being characterised
by the following distinguishing features:
• Separation to the world into bounded units;

• Separation of relational histories;
• Reconceptualisation of difference into hierarchical preference;
• Naturalisation of these representations; and
• Interventions that even unintentionally reproduce asymmetrical power
relations (Coronil, 1996/2019).
Brunner states that “Coronil’s definition of occidentalism provides a suit-

able tool to deconstruct unquestioned truth claims on many objects of
knowledge and the dispositives within which those claims come into
being” (Brunner, 2007, p. 6). We value this opportunity to engage with
a coherent framework which affords an opportunity for constructive
deconstruction of ‘unquestioned truths’. Additionally, the term occi-
dental as it is defined by Coronil not only contains the idea of privileging
Western ways of knowing as hierarchically superior to other epistemic
x Preface
positions, but also positions that ethnocentric vantage point as a plat-

form for leveraging global dominance of ideology. In other words,
privileging certain knowledge frameworks as superior to others simul-
taneously affords those knowledge systems and their incumbents with
a mechanism of exerting power or dominance over those who hold
to different systems of knowledge. Furthermore, Brunner positions the
West as synonymous with Occidentalism, referring interchangeably in
her work to the “‘Western/Occidental’ model of civilisation” (Brunner,
2010, p. 86). Occidentalism is:
inseparable from Western hegemony not only because as a form of knowl-

edge it expresses Western power, but because it establishes a specific bond
between knowledge and power in the West. Occidentalism is thus the
expression of a constitutive relationship between Western representations
of cultural difference and worldwide Western dominance. (Coronil, 1996,
p. 57)
The ways in which Coronil’s framework of Occidentalism (1996/2019)

relates to Brunner’s work on epistemic violence (2015, 2021) are that
epistemic violence is the action of disregard or eradication of one type
of knowledge paradigm by another. Let us take a moment to explore
this further. One of Brunner’s assertions in relation to her work on social
narratives of suicide bombing is that it is the occidentalist nature of most
academic knowledge on this topic that perpetuates the privileging of the
‘Western Self ’ (Brunner, 2007). Spivak (1994) originated these ideas in
a seminal paper entitled Can the Subaltern Speak? which gives a large
part of its content to an analysis of the colonising practices of British in
India whereby many Hindu practices were reframed and prohibited by
law. One example in this text is that of widows self-immolating on the
funeral pyre of their husband. This practice was deemed inappropriate
during the Hindu law reform and was made illegal.
Spivak (1994) uses this example to illustrate how the indigenous
knowledges of the Hindu people were either disregarded or could not be
heard because the cultural practices differed so much from those of the
British colonisers. Spivak describes epistemic violence as the subjugation
of “a whole set of knowledges that have been disqualified as inadequate
Preface xi
to their task or insufficiently elaborated: naive knowledges, located low

down on the hierarchy, beneath the required level of cognition or scien-
tificity” (Spivak, 1994, p. 76). In a more direct and provocative framing
of this practice, Spivak portrays this ignorance as “White men are saving
brown women from brown men” (ibid.). Whether we think of these
practices as arrogant, brutal, naïve, or misguided, at worst they may be
considered deliberate, forcible, conscious acts to super-impose one set of
cultural ways of being over another. At best, they are ignorant and arro-
gant attempts to ‘help’ others by introducing so-called improvements to
social order. From this very generous perspective, acts of harm could
be seen as iatrogenic—in other words harm caused in the process of
trying to do good. Perhaps this is what Spivak meant in his caricature of
white men ‘saving’ brown women. In some way, this implies that all they
could see from their worldview were oppressed women who needed to be
rescued. This is the danger globally of one cultural group attempting to
introduce practices in different cultural contexts and communities that
are perceived by the ‘benefactors’ as acts of emancipation or liberation
but may be experienced by their recipients as of violence, manipulation,
or obliteration.
An aspect of this kind of epistemic violence as it may apply to
our thesis on psychological trauma is the widespread application of
medical diagnostic categorisation of certain experiences. Spivak refer-
ences Foucault’s (1965) Madness and Civilization as the etiological
origins of the notion of epistemic violence, by locating it within
Foucault’s “complete overhaul of the episteme, in the redefinition of
sanity at the end of the European eighteenth century” (Spivak, 1994,
p. 76). Thus, the link is made between acts of epistemic violence gener-
ally and epistemic violence more specifically in relation to the ways
in which sanity and madness, normality and abnormality have been
dichotomously constructed according to a dominant Western scientific
paradigm.
Whilst the aim of this book is to consider these arguments in more
detail, the immediate reaction of many to being introduced to an aware-
ness of these meta narratives which have shaped our understandings of
xii Preface
history, culture, and deviance may be shock or even feelings of guilt.

In this regard, Ruck and colleagues warn us against squirming away
from facing up to these realities consciously or unconsciously because
of the dissonance evoked. Some experts in this field of study have noted
a phenomenon they refer to as ‘epistemological ignorance’ which “func-
tions as a psychological defense mechanism particularly against feelings
of guilt” (Ruck et al., 2019, p. 9). We simply offer a cautionary note
that the subtle benefits of slipping into epistemological ignorance either
wilfully or inadvertently can be a numbing of this discomfort. We can
psychologically defend ourselves from reflexive epistemological trans-
formation by resisting and avoiding feelings of discomfort. However,
perhaps by sitting with some of that discomfort, it may be possible to
hear what we have not been previously able to hear.
Logically, we may then begin to consider that we could possibly be
part of the solution to the division and ‘othering’ created by epistemic
supremacy. Perhaps even being motivated to find small ways to increase
epistemic equality. An interesting proposal made by feminist theorist and
activist Clare Hemmings (2012) is that differences in epistemic value
can only be achieved by affective engagement generated through conflict.
Without this, an inequitable status quo is maintained. Hemmings (2012)
describes the person of lower epistemic valence being the initiator of
change through affective compulsion, feeling a sense of anger or rage
at the injustice experienced, which in turn when expressed can effect
change. We embrace this inclusion of affect as a motivator for change,
in what otherwise may be a primarily intellectual academic endeavour
to rebalance these oppressive inequalities. In addition, we propose that
perhaps those who hold positions of epistemic privilege could also take
initiative to level the playing field. From this perspective, conflict and
rage may not be the motivators of change, but more affable qualities such
as appreciation and respect. We propose that these qualities represent our
Preface xiii
essential nature as human beings—capable of treating one another wher-

ever we meet, as equally precious, knowledgeable, and valuable in our
own different ways.
Tauranga, New Zealand Nikki Kiyimba

Chester, UK Christina Buxton
Manchester, UK Jo Shuttleworth
Glasgow, UK Emily Pathe
Acknowledgements We wish to thank all our family members and colleagues

for their support and encouragement as we have completed this book amidst a
deluge of personal, professional, and global challenges!
References
Brunner, C. (2007). Discourse–Occidentalism–Intersectionality approaching
knowledge on ‘suicide bombing’. Political Perspectives, 1(1), 1–24.
Brunner, C. (2010). Knowing culture, knowing peace? Epistemological and/as
political aspects of the ‘culture of peace’-initiative, concept, and programme
(pp. 82–101). Drava Verlag.
Brunner, C. (2015). Boatcă: Global inequalities beyond occidentalism. Österre-
ichische Zeitschrift für Politikwissenschaft, 45 (1) (February 2016), 81. http://
dx.doi.org/10.15203/ozp.1135.vol45iss1.
Brunner, C. (2016). Knowing suicide terrorism? Tracing epistemic violence
across scholarly expertise. Ethiopian Renaissance, 3(1), 3.
Brunner, C. (2021). Conceptualizing epistemic violence: An interdisciplinary
assemblage for IR. International Politics Reviews, 1–20.
Coronil, F. (1996). Beyond occidentalism: Toward nonimperial geohistorical
categories. Cultural Anthropology, 11(1), 51–87.
Coronil, F. (2019). Beyond occidentalism: Toward nonimperial geohistorical
categories (pp. 323–367). Duke University Press.
Einstein, A. (1955). Old man’s advice to youth: ‘Never lose a holy curiosity’.
Life Magazine, 2, 64.
Etherington, K. (2004). Research methods: Reflexivities-roots, meanings,
dilemmas. Counselling and Psychotherapy Research, 4 (2), 46–47.
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Foucault, M. (1965). Madness and civilization. Trans. Richard Howard.

