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<PN>Part III
<PT>Cross-Cultural Perspectives
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<CN>Chapter 5
<CT>Trauma in the Lifeworlds of Adolescents
<CST>Hard Luck and Trouble in the Land of Enchantment
<CA>Janis H. Jenkins and Bridget M. Haas
In this chapter, we argue that the diagnosis of posttraumatic stress disorder (PTSD)
requires substantial elaboration when applied to adolescents living under conditions of structural
violence and cultural conflict. We make this claim on the basis of ethnographic and clinical
research data collected for a NIMH-fundedstudy of forty-seven adolescents in the American
Southwest funded by the National Institute of Mental Health.1 To take a step toward
understanding the social and psychological nexus of trauma, our analysis is grounded in case
studies that illustrate the primacy and insistence of lived experience. This analysis reveals that
problems faced by these youths cannot be apprehended apart from both the historical
circumstances of their production and the sheer density of traumatic life events. The events
consist of violence, loss, and betrayal that biographically reverberate. When these events are
recurrent or unrelenting, it should be obvious that conceptualizations of trauma must come to
incorporate social and developmental trajectories that unsurprisingly complicate and supersede
the rudimentary diagnostic descriptor of PTSD. Indeed, our research with New Mexican youths
lays bare the raw quality of trauma not as circumscribed events of acuity but as recurrent events
and inexorable conditions of acuity. There is no “habituation.” There is no “adaptation.”
Insecurity and strain delineate lives through a pattern we have identified as precarious. Our
analysis also draws on the notion of precarity2 as advanced by Anne Lovell (2012) when applied
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to experience near-danger and life-threatening circumstances. In the present ethnographic case,
precarity prominently includes social abandonment and indifference (Jenkins 2014). These
conditions of existential vulnerability and harm are deeply rooted in regional legacies of
geopolitical conflict and oppression that are centuries in the making (Sanchez [1940] 1996;
Chavez 2006). These conditions supply the breeding grounds for recurrent cycles of trauma and
rupture in the social relations of kin and community.
We wish to point out that it is not our intention to conduct an inquiry into the status of the
diagnosis of PTSD as a moral, ontological, or political category. In an account of the extensive
geographic scale and application of the term, Fassin, Rechtman and Gomme (2009) offer an
historical analysis of trauma as empire instituted through uncontested claims of the veracity
and moral worthiness of PTSD. This account of the institutional genealogy is useful to trace the
contemporary circulation of the concept. In contrast, our interest is the lived experiences of
adolescents and their families who have actually experienced major psychic trauma. Many of the
families have extensive histories of trauma, the vastness and complexity of which simply cannot
be captured by a clinical diagnostic perspective. This comes as no surprise to experienced
clinicians. Our use of the term psychic trauma instead of “PTSD is therefore not meant to
portray these terms as diametric. We agree with the position articulated by Byron Good (1994)
that anthropological research on mental illness does well to utilize psychiatric diagnostic
categories as a starting point for analysis and comparison. This position is well taken as a counter
to wholesale dismissal of DSM criteria as a priori of no use for the description or organization of
particular kinds of illnesses. This point needs to be made explicit since it is an anthropological
commonplace to dismiss diagnostic constructs as presumptively universal. Such a priori
judgments are typically made in the absence of empirical research.
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We take as our starting point the fact that the adolescents we discuss in this chapter met
the criteria for PTSD (described more fully below). Our larger project, however, is to elaborate
the structure of these youths’ experiences. We see our approach as a stepwise one, in which we
take diagnoses of PTSD as our point of departure for a fuller elaboration of our participants’
lived experiences. Our intent in using the term “psychic trauma” is to move beyond clinical
descriptions and to draw theoretical attention to the complicated cultural and psychological
dimensions of these young people’s lived realities. In this regard, our analysis is firmly grounded
within an existential, phenomenological, and psychodynamic framework. At the same time, we
emphasize that these considerations must be understood as critically connected to and
reciprocally shaped by larger social and structural forces. Thus while we are primarily concerned
with phenomenological aspects of adolescents experiencing psychic trauma, our contention is
that these aspects of experience are always informed by broader forces and institutions, as we
underscore throughout our discussion.
While our case studies in this chapter, as with our larger research sample, come from a
particular geographic region—the American Southwest—comprised including predominantly by
Hispanic, Native American, and Anglo-American adolescents and their families, we do not
purport to describe a homogenous or space- and time-bound way of experiencing or
understanding trauma. Rather, the cultural analysis presented here adopts a broader
conceptualization of culture as a way of being in the world in which local, shared symbolic
forms articulate with intrapersonal and psychic processes. Hence, from the outset, our analysis
assumes the important connection between culture and psyche, as well as the inseparability of
subjectivity and intersubjectivity (Jenkins and Barrett 2004).
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<A>Study Background and Methods
This chapter draws on data from a longitudinal study, “Southwest Youth and the
Experience of Psychiatric Treatment” (SWYEPT), in which we investigated the experiences of
adolescents in psychiatric residential treatment in the Southwest United States, namely New
Mexico. Our interest here, as with the larger project, is in elucidating the sociocultural
dimensions of psychic trauma and mental illness among these youths. Methods of data collection
included ethnographic interviews with adolescents and their families; interviews with clinicians
and social workers; clinical observations; and observations of homes and communities. In
addition, study participants were administered the Structured Clinical Interview for DSM
Disorders (for children it is known as KID-SCID), a semistructured interview used for making
the major DSM Axis I diagnoses. The KID-SCID was administered by one of two study team
members of the team (a child psychiatrist and clinical psychologist both trained specifically to
reliably administer this research diagnostic interview). Adolescents were approached and
recruited in psychiatric facilities, although much of our follow-up interviews and observations
occurred within homes. Adolescents and their caregivers were interviewed at various intervals
over a period of one to two years.
