Journal articles on the topic 'Deaf Trauma Survivors'

This paper explores the applicability of a narrative approach to the understanding of psychological trauma and the process of recovery. We focus on a comparison of stories told by three survivors of sexual abuse in research interviews drawn from an ongoing study of recovery and resiliency in treated and untreated trauma survivors. Our aim is to learn how survivors make and remake the meaning of their experiences over the course of their lives and at different stages in their recovery, and to understand the role and functions of survivors’ stories in the recovery process. Replacing long-standing feelings of powerlessness with a new sense of agency and reclaiming a positive identity from a “damaged”self-definition are neither easy nor painless tasks. These accounts suggest the importance of “turning points”that open possibilities for sexual abuse survivors to restory their experiences and arrive at new understandings that support their efforts to confront and deal with past traumas, and move on with their lives. We also call for more attention—by researchers, therapists, and others in survivors’ lives—to the effects of our expectations and needs for coherent stories with positive endings that may make it difficult for us to “hear”what survivors are trying to tell us. (Narrative, Trauma, Sexual abuse)

Neo-Victorian narratives of trauma display a temporal duplicity in addressing nineteenthcentury traumas that still prevail at present, including natural catastrophes, wars, or more personal and insidious traumas, such as domestic violence and oppression, or child and sexual abuse. In this article, I argue that Guillermo del Toro’s neo-Victorian film Crimson Peak (2015) is constructed as a trauma narrative that exploits the trope of «the uncanny» (Freud 1919) and its main representations –i.e. the double, the return of the dead and repetition compulsion– to address the traumatic experience of gender violence and its impact on both Victorian and contemporary women. Furthermore, I contend that the film functions as a symbolical space where the audience can bear witness to and reflect on the multitemporal trauma of gender violence. That way, viewers can bear witness and develop empathy towards survivors of this traumatic experience.

- In response to a concern that the impact of the Holocaust will not be recognized by psychotherapists treating survivors, several psychoanalysts who were refugees from Nazi Germany devoted a great deal of time and effort to detailing the psychopathological consequences of the Holocaust trauma. Considering the magnitude of the trauma, it was not difficult to find evidence of psychopathology. However, because of their almost exclusive emphasis on psychopathology, most of these researchers failed to recognize the particular manner in which survivors mourned their enormous losses and made an effort to integrate their painful memories into the rest of their personality. This meant the loss of an opportunity to learn about the process of recovery following severe traumatization. The paper also described a hypothesis regarding the psychological mechanisms involved in adaptations to extreme conditions. From the author's point of view, this constituted a link in the survivors' effort to establish psychic continuity between their pre-Holocaust psychological organization and adaptations to a new life. Unlike her colleagues, the author believes that integration of traumatic memories was possible as long as the survivors encountered an empathic listening perspective and their effort to recover was validated. Survivors of trauma have every reason to expect that their stories will evoke fear, confusion, horror and disbelief and that therapists will protect themselves from these affects by resorting to generalizations or praise for the survivor's heroism or special qualities. Such responses however make it impossible for survivors to proceed, and the affects associated with the traumatic memory may never, or only partially, enter the therapeutic dialogue. Once recovered and articulated, the memories are accompanied by grief and anger, indicating that an increase in self-cohesion, a healing of the vertical split, has allowed the previously feared affects to enter consciousness. From the author's viewpoint, feeling anger is an expectable and healthy response in this context. Justified anger is not to be confused with chronic narcissistic rage, which can constitute the nucleus of severe personality disorders.Key words: Holocaust, trauma, traumatic memories, adaptation, integration, empathic listening.Parole chiave: Olocausto, trauma, ricordi traumatici, adattamento, integrazione, ascolto empatico.

Aims and MethodTo evaluate the effectiveness of treatment at the Traumatic Stress Service (TSS) by comparing pre- and post-treatment scores on patient self-report measures. Through a questionnaire survey, to explore therapists' views of problems presenting in addition to post-traumatic stress disorder (PTSD) and how, as a result, they adapted their approach to trauma work.ResultsTherapists reported that their patients present with a range of complex problems, and self-report measures show that patients suffer particularly high levels of psychopathology. Therapists identified a number of adaptations to trauma-focused work to deal with these additional problems. Of the 112 patients who completed therapy, 43% filled in pre- and post-treatment questionnaire measures. Analysis showed clinically and statistically significant improvements in levels of PTSD, depression and social functioning.Clinical ImplicationsThe typical presentation of trauma survivors is often not ‘simple’ PTSD, but PTSD resulting from chronic and multiple traumas and complicated by additional psychological and social difficulties. Adaptations to trauma-focused work can successfully treat such ‘complex’ PTSD.

Background: White blood cell (WBC) subtypes have been suggested to reflect patients’ immune-inflammatory status. Furthermore, the derived ratio of platelets and WBC subtypes, including monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), is proposed to be associated with patient outcome. Therefore, this study aimed to identify the association of platelets and white blood cells subtypes with the mortality outcome of trauma patients in the intensive care unit (ICU). Method: The medical information from 2854 adult trauma patients admitted to the ICU between 1 January 2009 and 31 December 2019 were retrospectively retrieved from the Trauma Registry System and classified into two groups: the survivors group (n = 2524) and the death group (n = 330). The levels of monocytes, neutrophils, lymphocytes, platelets, and blood-drawn laboratory data detected upon patient arrival to the emergency room and the derived MLR, NLR, and PLR were calculated. Multivariate logistic regression analysis was used to determine the independent effects of univariate predictive variables on mortality occurrence. Result: The results revealed the patients who died had significantly lower platelet counts (175,842 ± 61,713 vs. 206,890 ± 69,006/μL, p < 0.001) but higher levels of lymphocytes (2458 ± 1940 vs. 1971 ± 1453/μL, p < 0.001) than the surviving patients. However, monocyte and neutrophil levels were not significantly different between the death and survivor groups. Moreover, dead patients had a significantly lower PLR than survivors (124.3 ± 110.3 vs. 150.6 ± 106.5, p < 0.001). However, there was no significant difference in MLR or NLR between the dead patients and the survivors. Multivariate logistic regression revealed that male gender, old age, pre-existing hypertension, coronary artery disease and end-stage renal disease, lower Glasgow Coma Scale (GCS), higher Injury Severity Score (ISS), higher level of lymphocytes and lower level of red blood cells and platelets, longer activated partial thromboplastin time (aPTT), and lower level of PLR were independent risk factors associated with higher odds of trauma patient mortality outcome in the ICU. Conclusion: This study revealed that a higher lymphocyte count, lower platelet count, and a lower PLR were associated with higher risk of death in ICU trauma patients.

Un grand nombre de patients douloureux chroniques présentent un trauma psychique sous-jacent. La plainte douloureuse vient souvent être une demande de soins psychiques qui ne peut se dire, dans un premier temps, que par le biais du corps. Cela amène fréquemment ces patients à être en difficulté pour trouver un lieu de soins. À travers l’histoire de Noémie, rescapée d’un génocide et exilée en France, nous constatons combien il est nécessaire d’entendre le trauma à travers une écoute conjointe du corps douloureux et de la psyché.

The article reveals the question of how the Denial of the Armenian Genocide disturbs the mourning process in its survivors and descendants. This setback might psychologically explain certain transformational phenomena in the Armenian society. The Denial of the Armenian Genocide makes the genocide perfect: those dead have disappeared, they have never existed, and therefore, those unrecognized deaths disturb the relationship between the survivors and their historical past. According to the unconscious function of secrets and traumas, the existence of which is totally ignored, in third generations may develop affective inconsistent behaviours, problems unsolved in previous generations that are transmitted like psychological inheritance. In Armenian phenomena, the normal mourning process has been disrupted and the permanent Denial of the Armenian Genocide establishes the consequences of the trauma from generation to generation such as unconscious feelings of guilt, repetitions and impulses that lead to reactions like accidents or suicides and psychosomatic and mental disorders.

This article deals with Kovner’s graphic narrative Ezekiel’s World (2015) as a case of remediation and hypermediacy. The term ‘remediation’ refers to adaptations which involve the transformation of the original work into another medium. While some adaptations strive to eliminate the marks of the previous medium, others highlight the interplay between different media, resulting in ‘hypermediacy’. The latter approach characterizes Ezekiel’s World due to its unique blend of artistic materials adapted from different media. The author, Michael Kovner, uses his paintings to depict the story of Ezekiel – an imaginary figure based on his father, the poet Abba Kovner who was one of the leaders of the Jewish resistance movement during World War II. While employing the conventions of comics and graphic narratives, the author also makes use of readymade objects such as maps and photos, simulates the works of famous artists and quotes Abba Kovner’s poems. These are indirect ways of confronting the traumas of Holocaust survivors and ‘the second generation’. Dealing with the Holocaust in comics and graphic narratives (as in Spiegelman’s Maus: A Survivor’s Tale, 1986) is no longer an innovation, nor is their use as a means to deal with trauma; what makes this graphic narrative unique is the encounter between the works of the poet and the painter, which combine to create an exceptionally complex work integrating poetry, art and graphic narration.

This article explores how survivors’ experiences of extreme violence change their relationship with time. It draws on extensive fieldwork undertaken with survivors of the 1994 Genocide against the Tutsi and participatory observation of Rwanda’s annual commemoration ceremonies. It focuses on the practice of ‘care-taking’ that survivors engage in at genocide memorials that display human remains and dead bodies. This article identifies the different temporal practices that survivors use to help remake their worlds after the 1994 Genocide. In doing so, it asks: how do survivors construct time through informal mnemonic practices? How do they experience time during the commemoration? And what mode of temporality is inscribed in the materiality of memorials? The article demonstrates that care-taking and imagination produce a symbolic time-reversal, whereas the materiality of the memorial sites preserves the past in the present. The commemoration constructs different temporal logics, such as time homogenisation and a traumatic cyclicalisation, something I describe through the notion of ‘trauma-time’. The article concludes that multiple temporalities are produced and reproduced in various attempts to remake lives after genocide that counter simplistic ‘before and after’ accounts of time dominant in the transitional justice discourse.

Survivors of a trauma must deal with the life-long effects that result from their experiences. Depression, fear and a sense of isolation from society are only a few of the associated long-term effects of trauma. These traumatic repercussions are often passed down to their immediate family. These second and third generations must then live under the shadow of a trauma to which they were temporally displaced, but must cope with nonetheless. This paper deals with the concept of postmemory as it affects second generation Shoah, or Holocaust, survivors Art Spiegelman and Rafael Goldchain. Through an analysis of Spiegelman’s Maus and Goldchain’s I Am My Family, we can see not only how both artists work through their experience of postmemory via creative means, but how their use of the Verfremdungseffekt, a theory developed by Bertolt Brecht as a means of creating emotional distance, allows their pictorial representations of the Shoah to become bearable to a modern audience.

From recurring characters to the retelling of stories, repetition plays a central role in Varlam Shalamov'sKolymskie rasskazy(Kolyma Tales). Sarah J. Young examines how repetition functions in Shalamov's collections of short stories as an indicator of trauma, by foregrounding the tensions created by the erosion of identity in the labor camp and its connection to the gulag survivor/narrator's problematic relationship to memory. At the same time, repetition also becomes a means of drawing the uncomprehending reader into the text to act as witness to that trauma. Comparing Shalamov's mode of testimony to Giorgio Agamben's theorization of the nonsurvivor as the true witness to Auschwitz, drawn from Primo Levi's conception, Young argues that Shalamov's stories bear witness to the trauma of Kolyma and to those who did not survive it, not through a transformation of the writer, but through a reciprocity between writer and reader.

The assumptive world concept refers to the assumptions or beliefs that ground, secure, stabilize, and orient people. They are our core beliefs. In the face of death and trauma, these beliefs are shattered and disorientation and even panic can enter the lives of those affected. In essence, the security of their beliefs has been aborted. This article will look at the concept of the assumptive world, how attachments are impacted by its violation, and will make suggestions for intervention for those who work to rebuild survivors of loss.

This article explores practices of haunting and ghosting after conflict-related loss. This is not to suggest a focus on the occult or the paranormal, but to use these phenomena as a prism through which to understand the intersection between unresolved pasts and the transmission of trauma post-conflict. As Michael Levan notes, trauma lingers ‘unexorcisably in the places of its perpetration, in the bodies of those affected, in the eyes of the witnesses, and in the politics of memory’. The ghost, according to Avery Gordon ‘is the principal form by which something lost or invisible or seemingly not there makes itself known or apparent to us’. In this article I argue for three conceptualisations of haunting when past traumas remain unaddressed: the haunting of lost lives, the haunting of landscape, and the haunting presence of the unresolved past. The article focuses on Northern Ireland, a post-conflict jurisdiction described as being haunted by a ‘conflict calendar in which every day is an anniversary’ and extensive fieldwork with victims and survivors of the conflict. The article concludes by arguing that the presence of ghosts and the experience of haunting represent a ‘call to action’ in the quest to deal with a legacy of violent conflict and human rights abuses.

Friends, family, and significant others who receive disclosures of sexual assault from survivors are also susceptible to the effects of trauma. Most studies on the impact of sexual assault disclosure focus on the experiences of friends of survivors but not significant others or family members, and do not examine support providers’ (SPs) help-seeking behaviors. This study of 45 matched pairs of sexual assault survivors and SPs explored the impact of receiving a disclosure and dealing with the emotional weight of these disclosures. SPs were impacted emotionally and in post-disclosure behaviors. SPs reported feeling sadness, were triggered, felt angry, and felt inspired by survivors’ disclosures. Active cognitive and behavioral reactions included care-taking of survivors and engaging in prevention. SPs discussed different ways they sought help to deal with the disclosure and why they did or did not seek help post-disclosure. We provide recommendations for SPs and service providers using this data from a diverse, community sample.

AbstractThe proper management of the dead from catastrophes is an essential component of humanitarian response, together with the rescue and care of survivors and the provision and rehabilitation of essential services. Sadly, insufficient recognition of the importance of ensuring proper management of the dead and of caring for the needs of the bereaved, coupled with the frequent collapse of forensic services in the aftermath of catastrophes, contribute to perpetuating the tragedy and trauma suffered by survivors forever unable properly to bury and mourn their dead. In 2006 the Pan American Health Organisation (PAHO) and the International Committee of the Red Cross (ICRC), together with the World Health Organisation (WHO) and the International Federation of Red Cross and Red Crescent Societies (IFRC), published guidelines for the management of the dead, to help improve the management of the dead after catastrophes. The publication, Management of Dead Bodies after Disasters: A Field Manual for First Responders, offers practical and simple recommendations to non-specialists for the proper and dignified management of the dead in catastrophes and for the care of bereaved relatives. It also helps to dispel the principal myth which often complicates this difficult task: the unfounded association of cadavers with epidemics. The manual has proven to be a valuable tool for first responders, including humanitarian workers, for disaster response and preparedness in various operational contexts.

Abstract In her I Was a Child of Holocaust Survivors published in Canada in 2006, Bernice Eistenstein undertakes an attempt to cope with the inherited memories of the Holocaust. As a child of the Holocaust survivors, she tries to deal with the trauma her parents kept experiencing years after WWII had finished. Eisenstein became infected with the suffering and felt it inescapable. Eisenstein’s text, which is one of the first Jewish-Canadian graphic memoirs, appears to represent the voice of the children of Holocaust survivors not only owing to its verbal dimension, but also due to the drawings incorporated into the text. Therefore, the text becomes a combination of a memoir, a family story, a philosophical treatise and a comic strip, which all prove unique and enrich the discussion on the Holocaust in literature. For these reasons, the aim of this article is to analyze the ways in which Eisenstein deals with her postmemory, to use Marianne Hirsch’s term (1997 [2002]), as well as her addiction to the Holocaust memories. As a result of this addiction, the legacy of her postmemory is both unwanted and desired and constitutes Bernice Eisenstein’s identity as the eponymous child of Holocaust survivors.

Purpose: While researchers have established that sexual assault may adversely affect successful employment and academic achievement, little is known about the barriers and facilitators of occupational well-being from the perspective of sexual assault survivors. This study assessed the barriers and facilitators of occupational well-being. Design: Constructivist grounded theory. Method: Digitally recorded, semistructured interviews were used to collect data. Data were collected from 22 adult female sexual assault survivors. Analysis consisted of coding, creation of data matrices, and within and across case analysis. Findings: Theoretical saturation was achieved after interviews with 22 participants. Barriers to occupational well-being were mental health symptoms and diagnoses, substance abuse, inflexible attendance policies, and workplace bullying. Facilitators to occupational well-being were personal coping strategies, and organizational and social support. Conclusions: Sexual assault has significant effects on the occupational well-being of women. The work or academic environment can exacerbate the harms of sexual assault or facilitate healing in sexual assault survivors. To facilitate the occupational well-being of sexual assault survivors, workplaces and academic institutions can adopt a trauma-informed approach, create policies that allow for time off to deal with sequela of sexual assault, implement anti-bullying programs, and make resources for gendered violence available.

The current Flash floods disaster in Garut Regency precisely on September 20, 2016 starting at 23.00 WIB, which occurred due to overflowing of the Cimanuk river and Cikamiri river resulting in victims of loss of property: houses, property, livestock buried; Loss of lives of the closest people: loss of parents, children, wives, husbands or close relatives; Shock and confusion: Victims usually feel tremendous pressure so they think irrationally and are confused. Actions to deal with these disasters include: Evacuating survivors first to a safe place; Create temporary or permanent refugee barracks; Coordinate with disaster management agencies and hospitals. To overcome one of these problems, trauma healing activities are needed. Purpose of trauma healing Gives the motivation to revive the community, eliminates people's fear and encourages people to return to their normal activities. Methods and strategies are carried out through several stages starting from age classification, exploring understanding, explaining material and games according to local wisdom. The results obtained by all the target communities were so enthusiastic in participating in our trauma healing activities, and the community felt comforted and felt forgotten the trauma that had occurred. There needs to support all related elements in maintaining the results achieved.

The objective of our study was to systematically review research evidence for relationships between self-efficacy beliefs and psychological as well as somatic outcomes of collective traumatic events. Twenty-seven studies enrolling adult and adolescent survivors of acute, escalating, and chronic collective trauma with a total of N = 8011 participants were reviewed. Cross-sectional studies suggest medium to large effects of self-efficacy on general distress, severity and frequency of PTSD (posttraumatic stress disorder) symptoms (weighted r values range from –.36 to –.77), whereas longitudinal studies indicate large effects on general distress and PTSD symptom severity (weighted r values range: –.55 to –.62). Self-efficacy was also related to better somatic health (self-reported symptoms, i.e., less pain, fatigue, or disability). Studies addressing the relationship between self-efficacy and substance abuse after collective trauma revealed a more complex picture. Some types of pretreatment self-efficacy (e.g., self-efficacy for coping with urges) or changes in efficacy beliefs may predict less substance use or relapses. Studies testing the mediating role of cognitive or social variables in the relationship among efficacy beliefs and health outcomes indicated rather direct, unmediated effects of beliefs about ability to deal with adversities on posttraumatic adaptation. Men may benefit more from stronger efficacy beliefs. In terms of reciprocity between self-efficacy and health, evidence from longitudinal studies suggested that self-efficacy determines health-related outcomes, but changes in diagnosis do not predict changes in self-efficacy. Although a lack of experimental studies limits the conclusions, the results indicated that self-efficacy is a powerful predictor of posttraumatic recovery among collective trauma survivors.