Pantheon.
Galván-Álvarez, E. (2010). Epistemic violence and retaliation: The issue of
knowledges in” Mother India”/Violencia y venganza epistemológica: La
cuestión de las formas de conocimiento en Mother India. Atlantis, 11–26.
Harding, S. (1993). Rethinking standpoint epistemology: What is “strong
objectivity”? In L. Alcoff & E. Potter (Eds.), Feminist epistemologies (pp. 49–
82). Routledge.
Hemmings, C. (2012). Affective solidarity: Feminist reflexivity and political
transformation. Feminist Theory, 13(2), 147–161.
Quijano, A. (2010). Coloniality and modernity/rationality. In W. Mignolo &
A. Escobar (Eds.), Globalization and the decolonial option (pp. 22–32).
Routledge.
Ruck, N., Rutherford, A., Brunner, M., & Hametner, K. (2019). Scientists as
(not) knowing subjects: Unpacking standpoint theory and epistemological
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Spivak, G. C. (1994). Can the subaltern speak? In P. Williams & L. Chrisman
(Eds.), Colonial and postcolonial theory: A reader (pp. 66–111). Columbia
University Press.
Contents
1 Introduction 1
2 Historical Discourses of Psychological Trauma
and PTSD 13
3 Critique of Psychological Trauma as a Disorder 39
4 Treatment Decisions for Psychological Trauma 73
5 Psychological Resilience and Vulnerability 115
6 Post-traumatic Growth and Recovery 139
7 Cultural Discourses of Trauma 165
8 The Impact of Globalisation and Technology
on Discourses of Trauma 191
9 Trauma, Fear, Risk, and Contagion 219
10 Summary 239
Index 251
xv
1
Introduction
Erikson (1976) defined trauma as a “blow to the psyche that breaks

through one’s defenses so suddenly and with such brutal force that one
cannot react to it effectively” (p. 156). However, our usual Western way
of thinking about trauma as a primarily individual experience has been
turned on its head, as we collectively have been plunged into a worldwide
crisis. How we now think of and respond to trauma has been an evolving
process and will probably continue to be so for many years to come,
as people wrestle not only with its legacy but also with the permanent
changes in our society and relationships with one another.
The context of this book is to re-examine the concepts that have grown
up around our thinking about what psychological trauma is. To a large
extent, the way that we imagine and story our experiences has a lot
to do with our cultural background, the time in history that we find
ourselves, and our own life journey. As such, we position this book as
an examination of the ways that trauma is constituted by the discourses
that surround it, and in turn, how these discourses create and maintain
the phenomenon as a constructed reality. By looking back to histor-
ical narratives, by examining ways in which trauma responses have been
categorised diagnostically, and by holding in mind the possibility for
© The Author(s), under exclusive license to Springer Nature 1
Switzerland AG 2022
N. Kiyimba et al., Discourses of Psychological Trauma, The Language of Mental Health,
https://doi.org/10.1007/978-3-031-07711-1_1
2 N. Kiyimba et al.
different ways of making sense of the human experience, we take a step

back and reflect on what trauma means to us as a society and how we
might respond to it moving forwards.
Epidemiological studies indicate an increase in post-traumatic stress
disorder (PTSD) to the extent that it is now a major worldwide health
concern (Brunello et al., 2001). One of the ways in which this timely
book may contribute to our thinking about psychological trauma may
be to reflect on the new world order in which we find ourselves in rela-
tion to our global community. There has been a huge increase in fear and
anxiety worldwide because of the pandemic (Mota et al., 2020; Torales
et al., 2020), and these and other psychiatric conditions are predicted to
increase including suicide both peri- and post-pandemic (Sher, 2020).
At this time, the full extent of the biopsychosocial impact of COVID-19
and its implications for increase demand for trauma treatment is not yet
known, but the studies that are beginning to emerge indicate a consid-
erable worldwide challenge for mental health services to cope with the
increased demand that the pandemic has precipitated.
One of the critical perspectives that we draw on to examine the
discourses that surround the concept of psychological trauma are the
ways in which power relations operate and are systemically produced.
In doing so, we present an examination of the ways in which trauma
is currently positioned and by whom—the governments, agencies, and
organisations who have the authority to control the ways in which
mental health and ill-health are defined. We seek to offer the reader a
considered and thoughtful alternative view to these prevailing hegemonic
perspectives. The operation and production of power in psychiatry,
psychology, and mental health fields have gained increased interest and
increased in importance in recent years (Roberts, 2005). In the Western
world, mental health in general and trauma more specifically have come
to be accepted and understood through the lens of systems and insti-
tutions in society that in turn can be seen to exercise a source of
legitimised power over those deemed to be included in their collec-
tive remit. This in turn places the individual in the hands of what
are referred to in the literature as the ‘psy-experts’ (Parker, 1994) and
under whose gaze the ‘sufferer’ is subject to intervention designed to
1 Introduction 3
restore the boundaries of normality it prescribes. Within this framework,

symptom-based explanations are used to legitimise the needs for such
interventions, without which one may be at risk of being regarded as
‘mad’, ‘deviant’, and socially shunned. As Klein and colleagues (2021) in
a recent special journal publication state, “minds, behaviours and psyches
are increasingly and explicitly problematized within social, economic,
health, welfare, education, and development policy, in both the global
North and global South. While this shift is new, it also builds on a long
colonial history of the constitution and governance of the ‘psy’” (p. 1).
This system creates and perpetuates the need for such input, however
decontextualised and culturally devoid this may be.
Drawing on the ideas of the French philosopher Michel Foucault,
who has made immeasurable contributions to the understanding of the
existence and operation of power in several fields, these ideas will be
translated into the realms of trauma policy and practice. This involves
uncovering of the discursive and affective mechanisms of knowledge-
power relations that give rise to ideologies of truth and binary practices
that constitute the normal/abnormal divide. The discourses of treatment
and recovery are in turn examined epistemologically as socio-politically,
historically, and culturally determined concepts. The influence institu-
tions have is greater where those within them hold the position of ‘expert’
and have the weight of professionalism behind them, none more so
than the profession of psychiatry and the psy-institutions (Rose, 1996).
Here, knowledge and power act in combination to exert significant influ-
ence and to create an accepted ‘grand narrative’ (Clough et al., 2004).
Language is understood as a central device in post–structuralist perspec-
tives in both creating and replicating reality (Shankar et al., 2001).
Thus, for those labelled as ‘disordered’ or ‘mentally ill’, the language
used is pathological and deficient in nature. The experience of those
marginalised groups therefore becomes one of oppression and othering.
The teachings of the dominant psy-professions are reproduced in
society through language and through behaviours that are consistent
with, and that reinforce these dominant models. This is not to suggest
that individuals lack agency, but that agency is restricted by the symbolic
systems of language, and the technologies and material systems within
which we exist (Fisher, 2011). Rejecting the grand narrative as ‘truth’
4 N. Kiyimba et al.
provides an opportunity to question or deconstruct the ways in which