In the last decade, New Mexico has experienced a 13.2 percent increase in growth, with
the 2010 U.S. Census reporting a population of just over two million. The primary sites of our
study were the two most populous cities in the state, Albuquerque and Las Cruces. However,
New Mexico maintains a largely rural character, and, indeed, a good portion of our fieldwork
entailed traveling to much less populated areas within the state. According to census data, the
population of New Mexico is predominantly Hispanic (46.3 percent), followed by Anglo-
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Americans (40.5 percent) and Native Americans (9.4 percent). New Mexico has a notably high
rate of child poverty rate at 30 percent, one of the highest in the country (Macartney 2011:6).
The majority of adolescents in our study came from low-income households, and many
lived in neighborhoods or communities addled with drug use and gang activity. Housing
instability and transience as well as familial fragmentation largely marked the lives of these
adolescents. For example, it was not uncommon to find an adolescent living with another family
member at the time of a follow-up interview, or to discover that the family had abruptly fled
(from violence or eviction) their previous home. Overall, the lives of the families in our study
unfolded in contexts of structural violence (Farmer 2004), marked by the presence of drugs,
violent crime, and high unemployment, and a lack of access to educational, health, and social
services.
Street drugs were plentiful and near ubiquitous in many of the neighborhoods where our
study participants lived. Albuquerque and Las Cruces are major points of transmission of heroin
and other drugs for the Southwest, Midwest, and Pacific Northwest. New Mexico has the
inauspicious distinction of the highest per capita rate of heroin-related deaths in the nation.
Overall, drug-related overdose in New Mexico was recently reported as the leading cause of
unintentional death (New Mexico Department of Health 2011). Drug use, including use of
alcohol, cannabis, methamphetamines, and cocaine, was common among adolescents.
The existence of trauma in the lives of many of these adolescents emerged as a key
finding in this study. Adolescents and their families cited a range of traumatic events and life
conditions including, but not limited to, physical, sexual, and emotional abuse and assault;
witnessing of deaths, physical violence, or suicide attempts of family or friends; exposure to
gang-related activities, including sexual and physical assault and drug abuse; contact with police
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or the juvenile justice system; parental neglect or abandonment; and housing instability (family
being evicted and/or adolescents being removed from the home).
Adolescents in our study were primarily recruited from a large, university-based
psychiatric hospital for children in Albuquerque. Our study of adolescents in residential
psychiatric treatment centers included a comparison sample of nonhospitalized adolescents
recruited from a public school district. However, this chapter focuses solely on data collected
among the hospitalized sample. Children were referred here from all over the state. Over time,
with the retrenchment of health care services, the average stay for patients had declined from one
year to thirty days for residential patients. During the five-year period of the study (2005–11) we
saw that time eroded even further. This restriction of services was the source of great dismay for
clinicians, patients, and families. Under pressure from a health care management company that
had received the state contract within a year prior to our study’s beginning, payment for both
residential treatment and day treatment was approved with decreasing frequency, and more beds
had to be allocated to acute care for the institution to remain financially viable. At the time of our
work, a day hospital program had recently been eliminated, and one of the inpatient cottages had
switched from residential to acute care. Of the six units, each with a capacity for approximately
nine patients, one was dedicated to girls who were in legal trouble, one was for residential
treatment of adolescents, two were primarily for acute care of adolescents, and two were for
acute care of younger children. Simultaneous to the downsizing of health services during the
course of the study, Value Options, the largest privately held health care corporation in the
country at that time, began the process of centralizing all mental and behavioral services.
Through what was said to be competitive bidding in 2005, the state of New Mexico selected
Value Options to oversee public funding and delivery of health care throughout the state. Value
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Options operated as the state’s single managed care entity for the delivery of mental and
behavioral health care.
Participants in the study included forty-seven adolescents, twenty-five boys, and twenty-
two girls between the ages of thirteen and seventeen. The ethnicity of study participants included
a fairly equal distribution of Hispanic, Anglo-American, and Native American groups, although
there were other combinations of ethnicity to include African American and Southeast Asian
ancestry. The average age of the teens was fourteen. Close to 75 percent of our study participants
had been previously hospitalized on multiple occasions. Data from the KID-SCID are
remarkable with regard to the co-occurrence of psychiatric diagnoses.
Thirteen adolescents (28 percent) met full diagnostic criteria for PTSD. Girls were nearly
twice as likely to meet full diagnostic criteria for PTSD compared to boys in our study (eight or
36.4 percent and five or 20 percent respectively). This does not include several more who were
clinically subsyndromal for PTSD. For research and clinical practice alike, the diagnosis of
PTSD is complicated in ways that are not entirely comparable to other conditions such as
depression or psychosis. Assuming validity of the information provided by the patient, that is,
that they are willing to offer actual accounts of their experience to the diagnostician, posing a
series of questions may lead to a diagnosis on the basis of specific criteria. In the case of PTSD,
however, diagnosis can be considerably more difficult. Since the disorder can be characterized
by avoidance or profound disturbances of memory, for example, direct questions in these realms
can be fruitless. Given this, it is possible that the percentages of identified cases underestimate
the problem.
Diagnostic criteria aside, however, these youths had commonly committed violent or
suicidal acts, had experienced recent deaths of loved ones, had made heavy use of drugs and
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alcohol, had had legal troubles, were the object physical and/or sexual abuse (an alarming
number of girls were raped multiple times), and did routine self-cutting. These existential
dimensions of psychic trauma, which is our theoretical focus, are highlighted in the following
cases of two study participants, Danielle and Luis.3 Both Danielle and Luis met the research
diagnostic criteria for PTSD. Yet, it is by investigating the phenomenological features of their
experiences of psychic trauma that we make a critical move toward elaborating the meaning and
experience of their diagnoses.
