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In general, the training sessions, because of time constraints, were limited in scope and could not impart the level of technical skill training required for independent epidemiologic surveillance activities. However, the training sessions were useful in bringing people together who shared common interests, but were unfamiliar to each other before the training. Also, there was a great interest expressed from the attendants of the workshop for improved workforce competencies and data capacity development. The model of the NIDA Community Epidemiologic Workgroup was introduced and well accepted among attendants. There appeared to be a deep level of commitment to disseminating and exchanging information and resources throughout the region. As a next step, local leadership development must be ongoing. Sustainable funding must be sought to develop collaborative linkages between individuals interested in developing the capacity to monitor alcohol and drug problems in the region, as well as to evaluate existing and new intervention programs. [ABSTRACT FROM AUTHOR]

The primary conclusions drawn from this study is that the process of attempting to construct and implement a research methodology in a way that serves rather than takes from the community it centers around was worth as much or more than the actual data gathered. Factors such as designing a methodology that seeks to understand what the community itself sees as their own strengths and weaknesses, linking data to the historical and cultural context in which it occurs, and observing protocol in social interactions appeared throughout the process. The lessons learned from this project will undoubtedly inform future research projects undertaken in the Native Hawaiian community across a wide variety of settings, both urban and rural. [ABSTRACT FROM AUTHOR]

Any discussion of social change, by its very nature, precludes neat conclusions. The present comments attempt to introduce to a readership, perhaps less familiar with the Pacific Islands than with other parts of the world, some idea of the factors that create social problems that currently exist or are on the horizon. This section was particularly designed to give the reader a context that will make the chapters that follow more useful, especially for comparison both within and beyond an island world. Perhaps the only final message herein is that which is appropriate for an anthropologist: we share a common humanity, combined with a rich and wonderful diversity in our respective social and cultural lives. Both problems and solutions must be understood and solved against that background. [ABSTRACT FROM AUTHOR]

The Hmong in Asia comprise a large, distinctive ethnic group that inhabits the countries of China, Vietnam, Laos, Burma, and Thailand. Although they do live in lowland areas of even islands of the South China Sea, they are widely known as "mountain people" who dwell in the Annamite Chain of mountains, several thousand feet above sea level (Geddes, 1976). The Hmong, whose name for themselves means "free [people]," possess a long tradition of self-sufficiency and resistance to outside interference or domination (Lemoine, 1972). Throughout the twentieth century, national, regional, and even international forces have challenged their traditions, world views, and sociopolitical roles in Southeast Asia (Yang, 1974). [ABSTRACT FROM AUTHOR]

The cross-cultural treatment of traumatized refugees is complicated and difficult. The cross-cultural issues of language and values expectations of treatment add to the already difficult task of treating PTSD, depression, and other psychiatric disorders among the refugees. Treatment has usually been suggested with psychosocial therapeutic approaches. These have included psychoanalytic approaches (De Wind, 1971; Varvin &Hauff, 1998), behavioral and cognitive approaches (Basoglu, 1998), testimonial therapy (Cienfuegos &Monelli, 1983), and trauma-focused treatment techniques (Drozdek &Wilson, 2004). Research into the effectiveness of these techniques has been few, undoubtedly because of the large problems of psychotherapy outcome studies across both trauma and cultures. Arecent report found that after nine months in a psychotherapy program, the torture survivors showed little improvement (Carlsson, Mortensen, &Kastrup, 2005). [ABSTRACT FROM AUTHOR]

Psychological trauma is pervasive for Aboriginal Australians, both in its impact on individuals and their families through the earlier processes of colonisation, and in ongoing ways through disadvantage, experience of violence, illness, injury and premature mortality. Traumatic experiences have impacted on individuals, families and communities and on culture. And these experiences continue. As Ober, Peters, Archer, &Kelly (2000) cogently argue "understandings and responses to acute trauma in Aboriginal settings today" need to be understood "within a framework of collective and cumulative traumatisation over several generations" (p. 242). [ABSTRACT FROM AUTHOR]

