Relevant bibliographies by topics / Psychic trauma in literature

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Academic literature on the topic 'Psychic trauma in literature'

Author: Grafiati
Published: 4 June 2021
Last updated: 31 July 2024

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Journal articles on the topic "Psychic trauma in literature"

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Brody, Michael. "Batman: Psychic Trauma and its Solution." Journal of Popular Culture 28, no. 4 (March 1995): 171–78. http://dx.doi.org/10.1111/j.0022-3840.1995.00171.x.

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S, Sruthi, and Savitha A R. "Trauma and Psychological Self-Destruction: An Overview of the Exasperating Emotional Imbalance in K R Meera’s The Unseeing Idol of Light." Grove - Working Papers on English Studies 30 (December 30, 2023): 119–34. http://dx.doi.org/10.17561/grove.v30.8027.

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The present article discusses trauma and its impact on human emotions, particularly on women, in literature, with a focus on K R Meera's novel, The Unseeing Idol of Light. The research paper highlights the rise of trauma theory in literature and explores the cultural and psychological influence of trauma in literature. It also analyses the characters in the novel through the lens of emotional imbalance and interdependency and examines the interrelation between vision, love, and trauma. The prevalence of negative emotions over positive emotions in the novel has been discussed. The paper emphasises the importance of mental stability in contemporary society and discusses various themes such as psychic changes, loss, longing, and transformation. The researcher aims to analyse and relate the selected work with critical thinking to shed light on the cultural and psychological impressions of literature.
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Matus, Jill L. "HISTORICIZING TRAUMA: THE GENEALOGY OF PSYCHIC SHOCK IN DANIEL DERONDA." Victorian Literature and Culture 36, no. 1 (March 2008): 59–78. http://dx.doi.org/10.1017/s1060150308080042.

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In the penultimate book ofDaniel Deronda, Gwendolen Harleth appears in a state of physical and mental shock after the drowning of her detested husband. Exposed to an increasingly popularized discourse of trauma, today's readers would have little trouble in identifying and labeling Gwendolen as a traumatized subject, suffering from a variety of typical symptoms in the aftermath of her terrible experience. She is fixated on the “dead face” of Grandcourt in the water, hallucinating it everywhere. Later, she complains that she “can't sleep much” and that “[t]hings repeat themselves in me so. They come back – they will all come back” (659; ch. 65). Disoriented in the present, she seems to return repeatedly to the past, the line between her interior world and the external world growing increasingly tenuous: “She unconsciously left intervals in her retrospect, not clearly distinguishing between what she said, and what she had only an inward vision of” (594; ch. 56). In her conversation with Daniel Deronda, she is described as being silent for a moment or two, “as if her memory had lost itself in a web where each mesh drew all the rest” (592; ch. 56). Deronda wonders whether she “was she seeing the whole event – her own acts included – through an exaggerating medium of excitement and horror.” (591; ch. 56).
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S. Nikolopoulos, Dimitris, and Kalliopi Chatira. "Psychic Pain in Chronic School Failure/Learning Disabilities: Evidence from a Projective Technique." Open Pain Journal 7, no. 1 (November 24, 2014): 67–76. http://dx.doi.org/10.2174/1876386301407010067.

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The present study attempts to investigate the existence of psychic pain in young learners experiencing chronic school failure/learning disabilities. Using a projective technique, the participants were asked to express the thoughts, feelings, dreams and wishes of an ‘imaginary’ child of their own age. LD individuals: a mentioned terrifying nightmares, and b. did not ‘admit’ their LD, even though in subsequent questions the majority admitted a projection of their own thoughts and feelings onto the ‘imaginary’ child. A high proportion of ‘average/good’ academic performance individuals answered more positively. The response pattern of LD individuals in our projective task not only reveals the magnitude of the psychic pain experienced by LD individuals but also offers a unique depiction of the way in which each of these individuals experience the psychic pain. The feeling of ‘helplessness’ stemming from chronic LD, combined with other related negative experiences during the sensitive years of personality development, add up to severe psychological pressure like that described in the psychological trauma literature.
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Cachia, Pierre. "The impact of psychic trauma on love relationships: Implications for the practice of couple counselling." Counselling Psychology Review 25, no. 2 (June 2010): 34–41. http://dx.doi.org/10.53841/bpscpr.2010.25.2.34.

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Counselling psychologists working with couples inevitably encounter personal narratives embedded with traumata. These are often reported to impact the couple’s relationship or even to have caused the presenting problem. This paper draws on the psychodynamic literature on trauma and reflects on how ideas emerging in the analytic field can support our understanding of this phenomenon and facilitate relational recovery. Working with couples allows the practitioner to witness the emergence of traumatic material in the dyadic relational context and how this often relates to earlier trauma, whose genesis is likewise embedded in the dyad. The professional’s presence changes the relational context into a triadic one and this can then serve the important function of facilitating thinkingand reflection about these experiences, thereby allowing a detoxification of the enactments arising between the couple. The risk inherent to working with trauma manifest within this context is discussed, as well as the relational stance required of the professional in order to avoid being experienced as an uninvolved bystander amplifying traumatic anxieties. Finally, this paper emphasises that counselling psychologists working with couples need to appreciate the emergence of reparative and creative interaction within the couple as trauma starts to recede into the relational background.
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Barachetti, Paola, and Giovanni Giulio Valtolina. "I bambini e la guerra. Le conseguenze sullo sviluppo." QUADERNI ACP 30, no. 2 (2023): 77. http://dx.doi.org/10.53141/qacp.2023.77-80.

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There is extensive literature documenting the effects of early trauma on the development and psychological functioning of individuals. The syndrome that encompasses the consequences of trauma is PTSD (Post-Traumatic Stress Disorder), a disorder that arises in connection with a traumatic event of great impact that threatens one’s life or safety, such as war. Technologies and the development of neuroscience have allowed a more in-depth analysis of the consequences of war, which sees psychic trauma as an event capable of interfering with child development, even radically modifying the biology and psychology of adults and children. In the article, a brief review of the most recent studies in this field is presented, in order to highlight the need for early intervention to look especially after the small children.
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Milo Haglili, Ronna. "The Intersectionality of Trauma and Activism: Narratives Constructed From a Qualitative Study." Journal of Humanistic Psychology 60, no. 4 (March 16, 2020): 514–24. http://dx.doi.org/10.1177/0022167820911769.

