14.1 Introduction

The term intergenerational trauma describes how trauma experienced in one generation can lead to trauma in the lives of descendants. For scholars and practitioners of Developmental Origins of Health and Disease (DOHaD), intergenerational trauma is an important aspect of human experience that can shape physiological development and influence individual, family, and community health across generations. In a DOHaD model, parental and community experiences of trauma can be transmitted in utero and in early life, having a cumulative physiological effect such that historical experiences are embodied in the present. In this chapter, we provide a conceptual overview of ‘intergenerational trauma’ in the interdisciplinary field of DOHaD research. The concept has been variously defined in relation to other disciplines and implicitly or explicitly drawn on other concepts such as historical trauma, transgenerational trauma, and post-traumatic stress disorder (PTSD). Intergenerational trauma is of interest to many disciplines and frameworks in part because it lends itself to ‘biosocial’ understandings of violence and discriminatory social contexts as physiologically embodied. Yet, intergenerational trauma also presents challenges for scientific study due to the difficulties inherent in stabilising it as a scientific object. As a group of social theorists working across anthropology, gender studies, and science and technology studies (STS), we attend in this chapter to both the operationalisation of intergenerational trauma in DOHaD research (including the increasing importance of epigenetic mechanisms) and the particularities of how intergenerational trauma is enacted as a supposedly stable entity in science. Given the growing public interest in intergenerational trauma, and its increasing clinical uptake for the care of marginalised communities, this chapter also considers a range of important questions related to policy translation, biopolitics, and social justice.

14.2 What Is Intergenerational Trauma?

Broadly speaking, intergenerational trauma can be understood as ‘emotional and psychological wounding that is transmitted across generations’ [Reference Cerdeña, Rivera and Spak1]. It is entangled with the allied concepts of historical trauma and transgenerational trauma. While often used synonymously with intergenerational trauma, we distinguish historical trauma here through its connection to large-scale historical violence ‘such as enslavement, colonization, and genocide’ [Reference Cerdeña, Rivera and Spak1, Reference Bombay, Matheson and Anisman2]. While this understanding of historical trauma falls within the remit of intergenerational trauma, the latter can also encompass traumatising experiences that do not register in large-scale histories of global violence but occur on more personal and micro-scales, such as interpersonal violence. ‘Transgenerational trauma’ is another term that is often used synonymously with intergenerational trauma (e.g. [Reference Cerdeña, Rivera and Spak1, Reference Atkinson3]); however, in the DOHaD field, the term ‘transgenerational’ has a specific meaning that pertains to epigenetic mechanisms of transmission to two or more subsequent generations (as discussed in more detail later in this chapter). As we define it here, intergenerational trauma does not imply a particular kind of violence or a particular biological mechanism of transmission.

A capacious concept, intergenerational trauma has captured the attention of theorists, clinicians, and writers across innumerable fields. These range from Indigenous studies [Reference Bombay, Matheson and Anisman2, Reference Redvers, Yellow Bird, Quinn, Yunkaporta and Arabena4], psychology and psychiatry [Reference Scorza, Duarte, Hipwell, Posner, Ortin, Canino and Monk5–Reference Van Der Kolk7], social work [Reference Atkinson3], and public health, to literature [Reference Caruth8], queer studies [Reference Cvetkovich9], and memory studies [Reference Hirsch10]. Scholars across these fields differently approach intergenerational trauma as a useful concept for thinking through human relatedness, collective identity formation, and the channels through which histories and legacies are embodied, suturing us across time and space. Theories of how intergenerational trauma is inherited vary widely across these different approaches – from attention to narratives and material culture shared in families [Reference Atkinson3], to artistic texts and collective remembrance practices through which new generations are enculturated [Reference Hirsch10], to somatic mechanisms of implicit or bodily memory held by individuals [Reference Atkinson3, Reference Van Der Kolk7].

While social environments were key to early formulations of DOHaD [Reference Warin, Moore, Zivkovic and Davies11], the increasing molecularisation of the environment has narrowed the focus to biological mechanisms of transmission. This includes two important junctures. The first is the transmission to a fetus of a pregnant person’s real-time experience of a traumatic event/environment or its after-effects. Developmental programming in utero and in early life in response to trauma can foster a greater propensity for stress and mental health challenges [Reference Yehuda and Lehrner12] and can contribute to low birth weight, preterm birth, chronic disease, and immune and metabolic dysfunction later in life [Reference Singh, Morrison and Hoy13–Reference Lewis, Austin and Galbally15]. The second juncture is the effects of patterns of parental care behaviours, including breastfeeding, nutrition, and emotional responsiveness [Reference Conching and Thayer16]. Here, the destructive effects of trauma in caregivers’ own lives, often compounded by material disadvantage and ongoing discrimination, can lead to the re-creation of traumatising contexts for children. Manifesting as developmental challenges, sustained distress, and detachment from caregivers, communities, and culture, this is often referred to as the ‘cycle of trauma’. Here, trauma is both cause and effect. Past traumas suffered by parents, communities, or ancestors may be an origin of an individual’s present-day health challenges and may also manifest as personal experiences or psychological symptoms of trauma.

