Traumatic Contexts Research Articles

Experienced Social Support and Cultural Humility for Faith-Based Cross-Cultural Workers During COVID-19

Employees of faith-based international organizations have been shown to be uniquely at risk for mental health symptoms, including depression and posttraumatic stress, while social support has been demonstrated to be an important protective factor. Cultural humility, which is understood as an openness to appreciate and learn from others, has also been shown to contribute to wellbeing for cross-cultural employees. Eighty-eight cross-cultural faith-based workers completed the Hopkins Symptom Checklist, Social Provisions Scale, and Cultural Humility Scale as a part of a larger needs assessment conducted in late 2020 during the global COVID-19 pandemic. It was hypothesized that social support would relate inversely to mental health symptoms, and that cultural humility would moderate the relationship between support and symptoms. Path analysis confirmed this hypothesis. When participants reported moderate to high levels of cultural humility, there was a strengthened relationship between social support and lower mental health symptoms. Thus, cultural humility appears to activate the relationship between social support and reduced mental health symptoms. International organizations can contribute to employee resilience in traumatic contexts by promoting both cultural humility and social support.

Enteral bile reinfusion in severe abdominal trauma

Enteral reinfusion of bile is a rarely used technique in critical care, primarily indicated for treating digestive intolerances due to biliary fistulas. This case report presents a 22-year-old male who sustained closed abdominal trauma, resulting in bile duct injury and a high-output biliary fistula. The patient, initially intolerant to enteral feeding and showing signs of gastroparesis, was treated with bile reinfusion through the nasoenteric route, leading to good tolerance of food without complications. The liver secretes 600 to 1000 ml of bile daily, and injuries to the duodenal, pancreatic, and biliary tracts can cause excessive fluid output, leading to bile acid deficiency and associated complications like fat malabsorption, diarrhea, and electrolyte imbalances. In such scenarios, bile reinfusion can be an effective treatment method, providing a low-cost alternative to exogenous bile acid replacement and reducing the need for fluid resuscitation. This case involved a young man who suffered severe polytrauma from a vehicle collision, leading to a burst-type injury to the second duodenal portion. Initial surgical interventions included duodenal suture and gastroenteroanastomosis. Following complications, a second surgery was performed, externalizing bile and pancreatic fluids. Despite initial exclusive parenteral nutrition, enteral feeding was introduced but led to digestive intolerance. Subsequently, bile reinfusion was implemented, resulting in stable patient evolution, symptom resolution, and no complications. The reinfusion protocol included sterile collection of bile, reinfusion every 6 hours using a continuous infusion pump, and co-administration with enteral nutrition. The patient tolerated the procedure well, with no adverse effects observed over six weeks. This case highlights the potential of bile reinfusion as a viable, cost-effective intervention for patients with duodenal or bile duct injuries, particularly in the absence of extensive literature on its use in traumatic contexts. Further studies are warranted to validate the efficacy and safety of this technique in broader clinical settings

COVID-era sociolinguistics: introduction to the special issue

Abstract In the 18 months that have passed since COVID-19 was declared a global pandemic, linguists around the world have had to grapple with the practical and ethical issues that arose from trying to collect data in a safe and remote way while participants are experiencing an acute disaster. The current collection presents insights from a number of sociolinguistic research projects that were either initiated in response to the pandemic or that adjusted their research methods mid-trajectory. A concluding discussion article underscores that the honest reflections and concrete suggestions in this collection will remain relevant beyond the COVID-19 pandemic. They will be of value to any (socio)linguist who is navigating the ethics of fieldwork in uncertain or traumatic contexts, who is recruiting and retaining participants via remote means, or who is figuring out how to rapidly change their data collection methods.

Spiritual fortitude: A systematic review of the literature and implications for COVID-19 coping.

