Is it time to drop the diagnosis of PTSD?

Is it time to drop the diagnosis of PTSD?

In many respects post traumatic stress disorder (PTSD) has been an extraordinarily fruitful diagnosis.  It connected the politics of the Vietnam War with the suffering of hundreds of thousands of veterans (Alford, pp 9-13).  As the authors of The Empire of Trauma, Didier Fassin and Richard Rechtman, put it, trauma today is not a clinical but a moral judgment. Its advantage is that it has given us “this unprecedented ability to talk about—and hence experience—the violence of the world.” (p 276)  In addition, trauma has given us a new perspective on contemporary history, up close and from the ground up.  History written from the perspective of trauma is history written from the perspective of the victims.

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Dori Laub has a bad trauma theory, but he has still made a contribution

Dori Laub has a bad trauma theory, but he has still made a contribution.

Laub concludes an autobiographical essay, “On leaving home and the flight from trauma,” with the following lines.

Perhaps it is only through resisting the temptation and the pressures of becoming the same that he [the therapist] can listen to the patients as they really are, without succumbing to the generalizing effects of theory and the homogenizing produced by fashion and by political correctness. (2013a, pp 579-580)

Laub has adopted some of the most fashionable theories of trauma.  At the same time, it is hard to imagine that he is not a good therapist to the traumatized.  I conclude this from the way he writes about his patients, as well as having seen him interview survivors for the Fortunoff Video Archive for Holocaust Testimony at Yale University.

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Trauma is the disruption of the ability to maintain relationships. Psychoanalysis can help.

smartphone-1790833_1920Trauma is the disruption of the ability to maintain relationships. Psychoanalysis can help. Stephen Mitchell tells how. Unfortunately, the cure takes time and money.  A lot of time and money.  Here I’m going to lay out what I think it would take, and roughly how it would work.  Those uninterested in psychoanalysis may be tempted to skip this post, but I think laying out an ideal, a utopian treatment plan, shows us how far we are from an ideal, as well as directing our next steps, even if the pathway is currently blocked for most people.

Trauma is the loss of relationality

Trauma is the loss of relationality to self and to others.  By relationality I mean the ability to participate in relationships.  Trauma is the loss of access to sources of vitality deep within oneself, sources that are brought to life in spontaneous and authentic relations with others, from families to strangers. 

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Are PTSD and C-PTSD dissociative disorders? Does it matter?

art-1699977_1920Are PTSD and C-PTSD dissociative disorders?  Yes, but it’s more important to remember that they are first of all about terror.

It appears that PTSD and C-PTSD may be grouped under the dissociative disorders in the next edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders).  As Matthew Friedman points out, the new DSM-5 category of trauma and stress related disorders was intentionally placed next to the dissociative disorders in order to suggest their similarity (p. 549).  Whether this is a good direction to be heading is another question. 

A quick definition: dissociation is the division of parts of the self.  Dissociation occurs when the parts of the self that know and feel traumatic experience no longer communicate with the rest of the self.  Dissociation is generally seen on a continuum, more or less.   

What’s dissociative about PTSD and C-PTSD?  

I’ll get to C-PTSD (complex PTSD) in a minute. 

It’s easy enough to interpret the leading symptoms of PTSD in terms of dissociation.  The flashback is a dissociative symptom, a failure to prevent intrusion of unwanted and painful experience.

PTSD criteria read like a short laundry list of dissociative isolative and exclusionary processes (intrusion, numbing, and avoidance). (Chefetz, p. 28)

The dissociation associated with PTSD is characterized by an alteration between hyperarousal and numbing or constriction.  The dialectic of trauma moves between intrusion and numbing.   

Judith Herman (pp. 47-49) and others have argued that the experience of trauma generally moves from early hyperarousal to later numbing and constriction.  Others, such as Richard Chefetz see no progression, just the dominance of one position or another. 

Some people with PTSD present with flooding, and others are so emotionally shutdown that they present as emotionally flat, detached, with active dissociative process.  (p. 80)

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It’s time to stop letting the stressor define PTSD

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It’s time to stop letting the stressor define PTSD.  Not doing so makes the new categories of C-PTSD and DESNOS largely irrelevant.

I’ve been posting on this blog for about eighteen months now, a total of fifty-two posts.  Though I’ve written a couple of books on trauma (my latest is Trauma, Culture, and PTSD),  I still feel like a newcomer to the field.  In this post I want to talk about what still puzzles me about trauma theory.  The experience of writing this blog has led to more questions than answers.

I’ve been able to reconstruct to my own satisfaction the origins of PTSD in the Vietnam War  The new diagnostic category served political ends, pointing out what war does to the people who fight it.  The introduction of the disorder called PTSD was progressive politics.  It was also a humane diagnosis, helping to explain to those who suffered from it what was happening to them, giving both soldiers and their families a vocabulary for their pain. 

PTSD in DSM-5

At almost the same time as DSM-5 was being released, the National Institutes of Mental Health was refusing to fund any more research based on the DSM.

National Institute of Mental Health (NIMH) announcement
By Thomas Insel on April 29, 2013

Patients with mental disorders deserve better. . . . That is why NIMH will be re-orienting its research away from DSM categories . . . . The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.

If the DSM were the model for physical medicine, then a heart attack would be defined as “chest pain disorder,” a symptom without a cause.

Henceforth, the NIMH research goal is to fill in the “Draft Research Domain Criteria Matrix,” which links 5 basic natural formations, such as “systems for social processes,” including attachment and fear, with eight columns of units of analysis, such as genes, molecules, and cells.

The goal is to move from mind to brain, so that there will no longer be any need to talk about mind at all. It’s all about electricity and meat, as Gary Greenberg puts it.  And electricity and meat can be measured.  Not, however, in the language of human suffering. 

American psychiatry and psychology have been cut off from the official world of science, but not from VA funding (over 100 million dollars since 2012 for PTSD).   This has consequences.  One, I believe, is the failure of more trauma specialists to object to the VA’s endorsement of cognitive behavioral therapy (CBT), including exposure therapy, as the treatment of choice, the only “evidence based treatments.”

These treatments are short-term, can be learned from a manual, and administered by lesser trained persons.  CBT is quick and cheap compared to long term therapy by well trained persons.  But consider CBT’s difference not only from traditional talk therapy, but also from the rap groups that sprang up in the Vietnam War era, in which veterans could exchange experiences.  CBT discourages “cross talk,” as people talking with each other is called (Tasman et al., p. 1928).  The potential of PTSD to help sufferers explain to each other the varieties of torment and relief has been lost. 

This does not mean we should abandon the diagnosis of PTSD.  Indeed, when this is proposed it is often sufferers who object most strenuously, for the diagnosis has helped many people make sense of their disrupted lives.  It does mean that we should rethink the category. 