The scholarly genealogy of intergenerational trauma and its potential mechanisms is often traced to empirical studies of the effects of the Holocaust on children of survivors [Reference Conching and Thayer16, Reference Kellerman17]. These studies found that the children of Holocaust survivors experienced mental health challenges characteristic of those who experienced trauma directly [Reference Cerdeña, Rivera and Spak1, p. 2]. The application of the concept has since broadened considerably, including to explore the impacts of colonisation on First Nations communities [Reference Bombay, Matheson and Anisman2, Reference Redvers, Yellow Bird, Quinn, Yunkaporta and Arabena4]; the effects of forced displacement and armed conflict on survivors and refugee populations [Reference Clarkin18–Reference Perroud, Rutembesa and Paoloni-Giacobino20]; intergenerational harms among African American communities wrought by trans-Atlantic slavery and enduring racism [Reference Kuzawa and Sweet21, Reference Grossi22]; and the embodied legacies of systemic gender-based violence [Reference Uwizeye, Thayer, DeVon, McCreary, McDade, Mukamana, Park, Patil and Rutherford19, Reference Karpin23].

While ‘trauma’ is deployed as a stable biomedical entity in DOHaD-informed studies, defining and measuring trauma scientifically is a complex endeavour always entangled with social worlds. Far from a ‘timeless unity’ [Reference Leys24, p. 3], trauma is made measurable within diagnostic categories and measurement tools that stabilise it as a pathological disease entity. Chief among these are the diagnosis of PTSD, which was added to the Diagnostic and Statistical Manual (DSM) in the 1980s and has been critical to studies and therapeutic interventions for trauma; and measurement tools such as the Adverse Childhood Experiences scale [Reference Leitch25, Reference Müller and Kenney26], which aims to quantify experiences of trauma through scales tabulating challenging events and living conditions.

Such tools conceptualise and enact trauma differently from one-another and in context-dependent ways [Reference Dubois and Guaspare27]. For example, the association between context, symptom, and relationship is differently assembled in individual study designs. As Judy Atkinson and co-authors [Reference Atkinson, Nelson, Atkinson, Purdie, Dudgeon and Walker28, p. 289] have written, trauma is variously conceived as an ‘event, environment, or reaction’. Trauma is often implicitly conceptualised as an event itself, for example, a collective historical trauma or a set of adverse childhood experiences. Yet in other contexts, it is defined as the distress exhibited in response to an event or situation [Reference Cerdeña, Rivera and Spak1, p. 16]. These slippages have a significant impact on understanding what trauma is, who is affected, and the scales of intervention. Defining trauma with reference to a particular historical event such as colonisation, for example, risks homogenising members of a group by assuming they all experienced the event as similarly traumatising [Reference Gone and Kirmayer6]. As Andrew Kim [Reference Kim29] writes, studies of stress and trauma can also often result in researchers assessing whether a given event is traumatic according to their own worldview rather than through deep engagement with the worldview and reference points of the participants. Furthermore, studies that focus conceptualisations of trauma on an event can make it challenging to attend to heterogenous groups for whom traumas are compounding or not easily delineated as discrete events. As Cerdeña et al. [Reference Cerdeña, Rivera and Spak1, p. 2] note, one of the reasons that Latinx communities are underrepresented in the literature on intergenerational trauma may be due to their significant heterogeneity and the multiple overlapping sources of trauma, including diverse forms of colonisation, political oppression within Latin America, dangerous passages of international migration, and systemic racism.

14.3 Critiques of Trauma: Biopolitics and Pathologisation

Given the rising public and scholarly interest in epigenetic mechanisms of trauma transmission and intergenerational trauma more broadly, it is important to consider some questions related to policy translation, biopolitics, and social justice. While trauma-informed approaches have become increasingly important in DOHaD science and therapeutic interventions globally, researchers must also pay attention to cultural specificity and the limitations of cross-cultural translation. Trauma manifests in bodies in ways that are deeply localised, framed by situated histories, cultures, and modes of embodiment [Reference Kim29]. While instruments to measure stress and trauma are often adapted for local contexts, this is not always effective, with localised idioms of pain and distress rendered illegible [Reference Cerdeña, Rivera and Spak1, Reference Mendenhall and Kim41, p. 18]. Non-Western theories of intergenerational trauma and the holistic epistemologies of embodiment that they derive from, such as ‘blood memory’ among Native American communities [42] or ‘communal wounds’ [Reference Gilbert43] and ‘trauma trails’ [Reference Atkinson3] among Indigenous Australians, may likewise be rendered illegible by biomedical definitions and measures that place emphasis on the individualised scale of the patient. Differing cultural concepts of time, reproduction, and kinship that do not rely on colonial imperatives of linear temporalities also need to be considered. Compounding these challenges is the difficulty of measuring trauma when it is ongoing, without a clear beginning or end. For many communities that face intergenerational trauma, violent forces such as colonisation, racism, and socio-economic inequality are not only formations connected to historical events but are ongoing structures of devastation with deeply felt daily impacts.

