Post-traumatic Stress and the Transpersonal (an Indigenous Perspective on Western Cultural Medicine)

This blog post is most of a final paper I wrote during my master’s degree program, for a Transpersonal Psychology course that was one microagression and cultural appropriation after another. Since I had very little agency as a student, I decided to write this paper from an Indigenous perspective, and talk about white supremacy culture the way academia usually writes about Indigenous people. As such, there is an intentional lack of nuance, some cultural glossing, and a simulation of misunderstanding in some places.

The general subject matter was required (a topic on Transpersonal Psychology), as was a a self-reflective section and a distillation of available literature to prove a thesis, so I was unable to fully realize this as a commentary piece, nor fully deconstruct all the concepts presented. However, it does provide a useful medium for that commentary and deconstruction. If you find yourself becoming uncomfortable, take a moment to sit with both that and the stated intent of this piece.

Enjoy!

Post-traumatic Stress and the Transpersonal

Post-traumatic stress, as defined in the Western European and European-American cultural institution of psychology, is both somewhat new and very, very old. In the USA, the diagnosis of Post-traumatic Stress Disorder (PTSD) first appeared in the 3rd edition of the Diagnostic and Statistical Manual (DSM-III), in CE 1980 in the Gregorian Calendar. In spite of extensive evidence and demonstrated need, the DSM has not yet grown to include complex trauma, instead relying on a single-event trauma model for PTSD. Everywhere else in the world, however, the International Classification of Diseases, version 11 (ICD-11) introduced a code for Complex Post-traumatic Stress Disorder (CPTSD) in 2018. (Maercker, 2021).

Of course, the experience of trauma, and all its many sequelae, existed long before 1980, far predating even the existence of modern humans (Cantor, 2009). Most cultures recognize the ability and agency of both humans and nonhumans (such as animals, spiritual figures, plants, the land, etc.) to experience fear, and for that fear to have long-ranging effects. In European Ways of Knowing (abbreviated EWK here, often called science in the English language), a heavy reliance on observability and replicability, adherence to a cultural myth called objectivity, and a strong cultural bias that the observer must be a white European or European-American and preferably a cisgender man for the observation to hold any validity, have meant that most of the rest of the world’s knowledge regarding post-traumatic stress has been devalued or dismissed, and their vital contributions largely excluded from the ever-growing set of EWK holy texts known as the scientific literature. As this paper is written in the style of an EWK esoteric lineage known as the American Psychological Association, or APA, I will now cite a paper to imply in a culturally-acceptable manner that at least some of what I previously stated is factual (Helms, 1993).

Due to a modern preference within the European-derived cultural institution of psychology for evidence-based treatment (a term that means the treatment was developed using EWK customs and rituals), avenues of spiritual, religious, philosophical, and/or non-European cultural healing are often dismissed. Within psychology culture, methods of treatment that explore the spiritual or transcendental experience of humans are referred to using the term transpersonal psychology, meaning “beyond the person.” These interventions may sometimes be considered evidence-based if they are put through certain EWK ritual ordeals and found worthy (or statistically significant). Eye Movement Desensitization and Reprocessing (EMDR) and certain other mindfulness-based interventions, for example, can loosely be considered both transpersonal and evidence-based, although the term integrative is more commonly used (Krystal et al., 2002). These integrative approaches hold promise that psychology as an institution may someday recognize the validity of spiritual, religious and cultural healing modalities throughout the world. They also inspire grave concern that these modalities may continue to be colonized and strip-mined as fast as they can be noticed by a white European or European-American person (in EWK the term for this is discovering).

A Brief History of Western Traumatology

Given the relatively recent—and somewhat grudging—recognition of PTSD, CPTSD, and related phenomena by European and European-American cultural medicine as real and impactful, culturally-approved treatment options remain limited and the EWK understanding of trauma can be considered still in its infancy. Much of what is now available in terms of EWK research arose from studies focused exclusively on active-duty military and/or veteran populations, excluding—and in some cases, actively minimizing—the experiences of civilians.

Prior to the development of the modern DSM and ICD, Western European and European-American cultural medicine practitioners (known as psychiatrists in the English language) noticed a pattern of psychological distress in veterans of the newer, bigger, more violently destructive European and US wars of the late 18th, 19th, and 20th centuries. They used terms like “war neurosis,” “névrose de guerre,” and “Kriegsneurose” to describe what they observed, and over time, refined various theories about its etiology and the best course of treatment from the perspective of their various medicine folkways (Crocq & Crocq, 2000).