Oliver Wendell Holmes jr was a survivor of the Civil War. Wounded three times and left for dead once, he survived endless pain and death for a war for which he believed more in the beginning of the virtues of the war than he did at the end. But it was this important experience that pervades his long life. And we now know how to think about how trauma turns to memory sculptured onto the brain. Holmes’ emphasized experience in adjudication and context dependent problem solving or inquiry. Yet while he championed freedom, he had a rather limited view towards those for which the war was fought.

Many studies, reports, books, narratives, and surveys have focused on the disputable picture of the sustainable development of victims of the Bhopal Gas Disaster to understand the trauma, faced by the victims and survivors before and during the COVID-19 period. Traumatic accidents fundamentally shatter the time-based experience of humans between the present and the past. The poisonous night not only had an intense effect on their way of life, but also had an acute impact on their understanding of how to deal with problems. However, another whammy COVID-19 makes their lives more traumatized, unsustainable, and also the victims of another catastrophe. The researchers of the present study have attempted to focus on the traumatic conditions and lessons faced by the Bhopal Gas Victims. In short, the present study puts the focus on the disputable record of sustainable development of the Bhopal Gas Victims in duration, from 1984 to the COVID-19 period, through an analysis of different studies.

President Rodrigo Duterte’s drug war in the Philippines has exacted an enormous toll in human lives and suffering. This essay looks into one of the earliest and most graphic responses to this war: the work of photojournalists and the plurality of responses to their images. How does photojournalism become a kind of witnessing linked to the work of mourning? How are trauma and grieving braided together in the experience of photographers covering war? What is the role of the camera, and what are the ambivalent effects of the technical and aesthetic imaging of the dead and their survivors? How has the drug war, by instilling a biopolitics of fear, transformed the latter’s ways of seeing and being? What becomes of justice amid images of injustice? For example, how do returning spirits of the dead that appear in dreams of their families stimulate phantasms of revenge? How is revenge imagined as a form of justice that reinforces rather than detracts from the brutal logic of the drug war?

People left behind have to grieve and accept the powerlessness over death. They have to grapple and face the void left by the dead person. One of the most tragic deaths is suicide. The ultimate sufferers in this tragedy are those left behind to cope with the emotional trauma of losing a significant other, struggling with many unanswerable questions, self-blaming, and an inability to move on with their lives. For adolescents, losing a peer, classmate, or friend to suicide increases their risk of depression and anxiety. Their psychological well-being is compromised, often leading to complicated grief, major depression, and posttrauma stress. The present study aims to explore, describe, and interpret the lived experiences of peer suicide loss survivors.

By all rights, I should be dead. Not once, but a number of times. On 23 March 1979, as a 24-year-old, I witnessed and photographed the brutal beating of a young man in a sarape by some 10–12 Sheriff’s deputies on Whittier Blvd in East Los Angeles. In turn, the deputies turned on me with their riot sticks cracked my skull, and sent me to the hospital, charging me with attempting to kill 4 of the deputies. On my arrest report, it stated that I was the leader of a gang of 10–15 Mexicans. With active death threats from the original Sheriff’s deputies that drove to the jail war of the LA County Hospital, I was subsequently arrested/detained some 60 additional times, primarily by Sheriff’s deputies and LAPD officers. By the end of the year, the criminal charges were dropped and 6 years after that, I emerged victorious in a lawsuit. That was a generation ago. No. That was at least two generations ago. I healed long ago from PTSD, though the brutality I witnessed and lived continues to reside within me, intergenerationally. This defies explanation. I am healed, yet the trauma continues to live within my body, even some 40 years after the fact. My life thereafter has been dedicated to the elimination not only of this brutality, but also a trauma that I can literally trace to 1492 on this continent through my studies on this topic. How do the red-black-brown communities of this nation heal when that brutality and that memory have always been present intergenerationally and are not going away anytime soon? I want to explore the tension between fighting for the elimination of law enforcement abuse and living with that intergenerational trauma. The subtext of [anti-indigenous] racial profiling as used against Mexicans in this society, from police to immigration agents to the media, will be examined in this first-person article. How the survivors of this brutality and their families, who have lost loved ones and who fight against this brutality live with these traumas—particularly with the knowledge that as a result of impunity, there is no end in sight to this brutality—will also be examined.

OBJECTIVE:to identify predictors of death in blunt trauma patients sustaining pelvic fractures and, posteriorly, compare them to a previously reported series from the same center.METHOD: Retrospective analysis of trauma registry data, including blunt trauma patients older than 14 y.o. sustaining pelvic fractures admitted from 2008 to 2010. Patients were assigned into group 1 (dead) or 2 (survivors). We used Student's t, qui square and Fisher's tests for statistical analysis, considering p<0.05 as significant. Posteriorly, we compared predictors of death between both periods.RESULTS: Seventy-nine cases were included. Mean RTS, ISS and TRISS were, respectively, 6.44 + 2.22, 28.0 + 15.2 e 0.74 + 0.33. Nineteen patients died (24,0%). Main cause of death was hemorrhage (42,1%). Group 1 was characterized by (p<0.05) lower systolic blood pressure and Glasgow coma scale means on admission, higher heart rate, head AIS, extremity AIS and ISS means, as well as, higher frequency of severe head injuries and complex pelvic fractures. Comparing both periods, we notice that the anatomic and physiologic severity of injury increased (RTS and ISS means). Furthermore, there was a decrease in the impact of associated thoracic and abdominal injuries on the prognosis and an association of lethality with the presence of complex pelvic fractures.CONCLUSION: There were significant changes in the predictors of death between these two periods. The impact of thoracic and abdominal associated injures decreased while the importance of severe retroperitoneal hemorrhage increased. There was also an increase in trauma severity, which accounted for high lethality.

In the three years after World War II, prominent Jewish organizations in the United States and in the Land of Israel made films aimed at promoting Zionist goals. The film Adamah (Helmar Lerski, 1948) was produced in the Land of Israel with the support of the Jewish-American volunteer women’s organization Hadassah. It tells the rehabilitation story of Benjamin, a Holocaust survivor in the Land of Israel. When the final version was sent to Hadassah for approval, the directorate felt that the American public would not relate to it. Hadassah altered the footage and distributed its own version entitled Tomorrow’s a Wonderful Day (1949). This article presents a comprehensive analysis of the main differences between the two representations of trauma, which were taken from the same footage but shaped into two differing narratives. Based on studies in Zionism and a great deal of archival material, it shows how these films epitomized the differences in the perception of trauma and its representations between the Zionist organizations in the Land of Israel and the USA.

The Holocaust was the systematic, bureaucratic, state-sponsored persecution and murder of six million Jews by the Nazi regime and its collaborators. Holocaust is a word of Greek origin meaning "sacrifice by fire."All the books of Elie Wiesel deal with his struggle to handle the holocaust and to find God after the horror. As a survivor of holocaust Wiesel describes his own experiences, but words are not enough to explain his struggles. His books give us a clear picture of concentration camps and brutality of alienation created by Nazis.He is an American- Romanian Jewish writer who always raised his voice for the voiceless Jews.Night is the first book in the trilogy- Night, Dawn and Day which reflects Wiesel’s state of mind during and after holocaust.

At a time where so few survivors remain alive and the extermination of European Jews is leaving the field of direct human experience, the evolving collective memory of the event is reflected in popular culture. There has recently been a rise in the number of graphic novels written on the subject of the Shoah, particularly in France, Germany, and North America. These works, written by second or even third-generation survivors nearly 80 years after the genocide, approach the event from perspectives that not only further Art Spiegelman’s path in that they challenge the so-called limits of Holocaust representations, but also open up new discussions on transgenerational trauma. Focusing on two graphic novels, Michel Kichka’s Deuxième génération: Ce que je n’ai pas dit à mon père (2012) and Jérémie Dres’ Nous n’irons pas à Auschwitz (2011), my aim here is to examine the new aspects of trauma that these texts present, more specifically the reluctance to deal with one’s past, the struggle to bear the weight of the ‘sacred’ memory of Auschwitz, and in some cases the lack of interest of the youth in the Shoah. Both these autobiographical texts narrate the story of men who end up making the conscious decision never to go to Auschwitz after finding out about their ancestors’ history, asserting their desire to not solely be defined by their family tragedy. These issues, which fit in with what Matthew Boswell and Joost Krijnen define as ‘Holocaust impiety’, mark a break with graphic novels from the 1970s and 1980s which, as Gillian Rose writes, ‘mystified’ the event as ‘something we dare not understand’.

AbstractThe legacy of the Shoah invades christology as one of its most basic postfoundationalist challenges in the demise of modernity. Fackenheim heuristically amplifies the rupture of the metaphysical narratives of soteriology by the radical evil and sufferings in Auschwitz. As a representative instance of reorienting theological discourse through exposure to the trauma of the Shoah and the testimony of its Jewish survivors, Metz grounds practical christology in the biblical memory of suffering and an eschatological delimitation of time. Lévinas' phenomenology of the self counters residual issues in Metz and mediates a postfoundationalist framework for re-visioning christology after the Shoah. The phenomenological transposition of the notion of substitution to the ethical order rehabilitates Metz's practical christology and articulates the messianic significance of human agency as a sociopolitical responsibility for the sufferings of the broken and the dead.

Background: Burn injury is accompanied by modulation of the many components of immunity, including the system regulation, which includes soluble forms of leukocyte differentiation molecules. Earlier in burn patients, we detected changes in serum levels of soluble differentiation molecules CD25 (sCD25) and CD95 (sCD25). Despite the existence of data on change of serum level of the soluble molecules CD25 and CD95 in the blood of patients with a burn trauma, there are no data on particular cell producers.Aims: To conduct the analysis of serum level of the molecules sCD25 and sCD95 in the blood of patients with acute burn trauma in comparison with peripheral blood cells composition to obtain data on the types of cells that produce the molecules sCD25 and sCD95.Materials and methods: Blood samples from 24 heavily burnt patients aged 16 to 77 years were studied. Determination of sCD25 and sCD95 molecules serum levels was performed by ELISA. Number of CD45+CD25+ lymphocytes, CD45+CD95+ cells, CD14+CD95+ monocytes, CD16b+CD95+ neutrophils, and RFMI (relative mean fluorescence intensity) was evaluated by flow cytometry.Results: In the first five days of the date of burn sCD25 and sCD95 serum levels tended to increase. sCD25 molecules contents in the blood of surviving and dead patients did not depend on the relative content of CD45+CD25+ lymphocytes, RFMI index, but correlated with the absolute level of lymphocytes and leukocytes. Serum levels of sCD95 molecules showed the dependence on the absolute neutrophil count and leukocytes in the survivors and on the absolute content of lymphocytes, neutrophils, and leukocytes in patients who died.Conclusions: The findings suggest that the lymphocytes in the early period of burn disease are the main cells-producers of sCD25 and affect the increase of its content in the blood serum not due to changes in the density of CD25 molecules expression on their membrane followed by increased shedding but by increasing the number of CD25 positive cells. The main cells-producers of sCD95 molecules for survivors in the early period of burn disease are likely to be the neutrophils and lymphocytes; in the dead patients, the main producers are neutrophils.

AbstractThe majority of maxillofacial gunshot wounds are caused by suicide attempts. Young men are affected most often. When the lower one-third of the face is involved, airway patency (1.6% of the cases) and hemorrhage control (1.9% of the cases) are the two most urgent complications to monitor and prevent. Spinal fractures are observed with 10% of maxillary injuries and in 20% of orbital injuries. Actions to treat the facial gunshot victim need to be performed, keeping in mind spine immobilization until radiographic imaging is complete and any required spinal stabilization accomplished. Patients should be transported to a trauma center equipped to deal with maxillofacial and neurosurgery because 40% require emergency surgery. The mortality rate of maxillofacial injuries shortly after arrival at a hospital varies from 2.8% to 11.0%. Complications such as hemiparesis or cranial nerve paralysis occur in 20% of survivors. This case has been reported on a victim of four gunshot injuries. One of the gunshots was to the left mandibular ramus and became lodged in the C4 vertebral bone.MaurinO, de RégloixS, DubourdieuS, LefortH, BoizatS, HouzeB, CulomaJ, BurlatonG, TourtierJP. Maxillofacial gunshot wounds. Prehosp Disaster Med. 2015;30(3):14.

Performativity occurs in, and on behalf of the present. This can be seen with special clarity in the speech act of provocation. In this article, the performative of provocation is analysed by focusing on two works by the Polish artist Artur Zmijewski: Berek (Game of Tag) (1999) and 80064 (2005). Both works deal with the Holocaust in provocative ways and were highly controversial when they were exhibited. In their problematic nature these works substantiate Slavoj Žižek’s paradoxical statement that a coherent, truthful account of the traumatic past belies its own truthfulness. A narrative of trauma cannot be a clear narrative. This requires a different artistic, semiotic posture: not representation but performativity, so that conventional prescriptive moral rules can be replaced by an effective, affect-based ethics. Zmijewski’s videos shake up the fixed notions of Nazi victims and Holocaust survivors. And that is the first necessary step towards opening up the debate to a series of questions about the role of Polish people in the Holocaust. The importance and even necessity of these questions is demonstrated by the recent legislation in Poland that outlaws blaming Poles for the crimes of the Holocaust.

Objectives This study investigates the reporting of health-related quality of life (HRQoL) in patients following hip fracture. We compare the relative merits and make recommendations for the use for two methods of measuring HRQoL; (i) including patients who died during follow-up and (ii) including survivors only. Methods The World Hip Trauma Evaluation has previously reported changes in HRQoL using EuroQol-5D for patients with hip fractures. We performed additional analysis to investigate the effect of including or excluding those patients who died during the first four months of the follow-up period. Results The dataset included 503 patients, 25 of whom died between 30 days and four months of injury. There was a statistically significant difference in 30-day HRQoL between those alive (mean 0.331 and standard deviation (SD) 0.360) and those dead (mean 0.156 and SD 0.421) by four months (independent-samples t-test; p 0.022). The estimated difference of 0.175 in HRQoL (95% confidence interval 0.025 to 0.325) was also highly clinically significant. Conclusion When reporting HRQoL for patients after a hip fracture, excluding patients who die during follow-up leads to an overestimate of the effects of the intervention or treatment pathway. We would recommend that death-adjusted estimates should be used routinely when reporting HRQoL in this population. Cite this article: N. Parsons, X. L. Griffin, J. Achten, T. J. Chesser, S. E. Lamb, M. L. Costa. Modelling and estimation of health-related quality of life after hip fracture: A re-analysis of data from a prospective cohort study. Bone Joint Res 2018;7:1–5.

Communicable diseases represent a public health problem in developing countries, especially in those affected by disasters, and necessitate an appropriate and coordinated response from national and international partners. The importance of rapid epidemiological assessment for public health planning and resources allocation is critical. This review assesses infectious disease outbreaks during and after disasters caused by natural hazards and describes comprehensive prevention and control measures. The natural hazard event that causes a disaster does not transmit infectious diseases in the immediate aftermath of the disaster, nor do dead bodies. During the impact phase, most of the deaths are associated to blunt trauma, crush-related injuries, burns, and drowning rather than from infectious diseases. Most pathogens cannot not continue to survive in a corpse. The remaining survivors are the ones from which infectious diseases can be transmitted under appropriate conditions created by the natural disasters. Among several diseases, diarrheal diseases, leptospirosis, viral hepatitis, typhoid fever, acute respiratory infections, measles, meningitides, tuberculosis, malaria, dengue fever, and West Nile Virus commonly were described days, weeks, or months after the disaster event in areas where they are endemic. Therefore, diseases can also be imported by healthy carriers among a susceptible population. The objective of the public health intervention is to prevent and control epidemics among the disaster-affected populations. The rapid implementation of control measures should be a public health priority especially in the absence of pre-disaster surveillance data, through the re-establishment and improvement of the delivery of primary health care and restoration of affected health services. Adequate shelter and sanitation, water and food safety, appropriate surveillance, immunization and management approaches, as well health education will be strongly required for the reduction of morbidity and mortality.

✓ The authors enrolled 168 patients with closed-head trauma into a prospective trial to evaluate the effect of hyperbaric oxygen in the treatment of brain injury. Patients were included if they had a total Glasgow Coma Scale (GCS) score of 9 or less for at least 6 hours. After the GCS score was established and consent obtained, the patient was randomly assigned, stratified by GCS score and age, to either a treatment or a control group. Hyperbaric oxygen was administered to the treatment group in a monoplace chamber every 8 hours for 1 hour at 1.5 atm absolute; this treatment course continued for 2 weeks or until the patient was either brain dead or awake. An average of 21 treatments per patient was given. Outcome was assessed by blinded independent examiners. The entire group of 168 patients was followed for 12 months, with two patients lost to follow-up study. The mortality rate was 17% for the 84 hyperbaric oxygen-treated patients and 32% for the 82 control patients (chi-squared test, 1 df, p = 0.037). Among the 80 patients with an initial GCS score of 4, 5, or 6, the mortality rate was 17% for the hyperbaric oxygen-treated group and 42% for the controls (chi-squared test, 1 df, p = 0.04). Analysis of the 87 patients with peak intracranial pressures (ICP) greater than 20 mm Hg revealed a 21 % mortality rate for the hyperbaric oxygen-treated patients, as opposed to 48% for the control group (chi-squared test, 1 df, p = 0.02). Myringotomy to reduce pain during hyperbaric oxygen treatment helped to reduce ICP. Analysis of the outcome of survivors reveals that hyperbaric oxygen treatment did not increase the number of patients in the favorable outcome categories (good recovery and moderate disability). The possibility that a different hyperbaric oxygen treatment paradigm or the addition of other agents, such as a 21-aminosteroid, may improve quality of survival is being explored.