we view ourselves and others, and for providing an explanatory or even
emancipatory alternative to the dominant view (Clough et al., 2004).
By examining the subjective experiences of individuals, the concept of
othering opens a social space for challenging the reproduction of the
grand narrative, and to interrogate the notion of a singular explanation
of those experiences that fits with the dominant institutions of society.
The position we take is that trauma and its correlates can be viewed as
social constructions that are closely tied to the mechanisms of power and
politics within institutions and governments. These social constructions
define what it is to be ‘disordered’ and, by definition, what it is to be
‘normal’. Deviation from the socially acceptable boundaries of normality
can be recognised by the classification of ‘symptoms’, hence rendering
an individual in need of intervention conveniently also prescribed by the
same systems these organisations operate in. This is not a cynical posi-
tion, and we do not wish to undermine the real experiences of suffering
that many people endure because of exposure to horrific events. Nor
do we wish to minimize the great work that many health professionals
are engaged in their efforts to reduce the human suffering of others.
However, the discussion presented here will contribute further to the
debates on the social construction of trauma and explore the operation of
the social structures and systems involved. An examination of the place
and purpose of discourses surrounding these processes in society, and
the power and politics of institutions and governments involved will be
assessed.
The process of medicalisation typically does not account for environ-
mental and societal forces that also act upon individuals and commu-
nities and shape their life experiences. For example, Yanovsky (2017)
purports that social problems in the Ukraine such as poverty, alcoholism,
gender relations, and environmental disasters have become redefined
as medical. In this context, she argues that symptoms of distress and
oppression are reformulated within a psychiatric diagnostic framework as
symptoms of illness. Concepts of individualism and autonomy that are
dominant in Europe and the United States have arguably been central
to the movement towards the “global hegemony of psychiatric knowl-
edge” (Kirmayer, 2012, p. 108). When we think of hegemony, what is
1 Introduction 5
important, and worrying, is that “hegemony begins with the power of

defining, theorising and participating in public discourse, in scholarly
expertise, and in policy” (Brunner, 2007, p. 16). In other words, those
who have colonial dominance globally are those who have the power to
define knowledge and experience, to label and categorise. Unfortunately,
“systematic ignorance of blind spots and how they relate to one’s own
position within the matrices of oppression and privilege makes scientists
and laypersons alike prone to assume their own experiences, perspectives,
and theories as the norm and to reproduce and stabilize power relations”
(Ruck et al., 2019, p. 17). Once this happens, other forms of sense-
making or ways of knowing and understanding the human condition
are ostensibly obliterated.
The implication of how social problems become medicalised is that
their ‘treatment’ becomes individual and biomedical rather than social
and systemic. This kind of redefinition serves to divert responsibility
away from the larger social challenges of the Soviet system onto the
pathologised individual. The ethical dilemmas that are perpetuated by
the prioritisation of biomedical explanatory frameworks also impact the
ways in which historical and intergenerational trauma is understood. For
example, in Ukraine, behavioural adaptations to historical trauma that
have been developed as coping and survival strategies are likely to be
understood a ‘symptoms’ of an underlying mental illness (Yankovsky,
2017). There is also a growing trend in the literature to appropriate the
critical lens of medicalisation to bring awareness to the ways in which
“the global health agenda and its framing of problems are shifted toward
medical and technical solutions, neglecting necessary social, community,
or political action” (Clark, 2014, p. 23998).
Throughout this text as we critically examine the medico-logical posi-
tion that trauma ‘just is’, we do so not from naïve denial that real
people experience real suffering. Rather, we seek to explore and perhaps
loosen some of the rigidity around the dominant colonial explanation of
psychological trauma (aetiology, experience, and prognosis) as primarily
an internal and individual concern. In answering the question ‘what
exactly is the age of psychiatry? Felman answers her own question:
6 N. Kiyimba et al.
it is “the age of the establishment of the hegemony of psychiatric

discourse” whereby, “according to Foucault, from the age of reason,
the age that casts madness outside civilisation and outside society by
physically confining it, by locking it up within the walls of mental insti-
tutions, later to be transformed into the psychiatric clinic, endowed with
the authority of an objectifying knowledge. The mentally disturbed are
thereby robbed of subjectivity: they are observed and talked about, but
their own discourse is invalidated, their own experience is annulled and
voided. Madness becomes the symptom of a culture, but the symptom
is incorporated in a silenced body (and a silenced soul) whose suffering
cannot say itself ”. (Felman & Evans, 2003, p. 3)
Overview of the Book

The following section provides summary of each chapter.
Chapter Two
Chapter 2 introduces the main concepts as they relate to the fields of

clinical and academic study of psychological trauma. The development
of the terminology and key discourses is situated in a historical narra-
tive, including socio-political contexts, and the ‘trauma turn’. The aim
of this opening chapter is to provide an epistemological framework that
positions the way in which discourses of psychological trauma have been
made sense of historically and currently. The dominant Western scientific
paradigm within which the biomedical model of conceptualising trauma
as a mental health is contextualised, itself sits within the framework of
dominant sociological ways of making sense of experiences. In doing so,
we invite critical reflection about the ways in which social narratives and
epistemology are connected.
1 Introduction 7
Chapter Three
Chapter 3 addresses the differences between the Diagnostic and Statis-

tical Manual of Mental Disorders (DSM) and the International Clas-
sification of Diseases (ICD). With a focus on changes to the most
recent versions, the chapter highlights the inherent meaning in the
language used with trauma-related diagnoses in the DSM-5 and ICD-11,
evidencing that the way in which these are articulated both creates and
sustains the illusion of a disordered reality following adversity. Readers
are invited to critically reflect on power operations in the psy-industries
and discuss alternative perspectives. The practical implications are a
greater understanding of the way that what is considered ‘abnormal’ is
socially constructed through existing discourses, and how pathology is
not an absolute but is a socially derived, co-constructed, interpretive
endeavour.
Chapter Four
Chapter 4 begins by taking a critical stance in considering how different

conceptualisations of normality and deviance are socially constructed.
These constructs in turn inform the options for treatment or interven-
tion. An introduction is offered to model of evidence-based practice
and includes a critical evaluation of the hierarchical model of research
evidence that attaches different value to different kinds of evidence. In
addition, this chapter explores some of the ways in which this framework
is used by professional and regulatory bodies. The aim is to provide the
reader with a critical understanding of how decisions are made about
different treatment options. Some of the resultant recommended treat-
ment approaches and pathways will be explored, with reference to the
basis on which these treatment recommendations are made.
8 N. Kiyimba et al.
Chapter Five
Chapter 5 critically explores some of the competing, explanatory models

of resilience and vulnerability, and how discourses of resilience have
been impacted by the neoliberal socio-political climate which continues
to dominate mental health practice and research. We question whether
discourses of resilience are culturally limited and potentially used to
reinforce narratives which place responsibility for adversity on the indi-
vidual, exacerbating the difficulties faced by those who are often already
marginalised in society. We also examine the factors which are thought to
predispose individuals and groups to vulnerability, particularly consid-
ering the COVID-19 pandemic, as well as some of the risk factors
in being less resilient. Factors thought to affect the vulnerability or
resilience may include genetic, epigenetic, individual, interpersonal, envi-
ronmental, and intergenerational influences, including transgenerational
trauma.
Chapter Six
Chapter 6 explores discourses of growth and recovery following trauma.