Compounding this narrowed focus, due to European cultural customs, historically only cisgender men and people categorized as men under their strict gender binary system were allowed to fight in wars. As Western European and European-American cultures traditionally prioritize cisgender men above all other genders, and thus their traditional medicine practitioners also privilege cisgender men, this created a double-edged sword. Veterans and active-duty military personnel, as members of (or sufficiently proximal to) the prioritized gender, received respect from their traditional healers (called doctors) when they presented with symptoms of post-traumatic stress. This meant the experience was extensively researched, treated, and prevention strategies were explored, but only for military people and only through the lens of battlefield medicine. There was little to no recognition, except in mid-1900’s Russia (Crocq & Crocq, 2000), that post-traumatic stress could be an experience of non-military people, and virtually no attention was paid to the experiences of other genders. It was only when EWK researchers studying veterans, and researchers studying people categorized as women who were also survivors of sexual assault, began comparing notes that a wider definition of post-traumatic stress was recognized (Vogt, n.d.).

Given this long-term self-hobbling, it comes as no surprise that the Western understanding of post-traumatic stress currently leaves much to be desired. One thing that is well-documented, however, is that the Western European and European-American cultural institutions involved in colonization are a primary cause of trauma, inter-generational trauma, and post-traumatic stress in colonized regions (Linklater, 2014). Alarmingly, psychology is one of these colonizing institutions, yet is often also the only recourse available for people seeking help with post-traumatic stress through available systems like the IHS, VA, and county-based community mental health services. Transpersonal and integrative interventions, particularly those developed by colonized peoples themselves, have the potential to heal instead of perpetuate harm.

What is Post-traumatic Stress, According to Western European Cultural Medicine?

Current consensus among European-derived cultural medicine practitioners is that post-traumatic stress disorders are characterized by four primary symptoms: reliving distressing incidents involuntarily in thoughts, flashbacks, or dreams, avoidance of stimuli related to the trauma, emotional numbing, and a constant state of hypervigilance or increased activation (Crocq & Crocq, 2000). These symptoms can develop when a person directly experiences a traumatic event, witnesses a traumatic event happen to someone else, learns of a traumatic event happening to someone, or witnesses details of the aftermath of a traumatic event (American Psychiatric Association, 2022). If the trauma was severe and repeated or ongoing, Complex Post-traumatic Stress Disorder may also include difficulty maintaining interpersonal relationships, difficulty regulating affect, and persistent feelings of shame, worthlessness, guilt, failure, and similar emotions in relationship with the trauma (World Health Organization, 2022). Symptoms of post-traumatic stress can present immediately or may go through a latency period before emerging, and having an experience that meets the triggering criteria does not necessarily mean a person will go on to develop a post-traumatic stress disorder. If the precipitating event is severe enough, most people will develop symptoms that meet criteria for a diagnosis of PTSD or CPTSD, but not all (Crocq & Crocq, 2000). Additionally, it is more likely for a person to develop symptoms congruent with a diagnosis of PTSD if the precipitating trauma was due to an interaction with another human (e.g. assault) than if the trauma was environmental (Cantor, 2009). It is unclear what predisposes a person to develop or not develop a post-traumatic stress disorder, however EWK researchers have found that certain experiences are risk factors that may predispose people to develop post-traumatic stress disorders, such as having a lower socioeconomic status, having less access to education, and being categorized as female (all traumatic experiences in and of themselves under patriarchy and capitalism). Protective factors in civilians (from a meta-study on caretakers of adults with severe illness) have been found to include having greater social support, having a job, and having a mindfulness practice (Carmassi et al., 2020). EWK researchers also theorize that veterans with certain experiences, particularly being unwilling combatants, prisoners of war, and those who fought in wars they felt were unjust or unappreciated, have increased risk of developing PTSD. For example, in a survey of several hundred French people forced to fight for Nazi Germany and later held captive by Russia in World War II, approximately 3/4ths of the group met criteria for chronic PTSD 40 years after their release (Crocq & Crocq, 2000). In both of these populations (veterans and civilian caretakers), sense of purpose beyond the self, relationships, community connection, and “doing the right thing” all seem to be inextricably linked to both protective and risk factors. This is one of the areas where transpersonal psychology may provide some ideal frameworks and interventions for post-traumatic stress, with its focus on matters beyond the self, particularly for those wrestling with moral injury and meaning-making (Starnino et al., 2019).

Modern EWK perspectives on post-traumatic stress link it to evolutionary survival strategies and neurobiology. The key emotion in disorders of post-traumatic stress is thought to be fear. Responses to fear across many animal species, including humans, fall into 6 types: avoidance, vigilance, and the classic “fight/flight/freeze/fawn” quartet (Cantor, 2009). In experiences considered disordered under the DSM and ICD, these adaptive survival strategies become maladaptive or even disabling trauma responses, forming the symptoms of post-traumatic stress disorders. Vigilance becomes hypervigilance, avoidance becomes avoiding related stimuli, freeze becomes emotional numbing, fight becomes activation/reactivity/affect dysregulation, and so forth. Again, this is an area where transpersonal psychology may be of particular use. In addition to mindfulness-based interventions having a significant impact on the trauma response symptoms of post-traumatic stress (Starnino et al., 2019), culturally-appropriate spiritual practices, prayers, and rituals can be supportive to generating a feeling of connectivity and safety (Linklater, 2014), to counteract these fear responses. Additionally, the social and interactive aspect of spirituality and religion is known to aid with the processing and interpretation of trauma (Ramadan et al., 2021).