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The literature on social action in the face of trauma, even while relatively sparse, indicates potential links between these domains of experience. Drawing on this literature, this article explores the meanings made by two mental health professionals who identify as being highly involved in social activism and who experienced past trauma that has significantly affected their lives. The personal narratives of these individuals were compiled from semistructured interviews that were selected for a qualitative thematic analysis. Meaningful recurrent themes indicated mutual influences of social action and trauma. Themes included (1) retraumatization and emotional pain associated with activism, (2) trauma and empathy, (3) healing and transformation through activism, (4) from powerlessness to action, (5) from alienation to validation, and (6) integration of parts of self. When applied within the psychoanalytic context of “witnessing,” data revealed three modes: (1) witnessing oneself, (2) communal witnessing, and (3) the language of activism as a witness. While excessive, overwhelming contact with trauma through activism may, in certain situations, engender risks of retraumatization and psychic stagnation, social activism may serve as a facilitator of intrapsychic movement and trauma transformation. Additionally, processing trauma through psychotherapy may contribute to an effective activism. Therefore, while trauma may involve devastating consequences, this article illustrates how people who experienced trauma may avert psychological states of helplessness and powerlessness, and processes and conditions by which individuals who endured trauma may develop a humane, compassionate view of self and others.
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Yang, Seokwon. "Exploring the Causes of and Cures for Psychic Wounds: Freud’s Evolving Theory of Trauma Revisited." Criticism and Theory Society of Korea 27, no. 2 (June 30, 2022): 87–119. http://dx.doi.org/10.19116/theory.2022.27.2.87.

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This essay aims to weave together Freud’s seemingly disparate discussions of the causes of and cures for trauma and attempts to unravel the significance of his contribution to the literature on trauma. Investigating the aetiology of hysteria, Freud discovers trauma, characterizing it as a psychic wound that persistently impacts the structure of the mind and explains the cure as the recovery of forgotten memory—along with the abreaction of the affect attached to it. Freud’s theoretical shift from “dissociation” to “repression” makes him underscore the idea of “working-through” as a pivotal part of psychoanalytic therapy, one that enables the subject to come to terms with repressed memory.
 War neuroses brought the concept of the repetition compulsion to his notice, leading him to develop the theory of the death drive, and he defines trauma as the ego’s defense against both endo- and exo-psychic dangers. He interprets the traumatic dream as a repeated attempt to master the traumatic situation with anxiety—a signal that prepares the subject for danger—the absence of which triggers traumatic neurosis. Later, this idea evolves into his suggestion that strengthening the patient’s ego empowers him to master the trauma that had previously overpowered him. Observing, however, that the ego defends itself against the process of recovery, just as it does against the threat of dangers, Freud uncovers the death drive underneath this resistance to recovery and envisages the asymptotic and incomplete process of the cure.
 Freud’s engagement with the issue of trauma presents several important points. The idea of strengthening the ego for therapeutic purposes echoes his early view of unpleasure as resulting from the ego’s lack of inhibition in the Project of Scientific Psychology, thus providing a thread of consistency in the seemingly discontinuous trajectory of his trauma theory. His emphasis on working-through highlights the importance of the subject’s active role in recovery, which may be disregarded in neuroscientific trauma studies. In historiography, the concept of working-through connotes the therapeutic process of persistently witnessing the truth of wounded individuals without closure.
 Freud’s account of the cooperation of the analyst and the patient may serve as a model for the “social space” in which a sympathetic listener bears witness to the testimony of the traumatized subject. Finally, the death drive that Freud excavates beneath the ego’s resistance to recovery evokes the concept of death as the ultimate danger to the ego, the mortality that the subject encounters in the course of his traumatic experience. Freud’s reflections on traumatic neurosis testify to his unflinching commitment to discerning the mechanisms and cures of trauma in the process of probing the psychic wounds of his patients.
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SUDLIANKOVA, Volha. "TRAUMATIZED CONSCIOUSNESS IN LYUDMILA RUBLEWSKAYA`S NOVEL THE DAGUERROTYPE." Astraea 2, no. 2 (2021): 105–19. http://dx.doi.org/10.34142/astraea.2021.2.2.06.

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With the tragic events of the 20th century investigation of trauma as a psychic phenomenon has acquired paramount importance. It isan interdisciplinary subject involving doctors, psychologists, philosophers, writers. The Lost Generation authors and modernists were the first to address the problem of emotional shocks experienced by their heroes during WWI. Since then trauma, its causes and consequences have been one of the essential thematic components of world literature and, consequently, trauma studies have become an object of scholarly interest in the last decades of the 20th century in various humanitarian spheres. The present article addresses the way the contemporary Belarusian writer Lyudmila Rublewaskaya represents traumatized consciousness in her novel “The Daguerrotype” (2014). The novel draws its title from an old daguerreotype described in it. It was found by two contemporary young people together with a diary recounting the events of the late 19thcentury. The novel consists of two parts called “The Book of the Inner Circle” and “The Book of the Outer Circle” which are set in two interrelated time planes –the late 19th century and our time respectively. Through the intricately interwoven life stories of five personages the writer looks into various kinds of trauma, exposes their reasons, traces their consequences and describes her heroes’ ways of overcoming the mental distress. The traumatic experience of the characters was either due to the socio-political atmosphere in Russia in the late 19th century, or to a combination of a tragic accident, superstition and manipulation, or to a clash of rough force and nobleness. The significance of unveiling a person’s secret through narration for overcoming the traumatic psychic aftermath is illustrated in the novel, too.
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Jackson, Jeanne-Marie. "Stanlake Samkange’s Insufferable Zimbabwe: Distanciating Trauma from the Novel to Philosophy." Cambridge Journal of Postcolonial Literary Inquiry 8, no. 2 (April 2021): 158–76. http://dx.doi.org/10.1017/pli.2020.37.

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This article theorizes the Zimbabwean writer Stanlake Samkange’s turn from the novel to philosophy as an effort to circumvent the representational pressure exerted by African cultural traumatization. In breaking with the novel form to coauthor a philosophical treatise called Hunhuism or Ubuntuism in the same year as Zimbabwe achieves independence (1980), Samkange advances a comportment-based, deontological alternative to the psychic or subjective model of personhood that anchors trauma theory. Revisiting the progression from his most achieved novel, The Mourned One, to Hunhuism or Ubuntuism thus offers fresh insight into the range of options available to independence-era writers for representing the relationship between African individuality and collectivity. At the same time, it suggests a complementary and overlooked relationship between novelistic and philosophical forms in an African context.
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Dissertations / Theses on the topic "Psychic trauma in literature"

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Van, Niekerk Lydia Mary. "Personality changes after complex trauma : a literature survey and case study." Thesis, Stellenbosch : Stellenbosch University, 2002. http://hdl.handle.net/10019.1/52994.

