medication which would finally enable her to sleep. Over and over, she had repeated the same story: three paramilitary Serbs had come to her village. She had been told many times how the Serbs would kill men and rape women and when she saw the three men, she ran away in terror. The men ran after her and caught up with her inside a barn. There she was, faced by three men in battle fatigues, their frightening faces smeared with black. One of them waived his hand at the young woman and said “You, come over here…” At that moment, she fainted. How long she had remained unconscious, she didn’t know. What had happened during that time? Had she been sexually abused? She couldn’t really say… Was it because she was ashamed or had she truly forgotten? She preferred to think the men had left her there and gone away. But ever since that day, as soon as she fell asleep, she would see those same three frightening men approaching her and wake up with a start, drenched in sweat. Those first scary minutes of sleep were then followed by a long night of insomnia. The clinicians who treated her were all convinced that during those moments she relived the scene where she had fainted. Yet, when we set out to explore in detail exactly what she experienced during what she referred to as her nightmare — a violent constriction of the throat, suffocation, burning sensations on her neck — she gradually described what she in fact perceived. It wasn’t the paramilitary troops but a strange sort of bird, coming down from the sky, latching on to her neck and causing her to awaken with a start…

Hence, the habit of understanding dreams as containing precious messages about a person’s past had kept the patient’s therapists from solliciting information about her true perceptions. In point of fact, the young woman’s dream contained the following information: the extreme fright caused by the sight of the three paramilitary Serbs had fractured her being, causing a breach in which a mythic being had engulfed itself, a strange bird, a striga, which returned every night since then. Recognizing the existence of this being, exploring in depth with the patient both its nature and technical ways of getting rid of it sufficed for the young woman to find sleep again that very same night. The reason she had not been able to rest for so long was that her therapists had all suspended their investigation the moment the Serbs appeared in the dream. Understanding and treating the traumatic event at the root of traumatic symptoms is therefore not as simple a task as it might seem. After our long interview with the young woman, it was indeed clear that the etiology of her pathology, the origin of the breach in her psyche, was in fact fright. But how and why is fright the cause of disorder? As demonstrated by this particular case, but also by many cultural etiological models of fright found worldwide, fright evidently causes disorder because it puts human beings in the presence of beings from other worlds.

In terms of etiology, practitioners often note two fundamental emotions in relation to a trauma: fright and experiencing death. In fact, both characteristics are included in the very definition of the traumatic event in the DSM-IV [10]. Thus, a traumatized person is first and foremost someone who has been frightened. Apparently, the reason a new word was created in the field of psychopathology is because the common use of the terms fear or fright had gradually lost their physical connotations. Indeed, the emotional turmoil brought on in a moment of great fright associates sudden and unexpected fear, a physical startle response, an abrupt change in equilibrium, followed by tachycardia and a physical sensation of heaviness in the stomach or chest. The impression, when a frightened person manages to describe the experience, is both one of loss, as if her breath had suddenly been taken from her, and the feeling of an invasion, as though a foreign entity had penetrated by surprise inside her system. And, just as in the Kosovar example given above, such powerful fear is provoked when a person is faced with the experience of her own death. Not merely the fear of dying, but the actual living of one’s death, of an instant where one knows one is dying or sees oneself dead.

the Muslim Paradise where the dead wear long white gowns. He is X-rayed and tested: aside from several bruises, he presents no alarming symptoms, no broken bones or hurt organs. A week later, he is discharged from the hospital. Ever since, he suffers without respite from splitting headaches, dizziness, nausea, whisling in the ears, lower back pain, visual disorders and insomnia. Three years later, the traumatic pathology which developed in the wake of his encouter with his own death is still acute [11]. Many clinicians have encountered similar cases. Faced with the endless repetition of the same narrative, of the same traumatic scene, what can be done? The only way a therapist can possibly stand such a feeling of helplessness for weeks, months and sometimes years on end — a reflection of the patient’s experience of his own death — is by asking the question “why?”. Why him? Why then, on that day? Because of whom? By doing so, he or she is once more bound to witness the appearance of beings. For instance, so and so had made love to his wife, and later stored the towel stained with semen under the couple’s mattress, before going to work. That evening, his wife had asked him if he had seen the towel. He told her it was stored in the usual place, but she couldn’t find it. Later, he had forgotten about the incident. A week after, he had had the accident. As it turns out, his sister in law, his wife’s brother’s wife, who lives in the same building, had come over that day to borrow sugar. While her sister in law was busy with a child, she had crept into the couple’s bedroom and stolen the towel stashed under the mattress. Later that day, she had taken it to a sorcerer who had buried it in a cemetery… The point was to harm the couple most certainly out of spite or jealousy. This was in fact what had happened to the Algerian immigrant worker who fell from the scaffolding mentioned above. Now, there is only one way to recover the towel in such a case: the man must turn to a healer, a master of the spirits, for him to send one of his helper Djinns [12] out into the night to retrieve the missing object and thereby save the man from certain death.