Additionally, although traditional European and European-American healers often view the brain and emotions to be somehow fully separate from the rest of the body, this is obviously not rational. Few other societies entertain this peculiar cultural superstition, yet it has dominated EWK thought, treatment strategies, and research for much of history. More modernly, in addition to the physiologic changes in brain structures and neurotransmitter levels in people diagnosed with PTSD (Tomko, 2012), EWK research has begun to notice (discover) the consistent and extensive somatic symptoms that regularly present with post-traumatic stress (McFarlane & Graham, 2021), as well as what could be called the accompanying spiritual or existential injury (Starnino et al., 2019). The bodymind is one whole, and arguably the bodymindspirit is as well for those of a spiritual disposition. Because of this, it seems that a transpersonal approach may be not merely useful, but perhaps vital.

Perspectives on Treatment

For much of recent history, Western European and European-American folk medicine practitioners of various medicine lineages have relied on a variety of treatments for post-traumatic stress. Initially, during the various wars of the 19th and early 20th centuries fought in the European peninsula of Asia, treatments and preventative strategies were based in interventions for shock, and usually consisted of swift removal from the front line, rest, and occasionally, nutritional interventions like administration of milk and chocolate as a form of first aid. These of course did not provide sufficient support or healing, particularly if symptoms became chronic, and Western European and European American cultural medicine practitioners struggle to this day with finding effective treatments for post-traumatic stress (Crocq & Crocq, 2000). Evidence-based treatments, as well as psychopharmacological interventions, are common culturally-acceptable approaches. Pharmaceuticals can be helpful for some people, and are not helpful or desirable for all (Linklater, 2014). Despite the fact that religion and spirituality are consistently correlated with resiliency, and as protective factors against the development of many experiences that the Western world defines as mental illness (Ramadan et al., 2021), there appears to have been reluctance in the EWK research community until quite recently to explore transpersonal interventions.

Currently, for veterans in the USA, the most common interventions are exposure therapy and cognitive processing therapy, despite the fact that these do not always work well for everyone. Some recent interventions for veterans involving mindfulness meditation, spirituality-based support groups, and the search for meaning show promise for reduction in PTSD symptoms, even over multiyear study periods (Starnino et al., 2019).

For unaccompanied Latinx immigrant children experiencing PTSD, religious and spiritual thematic elements were found to be a helpful adjunct to a mindfulness-based CBT approach, providing tools for trauma conceptualization, identity formation, and meaning-making, as well as facilitating better engagement with the therapy providers (Fortuna et al., 2023). This indicates that when culturally appropriate and relevant, transpersonal approaches can aid both in treatment and in helping people to engage in that treatment. As avoidance of stimuli related to the traumatic event(s) is a common symptom of PTSD/CPTSD, reluctance to engage in therapy, where material around the trauma will have to be revisited, is a major barrier to care.

On the other hand, spirituality is not necessarily helpful for PTSD. Sometimes it is neutral, or it can be a structural support that fails under the weight of a life-altering trauma, leading to increased disillusionment, isolation, and hopelessness (Starnino et al., 2019). Being spiritual or religious also is not necessarily protective against developing PTSD. In a study of adolescent Syrian refugees, 3/4 of whom were strongly spiritual, no statistically significant protective or aggravating effect on PTSD prevalence was found in the spiritual individuals (Ramadan et al., 2021). For people who have experienced religious trauma in particular, such as LGBTQIA+ survivors of conversion torture, a religious or spiritual framework in therapy could be actively harmful. In such cases, respect for the survivor’s spiritual agency is paramount to providing appropriate support (Jones et al., 2022).

Author’s Approach

I am someone who is in the process of becoming a European cultural medicine practitioner, of the Marriage and Family Therapy lineage. I am simultaneously aware that this is just one of many cultural medicine lineages, and aware that it is one of very few approved medicine lineages according to the colonial government occupying the land I live on. Although I will continue to complete the various ritual ordeals required to become an initiate (licensed), it is my goal over time to develop strategies that can include and support the medicine traditions my clients bring with them. Culture is medicine, as we often say in Indigenous community. And each culture has its own medicine. I have no right to the medicines of others, nor would it be appropriate for me to practice most of my own Indigenous culture’s medicines. But I can find ways to encourage and support each client’s exploration of their own culture—lineage, community, activism, or otherwise—and its capacity to support, connect, engage, make meaning, and heal. I do not personally desire a manualized approach, or a particular framework, for transpersonal therapy. Instead, I come to each therapy session with a curiosity about how the transpersonal could support my client today, and make room for the possibility that it might not be what they want or need.