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Thesis (MA)--University of Stellenbosch, 2002.<br>ENGLISH ABSTRACT: A century of clinical observations and literature has repeatedly noted that trauma responses occur in across a spectrum and on a continuum of severity. The existing, DSMIV trauma response classifications include Acute Stress Disorder and PTSD as anxiety disorders. Complex PTSD or DESNOS was considered as a proposed, alternative classification during the DSM-IV PTSD Field Trials. It was not included as a separate diagnosis, but briefly mentioned as an associated feature ofPTSD. Subsequent research and replica studies have not proved conclusively whether Complex PTSD should be a separate or associated feature ofPTSD, and the controversy continues to date. Childhood traumatization is strongly associated with adult psychopathology, and various Axis I and Axis II disorders, especially Borderline Personality Disorder, and to a lesser extent, Antisocial Personality Disorder. Prolonged, repeated traumatization during adulthood is also associated with subsequent Axis II pathology, including Borderline, Obsessive-Compulsive and Avoidant Personality Disorders. Chronically traumatized people with Axis II pathology often present with comorbid Axis I disorders including Major Depression, PTSD, Substance Abuse, Somatization Disorder, and Dissociative Disorders. There are divergent views regarding the etiology of personality disorders in chronically traumatized individuals. On the one hand, repeated, prolonged trauma could cause enduring personality dysfunction in individuals despite normal premorbid functioning. On the other hand, genetics, temperament, environmental factors and even a pre-existing stress diathesis in the pre-trauma personality could contribute to the development of post-trauma personality disorders. These two views do not necessary contradict each other, but illustrate the complexity the human stress reaction. Despite the controversy the inclusion of DESNOS into the diagnostic canon, it is a valuable measure of predicting prognosis to existing treatment options. The present main psychological treatment for post-traumatic stress disorders has been a cognitive-behavioral based, exposure intervention. Alternative therapies include psychodynamic approaches, pastoral interventions and more recently, ecological and recovery based models. The Complex PTSD conceptualization contributes to a better understanding of the personality structure of chronically traumatized people. There are three main areas of disturbance. Firstly, a complex symptomatic presentation including somatization, dissociation, and affect dysregulation. Secondly, deep characterological shifts including deformations in concepts of relatedness and identity. Thirdly, and increased vulnerability to harm, either self-inflicted or at the hands of others. The usefulness of integrating these three concepts into the personality conceptualization of chronically traumatized individuals is illustrated a case study.<br>AFRIKAANSE OPSOMMING: Die literatuur en kliniese waarneming vand die afgelope eeu dui herhaaldelik op trauma reaksies oor 'n spektrum. In die bestaande DSM-IV stelsel, val trauma reaksies net Akute Stress Steuring and Post-Traumatiese Stress Steuring. Hoewel Komplekse PTSD in 1992 voorgestel was as 'n alternatiefin die DSM-IV, is dit nie as aparte diagnose ingesluit is nie, maar wel wel gelys as geassosieerde symptoom van PTSD. Latere navorsing en duplikaat studies het nog nie konklusiefbewys of Komplekse PTSD 'n geassosieerde or aparte simptoom van PTSD is nie, en debat duur nog voort. Trauma gedurende kinderjare word sterk geassosieer met volwasse psigopatologie en verskeie As I en As II steurings, veral Grenslyn Persoonlikheids Steuring, en tot In mindere mate, Antisosiale Persoonlikheids Steuring. Langstaande, herhaalde traumatisering gedurende volwassenheid word ook geassosieer met latere As II patologie, insluitende, Grenslyn, Obsessief-Kompulsief en Vermydende Persoonlikheids Steurings, Kronies getraumatiseerde individue met As II patologie presenteer ook dikwels met komorbiede As II steurings insluitende Major Depressie, Post-Traumatiese Stres Steuring, Somatiserings Steuring, and Dissosiatiewe Steurings. Daar is uiteenlopende sienings oor die etiologie van persoonlikheids steurings in kronies getraumatiseerde individue. Aan die een kant, kan langstaande, herhaalde trauma persoonlikheids veranderinge veroorsaak ongeag normale premorbide funksionering. Aan die ander kant, kan genetika, temperament, omgewing en'n pre-morbide stressvatbaarheid almal bydra tot die ontwikkeling van post-trauma persoonlikheids steurings. Hierdie twee sienings weerspreek mekaar nie noodwendig nie, maar dui op die kompleksiteit van die menslike stres reaksie. Ongeag die akademiese debakeloor die insluiting van die Kompleks PTSD konseptualisasie in DSM-IV diagnostiese stelsel, is dit 'n waardevolle praktiese meetinstrument van prognose onder bestaande behandelings opsies. Tot dusver word die primere sielkundige intervensies gebaseer op 'n kognitiewe-gedragsterapie model. Alternatiewe terapieë sluit in psigodinamiese, pastorale en meer onlangse ekologiese en herstel-gebasseerde intervensies. Die Kompleks PTSD konseptualisasie dra by tot beter kennis oor die persoonlikheids struktuur van kronies, getraumatiseerde mense. Daar is drie hoof areas of versteuring. Eerstens, a komplekse simptomatiese presentasie insluitende somatisering, dissosiasie en affek disregulasie. Tweedens, diep veranderings in karakter insluitende versteurings in identiteit en interpersoonlike verhoudings. Derdens, in groter vatbaarheid vir seerkry, of aan hulle eie hande, of aan die hande van ander. Die waarde van die integrasie van hierdie drie konsepte in die persoonlikheids konseptualisasie van kronies getraumatiseerde individue word geillustreer deur 'n gevallestudie.
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Harris, Sarah Dibble. "Voices from a wound recovery from trauma in Spanish narratives of memory since 1966 /." Diss., Restricted to subscribing institutions, 2008. http://proquest.umi.com/pqdweb?did=1619118711&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.

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Heiden, Elishia. "Somebody Else’s Second Chance." Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc699902/.

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Charles Baxter, in his essay “Dysfunctional Narratives: or: ‘Mistakes Were Made,’” implies that all trauma narrative is synonymous with “dysfunctional narrative,” or narrative that leaves all characters unaccountable. He writes: “In such fiction, people and events are often accused of turning the protagonist into the kind of person the protagonist is, usually an unhappy person. That’s the whole story. When blame has been assigned, the story is over.” For Baxter, trauma narrative lets everyone “off the hook,” so to speak. He would say that we write about our bitter lemonade to make excuses for our poor choices, and “audiences of fellow victims” read our tales, because their lemonade and their choices carry equal bitterness, and they require equal excuses. While trauma narrative can soothe us, as can other narrative genres, we should not dismiss trauma fiction because of a sweeping generalization. Trauma fiction also allows us to explore the missing parts of our autobiographical narratives and to explore the effects of trauma—two endeavors not fully possible without fiction. As explained in more detail later, the human mind requires narrative to formulate an identity. Trauma disrupts this process, because “trauma does not lie in the possession of the individual, to be recounted at will, but rather acts as a haunting or possessive influence which not only insistently and intrusively returns but is, moreover, experienced for the first time only in its belated repetition.” Because literature can speak what “theory cannot say,” we need fiction to speak in otherwise silent spaces. Fiction allows us to express, analyze, and comprehend what we could not otherwise.
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Hirth, Brittany Brooke. "The limits of language : gender, trauma and the Holocaust /." Abstract Full Text (HTML) Full Text (PDF), 2008. http://eprints.ccsu.edu/archive/00000489/02/1945FT.htm.

