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Article Excerpt
As disasters increase worldwide, there is greater need for effective and expedient disaster mental health response. The purpose of this paper is to present the etiology of transgenerational trauma to advance mental health counselors' understanding of the complex issues associated with trauma and disaster. The authors have woven literature from the field of trauma counseling with their own clinical experiences during deployment in post-Katrina New Orleans. The authors assert that mental health counselors can enhance clinical practice by using transgenerational trauma assessment and interventions as well as historical and contextual knowledge. A case example and recommendations are provided to demonstrate how to incorporate transgenerational trauma and resilience into clinical practice when working with disaster survivors.
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In the aftermath of Hurricane Katrina, there was an unprecedented presentation of mental health issues that are anticipated to have long-term effects over the next decade or more (T. Iliff, personal communication, June 8, 2007). Counselors competent in disaster response are needed to provide expedient services to affected communities (Rogers, 2007). Globally, the need for mental health disaster relief services is rising due to the increase in natural and human-made disasters (Guha-Sapir, Hargitt & Hoyois, 2004; U.S. Committee for Refugees and Immigrants [USCRI], 2006; Walter, 2005). Aggravating this phenomenon is the underlying concern that mental health counselors often fail to address transgenerational trauma (Danieli, 1998). This issue is particularly critical for socially marginalized clients (Burstow, 2003; Cross, 1998). We employ resilience theory as a lens for presentation of this issue as it allows clinicians to take into account client-defined risk and protective factors (Waller, 2001; Walsh, 2002). These factors are often ignored in traditional trauma counseling literature. The purpose of this paper is to introduce transgenerational trauma as an effective assessment and intervention approach for responding to disaster survivors. A case example from the disaster response activity in post-Katrina New Orleans is provided and five recommendations are offered to enhance disaster mental health counseling competence.
TRANSGENERATIONAL TRAUMA
Mental health counseling is often guided by the American Psychiatric Association's (APA), Diagnostic and Statistical Manual of Mental Disorders (DSM) (Eriksen & Kress, 2006; Mead, Hohenshil & Kusum, 1997; Seligman, 1999; White, 2002). Of particular interest to counselors providing post-disaster counseling is the influence of the diagnosis of posttraumatic stress disorder (PTSD), first included in the DSM in 1980. Indeed, creation of the PTSD diagnosis legitimized trauma as a psychological stressor and also defined the nature of trauma (Halpern & Tramontin, 2007; Scaer, 2001). Further, the PTSD diagnosis articulated expected effects of trauma (Rothschild, 2000; van der Kolk & McFarlane, 1996), informed mental health treatment (Becker, 1995; Danieli, 1998; Eriksen & Kress; Herman, 1997), and provided insurance coverage and legal recourse for those who experienced a traumatic event (Burstow, 2005; Cosgrove, 2005; James & Gilliland, 2005; McLaughlin, 2002; White).
However, the DSM provides a somewhat limited view of trauma in that the criteria consider only the direct experience of a psychically dangerous event to be traumatic (APA, 2000; Burstow, 2005; Danieli, 1998). Critics of the PTSD definition have noted the minimization of individual perception (Rothschild, 2000) and the exclusion of experiences that are common in certain communities (Levine, 1997), including patriarchal violence experienced by women (Burstow, 2003, 2005). The individualistic focus in the current definition excludes trauma that is situated within a larger context (Ivey & Ivey, 1998). Despite revisions in the DSM, significant limitations within the PTSD criteria persist (Burstow, 2003; Halpern & Tramontin, 2007). Specifically, the DSM definition excludes transgenerational trauma, or trauma that is passed down from one generation to another (Dass-Brailsford, 2007). This type of trauma occurs without direct traumatic stimulus but is instead transmitted from a parent who has experienced a traumatic event (Davidson & Mellor, 2001; Nagata, 1990). As such, transgenerational trauma is often overlooked by clinicians (Burstow, 2003; Danieli, 1998; Kira, 2001).
The concept of transgenerational trauma was developed primarily from the study of how Nazi Holocaust survivors' children were impacted by their parents' traumatic experiences (Danieli, 1998). The prevalence of mental health treatment for these children in the late 1960's sparked impact studies in Canada, the United States, and Israel. Investigations of transgenerational trauma have also included families of veterans from World War II and the Vietnam War (Aarts, 1998; Bernstein, 1998; Rosenheck & Fontana, 1998a, 1998b), indigenous peoples (Duran, Duran, Yellow Horse Brave Heart & Yellow Horse-Davis, 1998; Raphael, Swan & Martinek, 1998), and survivors of domestic violence and child abuse (Gardner, 1999; Schechter, Brunelli, Cunningham, Brown & Baca, 2002; Simons & Johnson, 1998; Walker, 1999).
The internment of Japanese Americans during World War II, the enslavement of Africans, and genocidal acts against indigenous peoples are three poignant examples of transgenerational trauma in the United States (Dass-Brailsford, 2007). These historical events continue to impact the mental health of those descendents; significant mental health effects, such as depression, anxiety, hypervigilance, low self-esteem, suicidal ideation and behavior, substance abuse, violence, and loss of cultural identity have been cited (Dass-Brailsford; Duran et al., 1998; Felsen, 1998; Raphael et al., 1998; Simons & Johnson, 1998). It is within this context that scholars have advocated for culturally sensitive assessment (Dana, 1993; Ibrahim, Roysircar-Sodowsky & Ohimshi, 2001; Suzuki, Meller & Ponterotto, 1996).
Transgenerational Trauma in Post-Katrina New Orleans
A disaster is a human-caused or natural event that results in significant destruction and often the loss of life, and has a lasting impact on the environment and the community (Halpern & Tramontin, 2007). For the residents of New Orleans, previous experiences with disasters can lay the foundation for comorbidity: transgenerational trauma on top of disaster-related trauma symptoms.
In a 2001 article in Scientific American, Mark Fischetti called the city, "a disaster waiting to happen," in part due to its precarious position below sea-level and the continual loss of its buffering delta. Additionally, at multiple times in recent history, New Orleans has either been impacted or been threatened by natural disasters. Hurricane Betsy, hitting the city in 1965, flooded some parts of the city with eight feet of water and killed 65 people (Brinkley, 2006). Hurricanes Andrew and Georges, in 1992 and 1998 respectively, both narrowly missed the city. Furthermore, in 1927, city officials purposefully flooded parts of New Orleans by dynamiting a levee in order to save other parts of the city from damage due to the Great Mississippi Flood (Brinkley). The Lower Ninth Ward, a predominantly Black working class neighborhood, and St. Bernard parish, a blue collar White community, were the adjoining areas sacrificed, engendering mistrust in the city government. The devastation to these two communities is parallel despite the skewed media focus on the Lower Ninth Ward following Hurricane Katrina (Frazier, 2006).
In the aftermath of...
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