Using Cultural-Historical Theory to Explore Trauma among Refugee Populations in Europe



The psychological impact of atrocities endured by refugee populations is clear, with the literature reporting significantly high prevalence rates of post-traumatic stress disorder (PTSD). Given the numerous criticisms surrounding the use of PTSD, we argue that cultural-historical psychology allows for a unique perspective in which to examine trauma among this population. Notably, we aim to bring a critical regard towards ‘psychiatrisation,’ arguing instead for a non-reductionist ontological vision of human nature and development as being rooted in cultural-historical context as well as material social practices. The results of a yearlong intervention in a center for refugee victims of torture in Athens is presented, which included 3 months of participant observation and 125 interviews with health professionals, refugee community leaders and individual victims of torture. A qualitative case study is presented to emphasise the social, cultural, and historical location of trauma. The paper highlights the need to focus on the current material ecologies of refugees entering Europe – their developmental activities in interaction with their environment.

General Information

Keywords: Cultural-historical theory, trauma, refugees, Vygotsky, development

Journal rubric: Psychotherapy and Psychocorrection

Article type: scientific article


For citation: Womersley G., Kloetzer L. Using Cultural-Historical Theory to Explore Trauma among Refugee Populations in Europe. Kul'turno-istoricheskaya psikhologiya = Cultural-Historical Psychology, 2018. Vol. 14, no. 1, pp. 87–97. DOI: 10.17759/chp.2018140110.

A Part of Article

Europe is living through a refugee crisis of historic proportions which has now become one of the continent’s defining challenges of the early 21st century. Not least among the difficulties are the public health challenges of the multiple traumas faced by this population which constitute severe threats to human, social, cultural, and community development.


