Årg. 25 Nr. 43 (2025): Det Biosociale
Originalartikler

En biosocial tilgang til moralske skader:: Livssituationer og deres affordances

Lars Williams
Dansk Institut for Internationale Studier (DIIS)
Forsiden med overskriften: Det Biosociale. Forestiller en rød og blå fugl med spredte vinger, malet i akvarel

Publiceret 2025-12-08

Nøgleord

  • PTSD,
  • Moral Injury,
  • Trauma,
  • biosocial,
  • Military psychology,
  • Military Anthropology
  • ...Mere
    Mindre

Citation/Eksport

Williams, L. (2025). En biosocial tilgang til moralske skader:: Livssituationer og deres affordances. Tidsskrift for Forskning I Sygdom Og Samfund, 25(43), 31–52. https://doi.org/10.7146/tfss.v25i43.147525

Resumé

Den almene diagnostiske forståelse af post-traumatisk stresslidelse (PTSD) bygger på en lineær forbindelse mellem en traumatisk hændelse og efterfølgende symptomer, som kan føres direkte tilbage til hændelsen. Denne lineær model er tidligere blevet kritiseret i den medicinske antropologi og kulturpsykiatrien. Nyere strømninger af biosocial tænkning i den kulturpsykiatrisk forskningslitteratur sigter mod at begrebsliggøre psykopatologi som fænomener, der udspringer i kontinuerlige vekselvirkninger mellem individuel biologi og sociale og kulturelle miljøer. Central i disse tilgange er anvendelsen af ældre begreber som Hackings ’looping effekter’ og Gibsons ’affordances’. Igennem en skildring af en enkelt empirisk case om Erik, en dansk krigsveteran, viser jeg hvordan forskellige livssituationer, karakteriseret ved specifikke affordances, skaber looping-effekter mellem kropslige symptomer, familierelationer, og kulturelle forestillinger om ”krigstraumer”. Jeg argumenterer for, at vi igennem en biosocial tilgang, hvor biologiske, sociale og kulturelle domæner integreres, kan tilgå PTSD hos danske krigsveteraner på mere fyldestgørende vis. Dette studie bidrager til en dels til militærpsykiatriske debatter om PTSD, samt til biosocial teoridannelse om psykopatologi.   