In recent years, leading medical journals have published a series of commentaries (Bracken, 2001; Bracken, Giller, &Summerfield, 1995; Summerfield, 1998; Van Ommeren, Saxena, &Saraceno, 2005) challenging the notion that mass trauma exerts an adverse effect on the mental health of populations from non-Western cultures. The diagnostic category, posttraumatic stress disorder (PTSD), has attracted particular criticism, the key issue being the nosologic validity of that diagnosis when applied across cultures (Summerfield, 1999, 2001; Terheggen, Stroebe, &Kleber, 2001). [ABSTRACT FROM AUTHOR]

Dissociation is a human capacity that can fulfill an adaptive or maladaptive function in specific circumstances, and which appears to be particularly recruited as a response to trauma in most cultural settings around the world. Although much of the initial work on dissociation was done in Europe and the United States, recent expansion of research on this topic in other cultural regions has led to welcome progress toward a more global understanding of dissociation. This progress is reflected in a greater ethno-cultural diversity of populations under study, expansion of the known phenomenology of dissociation and thus the conceptualization of the construct, creation of new assessment instruments, and renewed debate over existing diagnostic categories. This chapter reviews current understandings of the phenomenology and classification of dissociation from a cross-cultural perspective, including its relationship to trauma, with a focus on current assessment methodologies. These topics are illustrated with recent dissociation research from two non-US, non- European cultural settings, Puerto Rico and Turkey. [ABSTRACT FROM AUTHOR]

In the present chapter, we will give an account of the culture-specific facets of traumatic stress and of posttraumatic symptomatology in their respective societal contexts as they have been reported by asylum seekers belonging to different ethnic groups. We also intend to highlight the multiple and culture-dependent strain, asylum seekers are suffering from while trying to adjust to a foreign society and while being left in uncertainty about being granted asylum. We will also examine the pathogenetic impact that societies can have on individuals as well as the differential coping styles, resulting from divergent evaluations of traumatic events by people stemming from various parts of the world. From these findings, we will derive recommendations for diagnosing posttraumatic stress and for developing culturally sensitive treatment concepts when dealing with asylum seekers and refugees from non-Western societies. Special emphasis will be laid on differences between the three cultures under consideration. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) was introduced into the world psychiatric nomenclature in 1978 (World Health Organization, 1978) with the publication of the ICD-9, documenting the cross-cultural recognition of the typical symptomatic response to exposure to traumatic life events (e.g., Horowitz, 1976). The characteristic core of the disorder includes the distressing oscillation between intrusion and avoidance. Intrusion is characterized by nightmares, unbidden visual images of the trauma or its aftermath while awake, intrusive thoughts about aspects of the traumatic event, sequelae, or self-conceptions. Avoidance is typified by deliberate efforts to not think about the event, not talk about the event, and avoid of reminders of the event. Also characteristic are more active attempts to push memories and recollections of the event or its aftermath out of mind by increasing use of alcohol or drugs, overworking, or other strategies designed to divert attention or to so exhaust someone that he or she is temporarily untouched by the intrusive phenomenology. In addition to the frank avoidance, Horowitz also described emotional numbing as a not uncommon sequel to exposure to a traumatic life event (Horowitz, 1975; Horowitz &Kaltreider, 1977). There is empirical evidence supporting three of these four phenomena. [ABSTRACT FROM AUTHOR]

After receding into relative obscurity for much of the twentieth century, there has been a vigorous renewal of interest in the role of dissociation in the understanding of human responses to catastrophic events. The theoretical contributions and clinical observations of Janet, which had been largely eclipsed by developments within modern ego psychology, self-psychology, and more recently in neurobiology, have enjoyed a resurgence of interest. Putnam (1989), and van der Kolk and van der Hart (1989a, 1989b) have provided contemporary reinterpretations of the contributions of Janet to the understanding of traumatic stress and dissociation. [ABSTRACT FROM AUTHOR]

