Archives for : January2015

What is trauma? How does therapy cure?

Posted by :calford@umd.edu On : January 24, 2015
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Category: Thoughts on trauma

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Trauma is knowledge of the unbearably real. Trauma is a breaking of faith with all that one held sacred. Trauma is too much too soon. Trauma is “knowledge as disaster,” as Maurice Blanchot put it. The survivor of an environmental disaster captures the meaning of unbearable knowledge when she says

While it could be argued that it’s not a bad thing to become more knowledgeable, it is, I think, certainly a bad thing to become knowledgeable in the way that we’ve become knowledgeable. It’s like a person who’s an agoraphobic. If you’re terrified to go out of the house, you don’t live a very good life. (Erikson 1995, 197)

If trauma is knowledge, then what exactly is it knowledge of? That everyday life is a conspiracy to make the world seem safe enough to live in. Trauma is the result of an experience that makes it impossible for the traumatized to use social conventions the way most of us do in order to relieve anxiety, even dread. An example of such as convention is the statement “just you wait, everything is going to turn out ok.” Well, sometimes it doesn’t. Robinson Crusoe put the lie this way.

How infinitely good . . . providence is, which has provided in its government of mankind such narrow bounds to his sight and knowledge of things; and though he walks in the midst of so many thousand dangers, the sight of which, if discovered to him, would distract his mind and sink his spirits, he is kept serene and calm, by having the events of things hid from his eyes, and knowing nothing of the dangers which surround him. (Defoe, p. 163)

 

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What I learned about trauma from Holocaust survivors: not to idealize integration

Posted by :calford@umd.edu On : January 20, 2015
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Category: Thoughts on trauma

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Between 2007 and 2014, I viewed over 250 Holocaust testimonies at the Fortunoff Video Archive for Holocaust Testimony at Yale University (Alford, 2009, 2013). Many date from the late 1970’s, and were given before Holocaust testimony became its own genre, with its own norms. Many were talking about their experiences for the first time. Many had not spoken about their lives in the ghettos and concentration camps even with their families. It wasn’t until at least a decade later that talking about the Holocaust became widely accepted, even within the Jewish community.

One of the founders of the Archive was a psychoanalyst and child survivor, Dori Laub. He established an unstructured interviewing format that is still followed. Survivors would frequently talk for a half-hour without interruption. Most interviews lasted about two hours. A number lasted four. There was no time limit. In all this they are quite different from the interviews undertaken for Steven Spielberg’s Shoah Foundation (sfi.usc.edu).

What I learned

Extreme trauma lasts forever. People don’t get over it. They learn to live with it, alongside of it. Those who testified were, for the most part, “successful survivors.” They married or remarried (a number lost their entire families to the Holocaust), built businesses, raised families, had children and grandchildren. They survived surviving by living alongside their trauma, beside their Auschwitz self as one called it.

There are no constants among survivor testimonies, no universal themes. The two that come closest, are “no one can understand who wasn’t there,” and “even today I live a double existence.” Kraft (p. 2) argues that doubling is the near universal theme.

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What’s going on with the new PTSD diagnosis in DSM 5?

Posted by :calford@umd.edu On : January 20, 2015
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Category: PTSD, Thoughts on trauma

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There seems to be movement, but not much change, in the diagnosis of PTSD in DSM 5. PTSD is no longer a fear or anxiety disorder, but has its own category. In part, this seems to be the result of the popularity of PTSD. The APA justifies this stand-alone category partly in terms of the presence of PTSD “at the center of public as well as professional discussion.” (www.dsm5.org/Documents/PTSD%20Fact%20Sheet.pdf)

In reality, PTSD was created as a result of popular pressure, and it was expanded for the same reason. That is not necessarily a bad thing.
Intriguing is the movement of PTSD toward the category of a dissociative disorder.

The move has not yet been completed, but as Matthew Friedman points out, locating trauma and stress related disorders next to dissociative disorders in the “DSM metastructure” is no accident. The thinking of many seems to be that in the future they will be more closely related. This may be an attempt to come to terms with Chronic-PTSD, or DESNOS (disorders of extreme stress not otherwise specified), championed by Judith Herman, Bessel van Kolk, and others. As Friedman (2013, p. 524) puts it, “I recall overhearing a comment after my . . . presentation in 2011 on DSM-5, that the PTSD criteria were becoming more “DESNOS-ish.”

I’m going to assume that readers are familiar with the major changes in the diagnostic criteria for PTSD in DSM 5, and write more generally about the problem of thinking about trauma in terms of diagnostic criteria. Many diseases have similar symptoms, such as fever, swollen lymph nodes, low blood count, etc., but very different causes. It would be far better, and not just for PTSD, for the DSM to devote less time and attention to parsing symptoms, and instead looking for causes. But apparently the science is not up to the task. In effect, ever since the introduction of PTSD in DSM III in 1980, PTSD has been defined by the traumatic event that precedes it.

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Review of Crazy Like Us. With comments on its relationship to Herman’s Trauma and Recovery, and Empire of Trauma.

Posted by :calford@umd.edu On : January 18, 2015
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Category: PTSD, Reviews of trauma books

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Crazy Like Us isn’t a recent book, and it is certainly not an academic one. But maybe that’s good, for Watters makes statements about the state of the global PTSD industry that an academic might hesitate to make, at least in plain English.

Crazy Like Us isn’t just about exporting PTSD. It’s about exporting anorexia nervosa to Hong Kong, and a medicalized diagnosis of depression to Japan. But the chapter on the tsunami that brought PTSD to Sri Lanka is the one I’m interested in here.

Watters isn’t anti-psychiatry (his wife is a psychiatrist), and he isn’t against the diagnosis of PTSD per se. His point is that psychiatric categories are cultural categories, and particularly responsive to social change. As the medical anthropologist Allan Young put it, a diagnosis of PTSD “can be real in a particular place and time, and yet not be true for all places and times.” (101-102).

His most important insight is that PTSD is a diagnosis that fits a modern Western world, in which people see themselves as autonomous individuals first, and members of groups and social networks second. In a so-called traditional culture, the diagnosis just doesn’t make sense. So much the worse for us, Watters seems to be saying, but perhaps it’s not so simple.

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