<A>Case Studies
<B>Danielle Ramirez
At the time that we met Danielle, a chubby, attractive, and pleasant Hispanic girl who
was just days from her fifteenth birthday, she was living with her mother, stepfather, grandfather,
and three siblings in a working-class neighborhood that she described as fairly safe and
comfortable. However, the relatively stability of her living situation at that time belied Danielle’s
extensive history of housing instability, familial fragmentation, violence, abuse, and related
mental health struggles.
Danielle had recently been discharged from the children’s psychiatric hospital, having
been there for close to six months. This hospitalization, her second, had been prompted by an
incident at school in which Danielle had confided to a male classmate that she thinks about
choking people with a shoelace. This boy subsequently took a shoelace and attempted to choke
several students claiming, when caught by school officials, that Danielle forced him to do it.
School officials and police officers confiscated several of Danielle’s notebooks from her
backpack, in which she had written “awful stuff,” including her desire to harm and choke people,
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including her mother. In lieu of being taken to juvenile detention, Danielle was admitted to the
hospital for psychiatric treatment. In addition to PTSD, Danielle was also diagnosed with
psychosis, major depressive disorder, separation anxiety disorder, and oppositional defiant
disorder.
Danielle’s history of mental health challenges started in her childhood. Danielle grew up
in a poor town just east of Albuquerque with her siblings, her mother, and her mother’s husband,
Donny, until she was ten years old. Having been led to believe that Donny was her biological
father, Danielle was devastated when, at age seven, Donny told Danielle to “get out of my face . .
. cause you ain’t my daughter.” Danielle recalled her reaction: “I felt like I was worthless, like, I
didn’t have no purpose in life.”
Throughout Danielle’s childhood, her mother, Victoria, was a heroin dealer and active
gang member. Though Victoria claimed not to use any drugs other than alcohol or marijuana,
there was frequent “partying” (including heavy drug use and sexual encounters) that took place
at the family’s home(s), and Danielle and her siblings were exposed to egregious acts of
violence, including murder. For example, Danielle noted a particularly horrifying incident in
which her uncle was shot and killed in the family’s front yard in a gang fight. Furthermore,
domestic violence permeated family life, and Danielle would often witness her mother and
Donny in “knock-down, drag-out” physical altercations.
When Danielle was nine years old, Victoria was arrested for aggravated assault with a
deadly weapon and was sentenced to two and a half years in prison. Danielle was sent to live
with her maternal grandmother, who was a heroin-addicted gang member. It was at this time that
Danielle began to experience frightening auditory hallucinations. As she told interviewers,
Danielle had, from a very young age, had an imaginary friend with whom she conversed called
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the Man.” She insisted that “the Man was not that scary when I was little, but whenever I turned
nine, he started being really mean to me.” Asked to elaborate, she explained: “He started yelling
at me. He started screaming at me. He would tell me I was no good. He would tell me that I
should just kill myself.”
After Victoria was released from prison, in an attempt to stay out of gang life, the family
moved to Albuquerque, where they lived in an area referred to as “the war zone,” given the
neighborhood’s prevalence of drug and gang-related violence. By this time, Victoria had
divorced Donny. Fed up with the violence in the neighborhood, the family moved back to a town
east of Albuquerque, where they remained for close to two years. While Victoria still did not
return to gang life, she remained friends with gang members, with whom she partied and
engaged in promiscuous behavior. Additionally, Victoria’s siblings and parents, who lived in the
area, were all active gang members. Thus, violence remained a salient part of Danielle’s life, and
she continued to be haunted by the Man. After another brutal physical altercation and fearing
legal repercussions, Victoria fled back to Albuquerque, leaving Danielle to live with Donny and
his girlfriend. Donny was emotionally and sexually abusive, raping Danielle on two occasions.
Danielle was also expelled from school for attacking a classmate who was making fun of her and
her mother, reporting that “the voices told me to get a knife and stab him.” Feeling angry and
hopeless, Danielle attempted to commit suicide by hanging, but the rope broke. Danielle
demanded that Donny take her to her mother in Albuquerque.
After returning to Albuquerque, Danielle disclosed the sexual abuse to her mother and
older sister. Danielle’s hallucinations increased: “The voices were getting louder and louder.”
She was hospitalized and spent two months at a residential psychiatric treatment center. While
she found this treatment center to be a “bad experience”—primarily due to the fact that she was
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constantly restrained to the point where she had bruises on her arms—she does credit the
hospitalization for getting her on medication that helped mitigate her symptoms. The voices,
Danielle reported, did not disappear but “got quieter.”
Danielle was discharged from psychiatric treatment and spent the next year at home with
her family: her mother, her three siblings, her grandfather, and her mother’s new husband, Mark.
Danielle liked Mark, describing him as a “real understanding person,” and quickly began to refer
to him as “Dad.” Victoria had been attending weekly counseling and had been making attempts
to “turn [her] life around.”
Victoria, in her interviews, talked at length about her familial history of gang-related
violence, drug and alcohol addiction, and parental neglect and abuse. She recounted: “You know,
I grew up watching my mom abuse herself. You know, she got shot, she almost died. . . .
drinking, partying. Everybody doing drugs. They didn’t care if we [she and her siblings] were
sitting there. . . . So as far back as I remember, I remember people using needles. After
witnessing her uncle’s murder when she was nine years old, Victoria recounts: “I stopped talking.
I just started hurting myself. And my mom was in her addiction. She didn’t want to deal with me,
so she just put me in the [psychiatric] hospital. For a year and a half.”
Determined to stop the cycle of violence and abuse that had characterized her family
legacy for generations, Victoria boasted to research staff that in addition to quitting gang life,
drugs, and alcohol, she also no longer yelled at her children and was trying to improve
communication among everyone in the family. Danielle saw an improvement in her own life at
this time. She did continue to see the Man and hear voices, but these were kept to a minimum
with psychiatric medication.
