PTSD and the cultural brain: a review of Erin P. Findley’s War and Dislocation: A Neuroanthropological Model of Trauma Among American Veterans with Combat PTSD

by Mirjam Holleman

​In this excellent chapter, Erin P. Findley describes the intersectionality between (post-traumatic) stress, the brain, and the cultural environment.  She highlights four key elements of the PTSD experience  - stress and horror, dislocation and grief - and unpacks their neurological, psychological, and cultural underpinnings.
 
In an environment of prolonged and/or intense stress and danger, the brain undergoes a “neurobiological reshuffling” (p. 269) and is left with an “altered architecture” (p. 274). This shift signifies an activation of survival mode, in which humans react more quickly and more strongly/definitively, yet at the expense of an ability to focus, learn, or retain information not related to a direct threat (p. 269), as well as the ability to filter out relevant from irrelevant stimuli or information (p.270).  In other words, the brain interprets everything as danger or a potential threat, without ‘wasting time’ on cognitive task (such as focusing and accurately interpreting a situation) that are of lower priority in a situation where danger is ever present and unpredictable.  One feels threatened by everything, and (re)acts accordingly.“Rockstroh & Elbert have observed that repeatedly stressed brains appear to use what they call a ‘low-road’ for sensory processing that speeds up the ability configure a threat responses [i.e. react to stressors] by bypassing the prefrontal cortex’s [….] ability to analyze complex data and regulate emotion accordingly” (p. 274)
 
This response may be adaptive and necessary in a combat zone.  However, this ‘hyper-vigilance’ and fast and strong reactions to anything that might be a threat – bypassing all rational thinking processes and cognitive filters to determine whether something actually is a relevant threat and how to respond appropriately, in the interests of responding quickly – may not be appreciated or rewarded in other contexts or environments.  For example, the PTSD brain is frequently met with considerable repercussions when this ‘low-road’ response carries over into everyday social interactions.

One old veteran sheepishly recalled loosing his cool at the grocery store – not as a result of any direct threat, but because he felt the cashier had been rude to the elderly women ahead of him in line. He perceived that the young cashier had failed to show proper respect to a vulnerable elder. The source of his anger, therefore, was entirely justified within the cultural setting, although his means of expressing it – in this case, by yelling at the cashier - was not, and provoked considerable disapproval from his wife, who witnessed the exchange (p. 275).

Thus the neurological architecture that may trigger an adaptive response in an environment of actual danger may simply be interpreted as ‘overreacting’ when the danger is gone, but the ‘altered architecture’ remains.
 
This brings us to the next theme in the PTSD experience- the experience of ‘dislocation,’ referring to a sense of “uncomfortable distance” from others in their lives, from feeling at home and safe in the world, from earlier modes of perceptions and ways of reacting, or from some prior, preferred, sense of self.
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While it is becoming increasingly known that prolonged and/or severe stress may lead to an ‘altered architecture of the brain,’ it is important to consider how this altered state interacts with prior personal experiences and societal expectations of self. “For example, if a veteran has always prided himself on being a calm and easy going guy, then finding himself continually on edge and on guard may prompt a crisis of identity” (p. 275).  And as the above anecdote of the man in the grocery story illustrates, the neurological experience of PTSD is further mediated by cultural expectations and social reactions of others. Is the veterans’ change in behavior interpreted as: ‘he’s overreacting because the PTSD is affecting his brain’ or ‘he’s being a baby or a jerk?’  As noted earlier, the individuals themselves frequently struggle greatly with these changes in themselves; this distress at a sense dislocation from self may be compounded greatly by an additional sense of dislocation from other people when “friends and family members who are not well acquainted with PTSD may blame the veteran rather than the illness for unpleasant changes in behavior and attitude, often resulting in damaged relationships” (p. 275).  It is these personal, social, and cultural dislocations, rather than the stress and horror associated with trauma alone, that lead to the third aspect of combat trauma: Grief. “Grief, then, results from veterans’ internal and external dislocations; bereavement and interpersonal loss; being rent from a previously cherished view of self; overwhelming distress at finding the world can be without order, sense, or safety; and gaps in experience and understanding that lead to feeling distant from loved ones” (p. 279).
 
Thus, Findley offers a holistic view in which PTSD, or the pathways through which traumatic experiences and the accompanying stress are experienced, is presented as simultaneously neurological (caused by a “neurological reshuffling”), psychological (related to past experiences, individual disposition, and sense of self), social (tied in with the immediate reactions of others) and cultural (a desire to conform to expected socio-cultural norms of behavior and managing emotions).   In this way, the model that Findley presents does an excellent job of capturing the neuroanthropological consideration of  “how culture, experience, and biology come together” (p. 282).  I would further like to emphasis that from an anthropological perspective, ‘the biological,’ ‘the psychological,’ ‘the social and the cultural’ are of course not stand-alone factors that each contribute to the experience of PTSD, but each also shapes the other. For instance, personal expectations of self are closely linked social cues of what kind of dispositions are rewarded in ones’ environment, and these social expectations are in turn embedded within broader cultural norms and values regarding proper conduct and management of emotions and impulses.
 
Such an understanding of the interplay between the neurological, psychological, social, and cultural aspects of a phenomenon such as PTSD ought to encourage (mental) health care providers to take a holistic approach in their treatment plans, and “look beyond the psychological symptoms […] to imagine responses that go beyond clinical treatment” (p. 285). I imagine such an approach would be useful not just in the treatment of PTSD, but in any kind of treatment or intervention.
 
 
Findley, Erin, P. 2014. “War and Dislocation: A Neuroanthropological Model of Trauma Among American Veterans with Combat PTSD.”  In The Encultured Brain: An Introduction to Neuroanthropology, eds. Daniel H. Lende, & Greg Downey, 263-290, Cambridge, Massachusets: MIT Press.