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Thesis (M.A.) -- Central Connecticut State University, 2008.<br>Thesis advisor: Aimee L. Pozorski. "... in partial fulfillment of the requirements for the degree of Master of Arts in English." Includes bibliographical references (leaves 113-115). Also available via the World Wide Web.
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Lindsay, Stuart L. "Reading Chernobyl : psychoanalysis, deconstruction, literature." Thesis, University of Stirling, 2014. http://hdl.handle.net/1893/21790.

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This thesis explores the psychological trauma of the survivors of the Chernobyl nuclear disaster, which occurred on April 26, 1986. I argue for the emergence from the disaster of three Chernobyl traumas, each of which will be analysed individually – one per chapter. In reading these three traumas of Chernobyl, the thesis draws upon and situates itself at the interface between two primary theoretical perspectives: Freudian psychoanalysis and the deconstructive approach of Jacques Derrida. The first Chernobyl trauma is engendered by the panicked local response to the consequences of the explosion at Chernobyl Reactor Four by the power plant’s staff, the fire fighters whose job it was to extinguish the initial blaze caused by the blast, the inhabitants of nearby towns and villages, and the soldiers involved in the region’s evacuation and radiation decontamination. Most of these people died from radiation poisoning in the days, weeks, months or years after the disaster’s occurrence. The first chapter explores the usefulness and limits of Freudian psychoanalytic readings of local survivors’ testimonies of the disaster, examining in relation to the Chernobyl event Freud’s practice of locating the authentic primal scene or originary traumatic witnessing experience in his subjects’ pasts, as exemplified by his Wolf Man analysis, detailed in his psychoanalytic study ‘On the History of an Infantile Neurosis’ (1918). The testimonies read through this Freudian psychoanalytic lens are constituted by Igor Kostin’s personal account of the disaster’s aftermath, detailed in his book Chernobyl: Confessions of a Reporter (2006), and by Svetlana Alexievich’s interviews with Chernobyl disaster survivors in her book Voices from Chernobyl: The Oral History of a Nuclear Disaster (2006). The second chapter argues that Freudian psychoanalysis only provides a provisional, ultimately fictional origin of Chernobyl trauma. Situating itself in relation to trauma studies, this thesis, progressing from its first to its second chapter, charts the geographical and temporal shift between these first and second traumas, from trauma-as-sudden-event to trauma-as-gradual-process. In the weeks following the initial Chernobyl explosion, which released into the atmosphere a radioactive cloud that blew in a north-westerly direction across Northern Ukraine, Belarus, Latvia, Estonia, Finland and Sweden, symptoms of radiation poisoning slowly emerged in the populations of the abovementioned countries. To analyse the psychological impact of confronting this gradual, international unfolding of trauma – the second trauma of Chernobyl – the second chapter of this thesis explores the critique of the global attempt to archivise, elegise and ultimately understand the Chernobyl disaster in Mario Petrucci’s elegies, compiled in his poetry collection Heavy Water: A Poem for Chernobyl (2006), the horror film Chernobyl Diaries (2012, dir. Bradley Parker), and Adam Roberts’ Science Fiction novel, Yellow Blue Tibia (2009). Analysing the deconstructive approach of Jacques Derrida in these texts – his notions of archive fever, impossible mourning and ethical mourning – this chapter argues that the attempt to interiorise, memorialise and mourn the survivors of the Chernobyl disaster is narcissistic, hubristic and violent in the extreme. It then proposes that Derrida’s notion of ethical mourning, outlined most clearly in his lecture ‘Mnemosyne’ (1984), enables us to situate our emotional sympathy for survivors – who, following Derrida’s lecture, are maintained as permanently exterior and inaccessible to us – in our very inability or failure to comprehend or locate the origin of their Chernobyl traumas. The third and final chapter analyses the third trauma of Chernobyl: the psychological and physiological effects of the disaster on second-generation inhabitants living near the Exclusion Zone erected around the evacuated, cordoned-off and still-radioactive Chernobyl region. These second-generation experiences of living near a sealed-away source of intense radiation are reconstructed in literature and videogaming: in Darragh McKeon’s novel All That Is Solid Melts Into Air (2014), Hamid Ismailov’s novel The Dead Lake (2014) and the videogame S.T.A.L.K.E.R: Shadow of Chernobyl (2007), developed by the company GSC Game World. The analysis of these texts is informed by Nicolas Abraham and Maria Torok’s psychoanalytic theory of the intergenerational phantom: the muteness of a generation’s history which returns to haunt the succeeding generations. This chapter will explore the psychological effects upon second-generation Chernobyl survivors, which result from these survivors’ incorporation or unconscious interiorisation of their parents’ psychologically repressed traumatic Chernobyl experiences, by analysing reconstructions of this process in the abovementioned texts. These parental experiences, echoing the Exclusion Zone as a denied physical space, have been interred in inaccessible psychic crypts. By way of conclusion, the thesis then offers an alternative theory of reading survivors’ Chernobyl trauma. Survivors’ restaging of their Chernobyl witnessing experiences as jokes enables them to cathartically, temporarily abreact their trauma through the laughter that these jokes engender.
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Mackinnon, Jeremy E. "Speaking the unspeakable : war trauma in six contemporary novels." Title page, contents and abstract only, 2001. http://web4.library.adelaide.edu.au/theses/09PH/09phm15821.pdf.

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Includes bibliographical references (leaves 246-258) Presents readings of six novels which depict something of the nature of war trauma. Collectively, the novels suggest that the attempt to narrativise war trauma is inherently problematic. Traces the disjunctions between narrative and war trauma which ensure that war trauma remains an elusive and private phenomonen; the gulf between private experience and public discourse haunts each of the novels.
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Haller, Elizabeth Kari. ""The events of my insignificant existence" traumatic testimony in Charlotte Brönte's fictional autobiographies /." [Kent, Ohio] : Kent State University, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=kent1248038837.

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Thesis (Ph. D.)--Kent State University, 2009.<br>Title from PDF t.p. (viewed Mar. 11, 2010). Advisor: Vera J. Camden. Keywords: Charlotte Bronte; fictional autobiography; trauma theory; testimony; witness; Jane Eyre; Villette; The Professor; repetition compulsion. Includes bibliographical references (p. 140-146).
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Satterlee, Michelle. "Shadows of the self : trauma, memory, and place in twentieth-century American fiction /." view abstract or download file of text, 2006. http://proquest.umi.com/pqdweb?did=1196413471&sid=2&Fmt=2&clientId=11238&RQT=309&VName=PQD.