“This was not America.” Michael Charles Steinlauf in conversation with Elżbieta Janicka (Warsaw – New York – Warsaw, 2014–2015)Born in Paris in 1947, Michael Charles Steinlauf talks about his childhood in New York City, in the south of Brooklyn (Brighton Beach), in a milieu of Polish Jewish Holocaust survivors. His later experiences were largely associated with American counterculture, the New Left, an anti-war and antiracist student movement of the 1960s (Students for a Democratic Society, SDS) as well as the anticapitalist underground of the 1970s (“Sunfighter”, “No Separate Peace”). In the 1980s, having undertaken Judaic Studies at Brandeis University, Steinlauf arrived in Poland, where he became part of the democratic opposition circles centred around the Jewish Flying University (Żydowski Uniwersytet Latający, ŻUL). In the independent Third Republic of Poland, he contributed to the creation of the Museum of the History of Polish Jews in Warsaw.Michael C. Steinlauf’s research interests focus on the work of Mark Arnshteyn (Andrzej Marek) and of Yitskhok Leybush Peretz, Yiddish theatre as well as Polish narratives of the Holocaust. The latter were the subject of his monograph Bondage to the dead: Poland and the memory of the Holocaust (1997, Polish edition 2001 as Pamięć nieprzyswojona. Polska pamięć Zagłady). An important topic of the conversation is the dispute concerning the categories used to describe the Holocaust, including the conceptualisation of Polish majority experience of the Holocaust as a collective trauma. Controversies also arise in connection with the contemporary phenomena popularly conceptualised as the “revival of Jewish culture in Poland” and “Polish–Jewish dialogue.” Another subject of the conversation is Michał Sztajnlauf (1940–1942), Michael C. Steinlauf’s stepbrother. The fate of the brothers was introduced into the canon of Polish culture by Hanna Krall’s short story Dybuk (1995, English edition 2005 as The Dybbuk) and its eponymous stage adaptation by Krzysztof Warlikowski (2003). Looking beyond artistic convention, the interlocutors try to learn more about Michał himself. This is the first time the readers have an opportunity to see his photographs from the Warsaw Ghetto.The conversation is illustrated with numerous archival materials from periods before and after World War Two as well as from German-occupied Poland. „To nie była Ameryka”. Z Michaelem Charlesem Steinlaufem rozmawia Elżbieta Janicka (Warszawa – Nowy Jork – Warszawa, 2014–2015)Urodzony w 1947 roku w Paryżu, Michael Charles Steinlauf opowiada o dzieciństwie spędzonym w Nowym Jorku, na południowym Brooklynie (Brighton Beach), w środowisku ocalałych z Zagłady polskich Żydów. Istotna część jego późniejszych doświadczeń związana była z amerykańską kontrkulturą, Nową Lewicą, studenckim ruchem antywojennym i antyrasistowskim lat sześćdziesiątych (Students for a Democratic Society, SDS) oraz podziemiem antykapitalistycznym lat siedemdziesiątych („Sunfighter”, „No Separate Peace”). W latach osiemdziesiątych, w związku z podjęciem studiów judaistycznych na Brandeis University, Steinlauf przyjechał do Polski, gdzie stał się częścią środowiska opozycji demokratycznej, skupionego wokół Żydowskiego Uniwersytetu Latającego (ŻUL). W III RP miał swój udział w tworzeniu Muzeum Historii Żydów Polskich w Warszawie.Zainteresowania badawcze Michaela C. Steinlaufa ogniskują się wokół twórczości Marka Arnsztejna (Andrzeja Marka), Jicchoka Lejbusza Pereca, teatru jidysz oraz polskich narracji o Zagładzie, którym poświęcił monografię Pamięć nieprzyswojona. Polska pamięć Zagłady (2001, pierwodruk angielski 1997 jako Bondage to the dead: Poland and the memory of the Holocaust). Ważną część rozmowy stanowi spór dotyczący kategorii opisu Zagłady, w tym koncepcji polskiego doświadczenia Zagłady jako traumy zbiorowej. Kontrowersja nie omija zjawisk współczesnych, konceptualizowanych potocznie jako „odrodzenie kultury żydowskiej w Polsce” oraz „dialog polsko-żydowski”.Bohaterem rozmowy jest także Michał Sztajnlauf (1940–1942), przyrodni brat Michaela C. Steinlaufa. Historia braci weszła do kanonu kultury polskiej za sprawą opowiadania Hanny Krall Dybuk (1995) oraz teatralnej inscenizacji Krzysztofa Warlikowskiego pod tym samym tytułem (2003). Abstrahując od konwencji przekazu artystycznego, rozmówcy próbują dowiedzieć się czegoś więcej o samym Michale. Czytelniczki i czytelnicy po raz pierwszy mają możność zobaczyć jego fotografie pochodzące z getta warszawskiego.Rozmowa jest bogato ilustrowana niepublikowanymi dotąd archiwaliami sprzed drugiej wojny światowej i z okresu powojennego, a także z czasów okupacji hitlerowskiej w Polsce.

Background and Objective: Suicide attempts are 10-20X more common than completed suicide and an important risk factor for death by suicide, yet most people who attempt suicide do not die by suicide. The process of recovering after a suicide attempt has not been well studied. The Reasons to go on Living (RTGOL) Project, a narrative web-based study, focuses on experiences of people who have attempted suicide and made the decision to go on living, a process not well studied. Narrative research is ideally suited to understanding personal experiences critical to recovery following a suicide attempt, including the transition to a state of hopefulness. Voices from people with lived experience can help us plan and conceptualize this work. This paper reports on a secondary research question of the larger study: what stories do participants tell of the positive role/impact of the mental health system. Material and Methods: A website created for The RTGOL Project (www.thereasons.ca) enabled participants to anonymously submit a story about their suicide attempt and recovery, a process which enabled participation from a large and diverse group of participants. The only direction given was “if you have made a suicide attempt or seriously considered suicide and now want to go on living, we want to hear from you.” The unstructured narrative format allowed participants to describe their experiences in their own words, to include and emphasize what they considered important. Over 5 years, data analysis occurred in several phases over the course of the study, resulting in the identification of data that were inputted into an Excel file. This analysis used stories where participants described positive involvement with the mental health system (50 stories). Results: Several participants reflected on experiences many years previous, providing the privilege of learning how their life unfolded, what made a difference. Over a five-year period, 50 of 226 stories identified positive experiences with mental health care with sufficient details to allow analysis, and are the focus of this paper. There were a range of suicidal behaviours in these 50 stories, from suicidal ideation only to medically severe suicide attempts. Most described one or more suicide attempts. Three themes identified included: 1) trust and relationship with a health care professional, 2) the role of friends and family and friends, and 3) a wide range of services. Conclusion: Stories open a window into the experiences of the period after a suicide attempt. This study allowed for an understanding of how mental health professionals might help individuals who have attempted suicide write a different story, a life-affirming story. The stories that participants shared offer some understanding of “how” to provide support at a most-needed critical juncture for people as they interact with health care providers, including immediately after a suicide attempt. Results of this study reinforce that just one caring professional can make a tremendous difference to a person who has survived a suicide attempt. Key Words: web-based; suicide; suicide attempt; mental health system; narrative research Word Count: 478 Introduction My Third (or fourth) Suicide AttemptI laid in the back of the ambulance, the snow of too many doses of ativan dissolving on my tongue.They hadn't even cared enough about meto put someone in the back with me,and so, frustrated,I'd swallowed all the pills I had with me— not enough to do what I wanted it to right then,but more than enough to knock me out for a good 14 hours.I remember very little after that;benzodiazepines like ativan commonly cause pre- and post-amnesia, says Google helpfullyI wake up in a locked rooma woman manically drawing on the windows with crayonsthe colors of light through the glassdiffused into rainbows of joy scattered about the roomas if she were coloring on us all,all of the tattered remnants of humanity in a psych wardmade into a brittle mosaic, a quilt of many hues, a Technicolor dreamcoatand I thoughtI am so glad to be able to see this. (Story 187)The nurse opening that door will have a lasting impact on how this story unfolds and on this person’s life. Each year, almost one million people die from suicide, approximately one death every 40 seconds. Suicide attempts are much more frequent, with up to an estimated 20 attempts for every death by suicide.1 Suicide-related behaviours range from suicidal ideation and self-injury to death by suicide. We are unable to directly study those who die by suicide, but effective intervention after a suicide attempt could reduce the risk of subsequent death by suicide. Near-fatal suicide attempts have been used to explore the boundary with completed suicides. Findings indicated that violent suicide attempters and serious attempters (seriousness of the medical consequences to define near-fatal attempts) were more likely to make repeated, and higher lethality suicide attempts.2 In a case-control study, the medically severe suicide attempts group (78 participants), epidemiologically very similar to those who complete suicide, had significantly higher communication difficulties; the risk for death by suicide multiplied if accompanied by feelings of isolation and alienation.3 Most research in suicidology has been quantitative, focusing almost exclusively on identifying factors that may be predictive of suicidal behaviours, and on explanation rather than understanding.4 Qualitative research, focusing on the lived experiences of individuals who have attempted suicide, may provide a better understanding of how to respond in empathic and helpful ways to prevent future attempts and death by suicide.4,5 Fitzpatrick6 advocates for narrative research as a valuable qualitative method in suicide research, enabling people to construct and make sense of the experiences and their world, and imbue it with meaning. A review of qualitative studies examining the experiences of recovering from or living with suicidal ideation identified 5 interconnected themes: suffering, struggle, connection, turning points, and coping.7 Several additional qualitative studies about attempted suicide have been reported in the literature. Participants have included patients hospitalized for attempting suicide8, and/or suicidal ideation,9 out-patients following a suicide attempt and their caregivers,10 veterans with serious mental illness and at least one hospitalization for a suicide attempt or imminent suicide plan.11 Relationships were a consistent theme in these studies. Interpersonal relationships and an empathic environment were perceived as therapeutic and protective, enabling the expression of thoughts and self-understanding.8 Given the connection to relationship issues, the authors suggested it may be helpful to provide support for the relatives of patients who have attempted suicide. A sheltered, friendly environment and support systems, which included caring by family and friends, and treatment by mental health professionals, helped the suicidal healing process.10 Receiving empathic care led to positive changes and an increased level of insight; just one caring professional could make a tremendous difference.11 Kraft and colleagues9 concluded with the importance of hearing directly from those who are suicidal in order to help them, that only when we understand, “why suicide”, can we help with an alternative, “why life?” In a grounded theory study about help-seeking for self-injury, Long and colleagues12 identified that self-injury was not the problem for their participants, but a panacea, even if temporary, to painful life experiences. Participant narratives reflected a complex journey for those who self-injured: their wish when help-seeking was identified by the theme “to be treated like a person”. There has also been a focus on the role and potential impact of psychiatric/mental health nursing. Through interviews with experienced in-patient nurses, Carlen and Bengtsson13 identified the need to see suicidal patients as subjective human beings with unique experiences. This mirrors research with patients, which concluded that the interaction with personnel who are devoted, hope-mediating and committed may be crucial to a patient’s desire to continue living.14 Interviews with individuals who received mental health care for a suicidal crisis following a serious attempt led to the development of a theory for psychiatric nurses with the central variable, reconnecting the person with humanity across 3 phases: reflecting an image of humanity, guiding the individual back to humanity, and learning to live.15 Other research has identified important roles for nurses working with patients who have attempted suicide by enabling the expression of thoughts and developing self-understanding8, helping to see things differently and reconnecting with others,10 assisting the person in finding meaning from their experience to turn their lives around, and maintain/and develop positive connections with others.16 However, one literature review identified that negative attitudes toward self-harm were common among nurses, with more positive attitudes among mental health nurses than general nurses. The authors concluded that education, both reflective and interactive, could have a positive impact.17 This paper is one part of a larger web-based narrative study, the Reasons to go on Living Project (RTGOL), that seeks to understand the transition from making a suicide attempt to choosing life. When invited to tell their stories anonymously online, what information would people share about their suicide attempts? This paper reports on a secondary research question of the larger study: what stories do participants tell of the positive role/impact of the mental health system. The focus on the positive impact reflects an appreciative inquiry approach which can promote better practice.18 Methods Design and Sample A website created for The RTGOL Project (www.thereasons.ca) enabled participants to anonymously submit a story about their suicide attempt and recovery. Participants were required to read and agree with a consent form before being able to submit their story through a text box or by uploading a file. No demographic information was requested. Text submissions were embedded into an email and sent to an account created for the Project without collecting information about the IP address or other identifying information. The content of the website was reviewed by legal counsel before posting, and the study was approved by the local Research Ethics Board. Stories were collected for 5 years (July 2008-June 2013). The RTGOL Project enabled participation by a large, diverse audience, at their own convenience of time and location, providing they had computer access. The unstructured narrative format allowed participants to describe their experiences in their own words, to include and emphasize what they considered important. Of the 226 submissions to the website, 112 described involvement at some level with the mental health system, and 50 provided sufficient detail about positive experiences with mental health care to permit analysis. There were a range of suicidal behaviours in these 50 stories: 8 described suicidal ideation only; 9 met the criteria of medically severe suicide attempts3; 33 described one or more suicide attempts. For most participants, the last attempt had been some years in the past, even decades, prior to writing. Results Stories of positive experiences with mental health care described the idea of a door opening, a turning point, or helping the person to see their situation differently. Themes identified were: (1) relationship and trust with a Health Care Professional (HCP), (2) the role of family and friends (limited to in-hospital experiences), and (3) the opportunity to access a range of services. The many reflective submissions of experiences told many years after the suicide attempt(s) speaks to the lasting impact of the experience for that individual. Trust and Relationship with a Health Care Professional A trusting relationship with a health professional helped participants to see things in a different way, a more hopeful way and over time. “In that time of crisis, she never talked down to me, kept her promises, didn't panic, didn't give up, and she kept believing in me. I guess I essentially borrowed the hope that she had for me until I found hope for myself.” (Story# 35) My doctor has worked extensively with me. I now realize that this is what will keep me alive. To be able to feel in my heart that my doctor does care about me and truly wants to see me get better.” (Story 34). The writer in Story 150 was a nurse, an honours graduate. The 20 years following graduation included depression, hospitalizations and many suicide attempts. “One day after supper I took an entire bottle of prescription pills, then rode away on my bike. They found me late that night unconscious in a downtown park. My heart threatened to stop in the ICU.” Then later, “I finally found a person who was able to connect with me and help me climb out of the pit I was in. I asked her if anyone as sick as me could get better, and she said, “Yes”, she had seen it happen. Those were the words I had been waiting to hear! I quickly became very motivated to get better. I felt heard and like I had just found a big sister, a guide to help me figure out how to live in the world. This person was a nurse who worked as a trauma therapist.” At the time when the story was submitted, the writer was applying to a graduate program. Role of Family and Friends Several participants described being affected by their family’s response to their suicide attempt. Realizing the impact on their family and friends was, for some, a turning point. The writer in Story 20 told of experiences more than 30 years prior to the writing. She described her family of origin as “truly dysfunctional,” and she suffered from episodes of depression and hospitalization during her teen years. Following the birth of her second child, and many family difficulties, “It was at this point that I became suicidal.” She made a decision to kill herself by jumping off the balcony (6 stories). “At the very last second as I hung onto the railing of the balcony. I did not want to die but it was too late. I landed on the parking lot pavement.” She wrote that the pain was indescribable, due to many broken bones. “The physical pain can be unbearable. Then you get to see the pain and horror in the eyes of someone you love and who loves you. Many people suggested to my husband that he should leave me in the hospital, go on with life and forget about me. During the process of recovery in the hospital, my husband was with me every day…With the help of psychiatrists and a later hospitalization, I was actually diagnosed as bipolar…Since 1983, I have been taking lithium and have never had a recurrence of suicidal thoughts or for that matter any kind of depression.” The writer in Story 62 suffered childhood sexual abuse. When she came forward with it, she felt she was not heard. Self-harm on a regular basis was followed by “numerous overdoses trying to end my life.” Overdoses led to psychiatric hospitalizations that were unhelpful because she was unable to trust staff. “My way of thinking was that ending my life was the only answer. There had been numerous attempts, too many to count. My thoughts were that if I wasn’t alive I wouldn’t have to deal with my problems.” In her final attempt, she plunged over the side of a mountain, dropping 80 feet, resulting in several serious injuries. “I was so angry that I was still alive.” However, “During my hospitalization I began to realize that my family and friends were there by my side continuously, I began to realize that I wasn't only hurting myself. I was hurting all the important people in my life. It was then that I told myself I am going to do whatever it takes.” A turning point is not to say that the difficulties did not continue. The writer of Story 171 tells of a suicide attempt 7 years previous, and the ongoing anguish. She had been depressed for years and had thoughts of suicide on a daily basis. After a serious overdose, she woke up the next day in a hospital bed, her husband and 2 daughters at her bed. “Honestly, I was disappointed to wake up. But, then I saw how scared and hurt they were. Then I was sorry for what I had done to them. Since then I have thought of suicide but know that it is tragic for the family and is a hurt that can never be undone. Today I live with the thought that I am here for a reason and when it is God's time to take me then I will go. I do believe living is harder than dying. I do believe I was born for a purpose and when that is accomplished I will be released. …Until then I try to remind myself of how I am blessed and try to appreciate the wonders of the world and the people in it.” Range of Services The important role of mental health and recovery services was frequently mentioned, including dialectical behavioural therapy (DBT)/cognitive-behavioural therapy (CBT), recovery group, group therapy, Alcoholics Anonymous, accurate diagnosis, and medications. The writer in Story 30 was 83 years old when she submitted her story, reflecting on a life with both good and bad times. She first attempted suicide at age 10 or 12. A serious post-partum depression followed the birth of her second child, and over the years, she experienced periods of suicidal intent: “Consequently, a few years passed and I got to feeling suicidal again. I had pills in one pocket and a clipping for “The Recovery Group” in the other pocket. As I rode on the bus trying to make up my mind, I decided to go to the Recovery Group first. I could always take the pills later. I found the Recovery Group and yoga helpful; going to meetings sometimes twice a day until I got thinking more clearly and learned how to deal with my problems.” Several participants described the value of CBT or DBT in learning to challenge perceptions. “I have tools now to differentiate myself from the illness. I learned I'm not a bad person but bad things did happen to me and I survived.”(Story 3) “The fact is that we have thoughts that are helpful and thoughts that are destructive….. I knew it was up to me if I was to get better once and for all.” (Story 32): “In the hospital I was introduced to DBT. I saw a nurse (Tanya) every day and attended a group session twice a week, learning the techniques. I worked with the people who wanted to work with me this time. Tanya said the same thing my counselor did “there is no study that can prove whether or not suicide solves problems” and I felt as though I understood it then. If I am dead, then all the people that I kept pushing away and refusing their help would be devastated. If I killed myself with my own hand, my family would be so upset. DBT taught me how to ‘ride my emotional wave’. ……….. DBT has changed my life…….. My life is getting back in order now, thanks to DBT, and I have lots of reasons to go on living.”(Story 19) The writer of Story 67 described the importance of group therapy. “Group therapy was the most helpful for me. It gave me something besides myself to focus on. Empathy is such a powerful emotion and a pathway to love. And it was a huge relief to hear others felt the same and had developed tools of their own that I could try for myself! I think I needed to learn to communicate and recognize when I was piling everything up to build my despair. I don’t think I have found the best ways yet, but I am lifetimes away from that teenage girl.” (Story 67) The author of story 212 reflected on suicidal ideation beginning over 20 years earlier, at age 13. Her first attempt was at 28. “I thought everyone would be better off without me, especially my children, I felt like the worst mum ever, I felt like a burden to my family and I felt like I was a failure at life in general.” She had more suicide attempts, experienced the death of her father by suicide, and then finally found her doctor. “Now I’m on meds for a mood disorder and depression, my family watch me closely, and I see my doctor regularly. For the first time in 20 years, I love being a mum, a sister, a daughter, a friend, a cousin etc.” Discussion The 50 stories that describe positive experiences in the health care system constitute a larger group than most other similar studies, and most participants had made one or more suicide attempts. Several writers reflected back many years, telling stories of long ago, as with the 83-year old participant (Story 30) whose story provided the privilege of learning how the author’s life unfolded. In clinical practice, we often do not know – how did the story turn out? The stories that describe receiving health care speak to the impact of the experience, and the importance of the issues identified in the mental health system. We identified 3 themes, but it was often the combination that participants described in their stories that was powerful, as demonstrated in Story 20, the young new mother who had fallen from a balcony 30 years earlier. Voices from people with lived experience can help us plan and conceptualize our clinical work. Results are consistent with, and add to, the previous work on the importance of therapeutic relationships.8,10,11,14–16 It is from the stories in this study that we come to understand the powerful experience of seeing a family members’ reaction following a participant’s suicide attempt, and how that can be a potent turning point as identified by Lakeman and Fitzgerald.7 Ghio and colleagues8 and Lakeman16 identified the important role for staff/nurses in supporting families due to the connection to relationship issues. This research also calls for support for families to recognize the important role they have in helping the person understand how much they mean to them, and to promote the potential impact of a turning point. The importance of the range of services reflect Lakeman and Fitzgerald’s7 theme of coping, associating positive change by increasing the repertoire of coping strategies. These findings have implications for practice, research and education. Working with individuals who are suicidal can help them develop and tell a different story, help them move from a death-oriented to life-oriented position,15 from “why suicide” to “why life.”9 Hospitalization provides a person with the opportunity to reflect, to take time away from “the real world” to consider oneself, the suicide attempt, connections with family and friends and life goals, and to recover physically and emotionally. Hospitalization is also an opening to involve the family in the recovery process. The intensity of the immediate period following a suicide attempt provides a unique opportunity for nurses to support and coach families, to help both patients and family begin to see things differently and begin to create that different story. In this way, family and friends can be both a support to the person who has attempted suicide, and receive help in their own struggles with this experience. It is also important to recognize that this short period of opportunity is not specific to the nurses in psychiatric units, as the nurses caring for a person after a medically severe suicide attempt will frequently be the nurses in the ICU or Emergency departments. Education, both reflective and interactive, could have a positive impact.17 Helping staff develop the attitudes, skills and approach necessary to be helpful to a person post-suicide attempt is beginning to be reported in the literature.21 Further implications relate to nursing curriculum. Given the extent of suicidal ideation, suicide attempts and deaths by suicide, this merits an important focus. This could include specific scenarios, readings by people affected by suicide, both patients themselves and their families or survivors, and discussions with individuals who have made an attempt(s) and made a decision to go on living. All of this is, of course, not specific to nursing. All members of the interprofessional health care team can support the transition to recovery of a person after a suicide attempt using the strategies suggested in this paper, in addition to other evidence-based interventions and treatments. Findings from this study need to be considered in light of some specific limitations. First, the focus was on those who have made a decision to go on living, and we have only the information the participants included in their stories. No follow-up questions were possible. The nature of the research design meant that participants required access to a computer with Internet and the ability to communicate in English. This study does not provide a comprehensive view of in-patient care. However, it offers important inputs to enhance other aspects of care, such as assessing safety as a critical foundation to care. We consider these limitations were more than balanced by the richness of the many stories that a totally anonymous process allowed. Conclusion Stories open a window into the experiences of a person during the period after a suicide attempt. The RTGOL Project allowed for an understanding of how we might help suicidal individuals change the script, write a different story. The stories that participants shared give us some understanding of “how” to provide support at a most-needed critical juncture for people as they interact with health care providers immediately after a suicide attempt. While we cannot know the experiences of those who did not survive a suicide attempt, results of this study reinforce that just one caring professional can make a crucial difference to a person who has survived a suicide attempt. We end with where we began. Who will open the door? References 1. World Health Organization. Suicide prevention and special programmes. http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/index.html Geneva: Author; 2013.2. Giner L, Jaussent I, Olie E, et al. Violent and serious suicide attempters: One step closer to suicide? J Clin Psychiatry 2014:73(3):3191–197.3. Levi-Belz Y, Gvion Y, Horesh N, et al. Mental pain, communication difficulties, and medically serious suicide attempts: A case-control study. Arch Suicide Res 2014:18:74–87.4. Hjelmeland H and Knizek BL. Why we need qualitative research in suicidology? Suicide Life Threat Behav 2010:40(1):74–80.5. Gunnell D. A population health perspective on suicide research and prevention: What we know, what we need to know, and policy priorities. Crisis 2015:36(3):155–60.6. Fitzpatrick S. Looking beyond the qualitative and quantitative divide: Narrative, ethics and representation in suicidology. Suicidol Online 2011:2:29–37.7. Lakeman R and FitzGerald M. How people live with or get over being suicidal: A review of qualitative studies. J Adv Nurs 2008:64(2):114–26.8. Ghio L, Zanelli E, Gotelli S, et al. Involving patients who attempt suicide in suicide prevention: A focus group study. J Psychiatr Ment Health Nurs 2011:18:510–18.9. Kraft TL, Jobes DA, Lineberry TW., Conrad, A., & Kung, S. Brief report: Why suicide? Perceptions of suicidal inpatients and reflections of clinical researchers. Arch Suicide Res 2010:14(4):375-382.10. Sun F, Long A, Tsao L, et al. The healing process following a suicide attempt: Context and intervening conditions. Arch Psychiatr Nurs 2014:28:66–61.11. Montross Thomas L, Palinkas L, et al. Yearning to be heard: What veterans teach us about suicide risk and effective interventions. Crisis 2014:35(3):161–67.12. Long M, Manktelow R, and Tracey A. The healing journey: Help seeking for self-injury among a community population. Qual Health Res 2015:25(7):932–44.13. Carlen P and Bengtsson A. Suicidal patients as experienced by psychiatric nurses in inpatient care. Int J Ment Health Nurs 2007:16:257–65.14. Samuelsson M, Wiklander M, Asberg M, et al. Psychiatric care as seen by the attempted suicide patient. J Adv Nurs 2000:32(3):635–43.15. Cutcliffe JR, Stevenson C, Jackson S, et al. A modified grounded theory study of how psychiatric nurses work with suicidal people. Int J Nurs Studies 2006:43(7):791–802.16. Lakeman, R. What can qualitative research tell us about helping a person who is suicidal? Nurs Times 2010:106(33):23–26.17. Karman P, Kool N, Poslawsky I, et al. Nurses’ attitudes toward self-harm: a literature review. J Psychiatr Ment Health Nurs 2015:22:65–75.18. Carter B. ‘One expertise among many’ – working appreciatively to make miracles instead of finding problems: Using appreciative inquiry as a way of reframing research. J Res Nurs 2006:11(1): 48–63.19. Lieblich A, Tuval-Mashiach R, Zilber T. Narrative research: Reading, analysis, and interpretation. Sage Publications; 1998.20. Braun V and Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006:3(2):77–101.21. Kishi Y, Otsuka K, Akiyama K, et al. Effects of a training workshop on suicide prevention among emergency room nurses. Crisis 2014:35(5):357–61.