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The best trauma narrative I know is Aftermath

fear-1131143_1280The best trauma narrative I know is Aftermath: Violence and the Remaking of the Self, by Susan Brison.  It’s an account of her rape and attempted murder.  I call it the best trauma narrative because it combines philosophy, trauma theory, and narrative.  Alice Sebold’s Lucky, probably the most well known rape narrative (reviewed in this blog), is better written, and makes a more compelling story.  But Susan Brison is a distinguished philosopher, and she approaches her trauma, and trauma theory in general, from a perspective that combines philosophy and experience.    

Actually, Brison doesn’t think being a philosopher did her much good.  Rape and trauma challenge philosophy because they reveal how embodied we all are.  Before we are minds, even before we are body-minds, we are body.  Philosophy is generally not comfortable with bodies.  Philosophy is practiced by questioning the obvious, asking questions such as “what is time?”  But when confronted with an experience that is overwhelmingly obvious, her rape and near murder, Brison found no comfort in philosophy. 

But now, when I was confronted with the utterly strange and paradoxical, philosophy was of no use. (p. x)

 

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Testimony creates the trauma it discovers

zen-178992_1920Testimony can create the trauma it discovers.

Trauma theory and testimony grew up together, beginning in about 1980.  By this I mean that trauma theory and Holocaust testimony emerged as socially and historically significant at about the same time.  It’s worthwhile thinking about their relationship.  If we take the limits of testimony seriously, then much of current trauma theory, especially Cathy Caruth’s account of the “missing moment,” is mistaken. 

It is, of course, not literally true that trauma theory emerged in 1980.  Freud built much of psychoanalysis on his reinterpretation of his patients’ trauma almost a hundred years earlier.  Shell shock, as PTSD was then known, emerged with the First World War.  What happened beginning in the early 1980’s was the inclusion of PTSD in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III) for the first time.  The introduction of PTSD coincided with the “narrative turn” in the humanities and social sciences.  At about the same time, the Fortunoff Archive for Holocaust Testimony was established at Yale University. 

I have come to believe that Holocaust testimony leads to a misunderstanding of trauma, especially if one does not understand testimony’s limits.  I have published three books on trauma that draw on Holocaust testimonies in the Fortunoff Archive.  I think I understand the limits of testimony better now.  My instructor, so to speak, is Henry Greenspan, author of On Listening to Holocaust Survivors.  I also draw on some more recent papers of his.  In place of testimony, Greenspan has engaged in extended conversations with survivors.  Some of these conversations have lasted decades.  Out of these conversations comes a different way of thinking about testimony and trauma. 

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Trauma escapes language, but so does life

human-1411499_1920Trauma escapes language, but so does life.

Trauma theory has a problem with language.  Leading trauma theorists such as Cathy Caruth hold that the mark of a traumatic experience is that it escapes language.  This is the primary reason that Caruth and others have been attracted to the work of Bessel van der Kolk, and neuroscience generally.  Van der Kolk holds that traumatic experience is so sudden and overwhelming that it cannot be put into words.  Ruth Leys addressed the problem in a 2010 interview.  I don’t believe the intellectual situation has changed much since then, other than the increasing influence of affect theory: the claim that there is an autonomous neurological system that experiences not just trauma, but life, in such a way that language is always playing catch-up. 

It is my claim that a major reason for the popularity among postmodern theorists of non-cognitive theories of trauma and affects is that there is a deep coherence between the views of cultural critics and those of the scientists to whose work they are attracted. . . . Van der Kolk [a psychiatrist and neuroscientist] believes that the literal nature of the traumatic flashback or memory means that it belongs to a system of traumatic memory different from that of ordinary memory and as such is cut off or dissociated from ordinary recollection, symbolization, and meaning.  In the case of Caruth the same argument takes the deconstructive form of claiming that the aporia or gap in consciousness and representation that van der Kolk and others believe characterizes the victim’s traumatic experience stands for the materiality of the signifier in de Man’s sense, that ‘moment’ of materiality that simultaneously belongs to language but is aporetically cut off from the speech act of signification or meaning. (p. 666)

An aspect of this argument that does not get a lot of attention is how language normally develops.  The answer seems to be that language is always cut off from experience, not just among the traumatized, but among us all.  If so, then traumatic experience is continuous with ordinary experience.  Trauma does not operate in a parallel neurological or linguistic universe.  The difficulties the traumatized experience putting words to their experiences are exaggerated versions of everybody’s experience with language.  Trauma is uniquely painful, but the way traumatization happens is not unique, but is shared by all who speak. 

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Trauma destroys meaning. Psychoanalysis is not always helpful.

crow, croppedTrauma destroys meaning, and psychoanalysis is not the best way to understand how this happens.  Destructiveness, Intersubjectivity and Trauma: The Identity Crisis of Modern Psychoanalysis, by Werner Bohleber helped me reach this conclusion, which is not his.  Bohleber is a former president of the German Psychoanalytic Association, and editor of Psyche.

Bohleber holds that the psychoanalytic theory of trauma needs two models:

  • the Freudian psycho-economic model, and
  • the hermeneutic object relations model, as he calls it. 

The “economic” model captures the experience of being overwhelmed by an excess of violence, anxiety, and stimulation that cannot be mentally bound, largely because the ego was unprepared.  The term economic, in this context, refers to currency of mental energy, or libido. 

The object relations model explains the feelings of abandonment, including the destruction of emotional bonds with others, as well as the inability to connect with good objects, or feelings, in oneself, associated with trauma.  (pp. 97-98)

But even using both models, the psychoanalytic account faces a fundamental problem, “the almost complete separation of psychic and external realities within psychoanalytic reality.”  External reality is often devalued by psychoanalysts because it challenges the primacy of unconscious experience (p. 102).  The most important thing to know about trauma, says Bohleber, is that it is a “brute fact” that takes place in historical time (p. 109).

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Affect Theory and Trauma Theory

railway-station-1363771_1920Affect theory is coming to trauma theory.  In fact it’s already here.  The best account I’ve read is Ruth Leys “Trauma and the Turn to Affect.”  A historian of science, Leys is the author of the highly regarded Trauma: A Genealogy.  This post is indebted to her work. 

The main thing to understand about affect theory is that it has nothing to do with affect–that is, feeling and emotion.  According to affect theorists, affect is a

pre-subjective force that operates independently of consciousness or the phenomenological concept of subjectivity. (Leys, 2012) 

Affect is a mental state, separate from belief and desire, the affect program system as it is called.  Affect is the body acting on itself, free of cognition and emotion on the one hand, the quality of the stimulus, or stressor, on the other.  If this sounds weird, stick with me. 

As Patricia Clough puts it,

Trauma is the engulfment of the ego in memory. But memory might be better understood not as unconscious memory so much as memory without consciousness and therefore, incorporated, body memory, or cellular memory. (p. 6)

 

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The imitation of trauma by those who study it

abstract-art-516337_1920The transference is always active between the scholar and what he or she studies.  This is especially so when the subject is trauma.  So Dominick LaCapra argues, and I think he’s right. What does the transference mean in the case of trauma?  For LaCapra it means that “at some level you always have a tendency to repeat the problems you are studying.” (p. 142)         

More generally,

by transference I mean primarily . . . the tendency to repeat in one’s own discourse or practice tendencies active in, or projected into, the other or object [of study]. (P. xv)

In the case of trauma, those writing about it often write as though they have been traumatized.  The writing of Cathy Caruth and Shoshana Felman is frequently in “unmodulated, orphic, cryptic, indirect allusive form” that is designed to transmit the disorientation of trauma.  (LaCapra, p. 106)  This may be suitable for trauma fiction, as it is sometimes called (though I have questioned that in another post), but it is unnecessary and counterproductive when trying to explain trauma. 