Traumatic events, such as natural disasters, often lead to significant resource loss for survivors, which can negatively affect emotional well-being. In these situations, it is common for people to draw on their religious or spiritual faith to cope with their pain and struggle. One construct that has received increased attention within the field of religious/spiritual coping is spiritual fortitude (SF). SF refers to one's ability to draw on spiritual resources to transcend negative emotions in the face of stressors (Van Tongeren et al., 2019). In this review, we analyze eight empirical studies with 3,455 total participants. Specifically, we explore the relationship between SF and mental health and well-being, with a particular focus on its role in traumatic contexts (e.g., natural disasters). SF has been found to demonstrate a series of positive mental health benefits including higher meaning in life, spiritual well-being, positive religious coping, and perceived posttraumatic growth. We discuss areas for future research and implications for clinical practice, with specific consideration to coping with the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Impact of intertibiofibular graft on the ankle joint: Medium-term radiologic and clinical assessment

HypothesisIntertibiofibular graft (ITFG) bridges tibial non-union, but blocks bimalleolar mortise opening, leading to loss of ankle dorsiflexion. The aim of the present study was to assess dorsiflexion loss and to determine whether it was associated with secondary osteoarthritis.Material and method A 2-center retrospective study included cases of tibial non-union, without initial involvement of the ankle, treated by ITFG with more than 2 years’ consolidation. Clinical, functional and radiographic parameters were analyzed. Dorsiflexion stiffness was defined as<10° flexion. Symptomatic osteoarthritis was defined by radiologic joint impingement and/or osteophytosis associated with pain>4/10 on visual analog scale (VAS) restricting walking distance to less than 1 kilometer. ResultsThirty-one cases were analyzed at a mean 7±2.8 years’ follow-up. Mean pain on VAS was 3±2.6. Mean AOFAS score was 62.3±20.5 and mean SEFAS was 28.3±10.5. Mean dorsiflexion was significantly lower on the ITFG side, at 6.6±7.9° versus 15.1±4.8° on the healthy side. There was dorsiflexion stiffness in 26 cases. No correlation emerged between dorsiflexion stiffness and onset of osteoarthritis. ConclusionDorsiflexion was the most severely impacted motion. The rate of osteoarthritis was too low for any implication of dorsiflexion loss to be demonstrated, especially in traumatic contexts. Level of evidenceIV; retrospective study.

When it counts the most: Trauma-informed care and the COVID-19 global pandemic

CONTEXT: Evidence from the COVID-19 crisis suggests that children and youth are more likely to be subjected to maltreatment and exposure to family violence, while experiencing limited access to the usual services that support vulnerable families and provide targeted services to meet their needs. The current global pandemic itself can also be experienced as a traumatic event. Trauma-informed care draws attention to the potential impacts, from the individual to the global, that myriad traumatic experiences can illicit and proposes using these understandings as foundational to the development and implementation of policy and practice. OBJECTIVE: The aim of this opinion paper is to offer insights to guide practices and policies during this unprecedented global crisis through a discussion of the Substance Abuse and Mental Health Services Administration (2014)’s six trauma-informed care principles: trustworthiness and transparency; safety; peer support; collaboration and mutuality; empowerment and choice; and cultural, historical and gender issues. FINDINGS: Specific recommendations based on these six principles and applied to the current situation are presented and discussed. These principles can serve both in the immediate crisis and as preventative measures against unforeseen future traumatic contexts. CONCLUSION: COVID-19 renews the imperative to maintain and strengthen trauma-informed practices and policies. We argue that never before has trauma-informed care been so important to promote the health and well-being of all and to protect our marginalized populations at greatest risk.