A critical examination of the ways dominant discourses can negatively
position those who do not experience growth or recovery is presented.
These concepts are examined to identify their implicit assumptions
and how this may contribute to the oppression and control of those
experiencing marginalisation and discrimination. A positive psychology
approach to trauma is explored as an alternative discourse, focusing on
post-traumatic growth and explanatory models. The concepts of recovery
and post-traumatic growth are explored in terms of process and outcome,
and definitions of recovery are positioned in relation to clinically signifi-
cant change and personally meaningful understandings. Recovery models
are critiqued in relation to the locating of distress within the individual
rather than the challenging or traumatic circumstances.
1 Introduction 9
Chapter Seven
Chapter 7 engages with discourses of culture including the notion of

universality and how that applies to the arena of psychological trauma.
One aspect is to explore the impact of how differences between collective
and individualist cultural views may affect the way trauma is constructed
or identified in those different societies. Considering the potential for
incongruity of views of trauma in various cultures, the Western emphasis
on neurological explanations of trauma is critically examined in rela-
tion to narratives of colonisation. Indigenous ways of knowing are
provided a platform for equal epistemic rights, as conversations around
the potential dangers of enforcing one conceptual system onto another
are highlighted. The ethno-centric perspective is positioned as potentially
running counter to prevailing views and sense-making systems in other
cultures.
Chapter Eight
Chapter 8 examines some of the ways in which technology, in the

context of a globalised world, has impacted discourses of psycholog-
ical trauma. Through digital technologies such as social media, huge
numbers of people globally can now be exposed to potentially traumatic
audio-visual online content. We discuss the implications of this resultant
globalisation of trauma, including questioning whether technology could
potentially be contributing to a discourse around normalising trauma.
We explore the responsibility of both the media and individuals who use
technology to record and disseminate traumatic material and consider
the impact of easy access to potentially traumatic digitally available mate-
rial. Additionally, we examine how the use of digital technologies has
contributed to counter-discourses of trauma and supported activism and
empowerment of marginalised groups.
10 N. Kiyimba et al.
Chapter Nine
Chapter 9 provides an opportunity to reflect on some of the ways in

which micro- and macro-discourses of trauma interact with one another
in society, and how these can foster ‘contagious’ epidemics of fear. We
consider the creation and perpetuation of discourses of risk through
macro-level organisational narratives, and how these are symbiotically
related to the micro-conversations within people’s everyday interactions.
These discourses can emerge and change over time and are influenced by
the motivations of those in power. We review the relationship between
beliefs and fear and explore notions of deviance as a social construct
in the context of risk. The repositioning of narratives of ‘deviance’ to
‘dangerisation’ is critically explored in relation to hegemonic discourses
that may facilitate social control.
Summary
The summary contextualises the exploration of the narratives of psycho-

logical trauma presented throughout the book in relation to the ways
in which power can be exerted for social influence. The relationship
between power and knowledge is revisited as the messages from the
book are re-imagined through the lenses of occidentalism and epis-
temic violence introduced at the beginning of the book. We reiterate
the ways in which trauma has and is variously constructed by those
with power through discursive practices, which can determine what
constitutes normality and deviance, and can problematise deviance as
intrinsically or extrinsically created, morally or biologically accountable,
and culturally or universally determined.
1 Introduction 11
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2
Historical Discourses of Psychological
Trauma and PTSD
Introduction
The history of the terminology used to talk about psychological trauma is
relatively recent, with post-traumatic stress disorder (PTSD) only coming
into common parlance in the late twentieth century. However, the
history of discourses around these concepts has not been uneventful, and
the terms that we use today have been the product of conflicting opinions
and perspectives about how to define these terms for a diverse audi-
ence. Influences have arisen from sociological, political, psychological,
and medical arenas, each of which has drawn from different philosoph-
ical traditions to inform their perspectives. This chapter sets a foundation
for the rest of the book, to support the reader in an appreciative inquiry
as to how language does not merely describe the world around us but in
many ways constitutes and creates what we see as our reality.
This chapter introduces the key issues pertinent to debates in this
field in addition to outlining in chronological order the development
of a range of historical discourses relating to the concept of psycho-
logical trauma. The aim is to guide the reader into an understanding
of how these discourses have developed sociologically, culturally, and
© The Author(s), under exclusive license to Springer Nature 13
Switzerland AG 2022
N. Kiyimba et al., Discourses of Psychological Trauma, The Language of Mental Health,
https://doi.org/10.1007/978-3-031-07711-1_2
historically. It will also clarify the epistemological positioning of how

trauma discourses have been understood to date, with reference to the
predominance of a positivistic and largely medical model. This will be
contextualised within the framework of dominant Western sociological
ways of making sense of experiences and offers explanations about how
sociology and epistemology are connected, in both their construction of
and reactions to events and experiences.
One of the key conceptualisations within this debate has been the
notion of the ‘trauma-focused turn’ (Kerr, 2015), which is identified as
a time in history when psychological trauma became nosologically posi-
tioned as an entity. From this point onwards, there was also a trend for
retrospective reconstruction of what had previously not been considered
as ‘traumatic’ to now being reframed or even reclassified as a trauma reac-
tion, or as a disordered or pathological state. In doing so, this chapter
traces the historical development of the concept, and of the disorder,
through the discourses that surround it. In parallel, the development of
diagnostic criteria for PTSD will be explored and the changes in DSM
(Diagnostic and Statistics Manual) and ICD (International Classification
of Diseases) over time, in relation to the contextual factors of sociolog-
ical influences. Critical events and times in the lifespan of PTSD as a
disorder will be explored. This chapter also considers who the history
of trauma was written by for whom, and to what purpose, illuminating
how the discourses of trauma came into being and the social and political
agencies involved.
We also address the ways in which concepts relating to psycholog-
ical trauma are constituted by the discourses that surround them, and
in turn how these discourses create and maintain the phenomenon as a
constructed reality. From this information, it is hoped that the reader
will be furnished with an appreciation of the differences in dominant
discourses, and from here, we will then explore alternative discourses in
relation to these. We illustrate how different discursive repertoires are
linked to different sociological, political, theoretical, and philosophical
positions. To achieve this, we discuss the various influences, counter-
positions, and drivers behind these different debates. This chapter will
2 Historical Discourses of Psychological Trauma and PTSD 15
elaborate on these core theoretical concerns and guide readers to make

informed choices about their own professional practice and research
projects through discussion of the application of this historical under-
standing to practice.
The Historical Context of the ‘Trauma Turn’
What has now become a familiar reference point for professionals and lay
persons alike is the diagnosis of post-traumatic stress disorder (PTSD).
However, this diagnostic label was only first introduced into our language
in 1980 as a recognised medical condition when it was included in
the American Psychiatric Association’s (APA) Diagnostic and Statistical
Manual of Mental Disorders (DSM-III) (Lasiuk & Hegadoren, 2006).
Alongside the International Classification of Diseases (ICD), the DSM
is predominantly used by psychiatrists and medical professionals and is
the official point of reference for conditions that are regarded as identi-
fiable and treatable. One of the primary uses of this categorisation has
been to process administrative tasks such as insurance claims, for main-
taining records (Scott, 1990), and to assist in decision-making regarding
prescribing medication. Following the advent of this classification, there
was a move towards a retrospective reinterpretation of popular diagnoses
that were used earlier, particularly in relation to conditions exhibited by
soldiers during war (Jones & Wessely, 2005b).
These retrospective accounts have been traced back as far as 1300BC,
where investigation of diaries of ancient wars in Mesopotamia during the
Syrian dynasty indicated accounts of symptoms that we would consider
to be similar to modern understandings of PTSD (Abdul-Hamid &
Hacker-Hughes, 2014). It has been argued more recently that PTSD
symptoms were also identifiable from the accounts of American Civil
War veterans (Dean, 1997). In the Napoleonic Wars (1803–1815),
physicians encountered what they referred to as ‘cerebro-spinal shock’,
in the Crimean War (1853–1856) ‘palpitation’, and American Civil
War (1861–1865), ‘irritable heart’. These terms were all put forward
as ways of trying to describe otherwise unexplained somatic disorders
in servicemen (Jones & Wessely, 2005b). Interestingly, all these terms
related to a physical aspect of experience affecting the heart, brain, or