Abstract Background Decades of persecution culminated in a statewide campaign of organized, systematic, and violent eviction of the Rohingya people by the Myanmar government beginning in August 2017. These attacks included the burning of homes and farms, beatings, shootings, sexual violence, summary executions, burying the dead in mass graves, and other atrocities. The Myanmar government has denied any responsibility. To document evidence of reported atrocities and identify patterns, we interviewed survivors, documented physical injuries, and assessed for consistency in their reports. Methods We use purposive and snowball sampling to identify survivors residing in refugee camps in Bangladesh. Interviews and examinations were conducted by trained investigators with the assistance of interpreters based on the Istanbul Protocol – the international standard to investigate and document instances of torture and other cruel, inhuman, and degrading treatment. The goal was to assess whether the clinical findings corroborate survivors’ narratives and to identify emblematic patterns. Results During four separate field visits between December 2017 and July 2018, we interviewed and where relevant, conducted physical examinations on a total of 114 refugees. The participants came from 36 villages in Northern Rakhine state; 36 (32%) were female, 26 (23%) were children. Testimonies described several patterns in the violence prior to their flight, including the organization of the attacks, the involvement of non-Rohingya civilians, the targeted and purposeful destruction of homes and eviction of Rohingya residents, and the denial of medical care. Physical findings included injuries from gunshots, blunt trauma, penetrating trauma such as slashings and mutilations, burns, and explosives and from sexual and gender-based violence. Conclusions While each survivor’s experience was unique, similarities in the types and organization of attacks support allegations of a systematic, widespread, and premeditated campaign of forced displacement and violence. Physical findings were consistent with survivors’ narratives of violence and brutality. These findings warrant accountability for the Myanmar military per the Rome Statute of the International Criminal Court (ICC), which has jurisdiction to try individuals for serious international crimes, including crimes against humanity and genocide. Legal accountability for these crimes should be pursued along with medical and psychological care and rehabilitation to address the ongoing effects of violence, discrimination, and displacement.

Deep-shaft mining is regarded as a high-risk occupation with an increasing number of traumatic accidents. Though there are strategies for the management of post-traumatic stress disorder (PTSD), little has been done to document the male survivors’ perceptions of PTSD management strategies in the South African mining sector. An exploratory, descriptive and contextual study was conducted within the South African mining sector to explore and describe the survivors’ perceptions of PTSD management strategies. The population comprised all men who were suffering from PTSD as a result of accidents in the mines. A purposive sample of 29 men was selected to participate in the study and data saturation was achieved. Unstructured individual interviews and field notes were used as methods of data collection. One question was asked during the interviews: “What do think helped you recover from PTSD?” Communication skills were employed to facilitate the participation of the men during the interviews. Data were collected using a voice recorder and were then transcribed verbatim and analysed using Tesch’s descriptive method of data analysis. Measures for ensuring trustworthiness were applied to verify the findings. Three themes emerged during data analysis: (1) perceived emphasis on physical versus psychological treatments, (2) perceived coping strategies used to deal with the trauma, and lastly, (3) the perceived effect of social support networks during trauma. Based on the perceptions of the participants, it became evident that PTSD management did not meet expectations. An integrated approach is recommended for the future treatment of psychological and physical trauma among survivors of traumatic events in the mining sector.

At 8:15 am on August 6th, 1945, the world and the way in which we fight wars changed forever. Immediately following the drop of the Little Boy atomic bomb, the city of Hiroshima was decimated, leaving the surviving citizens to deal with poverty, starvation, loss of loved ones, and utter destruction of their lives. After the bombing, survivors were left with burns, radiation poisoning, and physical scars. Unknown to the survivors of the atomic bombings, or Hibakusha, were the ensuing psychological and emotional damages. In 2014, we know more about traumatic experiences than in 1945. Studies from Hiroshima’s Hibakusha have been invaluable to help us understand the psychological effects of traumatic events on the individual. As warfare continues in countries around the world and civilians become targeted more frequently, it is important to understand the factors involved in the process of overcoming stress-related disorders. Hiroshima stands out as the city that has become a leader in positive peace movements and global grassroots nuclear disarmament. By looking at the responses and methods used to treat individuals, we can begin to extend the knowledge about how to treat populations who have undergone mass traumas.

Abstract Background Emotions after surviving cancer can be complicated. The survivors may have gained new strength to continue life, but some of them may begin to deal with complicated feelings and emotional stress due to trauma and fear of cancer recurrence. The widespread use of Twitter for socializing has been the alternative medium for data collection compared to traditional studies of mental health, which primarily depend on information taken from medical staff with their consent. These social media data, to a certain extent, reflect the users’ psychological state. However, Twitter also contains a mix of noisy and genuine tweets. The process of manually identifying genuine tweets is expensive and time-consuming. Methods We stream the data using cancer as a keyword to filter the tweets with cancer-free and use post-traumatic stress disorder (PTSD) related keywords to reduce the time spent on the annotation task. Convolutional Neural Network (CNN) learns the representations of the input to identify cancer survivors with PTSD. Results The results present that the proposed CNN can effectively identify cancer survivors with PTSD. The experiments on real-world datasets show that our model outperforms the baselines and correctly classifies the new tweets. Conclusions PTSD is one of the severe anxiety disorders that could affect individuals who are exposed to traumatic events, including cancer. Cancer survivors are at risk of short-term or long-term effects on physical and psycho-social well-being. Therefore, the evaluation and treatment of PTSD are essential parts of cancer survivorship care. It will act as an alarming system by detecting the PTSD presence based on users’ postings on Twitter.

The study expounds upon the psychological concept of ‘ambiguous loss,’ proposed by Pauline Boss. The article attempts to broaden the concept’s individualistic focus by offering a more ethnographically nuanced and socioculturally contextualized application of the concept. It examines how Okinawan WWII survivors, who repatriated from the Northern Mariana Islands after the war, relied on their belief system to make sense of ‘abnormal’ deaths during war, and the lack of proper mortuary rituals usually conducted for ‘normal’ deaths. The article argues that religio-spiritual rituals during their pilgrimages to the Marianas were the means with which those struggling with ambiguous loss attempt to deal with their psychological trauma and spiritual pain. It is also argued, however, that the uncollected bodies/bones continue to haunt the bereaved families, so their struggle with the loss cannot come to a complete ‘closure,’ resulting in their repeated visits to the sites of their loved ones’ violent deaths.

Every year, natural disasters create havoc and threaten the strength & stability of communities throughout the world .The 2014 floods that struck Kashmir also created a lot of material and psychological devastation, by taking away many precious lives & destroying homes in its wake. Considering the same, the survivors of the floods were left not only with the challenges like unfinished repairs, lingering insurance claim disputes & financial strain but also the severe psychological problems like depression and trauma. Amidst such circumstances the depth of the psychological capital in the community has an important role to play. Broadly speaking, building resilience can be an effective response in this regard. As per Aldrich (2012) what contributes to efficient reconstruction is more important than ever. In this context the present study proposes a multi-step model of resilience development among flood affected people. As the model is grounded in principles of positive psychology and takes into consideration the Indian cultural context, it is hoped that, the same can be made use of by the mental health professionals in order to help the victims to effectively deal with the challenges by focusing on resilience development.