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Epigenetic transmission of trauma: gene or meme?

mice-800875_1920There’s lots of talk these days about the transgenerational transmission of trauma (TTT).  Some of it focuses on epigenetic changes in the chemical environment of the genes that make people more or less susceptible to trauma.  I find this topic incredibly complicated and difficult to understand.  I’ll try to explain it the best I can, but the reader should be clear that as far as PTSD is concerned, the epigenetic transmission of trauma is still up in the air, a hypothesis with no established empirical (scientific) basis.  As two of the leading researchers put it in the Journal of Traumatic Stress,

There have been no empirical demonstrations of epigenetic modifications per se in association with PTSD or PTSD risk. (Yehuda and Bierer, p. 430)

This reality has done little to dampen speculation, including that of Yehuda and Bierer, as we shall see.  I’m not sure if this is bad or good.  Mostly I think it’s irrelevant.

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Review of Stolorow’s Trauma and Human Existence, with remarks on his use of Heidegger

cropped-cropped-IMG_0531_editedblack-2_edited-11.jpgRobert Stolorow’s Trauma and Human Existence represents the kind of book trauma theory needs more of, a book that connects the psychology of trauma with a philosophy of human existence.  Connecting trauma to the philosophy of existence is at least as useful as connecting trauma to neuroscience, the current wave.  In this sense, Stolorow’s is an old fashioned book, and that’s a compliment.  

The trouble is the philosophy Stolorow chooses, that of Martin Heidegger.  For Heidegger does not fit well with Stolorow’s relational account of trauma.  For Stolorow, trauma is the loss of attachment, particularly the inability of parents and others to attune themselves to their children’s moods.  His case studies are mostly about patients who experienced troubled childhoods.  He uses a well-known quote from D. W. Winnicott as an epigraph to his second chapter, “there is no such thing as an infant.”  There is only the relationship between mother and child. 

His book could have been just about what is called today developmental trauma disorder (DTD).  Except that he bravely writes at length about his horror at finding his wife of many years dead in bed beside him, so cold and alien he couldn’t touch her. 

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Dori Laub, trauma, and a Holocaust without witnesses

faces-986236_1920Dori Laub puzzles me.  A child survivor of the Holocaust, and co-founder of the Fortunoff Archive for Holocaust Testimony at Yale University, both he and his achievements are admirable.  I’ve spent over 300 hours viewing testimony in an Archive that would not have existed, at least not in its present form, without Laub’s effort.  More than any other person, Laub created the format in which the testimonies were given, one in which the interviewer asks few questions, allowing the witness to speak for long periods without interruption.   Laub is a psychoanalyst, and the format psychoanalytically inspired. 

But if the man and his creation are admirable, his claims about trauma and the Holocaust are troubling.  The Holocaust, he says was an

event that produced no witnesses. . . . One  might say that there was, thus, historically no witness to the Holocaust either from outside or from inside the event. (Laub, An event, pp. 80-81, his emphasis)

Elsewhere Laub says

The Holocaust created in this way a world in which one could not bear witness to oneself. (Laub, Truth, p. 66, his emphasis)

What Laub means is that in order to experience an event, one must communicate it to an “inner Thou,” the addressee with whom inner dialogue takes place.  Without the “internal Thou,” an event cannot be symbolized, and hence cannot be known, even as it exerts a continuous pressure which expresses itself in trauma. 

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How trauma devalues the good past

IMG_2110,superliquidMost who study severe trauma agree that it stops time.  Trauma time is frozen time, in which the experiences of the past never become past, but remain as alive and intrusive as the day on which they happened, maybe more so.  Flashbacks, nightmares, hypervigilance, constriction: all are expressions of a past that continues to intrude upon the present. 

Less frequently written about is the way in which trauma can reach back behind the traumatic event itself and devalue past good experiences, experiences of attachments met and love acknowledged, experiences that preceded, often by decades the traumatic event. 

These observations about trauma are best suited to explaining adult-onset trauma.  It need not be the trauma of a single incident, it could be an experience as extending over years, but I assume that before the trauma there were good experiences, and good memories.  These good memories are not forgotten, but too often they become unavailable as an emotional resource to be drawn upon when times are tough. 

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Trauma and the pleasure principle

manhandstoheadMany who study trauma from a psychoanalytic perspective turn to Freud’s Beyond the Pleasure Principle (1920) in order to make sense of the apparent desire of people to repeat unpleasant experiences.  Why, the sensible person wonders, would a traumatized person keep repeating a horrible experience, whether it be war-time trauma, or the trauma of an abusive childhood?  In this context, the term “repeating” covers multiple forms of repetition, from flashbacks and nightmares, to acting-out an original trauma, in which, for example, a woman who was abused as a young girl continues to choose abusive partners.

Freud begins Beyond the Pleasure Principle with what he calls the traumatic neuroses, brought about by accidents and wartime trauma.  However, he quickly turns from “the dark and dismal topic of traumatic neurosis,” to children’s play (pp. 50-52).  The reader is at first disappointed.  Should not Freud have paid more than passing attention to the psychological suffering of so many who had just returned from a war that inflicted immense psychic suffering on its combatants?  He does, but one has to search for it.  Or create it. 

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Other people’s traumas: the limits of language

homeless-845709_1280Trauma is a popular topic these days because it meets a widespread longing for intensity. So argues Michael Roth (p. 90) and I think he’s right. Much of what is wrong with trauma theory today is the attempt to participate in this intensity through writing about it. The result is a mistaken view of how one should write about trauma. Either the author tries to imitate the experience through literary effect, such as multiple voices and sudden changes in time and place (see my post on trauma literature). Or the author approaches trauma as though it were a sacred experience, almost too awesome for words. But only “almost,” for academics write a lot about trauma. That includes me.

The problem of writing about trauma is a real problem. The experience of trauma is too extreme for words. Indeed, trauma is often described as the inscription of intense emotions on the psyche (or brain) in a way that cannot be put into narrative speech. If trauma is speechless, then how to write about it?

This problem is compounded when one is writing about massive historical traumas, such as The Holocaust. It has become almost a commonplace that the event cannot be understood, indeed that we show our respect by not even trying to understand it. “The obscenity of understanding” is how Claude Lanzmann, producer and director of the movie Shoah, puts it.

Words always disappoint, but sometimes they are all we have

I think we should write about trauma, including large scale historical trauma, just like we write about any other event. Words are a wonderful and terrible thing. Putting any intense experience into words never does it justice, if justice means reproducing the experience in the mind of the reader.