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Danielle’s struggles were far from over, however. Only months after being discharged
from her first hospitalization, Danielle was feeling unloved and again attempted suicide, this
time by taking “a whole bunch of Seroquel.” Danielle was extremely sick for several days, with
severe abdominal pains and vomiting. Yet she did not reveal to anyone that she had attempted to
kill herself by overdosing on Seroquel. In fact, Danielle said, “nobody really paid attention to
me, so they couldn’t even tell if I was sick or not.” Her suicide attempt and profound feelings of
loneliness and neglect did not come to light until she was hospitalized for the second time,
following the school incident with the shoelace described earlier.
Danielle understood her diagnosis of PTSD to mean “something tragic has happened to
you while you were young and it messes up your chemicals in your brain or something like that.”
Given that the Man became menacing at the time that Victoria went to prison and the auditory
hallucinations and suicide attempts occurred during and after periods of intense sexual and
emotional abuse, Danielle framed these as main factors in the development of her PTSD: “When
my mom went to jail that’s when it [hallucinations] started, like, getting really bad. And then
whenever I went with my stepdad it got really, really bad.”
While Danielle pointed to specific incidents of her mother’s imprisonment and to sexual
abuse perpetrated by her stepfather as possible origins of her PTSD diagnosis, Victoria was much
more ambivalent regarding this matter. When asked her thoughts on what may have accounted
for Danielle’s PTSD symptoms, Victoria offered multiple, if sometimes conflicting, speculations.
At first, Victoria offered that Danielle’s mental health issues may have been prompted by the
crowded apartment with little amenities that the family shared at the time: “I think maybe the
living situation was too much.” Yet Victoria later revealed more ambivalence about the source of
Danielle’s symptoms, particularly her auditory hallucinations: “Um, at first I, I thought it was
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because of everything that I had, um—going to prison, um, all the things they witnessed me do. I
mean, cause the first time my son seen me shoot someone he was like seven. . . . And I can
imagine what these kids seen.” Victoria even speculated that the origin(s) of Danielle’s trauma
could be located even earlier, as she wondered, “Was it something that I did when I was
pregnant, the behaviors or—cause I did drink and my husband used to beat me up a lot when I
was pregnant with her.” Yet, these perspectives of self-blame were also tempered by her
statement that ultimately Danielle’s mental health issues are “not all me, but maybe a little bit is
me.”
If Danielle and, especially, Victoria seemed ambivalent about the etiology of Danielle’s
mental health struggles, they also had doubts about the veracity of the PTSD diagnosis itself.
Both Danielle and Victoria wondered to interviewers if what Danielle “really [had]” was PTSD
or something else, namely schizophrenia. Danielle noted: “Well, I think I have schizophrenia
because I seen the Man way before . . . way before the rape and, um, [before] bad things
happened to me.” Danielle noted that “schizophrenia is the same thing as PTSD but
schizophrenia is when something has never happened to you but you still see things
[hallucinations].”
While Danielle noted to interviewers that clinicians never gave her a diagnosis of
schizophrenia, Victoria recalled one of the children’s psychiatric hospital clinicians suggesting
that Danielle’s symptoms “seem like schizophrenia.” (We should note that according to our
conversations with hospital clinicians and according to results of the psychiatrist-administered
SCID, Danielle did not meet the diagnostic criteria for schizophrenia.) Victoria, however,
dismissed the idea of a schizophrenia diagnosis, noting: “I did some research and schizophrenia
doesn’t happen to chicks.”
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At our last meeting with the family, Danielle reported doing much better. Victoria, who
was still sober and attending counseling, was looking for a new neighborhood in which to live,
primarily so that Danielle could resume school the following academic year. Danielle expressed
hopes to get back into school so that she could eventually become an architect. She rarely
experienced auditory or visual hallucinations anymore, a fact that she attributed to a change and
increase in psychiatric medications during her second hospitalization. In his clinical notes
following the SCID interview, our research psychiatrist expressed his sense that “a more settled
environment will be supportive” for Danielle but simultaneously underscored the enduring
effects of the “significant exposure to instability, insecurity, neglect and abuse in [Danielle’s]
early years.”
<B>Luis Gonzales
Upon enrolling in our study, Luis, a lanky, slightly awkward, and quiet but affable
Hispanic sixteen-year-old, had just moved to a residential treatment center after spending two
weeks in an acute psychiatric inpatient unit. By both his own account and that of his family’s,
Luis struggled with issues of depression, anxiety, paranoia, and intense anger. Requests to clean
his room at home or drives to the grocery store with his grandmother would evoke panic and
anger in Luis for reasons that he could not quite explain: “I just get nervous around, like, when
things start to happen—I don’t know what to do anymore. I just nervous and start freaking out.”
Luis also used alcohol and marijuana, which he described as a way of coping with his emotional
difficulties.
Luis vacillated between self-isolation and highly destructive behavior. Though he had
never harmed another person, he did sometimes harm himself, either by cutting himself or
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choking himself with a belt. More often, when he felt angry or anxious, he would violently
destroy property. At the time of enrollment in the study, Luis had been admitted to the acute
psychiatric unit following a violent episode in which he took a sledgehammer to his
grandmother’s small trailer, where he and his mother were also living at the time. After he had
put a “couch-sized hole” in the external wall of the trailer, his mother called the police, who
escorted Luis to the children’s psychiatric hospital. Luis was diagnosed with PTSD as well as
depression and separation anxiety disorder.