Hundreds of thousands of Australian children were born in the shadow of the Great War, fathered by men who had enlisted between 1914 and 1918. Their lives could be and often were hard and unhappy, as Anzac historian Alistair Thomson observed of his father’s childhood in the 1920s and 1930s. David Thomson was son of a returned serviceman Hector Thomson who spent much of his adult life in and out of repatriation hospitals (257-259) and whose memory was subsequently expunged from Thomson family stories (299-267). These children of trauma fit within a pattern suggested by Marianne Hirsch in her influential essay “The Generation of Postmemory”. According to Hirsch, “postmemory describes the relationship of the second generation to powerful, often traumatic, experiences that preceded their births but that were nevertheless transmitted to them so deeply as to seem to constitute memories in their own right” (n.p.). This article attempts to situate George Johnston’s novel My Brother Jack (1964) within the context of postmemory narratives of violence that were complicated in Australia by the Anzac legend which occluded any too open discussion about the extent of war trauma present within community, including the children of war.“God knows what damage” the war “did to me psychologically” (48), ponders Johnston’s protagonist and alter-ego David Meredith in My Brother Jack. Published to acclaim fifty years after the outbreak of the First World War, My Brother Jack became a widely read text that seemingly spoke to the shared cultural memories of a generation which did not know battlefield violence directly but experienced its effects pervasively and vicariously in the aftermath through family life, storytelling, and the memorabilia of war. For these readers, the novel represented more than a work of fiction; it was a touchstone to and indicative of their own negotiations though often unspoken post-war trauma.Meredith, like his creator, is born in 1912. Strictly speaking, therefore, both are not part of the post-war generation. However, they are representative and therefore indicative of the post-war “hinge generation” which was expected to assume “guardianship” of the Anzac Legend, though often found the narrative logic challenging. They had been “too young for the war to have any direct effect”, and yet “every corner” of their family’s small suburban homes appear to be “impregnated with some gigantic and sombre experience that had taken place thousands of miles away” (17).According to Johnston’s biographer, Garry Kinnane, the “most teasing puzzle” of George Johnston’s “fictional version of his childhood in My Brother Jack is the monstrous impression he creates of his returned serviceman father, John George Johnston, known to everyone as ‘Pop.’ The first sixty pages are dominated by the tyrannical figure of Jack Meredith senior” (1).A large man purported to be six foot three inches (1.9 metres) in height and weighing fifteen stone (95 kilograms), the real-life Pop Johnston reputedly stood head and shoulders above the minimum requirement of five foot and six inches (1.68 metres) at the time of his enlistment for war in 1914 (Kinnane 4). In his fortieth year, Jack Johnston senior was also around twice the age of the average Australian soldier and among one in five who were married.According to Kinnane, Pop Johnston had “survived the ordeal of Gallipoli” in 1915 only to “endure three years of trench warfare in the Somme region”. While the biographer and the Johnston family may well have held this to be true, the claim is a distortion. There are a few intimations throughout My Brother Jack and its sequel Clean Straw for Nothing (1969) to suggest that George Johnston may have suspected that his father’s wartime service stories had been embellished, though the depicted wartime service of Pop Meredith remains firmly within the narrative arc of the Anzac legend. This has the effect of layering the postmemory violence experienced by David Meredith and, by implication, his creator, George Johnston. Both are expected to be keepers of a lie masquerading as inviolable truth which further brutalises them.John George (Pop) Johnston’s First World War military record reveals a different story to the accepted historical account and his fictionalisation in My Brother Jack. He enlisted two and a half months after the landing at Gallipoli on 12 July 1915 and left for overseas service on 23 November. Not quite the imposing six foot three figure of Kinnane’s biography, he was fractionally under five foot eleven (1.8 metres) and weighed thirteen stone (82.5 kilograms). Assigned to the Fifth Field Engineers on account of his experience as an electric tram fitter, he did not see frontline service at Gallipoli (NAA).Rather, according to the Company’s history, the Fifth Engineers were involved in a range of infrastructure and support work on the Western Front, including the digging and maintenance of trenches, laying duckboard, pontoons and tramlines, removing landmines, building huts, showers and latrines, repairing roads, laying drains; they built a cinema at Beaulencourt Piers for “Brigade Swimming Carnival” and baths at Malhove consisting of a large “galvanised iron building” with a “concrete floor” and “setting tanks capable of bathing 2,000 men per day” (AWM). It is likely that members of the company were also involved in burial details.Sapper Johnston was hospitalised twice during his service with influenza and saw out most of his war from October 1917 attached to the Army Cookery School (NAA). He returned to Australia on board the HMAT Kildonian Castle in May 1919 which, according to the Sydney Morning Herald, also carried the official war correspondent and creator of the Anzac legend C.E.W. Bean, national poet Banjo Paterson and “Warrant Officer C G Macartney, the famous Australian cricketer”. The Herald also listed the names of “Returned Officers” and “Decorated Men”, but not Pop Johnston who had occupied the lower decks with other returning men (“Soldiers Return”).Like many of the more than 270,000 returned soldiers, Pop Johnston apparently exhibited observable changes upon his repatriation to Australia: “he was partially deaf” which was attributed to the “constant barrage of explosions”, while “gas” was suspected to have “left him with a legacy of lung disorders”. Yet, if “anyone offered commiserations” on account of this war legacy, he was quick to “dismiss the subject with the comment that ‘there were plenty worse off’” (Kinnane 6). The assumption is that Pop’s silence is stoic; the product of unspeakable horror and perhaps a symptom of survivor guilt.An alternative interpretation, suggested by Alistair Thomson in Anzac Memories, is that the experiences of the vast majority of returned soldiers were expected to fit within the master narrative of the Anzac legend in order to be accepted and believed, and that there was no space available to speak truthfully about alternative war service. Under pressure of Anzac expectations a great many composed stories or remained selectively silent (14).Data gleaned from the official medical history suggest that as many as four out of every five returned servicemen experienced emotional or psychological disturbance related to their war service. However, the two branches of medicine represented by surgeons and physicians in the Repatriation Department—charged with attending to the welfare of returned servicemen—focused on the body rather than the mind and the emotions (Murphy and Nile).The repatriation records of returned Australian soldiers reveal that there were, indeed, plenty physically worse off than Pop Johnston on account of bodily disfigurement or because they had been somatically compromised. An estimated 30,000 returned servicemen died in the decade after the cessation of hostilities to 1928, bringing the actual number of war dead to around 100,000, while a 1927 official report tabled the medical conditions of a further 72,388 veterans: 28,305 were debilitated by gun and shrapnel wounds; 22,261 were rheumatic or had respiratory diseases; 4534 were afflicted with eye, ear, nose, or throat complaints; 9,186 had tuberculosis or heart disease; 3,204 were amputees while only; 2,970 were listed as suffering “war neurosis” (“Enlistment”).Long after the guns had fallen silent and the wounded survivors returned home, the physical effects of war continued to be apparent in homes and hospital wards around the country, while psychological and emotional trauma remained largely undiagnosed and consequently untreated. David Meredith’s attitude towards his able-bodied father is frequently dismissive and openly scathing: “dad, who had been gassed, but not seriously, near Vimy Ridge, went back to his old job at the tramway depot” (9). The narrator-son later considers:what I realise now, although I never did at the time, is that my father, too, was oppressed by intimidating factors of fear and change. By disillusion and ill-health too. As is so often the case with big, strong, athletic men, he was an extreme hypochondriac, and he had convinced himself that the severe bronchitis which plagued him could only be attributed to German gas he had swallowed at Vimy Ridge. He was too afraid to go to a doctor about it, so he lived with a constant fear that his lungs were decaying, and that he might die at any time, without warning. (42-3)During the writing of My Brother Jack, the author-son was in chronically poor health and had been recently diagnosed with the romantic malady and poet’s disease of tuberculosis (Lawler) which plagued him throughout his work on the novel. George Johnston believed (correctly as it turned out) that he was dying on account of the disease, though, he was also an alcoholic and smoker, and had been reluctant to consult a doctor. It is possible and indeed likely that he resentfully viewed his condition as being an extension of his father—vicariously expressed through the depiction of Pop Meredith who exhibits hysterical symptoms which his son finds insufferable. David Meredith remains embittered and unforgiving to the very end. Pop Meredith “lived to seventy-three having died, not of German gas, but of a heart attack” (46).Pop Meredith’s return from the war in 1919 terrifies his seven-year-old son “Davy”, who accompanies the family to the wharf to welcome home a hero. The young boy is unable to recall anything about the father he is about to meet ostensibly for the first time. Davy becomes overwhelmed by the crowds and frightened by the “interminable blaring of horns” of the troopships and the “ceaseless roar of shouting”. Dwarfed by the bodies of much larger men he becomestoo frightened to look up at the hours-long progression of dark, hard faces under wide, turned-up hats seen against bayonets and barrels that are more blue than black ... the really strong image that is preserved now is of the stiff fold and buckle of coarse khaki trousers moving to the rhythm of knees and thighs and the tight spiral curves of puttees and the thick boots hammering, hollowly off the pier planking and thunderous on the asphalt roadway.Depicted as being small for his age, Davy is overwrought “with a huge and numbing terror” (10).In the years that follow, the younger Meredith desires emotional stability but remains denied because of the war’s legacy which manifests in the form of a violent patriarch who is convinced that his son has been rendered effeminate on account of the manly absence during vital stages of development. With the return of the father to the household, Davy grows to fear and ultimately despise a man who remains as alien to him as the formerly absent soldier had been during the war:exactly when, or why, Dad introduced his system of monthly punishments I no longer remember. We always had summary punishment, of course, for offences immediately detected—a cuffing around the ears or a sash with a stick of a strap—but Dad’s new system was to punish for the offences which had escaped his attention. So on the last day of every month Jack and I would be summoned in turn to the bathroom and the door would be locked and each of us would be questioned about the sins which we had committed and which he had not found out about. This interrogation was the merest formality; whether we admitted to crimes or desperately swore our innocence it was just the same; we were punished for the offences which, he said, he knew we must have committed and had to lie about. We then had to take our shirts and singlets off and bend over the enamelled bath-tub while he thrashed us with the razor-strop. In the blind rages of these days he seemed not to care about the strength he possessed nor the injuries he inflicted; more often than not it was the metal end of the strop that was used against our backs. (48)Ironically, the ritualised brutality appears to be a desperate effort by the old man to compensate for his own emasculation in war and unresolved trauma now that the war is ended. This plays out in complicated fashion in the development of David Meredith in Clean Straw for Nothing, Johnston’s sequel to My Brother Jack.The imputation is that Pop Meredith practices violence in an attempt to reassert his failed masculinity and reinstate his status as the head of the household. Older son Jack’s beatings cease when, as a more physically able young man, he is able to threaten the aggressor with violent retaliation. This action does not spare the younger weaker Davy who remains dominated. “My beating continued, more ferociously than ever, … . They ceased only because one day my father went too far; he lambasted me so savagely that I fell unconscious into the bath-tub, and the welts across my back made by the steel end of the razor-strop had to be treated by a doctor” (53).Pop Meredith is persistently reminded that he has no corporeal signifiers of war trauma (only a cough); he is surrounded by physically disabled former soldiers who are presumed to be worse off than he on account of somatic wounding. He becomes “morose, intolerant, bitter and violently bad-tempered”, expressing particular “displeasure and resentment” toward his wife, a trained nurse, who has assumed carer responsibilities for homing the injured men: “he had altogether lost patience with her role of Florence Nightingale to the halt and the lame” (40). Their marriage is loveless: “one can only suppose that he must have been darkly and profoundly disturbed by the years-long procession through our house of Mother’s ‘waifs and strays’—those shattered former comrades-in-arms who would have been a constant and sinister reminder of the price of glory” (43); a price he had failed to adequately pay with his uncompromised body intact.Looking back, a more mature David Meredith attempts to establish order, perspective and understanding to the “mess of memory and impressions” of his war-affected childhood in an effort to wrest control back over his postmemory violation: “Jack and I must have spent a good part of our boyhood in the fixed belief that grown-up men who were complete were pretty rare beings—complete, that is, in that they had their sight or hearing or all of their limbs” (8). While the father is physically complete, his brooding presence sets the tone for the oppressively “dark experience” within the family home where all rooms are “inhabited by the jetsam that the Somme and the Marne and the salient at Ypres and the Gallipoli beaches had thrown up” (18). It is not until Davy explores the contents of the “big deep drawer at the bottom of the cedar wardrobe” in his parents’ bedroom that he begins to “sense a form in the shadow” of the “faraway experience” that had been the war. The drawer contains his father’s service revolver and ammunition, battlefield souvenirs and French postcards but, “most important of all, the full set of the Illustrated War News” (19), with photographs of battlefield carnage. These are the equivalent of Hirsch’s photographs of the Holocaust that establish in Meredith an ontology that links him more realistically to the brutalising past and source of his ongoing traumatistion (Hirsch). From these, Davy begins to discern something of his father’s torment but also good fortune at having survived, and he makes curatorial interventions not by becoming a custodian of abjection like second generation Holocaust survivors but by disposing of the printed material, leaving behind artefacts of heroism: gun, the bullets, the medals and ribbons. The implication is that he has now become complicit in the very narrative that had oppressed him since his father’s return from war.No one apparently notices or at least comments on the removal of the journals, the images of which become linked in the young boys mind to an incident outside a “dilapidated narrow-fronted photographer’s studio which had been deserted and padlocked for as long as I could remember”. A number of sun-damaged photographs are still displayed in the window. Faded to a “ghostly, deathly pallor”, and speckled with fly droppings, years earlier, they had captured young men in uniforms before embarkation for the war. An “agate-eyed” boy from Davy’s school joins in the gazing, saying nothing for a long time until the silence is broken: “all them blokes there is dead, you know” (20).After the unnamed boy departs with a nonchalant “hoo-roo”, young Davy runs “all the way home, trying not to cry”. He cannot adequately explain the reason for his sudden reaction: “I never after that looked in the window of the photographer’s studio or the second hand shop”. From that day on Davy makes a “long detour” to ensure he never passes the shops again (20-1). Having witnessed images of pre-war undamaged young men in the prime of their youth, he has come face-to-face with the consequences of war which he is unable to reconcile in terms of the survival and return of his much older father.The photographs of the young men establishes a causal connection to the physically wrecked remnants that have shaped Davy’s childhood. These are the living remains that might otherwise have been the “corpses sprawled in mud or drowned in flooded shell craters” depicted in the Illustrated News. The photograph of the young men establishes Davy’s connection to the things “propped up our hallway”, of “Bert ‘sobbing’ in the backyard and Gabby Dixon’s face at the dark end of the room”, and only reluctantly the “bronchial cough of my father going off in the dawn light to the tramways depot” (18).That is to say, Davy has begun to piece together sense from senselessness, his father’s complicity and survival—and, by association, his own implicated life and psychological wounding. He has approached the source of his father’s abjection and also his own though he continues to be unable to accept and forgive. Like his father—though at the remove—he has been damaged by the legacies of the war and is also its victim.Ravaged by tuberculosis and alcoholism, George Johnston died in 1970. According to the artist Sidney Nolan he had for years resembled the ghastly photographs of survivors of the Holocaust (Marr 278). George’s forty five year old alcoholic wife Charmian Clift predeceased him by twelve months, having committed suicide in 1969. Four years later, in 1973, George and Charmian’s twenty four year old daughter Shane also took her own life. Their son Martin drank himself to death and died of organ failure at the age of forty three in 1990. They are all “dead, you know”.ReferencesAWM. Fifth Field Company, Australian Engineers. Diaries, AWM4 Sub-class 14/24.“Enlistment Report”. Reveille, 29 Sep. 1928.Hirsch, Marianne. “The Generation of Postmemory.” Poetics Today 29.1 (Spring 2008): 103-128. <https://read.dukeupress.edu/poetics-today/article/29/1/103/20954/The-Generation-of-Postmemory>.Johnston, George. Clean Straw for Nothing. London: Collins, 1969.———. My Brother Jack. London: Collins, 1964.Kinnane, Garry. George Johnston: A Biography. Melbourne: Nelson, 1986.Lawler, Clark. Consumption and Literature: the Making of the Romantic Disease. Basingstoke: Palgrave Macmillan, 2006.Marr, David, ed. Patrick White Letters. Sydney: Random House, 1994.Murphy, Ffion, and Richard Nile. “Gallipoli’s Troubled Hearts: Fear, Nerves and Repatriation.” Studies in Western Australian History 32 (2018): 25-38.NAA. John George Johnston War Service Records. <https://recordsearch.naa.gov.au/SearchNRetrieve/Interface/ViewImage.aspx?B=1830166>.“Soldiers Return by the Kildonan Castle.” Sydney Morning Herald, 10 May 1919: 18.Thomson, Alistair. Anzac Memories: Living with the Legend. Clayton: Monash UP, 2013.

<p>Response to Knox, S. (2018). Helicopter EMS in Cork: a paramedicine perspective. Irish Journal of Paramedicine, 3(2). doi:http://dx.doi.org/10.32378/ijp.v3i2.113</p><p> </p><p>Dear Editor,</p><p>I read Dr. Shane Knox’s commentary “Helicopter EMS in Cork” (1) in the current edition of the Journal with interest.<br /> Firstly, to be clear, I have the utmost respect for paramedics. The commencement of an EMS helicopter in Cork is a landmark step forward in prehospital care. The ‘Toyota’ reference made in the Knox article is in relation to a misquote published in the Irish Times from a recent RTE Radio interview I gave around the staffing model of a Helicopter EMS (HEMS). The reference I made to Toyota was in fact with respect to the physician-paramedic HEMS model that is the norm in Australia, Northern Ireland, Scotland, England, Wales and mainland Europe. I don’t view a physician-paramedic team as a Rolls-Royce, platinum or gold standard model, but rather more like a Toyota; attainable and highly durable. In August 2015, the College of Paramedics (UK) stated “The College of Paramedics support proposals for a HEMS service in Northern Ireland, with a view that this service should be integrated within a trauma network in Northern Ireland and consist of a specialist pre-hospital Doctor and Paramedic team.” (2) The HEMS in Northern Ireland is now staffed with this model by the Northern Ireland Ambulance Service (NIAS). <br /> The Irish government recently endorsed the development of a Trauma System for Ireland. Inherent to any trauma system is enhanced prehospital trauma care capability. Albeit the air ambulance will certainly bring speed, it will not bring enhanced skills without a doctor-paramedic team that will save additional lives, nor will it meet the PHECC dispatch standards for emergency calls by road (dual paramedic). The doctor-paramedic model can provide advanced prehospital critical interventions such as balanced emergency anaesthesia, mechanical ventilation, finger thoracostomy, blood transfusion and eye, life and limb-saving procedures (e.g. lateral canthotomy, resuscitative thoracotomy) as well as enhanced system activation such as prehospital massive transfusion activation and bringing a patient direct to theatre from helipad (code crimson).<br /> Recently, Mark Winter, an operations manager of Wales Air Ambulance (doctor-paramedic EMRTS team) said: “One of the things we talk about in our world is ‘unexpected survivors’-those patients who have had emergency front line treatment at the roadside or at the home who otherwise would have to be taken to the hospital, where it might have been too late.” (3) The similar EMRS in Scotland is increasing coverage as I write this to meet the demands of the newly developed Scottish Trauma Network. I’m sure the patient needs are the same in Ireland as they are in Northern Ireland or Great Britain. <br /> A doctor-paramedic team extends critical care to life-threatening prehospital and medical emergencies such as STEMI with cardiogenic shock requiring safe intubation and ventilation, central inotropic support or controlled mechanical ventilation and targeted BP control in neurological emergencies (e.g. subarachnoid haemorrhage, stroke with coma). This team responds rapidly to prehospital or hospital tasking and can provide intensive care level stabilisation and support anywhere. <br /> Certainly as Knox points out many of the interventions/skills that can be brought to the scene can also be performed by critical care paramedics (e.g. MICA in Victoria). This expertise does not occur overnight and takes years to develop. In my opinion, in Ireland a critical care paramedic model can only develop in the environment of a physician-paramedic team in terms of training, curriculum development and governance. There are excellent Irish advanced paramedics and prehospital specialist doctors in Ireland and abroad who together would make an excellent team that would serve the community and patient needs to the highest level. Now is the time. </p>