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Thesis (Ph. D.)--University of Oregon, 2006.<br>Typescript. Includes vita and abstract. Study of themes in the novels of Edward Abbey, Lan Cao, Toni Morrison, and Leslie Marmon Silko. Includes bibliographical references (leaves 233-238). Also available for download via the World Wide Web; free to University of Oregon users.
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Njovane, Thandokazi. ""The wings of whipped butterflies" : trauma, silence and representation of the suffering child in selected contemporary African short fiction." Thesis, Rhodes University, 2013. http://hdl.handle.net/10962/d1004214.

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This dissertation, which examines the literary representation of childhood trauma, is held together by three threads of inquiry. Firstly, I examine the stylistic devices through which three contemporary African writers – NoViolet Bulawayo, Uwem Akpan, and Mia Couto – engage with the subject of childhood trauma in five of their short stories: “Hitting Budapest”; “My Parents’ Bedroom” and “Fattening for Gabon”; and “The Day Mabata-bata Exploded” and “The Bird-Dreaming Baobab,” respectively. In each of these narratives, the use of ingén(u)s in the form of child narrators and/or focalisers instantiates a degree of structural irony, premised on the cognitive discrepancy between the protagonists’ perceptions and those of the implied reader. This structural irony then serves to underscore the reality that, though in a general sense the precise nature of traumatic experience cannot be directly communicated in language, this is exacerbated in the case of children, because children’s physical and psychological frameworks are underdeveloped. Consequently, children’s exposure to trauma and atrocity results in disruptions of both personal and communal notions of safety and security which are even more severe than those experienced by adults. Secondly, I analyse the political, cultural and economic factors which give rise to the traumatic incidents depicted in the stories, and the child characters’ interpretations and responses to these exigencies. Notions of subjectivity and intersubjectivity, identity and community, victimhood and survival, agency and disempowerment are discussed here in relation to the context of postcolonial Africa and the contemporary realities of chronic poverty, genocide, child-trafficking, the aftermath of civil war, and the legacies of colonialism and racism. Thirdly, this dissertation inspects the areas of congruence and divergence between trauma theory, literary scholarship on trauma narratives, and literary attempts to represent atrocity and trauma despite what is widely held to be the inadequacy of language – and therefore representation – to this task. There are certain differences between the three authors’ depictions of children’s experiences of trauma, despite the fact that the texts all grapple with the aporetic nature of trauma and the paradox of representing the unrepresentable. To this end, they utilise various strategies – temporal disjunctions and fragmentations, silences and lacunae, elements of the fantastical and surreal, magical realism, and instances of abjection and dissociation – to gesture towards the inexpressible, or that which is incommensurable with language. I argue that, ultimately, it is the endings of these stories which suggest the unrepresentable nature of trauma. Traumatic experience poses a challenge to representational conventions and, in its resistance, encourages a realisation that new ways of writing and speaking about trauma in the African continent, particularly with regards to children, are needed.<br>Adobe Acrobat 9.54 Paper Capture Plug-in
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Kussman, Soosun Kim. "Aucun de nous ne reviendra the journey of working through trauma /." Oxford, Ohio : Miami University, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=miami1249779135.

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Books on the topic "Psychic trauma in literature"

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Nossery, Névine El. The unspeakable: Representations of trauma in Francophone literature and art. Newcastle upon Tyne: Cambridge Scholars Pub., 2013.

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Stara, Alexandra. The edges of trauma: Explorations in visual art and literature. Newcastle upon Tyne: Cambridge Scholars Publishing, 2014.

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Wolfram, Mauser, and Pietzcker Carl 1936-, eds. Trauma. Würzburg: Königshausen & Neumann, 2000.

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Richardson, Michael. Traumatic affect. Newcastle upon Tyne: Cambridge Scholars Pub., 2013.

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Takács, Miklós. Sebek és szavak: Traumakultúra, traumairodalom. Budapest: Kalligram, 2018.

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Adami, Valentina. Trauma studies and literature: Martin Amis's Time's arrow as trauma fiction. Frankfurt am Main: Peter Lang, 2008.

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Łysak, Tomasz. Antologia studiów nad traumą. Kraków: Towarzystwo Autorów i Wydawców Prac Naukowych Universitas, 2015.

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Paulis, Maria Pia De, and Ada Tosatti. Senza traumi?: Le ferite della storia e del presente nella creazione letteraria e artistica italiana del nuovo millennio. Firenze: Franco Cesati editore, 2021.

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Abouddahab, Rédouane, and Pascal Bataillard. Écriture et libération: Trauma, fantasme, symptôme. Lyon]: Merry world, 2009.

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Luckhurst, Roger. The trauma question. New York, NY: Routledge, 2008.

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Book chapters on the topic "Psychic trauma in literature"

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van der Kolk, Bessel A., and Jose Saporta. "Biological Response to Psychic Trauma." In International Handbook of Traumatic Stress Syndromes, 25–33. Boston, MA: Springer US, 1993. http://dx.doi.org/10.1007/978-1-4615-2820-3_2.

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Haaken, Janice. "Psychic Trauma and the Body." In Psychiatry, Politics and PTSD, 83–111. New York, NY : Routledge, 2020.: Routledge, 2020. http://dx.doi.org/10.4324/9781003010913-4.

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Tesone, Juan-Eduardo. "Viability of psychic change." In Trauma and Pain Without a Subject, 130–34. London: Routledge, 2024. http://dx.doi.org/10.4324/9781032647791-21.

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Bryon, Deborah. "Psychic States in Andean Medicine." In Time and Trauma in Analytical Psychology and Psychotherapy, 49–74. London: Routledge, 2024. http://dx.doi.org/10.4324/9781003356448-6.

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Stevns, Martha, and Lucinda Hawkins. "Giving voice to psychic pain." In Transforming Infantile Trauma in Analytic Work with Children and Adults, 119–30. London: Routledge, 2022. http://dx.doi.org/10.4324/9781003268536-9.

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Frederick, Calvin Jeff. "Psychic trauma in victims of crime and terrorism." In Cataclysms, crises, and catastrophes: Psychology in action., 55–108. Washington: American Psychological Association, 1987. http://dx.doi.org/10.1037/11106-002.

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Pausch, Markus J., and Sven J. Matten. "Trauma and PTSD in Film and Literature." In Trauma and Trauma Consequence Disorder, 103–7. Wiesbaden: Springer Fachmedien Wiesbaden, 2022. http://dx.doi.org/10.1007/978-3-658-38807-2_9.

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Cash, Jean W. "Trauma." In The Routledge Companion to Literature of the U.S. South, 371–74. New York: Routledge, 2022. http://dx.doi.org/10.4324/9781003009924-93.

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Field, Robin E. "Witnessing Trauma." In Narratives of Trauma in South Asian Literature, 137–45. London: Routledge India, 2022. http://dx.doi.org/10.4324/9781003353539-15.