Referencer

  1. Andreasen, N. C. (2010). Posttraumatic stress disorder: a history and a critique. Annals of the New York Academy of Sciences, 1208(1), 67-71. doi: https://doi.org/10.1111/j.1749-6632.2010.05699.x
  2. APA (1980). Diagnostic and Statistical Manual of Mental Disorders (DSM), 3rd edition. American Psychiatric Association.
  3. APA (1987). DSM, 3rd edition, revised version. American Psychiatric Association.
  4. APA (2022). DSM, 5th edition, revised version. American Psychiatric Association.
  5. Bateson, G. (1972). Steps to an Ecology of Mind: Collected Essays in Anthropology, Psychiatry, Evolution, and Epistemology. Chicago: University of Chicago Press.
  6. Birk, R., & Manning, N. (2023). Towards an ecological social science? On introducing ‘social affordances’ to (some) social theory. Philosophical Psychology, 1-21. doi: https://doi.org/10.1080/09515089.2023.2277346
  7. Bonson, A., Murphy, D., Aldridge, V., Greenberg, N., & Williamson, V. (2023). Veterans’ experiences of moral injury, treatment and recommendations for future support. BMJ Military Health, e002332-. doi: https://doi.org/10.1136/military-2022-002332
  8. Brinkmann, S. (2023). Oplevelsessamfundet. København: Samfundslitteratur.
  9. Brinkmann, S., Birk, R., & Lund, P. C. (2023). Is Another kind of Biologization Possible? On Biology and the psy Sciences. Integrative Physiological and Behavioral Science, 57(3), 719-737. doi: https://doi.org/10.1007/s12124-023-09757-0
  10. Burkman, K., Gloria, R., Mehlman, H., & Maguen, S. (2022). Treatment for Moral Injury: Impact of Killing in War. Current Treatment Options in Psychiatry, 9(3), 101–114. doi: https://doi.org/10.1007/s40501-022-00262-6
  11. Clark, A. (2013). Whatever next? Predictive brains, situated agents, and the future of cognitive science. The Behavioral and brain sciences, 36(3), 181-204. doi: https://doi.org/10.1017/S0140525X12000477
  12. Clifford, J., & Marcus, G. E. (1986). Writing culture: The poetics and politics of ethnography: a School of American Research advanced seminar. Oakland: University of California Press.
  13. de Haan, S. (2020). Enactivism as a New Framework for Psychiatry. Philosophy, Psychiatry & Psychology, 27(1), 1-2. doi: https://doi.org/10.1353/ppp.2020.0000
  14. Downey, Greg (2016) Being human in cities: Phenotypic bias from urban niche construction. Current Anthropology 57(S13): S52–S64. doi: https://doi.org/10.1086/685710
  15. Downey, G. & Lende, D. H. (2012). Neuroanthropology and the Encultured Brain. In The Encultured Brain. Boston: The MIT Press. doi: https://doi.org/10.7551/mitpress/9219.003.0004
  16. Fletcher, J. R., & Birk, R. H. (2022). The conundrum of the psychological interface: On the problems of bridging the biological and the social. History of the Human Sciences, 35(3-4), 317-339. doi: https://doi.org/10.1177/09526951211070503
  17. Fuchs, T. (2018). Ecology of the Brain: The Phenomenology and Biology of the Embodied Mind. Oxford: Oxford University Press, Incorporated.
  18. Gendron, M., Mesquita, B., & Barrett, L. F. (2020). The Brain as a Cultural Artifact: Concepts, Actions, and Experiences within the Human Affective Niche. In L. J. Kirmayer, C. M. Worthman, S. Kitayama, R. Lemelson, & C. A. Cummings (Eds.), Culture, Mind, and Brain: Emerging Concepts, Models, and Applications (pp. 188–222). Cambridge, UK: Cambridge University Press. doi: https://doi.org/10.1017/9781108695374.010
  19. Gibson, J. J. (1979). The Ecological Approach to Visual Perception. Boston: Houghton, Mifflin and Company.
  20. Gómez-Carrillo, A., & Kirmayer, L. J. (2023). A cultural-ecosocial systems view for psychiatry. Frontiers in Psychiatry, 14, 1031390. doi: https://doi.org/10.3389/fpsyt.2023.1031390
  21. Hacking, I. (1996). The looping effect of human kinds. In D. Sperber, D. Premack, and A. J. Premack,
  22. (Eds.), Causal Cognition: A Multidisciplinary Debate (pp. 351–83). Oxford: Oxford University Press
  23. Han, S., Northoff, G., Vogeley, K., Wexler, B. E., Kitayama, S., & Varnum, M. E. W. (2013). A Cultural Neuroscience Approach to the Biosocial Nature of the Human Brain. Annual Review of Psychology, 64(1), 335–359. doi: https://doi.org/10.1146/annurev-psych-071112-054629
  24. Herman, J. L. (1992). Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror. New York: Basic Books.
