Discourses of Psychological Trauma (The Language of Mental Health)

This book offers a critical perspective of the dominant discourses within the field of psychological trauma. It provides a challenge to normative western constructs and unsettles assumptions about accepted notions of universality and the nature of trauma. Traditionally the concept of psychological trauma has been widely accepted within mental health professions. However, in a post-positivist era, the language of mental health is shifting and making room for alternative discourses that include wider contextual influences, such as the impact of sociological, cultural, and technological developments. These wider discourses are illuminated as the authors draw together some of these arguments into one accessible text. Rather than claim definitive answers to the issues raised, readers are invited to engage with the discussions presented in order to position themselves in relation to the range of trauma discourses available. Nikki Kiyimba is Chartered Clinical Psychologist, Researcher and Academic. She is a Senior Educator and Programme Lead for postgraduate programmes in Professional Practice, Leadership and Responding to Trauma at Bethlehem Tertiary Institute, NZ. Christina Buxton is Chartered Academic Psychologist and practitioner in the field of Psychological Trauma, and lead for the DProf Psychological Trauma and DProf Counselling and Psychotherapy at the University of Chester, UK. Emily Pathe is Chartered Counselling Psychologist and Digital Co-ordinator of Adult Mental Health with the National Health Service in Lanarkshire, Scotland. Emily is occasional lecturer with Glasgow Caledonian University and Chair of Division of Counselling Psychology, Scotland, UK. Jo Shuttleworth is Chartered Counselling Psychologist and Academic and Lecturer in Counselling Psychology at the University of Manchester, UK. Her clinical areas of specialisation are in complex trauma and gender-based violence Preface 6 References 14 Contents 16 1 Introduction 17 Overview of the Book 22 Chapter Two 22 Chapter Three 22 Chapter Four 23 Chapter Five 23 Chapter Six 24 Chapter Seven 24 Chapter Eight 25 Chapter Nine 25 Summary 26 References 27 2 Historical Discourses of Psychological Trauma and PTSD 29 Introduction 29 The Historical Context of the ‘Trauma Turn’ 31 The Diagnostic and Statistical Manuals, DSM-I and DSM-II 35 The Diagnostic and Statistical Manual DSM-III, and the Introduction of Criterion A 38 The Diagnostic and Statistical Manuals, DSM-IV, and DSM-5 42 Applications 46 Internal Versus External Locus Explanatory Discourses 46 Physiological Versus Psychological Explanatory Discourses 47 Trauma as an Event or a Reaction? 49 Conclusion 49 References 51 3 Critique of Psychological Trauma as a Disorder 54 Introduction 54 Locating Trauma in the Diagnostic Frameworks 56 From Stress to Anxiety and Back Again 56 The Changing Nature and Scope of Trauma Diagnosis: PTSD and CPTSD 60 PTSD in the DSM-5 60 PTSD and CPTSD in the ICD-11 63 Wider Trauma-Related Diagnostic Categories and Classifications 68 Diagnostic Thresholds: The Illusion of Boundaries 72 The Gatekeeper: Criterion A in the DSM-5 72 ICD-11: Event or No Event? 73 How Many Is a Problem? The Number of Symptoms Required 75 When Are We Disordered? A Timeline of Event/s 77 Applications 78 Conclusion 81 References 82 4 Treatment Decisions for Psychological Trauma 87 Introduction 87 Prevalence and Diagnosis 88 The Social Construction of Pathology and Its Relationship to Treatment Preferences 90 How Evidence-Based Practice Requirements Influence Trauma Treatment Options 95 Evidence for the Primary Treatment Modalities for Psychological Trauma 96 The Ethics of Help Versus Harm in the Treatment of Psychological Trauma and PTSD 100 The Phased Approach and Its Critics 104 Other Approaches to Trauma Therapy 107 Applications 114 Conclusion 116 References 117 5 Psychological Resilience and Vulnerability 128 Introduction 128 Defining Resilience 130 Trait Resilience 131 Resilience as a Process 133 Discourses of Vulnerability 133 Trauma and Resilience Across the Lifespan 136 The Role of Epigenetics: Can Resilience Be Impacted by Transgenerational Trauma? 137 Discourses of Resilience and Vulnerability in Practice: Impact on Service Provision 138 Application 140 Trigger Warnings for Students 140 Conclusion 143 References 144 6 Post-traumatic Growth and Recovery 151 Introduction 151 Post-traumatic Growth 152 Conceptualisation of Trauma 153 Growth as an Outcome 154 Post-traumatic Growth as a Process—Explanatory Models 156 Recovery 159 Definitions of Recovery as an Outcome 160 Dominant Discourses Regarding the Process of Trauma Recovery 163 Applications 166 Conclusion 169 References 170 7 Cultural Discourses of Trauma 176 Introduction 176 Defining Culture 177 Collectivist and Individualist Cultures 178 How Possible Is Diagnostic Universality? 179 International Trauma Research 181 Cultural Trauma 183 Cultural Trauma and Cultural Identity 186 Epigenetics and Inter-Generational Trauma 187 The Trauma of De-culturisation 190 Cultural Safety 191 Applications 192 Summary 194 References 195 8 The Impact of Globalisation and Technology on Discourses of Trauma 201 Introduction 201 Globalisation, Technology, and the Digital Divide 203 Globalisation of Mental Health 203 Technology and the Digital Divide 204 Questioning the ‘Ripple Effect’: Globalisation of Trauma? 205 Questioning the Ripple Effect 206 Criterion A in the Digital Age 208 Choice, Responsibility, and Lessons from the Digital Frontline 209 Lessons from the Digital Frontline 210 Globalisation or Normalisation? 210 Technology and Interpersonal Trauma: Discourses of Harm and Safety 211 Alternative Discourses of Trauma: The Role of Digital Technologies 213 Cultural Trauma and Counter-Discourses 214 Hashtag Activism 215 The Impact of Technology on Trauma Treatment 216 Applications 217 PTSD Coach and Virtual Reality Exposure Therapy 218 Conclusion 219 References 220 9 Trauma, Fear, Risk, and Contagion 228 Introduction 228 How Trauma Experience Alters Beliefs 229 The Relationship Between Beliefs and Fear 230 How Fear Becomes Contagious 231 Deviance, Risk and ‘Dangerisation’ 233 Fear as Social Control 235 States of Emergency 236 Emotional Contagion 238 Application 240 Conclusion 242 References 243 10 Summary 248 Power 248 Knowledge 250 Recovery 251 De-medicalisation 252 De-pathologisation 254 De-labelling 254 References 256 Index 259