  1. Adame A.L., Knudson R.M. Beyond the counter-narrative: Exploring alternative narratives of recovery from the psychiatric survivor movement. Narrative Inquiry, 2007. Vol. 17(2), pp. 157—178.
  2. Bakhtin M. The Dialogic Imagination, translated by Caryl Emerson and Michael Holquist. Austin: University of Texas Press, 2012, pp. 270—434.
  3. Bakhtin M. The Bildungsroman and its Significance in the History of Realism. Speech genres and other late essays, 1986. Vol. 10, pp. 21—119.
  4. Bhimji F. Collaborations and Performative Agency in Refugee Theater in Germany. Journal of Immigrant & Refugee Studies, 2015, pp. 1—23.
  5. Bracken P. Post-modernity and post-traumatic stress disorder. Social Science & Medicine, 2001. Vol. 53(6), pp. 733—743.
  6. Bruner J. The narrative construction of reality. Critical Inquiry, 1991. Vol 18(1), pp. 1—21.
  7. Carlson B.E. The most important things learned about violence and trauma in the past 20 years. Journal of Interpersonal Violence, 2005. Vol 20(1), pp. 119—126.
  8. Connery M.C., John—Steiner V., Marjanovic-Shane A. Vygotsky and creativity: A cultural-historical approach to play, meaning making, and the arts: Peter Lang, 2015. Vol 5, pp. 1—241.
  9. Daiute C., Lucić L. Situated cultural development among youth separated by war. International Journal of Intercultural Relations, 2010. Vol 34(6), pp. 615—628.
  10. Dauite C. Imagining in Community Engagement. In T. a. G. Zittoun, Vladimir (Ed.), Handbook of Imagination and Culture. Oxford, United Kingdom: Oxford University Press, 2018, pp. 273—100.
  11. de Arellano M.A., Danielson C.K. Assessment of Trauma History and Trauma-Related Problems in Ethnic Minority Child Populations: An INFORMED Approach. Cognitive and Behavioral Practice, 2008. Vol. 15(1), pp. 53—66.
  12. Drožđek B. Voices of Trauma: Springer, 2007, pp. 1—6.
  13. Drozdek B., Wilson J.P. Voices of trauma: treating psychological trauma across Cultures: Springer Science & Business Media, 2007, pp. 1—387.
  14. Fassin D., Rechtman R. The empire of trauma: An inquiry into the condition of victimhood: Princeton University Press, 2009, pp. 1—303.
  15. Gee J.P. An introduction to discourse analysis: Theory and method: Routledge, 2014, pp. 1—172.
  16. Gone J.P. Redressing First Nations historical trauma: Theorizing mechanisms for indigenous culture as mental health treatment. Transcultural psychiatry, 2013. Vol. 50(5), pp. 683—706.
  17. Goulart D.M. The psychiatrization of human practices worldwide: discussing new chains and cages. Pedagogy, Culture & Society, 2017. Vol. 25(1), pp. 151—156.
  18. Goulart D.M., González Rey F. Mental health care and educational actions: From institutional exclusion to subjective development. European Journal of Psychotherapy & Counselling, 2016. Vol. 18(4), pp. 367—383.
  19. Hauswirth M., Canellini A.M., & Bennoun N. Un improbable refuge. Les répercussions sur la santé mentale des procédures en matière d’asile. Psychothérapies, 2004. Vol 24, pp. 215—222.
  20. Hinton D.E., Lewis-Fernández R. The cross-cultural validity of posttraumatic stress disorder: implications for DSM- 5. Depression and anxiety, 2011. Vol. 28(9), pp. 783—801.
  21. Janoff-Bulman R. The aftermath of victimization: Rebuilding shattered assumptions. Trauma and its wake, 1985. Vol. 1, pp. 15—35.
  22. Kirmayer L.J. Landscapes of memory: Trauma, narrative, and dissociation. Tense past: Cultural essays in trauma and memory, 1996, pp. 173—198.
  23. Kirmayer L.J., Kienzler H., Afana A.H., Pedersen D. Trauma and disasters in social and cultural context. Principles of social psychiatry, 2010. Vol. 2, pp. 155—177.
  24. Kleinman A., Good B. Culture and depression. New England Journal of Medicine, 2004. Vol. 351, pp. 951—952.
  25. Lambert J.E., Alhassoon O.M. Trauma—focused therapy for refugees: Meta—analytic findings. Journal of counseling psychology, 2015. Vol. 62(1), pp. 1—10.
  26. Langemeyer I., Roth W.-M. Is cultural—historical activity theory threatened to fall short of its own principles and possibilities as a dialectical social science? Outlines. Critical Practice Studies, 2006. Vol. 8(2), pp. 20—42.
  27. Larrabee M.J., Weine S., Woolcott P. “The wordless nothing”: Narratives of trauma and extremity. Human Studies, 2003. Vol. 26(3), pp. 353—382.
  28. Luno J.A., Beck J.G., Louwerse M. Tell Us Your Story: Investigating the Linguistic Features of Trauma Narrative. The Cognitive Science Society, 2013, pp. 2955—2960.