Clúdach: Cover

Clúdach:Cover Angela Griffith Click for larger view View full resolution Cover. elke thönnes, glendalough, 2020 carborundum and aquatint Image used with the artist's permission. Nestled in the Wicklow Mountains, Glendalough is one of Ireland's most visited tourist locations. Its name in Irish, Gleann da Locha, rather prosaically translates as "the valley of the two lakes," giving little sense of the area's majestic beauty. In addition to being a site of stunning natural features, it is a place of national historic importance. Its numerous ruins testify to its evolution from a seventh-century Christian hermitage to an ecclesiastical center. It became one of the most important pilgrimage routes in Leinster, the pious drawn to the shrine of its founder, St. Kevin. In the eleventh and twelfth centuries some sought to establish a diocesan see in Glendalough in opposition to Dublin; however, this was not to be. While it retained its importance as a religious site, like other religious settlements across the country following Henry VIII's Dissolution of the Monasteries, by the 1600s the majority of Glendalough's church buildings were in ruins. While church authority had dissolved, the location continued to engage and host the devotions of the local populace. Into the nineteenth century, its pattern day, held on the feast of St. Kevin, June 3, drew large crowds to pray and to celebrate, these activities attracting the interest of artists such as Joseph Peacock and Maria Spilsbury Taylor. From the late eighteenth century, Glendalough and its environs became the focus of a number of artists and those associated with the antiquarian movement. The picturesque landscape with its scattered ruins attracted the likes of Gabriel Beranger, Jonathan Fisher, and George Petrie. Significantly, their work and that of others was produced as engraved prints and as book illustrations whose dissemination ensured Glendalough's fame as a place of historical importance and spectacular natural beauty, recognized both at home and abroad. The artist Elke Thönnes has lived and worked in Ireland for over thirty years and is a regular visitor to Glendalough. Despite the fact that the location—as a magnet for tourists and a place of refuge for near-local Dublin urbanites (of [End Page 157] which Thönnes is one)—can be crowded, the area retains a zen-like quality for her. She is fascinated by its religious history, admiring how Irish monastic founders located their places of prayer in wild isolation, searching for the godly in their relationship with nature. Thönnes believes that in making art, an individual is in search of something bigger than themselves. She argues that there can be limitations to what can be described verbally and that visual expression can be a more effective form of communication. There is a long tradition of Irish artists working in the genre of landscape. These images have been created from a myriad of perspectives, such as the colonizer's idealized viewpoint, as a point of departure for the poetic romantic, as nationalistic metaphors of heritage and identity, as modernist vehicles of self-expression. For Thönnes, despite her years of living in Ireland, the Irish landscape retains its sense of wonder. She is rooted in the country, but there remains a small albeit welcome sense of being an outsider. She has traveled the length and breadth of the island, and she looks to map her own identity within its borders, her childhood voice asking, am I there yet? She seeks to find, and define, her own space within the landscape. For Thönnes, as a city dweller all her life, the landscape, in particular the coastline, is associated with holidays. This pattern comes from her earliest days growing up in Cologne, Germany. Family trips were always centered around nature, and she describes them as magical. Her father, a veteran of World War II, wanted to visit places across Germany and Europe, in particular Norway and Finland, to see and experience landscapes removed from the traumatic contexts of war. Being in nature recalls happy times for Thönnes, times of release and restoration for her parents. Thönnes's method of working includes taking numerous photographs and, at times, making preliminary...

Caring for the mental health of humanitarian volunteers in traumatic contexts: the importance of organisational support

ABSTRACT Background: Humanitarian workers operate in traumatic contexts, putting them at an increased risk of adverse mental health outcomes. The quality of the support they receive from their organization, their supervisor, and team members are proposed as determinants of mental illness and well-being, via the stress-appraisal process. Objective: Grounded in organizational support theory, we sought to understand the relationship between organizational factors, including perceived organizational support, supervisor support, and team support, and indicators of both adverse mental health and mental well-being among humanitarian volunteers. This relationship is hypothesized to be mediated by the perceived psychological stress. Methods: A sample of 409 humanitarian volunteers from the Sudanese Red Crescent Society completed an online, anonymous, survey comprised of the Perceived Supervision, Perceived Organizational Support, Team Support, and Perceived Psychological Stress scales, as well as the Generalized Anxiety Disorder and Patient Health Questionnaire scales, (GAD-7 and PHQ- 8), and the Warwick-Edinburgh Mental Well-being Scale. Study objectives were tested using structural equation modelling (SEM) procedures. Results: Perceived helplessness (PH) and perceived self-efficacy (PSE), as measures of psychological stress, were both found to fully mediate the relationship between perceived organizational support and mental health outcomes. Perceived organizational support was associated with PSE and inversely with PH. PH was associated with adverse mental health and inversely related to mental well-being. PSE was only associated with mental well-being. Perceived supervision was negatively associated with PSE. Conclusions: Perceived organizational support is a key determinant of the mental health of humanitarian volunteers, with greater perceived support associated with lower distress symptomology and greater mental well-being. Humanitarian agencies should take actions to improve their internal organization support systems to mitigate the stress associated with working in traumatic contexts. Specifically, more attention should be paid to the organizational support of the volunteers as front-line workers in humanitarian settings.