  25. Ingold, T. (2000). The Perception of the Environment: Essays on Livelihood, Dwelling and Skill. London: Routledge. doi: https://doi.org/10.4324/9780203466025
  26. Ingold, T. (2018). Back to the future with the theory of affordances. HAU: Journal of Ethnographic Theory, 8(1-2), 39-44. doi: https://doi.org/10.1086/698358
  27. Ingold, T. (2022). Anthropological Affordances. In: Z. Djebbara (Eds.), Affordances in Everyday Life (pp. 51-60). New York: Springer. doi: https://doi.org/10.1007/978-3-031-08629-8_6
  28. Ingold, T., & Palsson, G. (2013). Biosocial Becomings. Cambridge, UK: Cambridge University Press.
  29. Johansson, S. & Astrup, P. (2017, 29. november). De tikkende bomber: Danske krigsveteraner svigtes. BT. https://www.bt.dk/danmark/de-tikkende-bomber-danske-krigsveteraner-svigtes. Besøgt: 25-07-24.
  30. Kirmayer, L. J. (1984). Culture, Affect and Somatization: Part II. Transcultural Psychiatric Research Review, 21(4), 237-262. doi: https://doi.org/10.1177/136346158402100401
  31. Kirmayer, L. J., & Bhugra, D. (2009). Culture and Mental Illness: Social Context and Explanatory Models. In H. Herrman, I.M. Salloum and J.E. Mezzich (Eds.), Psychiatric diagnosis: Challenges and prospects (pp. 29-40). New York: John Wiley & Sons, Ltd. doi: https://doi.org/10.1002/9780470743485.ch3
  32. Kirmayer, L. J., & Gómez-Carrillo, A. (2019). Agency, embodiment and enactment in psychosomatic theory and practice. Medical Humanities, 45(2), 169-182. https://doi.org/10.1136/medhum-2018-011618
  33. Kirmayer, L. J., & Sartorius, N. (2007). Cultural models and somatic syndromes. Psychosomatic Medicine, 69(9), 832-840. doi: https://doi.org/10.1097/PSY.0b013e31815b002c
  34. Kirmayer, L. J., Dao, T. H. T., Smith, A. (1998). Somatization and psychologization: Understanding cultural idioms of distress. In S. O. Okpaku (Ed.), Clinical methods in transcultural psychiatry, 233-265. Washington DC: American Psychiatric Association.
  35. Kitayama, S., & Yu, Q. (2020). Mutual Constitution of Culture and the Mind: Insights from Cultural Neuroscience. In L. Kirmayer, C. M. Worthman, S. Kitayama, R. Lemelson, & C. A. Cummings (Eds.), Culture, Mind, and Brain: Emerging Concepts, Models, and Applications (pp. 88–119). Cambridge, UK: Cambridge University Press. doi: https://doi.org/10.1017/9781108695374.006
  36. Kirmayer, Worthman & Kitayama (2020). Co-constructing Culture, Mind and Brain. In L. Kirmayer, C. M. Worthman, S. Kitayama, R. Lemelson, & C. A. Cummings (Eds.), Culture, Mind, and Brain: Emerging Concepts, Models, and Applications (pp. 188–222). Cambridge, UK: Cambridge University Press.
  37. Kleinman, A. M. (1977). Depression, somatization and the “new cross-cultural psychiatry”. Social Science & Medicine, 11(1), 3-9. doi: https://doi.org/10.1016/0037-7856(77)90138-X
  38. Koenig, H. G., Ames, D., Youssef, N. A., Oliver, J. P., Volk, F., Teng, E. J., Haynes, K., Erickson, Z. D., Arnold, I., O’Garo, K., & Pearce, M. (2018). Screening for Moral Injury: The Moral Injury Symptom Scale - Military Version Short Form. Military Medicine, 183(11–12), E659–E665. doi: https://doi.org/10.1093/milmed/usy017
  39. Kofoed, J. (2016, 19 juli). Veteraner med PTSD føler, at mange er bange for dem. Danmarks Radio. https://www.dr.dk/ligetil/veteraner-med-ptsd-foeler-mange-er-bange-dem. Besøgt: 25-07-24.
  40. Lang & Williams, in review. The generous science: a history of trauma in the Danish military, 1991-2021, General Review of Psychology.
  41. Lægehåndbogen. (2023). Posttraumatisk belastningsreaktion (PTSD). Sundhed.dk. https://www.sundhed.dk/sundhedsfaglig/laegehaandbogen/psykiatri/tilstande-og-sygdomme/oevrige-sygdomme/posttraumatisk-belastningsreaktion-ptsd/. Besøgt: 25-07-24.
  42. Lende, D. H. & Downey, G. (2020). Neuroanthropological Perspectives on Culture, Mind and Brain. In L. J. Kirmayer, C. M. Worthman, S. Kitayama, R. Lemelson & C. A. Cummings (Eds.), Culture, Mind, and Brain: Emerging Concepts, Models, and Applications (pp. 277-299). Cambridge, UK: Cambridge University Press. doi: https://doi.org/10.1017/9781108695374.014
  43. Lifton, R. J. (1973). Home from the war: Learning from Vietnam veterans. New York: Simon & Schuster.