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Trauma as Attachment

aurora-1197753_640My main idea in this post: one reason the symptoms of trauma persist is because people become attached to their traumas. Symptoms serve as a locus of attachment in a world in which each and every attachment can vanish in a moment. It’s kind of like a small child clinging to an abusive parent.

Tom, a Vietnam veteran, went to see Bessel van der Kolk about his PTSD. Among his most disturbing symptoms were nightmares. Van der Kolk prescribed a drug that had been shown to be effective in reducing the incidence and severity of nightmares. Returning two weeks later, Tom said the medicine didn’t work because he wasn’t taking it. Why?

I realized that if I take the pills and the nightmares go away . . . I will have abandoned my friends, and their deaths will have been in vain. I need to be a living memorial to my friends who died in Vietnam. (p. 10)

Van der Kolk writes that Tom’s answer led him to realize he would probably be spending the rest of his life trying to learn the answers to the mysteries of trauma. I’m not sure van der Kolk learned the right lesson.

For van der Kolk, trauma is a disorder in the brain that is expressed in and through the body. Thus, the title of his recent book, The Body Keeps the Score. However, if we take Tom’s answer seriously, it seems as if it is the meaning of the story that is important. It is the meaning of Tom’s trauma that keeps him locked in the past.

Trauma is attachment to our traumas

If we think about Tom’s trauma in this way, then his nightmares and other traumatic symptoms keep him attached to the only place that really counts in his life. The past is the most meaningful place he knows, as it is for many traumatized soldiers who fail to distinguish their attachment to their buddies from attachment to their trauma. If this were so, it would help to explain why traumatized people get stuck in the past. Considering the alternatives, it’s where they most want to be, or at least where they most need to be.

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What I learned about PTSD from the University of Google

childineyeThe Urban Dictionary says that the “University of Google” refers to a major ignoramus who pretends to be an intellectual. Well, I decided to attend the University of Google for a few days to see what I could learn about PTSD. It’s pretty depressing. So-called reputable sites were the worst. There are a couple of interesting exceptions.

I looked at every site listed on the first three pages of my Google search “PTSD.” This was over the days February 18-22, 2016. The top sites changed every day (sometimes every hour), but not by much, and I included sites that paid to be listed first. Since I’ve done a lot of trauma searches with Google on my computer, my rankings were not quite the same as on my wife’s computer, my i-pad, and my school computer, which I rarely use. Google customizes (that is, markets) its information. Nevertheless, the overlap was considerable.

After a while, the sites started to sound the same. There were a couple of exceptions.

Wiki disappoints

Wikipedia’s entry on PTSD was disappointing. “Psychotherapy is the ‘gold standard’ of treatment for PTSD.” A promising start, but under psychotherapy Wiki includes prolonged exposure therapy (PE), cognitive behavioral therapy (CBT), and eye movement desensitization and reprocessing (EMDR). I expected more from Wiki; I’m not sure why.

Rats, mice, ecstasy, and dogs

A surprising number of sites reported on research with mice and rats, and several report the results of delivering electric shocks to people. In one, people with PTSD show heightened brain activity in areas thought to be associated with stress when shown pictures of frightened face when shocked and not shocked (that is, no difference), while people without PTSD show more anxiety when shocked. The significance of this is left unclear.

The same site, The Brain and Behavior Research Foundation, summarizes a study which shows that MDMA — also known as the rave drug Ecstasy — can treat symptoms of post-traumatic stress disorder in mice. At: https://bbrfoundation.org/ptsd?gclid=CIrI-YnshssCFclkhgodKkIKew. Don’t try this at home.

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What if Bessel van der Kolk is right about trauma?

B0000757Bessel van der Kolk (vdK) is probably the world’s most well known trauma theorist. I reviewed his recent book, The Body Keeps the Score, in an earlier post. Since then I’ve read more of his work and listened to him speak for hours (he is all over youtube). The best way I’ve figured out to think seriously about his work is to ask what difference it would make if he were right.

What he says

Asked about how he treats the victims of acute trauma, vdK says

Holding them, rocking them, giving them massages, calming their bodies down is a critical issue. I am probably the minority among my colleagues in that I am much more focused on bodily state than on articulating what’s going on. I think that words are not really the core issue here. It is the state of being, of tenseness, of arousal, and of numbing, and that people need to learn again to be safely in their bodies. (http://www.medscape.com/viewarticle/408691)

Think about this for a minute. One might expect a trauma therapist to say something like “I try to create a safe environment in which my patients can put words to unspeakable experiences. I try to help them remember an experience so they don’t have to constantly relive it.” This makes sense, for trauma is a disorder of time, in which the past is never past but is constantly intruding upon the present.

VdK would have no difficulty with the last sentence, and yet his treatment program (or rather programs) has little to do with the past, and everything to do with the present. Trauma is when the past colonizes the present. Its treatment depends on reappropriating the present, and one does that not through understanding the past, but coming to live in the present, and the best way to do this is to bring the body into the present.

Behind vdK’s approach is his view that PTSD and related traumatic disorders, particularly developmental trauma (childhood abuse and neglect), are disorders of the limbic system, one of the oldest parts of the brain, the one we share with all mammals. In the limbic system, threat is experienced as sensation, and the impulse to fight or flee. Threat turns into trauma when we can neither fight nor flee, when we are trapped, and the stress is turned against the self. Trauma is embedded in the body-mind, a single entity.

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Levinas, trauma, and God: Does Emmanuel Levinas idealize trauma?

IMG_1140,colorcurve,autocolor,crop2Emmanuel Levinas was an unlikely combination of Talmudic scholar and postmodern philosopher. Or at least he was adopted by postmoderns, such as Jacques Derrida, who wrote a book about him, Adieu to Emmanuel Levinas.

Levinas struggled with what a modern experience of God might actually be like. He ended up describing the experience in terms of trauma. The idea that an encounter with God is traumatic has a venerable history, going back to Moses, from whom God concealed His face, lest Moses be struck dead (Exodus 33.22). But Levinas is dealing with a postmodern God, whom we experience through an encounter with Infinity.

Cathy Caruth and trauma

An encounter with infinity is traumatic enough, and the terms in which Levinas describes this trauma come remarkably close to Cathy Caruth’s account of trauma. Caruth is probably the most influential figure in literary trauma theory today. For Caruth, the traumatic experience cannot be represented because it occurred before its recipient was prepared to know it. Or as Caruth puts it, deeply traumatic experiences are events without witnesses, experienced a moment too late, before the self was there to mediate it. As a result, the trauma remains unsymbolized, unintegrated into normal memory.

Unlike Freud, Caruth’s is not a developmental claim but a temporal one. Extreme trauma is inscribed upon an otherwise-mature subject who was not there, because the experience was so far beyond the normal it could not be prepared for, categorized, or shared. The traumatized, says Caruth,

carry an impossible history within them, or they become themselves the symptom of a history that they cannot entirely possess (p. 5).

In a sense, the traumatized are their trauma until they are able to integrate it, almost always with the help of another who hears what the traumatized are unable know.