Growing up, Luis moved frequently: by his own account, he had moved nine times by the
time he was twelve. Luis had not had contact with his biological father since he was three years
old. His mother remarried when Luis was a toddler, and Luis had a younger half sister, who was
six years his junior (ten years old at the time we enrolled Luis in the study). Luis’s mother, Paula,
who was a drug addict, was in and out of jail throughout Luis’s life. During his mother’s
episodes of incarceration, Luis sometimes lived with his stepfather (his younger sister’s
biological father), Kevin, though he was usually sent to live with his aunt Linda, who was also a
drug addict, or his grandmother, both of whom lived in areas of poverty rife with drug users and
gang members. Kevin was emotionally and physically abusive. Luis recalled, for example, Kevin
smashing his head with the lid of a washing machine. Luis also recounted times when he, at age
eleven or twelve, was locked in a closet while his mother and stepfather used drugs and had sex.
In 2005, Luis’s mother divorced Kevin. Their relationship had been increasingly difficult
and destructive, and Paula had discovered that Kevin had slept with her sister Linda. At this time,
Paula was heavily using drugs, primarily cocaine, and was, as she put it, “in a crisis situation.”
She attempted suicide by cutting her wrists and a vein in her neck. Luis witnessed his mother’s
suicide attempt and subsequently became very agitated and upset, claiming, “I couldn’t take it.”
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Luis’s grandmother Manuela took him to the psychiatric unit of a local hospital, where he was
admitted for two weeks for inpatient care.
While both Paula and Luis were hospitalized, Kevin reported Paula to the local child and
family services, and, following an investigation, Paula was charged with child endangerment and
neglect, and Luis was sent to foster care for two years, which Luis described as the worst time of
his life. Manuela was made Luis’s legal guardian following his release from foster care, and he
moved into the small trailer that Manuela shared with her partner of twenty-five years, Roberto.
The trailer was small and crowded and located in a poor, drug-addled neighborhood. Paula had
also been living with Manuela and Roberto at this time, though the state denied her custody of
Luis. Moreover, in the years preceding Paula’s suicide attempt, Kevin had secured a restraining
order against Paula, and Paula was allowed only minimal contact with her daughter. On the
evening prior to our first interview with the family, Linda had been arrested and imprisoned on
drug charges, which Manuela had described as “a blessing” given Linda’s history of “terrorizing
this family.” Indeed, Linda, a crack cocaine addict had been visiting Manuela’s home at all hours
of the night, begging for or stealing money, especially from Luis.
Luis articulated ambivalent and deeply fraught feelings regarding his family, particularly
his mother. He expressed feeling “better when I’m with family” but also described anxious and
angry feelings prompted by interactions with family members. When Luis was in treatment, he
described feeling claustrophobic and angry at home, yet he also told interviewers that the hardest
thing about being in residential treatment was that he wasn’t able to be with his family or talk to
his family when he wanted. Luis seemed to struggle the most in negotiating his desire for
familial connection with his feelings of anger and abandonment toward his mother. Paula’s
sporadic attempts at reconnection with Luis were a particular point of contention for him: “She’s
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always going to jail so I just—I don’t like it when she goes to jail. . . . [Now] I’m talking to her
but I’m still kind of mad at her and I don’t like her touching me all the time cause sometimes
she tries to give me hugs and kisses and stuff and I don’t like that.”
Paula likewise reflected ambivalent feelings regarding her relationship with Luis,
reporting, “We really don’t have good communication.” Given her absences throughout Luis’s
life and her abdication of legal guardianship, both Paula and Luis struggled to define personal
and relational expectations. Ultimately, Luis’s grandmother emerged as the most stable figure in
his life, though she struggled to balance taking care of Luis and caring not only for herself (she
had serious health issues, including rheumatoid arthritis and diabetes), but also for her elderly
father, who lived on his own. Manuela was nurturing and caring of Luis, but also reported
feeling worn out by caring for him.
Luis and his family struggled to make sense of a diagnosis of PTSD, in that they
expressed ambivalence over the origin of his emotional and psychological problems. Luis framed
his grief, anger, anxiety, and paranoia as tied to his abuse by Kevin and his abandonment by his
mother. Paula was more ambivalent regarding the impact of parental abuse and neglect on Luis.
While she did cede that her episodes of neglect and abandonment added to Luis’s struggles,
Paula nonetheless conceived of the origin of Luis’s problems, including PTSD symptomatology,
as more biologically based. More specifically, Luis’s mother and grandmother—and to a much
lesser extent Luis himself—cited brain surgery to correct a prematurely closed fontanel that Luis
had undergone as an infant as a primary trauma from which his subsequent mental health issues
stemmed. This surgery, Luis’s caregivers stressed, were surely a “trauma” and caused a “brain
injury” that resulted in Luis’s psychiatric and emotional issues that developed in adolescent.
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Both Manuela and Paula were adamant about this despite clinician’s reassurance that such a
surgery would not account for Luis’s diagnoses of PTSD, depression, or anxiety.
In addition to viewing brain surgery as a key factor in the development of Luis’s mental
life struggles, Luis and his caregivers (mother and grandmother) also identified foster care as a
key factor in his rage, anxiety, and paranoia. Luis asserted that it was when he went to foster care
that his “life starting falling apart.” Likewise, Manuela asserted that foster care “screwed [Luis]
up really badly. To where’s he’s paranoid. [Luis] was never paranoid like that.” She added: “If he
has abandonment issues, I blame it on that.” In addition to expressing ambivalence about the
source of Luis’s emotional and psychological issues, Luis’s mother and grandmother expressed a
struggle over finding the “right” diagnosis. Manuela, somewhat exasperatedly, described Luis’s
history of various psychiatric diagnoses, in addition to PTSD: I’ve been told that [Luis] has
anger-management problems. I’ve been told he’s paranoid. And he suffers severe depression. Ok,
and I’ve asked ‘is there a possibility that he could be bipolar?’ [Clinicians say,] No, no, no. It
wasn’t until now that [a hospital clinician] said that she thinks he’s bipolar. And with something
else, but they wouldn’t know until he got older because he could outgrow it. I don’t know if
that’s schizophrenic or, or what it is.