  44. Litz, B. T., & Kerig, P. K. (2019). Introduction to the Special Issue on Moral Injury: Conceptual Challenges, Methodological Issues, and Clinical Applications. Journal of Traumatic Stress, 32(3), 341-349. doi: https://doi.org/10.1002/jts.22405
  45. Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical psychology review, 29(8), 695-706. doi: https://doi.org/10.1016/j.cpr.2009.07.003
  46. Luhrmann, T. M., Padmavati, R., Tharoor, H., & Osei, A. (2015). Hearing Voices in Different Cultures: A Social Kindling Hypothesis. Topics in Cognitive Science, 7(4), 646–663. doi: https://doi.org/10.1111/tops.12158
  47. Manning, N., Birk, R., & Rose, N. (2023). Niche Sociality: Approaching Adversity in Everyday Life. Sociology (Oxford), 57(1), 72-95. doi: https://doi.org/10.1177/00380385221094770
  48. Maturana, H. R., & Varela, F. J. (1992). The tree of knowledge: The biological roots of human understanding. Boulder: New Science Library/Shambhala Publications.
  49. McNally, R. J. (2003). Remembering Trauma revisited. Nature Medicine, 9(12), 1448–1448. doi: https://doi.org/10.1038/nm1203-1448
  50. Meloni, M., Cromby, J., Fitzgerald, D., Lloyd, S. (2018). Introducing the New Biosocial Landscape. In: Meloni, M., Cromby, J., Fitzgerald, D., Lloyd, S. (Eds.), The Palgrave Handbook of Biology and Society (pp. 1-22). London: Palgrave Macmillan. doi: https://doi.org/10.1057/978-1-137-52879-7_1
  51. Mikkelsen, L. B., Felding, S. U. & Bach, Bo. (2022, 24. Januar). Forskelle og ligheder ved kompleks PTSD og personlighedsforstyrrelse. Ugeskriftet for Læger, 184:V06210517. https://ugeskriftet.dk/videnskab/forskelle-og-ligheder-ved-kompleks-ptsd-og-personlighedsforstyrrelse. Besøgt: 25-07-24.
  52. Miresco, M., & Kirmayer, L. (2006). The persistence of mind-brain dualism in psychiatric reasoning about clinical scenarios. The American Journal of Psychiatry, 163(5), 913–918. doi: https://doi.org/10.1176/appi.ajp.163.5.913
  53. Molendijk, T. (2018). Moral injury in relation to public debates: The role of societal misrecognition in moral conflict-colored trauma among soldiers. Social Science & Medicine (1982), 211, 314–320. doi: https://doi.org/10.1016/j.socscimed.2018.06.042
  54. Molendijk, T. (2021). Moral Injury and Soldiers in Conflict: Political Practices and Public Perceptions. London: Routledge.
  55. Niewöhner, J., & Lock, M. (2018). Situating local biologies: Anthropological perspectives on environment/human entanglements. BioSocieties, 13(4), 681–697. doi: https://doi.org/10.1057/s41292-017-0089-5
  56. Noble, D. (2016). Dance to the Tune of Life: Biological Relativity. Cambridge, UK: Cambridge University Press. doi: https://doi.org/10.1017/9781316771488
  57. Ramstead, M. J. D., Veissière, S. P. L., & Kirmayer, L. J. (2016). Cultural Affordances: Scaffolding Local Worlds Through Shared Intentionality and Regimes of Attention. Frontiers in Psychology, 7, 1090–1090. doi: https://doi.org/10.3389/fpsyg.2016.01090
  58. Rietveld, E., & Kiverstein, J. (2014). A Rich Landscape of Affordances. Ecological Psychology, 26(4), 325–352. doi: https://doi.org/10.1080/10407413.2014.958035
  59. Rose, N., Birk, R., & Manning, N. (2022). Towards Neuroecosociality: Mental Health in Adversity. Theory, Culture & Society, 39(3), 121-144. doi: https://doi.org/10.1177/0263276420981614
  60. Shatan, C. F. (1972, 6. maj). Post-vietnam syndrome. The New York Times, 6(5). https://www.nytimes.com/1972/05/06/archives/postvietnam-syndrome.html. Besøgt: 26-07-24.
  61. Shatan, C. F. (1973). The grief of soldiers: Vietnam combat veterans' self-help movement. American Journal of Orthopsychiatry, 43(4), 640-653. doi: https://doi.org/10.1111/j.1939-0025.1973.tb00834.x
  62. Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31(2), 182-191. doi: https://doi.org/10.1037/a0036090
  63. Voergaard, P. (2013, 28. marts). De danske helte: Soldaten, der kravlede ind i krydsilden. BT. https://www.bt.dk/danmark/de-danske-helte-soldaten-der-kravlede-ind-i-krydsilden. Besøgt: 25-07-24.
  64. Wexler, B. E. (2006). Brain and Culture: Neurobiology, Ideology, and Social Change. Cambridge, USA: MIT Press. doi: https://doi.org/10.7551/mitpress/1658.001.0001
  65. Wilson, E. A. (2004). Psychosomatic: Feminism and the neurological body. Durham: Duke University Press.
  66. Wittgenstein, L. (1953). Philosophical Investigations. Hoboken: Blackwell.