Levinas

Levinas sounds remarkably like Caruth. For Levinas, the experience of the Infinite is traumatic because it slips into me before I am ready, “despite the taut weave of consciousness.” The experience of the infinite is “a trauma (traumatisme) that surprises me absolutely, always already passed in a past that was never present.” (1987, p. 75) The past was never present because it remains stuck in traumatic time, the past that occupies the present without being subject to it. If the past were subject to the present, it could be repressed.

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Moral injury in civilian life: a new category of trauma

DSC00286To live in the United States today is to be constantly exposed to moral injury. Moral injury is not, however, equally distributed. Some people are vastly more injured than others, and some are not injured at all. Some people inflict moral injury on others. Lots of people are morally injured, and it is not always obvious.

One might argue that such a grand category, applying to so many, must result in pathologizing a normal experience. Moral injury may be normal, but it’s not good. The lives of the morally injured manifest in chronic sadness and despair, overlaying a rage that occasionally becomes dramatic.

From military trauma to everyday moral injury

Moral injury has become something of a hot topic among those who write about the trauma experienced by soldiers at war. So far, I can find nothing written about moral injury that applies to the experiences of civilians in everyday life. Yet, there is no reason it shouldn’t, particularly if it is interpreted properly.  Moral injury is the result of the use of  political power to deny the experiences of others. There is no more pernicious political power than this.

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Depoliticizing moral injury

B0000904Moral injury is a relatively new and puzzling category to the Department of Veterans Affairs, National Center for PTSD. Lots of researchers seem to recognize that it exists, but nobody can categorize it (Maugen and Litz). Or figure out an effective therapy for it, one that is evidence based, as they say, such as cognitive behavioral therapy (CBT), or prolonged exposure therapy (PE). The practical irrelevance of these therapies when dealing with moral injury makes moral injury a challenging category. 

Events are considered morally injurious if they “transgress deeply held moral beliefs and expectations,” as one of the first academic papers sponsored by the VA put it (Litz, et al., pp. 696, 700). A moral injury occurs when an act shatters the moral and ethical expectations of soldiers and others, including expectations about fairness, the value of life, and that leaders will tell the truth.

Though the publications of the VA recognize the existence of moral injury, it is not a currently accepted diagnostic category. One can receive recompense and treatment for PTSD, but not for moral injury, except on an experimental basis. Shame, guilt, and anger at the self or others’ betrayal of basic human values are central to moral injury. These emotions may occur with PTSD, but they are not key to its definition. PTSD is generally regarded as a fear-based disorder (in spite of DSM-5’s currently grouping it with dissociative disorders). Moral injury is guilt and shame based (Maguen and Litz, p. 2).

As I explain below, I think the VA has depoliticized what was originally a political concept.

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Trauma theory and Melanie Klein

B0000766Melanie Klein’s clinical researches on early childhood led her to postulate that the traumatic pathogenic situation par excellence is the overriding triumph of the death instinct. (Hernandez)

Trauma theory poses a problem for Melanie Klein, and Melanie Klein poses a problem for trauma theory. From a Kleinian perspective, the traumatic experience is not traumatic in itself. The traumatic experience is traumatic to the degree that it activates the fear of annihilation and destruction that is always waiting within, the haunting presence of the death instinct. The death instinct, in turn, gives rise to primitive defenses. Fearing death, the traumatized person projects his fear outward into persecutory objects and people, who then come back to haunt him.

A Kleinian theory of trauma in effect blames the victim. It is as though the Kleinian therapist said

Getting run over, almost dying, and spending six months in the hospital recovering isn’t the real source of your trauma. The real source of your trauma is the hate and aggression you feel toward what we call good objects, the people who really care for you. Your PTSD is so extreme right now because you fear you cannot protect the good from your own anger and hate.

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The lesson of trauma comes from its content, not form

B0000871The Sorrow of War: A Novel of North Vietnam, by Bao Ninh, is an important but not particularly well known literary trauma narrative.*  Ninh was a North Vietnamese soldier during the war.

The question I want to ask is what difference all the literary devices make, the devices that are supposed to make us feel the narrator’s trauma. Jane Robinett says they make all the difference in the world. I don’t think they make any difference at all. It’s an interesting question because much writing about literary trauma fiction focuses on the form, not the content, as though it is through the form that we can feel what the narrator feels.

Form or content?

Consider the following passage by Ninh, followed by its interpretation by Robinett.

Often in the middle of a busy street in broad daylight I become lost in a daydream. On smelling the stink of rotten meat I’ve suddenly imagined I was back crossing Hamburger Hill in 1972, walking over strewn corpses. The stench of death is often so overpowering I have to stop in the middle of the pavement, holding my nose, while startled, suspicious people step around me avoiding my mad stare. (Ninh, 46)

Robinett interprets.

The subtle shift in tenses (from present perfect to past and abruptly into present) in the middle of the paragraph moves readers directly into the experience just as the narrator abruptly finds himself reliving it. (Robinett, 297)

When I read the passage by Ninh it’s the content that counts, the way in which trauma intrudes on his postwar life. The shift in tenses doesn’t add much.

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Did literary trauma theory encourage the Iraq War?

B0000955Contemporary American Trauma Narratives, by Alan Gibbs (2014) is a fascinating book. Most provocative is Gibbs’ claim that a trauma theory perspective on 9/11 actually supported the Bush administration’s invasions of Iraq and Afghanistan. But I’ll get to that later.

The idea of analyzing literature from the perspective of trauma theory is still a little strange to me, even if I have analyzed narratives of the traumatized countless times. See my last post on Alice Sebold’s Lucky, an account of her rape. If I have been misled by Gibbs, or my own ignorance, I hope readers will correct me. *

Second hand trauma

A particularly troubling tendency in literary trauma theory is its claim that “authentic trauma fiction” enlists its

readers to become witnesses to these kinds of stories through the unconventional narrative translations of traumatic experience and memory that give them a different kind of access to the past than conventional frameworks . . . . when readers absorb these stories [like Beloved] through the division of voice . . . they experience something analogous to splitting. (Vickroy, 20, 27-28)

This makes no sense at all. There is no such thing as “something analogous to splitting.” With this claim we have entered the realm of “second-hand trauma.” (Gibbs, 29)

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The Trauma of Rape Can Be Told

B0000782I just finished reading Lucky, by Alice Sebold. It’s an account of her rape when she was a 19 year old freshman at Syracuse University. The book has really caused me to rethink trauma theory, for there is nothing theoretical about Lucky. She describes her rape in horrifying detail. Even more troubling, at least in some respects, is the response of those around her.

I was now on the other side of something they could not understand. I didn’t understand it myself. (p. 27)

This isn’t a review of the book, which was published in 1999. It has been often reviewed. It even has its own Wikipedia entry. Sebold subsequently published The Lovely Bones, which was made into a movie. She is a good writer.

This post is about my embarrassment at writing about trauma theory after reading Sebold’s book. Not that there is anything wrong with trauma theory, but there is something so real about Sebold’s account that it makes the theory of trauma seem an overly intellectual exercise. At least for me, at least for a little while.