Imaginario emocional de la violencia en narrativas colombianas recientes

In a set of recently published Colombian novels the emotional arises as a protagonist force to signify the intangible reality derived from political violence. The writers that we approach resume recurrent concerns of Colombian literature (war, humiliation, defeat, etc.), to treat them from the filter of the affective and show another logic of the violent. The affective, as a literary element, allows not only the aesthetic exploration of the mood of the subject who has lived in traumatic contexts, but also an approach to violence that goes beyond the logic of its causes, perpetrators and material effects, aspects that have had greater visibility in the texts and speeches. Narrating the chaotic reality of a country from the affective field permits to visualize the emotional imaginary of violence and its impact on social identity.

Hurtful Gifts? Trauma and Growth Transmission Among Local Clinicians in Postearthquake Haiti.

Although working with trauma survivors can be a source of both deleterious and positive transformations in mental health professionals, little is known about the experience of clinicians in shared traumatic contexts, particularly in the Global South, where most humanitarian crises occur. In collective disasters or armed conflicts, the personal and professional experiences of mental health staff inform each other, situating the clinical space at the intersection between singular and collective spheres. Drawing on an intersubjective and socioecological perspective, this qualitative study explored the ways in which working in a shared traumatic context affected mental health and psychosocial staff in postearthquake Haiti. We interviewed 22 local mental health workers in the capital, Port-au-Prince, 2.5 years after the 2010 disaster. We coded and thematically analyzed interviews using an iterative process, based on grounded theory principles. Thematic analysis uncovered four dynamic poles in clinicians' narratives: balancing duty and desire to help, experiencing fragility and strength, negotiating separation and connection, and sharing hurt and hope. Our findings suggest clinicians considered their work mainly as a source of strength in the face of adversity, whereas experiences of trauma and growth transmissions were mutual and intimately intertwined. We discuss the complexities of clinical work in shared traumatic settings as well as the dynamic interplay between professionals' experiences of suffering and growth. We conclude with recommendations on ways to involve local mental health clinicians in postdisaster contexts while addressing the special needs that they may have to process their own trauma.

“I Will Show You My Faith by My Works”: Addressing the Nexus between Philosophical Theodicy and Human Suffering and Loss in Contexts of ‘Natural’ Disaster

As a practical theologian and researcher in the field of ‘natural’ disasters, as well as being a disaster responder chaplain, I am often confronted by, and have to confront, the nexus between theology/philosophy and “real life” in extremely traumatic contexts. The extreme suffering that is often the consequence of catastrophic natural disasters warrants solutions that can help vulnerable populations recover and adapt to live safely with natural hazards. For many practice-based responders, speculative theological/philosophical reflections around situations that are often human-caused seem predominantly vacuous exercises, potentially diverting attention away from the empiricism of causal human agency. In this article, I explore a middle ground involving a nuanced methodological approach to theodicy that is practical but no less intellectually demanding, that is theological more than philosophical, practical more than theoretical; a middle ground that also takes seriously the human culpability as causal for the human, and some would say the divine, suffering from disasters. I will include in this exploration my ethnographic fieldwork following the catastrophic earthquake to hit the Caribbean nation of Haiti in 2010.

Le deuil médiatique, une forme spécifique du deuil post-traumatique

Resume Dans un contexte societal ou les morts dans des contextes traumatiques sont de plus en plus souvent mediatisees, cet article vise a mieux comprendre les incidences de cette mediatisation sur le processus de deuil des personnes ayant perdu un proche dans ces situations. La mort ou la menace de mort surajoutee a la perte d’un proche dans une circonstance mediatisee fait de ces deuils post-traumatiques des circonstances bien particulieres entrainant un processus de deuil complexe qui intrique l’adaptation a la perte du proche perdu, l’apprivoisement et l’elaboration de ses propres troubles post-traumatiques et la gestion de l’intrusion mediatique et societale dans leur intimite. Cet article abordera dans un premier temps le rappel sur la clinique du deuil post-traumatique, puis la specificite du deuil mediatique et nous envisagerons dans un troisieme temps les perspectives de prises en charge dans ce type de contexte.