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Trezise, Bryoni. "Feeling Remediated: The Emotional Afterlife of Psychic Trauma TV." In Performing Feeling in Cultures of Memory, 79–106. London: Palgrave Macmillan UK, 2014. http://dx.doi.org/10.1057/9781137336224_4.

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Conference papers on the topic "Psychic trauma in literature"

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PLĂMĂDEALĂ, Victoria, and Valentina STRATAN. "Loneliness – consequence of psychological trauma." In Probleme ale ştiinţelor socioumanistice şi ale modernizării învăţământului. "Ion Creanga" State Pedagogical University, 2022. http://dx.doi.org/10.46728/c.v1.25-03-2022.p170-173.

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The aim of this study is to analyze the causes of experiencing the feeling of loneliness from the perspective of the theory of psychic trauma. This paper is an analytical synthesis of the consequences of psychic trauma, among which is the feeling of loneliness with a clearly negative connotation. Synthesizing scientists' concerns in loneliness and psychotraumatology can be brought to a common denominator: when secure attachments between parents-children are severely disturbed, children experience an emotional chaos called - attachment trauma, which affects the psyche so that it is impossible to build healthy relationships of subsequent attachment, which is actually the feeling of loneliness. These children becoming adults spend their lives constantly looking for intimate connections with others, who did not have them with their parents, but who are doomed to failure with great disappointment. The situation can only be overcome by a psychotherapeutic process on attachment trauma.
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Furman, Cara. "Facing Medusa: Approaches to Trauma in Children's Literature." In 2020 AERA Annual Meeting. Washington DC: AERA, 2020. http://dx.doi.org/10.3102/1581302.

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Bahar, Salma. "The Psychology of the Other; Narrating Diaspora Identity and Psychic Trauma in Leila Halaby’s Once in a Promised Land." In – The European Conference on Arts & Humanities 2022. The International Academic Forum(IAFOR), 2022. http://dx.doi.org/10.22492/issn.2188-1111.2022.2.

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Alvarez, Adam. "Seeing Race in the Education Research Literature on Trauma." In 2020 AERA Annual Meeting. Washington DC: AERA, 2020. http://dx.doi.org/10.3102/1571025.

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Montoya, Luisa, Bridget Kool, Gabrielle Davie, and Bridget Dicker. "P2.005 Epidemiology of major trauma in New Zealand: a literature review." In Virtual Pre-Conference Global Injury Prevention Showcase 2021 – Abstract Book. BMJ Publishing Group Ltd, 2021. http://dx.doi.org/10.1136/injuryprev-2021-safety.95.

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Vil, Christopher St. "25 Correlates of trauma recidivism: results from a systematic literature review." In Society for the Advancement of Violence and Injury Research (SAVIR) 2020 conference abstracts. BMJ Publishing Group Ltd, 2020. http://dx.doi.org/10.1136/injuryprev-2020-savir.101.

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Nojoum, Magd. "20 A literature review of trauma-informed responses for refugee paediatric population." In Royal College of Paediatrics and Child Health, Abstracts of the RCPCH Conference, Liverpool, 28–30 June 2022. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health, 2022. http://dx.doi.org/10.1136/archdischild-2022-rcpch.71.

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Oliveira, Amanda Gomes, Anderson José do Nascimento Duda, Camila Barros Vieira, Débora Aline Oliveira Portela de Carvalho, Juliana Soares de Oliveira Rego, Larissa Valeska da Silva Moura, Nadine Nebl Jardim Lacerda Andrade, Neila Vasconcelos Spencer Netto, Wellington Matheus Pereira das Neves, and Wagner Gonçalves Horta. "Epidemiology of Spinal Cord Trauma in Brazil: a review of the literature." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.068.

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Background: Spinal cord trauma (SCT) is an injury that affects any region of the spinal cord, bringing not only organic implications, but also an important socioeconomic impact due to its high morbidity and mortality. Thus, it is relevant to evaluate the distribution of risk factors that contribute to its prevalence in Brazil. Objectives:To evaluate the risk factors that contribute to the prevalence of SCT in Brazil. Design and setting: Review of the literature in Catholic University of Pernambuco Methods: Searches were performed in the databases PUBMED, BVS and Scielo, with the descriptors: ‘’epidemiology’’ and ‘’spinal cord trauma’’ and ‘’Brazil’’. Included were articles published from 2015 to 2021. 63 results found and 5 selected. Results: The analysis showed that the epidemiology of spinal cord trauma in Brazil is predominantly male, with ages ranging from 35.2 to 44 years, with the cervical spine being the most affected segment and traffic accidents as the major causal factor. Conclusions: The socioeconomic damages deeply impact the quality of life of the individual affected by spinal cord injury, so understanding the epidemiology is essential to plan preventive actions and treatments. We emphasize the need for further studies, considering the low number of articles on.
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Wen, Zhang. "Spatial Approach to the Holocaust Trauma in Enemies, A Love Story." In 6th Annual International Conference on Language, Literature and Linguistics (L3 2017). Global Science & Technology Forum (GSTF), 2017. http://dx.doi.org/10.5176/2251-3566_l317.32.

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Mullins, M. J., B. M. Moloney, D. Bergin, and T. Tarmey. "Value of Digital Radiography in Acute Spinal Trauma. A Retrospective Analysis and Literature Review." In 26th Annual Scientific Meeting of the European Society of Musculoskeletal Radiology (ESSR). Georg Thieme Verlag KG, 2019. http://dx.doi.org/10.1055/s-0039-1692560.

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Reports on the topic "Psychic trauma in literature"

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Mangelsdorff, A. D. Proceedings User's Stress Workshop (7th) Held in San Antonio, Texas on December 10-15, 1989: Training for Psychic Trauma. Fort Belvoir, VA: Defense Technical Information Center, December 1990. http://dx.doi.org/10.21236/ada234583.

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Jangir, Hemlata, Aparna Ningombam, Arulselvi Subramanian, and Subodh Kumar. Traumatic Jejunal Mesenteric Pseudocyst in the Vicinity of Blunt Abdominal Trauma with a Brief Review of Literature. Science Repository, January 2023. http://dx.doi.org/10.31487/j.ajscr.2022.04.04.

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Mesenteric pseudocyst (MP) is a rare heterogeneous group of intra-abdominal benign cystic lesions with different etiopathogenesis and clinically silent behaviours. These lesions are introduced as one of the entities based on the histological features of thick fibrous cyst walls, barren of the epithelial lining. Often, they present as expanding abdominal masses or are diagnosed incidentally in conventional radiological studies, exploratory laparotomies, or with symptoms of complications such as infection, torsion, or rupture. Surgical removal of the cyst, with or without resection of the affected intestinal segment, is the treatment of choice. Depending upon the size and location of the lesion and related complications, it can be managed by open surgical procedures or laparoscopic approach. Only a handful of 7 cases of traumatic mesenteric cysts have been reported yet in the vicinity of blunt abdominal trauma. We report a rare incidentally detected case of mesenteric pseudocyst (traumatic) in a male of early 20s with a history of blunt abdominal trauma 13 months back and for which serial abdominal exploratory laparotomies were performed. A brief review of the literature is provided, conforming to the rarity of the case. This case highlights the role of histomorphology in diagnosing a benign cystic entity with accuracy, that could be misdiagnosed as infectious granulomatous lesion.
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Colt, John, Gerald R. Bouck, and Larry Fidler. Review of Current Literature and Research on Gas Supersaturation and Gas Bubble Trauma: Special Publication Number 1, 1986. Office of Scientific and Technical Information (OSTI), December 1986. http://dx.doi.org/10.2172/6473636.