Thus, trauma is one of the only modern notions for which the knowledge conveyed by traditional cultures turns out to be decisive. A short review of the etymology of the word fright in several languages will demonstrate how deeply such concepts are embedded in the culture’s vocabulary [13].

Up until the 19th century, it was still a common idea in France that the mere encounter with an epileptic or with a person suffering from tics was enough to transmit to the onlooker, through fright, the same being, spirit or demon which afflicted the person. “Never look at an epileptic having a seizure because you might catch the devil”, was a common saying. But if a human being can be taken over by a being from another world, it is because his own being, his “self” — or maybe one should say his “soul” — has fled under the shock of fear.

In Wolof, sama feet na — which is usually translated as “I’m frightened”— literally means “his or her ‘soul’ (feet = ‘soul’, life principle) has fled or taken leave of his or her body”.

In Bambara, diatiggé (from dia = ‘shadow’ and by association ‘soul’, ‘psyche’ and tiggé = ‘cut’), specifically refers to nightly terror caused by the encounter with a supernatural being such as a spirit (djinna), a sorcerer (subkha) or the soul of a dead person. As in Wolof, the word which expresses the concept of fright means “the soul is cut, or separated from the body of the person”. By extension, diatiggé also refers to the psychic disorders caused by fright, in particular agitation or brief psychotic episodes.

In Arabic, two words can be used to refer to fright. One of them, sar’; though very widespread is rather literary. It is derived from a root which means “to spill”, lose one’s original shape or even lose any kind of shape. The other word, khal’a, more commonly used in the Arabic dialects of the Maghreb, is directly derived from the verb meaning “to uproot”, to extract violently. The first word, sar’, was largely used in Medieval Arabic medicine and, after a series of metonymies, came to refer to disorders including chaotic physical agitation which modern authors identify as epilepsy or hysteria but which are closer to what anthropologists and ethnopsychiatrists describe as possession disorders [14]. Once more, then, we are in the presence of a word which refers to both fright and to the etiology of a disorder caused by the occupation of the inner world of a human being by another, non human, being. As for the word khal’a, which can be translated as “uprooted soul”; it is very similar to other traditional etiologies and, as in Bambara or Wolof, is used to describe chaotic pathologies ranging from pediatric autism to psychomotor agitation syndromes and including the entire scope of defensive reactions to the environment such as mutism, echolalia, echopraxia and coprolalia.

In Spanish and Portuguese, susto, or “start”, also means fright and refers — in Spain, Portugal but also in Latin America — to a depressive type disorder the etiology of which is once again an encounter with a being from another world who chases the victim’s soul from his or her body in order to take its place. In Peru, among the Quechua people, the symptoms of susto include the gradual weakening of physical strength, isolation behavior, anorexia and insomnia. According to the Quechua, the disorder, which is common even in big cities, is caused by the capture of the victim’s soul by the Earth or by one of its representative deities [15] .

The Hakka Chinese of Tahiti interpret a series of symptoms as the result of a frightening experience (hak tao) which has separated the person (often a child) from his double (t’ung ngiang tsai) which can therefore no longer reach its original location. The healer must do everything in his or her power to retrieve it, through persuasion, promises, tricks, intimidation or threats [16].

In Kirundi, the language spoken in Burundi, the same root, kanga, is found in a series of words related to the notion of fright. Sylvestre Barancira explains the following [17] :