spine. It is perhaps not surprising that medical diagnoses of the time
were physically or somatically focused, as the discipline of psychology
was not birthed until the late nineteenth century in Europe (Blumen-
thal & Danziger, 2001). Whilst these accounts provide an insight into
the experiences or ‘symptoms’ of these soldiers, they were not under-
stood as what we would now think of as PTSD at the time and can only
be viewed as such through the lens of the DSM in the current diagnostic
discourse. Our current diagnostic discourse is historically situated within
a paradigm that expects and embraces individual internal psycholog-
ical or psychiatric experiences as real and (largely) discreet from physical
somatic experiences.
Regarding the politics of disease classification, Scott (1990) has argued
that over time, medical scientists have been successful in not only
advancing diagnoses as representative descriptions of an objective reality,
but also as a ‘discovery’ of a phenomenon that previously existed but had
not yet been identified. This retrospective application of the new clas-
sification terminology for similar symptoms excavated from the annals
of historical records claims to provide evidence that PTSD is an age-old
psychological disorder. However, this retrospective assertion of a modern
classification system is not without its antagonists and therefore cannot
be considered to constitute viable ‘evidence’ of its ubiquitous presence in
human experience throughout time. Rather, it is argued that the pathol-
ogisation of suffering as ‘disordered’ represents an a priori assumption
which has been designed to conform to a modern Western biomedical
model of psychiatric classification. Suffering is not universally considered
to be a pathological state throughout history and across cultures; rather,
the effects of adverse life experiences have for centuries been accepted as
part of the norm of human existence.
The advent of PTSD appearing as a discrete category within the DSM-
III was in effect a turning point whereby it became an “official medical
psychiatric reality” (Scott, 1990, p. 294). Prior to the 1980 creation of
PTSD as an official mental health disorder, various alternative descriptive
labels were used to refer to what we would now consider to be psycho-
logical trauma-related symptoms (Jones & Wessely, 2005b). During the
First World War (1914–1918) for example, British military physicians
coined the phrase ‘shell shock’ to explain the disoriented state and disor-
dered behavioural and psychological responses of soldiers during and
shortly after combat (Jones, 2014). These symptoms were attributed to
physiological damage caused by exposure to exploding artillery shells
(Scott, 1990), and in 1916, ‘shell shock’ was officially adopted by the
British Army as a classification that recognised it as legitimate war
injury, in response to the large numbers of soldiers being diagnosed
(Summerfield, 1998).
However, at the end of the First World War, the debate regarding
whether shell shock was physiological or psychological was rife. This
makes sense given that psychology and psychiatry were relatively
fledgling disciplines, and as such finding their feet in the diagnostic
medical system. At the time, psychological treatments were still regarded
by some with suspicion and concern that it might “encourage morbid
introspection and egoism, heightened suggestibility and aggravate an
existing deficiency of willpower” (Jones & Wessely, 2005a, p. 1). Thus,
the debate continued to divide physicians favouring a physiological
explanation, and those arguing for a psychological formulation of the
symptoms observed in those returning from war. Despite its popular
use in the First World War, in 1939 in Europe at the start of the
Second World War (1939–1944), the term ‘shell shock’ was discouraged
(Crocq & Crocq, 2000). It appears that there was a perception amongst
senior military personnel that this kind of ‘war neuroses’ was more likely
to affect psychologically weaker individuals, which led to decisions being
made by draft boards in the United States to screen for the potentially
‘psychologically weaker’ individuals at the recruitment stage. As such,
more than a million potential new recruits were deemed to be “psycho-
logically unfit to fight” (Scott, 1990, p. 296). At the same time, there
was also a view amongst some senior officers that those claiming to be
suffering from shell shock were really malingering (Scott, 1990). This
view was fuelled by observations from some physicians that similar symp-
toms had been observed in soldiers who had not been exposed to artillery
barrages as those who had, indicting the potentially unfounded nature
of their claims. Problematically, it is also recorded that at one point,
the numbers of soldiers leaving the army on psychiatric grounds was
exceeding the numbers of new recruits being signed up (Bourne, 1970).
Thus, the use of the term ‘shell shock’ tended to be discouraged to limit
the number of soldiers diagnosed (Crocq & Crocq, 2000). By discour-
aging its use however, a number of other labels were introduced including
‘soldiers heart’, ‘war neuroses’, and ‘lacking moral fibre’, with enhanced
military discipline being regarded as the most appropriate response for
the latter (Summerfield, 1998). Summerfield (1998) also contended that
during the war, 307 absent soldiers were hunted down and shot on this
basis.
The important thing for us to note at this point is that there had
been a clear move in the discourse of trauma from something that had
happened to soldiers resulting from their war experiences, towards a
discourse of something wrong with the soldiers due to a personal weak-
ness in their constitution or morality. This is a critical turning point.
Initially, there was recognition of the physiological somatic experience
in the bodies of veterans that was recognised and labelled (‘palpitation’;
‘irritable heart’), followed by an acknowledgement that this experience
was triggered by being in active service (‘shell shock’). Up to this point,
what we know now as PTSD was articulated as a medical fact that was
triggered by the impact of an extreme external event. Notably, this is
the exact opposite of our current trauma-informed discourses of trauma
which frame it as something that happened to rather than wrong with
someone (Courtois, 2014). Building on this evolving discourse of indi-
vidual deficiency were the discourses of psychological (neurosis) and
moral weakness (lacking moral fibre). So, more than just having some-
thing wrong with the sufferer, an added layer of moral accountability was
added that further stigmatised the person experiencing those symptoms.
This may also have been a cultural reflection of the views of the general
population in relation to religious perspectives of the time.
Clearly, the influence of the social and political is evident in the ways
in which the experiences of soldiers were positioned as either inter-
nally located (thus morally and psychologically accountable) or externally
precipitated (a ‘no blame’ position). Regarding our thesis about how
discourses of trauma are socially constructed, this change in attribu-
tion and accountability about the impact of traumatic events is a good
example of the power and influence of social, religious, and political
forces as they are situated culturally and historically. Discourses about
what is or isn’t a reality or fact are clearly flexible and movable depen-
dent on dominant cultural norms of the time and political and social
agendas. Whilst many military medical personnel and soldiers preferred
to use the term ‘combat fatigue’ suggesting a physiological aetiology.
Sigmund Freud argued that ‘shell shock’ was a psychological condition
different from neurosis developed in childhood and should be treated
using psychoanalysis (Scott, 1990). Thus, with support from some well-
known psychiatrists of the time, a psychological explanation for shell
shock became favoured.
In the Second World War, the same debate that had lingered after the
First World War returned in relation to how to conceptualise the effects
of war as either physical or psychological. Some physicians favoured the
term ‘battle neurosis’, which was included in certain professional publica-
tions in place of the term ‘exhaustion’, implying that rather than being a
physical illness, the neurosis was due to a “psychological or constitutional
weakness” (Jones & Wessely, 2005b, p. 193). This reinforced the general
trend that had begun after the First World War towards an internal
and psychological explanation and further away from an external phys-
iological understanding. These conceptualisations that were influenced
by numerous social and political influences during war time eventually
became solidified into diagnostic criteria in official publications such as
the DSM and ICD.
The Diagnostic and Statistical Manuals, DSM-I