At the time of our second meeting with him, approximately five months following our
initial interview, Luis had been feeling “less angry and paranoid,” which he attributed to his
medication regimen, though he also disliked taking medication and being prompted by his
mother or grandmother to take his medication was a major trigger for his anger and anxiety. He
and his mother were working on improving their relationship.
The attempts at rebuilding a relationship with his mother were curtailed shortly after our
second meeting with Luis, however, as his mother was arrested and again put in jail following an
Hinton and Good Chapter 5 233
automobile accident in which she was driving a stolen vehicle. She was in jail for six months and
then put on one-year probation upon her release. In the eleven months between our second and
third (and final) meeting with the family, Luis had been in and out of several psychiatric
treatment centers as well as a juvenile detention home, each time following an episode of violent
or destructive behavior. Luis had also begun abusing cocaine. At our research team’s last contact
with the family, Paula had been released from prison and was on probation. She had secured a
part-time job as a security guard, was taking classes at a local community college, and was
attended counseling at her church. Linda had also been released from prison and was no longer
using drugs. In contrast to this, Luis’s problems had only seemed to increase during this same
time period, and at the final research visit to the family, Luis had been hospitalized at a
residential treatment center several hours away from Albuquerque. He had been there for three
weeks and had six weeks left in the program. Both Manuela and Paula expressed concern about
his anger, depression, and anxiety, as well as his newly developed cocaine habit. Underscoring
the ambivalence that the family seemed to have toward Luis’s future, Paula noted that Luis “was
not proactive in his recovery,” yet she also pointed the interviewer to a handmade Mother’s Day
card in which Luis had expressed his love for Paula and contrition for his past actions—
something he never done previously and which Paula hoped was a sign of a more hopeful future.
<A>Existential Vulnerability and Legacies of Harm
The cases of Danielle and Luis, like other research participants diagnosed with PTSD,
reveal the ways in which the lives of the adolescents in our study are marked by what Jenkins
(2014) has identified as a “pattern of precarious conditions.” These adolescents must often
contend with parental abandonment or neglect as they navigate their social worlds. The
Hinton and Good Chapter 5 234
conditions of vulnerability in which these youths’ lives unfold, and which are shaped by larger
sociocultural, political, and economic forces, allow for repeated and pervasive acts of trauma to
occur. Though the narratives presented here concern how symptoms that get identified as PTSD
are negotiated within families, such familial dynamics must be understood as embedded in a
larger set of histories, both intergenerational and regional.
Many parents discussed their own histories of abusive or violent childhoods and spoke of
family legacies of drug abuse, gang activity, and parental abandonment. Victoria’s narrative
painfully highlighted her own experiences of neglect and abandonment, as well as early exposure
to violent crimes committed by her parents and other family members. While Victoria took to
selling heroin at a young age, eleven, as a way to “get the hell out” of gang life and poverty, this
only entrapped her further within these elements. Manuela summed up the family dynamics of
Luis’s extended family by stating: “We are a very dysfunctional family from the get-go. . . . At a
time when people were nurturing their children, I was learning survival skills. . . . I was an
abused person, I was an abused wife. I got my beatings. . . . [Paula] nearly drowned in the
bathtub by her dad and that was just him.” Within a context of economic and social
marginalization, and subjected to multiple forms of violence, these women’s agency took the
form of survival. The lack of access to supportive social, economic, and health care resources
that characterized the marginal positions of caregivers evoked an environment where self-
preservation often trumped their ability to provide adequate protection or care for their children.
The intergenerational patterns of violence that were referenced across study participants’
narratives must be seen within the broader framework of regional history, namely traced to the
colonial history of New Mexico. An elaborated history of some five centuries of conflict among
Native American, Spanish, Anglo-American, and Mexican populations is beyond the scope of
Hinton and Good Chapter 5 235
this chapter (see Chavez 2006; Sanchez 1996). Yet, this historical context is critical to theorize
how regional political and cultural instability gets reproduced within the intimate domain of the
family in this setting (Jenkins 2014).
Many of the families in our study, such as the families of Danielle and Luis, felt the
constriction of social and economic disenfranchisement, drug and alcohol abuse, and various
forms of violence. Against such a backdrop of vulnerable existence, where parental care is often
altogether lacking or inadequate, multiple forms of child abuse and neglect are made possible.
The configuration of the breakdown in human relations in turn fractures the psyches of those
whose bodily and psychic dignity is violated. The rupture involved is profoundly disorganizing,
so that symptoms of PTSD develop as sequelae of such patterned conditions.
Luis responded to the neglect and abandonment of his primary caregivers, namely his
mother, with a self-system in which he would, at turns, isolate himself from the attention and
care of others and be an explosive center of attention during dramatic episodes of material
destruction. Such extreme behavior reflects the ambivalence and mistrust that Luis articulated
regarding family relationships. His narratives reveal a desperate desire to connect with and be
protected by family. Yet these narrative aspects are tempered by Luis’s deep mistrust that such
protection could even be a viable desire. For Luis, his childhood was characterized by shifting
and ambiguous notions of not only who was there to care for him, but if anyone was there to care
for him. In this way, mistrust and ambivalence about familial roles and connection are not just an
understandable response to years of existential vulnerability and insecurity, but also emerge as an
important system of self-protection. Resisting his mother’s overtures at affection and her
insistence that she’s “not going anywhere,” might have, for example, allowed Luis a measure of
protection except that, in fact, she was back in jail months later. Seemingly lost in a world that
Hinton and Good Chapter 5 236
consistently left him insecure and vulnerable, Luis engaged in behavior that both connected and
alienated him from others; that repaired relationships and dismantled them; that protected him
and harmed him.