One of the most pressing interrelated questions around invoking intergenerational trauma in DOHaD is how to effectively translate this into policy in such a way that avoids pathologising individuals and instead addresses ongoing structural inequalities. In the Australian context, with which the authors are most familiar and from where we write, there is considerable concern that ‘trauma’ and associated concepts such as intergenerational trauma and trauma-informed care are becoming ‘buzzwords’ that are used in policy discussions but do not lead to any concrete policy changes. Instead, invoking ‘trauma’ can obfuscate the need to direct attention to specific socio-environmental situations that need to be urgently addressed. The use of ‘intergenerational trauma’ in particular can lend to a sense that the marginalisation and discrimination that continue to impact the lives of many people are somehow inevitable and fixed [Reference Pentecost44].

For example, prominent Aboriginal scholar Chelsea Watego recently contended that the strikingly high rate of incarceration of Indigenous people in Australia, which is often described as an ‘intergenerational trauma issue’, is in fact an ‘institutional racism issue’ [Reference Watego45]. As seen in this example, there is a risk that trauma is being used as a vague umbrella term that does not name or make explicit the proximate sources of trauma. ‘Trauma’ can be a euphemism for the experience of forces like racism, poverty, and domestic violence, erasing the perpetrators (individual and/or state) and placing attention on the ‘recipient’ of the trauma and their capacity to ‘manage’, rather than on structural injustice and policy failures that need correcting. In the case of DOHaD, where the concept of intergenerational trauma is often invoked in relation to parenting, we are concerned that discourses of trauma can perpetuate increased surveillance of the ability of parents to cope with ‘their trauma’, rather than keeping the lens squarely focused on the structural conditions that lead to circumstances of difficulty in which families live.

Further, this focus on individual risk factors and parenting is often directed towards women and mothering. In their review of literature on intergenerational trauma in Latinx communities, Cerdeña et al. [Reference Cerdeña, Rivera and Spak1] found that, of the many mechanisms of intergenerational trauma transmission, the ‘vast majority center around disrupted maternal behaviour (e.g. maternal distress, maternal substance abuse, harsh parenting) and impaired attachment’. They describe this focus on maternal behaviour as a ‘weakness’ in DOHaD literature on intergenerational trauma as it fails to account for structural barriers [Reference Cerdeña, Rivera and Spak1, p. 17]. This slippage or trick is a common problem in studies of trauma, and in the DOHaD field more generally. Here, theories attuned to the biosocial are engaged to bring to light structural inequalities and marginalisation at socio-ecological levels (e.g. intergenerational trauma). Yet through the research process the undue focus on individual (and most often, maternal) behaviour as the scale of inquiry routinely propagates reductive frames of individual responsibility.

14.4 Conclusion

Intergenerational trauma is a powerful concept within the scientific fields that contribute to DOHaD research, and within a range of academic disciplines in the humanities and social sciences. The reach and utility of intergenerational trauma is a strength, allowing concepts from DOHaD research to travel far beyond the field and, in turn, to be influenced by many other disciplines concerned with biopolitics and social justice. However, with these strengths come inevitable weaknesses. Intergenerational trauma can be used to denote a cause, a mechanism, an effect, or all three at once. This capaciousness of the concept increases its usefulness to a range of scholars but decreases its precision. When there are attempts to operationalise intergenerational trauma through more precise definitions (e.g. PTSD diagnosis) and measurements (e.g. ACE scales), these can erase certain experiences of trauma, for example, those derived from a range of chronic experiences of racism and marginalisation rather than a discrete historical event. Further, focusing on the effects of intergenerational trauma on individuals often leads to a focus on interventions that seek to improve individual coping mechanisms rather than interventions that address the structural causes of trauma for marginalised groups. This can cause pathologising treatment of these groups as ‘inherently’ traumatised, paradoxically compounding the effects of intergenerational trauma. Similarly, a focus on pregnancy and maternal care as a mechanism of the transmission of intergenerational trauma can lead to the pathologisation of mothers as inherently risky to their children and as a site of surveillance and interventions.

For intergenerational trauma to be an empowering concept that leads to structural, collective change rather than punitive measures towards individuals, the tendency of DOHaD research and media reporting of this research to focus on mothers’ individual behaviours needs to be challenged (see [Reference Lappé46–Reference Richardson, Daniels, Gillman, Golden, Kukla, Kuzawa and Rich-Edwards48]). Similarly, the keen interest in intergenerational trauma in DOHaD research should be balanced by stories of survivance and strength from communities that face intergenerational marginalisation. The growing interest in intergenerational trauma among a wide range of scholarly and clinical practitioners provides an opportunity for DOHaD researchers to exert a wide influence. The onus is on DOHaD researchers to ensure this influence leads to outcomes that promote social and reproductive justice.