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Avdimetaj, Teuta. Interacting with Trauma: Considerations and Reflections from Research in Kosovo. RESOLVE Network, October 2022. http://dx.doi.org/10.37805/rve2022.2.

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This chapter explores the role of trauma in violent extremism research, offering insights on its effects on the research process, providing insights on the radicalization process of individual cases, and informing reintegration prospects of returning foreign fighters and their family members. The chapter focuses on war-related trauma as a widespread experience in post-conflict societies, which may persist years after the war ends, scarring societies in numerous ways for generations and potentially creating an ongoing cycle of violence. The chapter begins with a brief overview of the available literature on the link between trauma and radicalization while bringing attention to existing gaps within this field. It then continues with insights from field research in Kosovo on how trauma was expressed among the family members of foreign fighters, including women returnees from the conflict zones in Syria and Iraq, and provides insight into how the author approached the subject in her own research.
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Zeng, Siyao, Lei Ma, Lishan Yang, Xiaodong Hu, Xinxin Guo, Yi Li, Yao Zhang, et al. Advantages of damage control surgery over conventional surgery inmultiple trauma: a meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, October 2022. http://dx.doi.org/10.37766/inplasy2022.10.0006.

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Review question / Objective: This meta-analysis aims to explore whether damage control surgery has advantages over traditional surgery in the treatment of multiple trauma. Information sources: The Chinese Biomedical literature (CBM), Chinese National Knowledge Infrastructure (CNKI), Weipu (VIP), Duxiu, WanFang, Web of sciense, PubMed, Scopus, Ovid, EMbase, ProQuest, Cochrane, Chinese clinical trial Registry and Clinical Trials.gov databases. Main outcome(s): mortality rate, the success rate of rescue, In-hospital length of stay, ICU length of stay, the overall incidence rate of complications, incidence of disseminated intravascular coagulation (DIC), incidence of multiple organ dysfunction syndrome (MODS) , incidence of shock.
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Johnson-Lawrence, Vicki, Rodlescia Sneed, Kenyetta Dotson, Margaret Njoroge, and Pamela Pugh. Trauma-Informed Approaches and Community Engagement: Community Engaged Research (CEnR) and Programming for Public Health and Health Inequities. RTI Press, March 2024. http://dx.doi.org/10.3768/rtipress.2024.rb.0037.2403.

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In communities heavily affected by trauma, trauma-informed approaches (TIAs) are essential to minimize unintended consequences and harm associated with receiving clinical, social, and other support services. The visibility of traumatic events continues to increase. In turn, public health teams must build capacity and integrate TIAs into public health research and practice, particularly for communities managing multiple health inequities. Community-engaged approaches have become increasingly common in public health to address health inequity. Community-engaged research (CEnR) is a TIA that public health researchers use to serve traumatized individuals and communities meaningfully and respectfully. CEnR is often intended to address health disparities and inequities, and public health program developers can use similar engagement strategies. Community-engaged public health teams usually include partners from community, research, and other professions, and they often work in minoritized and vulnerable communities. In CEnR and program design, the team can use the principles of TIAs to guide the development and decision-making processes; they can also use feedback during the process to enhance the community benefit of the research and programs being offered. The team can benefit from training to understand and use TIAs to support their work. Finally, community-engaged public health teams can enhance CEnR by building upon the scientific literature about TIAs to extract strategies and practices to extend their impacts on the people they serve and their own organizations.
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Hu, XinYi, JingXuan Hao, and HangYue Wang. Improvement of Environmental enrichment on Cognitive Functions in Patients and animals : A systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, December 2022. http://dx.doi.org/10.37766/inplasy2022.12.0014.

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Review question / Objective: To study the relationship between environmental enrichment and cognitive function through a meta-analysis of the literature, analyze its effects on the improvement of cognitive function in patients and animals, and evaluate the effects of different environmental enrichment measures on cognitive function improvement. Condition being studied: Cognitive decline refers to an individual's memory, language, reasoning and other aspects of cognitive function showing obvious, measurable decline or abnormal. The causes of cognitive decline are various, including neurodegeneration, cerebrovascular disease, infection, trauma, and depression. Alzheimer's disease and stroke are the most common.
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Onufriv, Solomiya, Olivier Abdelhamid та Simone van Dormolen. Комунікація без заподіяння шкоди: оглядове дослідження висвітлення в медіа травматичних подій. Ivan Franko National University of Lviv, березень 2023. http://dx.doi.org/10.30970/vjo.2023.52-53.11747.

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The literature review collected and systematized existing knowledge and experience of effective communication in media outlets about traumatic events with people, guided by the principle of “do no harm”. The essence of this efficiency is that journalists, communicating with respondents, in particular military and civilian, did not injure the heroes of their journalistic materials and the audience. It is also about avoiding stigmatization and re-traumatization during media coverage of traumatic events. The high prevalence and profound effects of PTSD among civilians and journalists in conflict zones alike underscore the need for a conscious approach to the subject and trauma-related events by media outlets. Research has shown, however, that increased and improved knowledge about mental health plays a crucial role in its de-stigmatization. Despite the negative consequences of the influence, the media have the potential to develop appropriate professional recommendations for overcoming the trauma of war based on the experience of covering war events in Ukraine. Key words: communication, traumatic event, re-traumatization, de-stigmatization, post-traumatic stress disorder (PTSD), media coverage.
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Slaughter-Acey, Jaime, Kathryn Behrens, Amy M. Claussen, Timothy Usset, Carrie Neerland, Sameerah Bilal-Roby, Huda Bashir, et al. Social and Structural Determinants of Maternal Morbidity and Mortality: An Evidence Map. Agency for Healthcare Research and Quality (AHRQ), December 2023. http://dx.doi.org/10.23970/ahrqepccer264.

