What 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.

Factory Fires in Bangladesh

Consider the clothing factory fires in Bangladesh. Well over two thousand people have been killed since 2012 if we include the factory collapse outside Dhaka that killed 1,129 people (DePillis). The Washington Post story tells about the trauma of survivors and their families two years after the collapse in 2013, but that is not its primary concern. Its concern is that victims have not been compensated, that inspections are not being vigorously conducted, and that nascent trade unions are being repressed.

The great virtue of approaching events like the Bangladesh factory fires and collapses in terms of trauma is that it focuses on the suffering of individuals, as well as the violence inflicted upon them. Even if groups of people experience trauma, only individuals suffer trauma, and categories like PTSD are helpful in this regard.

Nevertheless, focusing on the trauma suffered by workers and their families raises another issue, transforming a political and economic problem into a medical or psychological one. That is, we risk depoliticizing the trauma. This is not a great risk if the trauma is caused by an individual or identifiable group, such as greedy factory owners.

But what if we think about the source of the Bangladeshi fires and collapses as globalized neo-liberal capitalism (Buelens, Durrant and Eaglestone, p. xiv)? Seen from this perspective, there is a system of trauma at work, one that includes the consumers of cheap clothes (you and me), the companies that sell them, and the local factory owners who employ cheap labor under stressful and dangerous conditions, while paying them as little as possible.

Do we want to include “post-traumatic factory fire and collapse trauma” as a new category of trauma? Probably not. If we went down this road, we would have a thousand types of trauma. Perhaps there are, but this does not seem a fruitful route. While there is no reason to assume that the symptoms of trauma are identical, and enough cross-cultural studies to suggest they are not (Fernando), it seems more useful in this context to talk about the stressor, as it is called, what the official definition of PTSD calls criterion A.

PTSD, C-PTSD, and ICD-11.

Since the category of “railway spine,” the term by which the post-traumatic symptoms of railroad accidents were described in the 19th century, psychic trauma has almost always been characterized in terms of the intrusion of an external force. The force could be a general one, such as the trauma of war, called “shell shock” in the First World War, “combat fatigue” in the Second, and finally PTSD (Post Traumatic Stress Disorder) in the post-Vietnam era.

But the trauma inflicted by more abstract forces, such as global capitalism and post-colonialism, really have no good name. The forthcoming eleventh edition of the International Classification of Diseases (ICD 11) takes the semi-radical step of removing the criterion of an identifiable stressor as necessary for the diagnosis of PTSD. If you have the symptoms, you have the disorder. ICD 11 also includes the category of complex PTSD (C-PTSD) for the first time. C-PTSD is intended to include those who suffer chronic trauma, such as child abuse or the violence inflicted by civil war and poverty on civilians (Friedman). However, since all the criteria for PTSD must be met before C-PTSD can be diagnosed, the result is not likely to increase the number of certified trauma victims significantly. Perhaps that was the intent.

Trauma is a net, not just a blow

People are the locus of trauma, where it occurs, where we see the suffering if we bother to look. But the trauma at issue is less like a blow or intrusion, and more like a net which traps its victims in conditions from which there is no escape, conditions that degrade, devalue, and overwhelm its victims, even those who survive the most dramatic disasters, such as fires and building collapses.

Many of the refugees flowing into Europe from war and civic collapse in the Middle East are likely traumatized. Some number will continue to be traumatized for years, but is psychological trauma the best way to understand their experience? No, it is only part of the experience, the result. The proximate cause is the collapse of authoritarian regimes, in many cases brought about by American military power. The distal cause is colonialism.

This may all sound obvious, and perhaps it is, but the desire to directly link the trauma to the source, to label the trauma with the name of its source, misses the point, as well as risking the medicalization of political events.

But the problem is even more difficult than this, for some traumas don’t even look like trauma. They look like everyday life for millions of people. From a clinical perspective, “the normative, quotidian aspects of trauma in the lives of many oppressed and disempowered persons” leave many psychotherapists unable to recognize that a person is suffering from post-traumatic distress (Brown, p. 18).

Just right from the clinical perspective, from a political perspective we need to look at the economic, social, and political forces that create and perpetuate this distress. A Marxist critique of political economy is a good place to start. The contribution of trauma theory, I believe, would be to keep such an analysis from spiraling off into the dialectic, keeping the focus on the suffering of those affected.

Conclusion: an imagination for stressors

Trauma has been so identified with its source, “the stressor,” that it is hard to think about separating them. But this is exactly what we need to do if we are to think clearly, and politically, about trauma. The sources of psychic trauma are as concrete as a brutal assault, and as subtle as a lifetime of poverty and insecurity (if that is truly subtle). Only when we separate the stressor from the trauma can we begin to develop an imagination for stressors, seeing entire ways of life as implicated in trauma, ways that may even seem entirely natural, such as a caste system, by whatever name it is called. Caste systems are not confined to South Asia.

ICD-11 should have begun that process, for it allows for the existence of trauma without an identifiable stressor. However, its definition of trauma is still so tied to PTSD that this seems likely to be of little practical consequence. However, once we begin thinking about a trauma that does not require an identifiable stressor, space in which we can imagine more stressors may open up.

That would be good. Trauma is not a scarce resource, and neither is the diagnosis, except perhaps within health systems trying to hold down costs, or psychiatrists trying to prevent “bracket creep,” as it is called (McNally). But these are worthy goals only in the most limited of contexts. In the wider world, an imagination for stressors is all to the good.

References

Laura S. Brown, Cultural Competence in Trauma Therapy: Beyond the Flashback. Washington, DC: American Psychological Association, 2008.

Gert Buelens, Sam Durrant and Robert Eaglestone, editors, The Future of Trauma Theory: Contemporary Literary and Cultural Criticism. New York: Routledge, 2014.

Lydia DePillis, “Two years ago, 1,129 people died in a Bangladesh factory collapse. The problems still haven’t been fixed.” The Washington Post. www.washingtonpost.com/ news/wonkblog/wp/2015/04/23/two-years-ago-1129-people-died-in-a-bangladesh-factory-collapse-the-problems-still-havent-been-fixed

Gaithri Fernando (2008), “Assessing Mental Health and Psychosocial Status in Communities Exposed to Traumatic Events: Sri Lanka as an Example.” American Journal of Orthopsychiatry, 78 (2): 229-239.

Matthew J. Friedman (2014), “Literature on DSM-5 and ICD-11,” PTSD Research Quarterly, 25 (2): 1-10.

Richard J. McNally, “The Expanding Empire of Posttramatic Stress Disorder,” April 10, 2006. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1785189/

Alvin Poussaint and Amy Alexander, Lay My Burden Down: Suicide and the Mental Health Crisis among African-Americans. Boston: Beacon, 2000.

Tariana Turia, “Tariana Turia’s Speech Notes.” www.converge.org.nz/pma/tspeech.htm.