In the years surrounding the turn of the millennium, there emerged an assemblage of American and Spanish horror films fixated on uncanny child characters. Caught in the symbolic abyss between death and life, these figures are central to the films’ building of suspense and Gothic frisson—they are at once familiar and unfamiliar, vulnerable and threatening, innocent yet unnervingly inscrutable. Despite being conceived and produced in two very different cultural climates, these films construct the child as an embodiment of trauma in parallel ways. In turn, these Gothic children express the wavering of narratives of progress which suffused the liminal moment of the millennial turn. Steven Bruhm suggests that there is “a startling emphasis on children as the bearers of death” (author’s emphasis 98) in popular Gothic fiction at the turn of the new millennium, and that this contemporary Gothic “has a particular emotive force for us because it brings into high relief exactly what the child knows ... Invariably, the Gothic child knows too much, and that knowledge makes us more than a little nervous” (103). A comparative analysis of trans-millennial American and Spanish supernatural horror films reveals the specifically threatening register of the Gothic child’s knowledge, and that the gradual revelation of this knowledge aestheticizes the mechanics of trauma. This “traumatic” aesthetic also entails a disruption to linear progress, exposing the ways in which Gothic representations of the child’s uncanny knowledge express anxieties about the collapse of temporal progress. The eeriness associated with the child’s knowledge is thus tied to a temporal disjuncture; as Margarita Georgieva explains, child-centred Gothic fiction meditates on the fact that “childhood is quickly lost, never regained and, therefore, outside of the tangible adult world” (191). American films such as The Sixth Sense (M. Night Shyamalan, 1999) and Stir of Echoes (David Koepp, 1999), and Spanish films The Nameless (Jaume Balagueró, 1999) and The Devil’s Backbone (Guillermo del Toro, 2001), and also American-Spanish co-productions such as The Others (Alejandro Amenábar, 2001) and Fragile (Jaume Balagueró, 2005), expose the tangle of contradictions which lurk beneath romanticised definitions of childhood innocence and nostalgia for an adult’s “lost” childhood. The child characters in these films tend to be either ghosts or in-between figures, seemingly alive yet acting as mediators between the realms of the living and the dead, the past and the present. Through this liminal position, these children wreak havoc on the symbolic coherence of the films’ diegetic worlds. In so doing, they incarnate the ontological wound described by Cathy Caruth in her definition of trauma: “a breach in the mind’s experience of time, self, and the world” caused by an event that “is experienced too soon, too unexpectedly, to be fully known and is therefore not available to consciousness until it imposes itself ... repeatedly ... in the nightmares and repetitive actions” (4) of those who have experienced trauma. The Gothic aesthetic of these children expresses the ways in which trauma is locatable not in the original traumatic past event, but rather in “the way it was precisely not known in the first instance”, through revealing that it is trauma’s unassimilated element which “returns to haunt the survivor later on” (Caruth, author’s emphasis 4). The uncanny frisson in these films arises through the gradual exposition of the child character’s knowledge of this unassimilated element. As a result, these children trouble secure processes of symbolic functioning, embodying Anne Williams’ suggestion that “Gothic conventions imply a fascination with … possible fissures in the system of the symbolic as a whole” (141). I suggest that, reflecting Bruhm’s assertion above, these children are eerie because they have access to memories and knowledge as yet unassimilated within the realm of adult understanding, which is expressed in these films through the Gothic resurfacing of past traumas. Through an analysis of two of the most transnationally successful and influential films to emerge from this trend—The Sixth Sense (1999) and The Devil’s Backbone (2001)—this article explores the intersecting but tellingly distinctive ways in which the American and Spanish horror films figure the child as a vessel for previously repressed trauma. In both films, the eeriness of the children, Cole and Santi respectively, is associated with their temporal liminality and subsequent ability to invoke grisly secrets of the past, which in turn unsettles solid conceptions of identity. In The Sixth Sense, as in other American ghost films of this period, it is an adult character’s subjectivity which is untethered by the traumas of the uncanny child; Bruhm suggests that the contemporary Gothic “attacks adult self-identity on multiple fronts” (107), and in American films the uncanny child tends to launch this traumatic assault from within an adult character’s own psyche. Yet in the Spanish films, the Gothic child tends not to threaten an individual adult figure’s self-identity, instead constituting a challenge to secure concepts of socio-cultural identity. In The Sixth Sense, Cole raises a formerly repressed trauma in the mind of central adult character Malcolm Crowe, while simultaneously disturbing the viewer’s secure grasp on the film’s narrative world. Ultimately, Cole raises Freudian-inflected anxieties surrounding childhood’s disruption to coherent adult subjectivity, functioning as a receptacle for the adult’s repressed secrets. Cole’s gradual exposure of these secrets simulates the effects of trauma for both Malcolm and the viewer via a Gothic unsettling of meaning. While The Sixth Sense is set in the present, The Devil’s Backbone is set during the Spanish Civil War (1936-39)—a violent and traumatic period of Spain’s history, the ramifications of which have been largely unexplored in Spanish popular culture until very recently as a result of forty years of strict censorship under General Franco, whose dictatorship eroded following his death in 1975. Unlike Cole, Santi does not arouse a previously submerged trauma within an adult character’s mind, instead serving to allegorically raise socio-cultural trauma. Santi functions as an incarnation of Gilles Deleuze’s “child seer”, a figure who Deleuze claims first emerged in Italian neo-realist films of the 1940s as a response to the massive cultural rupture of World War II (3). The child seer is characterised by his entrapment in the gap between the perception of a traumatic event, and the understanding and subsequent action required to move on from it. Thus, upon experiencing a disturbing event, he suffers a breach in comprehension which disrupts the typical sensory-motor chain of perception-understanding-action, rendering him physically and mentally unable to escape his situation. Yet in experiencing this incapacity, the seer gains a powerful insight beyond the limits of linear temporality. On becoming a ghost, Santi escapes coherent space-time, and invokes the repressed spectre of Spain’s violent Civil War past, inciting an eerie collision of past and present. This temporal disruption has deep allegorical implications for contemporary Spain through the child’s symbolic status as vessel for the future. Santi’s embodiment of cultural trauma ensures that Spain’s past, as constructed by the film, eerily folds into the nation’s extra-diegetic present. The Sixth Sense In The Sixth Sense, adult protagonist Malcolm Crowe is a child psychiatrist, thus unravelling the riddles of the child’s psyche is positioned as the central quest of the film’s narrative. The dramatic twist in the film’s final scene reveals that the analysis of the child Cole’s “phobia” has in fact exhumed dormant spectres within Malcolm’s own mind, exposing the Gothic mechanisms whereby the uncanny child becomes conflated with the adult’s repressed trauma. This impression is heightened by the narrative structure of The Sixth Sense, in which the twist in the final scene shifts the meaning of all that has happened before. Both the audience and Malcolm are led to assume that they have uncovered and come to terms with Cole’s secret once it becomes clear two-thirds into the film that he “sees dead people”. However, the climactic twist exposes that Cole has in fact been hiding another secret which is not so easily ameliorated: that Malcolm is one of these dead people, having died in the film’s opening sequence. If the film’s narrative “pulling the rug out” from under the audience functions as intended, at the climax of the film both Malcolm and viewer simultaneously become privy to a layer of Cole’s secret previously inaccessible to us, both that Malcolm has been dead all along and that, subsequently, the hidden quest underlying the surface narrative has been Malcolm’s journey to come to terms with this disturbing truth. Thus, the uncanny child functions as a symbolic stage for the adult protagonist’s unassimilated trauma, and the unsettling nature of this experience is extended to the viewer via the gradual exposure of Cole’s secret. Further intensifying the uncanny effects of this Gothic disruption to adult knowledge, Cole also functions like a reincarnation of the crisis which has undermined Malcolm’s coherent identity as a successful child psychiatrist: his failure to cure former patient Vincent. Thus, Cole is like uncanny déjà vu for Malcolm and the viewer, an almost literal re-evocation of Malcolm’s past trauma. Both Vincent and Cole have a patch of grey hair at the back of their head, symbolising their access to knowledge too great for their youth, and as Malcolm explains, “They’re both so similar. Same mannerisms, same expressions, same things hanging over their heads.” At the opening of the film, Vincent is depicted as a wretched madman. He appears crying and half naked in Malcolm’s bathroom, having broken into his house, before shooting Malcolm and then turning the gun on himself. Thus, Vincent is an abject image of Malcolm’s failure, and his taunting words expose a rupture in Malcolm’s paternalistic, professional identity by hinting at his lack of awareness. “You don’t know so many things” Vincent remarks, and sarcastically undermines Malcolm’s “saviour” status by taunting, “Don’t you know me, hero?”. Functioning as a repetition of this trauma, Cole provides Malcolm with an opportunity to discover the “so many things” that he does not know, and also to once again become a “hero”. Cole functions as a literalisation of Malcolm’s compulsion to repeat the trauma which has exposed a breach in his sense of self, and to gain mastery over it. On first viewing, the audience is led to believe that this narrative is the primary one in the film, and that the film is wrapped up when Malcolm finally achieves his goal and becomes Cole’s hero. However, the final revelation that Cole has been keeping yet another secret from Malcolm—that Malcolm has been dead all along—reveals that this trauma is actually irrevocable: Malcolm was in fact killed by Vincent at the beginning of the film, thus the adult’s subjective breach (symbolised by his gunshot wound, which he suddenly notices for the first time) cannot be filled or repaired. All Malcolm can do at the close of the film is disappear, as a close-up of his face fades into the mediated image of him, now his only form of existence in the world as we know it, on the home videotapes of his wedding which play as his wife sleeps. Thus, Cole evokes the experience of a violent, unassimilated trauma which is experienced “too soon, too unexpectedly to be fully known in the first instance” (Caruth 4), a breach in subjectivity which has only become consciously known to Malcolm through the “nightmare repetition” figured by Cole. This experience of a traumatic disruption to the wholeness and coherence of subjective reality is echoed by the viewer’s own experience of The Sixth Sense, if the twist-narrative functions as intended. While on first viewing we are led to believe that we are watching a straightforward ghost story about a paternalistic psychologist helping a young child with an uncanny gift, we learn in the final scene that there has been an underlying double reality haunting the surface narrative all along. Central to this twist is the recognition that Cole was always aware of this second reality, but has been concealing it from Malcolm—underscoring the ways in which Malcolm’s trauma is bound up largely with what he was unable to comprehend and assimilate when the traumatic event of his death first occurred. The eerie effects of Malcolm’s traumatic confrontation with the child’s Gothic knowledge is extended to the viewer via the film’s narrative structure. Erlend Lavik discusses The Sixth Sense and other twist films in terms of a particular relationship between the syuzhet (the way in which a story’s components are organized) and the fabula (the raw components which constitute the story). He explains that in such films, there is a “doubling of the syuzhet, where we are led to construct a fabula that initially seems quite straightforward until suddenly a new piece of information is introduced that subverts (or decentres) the fictional world we have created. We come to realize the presence of another fabula running parallel to the first one but ‘beneath’ it, hidden from view” (Lavik 56). The revelation that Malcolm has been a ghost all along shatters the fabula that most viewers construct upon first viewing the film. The impression that an eerie, previously hidden double of accepted reality has bubbled to the surface of our perceptions is deeply uncanny, evoking the experience of filmic déjà vu. This is of course heightened by the fact that the viewer is compelled to re-watch the film in order to construct the second, and more “correct”, fabula. In doing so, the viewer experiences a “narrative bifurcation whereby we come to notice how traces of the correct fabula were actually available to us the first time” (Lavik 59). The process of re-watching the film in an attempt to solve the riddles of Malcolm’s existence reveals the viewer’s compulsion to undergo their own “detective work” in a parallel of Malcolm’s analysis of Cole: the exposure of the child’s secret turns a mirror upon the protagonist and audience which exposes a fracture in the adult’s subjectivity. Discussing the detective story, Slavoj Žižek explains that “the detective's role is ... to demonstrate how ‘the impossible is possible’ ... that is, to resymbolize the traumatic shock, to integrate it into symbolic reality” (58). On first viewing, this detective work is realized through Malcolm’s quest to comprehend Cole’s secrets, and then to situate the abject ghosts the child sees into a secure framework whereby they disappear if Cole helps them. The compulsion to re-watch the film in order to better understand how Malcolm experiences time, consciousness and communication (or lack there-of) represents an analogous attempt to re-integrate the traumatic shock raised by the twist-ending by imposing more secure symbolic frameworks upon the film’s diegetic world: to suture the traumatic breach in meaning. However, there are many irremediable gaps in Malcolm’s experiences—we do not actually see him trying to pay for the bus, or meeting Cole’s mother for the first time, or pondering the fact that no other human being has spoken to him directly for six months apart from Cole—fissures which repeat viewings cannot repair. The Devil’s Backbone The Devil’s Backbone is set in the final years of the Civil War, a liminal period in which the advancement of Spain’s national narrative is disturbingly uncertain. The film takes place in an orphanage for young boys from Republican families whose parents have been killed or captured in the Civil War. In the middle of the orphanage’s courtyard stands an unexploded bomb, an ominous and volatile reminder of the war. As well as being haunted by this unexploded bomb, the orphanage is also haunted by a child ghost, Santi, a former inhabitant of the orphanage who disappeared on the same night that the bomb landed in the orphanage’s grounds. We learn mid-way through the film that Santi in fact drowned in the orphanage’s cavernous cistern: after being struck on the head by the angry groundskeeper, Santi was left unable to swim, and is shown sinking helplessly into the water’s murky depths. Thus, Santi’s death represents the ultimate extreme of the child seer’s traumatic entrapment between perceiving and understanding the traumatic event, and the physical action required to escape it. Both the ghostly Santi and the unexploded bomb exude an eerie power despite, and perhaps because of, their apparent physical incapacity. Such corporeal powerlessness is the defining feature of Deleuze’s “child seer”, as the breach in the sensory-motor chain comes to imbue the child who encounters trauma with a penetrating gaze which sees beyond temporal borders. Once he becomes a ghost, Santi escapes the bounds of linear time altogether, becoming forever fused to the moment of his drowning. Santi’s spectral presence warps the ether around him as if he is permanently underwater, and the blood from his head wound constantly floats upwards. The sensory-motor chain becomes completely severed in a cinematic moment which can be likened to Deleuze “crystal of time”. Like the dual layers of narrative in The Sixth Sense, this crystal of time sparks a moment of Gothic frisson as linear time collapses and dual modes of temporality are expressed simultaneously: the chronological moment of Santi’s death—a ‘dead’ present that has already passed—and the fractured, traumatic memories of this past which linger in the present—what Deleuze would call a ‘virtual’ past which “coincides with the present that it was” (79). The traumatic effect of this collapse of temporal boundaries is enhanced by the fact that the shot of Santi drowning is repeated multiple times throughout the film—including in the opening minutes, before the audience is able to comprehend what we are seeing and where this scene fits into the film’s chronology. Ultimately, this cinematic crystal symbolically ungrounds linear narratives of Spanish history, which position the cultural rupture of the Civil War as a remnant of Spain’s past which has successfully been overcome. Through uncanny repetition, Santi’s death refuses to remain lodged in an immobilized “historical” past—a present that has passed—but remains forever alongside the present as an ethereal past that “is”. Santi’s raising of Gothic knowledge incites the wavering of not an adult character’s self-identity, as in The Sixth Sense, but a trembling in conceptual models of linear cultural progress. As a ghost, Santi is visually constructed as a broken porcelain doll, with cracks visible all over his body, emphasising his physical fragility; however, in his ghostly form it is this very fragility which becomes uncanny and threatening. His cracked body fetishizes his status as a subject who is not fully formed or complete. Thus, the film presents the post-Civil War child as a being who has been shattered and broken while undergoing the delicate process of being formed: an eerie incarnation of a trauma that has occurred “too soon” to be properly integrated. Santi’s broken body visualises the mechanisms whereby the violent conditions and mentalities of war permeate the child’s being in irreversible ways. Because he is soldered to the space and time of his death, he is caught forever as an expression of trauma in the inescapable gap between perception, assimilation and action. His haunting involves the intrusion of this liminal space onto the solid boundaries and binaries of the diegetic present; his abject presence forces other characters, and viewers, to experience the frisson of this previously concealed traumatic encounter. In so doing, Santi allegorically triggers the irruption of a fissure in the progression of Spain’s socio-cultural narrative. He embodies the ominous possibility that Spain’s grisly recent past may return within the child mutated by wartime trauma to engulf the future. The final scene of the film ideates the threshold of this volatile future, as the orphaned children stand as a group staring out at the endless expanse of desert beyond the orphanage’s bounds, all the adult characters having killed each other in a microcosm of the Civil War. Ultimately, both Cole and Santi enforce an eerie moment of recognition that the previously unassimilated traumas of the past live on within the present: a Gothic drawing forth of buried knowledge that exposes cracks in coherent meaning. In The Sixth Sense, Cole reveals the extent to which trauma is located in “the way it was precisely not known in the first instance” (Caruth 4), haunting Malcolm with his previous failure before exposing the all-encompassing extent to which this past trauma has fractured Malcom’s subjectivity. Santi of The Devil’s Backbone alludes to the ways in which this process of eliding past trauma extra-diegetically haunts contemporary Spain, particularly because those who were children during the Civil War are now the adult filmmakers, political leaders and constituents of Spanish society. These disturbances of historical and personal progress are rendered particularly threatening emerging as they do at the millennial turn, a symbolic temporal threshold which divides the recent past and the “new” present. The Gothic child in these contexts points to the danger inherent in misrecognizing traumatic histories—both personal and socio-cultural—as presents that have long-since passed instead of pasts that are. ReferencesBruhm, Steven. “Nightmare on Sesame Street: or, The Self-Possessed Child.” Gothic Studies 8.2 (2006): 98-210. Caruth, Cathy. Unclaimed Experience: Trauma, Narrative and History. Baltimore: Johns Hopkins University Press, 1996. Deleuze, Gilles. Cinema 2: The Time-Image. London: Continuum Books, 2005. The Devil’s Backbone. Dir. Guillermo del Toro. Perf. Fernando Tielve, Junio Valverde and Eduardo Diego. El Deseo S.A., 2001. Georgieva, Margarita. The Gothic Child. Basingstoke: Palgrave Macmillan, 2013. Fragile. Dir. Jaume Balageuró. Perf. Calista Flockhart, Richard Roxburgh and Ivana Baquero. Castelao Producciones, 2005. Lavik, Erlend. “Narrative Structure in The Sixth Sense: A New Twist in ‘Twist Movies?’” The Velvet Light Trap 58 (2006): 55-64. The Nameless. Dir. Jaumé Balaguero. Perf. Emma Vilarasau, Karra Elejalde and Tristán Ulloa. Filmax S.A., 1999. The Orphanage. Dir. Juan Antonio Bayona. Perf. Belén Rueda, Fernando Cayo and Roger Príncep. Esta Vivo! Laboratorio de Nuevos Talentos, 2007. The Others. Dir. Alejandro Amenábar. Perf. Nicole Kidman, Alakina Mann and James Bentley. Sociedad General de Cine, 2001. The Sixth Sense. Dir. M. Night Shyalaman. Perf. Haley Joel Osment, Bruce Willis and Toni Collette. Hollywood Pictures, 1999. Stir of Echoes. Dir. David Koepp. Perf. Kevin Bacon, Zachary David Cope and Kathryn Erbe. Artisan Entertainment, 1999. Williams, Anne. Art of Darkness: A Poetics of Gothic. Chicago: University of Chicago Press, 1995. Žižek, Slavoj. Looking Awry: An Introduction to Jacques Lacan Through Popular Culture. Cambridge: MIT Press, 1991.