Conclusion

Transpersonal psychotherapy has great potential to inform and create effective interventions for post-traumatic stress in many populations. Connection to the spiritual can provide a route to meaning-making, community connection, identity strengthening, mindfulness, and building a sense of internal safety, all helpful to the reduction of PTSD and CPTSD symptoms. It can also reduce barriers for spiritual or religious people who fear engaging with traumatic material in psychotherapy.  However, as with any other lineage of psychology culture, it would be a mistake to believe it is the correct, comprehensive cure for all people experiencing post-traumatic stress. I will continue to weave the transpersonal into my interventions in a client-centered way, and support each client’s agency as they decide what they would like to include in their therapy.

References

American Psychiatric Association. (2022). Posttraumatic stress disorder. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

Cantor, C. (2009). Post-traumatic stress disorder: evolutionary perspectives. Australian & New Zealand Journal of Psychiatry, 43(11), 1038-1048. https://doi-org.ciis.idm.oclc.org/ 10.3109/00048670903270407

Carmassi, C., Foghi, C., Dell'Oste, V., Bertelloni, C. A., Fiorillo, A., & Dell'Osso, L. (2020). Risk and protective factors for PTSD in caregivers of adult patients with severe medical illnesses: a systematic review. International Journal of Environmental Research and Public Health, 17(16). https://doi.org/10.3390/ijerph17165888

Crocq, M.-A., & Crocq, L. (2000). From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology. Dialogues in Clinical Neuroscience, 2(1): 47–55. https://doi.org/10.31887/DCNS.2000.2.1/macrocq

Fortuna, L. R., Martinez, W., & Porche, M. V. (2023). Integrating spirituality and religious beliefs in a mindfulness based cognitive behavioral therapy for ptsd with Latinx unaccompanied immigrant children. Journal of Child & Adolescent Trauma, 16(3), 481–494. https://doi.org/10.1007/s40653-023-00541-1

Helms, J. E. (1993). I also said, "white racial identity influences white researchers.". Counseling Psychologist, 21(2), 240–43.

Jones, T. W., Power, J., & Jones, T. M. (2022). Religious trauma and moral injury from LGBTQIA conversion practices. Social Science & Medicine (1982), 305, 115040–115040. https://doi.org/10.1016/j.socscimed.2022.115040

Krystal, S., Prendergast, J. J., Krystal, P., Fenner, P., Shapiro, I., & Shapiro, K. (2002). Transpersonal psychology, Eastern nondual philosophy, and EMDR. In Shapiro, F. (Ed.), EMDR as an integrative psychotherapy approach: Experts of diverse orientations explore the paradigm prism (pp. 319-339). American Psychological Association.

Linklater, R. (2014). Decolonizing trauma work: Indigenous stories and strategies. Fernwood Publishing.

Maercker, A. (2021). Development of the new CPTSD diagnosis for ICD-11. Borderline Personality Disorder and Emotion Dysregulation, 8(7). https://doi.org/10.1186/s40479-021-00148-8

McFarlane, A. C., & Graham, D. K. (2021). The ambivalence about accepting the prevalence somatic symptoms in ptsd: is ptsd a somatic disorder? Journal of Psychiatric Research, 143, 388–394. https://doi.org/10.1016/j.jpsychires.2021.09.030

Ramadan, M., Kheirallah, K., Saleh T., Bellizzi, S., & Shorman, E. (2022) The relationship between spirituality and post-traumatic stress symptoms in Syrian adolescents in Jordan. Journal of Child & Adolescent Trauma, 15(3), 585–593. https://doi.org/10.1007/s40653-021-00401-w

Starnino, V. R., Angel, C. T., Sullivan, J. E., Lazarick, D. L., Jaimes, L. D., Cocco, J. P., & Davis, L. W. (2019). Preliminary report on a spiritually-based ptsd intervention for military veterans. Community Mental Health Journal, 55(7), 1114–1119. https://doi.org/10.1007/s10597-019-00414-8

Tomko, J. R. (2012) Neurobiological Effects of Trauma and Psychopharmacology. In Levers, L. L. (Ed.), Trauma counseling: Theories and interventions (pp. 59-76). Springer Publishing Company.

Vogt, D. (n.d.) Research on women, trauma and PTSD. U.S. Department of Veterans Affairs: National Center for PTSD. https://www.ptsd.va.gov/professional/treat/specific/ptsd_research_women.asp

World Health Organization. (2022). ICD-11: International classification of diseases (11th revision). https://icd.who.int/