Evaluating in traumatic contexts: Considering the contextual, ethical, emotional, and political aspects

Evaluating in traumatic contexts: Considering the contextual, ethical, emotional, and political aspects

Strengthening family coping resources: The feasibility of a multifamily group intervention for families exposed to trauma

Families exposed to urban poverty face a disproportionate risk of exposure to repeated trauma. Repeated exposures can lead to severe and chronic reactions in multiple family members with effects that ripple throughout the family system. Interventions for distressed families residing in traumatic contexts, such as low-income, urban settings are desperately needed. This report presents preliminary data in support of Strengthening Family Coping Resources, a trauma-focused, multifamily, skill-building intervention. Strengthening Family Coping Resources is designed for families living in traumatic contexts with the goal of reducing symptoms of posttraumatic stress disorder and other trauma-related disorders in children and caregivers. Results from open trials suggest Strengthening Family Coping Resources is a feasible intervention with positive effects on children's symptoms of trauma-related distress.

The “Short Step” from Love to Hypnosis: A Reconsideration of the Stockholm Syndrome

This article discusses key work on the development of the Stockholm syndrome as a psychological explanation for the development of a bond between hostage‐taker and hostage in hijack and siege situations. Within this work, the Stockholm syndrome is explained in part as an unconscious identification, but is also regarded as a conscious coping strategy which can be understood as a form of adaptive behaviour, providing hope for the victim in an otherwise hopeless situation. The author links these paradoxical accounts of intersubjectivity with recent genealogies of trauma, panic disorder and hypnotism which argue that the development of the former is characterized by a tension between accounts of the subject as autonomous and those which imply that the subject’s capacity to merge with or depend upon the other is constitutive of subjectivity. The article engages with recent perspectives associated with the “turn to affect” which posit openness to affect as intrinsically hopeful. The author argues that notions of openness to affect have historically been aligned with hierarchical models which produce some subjects as more susceptible to influence. In conclusion, the article draws on contemporary theories which posit trauma as a mode of collective memory. The author argues that the Stockholm syndrome relies in part for its intelligibility on a particular reading of the violent and traumatic social situations from which it emerged, one which disavows a longer history of violence between the Western “victim” and the post‐colonial other. Finally, the author suggests that the Stockholm syndrome calls up the possibility of modes of empathy and connection which enable a reconsideration of how the development of bonds between people in traumatic contexts can be understood as hopeful.

Global Trauma and Narrative Cinema

This article examines how the global traumas of resource-driven conflicts and acts of terrorism are mapped in 21st-century US and UK narrative cinema, and suggests that guilt, elicited in the implied Western viewer, is displaced in the films onto images of Western women. Revisiting Mulvey’s influential theory of ‘visual pleasure’ through the ‘male gaze’, this article analyses the films Traffic (2000), a depiction of US complicity with global drug cartels, Babel (2006), the story of a global media frenzy surrounding American tourists victimized in Morocco, and three films about crises in Africa: Shooting Dogs (2005), a dramatization of Western apathy during the 1994 Rwandan genocide, The Constant Gardener (2005), about pharmaceutical testing in Kenya, and Lord of War (2005), based upon the life of an arms dealer. A theoretical re-engagement with feminist film theory is followed by analyses of the films to illustrate how the guilt elicited by each of the films’ traumatic contexts conjoins with the primal psychological experience of lack. Viewers’ and their screen surrogates’ combined sense of helplessness in the face of others’ trauma is displaced ‘hysterically’ onto images of women, exposing a troubling new looking relation in our traumatic age.

