International Handbook of Human Response to Trauma Edited by Arieh Y. Shalev, Rachel Yehuda & Alexander C. McFarlane. New York: Kluwer Academic/Plenum. 2000. 477 pp. US$l 15.00 (hb). ISBN 0 306 46095 5

The rise of ‘trauma’ over the past 2 decades has been something of a sociological phenomenon, albeit merely one of the latest examples of the medicalisation of life which has gathered pace over the past century. ‘Trauma’ has a life inside the clinic as a psychiatric category, and outside it as a Western cultural idiom. It is because medicalised and psychologised thinking is now so embedded in popular constructions of ‘common sense’ that the conflation of ‘trauma’ with distress (even after relatively everyday adverse events) has a naturalistic feel.

One marker of this trend comes from the database of the US National Centre of Post Traumatic Stress Disorder, which in recent years has been logging journal articles, books, technical reports, doctoral dissertations, etc. Although their coverage is mostly limited to the English language, and even then is only partial, there were over 16 000 publications indexed by September 1999, the last time I enquired. The traumatic stress field has rapidly acquired its own space as a mental health specialism, an expanding one, with academic activities and a literature to match. None the less, there have been doubting voices, mostly not represented in this book, querying the universalist assumptions of the post-traumatic stress disorder (PTSD) model (does traumatic stress mean the same thing, or anything, to Cambodians?), whether it is somewhat ahistorical (did Neolithic man have PTSD?) and whether overly reductive and mechanistic interpretations of human responses to negative events risk jettisoning too much. This book, drawn from contributions to the 1996 Jerusalem conference of the International Society for Traumatic Stress Studies, considers global questions, even though 52 of the 53 contributors come from the West. Most of these have mental health affiliations, with many already in the trauma field, and the lack of contributions from non-Western workers, and from anthropology and sociology, is telling.

That said, there are some excellent chapters. Alexandra Argenti-Pillen, who does have an anthropology background, describes an ethnographic method for reviewing the discourse on trauma in non-Western cultural contexts. She notes that PTSD is a contemporary discourse about suffering that Western mental health professionals present to people from non-Western cultures, and that this may form a triad with the religion and cosmology locally applicable. She discusses the impact, for good or ill, that imported knowledge and techniques may have on communities whose cultural resources have been destabilised by war or other catastrophe. The idea that traumatic stress causes psychological disruption may not be helpful or valid in cultures that place a premium on fate, determinism and spiritual influences. There are dangers of an unwitting imperialism here. After all, the trauma discourse introduces elements that are not merely surface phenomena but are core components of Western culture: a secular source of moral authority, a sense of time and identity and a theory of memory.

There is a masterly chapter on an alternative history of traumatic stress by Alan Young, a medical anthropologist from McGill University, Montreal, who wrote The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder (Young, 1997), the seminal book on the genesis of PTSD. He writes that the association between memory and the self has a long history, and that St Augustine wrote of this in his Confessions at the end of the 4th century. He traces the development of a new science of memory through from the 19th century and raises questions about the assumption that ‘traumatic’ memory — a static, pathological entity — is at the heart of PTSD. Recent research on Gulf War veterans has demonstrated the malleability of traumatic memories, including the extent to which what is produced is a function of context. He argues that current diagnostic techniques based on clinical interviews, protocols and psychometric scales are incapable of distinguishing between so-called traumatic memory and painful memories associated with antecedent psychiatric problems. This is to cast considerable doubt upon the disease status of PTSD, although he concedes that the process of diagnosis and treatment may function as therapeutic myth and ritual. PTSD originally arose out of work with returned US Vietnam War veterans, a most atypical group for extrapolation to other populations.

The final section is on societal healing and what is called “ preventing the cycle of violence”. Trauma programmes in war zones have claimed that timely prophylactic work can prevent traumatised victims from becoming perpetrators of violence, but this is to pass off a Judaeo-Christian piety as a medico-psychological fact. Virtually all acts of politically motivated violence, including mass atrocity and torture, are committed by psychologically normal people. There is a discussion of the role of the Truth and Reconciliation Commission in South Africa, probably the most ambitious endeavour of its kind to date.