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Objective. The purpose was to review available evidence of risk factors associated with maternal morbidity and mortality in the United States during the prenatal and postpartum periods to inform a National Institutes of Health Pathways to Prevention Workshop: Identifying Risks and Interventions to Optimize Postpartum Health, held November 29–December 1, 2022. Data sources. We searched MEDLINE®, CINAHL®, and the Social Sciences Citation Index through November 2022. Review methods. We searched for observational studies examining exposures related to social and structural determinants of health and at least one health or healthcare-related outcome for pregnant and birthing people. We extracted basic study information and grouped studies by social and structural determinants of health domains and maternal outcomes. We prioritized studies according to study design and rigor of analytic approaches to address selection bias based on the ROBINS-E. We summarize all included studies and provide additional descriptions of direction of association between potential risk exposures and outcomes. Results. We identified 8,378 unique references, with 118 included studies reporting social and structural determinants of health associated with maternal health outcomes. Studies covered risk factors broadly, including identity and discrimination, socioeconomic, violence, trauma, psychological stress, structural/institutional, rural/urban, environment, comorbidities, hospital, and healthcare use factors. However, the risk factors we identified represent only a subset of potential social and structural determinants of interest. We found an unexpectedly large volume of research on violence and trauma relative to other potential exposures of interest for pregnant people. Outcome domains included maternal mortality, severe maternal morbidity, hypertensive disorders, gestational diabetes, cardio/metabolic disorders, weathering (the physiological effect of premature aging caused by chronic stressful experiences), depression, other mental health or substance use disorders, and cost/healthcare use outcomes. Depression/other mental health outcomes represented a large proportion of medical outcomes captured. Risk of bias was high, and rarely did studies report the excess risk attributable to a specific exposure. Conclusions. Identifying risk factors pregnant and birthing people face is vitally important. Limited depth and quality of available research within each social and structural determinant of health impeded our ability to outline specific pathways, including risk factor interdependence. While more recently published literature showed a trend toward increased rigor, future research can emphasize techniques that estimate the causal impacts of risk factors. Improved reporting in studies, along with organized and curated catalogues of maternal health exposures and their presumed mechanisms, would make it easier to examine exposures in the future. In the longer term, the field could be advanced by datasets designed to more fully capture the data required to robustly examine racism and other social and structural determinants of health, in combination with their intersections and feedback loops with other biologic/medical risk factors.
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Totten, Annette, Dana M. Womack, Marian S. McDonagh, Cynthia Davis-O’Reilly, Jessica C. Griffin, Ian Blazina, Sara Grusing, and Nancy Elder. Improving Rural Health Through Telehealth-Guided Provider-to-Provider Communication. Agency for Healthcare Research and Quality, December 2022. http://dx.doi.org/10.23970/ahrqepccer254.

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Objectives. To assess the use, effectiveness, and implementation of telehealth-supported provider-to-provider communication and collaboration for the provision of healthcare services to rural populations and to inform a scientific workshop convened by the National Institutes of Health Office of Disease Prevention on October 12–14, 2021. Data sources. We conducted a comprehensive literature search of Ovid MEDLINE®, CINAHL®, Embase®, and Cochrane CENTRAL. We searched for articles published from January 1, 2015, to October 12, 2021, to identify data on use of rural provider-to-provider telehealth (Key Question 1) and the same databases for articles published January 1, 2010, to October 12, 2021, for studies of effectiveness and implementation (Key Questions 2 and 3) and to identify methodological weaknesses in the research (Key Question 4). Additional sources were identified through reference lists, stakeholder suggestions, and responses to a Federal Register notice. Review methods. Our methods followed the Agency for Healthcare Research and Quality Methods Guide (available at https://effectivehealthcare.ahrq.gov/topics/cer-methods-guide/overview) and the PRISMA reporting guidelines. We used predefined criteria and dual review of abstracts and full-text articles to identify research results on (1) regional or national use, (2) effectiveness, (3) barriers and facilitators to implementation, and (4) methodological weakness in studies of provider-to-provider telehealth for rural populations. We assessed the risk of bias of the effectiveness studies using criteria specific to the different study designs and evaluated strength of evidence (SOE) for studies of similar telehealth interventions with similar outcomes. We categorized barriers and facilitators to implementation using the Consolidated Framework for Implementation Research (CFIR) and summarized methodological weaknesses of studies. Results. We included 166 studies reported in 179 publications. Studies on the degree of uptake of provider-to-provider telehealth were limited to specific clinical uses (pharmacy, psychiatry, emergency care, and stroke management) in seven studies using national or regional surveys and claims data. They reported variability across States and regions, but increasing uptake over time. Ninety-seven studies (20 trials and 77 observational studies) evaluated the effectiveness of provider-to-provider telehealth in rural settings, finding that there may be similar rates of transfers and lengths of stay with telehealth for inpatient consultations; similar mortality rates for remote intensive care unit care; similar clinical outcomes and transfer rates for neonates; improvements in medication adherence and treatment response in outpatient care for depression; improvements in some clinical monitoring measures for diabetes with endocrinology or pharmacy outpatient consultations; similar mortality or time to treatment when used to support emergency assessment and management of stroke, heart attack, or chest pain at rural hospitals; and similar rates of appropriate versus inappropriate transfers of critical care and trauma patients with specialist telehealth consultations for rural emergency departments (SOE: low). Studies of telehealth for education and mentoring of rural healthcare providers may result in intended changes in provider behavior and increases in provider knowledge, confidence, and self-efficacy (SOE: low). Patient outcomes were not frequently reported for telehealth provider education, but two studies reported improvement (SOE: low). Evidence for telehealth interventions for other clinical uses and outcomes was insufficient. We identified 67 program evaluations and qualitative studies that identified barriers and facilitators to rural provider-to-provider telehealth. Success was linked to well-functioning technology; sufficient resources, including time, staff, leadership, and equipment; and adequate payment or reimbursement. Some considerations may be unique to implementation of provider-to-provider telehealth in rural areas. These include the need for consultants to better understand the rural context; regional initiatives that pool resources among rural organizations that may not be able to support telehealth individually; and programs that can support care for infrequent as well as frequent clinical situations in rural practices. An assessment of methodological weaknesses found that studies were limited by less rigorous study designs, small sample sizes, and lack of analyses that address risks for bias. A key weakness was that studies did not assess or attempt to adjust for the risk that temporal changes may impact the results in studies that compared outcomes before and after telehealth implementation. Conclusions. While the evidence base is limited, what is available suggests that telehealth supporting provider-to-provider communications and collaboration may be beneficial. Telehealth studies report better patient outcomes in some clinical scenarios (e.g., outpatient care for depression or diabetes, education/mentoring) where telehealth interventions increase access to expertise and high-quality care. In other applications (e.g., inpatient care, emergency care), telehealth results in patient outcomes that are similar to usual care, which may be interpreted as a benefit when the purpose of telehealth is to make equivalent services available locally to rural residents. Most barriers to implementation are common to practice change efforts. Methodological weaknesses stem from weaker study designs, such as before-after studies, and small numbers of participants. The rapid increase in the use of telehealth in response to the Coronavirus disease 2019 (COVID-19) pandemic is likely to produce more data and offer opportunities for more rigorous studies.
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