Nevertheless, it’s not so simple, for trauma theory helped Sebold, who says that she learned that a short passage from her book had been published in Judith Herman’s classic work, Trauma and Recovery. Sebold said she decided not just to keep Herman’s book as a memento, but to actually read it. It may not have changed her life, Sebold did that for herself, but it helped her make sense of her experience.

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Cognitive behavioral therapy is a terrible way to treat trauma. And it’s government approved.

IMG_0525_editedblack-1_edited-1The Department of Veterans Affairs may today deliver the worst trauma treatment known to man or woman.

The diagnosis of PTSD is an outgrowth of the protests over the Vietnam War. Distraught and disillusioned Vietnam veterans, together with psychiatrists such as Robert Jay Lifton and Chaim Shatan, developed the “rap groups” that provided psychological support in a community of other vets who had undergone similar experiences. Rap groups worked because they provided a place to share common experiences, including terror and remorse. Rap groups provided community and social support.

The effectiveness of rap groups eventually convinced the American Psychiatric Association to include Post Traumatic Stress Disorder in the third edition of its Diagnostic and Statistical Manual, though this is a long and convoluted story (see http://www.traumatheory.com/whats-going-on-with-dsm-5/ for more details). For some time, rap groups were employed by the VA, often with reluctance, for their members were not always easily managed (Sonnenberg, Blank, Talbott).

No more. David Morris’ recent account of his experience with cognitive behavioral therapy at the San Diego VA tells of a sign on the wall of a waiting room for a small group of vets who were about to enter therapy (p. 195).

PLEASE REFRAIN FROM TELLING WAR STORIES. YOUR STORY COULD BE A “TRIGGER” FOR SOMEONE ELSE.

If the traumatized cannot talk with each other, but only through a therapist, even in a group, then therapy is no longer about creating a community of support for those who suffer. It’s about isolating those who suffer from each other, so they can be processed individually, their trauma chopped into bits.

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Trauma narratives without the narrator: a trauma marker

DSC00212slimThere is an influential school of thought about trauma which argues that psychic trauma is the direct intrusion upon the mind of an unmediated experience. Cathy Caruth and Shoshana Felman are associated with this view.

As it is generally understood today, post-traumatic stress disorder reflects the direct imposition on the mind of the unavoidable reality of horrific events, the taking over of the mind, psychically and neurobiologically, by an event that it cannot control. (Caruth, p. 58)

Elaborated, this view holds that people do not have traumatic “experiences.” Traumatic events happen when people are unable to possess their own experiences in narrative form. The traumatized are deeply affected by these experiences, but unable to know them, for narrative is the language of experience.

In my experience, narrative competence is a poor measure of trauma.

This doesn’t fit my research

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From a trauma perspective, Freud’s fort-da game replaces Oedipus

B0000852This post is largely based on re-reading Freud’s Beyond the Pleasure Principle (1920). If one reads the book from a trauma perspective, the fort-da game he describes is more important than the Oedipus complex in the formation of character.

Readers familiar with Freud will recall his puzzlement over the existence of traumatic nightmares. Freud was surprised because he believed that the mind is organized around the pleasure principle, which would imply that dreams are a variety of wish fulfillment. But, what pleasure could there be to the recurrence of a traumatic experience in a dream, what wish could a nightmare fulfill? “People,” says Freud, “have shown far too little surprise at this phenomenon.” (p. 51)

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The assumptive world theory of trauma

DSC00481This post is a review of The Loss of the Assumptive World: A Theory of Traumatic Loss, edited by Jeffrey Kauffman. The approach is popular among a group of clinicians, though I think its thesis is widely, if tacitly, held. It’s a good theory with a remarkable flaw.

The assumptive world

The assumptive world is the only world we know and it includes everything we know or think we know. It includes our interpretation of the past and our expectations of the future, our plans and our prejudices. (Tom Attig, quoting Parkes, p. 55)

Robert J. Lifton and Irvin Yalom play pretty big roles in assumptive world theory, which could be called existential crisis theory. Trauma happens when our basic assumptions about the world are shattered. These assumptions are as fundamental as “I will continue to live,” “I will not be alone and isolated for the rest of my life,” and “my life has meaning and purpose.”

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Psychoanalysis is itself a defense against trauma: Wilfred Bion, post 2

This is my second post on Wilfred Bion and trauma. It makes sense on its own, but it will make the most sense if you read the previous post, “Bion’s Trauma and Trauma Theory” (http://www.traumatheory.com/?p=257).

Wilfred Bion is not well known among trauma theorists, and is not generally considered a trauma theorist. I think he should be. Taking Bion seriously leads to the conclusion that psychoanalysis has focused too much on the internal sources of distress; it should pay more attention to trauma, the experience of obliteration. This post has been inspired by James Grotstein’s A Beam of Intense Darkness: Wilfred Bion’s Legacy to Psychoanalysis. The conclusions are my own.IMG_1140,colorcurve,autocolor,crop2

Pariah of “O”

For many years, Bion was considered the intellectual successor to Melanie Klein, the founder of object relations theory. His elaboration of projective identification as a means of communication, and his theory of container and contained, became fundamental to Kleinian theory, “basic components of the ‘post-Kleinian’ episteme in London.” (Grotstein, p. 20) Then Bion developed the concept of O, which represents the absolute. The absolute of what is the question. I think O represents the absolute of trauma. However, most of what Bion wrote about O is more recondite, Zen-like. In any case, Bion’s elevation of O resulted in his fall from grace in London psychoanalytic circles. He became a “pariah of O,” in Grotstein’s phrase. The pariah moved to California, where he received a warm welcome. I’ll let you decide if that’s ironic.

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Bion’s Trauma and Trauma Theory

B0001063When one thinks of trauma theorists, not only does the name of Wilfred Bion rarely spring to mind. One almost never thinks of him. Yet, Bion, who along with Melanie Klein and D. W. Winnicott remade psychoanalysis, is the analyst most concerned with trauma. Klein created object relations theory. Winnicott and Bion developed it in its most distinctive variations.

Bion presents his encounter with trauma in a series of autobiographies. We must make the connection to his theory. Throughout his adult life, from a diary written for his parents, to several volumes of autobiography, to a memoir written forty years after the event, Bion refers to his experience as a teenage tank commander in World War I. By the age of 20 he had already been nominated for the Victoria Cross (Britain’s highest military honor), and awarded the Distinguished Service Order (DSO).

As Kay Souter (p. 796) puts it,

His autobiographies have the quality of survivor testimony, with the associated emotional numbness, low self-esteem, grief and guilt. Editing the fragment ‘Amiens’ after his death, Francesca Bion [his widow], gave the title ‘Fugue’ to this account of 8 August, explaining it as ‘‘meaning ‘loss of one’s identity.’’’ Although she does not further explain, it is clear that she understood it to be an account of psychic flight and catastrophe.

Portions of Amiens are written in the third person, as in “Captain Bion had felt extremely frightened.”