Culture influences or defines youths' characteristic reactions, methods of expressing reactions, and therapeutic needs following traumatic experiences (Nader, in press; see Box 1). Culture shapes the mediating and moderating factors -the traits, circumstances, and environmental issues that may alter outcomes -associated with traumatic response. Cultural heritage molds the family unit, which in turn helps to form a youth's identity development (Sonderegger, Barrett, &Creed, 2004). Findings have been mixed regarding many aspects of youths' traumatic responses. Many factors, including cultural issues, may account for these mixed findings. The norms of one culture may not apply to those of other cultures (Lee, Lei, &Sue, 2001; Rousseau &Drapeau, 1998). [ABSTRACT FROM AUTHOR]

A majority of trauma research has been conducted in Western nations on patients from a similar background, and its findings are typically published in English, with only 6% in languages other than English (Bedard, Greif, &Buckley, 2004). Thus, clinicians and researchers do not yet know whether people from non-Western societies have similar reactions or symptom patterns to specific trauma. This chapter aims to fill this knowledge gap by reviewing available literature on the assessment of posttraumatic stress reactions and related psychiatric disturbances in contemporary Chinese societies of Hong Kong, mainland China, and Taiwan. [ABSTRACT FROM AUTHOR]

Being an asylum seeker in these times of increasing fear from international terrorism, mass migrations, ongoing political violence, social and economic inequity in the world and a global search for identity of large groups of people means having a very tough existence and suffering from a breakdown in different aspects of life, including psychological well-being. [ABSTRACT FROM AUTHOR]

Over 20 million displaced persons have relocated in Asia (49%), Europe (21%), and the Americas (10%) (UNHCR, 2003). Victimized by torture, trauma, imprisonment, and human rights violations, these unwilling immigrants are burdened by extraordinary psychological, emotional, physical, and acculturative sources of distress, resulting in an international dilemma. Resettlement in host countries may necessitate mental health services, healing of core adaptation systems, and succor for housing, employment, language, and coping skills necessary for survival and psychological well-being in unfamiliar cultures. [ABSTRACT FROM AUTHOR]

This chapter emphasizes the time dimension in trauma assessment. As will be detailed, an approach that examines preceding generations' trauma exposure yields the most complete assessment of an individual's posttraumatic status. This status is best understood within my multidimensional, multidisciplinary framework. This chapter draws heavily on the International Handbook of Multigenerational Legacies of Trauma (Danieli, 1998) that the interested reader is urged to consult for further details. [ABSTRACT FROM AUTHOR]

This chapter argues that the contemporary practice of cultural competence falls short of ethnomedical competence. Ethnomedicine is the study of culturally embedded or alternative beliefs and practices for health care (Genest, 1978; Nichter, 1992). Interdisciplinary with medical anthropology, ethnomedical critique examines the processes by which societies abandon their culturally embedded practices in favor of modern practices. [ABSTRACT FROM AUTHOR]

This chapter is premised on the assumption that the definition of trauma entails the cultural and ecological systems that mediate human experience and provide resources for coping and meaning making. Furthermore, the detection of traumatic stress disorder implies that the stressful event has overtaxed personal and, in some cases, community capacities. It follows that in considering cultural and ecological factors in the understanding of trauma and trauma recovery, both community resources for resilience and personal resources for coping that are appropriated from culture should be assessed. This emphasis on the cultural and the ecological is in response to the limitations of individually focused western conceptions of trauma and concerns about medicalized approaches to trauma intervention that insufficiently account for contextual factors in trauma recovery (Argenti-Pullen, 2000; Burstow, 2003; Summerfield, 2004). [ABSTRACT FROM AUTHOR]

The relationship between trauma and culture is an important one because traumatic experiences are part of the life cycle, universal in manifestation and occurrence, and typically demand a response from culture in terms of healing, treatment, interventions, counseling, and medical care. To understand the relationship between trauma and culture requires a "big picture" overview of both concepts (Marsella &White, 1989). What are the dimensions of psychological trauma and what are the dimensions of cultural systems as they govern patterns of daily living? How do cultures create social-psychological mechanisms to assist its members who have suffered significant traumatic events? [ABSTRACT FROM AUTHOR]