and DSM-II
One of the consequences of the Second World War was that psychi-
atrists from across the world and from different parts of the United
States, complete with their differing conceptual frameworks, training,
and approaches to diagnosis and treatment, had been brought together
(Andreasen, 2010). It transpired that amongst this group there was a
consensus regarding the need for more standardisation, and this was the
catalyst for the American Psychiatric Association (APA) to develop the
first Diagnostic and Statistical Manual (DSM-I). In the first edition of
the DSM in 1952, contributors drew upon the recommendations of
psychiatrists who had served in the Second World War and included
the diagnosis ‘gross stress reaction’ which was described as a temporary
condition precipitated by extreme environmental stress (Scott, 1990).
This description was relatively benign, placing its aetiology neither
within the individual nor within the environment. Based on the DSM-
I (1952), the diagnosis of ‘gross stress reaction’ was defined as a stress
syndrome in response to “exceptional physical or mental stress” which
might occur in individuals who were otherwise normal (Andreasen,
2010, p. 68). The diagnosis was typically used for military personnel, and
recovery was expected within a few days or weeks, and where symptoms
had not abated during this time an alternative diagnosis was recom-
mended (Scott, 1990). The implications of the adoption of ‘gross stress
reaction’ as an agreed diagnostic label were that any adverse symptoms
experienced by veterans were acknowledged to be related to the environ-
mental stressors of war (‘reaction’) but were only limited to a relatively
short duration.
Problematically, this aspect of the diagnostic criteria did not account
for prolonged or delayed onset of symptoms. This was despite evidence at
the time that indicated that symptoms might also appear later. In partic-
ular, the influential book Men Under Stress (Grinker & Spiegel, 1963)
detailed accounts of sixty-five predominantly air force soldiers’ reactions
to combat, which revealed a high number of delayed symptoms, and
some persisting for several years. Thus, ‘gross stress reaction’ as a diag-
nostic term captured something of the external environmental influence
as a causative factor, but arguably did not go far enough in relation to
acknowledging delayed onset or chronic reactions.
Following a time of relative peace and stability in the post-war period,
in 1968 the American Psychiatric Association published its first revi-
sion of the manual, the DSM-II. However, perhaps surprisingly, the
diagnosis of ‘gross stress reaction’ was omitted with no alternative diag-
nosis included to replace it, thus leaving no specific entry in the manual
relating to psychological injury sustained through combat. Consequently,
from 1968 to 1980, there was no officially recognised diagnosis for stress
disorders (Andreasen, 2010). Although there is little evidence for why
this decision was made, the foreword to the manual stated that “deci-
sions were made about certain diagnoses which have not been generally
accepted in US psychiatry”, and that “some of these diagnoses have been

omitted” (APA, 1968, viii). The DSM-II also went on to explain that
the reason for this had been to align itself more explicitly with the
International Classification of Diseases (ICD-8) (WHO, 1967).
Some speculations about the reasons for its omission were that those
involved in writing the revisions for the second edition did not have
military experience (Scott, 1990), or that the inclusion of what was
considered at the time to be a specifically ‘military’ diagnosis was no
longer appropriate in a period of peace (Andreasen, 2010). The implicit
assumption at the time was that psychological trauma was purely a
war-based problem and therefore not something that required specific
diagnosis outside that frame. Thus, in relation to the epistemological
positioning of trauma diagnosis, the discourse of this time was that
trauma was only and specifically a short-term war–related condition, and
that anything outside of this frame of reference could not be consid-
ered as a trauma reaction. It was therefore not considered necessary to
even include the diagnosis in the DSM II, as it was assumed that in
a time of peace that there would be no requirement for its use. Gross
Stress Reaction, as it was conceived in DSM-I, only showed itself to
be a discourse of this kind of specificity retrospectively in the light of
its later removal from DSM-II. This retrospective perspective allows a
clearer picture of the sociological and historical factors that influence the
ways in which mental and physical health conditions, and the constructs
of normality and pathology are conceptualised, and demonstrates clearly
that the discourses of normality and illness are not as objective as we
might be led to believe.
Points to consider
• Reflect on what the impact might have been for soldiers subject
to personal internal blame discourses of ‘lacking moral fibre’ when
suffering from psychological combat-related symptoms, in compar-
ison with our modern discourses of external causality, and therefore
absolution of personal blame discourses.
However, the change in APA classification in the DSM-II in 1968

had been written at a time of relative peace, coincided with the esca-
lation of the Vietnam War (1955–1975), and this was problematic for
many returning veterans as insurance companies, hospitals, and courts
used the manual as the official diagnostic authority. With the fact that
there was then no accepted diagnosis available for those with psychi-
atric symptoms, and minimal treatment facilities, activists began to
dispute the injustice of sending men to war and yet failing to recognise
psychiatric consequences and provide appropriate treatment (Andreasen,
2010). This brought the issue into public awareness and to political
attention. Despite its removal from the DSM-II, there were still many
psychiatrists who continued to believe that the original DSM-I diag-
nosis of ‘gross stress reaction’ retained some validity for explaining the
symptoms described by military veterans, and in 1969, the psychia-
trist John Talbott published a critique of the DSM-II recommending
that the authors of future editions of the manual reintroduce it as a
legitimate diagnostic classification (Talbott, 1969). In addition, political
campaigning and lobbying of the US government for recognition and
adequate treatment for returning Vietnam soldiers continued.
The result was that the field of psychiatry changed their predomi-
nant discourse in relation to the condition and began adopting a range
of terms that clearly related the condition to the impact of war; these
included the labels ‘post combat disorder’ (Scott, 1990), ‘post-Vietnam
syndrome’ (Andreasen, 2010), and ‘catastrophic stress disorder’ (Burstow,
2005). What psychiatrists once regarded as ‘abnormal’ responses to
combat situations in the 1980s were now reconsidered to be normal reac-
tions to the horrors of war (Scott, 1990). When the task force to develop
the new DSM- III was assembled in the mid-1970s, some of the issues
that it faced were to consider Talbott’s critique and the political activism
of the returning Vietnam veterans (Andreasen, 2010).
The Diagnostic and Statistical Manual DSM-III,

and the Introduction of Criterion A
The development of the third edition of the DSM (DSM–III ) began

in 1974 and was completed in 1980, and this was coordinated with
the development of the ninth edition of the ICD (ICD–9 ), which
occurred between 1975 and 1978. It appears that one of the prevailing
attitudes between the development of DSM-I and DSM-II was that
the diagnosis ‘gross stress reaction’ was no longer relevant during a
time of peace. However, this belief assumed that it was reserved as a
primarily military-related condition and therefore not a problem that
might require diagnosis for members of the civilian community. Indeed,
Grinker and Spiegel made a strong case that “the stress of war tries men
as no other test that they have encountered in civilized life” (1963, p. 6).
Nevertheless, in Europe after the Second World War, it was becoming
clear that there were individuals who had survived the atrocities of the
Holocaust, as well as civilian casualties of the war who had also been
exposed to extreme stress and horror. Thus, within the wider political
sphere, stories began to emerge from survivors who were sharing their
experiences of discrimination and persecution (Buelens et al., 2014).
The recognition of the impact that the atrocities of war also had on
the civilian community began to occupy both public and political arenas.
Rather than the previous restriction to military institutions, the issue
then became a wider public matter concerning human rights (Kirk &
Kutchins, 1997). One of the major factors in this acceptance that civil-
ians as well as military personnel may be significantly adversely affected
by their experiences was that there began to be an accepted view that a
psychological disorder could be precipitated by an event or experience
external to the individual him or herself. This recognition also heralded
a change in the way that patients who had been affected were perceived,
from being ‘defective’ in some way due to internal weakness of consti-
tution or lacking moral fibre, and instead recognising the impact of
traumatic events on an individual’s psyche. Shephard argued that the
popularisation of the term ‘trauma’ in the 1980s was a mixed blessing
due to the subsequent impact of stress-related diagnosis on the way that
the public began to reconsider personal responsibility and accountability
(2002, p. xxii). Importantly, if the cause of the individual’s suffering was

