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. 


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. 


Comments (7)

  1. John B.

    I would build on your assertions by pointing out that the worst posttraumatic stress (PTS), in other words, that PTS which becomes “disordered” is similar to torture in that it results from intentional human acts. War, genocide, rape, slavery, sustained abuse or severe single-incident abuse by a person in a position of intimate trust (e.g. a parent), and torture results in trauma that endures for decades, if not for the entire lifetime of the traumatized person. Survivors of natural disasters, or no-fault vehicle collisions typically fare much better over the course of their lives. The explanation provided by these survivors and/or by their trauma therapists that the event was accidental eventually is accepted as valid narrative. However, torture is an explicit betrayal of the pact we share as fellow human beings shattering our connections to others and so to the world (more on this in the discussion on attachment below). Torture will never make sense and all narratives around the event become incoherent.

    For purposes of discussion, let’s consider a military veteran who survives childhood abuse, who then survives combat trauma, and who then perpetrates torture on the battlefield. Any one of those experiences would be overwhelming and unbearable on their own (not only for the Soldier, but also for the tortured). And none of these experiences lend themselves to a coherent narrative. The Soldier struggles with his mother hating him and abusing him, but not his brother. The Soldier struggles with seeing his good Army brothers die through cowardly improvised explosive attacks. The Soldier struggles with memories of him striking a suspected bomb maker with his rifle butt and splitting his skull open while the suspected bomb maker’s child looks on in terror (a look familiar to him as what he must have looked like as a child himself when the Soldier’s mother was violently raging at him).

    The Soldier’s psychic pain is endless, and he has difficulty remembering a time when he didn’t want to destroy himself. The physical pain of being physically hit by a caregiver pales in comparison to living in a world without emotional attachment to others who love him and whom he loves. Attachment is the prime mover in human existence. From the day we are born until the day we die, as human beings, we are oriented to attach. Wolves are born wrestling with their siblings in preparation for their role as predators. Deer are born ready to walk (and eventually run) within minutes in preparation for their role as prey. Humans (even before birth) are oriented to attach. A baby and a baby’s caregiver would have a hard time distinguishing who is cradling who during these moments of human touch. There is a mutual regulation of affect within the “mothering pair” with oxytocin released in child and parent. And so, yes there is a both a mental and a physical component to healing of psychic trauma and related attachment injuries. Attuned and empathic talk therapy vs. therapy advocated by van der Kolk and Levine? It is not either/or; it is both/and.


      John, as I said, very good. One more thought: perhaps you should write a trauma blog, or contribute to mine. Fred

  2. Anonymous

    Dear John, of course you are right. It’s not talk vs body therapy, but both. I think this is why I have respect for van der Kolk, even when I think he’s simplistic. He understands that trauma is not beyond but beneath words, and though he focuses on the body, I never get the sense that he is hostile to talk. So, thank you for reminding me, and others, that it is not either/or. Fred

  3. James

    As a Generation-Xer, I have to say “OMG!” This is perhaps the best blog post I’ve read about trauma. Particularly poignant is the loss of voice associated with trauma. One of the three main themes of my curremt research hinges on voice, and I find that I have the tendency to conflate my life’s experiences with my data interpretation. This blog helps clarify the origin of that conflation.

    • Anonymous

      James, sometimes we conflate our experiences, and sometimes we use our experiences to make sense of concepts that are otherwise terribly abstract. I’m glad my post helped. Fred