  29. Ma J. The synergy of Peirce and Vygotsky as an analytical approach to the multimodality of semiotic mediation. Mind, Culture, and Activity, 2014. Vol. 21(4), pp. 374—389.
  30. Maercker A., Hecker T. Broadening perspectives on trauma and recovery: A socio-interpersonal view of PTSD. European journal of psychotraumatology, 2016. Vol. 7, pp. 1—9.
  31. Maier T., Straub M. “My head is like a bag full of rubbish”: Concepts of illness and treatment expectations in traumatized migrants. Qualitative health research, 2011. Vol. 21(2), pp. 233—248.
  32. Marková I. The dialogical mind: Common sense and ethics: Cambridge University Press, 2016. Pp. 1—242.
  33. Marsella A.J. Ethnocultural aspects of PTSD: An overview of concepts, issues, and treatments. Traumatology, 2010. Vol. 16(4), pp. 17—26.
  34. Marsella A.J., Friedman M.J., Spain E.H. Ethnocultural aspects of posttraumatic stress disorder: Issues, research, and clinical applications: American Psychological Association, 1996, pp. 1—576.
  35. Mattar S. Educating and training the next generations of traumatologists: Development of cultural competencies. Psychological Trauma: Theory, Research, Practice, and Policy, 2011. Vol. 3(3), pp. 258—265.
  36. Pratt G., Johnston C., Banta V. Filipino migrant stories and trauma in the transnational field. Emotion, Space and Society, 2015. Vol. X., pp. 1—10.
  37. Pupavac V. Pathologizing populations and colonizing minds: International psychosocial programs in Kosovo. Alternatives, 2002, pp. 489—511.
  38. Ratcliff B. G., Rossi I. Santé mentale et sociétés plurielles. Alterstice—Revue Internationale de la Recherche Interculturelle, 2015. Vol. 4(2), pp. 3—12.
  39. Rey F.L.G. Subject, subjectivity, and development in cultural-historical psychology. In van Oers B., Wardewekker W., Elbers E., Van der Veer R. (Eds.) The Transformation of Learning: Advances in Cultural-Historical Activity Theory. Cambridge University Press: Cambridge, 2008, pp. 137—156.
  40. Roth W.-M., Lee Y.-J. “Vygotsky’s neglected legacy”: Cultural—historical activity theory. Review of educational research, 2007. Vol. 77(2), pp. 186—232.
  41. Rousseau C., Drapeau A., Corin E. The influence of culture and context on the pre- and post-migration experience of school—aged refugees from Central America and Southeast Asia in Canada. Social Science & Medicine, 1997. Vol. 44(8), pp. 1115—1127.
  42. Schick M., Zumwald A., Knöpfli B., Nickerson A., Bryant R.A., Schnyder U., Muller J., Morina, N. Challenging future, challenging past: The relationship of social integration and psychological impairment in traumatized refugees. European journal of psychotraumatology, 2016. Vol. 7(1), pp. 28—57.
  43. Schweitzer R., Melville F., Steel Z., Lacherez P. Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Australian and New Zealand Journal of Psychiatry, 2006. Vol. 2(40), pp. 179—187.
  44. Silove D., Steel Z., McGorry P., Mohan P. Trauma exposure, postmigration stressors, and symptoms of anxiety, depression and post-traumatic stress in Tamil asylum-seekers: comparison with refugees and immigrants. Acta Psychiatrica Scandinavica, 1998. Vol. 97(3), pp. 175—181.
  45. Silove D., Steel Z., Watters C. Policies of deterrence and the mental health of asylum seekers. Jama, 2000. Vol. 284(5), pp. 604—611.
  46. Smagorinsky P. “Every individual has his own insanity”: Applying Vygotsky’s work on defectology to the question of mental health as an issue of inclusion. Learning, Culture and Social Interaction, 2012. Vol. 1(2), pp. 67—77.
  47. Squire C. Experience-centred and culturally-oriented approaches to narrative. In Andrews M., Squire C., Tamboukou M. (Eds) Doing Narrative Research. London: Sage, 2008, pp. 1—47.
  48. Steel Z. Beyond PTSD: towards a more adequate understanding of the multiple effects of complex trauma. Traumatiserungen von Flüchtlingen und Asyl Schenden: Einflus des politischen, sozialen und medizinischen Kontextes, 2001, pp. 66—84.
  49. Steel Z., Chey T., Silove D., Marnane C., Bryant R.A., Van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta—analysis. Jama, 2009. Vol. 302(5), pp. 537—549.
  50. Stetsenko A. From relational ontology to transformative activist stance on development and learning: expanding Vygotsky’s (CHAT) project. Cultural Studies of Science Education, 2008. Vol. 3(2), pp. 471—491.