This article explores resilience as it is experienced by refugees in the context of a relational community, visiting the notions of trauma, a thicker description of resilience and the trajectory toward positive growth through community. It calls for going beyond a Western biomedical therapeutic approach of exploration and adopting more of an emic perspective incorporating the worldview of the refugees. The challenge is for service providers working with refugees (who have experienced trauma) to move forward from a ‘harm minimisation’ model of care to recognition of a facilitative, productive community of people who are in a transitional phase between homelands. Contextualising Trauma Prior to the 1980s, the term ‘trauma’ was not widely used in literature on refugees and refugee mental health, hardly existing as a topic of inquiry until the mid-1980’s (Summerfield 422). It first gained prominence in relation to soldiers who had returned from Vietnam and in need of medical attention after being traumatised by war. The term then expanded to include victims of wars and those who had witnessed traumatic events. Seahorn and Seahorn outline that severe trauma “paralyses you with numbness and uses denial, avoidance, isolation as coping mechanisms so you don’t have to deal with your memories”, impacting a person‘s ability to risk being connected to others, detaching and withdrawing; resulting in extreme loneliness, emptiness, sadness, anxiety and depression (6). During the Civil War in the USA the impact of trauma was referred to as Irritable Heart and then World War I and II referred to it as Shell Shock, Neurosis, Combat Fatigue, or Combat Exhaustion (Seahorn & Seahorn 66, 67). During the twenty-five years following the Vietnam War, the medicalisation of trauma intensified and Post Traumatic Stress Disorder (PTSD) became recognised as a medical-psychiatric disorder in 1980 in the American Psychiatric Association international diagnostic tool Diagnostic Statistical Manual (DSM–III). An expanded description and diagnosis of PTSD appears in the DSM-IV, influenced by the writings of Harvard psychologist and scholar, Judith Herman (Scheper-Hughes 38) The Diagnostic and Statistical Manual (DSM-IV) of Mental Disorders (American Psychiatric Association, 2000) outlines that experiencing the threat of death, injury to oneself or another or finding out about an unexpected or violent death, serious harm, or threat of the same kind to a family member or close person are considered traumatic events (Chung 11); including domestic violence, incest and rape (Scheper-Hughes 38). Another significant development in the medicalisation of trauma occurred in 1998 when the Victorian Foundation for Survivors of Torture (VFST) released an influential report titled ‘Rebuilding Shattered Lives’. This then gave clinical practice a clearer direction in helping people who had experienced war, trauma and forced migration by providing a framework for therapeutic work. The emphasis became strongly linked to personal recovery of individuals suffering trauma, using case management as the preferred intervention strategy. A whole industry soon developed around medical intervention treating people suffering from trauma related problems (Eyber). Though there was increased recognition for the medicalised discourse of trauma and post-traumatic stress, there was critique of an over-reliance of psychiatric models of trauma (Bracken, et al. 15, Summerfield 421, 423). There was also expressed concern that an overemphasis on individual recovery overlooked the socio-political aspects that amplify trauma (Bracken et al. 8). The DSM-IV criteria for PTSD model began to be questioned regarding the category of symptoms being culturally defined from a Western perspective. Weiss et al. assert that large numbers of traumatized people also did not meet the DSM-III-R criteria for PTSD (366). To categorize refugees’ experiences into recognizable, generalisable psychological conditions overlooked a more localized culturally specific understanding of trauma. The meanings given to collective experience and the healing strategies vary across different socio-cultural groupings (Eyber). For example, some people interpret suffering as a normal part of life in bringing them closer to God and in helping gain a better understanding of the level of trauma in the lives of others. Scheper-Hughes raise concern that the PTSD model is “based on a conception of human nature and human life as fundamentally vulnerable, frail, and humans as endowed with few and faulty defence mechanisms”, and underestimates the human capacity to not only survive but to thrive during and following adversity (37, 42). As a helping modality, biomedical intervention may have limitations through its lack of focus regarding people’s agency, coping strategies and local cultural understandings of distress (Eyber). The benefits of a Western therapeutic model might be minimal when some may have their own culturally relevant coping strategies that may vary to Western models. Bracken et al. document case studies where the burial rituals in Mozambique, obligations to the dead in Cambodia, shared solidarity in prison and the mending of relationships after rape in Uganda all contributed to the healing process of distress (8). Orosa et al. (1) asserts that belief systems have contributed in helping refugees deal with trauma; Brune et al. (1) points to belief systems being a protective factor against post-traumatic disorders; and Peres et al. highlight that a religious worldview gives hope, purpose and meaning within suffering. Adopting a Thicker Description of Resilience Service providers working with refugees often talk of refugees as ‘vulnerable’ or ‘at risk’ populations and strive for ‘harm minimisation’ among the population within their care. This follows a critical psychological tradition, what (Ungar, Constructionist) refers to as a positivist mode of inquiry that emphasises the predictable relationship between risk and protective factors (risk and coping strategies) being based on a ‘deficient’ outlook rather than a ‘future potential’ viewpoint and lacking reference to notions of resilience or self-empowerment (342). At-risk discourses tend to focus upon antisocial behaviours and appropriate treatment for relieving suffering rather than cultural competencies that may be developing in the midst of challenging circumstances. Mares and Newman document how the lives of many refugee advocates have been changed through the relational contribution asylum seekers have made personally to them in an Australian context (159). Individuals may find meaning in communal obligations, contributing to the lives of others and a heightened solidarity (Wilson 42, 44) in contrast to an individual striving for happiness and self-fulfilment. Early naturalistic accounts of mental health, influenced by the traditions of Western psychology, presented thin descriptions of resilience as a quality innate to individuals that made them invulnerable or strong, despite exposure to substantial risk (Ungar, Thicker 91). The interest then moved towards a non-naturalistic contextually relevant understanding of resilience viewed in the social context of people’s lives. Authors such as Benson, Tricket and Birman (qtd. in Ungar, Thicker) started focusing upon community resilience, community capacity and asset-building communities; looking at areas such as - “spending time with friends, exercising control over aspects of their lives, seeking meaningful involvement in their community, attaching to others and avoiding threats to self-esteem” (91). In so doing far more emphasis was given in developing what Ungar (Thicker) refers to as ‘a thicker description of resilience’ as it relates to the lives of refugees that considers more than an ability to survive and thrive or an internal psychological state of wellbeing (89). Ungar (Thicker) describes a thicker description of resilience as revealing “a seamless set of negotiations between individuals who take initiative, and an environment with crisscrossing resources that impact one on the other in endless and unpredictable combinations” (95). A thicker description of resilience means adopting more of what Eyber proposes as an emic approach, taking on an ‘insider perspective’, incorporating the worldview of the people experiencing the distress; in contrast to an etic perspective using a Western biomedical understanding of distress, examined from a position outside the social or cultural system in which it takes place. Drawing on a more anthropological tradition, intervention is able to be built with local resources and strategies that people can utilize with attention being given to cultural traditions within a socio-cultural understanding. Developing an emic approach is to engage in intercultural dialogue, raise dilemmas, test assumptions, document hopes and beliefs and explore their implications. Under this approach, healing is more about developing intelligibility through one’s own cultural and social matrix (Bracken, qtd. in Westoby and Ingamells 1767). This then moves beyond using a Western therapeutic approach of exploration which may draw on the rhetoric of resilience, but the coping strategies of the vulnerable are often disempowered through adopting a ‘therapy culture’ (Furedi, qtd. in Westoby and Ingamells 1769). Westoby and Ingamells point out that the danger is by using a “therapeutic gaze that interprets emotions through the prism of disease and pathology”, it then “replaces a socio-political interpretation of situations” (1769). This is not to dismiss the importance of restoring individual well-being, but to broaden the approach adopted in contextualising it within a socio-cultural frame. The Relational Aspect of Resilience Previously, the concept of the ‘resilient individual’ has been of interest within the psychological and self-help literature (Garmezy, qtd. in Wilson) giving weight to the aspect of it being an innate trait that individuals possess or harness (258). Yet there is a need to explore the relational aspect of resilience as it is embedded in the network of relationships within social settings. A person’s identity and well-being is better understood in observing their capacity to manage their responses to adverse circumstances in an interpersonal community through the networks of relationships. Brison, highlights the collective strength of individuals in social networks and the importance of social support in the process of recovery from trauma, that the self is vulnerable to be affected by violence but resilient to be reconstructed through the help of others (qtd. in Wilson 125). This calls for what Wilson refers to as a more interdisciplinary perspective drawing on cultural studies and sociology (2). It also acknowledges that although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. To date, within sociology and cultural studies, there is not a well-developed perspective on the topic of resilience. Resilience involves a complex ongoing interaction between individuals and their social worlds (Wilson 16) that helps them make sense of their world and adjust to the context of resettlement. It includes developing a perspective of people drawing upon negative experiences as productive cultural resources for growth, which involves seeing themselves as agents of their own future rather than suffering from a sense of victimhood (Wilson 46, 258). Wilson further outlines the display of a resilience-related capacity to positively interpret and derive meaning from what might have been otherwise negative migration experiences (Wilson 47). Wu refers to ‘imagineering’ alternative futures, for people to see beyond the current adverse circumstances and to imagine other possibilities. People respond to and navigate their experience of trauma in unique, unexpected and productive ways (Wilson 29). Trauma can cripple individual potential and yet individuals can also learn to turn such an experience into a positive, productive resource for personal growth. Grief, despair and powerlessness can be channelled into hope for improved life opportunities. Social networks can act as protection against adversity and trauma; meaningful interpersonal relationships and a sense of belonging assist individuals in recovering from emotional strain. Wilson asserts that social capabilities assist people in turning what would otherwise be negative experiences into productive cultural resources (13). Graybeal (238) and Saleeby (297) explore resilience as a strength-based practice, where individuals, families and communities are seen in relation to their capacities, talents, competencies, possibilities, visions, values and hopes; rather than through their deficiencies, pathologies or disorders. This does not present an idea of invulnerability to adversity but points to resources for navigating adversity. Resilience is not merely an individual trait or a set of intrinsic behaviours that can be displayed in ‘resilient individuals’. Resilience, rather than being an unchanging attribute, is a complex socio-cultural phenomenon, a relational concept of a dynamic nature that is situated in interpersonal relations (Wilson 258). Positive Growth through a Community Based Approach Through migrating to another country (in the context of refugees), Falicov, points out that people often experience a profound loss of their social network and cultural roots, resulting in a sense of homelessness between two worlds, belonging to neither (qtd. in Walsh 220). In the ideological narratives of refugee movements and diasporas, the exile present may be collectively portrayed as a liminality, outside normal time and place, a passage between past and future (Eastmond 255). The concept of the ‘liminal’ was popularised by Victor Turner, who proposed that different kinds of marginalised people and communities go through phases of separation, ‘liminali’ (state of limbo) and reincorporation (qtd. in Tofighian 101). Difficulties arise when there is no closure of the liminal period (fleeing their former country and yet not being able to integrate in the country of destination). If there is no reincorporation into mainstream society then people become unsettled and feel displaced. This has implications for their sense of identity as they suffer from possible cultural destabilisation, not being able to integrate into the host society. The loss of social supports may be especially severe and long-lasting in the context of displacement. In gaining an understanding of resilience in the context of displacement, it is important to consider social settings and person-environment transactions as displaced people seek to experience a sense of community in alternative ways. Mays proposed that alternative forms of community are central to community survival and resilience. Community is a source of wellbeing for building and strengthening positive relations and networks (Mays 590). Cottrell, uses the concept of ‘community competence’, where a community provides opportunities and conditions that enable groups to navigate their problems and develop capacity and resourcefulness to cope positively with adversity (qtd. in Sonn and Fisher 4, 5). Chaskin, sees community as a resilient entity, countering adversity and promoting the well-being of its members (qtd. in Canavan 6). As a point of departure from the concept of community in the conventional sense, I am interested in what Ahmed and Fortier state as moments or sites of connection between people who would normally not have such connection (254). The participants may come together without any presumptions of ‘being in common’ or ‘being uncommon’ (Ahmed and Fortier 254). This community shows little differentiation between those who are welcome and those who are not in the demarcation of the boundaries of community. The community I refer to presents the idea as ‘common ground’ rather than commonality. Ahmed and Fortier make reference to a ‘moral community’, a “community of care and responsibility, where members readily acknowledge the ‘social obligations’ and willingness to assist the other” (Home office, qtd. in Ahmed and Fortier 253). Ahmed and Fortier note that strong communities produce caring citizens who ensure the future of caring communities (253). Community can also be referred to as the ‘soul’, something that stems out of the struggle that creates a sense of solidarity and cohesion among group members (Keil, qtd. in Sonn and Fisher 17). Often shared experiences of despair can intensify connections between people. These settings modify the impact of oppression through people maintaining positive experiences of belonging and develop a positive sense of identity. This has enabled people to hold onto and reconstruct the sociocultural supplies that have come under threat (Sonn and Fisher 17). People are able to feel valued as human beings, form positive attachments, experience community, a sense of belonging, reconstruct group identities and develop skills to cope with the outside world (Sonn and Fisher, 20). Community networks are significant in contributing to personal transformation. Walsh states that “community networks can be essential resources in trauma recovery when their strengths and potential are mobilised” (208). Walsh also points out that the suffering and struggle to recover after a traumatic experience often results in remarkable transformation and positive growth (208). Studies in post-traumatic growth (Calhoun & Tedeschi) have found positive changes such as: the emergence of new opportunities, the formation of deeper relationships and compassion for others, feelings strengthened to meet future life challenges, reordered priorities, fuller appreciation of life and a deepening spirituality (in Walsh 208). As Walsh explains “The effects of trauma depend greatly on whether those wounded can seek comfort, reassurance and safety with others. Strong connections with trust that others will be there for them when needed, counteract feelings of insecurity, hopelessness, and meaninglessness” (208). Wilson (256) developed a new paradigm in shifting the focus from an individualised approach to trauma recovery, to a community-based approach in his research of young Sudanese refugees. Rutter and Walsh, stress that mental health professionals can best foster trauma recovery by shifting from a predominantly individual pathology focus to other treatment approaches, utilising communities as a capacity for healing and resilience (qtd. in Walsh 208). Walsh highlights that “coming to terms with traumatic loss involves making meaning of the trauma experience, putting it in perspective, and weaving the experience of loss and recovery into the fabric of individual and collective identity and life passage” (210). Landau and Saul, have found that community resilience involves building community and enhancing social connectedness by strengthening the system of social support, coalition building and information and resource sharing, collective storytelling, and re-establishing the rhythms and routines of life (qtd. in Walsh 219). Bracken et al. suggest that one of the fundamental principles in recovery over time is intrinsically linked to reconstruction of social networks (15). This is not expecting resolution in some complete ‘once and for all’ getting over it, getting closure of something, or simply recovering and moving on, but tapping into a collective recovery approach, being a gradual process over time. Conclusion A focus on biomedical intervention using a biomedical understanding of distress may be limiting as a helping modality for refugees. Such an approach can undermine peoples’ agency, coping strategies and local cultural understandings of distress. Drawing on sociology and cultural studies, utilising a more emic approach, brings new insights to understanding resilience and how people respond to trauma in unique, unexpected and productive ways for positive personal growth while navigating the experience. This includes considering social settings and person-environment transactions in gaining an understanding of resilience. Although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. Social networks and capabilities can act as a protection against adversity and trauma, assisting people to turn what would otherwise be negative experiences into productive cultural resources (Wilson 13) for improved life opportunities. The promotion of social competence is viewed as a preventative intervention to promote resilient outcomes, as social skill facilitates social integration (Nettles and Mason 363). As Wilson (258) asserts that resilience is not merely an individual trait or a set of intrinsic behaviours that ‘resilient individuals’ display; it is a complex, socio-cultural phenomenon that is situated in interpersonal relations within a community setting. References Ahmed, Sara, and Anne-Marie Fortier. “Re-Imagining Communities.” International of Cultural Studies 6.3 (2003): 251-59. Bracken, Patrick. J., Joan E. Giller, and Derek Summerfield. Psychological Response to War and Atrocity: The Limitations of Current Concepts. Elsevier Science, 1995. 8 Aug, 2013 ‹http://www.freedomfromtorture.org/sites/default/files/documents/Summerfield-PsychologicalResponses.pdf>. Brune, Michael, Christian Haasen, Michael Krausz, Oktay Yagdiran, Enrique Bustos and David Eisenman. “Belief Systems as Coping Factors for Traumatized Refugees: A Pilot Study.” Eur Psychiatry 17 (2002): 451-58. Canavan, John. “Resilience: Cautiously Welcoming a Contested Concept.” Child Care in Practice 14.1 (2008): 1-7. Chung, Juna. Refugee and Immigrant Survivors of Trauma: A Curriculum for Social Workers. Master’s Thesis for California State University. Long Beach, 2010. 1-29. Eastmond, Maria. “Stories of Lived Experience: Narratives in Forced Migration Research.” Journal of Refugee Studies 20.2 (2007): 248-64. Eyber, Carola “Cultural and Anthropological Studies.” In Forced Migration Online, 2002. 8 Aug, 2013. ‹http://www.forcedmigration.org/research-resources/expert-guides/psychosocial- issues/cultural-and-anthropological-studies>. Graybeal, Clay. “Strengths-Based Social Work Assessment: Transforming the Dominant Paradigm.” Families in Society 82.3 (2001): 233-42. Kleinman, Arthur. “Triumph or Pyrrhic Victory? The Inclusion of Culture in DSM-IV.” Harvard Rev Psychiatry 4 (1997): 343-44. Mares, Sarah, and Louise Newman, eds. Acting from the Heart- Australian Advocates for Asylum Seekers Tell Their Stories. Sydney: Finch Publishing, 2007. Mays, Vicki M. “Identity Development of Black Americans: The Role of History and the Importance of Ethnicity.” American Journal of Psychotherapy 40.4 (1986): 582-93. Nettles, Saundra Murray, and Michael J. Mason. “Zones of Narrative Safety: Promoting Psychosocial Resilience in Young People.” The Journal of Primary Prevention 25.3 (2004): 359-73. Orosa, Francisco J.E., Michael Brune, Katrin Julia Fischer-Ortman, and Christian Haasen. “Belief Systems as Coping Factors in Traumatized Refugees: A Prospective Study.” Traumatology 17.1 (2011); 1-7. Peres, Julio F.P., Alexander Moreira-Almeida, Antonia, G. Nasello, and Harold, G. Koenig. “Spirituality and Resilience in Trauma Victims.” J Relig Health (2006): 1-8. Saleebey, Dennis. “The Strengths Perspective in Social Work Practice: Extensions and Cautions.” Social Work 41.3 (1996): 296-305. Scheper-Hughes, Nancy. “A Talent for Life: Reflections on Human Vulnerability and Resilience.” Ethnos 73.1 (2008): 25-56. Seahorn, Janet, J. and Anthony E. Seahorn. Tears of a Warrior. Ft Collins, USA: Team Pursuits, 2008. Sonn, Christopher, and Adrian Fisher. “Sense of Community: Community Resilient Responses to Oppression and Change.” Unpublished article. Curtin University of Technology & Victoria University of Technology: undated. Summerfield, Derek. “Childhood, War, Refugeedom and ‘Trauma’: Three Core Questions for Medical Health Professionals.” Transcultural Psychiatry 37.3 (2000): 417-433. Tofighian, Omid. “Prolonged Liminality and Comparative Examples of Rioting Down Under”. Fear and Hope: The Art of Asylum Seekers in Australian Detention Centres Literature and Aesthetics (Special Edition) 21 (2011): 97-103. Ungar, Michael. “A Constructionist Discourse on Resilience: Multiple Contexts, Multiple Realities Among at-Risk Children and Youth.” Youth Society 35.3 (2004): 341-365. Ungar, Michael. “A Thicker Description of Resilience.” The International Journal of Narrative Therapy and Community Work 3 & 4 (2005): 85-96. Walsh, Froma. “Traumatic Loss and Major Disasters: Strengthening Family and Community Resilience.” Family Process 46.2 (2007): 207-227. Weiss, Daniel. S., Charles R. Marmar, William. E. Schlenger, John. A. Fairbank, Kathleen Jordon, Richard L. Hough, and Richard A. Kulka. “The Prevalence of Lifetime and Partial Post- Traumatic Stress Disorder in Vietnam Theater Veterans.” Journal of Traumatic Stress 5.3 (1992):365-76. Westoby, Peter, and Ann Ingamells. “A Critically Informed Perspective of Working with Resettling Refugee Groups in Australia.” British Journal of Social Work 40 (2010): 1759-76. Wilson, Michael. “Accumulating Resilience: An Investigation of the Migration and Resettlement Experiences of Young Sudanese People in the Western Sydney Area.” PHD Thesis. University of Western Sydney ( 2012): 1-297. Wu, K. M. “Hope and World Survival.” Philosophy Forum 12.1-2 (1972): 131-48.