Danielle also exhibited a sense of mistrust and ambivalence toward her family,
particularly her mother. Her life story revealed a profound breakdown in the provision of
parental protection as the ground for sustained and repetitive events that for her created deep and
enduring psychic trauma. Danielle’s history was marked by significant acts of abandonment and
abdication of protection and care, starting with Donny’s disavowal of her as his daughter,
continuing with her mother’s physical absences while in prison and with her leaving Danielle
alone in Donny’s care miles away from where she lived. Even Danielle’s “nice” childhood
imaginary friend became a menacing and haunting figure. Stripped of any sense of protection,
care, or love, Danielle was awash in a lonely and hopeless world leading her to attempt suicide
on two occasions. While Danielle expressed a sense of hope and excitement about her mother’s
newfound active parenting style, her narratives also revealed contradictory and ambivalent
emotions surrounding family. This was made most clear after Danielle’s confiscated notebooks
revealed feelings of anger and even fantasy of harm toward her mother.
<A>Family Struggles with Clinical Diagnoses
Both Luis and Danielle and their families struggled to make sense of these adolescents’
psychiatric diagnoses, especially PTSD. The search for the cause of PTSD seemed to be a highly
fraught endeavor for these families. Their attempts to map (their interpretation of) a diagnostic
framework onto their life histories had conflicting and ambivalent results. Danielle’s
understanding of PTSD etiology as “something tragic [that] has happened to you while you were
Hinton and Good Chapter 5 237
young” seems to echo others in our study. The issue at hand is identifying what the “something
tragic” is, and how study participants identify it within this particular cultural context. As we
have detailed, families in our study were subjected to “everyday violences,” which in turn set the
stage for parental abdication of care and protection (Kleinman 2000). Part of what makes
structural violence so trenchant in the lives of people on the margins is its routinization (Farmer
2003, 2004), its misrecognition as part of a social order that is the taken for granted (Bourdieu
1977). Such routinization of violence(s) often obscures its force in shaping everyday lived
experience and subjectivity. For example, in her narrative, Danielle identified her mother’s
imprisonment and the sexual assault by her stepfather as “tragic things that happened,”
productive of PTSD. Yet her narratives also recount a painful childhood in which she routinely
witnessed violent crimes and drug abuse, and experienced parental neglect, though she identified
none of these in her attempt to fit life experiences into her understanding of diagnostic
categorization.
Yet our ethnographic data reveal that the lived experiences and circumstances of
routinized violence and neglect, even if not overtly identified by participants as tragic or
productive of psychiatric illness, are nonetheless productive of forms of psychic trauma.
Experiences of housing instability and family rupture, and witnessing of drug abuse or violent
crimes evoke anxious, fractured, and vulnerable subjective states of being. This is the case even
if these experiences are not identified as specific etiologic factors of psychiatric illness.
In attempting to make sense of youths’ psychic struggles, biomedical or biologically
based explanatory frameworks seemed to have much more allure with parents than with
adolescents themselves. Caregivers, as we have seen in the two cases presented above, often
pointed to (or, rather, speculated on) potential biologically rooted causes of trauma. For instance,
Hinton and Good Chapter 5 238
Paula and Manuela both stressed that Luis’s brain surgery in infancy served as a “brain trauma”
that at least partially, if not primarily, accounted for his behaviors in the present. Paula, when
reflecting on the development of Luis’s problems, underscored his compromised mental health
as due to his brain surgery and suggested that her attempted suicide “was harder on him than I
think a normal kid.” This statement is striking in that it posits a biologically based etiology (brain
injury/surgery) to Luis’s anxiety, rage, and paranoia, and perceived abnormal personhood,
while events of parental abuse and neglect are framed as exacerbating factors rather than primary
sources of psychic trauma.
In further speculating on a biological genesis of Luis’s behavior in adolescence, Manuela,
rather offhandedly, noted: “I read in some medical record somewhere . . . that the lid to the
washing machine hit [Luis] on the head and that he got a big egg [swelling on head] off of it. I
don’t ever remember that, OK, but from what [Luis] recalls, it was [Kevin] that slammed the lid
on his head.” She offered this to the interviewer as a way of providing further evidence of a
“brain injury.” Notably, Manuela’s emphasis here is on the physical not the psychic effect of an
act of abuse by a paternal figure. Luis, on the other hand, discussed this incident not in terms of
its physicality but rather as an act of profound violation that provoked feelings of confusion and
fear and a sense of existential vulnerability.
Ambivalence and contestation regarding youths’ diagnoses occurred throughout families’
narratives in our study. Indeed, the caregivers of both Luis and Danielle struggled over the right
diagnosis. In the case of Danielle, the family questioned: PTSD or schizophrenia? For Luis, his
grandmother cited various diagnoses ranging from PTSD to depression to bipolar disorder,
ultimately concluding “I don’t know . . . what it is.” Both Luis and Danielle and their families
struggled to locate the cause of their PTSD. Both of these young people pointed to specific
Hinton and Good Chapter 5 239
episodes or relations of abuse and abandonment that undoubtedly informed their mental health.
Yet both sets of families pointed to the existence of early symptoms of emotional problems: Luis
had reportedly been “ antisocial” as a toddler, and Danielle heard voices—albeit friendly ones—
starting in early childhood. Such haziness regarding the locus or source of the problem for
these families reflects the difficulty in identifying a singular—or even primary—source of
psychic trauma in contexts of enduring and pervasive precarity. The lived experiences of the
youth in our study suggest that psychic trauma is often diffuse and ambiguous in its origin and
persistence in these young people’s lifeworlds.