“Gukanga, means frightened; Kwikanga means to start; Ggukangagurika means to wake up frequently while shivering, to sleep agitatedly, to be on the lookout and to start frequently. [Meanwhile,] “Igikangge refers to an invisible being found in the wilderness, marshes, chasms, bushes or the depths of the earth. Its presence can be detected through smoke rising from bushes in the early morning or evening, or through sparks in the night, or unexpected noises which sometimes resemble cattle sounds, or simply when the vegetation stirs even though there is no wind. [As in many African countries,] the swirls of dust rising from the ground at sundown also indicate the presence of the frightening spirit. People say such swirls are in fact the sign of the spirit from beneath, the sacred python on its way to the drinking trough… A sudden cold, hot or numbing feeling is also a sign. These spirits of the wilderness have their own autonomous lives and, [like the Djinns or Jnun in Arabic cultures,] they also marry, have children, raise cattle and practice the same faith as humans, namely [the traditional religion of the Barundi:] the Kubandwa possession cult… It sometimes happens that an Ibikangge or Ibihume spirit may call out someone’s name as that person passes by, at sundown or in the wee hours of the morning. He or she who answers the call risks illness, madness or even death… Skin allergies, the sudden swelling of joints, paralysis of an arm or a leg, mutism, convulsions, agitation or delusions [are often attributed to the action of these spirits]… The etiology of such pathologies is the encounter with spirits, the victim having been frightened — yarakanzwe — by his or her meeting with bush spririts such as Igikangge, Ibinyamwonga or Iggihume. Iggihume is a frightening ghost, a monster, a wild and malevolant spirit, or the spirit of a person who died a violent death and wasn’t buried and who returns to haunt the living…”

massacres reached the scale of genocides. Among them, the 1994 events in Rwanda remain by far the most ghastly and incomprehensible. They were triggered in the early morning of April 6, 1994 by the shooting down by ground to air missiles of the airplane carrying the president of the country as it was preparing to land at the Kigali airport, the country’s capital. The Presidential Guard and the Interahamwe, a Hutu militia under the government’s command, immediately took over and set out to carry out a plan to physically eliminate every single Tutsi living in Rwanda. Within a few weeks, the country had literally become a blood bath, river waters turning red with th blood of countless bodies, corpses by the tens of thousands littering the roads. Four months later, one eighth of the country’s population had been brutally murdered by organized mobs wielding machetes, clubs, billhooks, and less often, guns [19].

We were a group of people in the room specially set up for consultations at the University of Budjumbura. Among the young psychologists, several had lived through the same events but none had been so close to death. Everyone listened closely to Jean-Chrysostome’s story. When someone asked him where he had found the strength to resist, he answered that God had entered him, at the moment of the most intense fright, God who had manifested Himself in the ladder dream and given him the strength to climb out from the latrine. Since then, Jean-Chrysostome, both clinical psychologist and pastor in an Evangelical church, prays and heals, guided by the same being who appeared to him during those twenty four hours spent at the bottom of the latrine…

Here again, the fright caused by the accident, the experience of waking up in the world of the dead, changed that. His posttraumatic symptomatology was alleviated only once the other world characteristic of his culture of origin had been recognized and he received proper expert treatment within the framework of that other, hidden world. In both these examples, as in many such cases, the traumatic event put the victims in contact with the hidden world within their respective cultural contexts. In terms of therapy, the first step towards curing this type of patient is to give credit to the non human, invisible beings recognized and described as such by the patient’s cultural tradition. In our experience, a single session is often enough to obtain significant improvement.

Though similar to the first two, Jean-Chrysostome’s case, on the other hand, is slightly different. Following his traumatic experience, Jean-Chrysostome did not develop posttraumatic symptoms as did our first two examples. Quite the opposite, as a matter of fact, since after living through his own death and resuscitation, Jean-Chrysostome took on the responsibilities of a public figure, both a healer and a religious leader. In his case, rather than putting him in contact with traditional invisible beings of his cultural world, extreme fright, experiencing death and coming back to life, forced him to contend with forces which are presently taking over Burundi, and to actively participate in the construction of a new social reality. In effect, Christian churches of all imaginable denominations, as well as cults of Christian inspiration are rampant throughout Central Africa and are currently becoming the leading political forces in the region. Incidently, Jean-Chrysostome’s experience suggests the ways in which the traumatic process can be — and very often is — deliberately used as a political tool to bring about radical transformation and set up a new world. Though in his case he was destined to die by his agressors — the very fact that he survived is living proof that Jesus is indeed his personal Saviour -—, his subsequent transformation or transfiguration nevertheless clearly demonstrates how orchestrating someone’s death and rebirth through the use of fright can be a powerful psychological and political tool allowing for a complete and irreversible transformation of the person. Indeed, for this very reason, trauma is a tool well known to traditional cultures as shown by the structure of numerous initiation rites around the world [21]. For the same reason, it is also a tool more and more frequently put to use by present day radical political and religious groups.

