PTSD is Torture

PTSD is torture.  

The most obvious thing to say about the relationship between torture and severe psychic trauma is that psychic trauma is often the result of being tortured.  That’s true, but the relationship is closer than that.  Severe psychic trauma is torture.   PTSD has many of the same features as the pain intentionally inflicted by torture.  (PTSD is a narrower category than severe trauma.  I use PTSD only for convenience, not as a diagnostic category.)   In other words, the relationship between torture and PTSD is not simply sequential.  In many respects, PTSD is torture. 

My authority for the pain of torture is the well known work by Elaine Scarry, The Body in Pain: The Making and Unmaking of a World.  All page references are to this work unless otherwise noted.  Others have written thoughtful works on torture, including Jean Améry, who was himself tortured.  I have written about Améry elsewhere (Trauma and Forgiveness), but Scarry’s description of the experience of torture seems more relevant.

Small places

Torture exists to extract information through the deliberate infliction of pain.  Generally the information is irrelevant or useless.  People under torture say anything to get it to stop, even for a few minutes.  Torture exists because it “unmakes” the world of the victim, to use Scarry’s term.  Torture exists in order to demonstrate the power of the torturers to do anything, to violate any limit.

PTSD is often inflicted accidentally, or as a side-effect of war.  But when I read Scarry’s description of the unmaking of the self that is the results of torture, it sounded like PTSD.

     World, self, and voice are lost, or nearly lost, through the intense pain of torture. (p 35)

Like PTSD, the pain of torture shrinks the world, generally to the size of the torture room, sometimes to the boundaries of the body.  As Scarry puts it,

     In torture, the world is reduced to a single room or set of rooms. (p 40)

Unlike torture, in which the torturer is in complete control, the sufferer of severe PTSD shrinks the world in order to live in a place totally under his or her control.  That is a small world indeed, generally just a room or house.  The cost of this safety, which is never really safe because the threat is within, is the loss of a world in which the traumatized one can live, love, and express himself or herself.  Without a feeling of basic safety, nothing else is of any value, nothing else can be used to enliven and enrich the self.

Body and Voice

In torture, body and voice are opposites.  The torturer works on the body (and sometimes the bodies of loved ones), and there is nothing the victim can say, just the screams of a wounded animal.  I am assuming, at this point, that the fiction of “information” has been abandoned.  Torture is an act of power on a vulnerable and unwilling body.

Trauma therapy, at least the best trauma theory, aims to turn trauma into voice, so that the traumatized person can speak, and finally transform his or her trauma into narrative.  The broken fragments of experience are made whole. 

This sounds right, but the more I thought about the comparison with torture, the more it seemed to me that this ideal of narrative as cure is the ideal of the trauma theorist, a man or woman of words.  What if PTSD is more like torture than a broken narrative?  Then body-work becomes more important.  Less words, more body, from holding to touching to physical therapy, to massage to cradling.  All this wonderful touching.  What if that put the embodied self (the body-mind) together better?  Of course, these need not be alternatives.  A combination would work best.  Body-work is recognized.  Bessel van der Kolk understands its importance better than most.   But body-work remains on the margins of therapy, from psychoanalytic therapy to the so-called evidence based theories of the Veterans’ Administration.

      The person in great pain experiences his own body as the agent. (p 47)

This is true, but perhaps not as true, with PTSD.  Certainly the gastritis, muscle aches, irritable bowel syndrome (IBS), headaches, neuropathy, and other body pains associated with severe psychic trauma make the body, as well as the mind, the enemy.  Trauma is not just the memory of horror.  Trauma is the memory of the memory of horror.  PTSD resides within the body-mind.

Psychic trauma

It has often been observed that when a knife or a nail or pin enters the body, one feels not the knife, nail or pin but one’s own body, one’s own body hurting one.  (p 52)

The situation with psychic trauma is similar.  In physical medicine, trauma refers to the injury done by an object, as in “blunt force trauma.”  In psychology, on the other hand, trauma refers not to the injury to the mind, but the mind’s reaction to injury.  What is experienced as an intrusion, and often treated as one, is entirely one’s own reaction.  The only term we really need is psychic trauma, understanding that its origin is within, even if its stimulus is without.

While this would result in conceptual clarification, I do not recommend it, just as I do not recommend abandoning the term PTSD.   The more objectified the trauma, the more exterior its source, the more seriously it is taken by others.  Even neuroscience, particularly the fMRI, which claims identify the source of trauma in the brain, while bad science, is politically useful to the degree it makes PTSD more objectifiable, more real.  As one who studies PTSD put it,

the research makes clear that [PTSD] is real.  There is objective evidence that something is wrong in the brains of these veterans. (New York Times, 6/14/2013, p 1-A)

Those who deal with the human consequences of torture face the same problem.

One of its [pain’s] most frightening aspects is its resistance to objectification. Though indisputably real to the sufferer, it is, unless accompanied by visible body damage or a disease label, unreal to others . . . The lack of acknowledgment and recognition . . . becomes a second form of negation and rejection, the social equivalent of the physical aversiveness. (p 56)

What really links torture and PTSD?

The pain of torture and PTSD are similar because both are a reaction to unbearable experience.  They are similar because they don’t stop when the pain stops, whether physical or psychic.  In some respects the memory is worse, for the sufferer is constantly reminded of the body’s vulnerability.  Our mental and physical boundaries are readily breached by intolerable experience. 

The advantage of identifying torture with PTSD is it points out the similarity between physical and psychic vulnerability.  In neither case do we control what gets in.  And once inside the pain and its memories take up residence, so that we end up torturing ourselves.  What’s gets inside stays inside. 

An important difference is that with the pain of torture the most intense pain is during torture, at least in most cases.  With PTSD the most intense pain is afterwards.  But in both cases the pain remains in the body-mind for years.  Therapy helps, but as the sheer physicality of torture reveals, therapy works best that does not assume that the goal is to put narrative to pain.  The therapy that works best is the one that takes the body-mind seriously, soothing the body until it is no longer hyper-reactive (as true with trauma as torture).  Only then can the story-telling begin.

For severe psychic trauma I have used the term PTSD, not as a diagnostic category, but because it is a widely known and recognized term, reflecting the objective reality of psychic trauma.  C-PTSD, or chronic PTSD, the trauma that begins with childhood abuse and neglect, is not yet a widely accepted category.  Like pain, it suffers from the political problem (as far as recognition and funding are concerned) of not being as readily objectified.  One can’t see the psychic trauma induced by a family in the same way one can see the psychic trauma of a war wound.  Both are just as real.  Both deserve treatment. 

Torture is more “real” because almost everyone agrees it is abhorrent.  That doesn’t make it worse.  Pain can’t really be compared.  Some pain is certainly worse than others, and perhaps we sometimes need to make distinctions. The wrong way is to focus on whether the pain is objectifiable.  The right way is to recognize that with torture, PTSD, and C-PTSD, the pain is inside.  The goal isn’t to bring it out, but to help sufferers find a way of living with it. 

References

C. Fred Alford, Trauma and Forgiveness. Cambridge University Press, 2013.

Elaine Scarry, The Body in Pain: The Making and Unmaking of the World.  Oxford University Press, 1985. 

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