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An imagination for stressors: trauma as a global network

B0000982What do we make of trauma when we recognize that it does not happen in isolation, but in a political and global context? There is no easy answer. Tariana Turia writes of “Postcolonial Traumatic Stress Disorder,” and Alvin Poussaint and Amy Alexander write of “Posttraumatic Slavery Syndrome.” (pp. 12-20) Something is troubling about this expansion of trauma, as it seems to confuse the cause (such as global capitalism, or slavery) with the result (trauma). On the other hand, one can understand the desire to make this connection explicit. Since trauma is regularly defined in terms of a singular causal event (the stressor), postcolonialism or the legacy of slavery normally don’t count.

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Does it mean anything to claim that trauma is “aporetic”? No.

DSC00267_edited-2b&wThe first time I read that trauma is aporetic I rushed to my dictionary. An aporia is from the Greek, referring to an impasse, and generally refers to a paradox or perplexity that cannot be resolved. The term is frequently used in rhetoric; a Texan declaring that all Texans are liars would be a rhetorical aporia. Aporetic is the adjective, describing the condition of being caught in a paradox or contradiction.

Many, perhaps most, who have written about trauma from a literary perspective have seen trauma as aporetic. My comments are informed by Roger Luckhurst’s The Trauma Question, though mine is not so much a review as an appreciation of the issues he raises. It’s a good book.

For Cathy Caruth, doyenne of literary trauma theory, trauma is paradoxical or aporetic because its truth cannot be known at the time of its experience. Not just the traumatic event, but the trauma itself can only be understood after the fact, as it “returns to haunt the survivor later on.” (p. 4) Shoshana Felman and Dori Laub call this a crisis of history and truth, in which the most privileged observers of their own experience are unable to recount it. “The necessity of testimony . . . derives, paradoxically enough from the impossibility of testimony.” (p. 224, their emphasis).

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Review of a really good article on “memory envy” and the limits of literary trauma theory

I want to tell you about a really good article about trauma theory. The article is organized around this statement. “With improved conceptual precision we can differentiate between trauma and the culture of trauma, or, put differently, between trauma and entertainment.” (p. 195).

cropped-IMG_0402-1-1-e1421442766650.jpgThe article is “Genealogy of a Category Mistake: A Critical Intellectual History of the Cultural Trauma Metaphor,” by Wulf Kansteiner. It’s not new (2004), but it generates a provocative criticism of the application of trauma theory to literature. Nevertheless, Kansteiner’s conclusion is wrong, for he thinks that to take trauma seriously we must limit it to extreme events.

For literary or cultural trauma theory, the Holocaust is the ur-trauma, and the problem is that it soon becomes an abstraction. Though Kansteiner sees this tendency in Horkheimer and Adorno’s Dialectic of Enlightenment, it becomes a real problem only in Lyotard.

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How to turn trauma into loss. It’s not easy.

B0000724This post is inspired by a not very recent and probably not very well known essay, “A Late Adventure of the Feelings: Loss, Trauma, and the Limits of Psychoanalysis,” by Gregg Horowitz. It’s in a collection titled The Trauma Controversy. I never did find out what the trauma controversy is. I thought there were only controversies.

Loss

Loss, says Horowitz, is the substance of our lives. And we never get over it. “The loss we never make good on, yet which we never leave behind, is the very texture of our ordinary lives.” (31) In loss the origin keeps happening over and over again. The main reason is because the loss is incomprehensible. Easy enough to grasp, impossible to believe. It sounds like trauma, but it’s not.

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Winnicott and the vastness of trauma

B0000969What would we do with a trauma so vague and vast that we have no name for it? I think there is such a trauma, and the British Psychoanalyst D. W. Winnicott identified it over half a century ago. Winnicott (1989) wrote specifically about trauma, but I’m not going to write about that. I’m going to write about the implications of his work in general.

The trauma identified by Winnicott doesn’t fit the definition of PTSD. Nor does it fit any of the categories by which experts think about developmental trauma, such as DESNOS (disorders of extreme stress not otherwise specified), C-PTSD (chronic or complex PTSD) or DTD (developmental trauma disorder).

All these categories, with the exception of PTSD, are traumas that primarily affect the developing child, though they may occur in any long term abusive situation, such as wife abuse. With children C-PTSD is generally the result of physical or sexual abuse or obvious neglect. A website explaining C-PTSD begins this way.

As a child, Olivia, who never knew the identity of her father, was consistently abused and neglected by her mother. Her mother’s emotional temperament was highly variable—shifting from dark moods during which she was verbally and physically abusive to her daughter, and manic periods during which she left Olivia to fend for herself for days at a time. (http://www.elementsbehavioralhealth.com/mental-health/what-are-the-symptoms-of-complex-ptsd/)

There are differences between C-PTSD and DESNOS, but they are primarily terminological (see my post http://www.traumatheory.com/?p=178).  DTD is identical to C-PTSD. The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) does not officially recognize C-PTSD, but its new subcategories of dissociative and pre-school subtypes of PTSD come close. The International Classification of Diseases (ICD-11) will include C-PTSD.

A trauma so vague and vast we have no name for it

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The Book of Woe, and why NIMH said goodbye to DSM-5

IMG_1078This book review and comment are a little off my beat, for they are about DSM-5 in general, not just its diagnosis of trauma, which I addressed in my post of January 20, 2015, http://www.traumatheory.com/?p=86.

The full title of Gary Greenberg’s book is The Book of Woe: The DSM and the Unmaking of Psychiatry. Greenberg is a psychologist and journalist. Some of the juiciest pieces of this book appeared in The New Yorker between 2010 and 2013 (Google Greenberg + DSM + New Yorker; they are all there).

The book begins with a story about Sandy, one of Greenberg’s patients. When Greenberg first saw him Sandy could barely go out of his house. By the end of therapy Sandy had a job, a girlfriend, and what most of us would call a life. Sandy and Greenberg exchanged emails after Sandy moved half way across the country from Connecticut. Eventually the emails stopped. A couple of years later Greenberg received a call from Sandy in the middle of the night. It ran something like this.

You’ve got to help me. They’ve sucked all the bones out of my body. I’m here in this hotel room and my bones are gone. My mother and my father and James. They’ve done this to me. And I don’t want to die. Please don’t let them kill me. You’re the only one who can help. Good-bye. Good-bye. (p. 9)

Greenberg tried to call Sandy back at the hotel he had called from, but there was no answer. He never heard from Sandy again.

The book turns on what to make of Sandy’s phone call.

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Whatever happened to DESNOS?

IMG_0319_edited-2DESNOS stands for Disorders of Extreme Stress Not Otherwise Specified, about as clumsy a diagnosis as one could imagine, and an only slightly better acronym. It owes its existence to the persistence of Judith Herman, who in her classic Trauma and Recovery, argued for a special category of trauma she called complex PTSD (C-PTSD). C-PTSD = DESNOS for all practical purposes.

It has long been recognized that there are different types of trauma, but no one has figured out what to do about it as far as PTSD is concerned. Rape, a serious car accident, most wartime trauma takes place during a specified period of time, and often results in the familiar symptoms of PTSD, such as flashbacks, nightmares, sleeplessness, hypervigilance, and a gradual retreat into a smaller world in which the victim is less likely to encounter situations reminding him or her of the original trauma.