Dream, 2008Go to visit a friend with vulvodynia who recently had a baby only to find that she is desolate. I realise the baby–a little boy–died. We go for a walk together. She has lost weight through the ordeal & actually looks on the edge of beauty for the first time. I feel like saying something to this effect–like she had a great loss but gained beauty as a result–but don’t think it would be appreciated. I know I shouldn’t stay too long &, sure enough, when we get back to hers, she indicates she needs for me to go soon. In her grief though, her body begins to spasm uncontrollably, describing the arc of the nineteenth-century hysteric. I start to gently massage her back & it brings her great relief as her body relaxes. I notice as I massage her, that she has beautiful gold and silver studs, flowers, filigree on different parts of her back. It describes a scene of immense beauty. I comment on it.In 2008, I was following a writing path dictated by my vulvodynia, or chronic vulval pain, and was exploring the possibility of my disorder being founded in trauma. The theory did not, in my case, hold up and I had decided to move on when serendipity intervened. Books ordered for different purposes arrived simultaneously and, as I dipped into the texts, I found startling correspondence between them. The books? Neurologist Jean-Martin Charcot’s lectures on hysteria, translated into English in 1889; psychiatrist W.H.R. Rivers’s explication of a biological theory of the neuroses published in 1922; and trauma neurologist Robert C. Scaer’s interpretation, in 2007, of the psychosomatic symptoms of his patients. The research grasped my intellect and imagination and maintained its grip until the ensuing chapter was done with me: my day life, papers and books skewed across tables; my night life, dreams surfeited with suffering and beauty, as I struggled with the possibility of any relationship between the two. Just as Rivers recognised that the shell-shock of World War I was not a physical injury as such but a trigger for and form of hysteria, so too, a few decades earlier, did Charcot insistently equate the railway brain/spine that resulted from railway accidents, with the hysteria of other of his patients, recognising that the precipitating incident constituted trauma that lodged in the body/mind of the victim (Clinical 221). More recently, Scaer notes that the motor vehicle accident (MVA) from which whiplash ensues is usually of insufficient force to logically cause bodily injury and, through this understanding, links whiplash and the railway brain/spine of the nineteenth century (25).In terms of comparative studies, most exciting for a researcher is the detail with which Charcot described patient after patient with hysteria in the Salpêtrière hospital, and elements of correspondence in symptomatology between these and Scaer’s patients, the case histories of which open most chapters of his book, titled appropriately, The Body Bears the Burden.Here are symptoms selected from a case study from each clinician:She subsequently developed headaches, neck pain, panic attacks, and full-blown post-traumatic stress disorder, along with significant cognitive problems [...] As her neck pain worsened and spread to her lower back, shoulders and arms, she noted increasing morning stiffness, and generalized pain and sensitivity to touch. With the development of interrupted, non-restorative sleep and chronic fatigue, she was ultimately diagnosed by a rheumatologist with fibromyalgia (Scaer 107).And:The patient suffers from a permanent headache of a constrictive character [...] All kinds of sound are painful to his ear, and he does his best to avoid them. It is impossible for him to fix his attention to any matter, or to devote himself to anything without speedily experiencing very great fatigue [...] He has insomnia and is frequently tormented by horrible dreams [...] Further, his memory appears to be considerably weakened (Charcot, Clinical 387).In the case of both patients, there was no significant physical injury, though both were left physically, as well as psychically, disabled. In the accidents that precipitated these symptoms, both were placed in positions of terrified helplessness as potential destruction bore down on them. In the case of Scaer’s patient, she froze in the driver’s seat at traffic lights as a large dump truck slowly reversed back on to her car, crushing the bonnet and engine compartment as it moved inexorably toward her. In the case of Charcot’s patient, he was dragging his barrow along the road when a laundryman’s van, pulled at “railway speed” by a careering horse, bore down on him, striking the wheel of his barrow (Clinical 375). It took some hours for the traumatised individuals of each incident to return to their senses.Scaer describes whiplash syndrome as “a diverse constellation of symptoms consisting of pain, neurologic symptoms, cognitive impairment, and emotional complaints” (xvii), and argues that the somatic or bodily expressions of the syndrome “may represent a universal constellation of symptoms attributable to any unresolved life-threatening experience” (143). Thus, as we look back through history, whiplash equals shell-shock equals railway brain equals the “swooning” and “vapours” of the eighteenth century (Shorter Chap. 1). All are precipitated by different causes, but all share the same outcome; diverse, debilitating symptoms affecting the body and mind, which have no reasonable physical explanation and which show no obvious organic cause. Human stress and trauma have always existed.In modern and historic studies of hysteria, much is made of the way in which the symptoms of hysterics have, over the centuries, mimicked “real” organic conditions (e.g. Shorter). Rivers discusses mimesis as a quality of the “gregarious” or herd instinct, noting that the enhanced suggestibility of such a state was utilised in military training. Here, preparation for combat focused on an unthinking obedience to duty and orders, and a loss of individual agency within the group: “The most successful training is one which attains such perfection of this responsiveness that each individual soldier not merely reacts at once to the expressed command of his superior, but is able to divine the nature of a command before it is given and acts as a member of the group immediately and effectively” (211–12). In the animal kingdom, the herd instinct manifests in behaviour that impacts the survival of prey and predator: schools of sardines move as one organism, seeking safety in numbers, while predatory sailfish act in silent concert to push the school into a tighter formation from which they can take orchestrated turns to feed.Unfortunately, the group mimesis created through a passive surrender of the individual ego to the herd, while providing a greater sense of security and chance of survival, also made World War I soldiers more vulnerable to the development of post-traumatic hysteria. At the Salpêtrière, Charcot described in meticulous detail the epileptic-like convulsions of hysteria major (la grande hystérie), which appeared to be an unwitting imitation of the seizures of epileptic inmates with whom hysteria patients were housed. Such convulsions included the infamous arc en circle, or backward-arched bodily semicircle, through which the individual’s body was thrust, up into the air, in an arc of distress only earthed by flexed feet and contorted neck (Veith 231). The suffering articulated in this powerful image stayed with me as I read, and percolated through my dreams.The three texts in which I remained transfixed had issued from different eras and used different language from each other, but all three contained similar and complementary insights. I found further correspondence between Charcot and Scaer in their understanding of the neurophysiology underlying hysteria/trauma. Though he did not have the technology to observe it, Charcot insisted that the symptoms of hysteria were the result of real changes in the nervous system. He distinguished between “organic” causes of disease, and the “functional” or “dynamic” causes of such disorders as hysteria and epilepsy: as he noted of the “hystero-traumatic paraplegia” of a patient, “it depends upon a dynamic lesion affecting the motor and sensory zones of the grey cortex of the brain which in a normal state preside over the functions of that limb” (Clinical 382). He proposed a potentially reversible “dynamic alteration” in the brain of the hysteric (Clinical 223–24). Compare Scaer: “Clinical syndromes previously categorized as ‘nonphysiological,’ ‘psychosomatic,’ or ‘functional’ may be based on demonstrable dynamic neurophysiological changes in the brain” (xx–xxi).Another link between the work of Charcot and Scaer is their insistence on the mind/body as a continuum, rather than separate entities. The perspicacity of the two researcher/clinicians forms bookends to a model separating mind from body that, in the wake of the popularisation and distortion of Freudian theory, characterised the twentieth-century. Said Charcot: “the physician must be a psychologist if he wants to interpret the most refined of cerebral functions, since psychology is nothing else but physiology of a part of the brain” (cited by Goetz 32). Says Scaer: “The distinction between the ‘psychological’ and physical pathological manifestations of traumatic stress, as suggested in the term ‘psychosomatic,’ needs to be discarded” (127). He proposes that, instead, we consider a mind/brain/body continuum which more accurately reflects, “the pathophysiological, neurobiological, endocrinological, and immunological changes induced by trauma” and the bodily manifestations of disease which follow (127).Charcot’s modernity is perhaps most evident in his understanding of equivalence between mind and brain, and his belief in what we now call “neuroplasticity”. Dealing with two patients with hysterical (traumatic) paralysis, Charcot recognised the value of friction, massage, and passive movements of the paralysed limb, not to build muscle strength, but to “revive” the “motor representation” in the brain as a necessary precursor to voluntary movement (Clinical 310). He noted the way in which, through repetition, movement strengthens. The parallel between Charcot’s insight, and recent research and practice which indicates that intense exercise for stroke victims assists the retrieval of motor programmes in the nervous system, in turn facilitating increased strength and movement, is quite astounding (Doidge Chap. 5).Scaer, like Rivers before him, understands the “freeze” or immobility response to threat as a very primitive or arcane level of the survival instinct. When neither fight nor flight will ensure an animal’s survival, it often manifests the freeze response, playing “dead”. After danger has passed, the animal might vibrate and shake, discharging the stored energy, physiologically “effecting” its defence or escape, and becoming fully functional again. Scaer describes this discharge process in animals as being “as imperceptible as a shudder, or as dramatic as a grand mal seizure” (19). The human, being an animal, also instinctually resorts to immobility when that is the reaction that will best ensure survival. As a result of this response, energy that would have been discharged in fighting or fleeing is bound up in the nervous system, along with accompanying terror, rage and helplessness. Unlike other animals that naturally discharge this energy when safe, humans often cognitively override the subtle but essential restorative behaviours that complete the full instinctual response, leaving them in a vicious cycle of fear and immobility and ultimately generating the symptoms of trauma.Scaer writes, “this apparent lack of discharge of autonomic energy after the occurrence of freezing [...] may represent a dangerous suppression of instinctual behavior, resulting in the imprinting of the traumatic experience in unconscious memory and arousal systems of the brain” (21). He proposes a persuasive model of “somatic dissociation” in which the body continues to manifest a threat to survival through impairment of the region of the body that perceived the sensory messages, and disability that reflects the incomplete motor defence (100). He writes of his patients in a chronic pain programme: “We invariably noticed that the patient’s unconscious posture reflected not only the pain, but also the experience of the traumatic event that produced the pain. The asymmetrical postural patterns, held in procedural memory, almost always reflect the body’s attempt to move away from the injury or threat that caused the injury” (84).Scaer’s concept of somatic dissociation, when applied to some of Charcot’s case studies, makes sense of their bodily symptoms. Charcot’s patient P— experiences no life threat, but a shock that involves grief and shame (Clinical 131–39). On a fox-hunting outing, he mistakes his friend’s dog for a fox, accidently shooting it dead. The friend is distraught, and P— consequently deeply distressed. He continues with the hunt, but later, when he raises his fire-arm to shoot a rabbit, collapses with a paralysis of the right side (he is right-handed), and then a loss of consciousness, with consequent confused recollection. Charcot’s lecture focuses on the “word-blindness” P— evidences, apparently associated with post-traumatic memory-deficits, but what is also arresting is the right-sided paralysis which lasts for some days, and the loss of vision on his right side. It is as if the act to shoot again is prevented by a body, shocked by its former action. The body parts affected hold meaning.In the case of the barrow man discussed earlier; although he has no lasting organic damage to his legs, nevertheless, his “feet remain literally fixed to the ground” (Clinical 378) when he is standing, perhaps reproducing the immobility with which he faced the rapidly looming van as it bore down on him. His paralysis speaks of his frozen helplessness, the trauma now locked in his body.In the case of the patient Ler—, aged around sixty, Charcot links her symptoms with a “series of frights” (Lectures 279): at eleven she was terrorised by a mad dog; at sixteen she was horrified by the sight of the corpse of a murdered woman; and, at the same age, she was threatened by robbers in a wood. During her violent hystero-epileptic attacks Ler— “hurls furious invectives against imaginary individuals, crying out, ‘villains! robbers! brigands! fire! fire! O, the dogs! I’m bitten!’” (Lectures 281). Here, the compilation of trauma is articulated through the body and the voice. Given that the extreme early childhood poverty and deprivation of Ler— were typical of hysterical patients at the Salpêtrière (Goetz 193), one might speculate that the hospital population of hysterics was composed of often severely traumatised women.The traumatised person is left with a constellation of symptoms familiar to anyone who has studied the history of hysteria. These comprise, but are not limited to, flashbacks, panic attacks, insomnia, depression, and unprovoked rage. The individual is also affected by physical symptoms that might include blindness or mutism, paralysis, spasms, skin anaesthesia, chronic fatigue, irritable bowel, migraines, or chronic pain. For trauma theorist Peter A. Levine, the key to healing lies in completing the original instinctual response; “trauma is part of a natural physiological process that simply has not been allowed to be completed” (155). The traumatised person stays stuck in or compulsively relives trauma in order to do just that. In 1885, Jean-Martin Charcot lectured at the Salpêtrière hospital in Paris, including among his case studies the patient he names Deb—. She resides more evocatively in my imagination as “the lady in the carriage”, a title drawn from Charcot’s description of her symptoms, and from the associated photographs which capture static moments of her frenzied and compulsive dance:Now look at this patient [...] In the first phase, rhythmical jerkings of the right arm, like the movements of hammering, occur [...] Then after this period there succeeds a period of tonic spasms, and of contortions of the arm and head, recalling partial epilepsy [...] Finally, measured movements of the head to the right and the left occur; rapid movements defying all interpretation, for I ask you, what do they correspond to in the region of physiological acts? At the same time the patient utters a cry, or rather a kind of plaintive wail, always the same [...] You see by this example that rhythmical chorea may be in certain cases a grave affection [affliction]. Not that it directly menaces life, but that it may persist over a very long period of time, and become a most distressing infirmity [...] The chorea has lasted for more than thirty years [...] The onset occurred at the age of thirty-six. About this time, when out driving in a carriage with her husband, she fell over a precipice with the horse and carriage. After the great fright which she had thus experienced she lost consciousness for three hours. This was followed by a convulsive seizure of hysteria major, by rigidity of the limbs of the right side, and cries like the barking of a dog (Clinical 193–95).I found this case study early in my reading of Charcot, but the lady in the carriage stayed with me as a trope of the relentless embodiment of trauma in its drive to be conclusively expressed, properly acknowledged, and potentially understood. Hence the persistent pain and distress of Scaer’s MVA patients; the patients treated by Rivers, with limbs and vocal-chords frozen in a never-ending moment of self-defence; the dramatic hysterical attacks of the impoverished patients in Charcot’s Salpêtrière; and the rhythmical chorea of the lady in the carriage, her involuntary jerky dance a physical re-enactment of her original trauma, when the carriage in which she was driving went over a precipice. Her helplessness in the event which precipitated her hysteria is a central factor in her continuing distress, her involuntary passivity removing her sense of agency and, like the soldier confined endlessly and powerlessly in the trenches waiting for inevitable terrifying action, rendering her unable to fight or flee.The fact that the lady in the carriage may be stuck in a traumatic incident experienced more than thirty years before attests to the way in which trauma insistently pushes to be resolved. Her re-enactment is literal, but Levine acknowledges the relevance of a “repetition compulsion” (181), expressed originally by Freud as the “compulsion to repeat” (19). This describes the often subtle way in which we continue to involve ourselves in situations that are replays of traumatic themes from childhood—symbolic re-enactments. Levine revitalises the idea however, by focusing on the interrupted instinctual response that calls for physiological resolution: “the drive to complete the freezing response remains active no matter how long it has been in place” (111).The knowledge a traumatised person seeks is, in trauma, literally locked in the body/mind. It rises up through dreams and throws itself aggressively at one in memories that are experienced as a terrifying present. It twists limbs in painful contractures and paralyzes the limb that was lifted in defence. The fear of turning to face this knowledge locks the individual in a recurring cycle of terror and immobility. At its end-point, s/he survives in the pathological limbo of Post-Traumatic Stress Disorder (PTSD), avoiding any arousal that might trigger all the physiological and emotional events of the original trauma. The original threat or trauma continues to exist in a perpetual present, with the individual unable to relegate it to the past as a bearable memory.It is possible to interpret such suffering in many ways. One might, for instance, focus on the pathology of an apparent system malfunction, which keeps the body/mind inefficiently glued to an unsolvable past. I choose to emphasise here, however, the creativity and persistence of the human body/mind in its drive to resolve the response to trauma, recover equilibrium and face effectively the recurrent challenges of life. As well as physical symptoms which exact attention, this drive or instinct might include the prompting of dreams and the meaningful coincidences we notice as we open our eyes to them, all of which can lead us down previously unconsidered paths. Does the body/mind only continue to malfunction due to our inability to correctly decipher its language? In relation to trauma, the body/mind bears the burden, but it might also hold the key to recovery.References Charcot, Jean-Martin. Lectures on the Diseases of the Nervous System. Trans. George Sigerson. London: The New Sydenham Society, 1877.---. Clinical Lectures on Diseases of the Nervous System: Volume 3. Trans. Thomas Savill. London: The New Sydenham Society, 1889.Doidge, Norman. The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. Melbourne: Scribe, 2008.Freud, Sigmund. “Beyond the Pleasure Principle.” The Standard Edition of the Complete Psychological Works of Sigmund Freud. Ed. and Trans. James Strachey. London: Hogarth Press, 1955. 7–64.Goetz, Christopher G, Michel Bonduelle, and Toby Gelfand. Charcot: Constructing Neurology. New York: Oxford University Press, 1995.Levine, Peter A. Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences. Berkeley, CA: North Atlantic Books, 1997.Rivers, W. H. R. Instinct and the Unconscious: A Contribution to a Biological Theory of the Psycho-Neuroses. 2nd ed. Cambridge: Cambridge University Press, 1922.Scaer, Robert C. The Body Bears the Burden: Trauma, Dissociation, and Disease. 2nd ed. New York: Haworth Press, 2007.Shorter, Edward. From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era. New York: Free Press, 1992.Veith, Ilza. Hysteria: The History of a Disease. Chicago: University of Chicago Press, 1965.