identified as being outside their control, then this may become a legal
matter, with the potential for restitution or compensation being sought
(Furedi, 2014). Again, we can see the major influence of economic and
political mechanisms wielding power over the way that the impact of
experiencing traumatic events was conceptualised. Clearly, the diagnostic
history of psychological trauma and PTSD has been chequered with
different discourses that have been differentially influenced by political,
social, and now legal and economic drivers. Whether PTSD ‘exists’ as a
discrete entity therefore is not so much a matter of whether it does or
doesn’t, but a matter of whose agenda has been served by describing it in
a particular way, and for what purposes at a particular point in time.
Following the exertion of different scientific, political, and social pres-
sures, there were several noteworthy changes that were introduced into
the DSM-III; first, the acknowledgement that the onset of the condi-
tion may be delayed and may be more prolonged that the DSM-II had
appreciated; second, the change of name from ‘gross stress reaction’ to
‘post-traumatic stress disorder’; and third, the inclusion of what was
termed ‘Criterion A’, a reference point relating to the external precipi-
tating factor. The latter point is particularly significant, as at the time,
and still today, this is the only diagnosis that has an external event
overtly acknowledged as a causative factor in the aetiology of the disorder.
Although the advent of ‘Criterion A’ placed PTSD firmly on the map as
a psychiatric illness brought about by exposure to an extreme event, its
scope at this point was “defined relatively narrowly” (Andreasen, 2010,
p. 69). Specifically, the precipitating event was required to be “outside the
range of usual human experience” (APA, 1980, p. 250). One criticism of
the new diagnostic discourse of PTSD was that it “embodies certain new
assumptions about how trauma affects its victims, but it does not rest on
any specific scientific breakthrough nor offer any great step forward in
treatment” (Shephard, 2002, p. xx).
Furthermore, in an increasingly globalised world where floods, earth-
quakes, political unrest, wars, as well as interpersonal abuse and violence
were becoming a more common part of many people’s everyday lives,
this narrow definition of what constituted a ‘traumatic’ event seemed
inadequate to many. It has been argued that what might previously have
been conceived by the authors of the DSM-II as ‘outside the usual’

were much more within the range of ‘usual’ human experience than had
been recognised (Kiyimba, 2017). As Andreasen (2010) argued, many
questions about the stressor were still unanswered regarding whether
stressors inflicted by human cruelty create more psychological distress
than those occurring by accident, or whether the duration of the stressor
makes a difference to the impact on the individual. Despite these
being very challenging questions to answer, the power (and responsi-
bility) to diagnose was then and is still now reserved for professionals
within medicine, psychiatry, and other qualified mental health practi-
tioners—thus, removing decisions about what constitute ‘usual human
experiences’ from the authority of everyday folk.
One group of activists who took a lead in challenging the narrow defi-
nition of ‘trauma’ that the APA stipulated have been feminists, keen to
point out the patriarchal foundation of diagnostic criteria and the omis-
sion of acknowledgement of many other traumatic experiences including
sexual abuse, childhood abuse, and domestic violence (Burstow, 2005).
In relation to this, the DSM-I specifically dictated that a diagnosis of
gross stress reaction could only be given to individuals who were ‘normal’
prior to the stressor that they experienced. However, this single incident
stressor perspective limited its use, without considering the experiences
of those who may have experienced numerous traumatic stressors over a
long period of time (many since childhood). Additionally, in DSM-I,
if there was another pre-existing psychiatric disorder, such as depres-
sion, the stress reaction would be treated as secondary, and therefore
not given a separate diagnosis (Andreasen, 2010). The implications in
terms of stigma and potentially blame are interesting in the sense that
if there were previously unacknowledged traumas that resulted in symp-
toms of depression for which this was given as a primary diagnosis, a
later acknowledgement of the stressors as contributing to the condition
would not be possible. Although the limitations of the diagnostic criteria
were apparent, with one comment regarding the label PTSD being that it
was “a cumbersome phrase devised by a cumbersome committee” (Shep-
hard, 2002, p. xx), some therapists began to use the term where they
perceived it to be an appropriate way to ‘legitimise’ the distress that they
could see in their clients (Kirk & Kutchins, 1997). This demonstrates
that even where language fails to encapsulate the full breadth of what it
seeks to represent, words are often used pragmatically where they consti-
tute the closest approximation of a verbal lexicon for recognition of a
client’s distress.
The Diagnostic and Statistical Manuals, DSM-IV,

and DSM-5
Following a six-year effort to review existing literature by a team of

over a thousand professional organisations and individuals, the DSM-IV
was published in 1994. Those involved in developing the DSM-IV also
liaised with those specialists who were working on the 10th edition of the
ICD to coordinate their efforts. The ICD-10 was published in 1992, and
several changes were made from version nine, such as adding, deleting,
and reorganising several different disorders throughout. The ICD-10,
which was published two years before the DSM-IV contained for the first
time an independent diagnostic label for post-traumatic stress disorder,
complete with specification for a ‘Criterion A’ event. This was defined
as: exposure to a stressful event or situation (either short or long lasting)
of exceptionally threatening or catastrophic nature, which is likely to
cause pervasive distress in almost anyone (WHO, 1992). In a similar
vein, when the DSM-IV was published, it had widened its definition
Criterion A, now stating that it required that “a person, or persons, had
experienced, witnessed, or been confronted with an event or events that
involved actual or threatened death or serious injury, or experienced a
threat to the physical integrity of self or others” and “that the person’s
response involved intense fear, helplessness, or horror” (APA, 1994 n.p).
The wider definition of Criterion A provided in the DSM-IV presented
the opportunity for a wider population of individuals with varied experi-
ences of different kinds of stressors to be acknowledged, including those
who had experienced sexual and domestic abuse.
Another key change through the inclusion of this wording of the new
definition was that a trauma reaction could be ‘legitimately’ experienced
indirectly as a witness to threat to another person’s life. The implications
of this were that there was a move away from just acknowledging a direct
experience of a life-threatening event as being potentially disabling, to a