  51. Stetsenko A., Arievitch I.M. The self in cultural—historical activity theory reclaiming the unity of social and individual dimensions of human development. Theory & Psychology, 2004. Vol. 14(4), pp. 475—503.
  52. Sturm G., Baubet T., Moro M.R. Culture, trauma, and subjectivity: The French ethnopsychoanalytic approach. Traumatology, 2010. Vol. 16(4), pp. 27—37.
  53. Summerfield D. L’impact de la guerre et des atrocités sur les populations civiles: principes fondamentaux pour les interventions des ONG et une analyse critique des projets sur le traumatisme psychosocial: Overseas Development Institute, 1996.
  54. Summerfield D. The invention of post—traumatic stress disorder and the social usefulness of a psychiatric category. BMJ: British Medical Journal, 2001. Vol. 322 (7278), pp. 95—98.
  55. Tang C.-S.-K. Culturally relevant meanings and their implications on therapy for traumatic grief: Lessons learned from a Chinese female client and her fortune—teller. Voices of Trauma: Springer, 2007, pp. 127—150.
  56. Tankink M., Richters A. Silence as a coping strategy: The case of refugee women in the Netherlands from South— Sudan who experienced sexual violence in the context of war Voices of Trauma: Springer, 2007, pp. 191—210.
  57. Toomela A. There can be no cultural—historical psychology without neuropsychology. And vice versa. The Cambridge Handbook of Cultural—Historical Theory, 2014, pp. 315—349.
  58. Tummala—Narra P. Conceptualizing Trauma and Resilience Across Diverse Contexts. Journal of Aggression, Maltreatment & Trauma, 2007. Vol. 14(1—2), pp. 33—53.
  59. van der Riet M. Working with historicity: tracing shifts in contraceptive use in the activity system of sex over time. Psychology in Society, 2012. Vol. 43, pp. 23—39.
  60. Van der Veer R., Valsiner J. The Vygotsky Reader: Blackwell Oxford, 1994.
  61. Van Ommeren M., de Jong J.M., Sharma B., Komproe I., Thapa S.B., Cardeña E. Psychiatric disorders among tortured bhutanese refugees in nepal. Archives of General Psychiatry, 2001. Vol. 58(5), pp. 475—482.
  62. Vasilyuk F. Psikhologiya perezhivaniya. Analiz preodoleniya kriticheskikh situatsii [The psychology of experiencing. Analysis of resolution of life’s critical situations]: Moscow: Moscow University Press, 1984, pp. 1—205.
  63. Vygotskij L.S., Sève F., Clot Y. Pensée et langage: Messidor, 1985, pp. 1—420.
  64. Vygotsky L. Speech and thinking. L.S. Vygotsky, Collected Works, 1987. Vol. 1(3), pp. 39—45.
  65. Vygotsky L.S. Mind in society: The development of higher psychological processes: Harvard University Press, 1980, pp. 1—153.
  66. Wang S. Aidez-nous à comprendre vos Chinois! Genèses, 2016. Vol. 4, pp. 141—156.
  67. Watters C. Emerging paradigms in the mental health care of refugees. Social Science & Medicine, 2001. Vol. 52(11), pp. 1709—1718.
  68. Weine S.M., Kuc G., Eldin D., Razzano L., Pavkovic I. PTSD among Bosnian refugees: A survey of providers’ knowledge, attitudes and service patterns. Community Mental Health Journal, 2001. Vol. 37(3), pp. 261—271.
  69. Williams C. The epistemology of cultural competence. Families in Society: The Journal of Contemporary Social Services, 2006. Vol. 87(2), pp. 209—220.
  70. Wilson J.P., Wilson J.P., & Drozdek B. Broken spirits: The treatment of traumatized asylum seekers, refugees and war and torture victims: Routledge, 2004. Pp. 1—689.
  71. Young A. The harmony of illusions. Princeton: Princeton University Press, 1995, pp. 1—321.
  72. Zepke N., Leach L. Contextualised Meaning Making: one way of rethinking experiential learning and self—directed learning? Studies in Continuing Education, 2002. Vol. 24(2), pp. 205—217.
  73. Zittoun T. Three dimensions of dialogical movement. New Ideas in Psychology, 2014. Vol. 32, pp. 99—106.
  74. Zittoun T., Sato T. Imagination in adults and the aging person: possible futures and actual past. In Glavenau V.P., & Zittoun T. (Eds.) Handbook of Imagination and Culture. Oxford University Press: Oxford, 2018, pp. 187—210.

Information About the Authors

Gail Womersley, Master of Clinical Psychology, Postgraduate Student, Institute of Psychology and Education, Neuchatel University, Neuchatel, Switzerland, e-mail:

Laure Kloetzer, Assistant Professor, Assistant Professor in Sociocultural Psychology, Institute of Psychology and Education, Neuchatel University, Neuchatel, Switzerland, ORCID:, e-mail:



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