But, some trauma doesn’t fit this pattern, generally because it is prolonged, frequently happens at an early age, and often involves people with whom the victim has an intimate relationship. Child abuse is exemplary, but prolonged captivity and confinement of any type also fits the pattern. This includes emotional and physical abuse in marriage or other relationships.

The about to be released International Classification of Diseases, ICD-11, which serves as the DSM for the rest of the world, includes C-PTSD, but only if the victim first fulfills all the requirements of a diagnosis for PTSD. DSM-5 includes most of the symptoms of C-PTSD, achieved in part by enlarging the number of symptoms to twenty. In addition, it includes a dissociative subtype and a pre-school subtype. As with the ICD-11, the basic requirements of PTSD must first be met. DSM-5 does not officially recognize C-PTSD, but one professional’s comment on PTSD in DSM-5 gets it right, remarking that it has become more “DESNOS-ish.”

Here’s the problem

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How trauma works: by destroying the inner other (revised, 7/12)

How Trauma Happens

B00007701. Throughout our lives we need an inner other. We need someone with whom we can carry on an internal dialogue. An inner other is different from an internal object.

Unlike Melanie Klein’s internal object, the inner other is not a projection of innate love and hate, subsequently modified by the real world, before being reintrojected. The inner other reflects the need to be understood. The inner other is created in interaction with others. It is always already a relationship. In this regard it comes closer to John Bowlby’s “internal working model.” The inner other is a relationship, and a relationship takes two.

Unlike Heinz Kohut’s selfobject, the inner other is separate from the self. The inner other is not experienced, even as a young child, “as nonautonomous components of the self,” which exist to serve the self’s need to be mirrored. Nor does the inner other exist in order to be idealized. It exists in order to draw the child into the world. Without the otherness of the inner object the world would be empty of value and joy. See the quote from Daniel Stern below (number 3). The same principle applies to adults.

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Neuroimaging in trauma studies is bad science and worse understanding

DSC00633In his recent book, The Body Keeps the Score (2014), Bessel Van der Kolk writes about the first time he used neuroimaging in his work. He placed eight traumatized subjects in a scanner similar to the fMRI (functional MRI), which records in real time changes in the blood flow in the subject’s brain. With the subject in the scanner, an associate read back an account of the subject’s traumatic experience(s). All subjects experienced flashbacks while in the scanner.

I taped the scans up on the refrigerator in my kitchen, and for the next few months I stared at them every evening. It occurred to me that this was how early astronomers must have felt when they peered through a telescope at a new constellation. (van der Kolk, 2014, p. 42)

fMRI: the basics

Is neural imaging really is equivalent to the Galilean revolution? In order to answer that question, it will be useful to understand how neuroimaging works in practice in the study of psychic trauma.

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Should reading Maus feel cozy? On the 35th anniversary of the original publication of the graphic novel by Art Spiegelman

cropped-IMG_0531_editedblack-2_edited-11.jpgA friend who has been reading my posts and knows of my desire to reach a wider-audience suggested that I consider the Maus books by Art Spiegelman. I did, and told my friend that they were fun. I think my friend was a little put off, as though a comic book about the Holocaust could be fun. I think my reaction, while not well put, reflects something real going on in Maus, but first a little background on this Holocaust comic.

Maus is a graphic novel drawn and written by Art Spiegelman, the son of Holocaust survivors. Spiegelman first presented Maus in serial form in Raw, an adult comic book, from 1980-1991. Spiegelman had all along intended to write a graphic novel, and in 1986, after an enthusiastic review by The New York Times, the serialized installments were published by Pantheon. In 1992, Maus became the first graphic novel to win a Pulitzer Prize. By the way, Spiegelman objected when the New York Times located his book under the category of fiction on its best-seller list. The Times responded by listing the second volume as non-fiction. The Library of Congress considers the book non-fiction.

Maus is not so much the story of the Holocaust as it is the story of Artie’s attempt to come to terms with his difficult father, who along with his mother survived Auschwitz. It has the outward form of a fable, in which the Jews are mice, the Germans cats, the Poles pigs, and the Americans dogs. Unlike the traditional fable there is no moral of the story. Except perhaps that “suffering doesn’t make you better, it just makes you suffer,” as Art puts it about his father’s racism (Meta, p. 36). But while there is no moral to the story, there is a meaning. It resides in Artie’s use of the Holocaust as a way to meet his father. Vladek was so overwhelmed by the Holocaust that there could be no other ground on which to meet him.

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Do Holocaust survivors unconsciously want to kill their children?

B0000782Erik Hesse and Mary Main, leading attachment theorists, explain the process of second generation trauma this way. During the normal course of child rearing, traumatized parents will reexperience their original trauma, leading to episodes of parental detachment and confusion. This is the case even with good, generally competent, parents. Incapable of understanding the source of the parents’ distress, the child will either blame itself, or be drawn into compulsively trying to comfort the parent. Role reversal, the child comforting the parent, is a common attachment strategy undertaken by children of traumatized or disturbed parents. It is a leading marker of anxious or ambivalent attachment.

The next step: the internalized aggressor

Adah Sachs has taken this argument a step further, suggesting that the alien role the child is forced into is the result of the parents having internalized the aggressor, a consequence of helpless terror.

While most of these parents would have given their lives away to protect their offspring, they could not protect them from the messages of their traumatic introjects, and from the death threats that were carried and implied by them . . . . The survivors of the Holocaust continued to carry the terrifying introjects of the perpetrators and their murderous wishes, in a dissociated way      . . . . These children had to rely on the love of an attachment figure who had a murderous aggressor internalised. (p. 31)

The child senses this murderer in the parent, and lives to keep it inside the parent. The result is a very, very good child. Sachs calls the result “an infanticidal attachment pattern.” (p. 34)

This is a disturbing, scary, awful thought!

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The trauma of whistleblowers: stuck in static time

DSC00212slim“All sorrows can be borne if you put them into a story or tell a story about them.” The story reveals the meaning of what otherwise would remain an unbearable sequence of sheer happenings. –Hannah Arendt, “Isak Dinesen”

If psychic trauma is understood as an inability to stop reliving the same set of experiences, that is, an inability to leave the past behind, then whistleblowers are among the most traumatized people I have ever met. Most don’t experience flashbacks, and other dramatic symptoms. Instead, they remain stuck in static time, “the turbulence of stagnant motion,” as one whistleblower put it.

I was introduced to whistleblowing through my observation of a whistleblowers support group organized by the Government Accountability Project in Washington, D. C. Over a period just short of a year I spent almost one hundred hours with the support group. At first I assumed that the whistleblowers, mostly middle-aged men and women, were talking about recent experiences: blowing the whistle, experiencing retaliation, getting fired. Only after a couple of months did I realize that most were talking about events five, ten, fifteen, or even twenty years ago. Their narratives seemed so fresh, their pain still so sharp, it was hard to believe they were talking about ancient history, or at least so it seemed to me.

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