The transforming power of trauma pertains to the cumulative aspect of the traumatic process. If we accept the idea suggested by cultural fright etiologies that extreme fright shatters the person, thereby putting him in contact with beings from another, unknown world, then the primary effect of trauma is a breakdown of the person’s former, habitual world. In it’s place, as we have seen, a new, hidden world is revealed. Yet, if and when this process is repeated several times, the culturally accepted hidden or unknown world and beings, revealed by the initial traumatic event, will in turn be shattered, putting the victim in contact with beings and worlds previously unknown not only to him or her but to mankind. This indeed explains the isolating effect of cumulative trauma, the victim, gradually becoming the only person on Earth to know of hidden worlds which noone else can see or perceive. Thus, with each new traumatic event, the person’s usual, everyday world loses meaning until it has become totally senseless and empty, obligating the victim — and also his or her therapists — to construct a “neo-world” in which the succession of events and their implications make some sort of sense. The following account written by an Auschwitz survivor is both a chilling and articulate description of this process [22]. At the time of the excerpted incident, the author has been in Auschwitz for some time ; he has run into a man he knew from Paris and followed him to his block hoping to get some extra soup.

“I’m gulping the contents of a dish of soup when lightning strikes me.

A voice announces: ‘Lagersperre!’ Camp closed! Curfew!

What am I doing here? I drop the dish and race out the door.

I won’t make it this time. I’m dead. The reason is simple: I’m not in my own block in time for the curfew. For an SS, if this isn’t an attempted escape, then what is?

…I run and run and run, expecting a burst of machine gun fire from one of the miradors. Noone could avoid it. Each surveillance post watches over a sector within its range and it’s impossible to find cover. The only solution would be to throw myself against the electrified barbed wire fence.

I discover true fear. Not just anxiety, not just heightened imagination but reality. I am the prime target of all the SS machine gunmen. The only question is which one of the miradors will be the first to fire?

At that precise moment, I stopped being part of the “normal” world, acquiring my new skin: the skin of a camp prisoner [23]. Until that instant, I knew intellectually what was going on in the Lager. That evening, I lost all contact with my peers by perceiving relations between human beings from a perspective I hadn’t suspected, namely relations governed by the absence of laws. In effect, I am a solitary participant in an absurd game, the rules of which noone can master since each SS has the right to improvise according to his mood. For me, the name of the game, winner or loser, is death.

From now on, I am a Häftling, a full-fledged convict, a thing with a human face. The SS refer to deportees as a “Stück”, a piece or a part. A piece of wood or metal has value, at least commercially. The Stück I have become has no value whatsoever, be it esthetic, moral or commercial. It can be thrown away or burned. From now on, I am part of this world of spare parts. I am but a very small piece of a new world I couldn’t have imagined even though I am fitted into it.” [24].

Trauma, then, is a process whereby something happens not just to the person but to the world itself, thereby rendering the victim permeable to new ideas, open to the advent of a new order, in search of new meanings. This is one of the primary dangers of cumulative trauma. Once the person has been “opened up” by successive traumatic events, he or she is vulnerable to all sorts of social, political, religious and or esoteric forces and ideas, sometimes simultaneously, sometimes experimenting one proposition after the other in an endless search for meaning. The work of the therapist, in these cases, is to strive to both identify and construct, together with the patient, the new world heralded by the traumatic events and establish the patient’s place in it. Not a simple task…

true otherness, not our fellow “others” who are in fact identical, but “others from another world”, whose mere encounter causes a breach in our psyches, whose mere presence petrifies us! Taken a step further, cumulative fright compels the therapist to construct a new world for his or her traumatized patient.

The Kashinawa natives of the Amazon forest, who are aware of the advantage of producing individuals curious about other worlds, profess a true apology of fright. They claim that the ability to be frightened is a virtue which makes both a skilled hunter and a skilled shaman. Indeed, a hunter needs to be keenly attuned to the animal world and the shaman to the world of spirits [25] and fright is the only way to introduce a person to another world. In order to initiate their professionals to the mastery of fright, apprentices are given a beverage called ayawaska containing juices derived from a liana and from leaves of a specific kind of tree. The Kashinawas provide the subtle explanation that the leaves produce the visions while the liana makes it possible to vomit the terror produced by the visions. The alternation between vision and regurgitation gradually confers to the apprentice the ability to stand his beneficial fright [26]. The ability to cope with being frightened is thus equivalent to the ability to perceive different worlds based on unknown logical principles. This ability can be compared to the curiosity of the researcher who has to be able to tolerate being surprised.

Today, the word “fright” is seldom used by psychopathology professionals who favor words such as “trauma” or “stress”, yet interest is growing in all the notions it subsumes. Recent research in the psychopathology of trauma and in ethnopsychiatry point to its relevance and to the fact that traditional cultures are right to hold on to it.