Individual and collective exposure to political violence: Palestinian adolescents coping with conflict

We conducted a survey of Palestinian adolescents in school. We hypothesized that collective and individual exposures to violence would both negatively affect adolescents' mental health. We also anticipated that the negative effect of collective exposures on mental health would be less than that of individual exposures. Our analysis was designed to test these hypotheses. A representative sample of 3415 students of 10th and 11th grades from the Ramallah District of the West Bank participated in the survey. The primary independent variables were scales of individual and collective exposures to trauma/violence (ETV) by the Israeli military and settlers. Factor analysis revealed several sub-scales. Outcome measures were constructed and included: a binary measure of depressive-like states, and emotional, depressive-like state, and somatic scales. Several variables were identified as possible covariates: gender, age, school-type, residence, employment status of father, and identity documents held. Logistic and multiple regression analyses revealed a strong relationship between ETV and adolescents' mental health, with both individual and collective exposures having independent effects. There was a higher prevalence of depressive-like symptoms among girls compared with boys, and in adolescents living in Palestinian refugee camps compared with those living in cities, towns and villages. The findings confirmed our hypothesis that both individual and collective ETV independently affect the mental health of adolescents. Contrary to expectations, individual exposures did not consistently have a greater negative effect on health outcomes than collective exposures, although the sub-scale of direct personal exposures to violence consistently showed the strongest effect among sub-scales. The results emphasize the importance of going beyond individual experiences and including the health outcomes of collective violation when analyzing violent and traumatic contexts.

The Traumas of Unbelonging: Reinaldo Arenas's Recuperations of Cuba

Comparatists have recognized in recent decades a shift away from exclusively national literatures and notions of place-bound culture. Increasingly we are dealing with what Bruce Robbins calls different modalities of situatedness-in-displacement (250) as globalization, migration, and forced exile have separated people from places and made conceptions of ethnicity less static and more mobile, fluid, and hybrid as they are subject to a greater variety of cultural influences. (1) However, these conditions also raise the question of the relationship between culture and self, and feeling bound to a place remains an imperative for some, particularly if the separation from homeland is traumatic. While situations of displacement often foster survival through cultural adaptability, in the context of traumatic exile a lost home can remain not only psychically embedded as a place of origin and identity but also of an anguished dissolution of self. The case of contemporary Cuba and in particular the work of exiled Cuban writer Reinaldo Arenas (1943-1990) is exemplary, specifically in how the traumas of revolution, oppression, and dislocation produce a fragmented, isolated, and dissociated identity and an aesthetic sensibility compelled to both critique and reconnect to homeland. Arenas's estrangements from authorities and other Cubans both before and after he flees Cuba fuel his imagination, provoking recreations of Cuba through which he can revisit in some way his losses and hopes for his country and himself. His own displacement also mirrors other Cubans' fragmented political, cultural, and psychological life. Writing most of his work in exile in the US, (2) he chronicles his own persecution for being homosexual and uncompromisingly observes how in Cuban society a powerful, masculinized cultural order attempts to suppress other influences, more specifically, the nexus of art, gender, and sexuality that he associates with the feminine. Like many trauma writers, Arenas adopts a testimonial approach to bear witness for a suppressed past (Vickroy 5). His writing carries the imprint of overwhelming, psychologically disruptive events, and he attempts to reshape cultural memory of these events in his focus on artists' authenticity and survival, and in imaginatively revisiting emotionally over-determined contexts symptomatic of traumas. Art provides mediated structures by which he withstands attempts to obliterate his person and his work. This study will establish the traumatic contexts of Arenas's life and then will analyze how his imagination and art, especially through the lenses of gender and sexuality, become the means to express and, to some extent, overcome trauma. Trauma narratives, I contend, are personalized responses to this century's emerging awareness of the catastrophic effects of wars, poverty, colonization, and oppression on the individual psyche. They are often concerned with human-made traumatic situations and are implicit critiques of the ways social, economic, and political structures can create and perpetuate trauma (Vickroy 4). They highlight postcolonial concerns with rearticulating the lives and voices of marginal people, and reveal trauma as an indicator of social injustice or oppression, as the ultimate cost of destructive sociocultural institutions (Vickroy x). Many of these narratives have characteristics of testimonio or testimonial narrative that seeks to create a feeling of lived experience and expresses a problematic collective social situation through a representative individual (Beverley 94-95). Testifying to the past has been an urgent task for many fiction writers in recent decades as they attempt to preserve personal and collective memories from assimilation, repression, or misrepresentations (Vickroy 1). Arenas exemplifies this approach in his recounting of the effects of Castro's regime, describing aspects of Cuban culture lying outside of official versions, and revealing the follies of Cuban life and history as he sees them. …