broader conceptualisation that included the possibility that others, such
as bystanders and witnesses, may also be similarly affected. Potentially,
with the broadening of scope, there were repercussions throughout legal
and social institutions, as the possibilities for institutional accountability
were increased. The broadening of inclusivity had brought welcome
changes from many spheres in relation to a greater appreciation and
acknowledgement of the range of traumatic experiences that people in
the public may experience.
A corollary of this reclassification and broadening of Criterion A was
that it changed the way that many life events were considered, bringing
many more human experiences into the range of ‘abnormality’. Our
argument here is to question the appropriateness of who gets to say
what a normal or abnormal human experience is. In many ways, the
introduction of Criterion A went far beyond the previous scope of the
diagnostic manuals seeking to classify symptoms and moved into a posi-
tion of authoritatively dictating which life events should or shouldn’t
be considered ‘normal/abnormal’. The ubiquitous use of the medical
and therefore pathological diagnosis also had the effect of increasing
the number and range of human experiences that were pathologised.
It is argued that through a process that was arguably a benign effort
to account for the socio-political pressures to widen Criterion A and to
capture the impact of people’s experiences more fully, there was an iatro-
genic effect of simultaneously pathologising and medicalising common
life events.
This definition of a trauma reaction being something that could be
‘witnessed’ as well as personally experienced also remained within the
DSM-5. However, although Criterion A remained in DSM-5, its pres-
ence had been a matter of debate, which resulted in two specific caveats
being added that restricted its scope. The first was that any indirect expo-
sure to witnessing actual death or threat to life of a family member
was required to have been via violent or accidental means, thus indi-
rectly excluding death from natural causes such as heart attack (APA,
2013). Friedman (2013) justified this paring down of the inclusion
criterion by explaining that elimination of indirect exposure completely
would have ignored the evidence that those individuals learning about
the deaths of loved ones without direct exposure had exhibited some
symptoms of post-traumatic response. However, in what appears to be
a somewhat arbitrary move, “the subgroup tightened up this criterion by
requiring that if a loved one died, such a death must have been violent
or accidental” (Friedman, 2013, p. 550). This decision would have effec-
tively removed eligibility for a diagnosis of PTSD from those who were
bereaved of a family member without being direct witnesses of the death,
and where the death was neither accidental nor violent. Therefore, death
of a loved one by ‘natural causes’ however distressing, upsetting or sudden
for relatives, would not be deemed to be ‘traumatic’ according to the new
DSM-5 official definition.
The second caveat was that the person’s response was no longer
required to involve ‘fear, helplessness and horror’. The argument
presented by Friedman et al. (2011) for its removal was that research
evidence suggested that it did not improve diagnostic accuracy. In
practice however, simple changes such as this could have quite large
repercussions for the medical and health insurance fields, due to the
inevitable reduction in the prevalence of a disorder if part of the diag-
nostic criteria has been removed or narrowed. Removal or reduction of
the scope of a criterion makes it more difficult for a patient to meet
the threshold for a specific diagnosis. However, it is worth noting at this
stage that the ICD-11 has retained an emphasis on the requirement for
a reaction to a traumatic event including ‘fear, helplessness and horror’
(Hyland, 2017).
Some of the implications for the ways in which discourses about
psychological trauma have been influenced by historical, sociological,
political, economic, and legal contexts are that there have been signifi-
cant fluctuations in the institutional discourses that have been prevalent
at different times. Additionally, there has been a general paradigm shift
towards the pathologisation of human experience, especially with the
advent of a disorder based on an event. The third process that has been
influential is what has been dubbed the ‘psychologisation’ of health and
illness. Each of these will be discussed further. One of the key impli-
cations of the way that dominant diagnostic discourses have become
legitimised is in relation to the ways in which natural responses that
may potentially have a functional and/or adaptive purpose can be repre-

sented as seemingly disordered or pathological. Before the advent of
socially constructed pathologising labels designed to categorise what we
now understand as PTSD, distress, misery, and disturbing recollections
were understood to be quite normal responses to pain and suffering after
adverse life events (Hiley-Young et al., 1995). Embracing the notion of
PTSD has been argued to be detrimental in several ways, as it has “moved
the mental health field away from, rather than towards a better under-
standing of the natural psychological responses to trauma” (McHugh &
Treisman, 2007, p. 211).
One of the problems with the public not having equal access to
different discursive repertoires that may give alternative meaning to their
experiences is that there can be a power imbalance between the meaning-
making mechanisms and associated discourses of those who are deemed
to be ‘experts’ and others. Within the dominant frameworks of psychi-
atry and psychology, the primary explanatory model for the effects of
adverse life events gives rise to what De Vos (2012) refers to as the a
priori psychological subject. What this means in essence is that the indi-
vidual is seen primarily as a potential psychological/psychiatric candidate,
whereby any reported behaviours, thoughts, or experiences from that
person are viewed exclusively through this explanatory lens.
This process of ‘psychologisation’ assumes that psychological explana-
tions become the dominant ways of talking and thinking not just for
mental health practitioners, but also, through hegemonic processes, for
members of the public who adopt this as their own internalised domi-
nant explanatory discourse. Ultimately, this pervasive process leads to
a situation where there is not another available explanation for people
to make sense of their reactions to adverse life events (De Vos, 2012).
The process of acceptance and reinforcement of a dominant psychi-
atric/psychological explanatory discourses is iterative and cyclical; this
occurs where there is both the opportunity for the explanatory frame-
work of ‘experts’ to become dominant and the hegemonic influence of
pervasive discourses leading to an internalisation of those discourses for
individuals. Therefore, this legitimises institutional discourses that have
the power to influence the way that individuals interpret their experi-
ences (Madsen & Brinkmann, 2011). The history of what are referred
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Discourses of Psychological Trauma

FINCHES FOR DUMMIES 2nd Edition Nikki Moustaki

DARLING NIKKI (Blood Legacy Series Book 3) Kenya Goree-

On the Self: Discourses of Mental Health and Education

The Incubus Curse (The Court of The Ancients Book 1)

The Racial Trauma Handbook for Teens: CBT Skills to

Current Therapy of Trauma and Surgical Critical Care

Trauma 9th Edition David V. Feliciano

Contemporary Discourses in Social Exclusion Aminkeng A.

The Language of Mental Health

© The Editor(s) (if applicable) and The Author(s) 2022

Cover illustration: Richard Schofield/Alamy Stock Photo

have experienced trauma as well as teaching other professionals about

As we navigate this topic together, throughout the book we pivot

realm of scholarly activity that values the production of books such as

colonialism was a product of a systematic repression, not only of the

It is thus, in exercising ‘strong reflexivity’ (Harding, 1993), with as much

• Separation to the world into bounded units;

Brunner states that “Coronil’s definition of occidentalism provides a suit-

positions, but also positions that ethnocentric vantage point as a plat-

inseparable from Western hegemony not only because as a form of knowl-

The ways in which Coronil’s framework of Occidentalism (1996/2019)

to their task or insufficiently elaborated: naive knowledges, located low

history, culture, and deviance may be shock or even feelings of guilt.

essential nature as human beings—capable of treating one another wher-

Tauranga, New Zealand Nikki Kiyimba

Acknowledgements We wish to thank all our family members and colleagues

Foucault, M. (1965). Madness and civilization. Trans. Richard Howard.

Erikson (1976) defined trauma as a “blow to the psyche that breaks

different ways of making sense of the human experience, we take a step

restore the boundaries of normality it prescribes. Within this framework,

provides an opportunity to question or deconstruct the ways in which

important, and worrying, is that “hegemony begins with the power of

it is “the age of the establishment of the hegemony of psychiatric

Overview of the Book

Chapter 2 introduces the main concepts as they relate to the fields of

Chapter 3 addresses the differences between the Diagnostic and Statis-

Chapter 4 begins by taking a critical stance in considering how different

Chapter 5 critically explores some of the competing, explanatory models

Chapter 6 explores discourses of growth and recovery following trauma.

Chapter 7 engages with discourses of culture including the notion of

Chapter 8 examines some of the ways in which technology, in the

Chapter 9 provides an opportunity to reflect on some of the ways in

The summary contextualises the exploration of the narratives of psycho-

historically. It will also clarify the epistemological positioning of how

elaborate on these core theoretical concerns and guide readers to make

The Historical Context of the ‘Trauma Turn’

related to a physical aspect of experience affecting the heart, brain, or

The Diagnostic and Statistical Manuals, DSM-I

accepted in US psychiatry”, and that “some of these diagnoses have been

However, the change in APA classification in the DSM-II in 1968

The Diagnostic and Statistical Manual DSM-III,

The development of the third edition of the DSM (DSM–III ) began

(2002, p. xxii). Importantly, if the cause of the individual’s suffering was

been conceived by the authors of the DSM-II as ‘outside the usual’

The Diagnostic and Statistical Manuals, DSM-IV,

Following a six-year effort to review existing literature by a team of

experience of a life-threatening event as being potentially disabling, to a

may potentially have a functional and/or adaptive purpose can be repre-

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you

1.F.5. Some states do not allow disclaimers of certain implied

1.F.6. INDEMNITY - You agree to indemnify and hold the

Section 2. Information about the Mission of