<A>Concluding Remarks
The ethnographic data presented in this chapter underscore the necessity of cultural and
psychological analyses of trauma to attend to both the personal and collective levels of
experience. At the personal level, for adolescents subjected to psychic trauma, making meaning
of everyday life and even of one’s own existence can be a challenge. To be sure, the existential
chaos of these adolescents’ lives often evokes a sense of incomprehensibility or bafflement
(Jenkins 2014). Psychic trauma circumscribed these adolescents’ very being-in-the-world, and
these young people adapted their lives to respond to the chaos and existential threats that they
continued to endure. At the collective level, our analyses reveal a pattern of conditions of neglect
and abandonment that rendered many of the adolescents in our study vulnerable to repeated and
sustained traumatic events. This pattern of neglect is rooted in family and regional histories of
violence, loss, and struggle and occurs within a context of structural violence in which
adolescents and their families often have few social resources to mitigate their sense of
existential struggle.
Hinton and Good Chapter 5 240
Drawing on the case of warfare, Kardiner (1941) conceived of this type of reaction to
trauma as a defensive move resulting from an individual’s inability to adapt to the aftermath of
the trauma. Indeed, there now are studies to show that adaptation following exposure to warfare
is notoriously intricate (Jenkins 1991, 1996a, 1996b; Jenkins and Hollifield 2008; Jenkins and
Valiente 1994). Extending this, recent studies have investigated the process of defense and
adaptation of children who are repetitively exposed to traumatic events as the everyday
conditions of their lives (Cook et al. 2005; Herman 1997; Holt et al. 2008; Margolin and
Vickerman 2007; Patel 2000; van der Kolk 2005). Our work presented here aims to enrich our
understanding of such defense and adaptation responses in children by ethnographically bringing
into relief the contours of lives permeated by ongoing psychic trauma.
Taking our study participants’ diagnoses of PTSD as a starting point, we have illustrated
the theoretical importance of adopting a phenomenological, existential, and psychodynamic
framework in elucidating psychic trauma. Our ethnographic investigation, reflected in the
presentation of two case studies here, has underscored that profound experiences of violence and
loss cannot be adequately described by diagnostic categories. There is a danger in reducing the
complexity of lived experiences of chaos and fractured subjectivities wrought by violence to a
diagnostic category of PTSD. Indeed, the struggles over making meaning of diagnoses among
the families described here attest to the complexities of lived experiences of trauma. To begin to
more fully comprehend experiences of trauma and loss, we must be more theoretically attuned to
the contexts of psychological development and social historical structures from which they arise.
As indicated above, our study suggests that the lived experiences of psychic trauma are often
diffuse and ambiguous in its origin and persistence in these young people’s lives. While more
substantial research on the primacy of lived experience is required, we believe that our analysis
Hinton and Good Chapter 5 241
of precarious quality of life and suffering holds comparative relevance across a range of locales
from London to Mumbai to Buenos Aires.
<A>Notes
Hinton and Good Chapter 5 242
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<endfile>
1 The authors were part of a collaborative research project (2005–11) funded by National
Institute of Mental Health (Grant # RO1 MH071781-01, Thomas J. Csordas and Janis H.
Jenkins, Co-Principal Investigators). Along with the PIs and Dr. Whitney Duncan, Dr. Bridget
Haas carried out fieldwork for collection of adolescent and family interview and ethnographic
observational data. The study entailed ethnographic interviews and observations based in
Albuquerque but was carried out from all parts of the state of New Mexico. Child psychiatrist
Michael Stork, M.D., and clinical psychologist Mary Bancroft, Ph.D., accomplished the work of
research diagnostic interviews. Data organization and analysis was with the assistance of
Heather Hallman and Allen Tran, Eliza Dimas, Jessica Hsueh, Nofit Itzhak, Tara Maguire,
Jessica Novak, and Celeste Padilla.
2 The first author is grateful for conversations with Anne Lovell (2012) that enhance our analysis
of the socially precarious.
3 All names of study participants have been changed to protect confidentiality.
... Together, their research team pioneered an integrated approach that can usefully serve as a model for future studies (Storck et al., 2000). Additional interdisciplinary collaborations (with relatively large sample sizes) are of value because they were designed to combine specific research clinical diagnostic instruments (requiring months of methodological training for administration and scoring to achieve research reliability) along with intensive anthropological techniques of ethnographic interviews, observations, and participation in everyday settings (Karno et al., 1987;Jenkins and Schumacher, 1999;Nasser et al., 2002;Lopez et al., 2004;Hollifield et al., 2005;Sajatovic et al., 2005;Jenkins and Hollifield, 2008;Floersch et al., 2009;Jenkins and Haas, 2015). ...
Chapter
Full-text available
Anthropology and psychiatry have long shared common intellectual and scientificg r o u n d .B o t ha r e interested in human beings, the societies within which they live and their behaviours. A key starting difference between the two is anthropology's interest in relativism, whereas psychiatry has been interested in universalism. Also, both anthropology and psychiatry have a long history of common interest in phenomenology and the qualitative dimensions of human experience, as well as a broader comparative and epidemiological approach. Jenkins illustrates the common ground by emphasizing that both disciplines contribute to the philosophical questions of meaning and experience raised by cultural diversity in mental illness and healing. Both disciplines also contribute to the practical problems of identifying and treating distress of patients from diverse ethnic, gender, class and religious backgrounds. Psychiatry focuses on individual biography and pathology, thereby giving it a unique relevance and transformation. Patient narratives thus become of great interest to clinicians and anthropologists. Development of specializations such as medical or clinical anthropology puts medicine in general and psychiatry in particular under a magnifying glass. Using Jungian psychology as an exemplar could lead to a clearer identification of convergence between the two disciplines. The nexus between anthropology of emotion and the study of psychopathology identified in her own work by Jenkins looks at normality and abnormality, feeling and emotion, variability of course and outcome, among others. She ends the chapter on an optimistic note, highlighting the fact that the convergence between these two disciplines remains a very fertile ground for generating ideas and issues with the potential to stimulate both disciplines.
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