  4. Hopeful

    Mr. Alfred,
    Thank you for having this site and allowing discussion.
    As I mentioned in my comment under Projective Identification, I have cPTDS resulting from extreme physical, emotional, psychological and spiritual abuse by my mother. These abuses also included witnessing my siblings being abused as children by my mother and others.
    I was also sexually abused within the first 4 years of my life.
    I am in therapy now because I want to become therapist myself so I am not only healing but I am paying attention to my healing process and progress.
    Imagine my horror when I started to disintegrate every time I had a therapy session and started to talk about my trauma which BTW I sort of cut it out like I started life only30 years ago (I am 47 now).
    I could not stop myself from dissociating. Well that was weird. Because I wanted to do therapy so bad and heal myself, I had no resistance in therapy and to transference. So I was like a jello in every session – complete loss of reality. Could not contain the flood of feelings and clusters of emotions I shut down many years ago.
    Now one must ask how my trauma did impact me in my everyday life. I have controlling personality (something I am admitting now but was not obvious to me in the past. I just thought I am cautious about things). I had severe bodily pains, unexplained muscle tensions (like I want to run but cannt and got stuck in the motion), I had a lot of stomach issues and digestive problems and not to mention – I did not know how to breathe properly. And I basically lived in dissociation for 30yrs since I was 18. Great! I am functional but in straight jacket. Not to mention, I split on anything that gives me anxiety – no driving (I had bad experience). No sports (I am never good enough). No certain food (cause I just hate). I hate or l love no in between. I have been a toddler in adult body.
    So I was tortured but I could maintain it for all my life. I just controlled all external stimuli. Never again for bad relationships. Anyone crazy enough, good bye! And so on.
    In therapy now, I am learning some very fundamental things about myself and I do not think I am alone obviously but wonder if others feel similar. IMHO, PTDS is a layer disease. What I mean by that is, it is not something (at least for me) that I was born with like I have brown eyes. It is an experience, albeit long one, that is given to me. And for whatever reason, I took it. I took it because I could not escape. I took the blunt force against me willingly and just closed my eyes and muted my ears.
    Why did I survive in such harsh reality that I grew up? Any adult put in exactly similar fashion of being pushed, slapped, bitten, beaten, electrified, spit on, hair pulled, mutilated, sexually abused, pour cold water for 18 yrs would go so crazy as to be hospitalized? But why am I still here and semi- normal? I do not really know what normal means but I can hold a job, maintain relationships like friends, and/or family and can deal with a lot of losses and grief and I have no any other mental conditions? Why am I still here? How exactly did I survive?
    What is the mechanism a baby/toddler/child of small weight can endure but adult would go berserk for one incident of such experience?
    What mechanism in babies that allows to develop defenses that protect the mind but let the body take the hit? Why it is a baby can survive horrendous incidents of familial abuse but adult cannot as long without it becoming hostage situation? I am not implying babies survive in flying colours but babies and very young children survive bad, really bad abuses every day but most adults cannot handle even one incident without calling the cops or getting help or running away? So I asked myself many times what mechanism we do not have access to as adults that make a child survive in abusive relationships until they are rescued or died but that makes the adult so unbearable that in one incident, they would call for help.
    In therapy, we talk about all these great primitive defenses babies develop in order to ward off bad objects or to save good parts or to split off bad parts …a lot of mental/psychic activities are going on that are saving the core of the child? What happens to that as we grew up and become adult cause our pain is just too unbearable and we need help ASAP. Do we stop growing more defenses and forgot the one we had before?
    Something is amiss here.
    This is my feeling. As a baby, the body takes the hit, the pain, the PTDS. The mind hides behind all the activated defenses and the developmental mechanisms in place. The deal is the mind says, I will block this from reaching the core, but you, the body will take the hit and carry the pain until later date when you are in a safe place. It is better this way, says the mind, because if I do not protect (let us say the soul here), the soul, we are either dead or completely destroyed beyond repair in this life time. So ms. body, please take the pain since humans prefer physical pain to mental or emotional pain and I will carry the soul pain.
    So PTDS is in the body and the mind is ready to resolve when the person is ready and is in safe place.
    For me, the first indication of therapy working was the release of my muscles in my legs and in my diaphragm and in my stomach. All of sudden, I could breathe. I was like What? How did I survive without breathing properly for so long? I do not know.
    As I felt safe and safer, my body relaxed more and more and my allergies are gone. My digestive issues gone. Even my voice changed from little panicky sound to soft, almost whisper. I stare at people less (less vigilance). These are real changes and I know because they happened quite fast early in therapy…so fast that I did not recognize myself when people keep asking me to repeat myself?

    To me, as I explored my dreams, and document my progress in healing, it became real to me that PTDS is a layer at the top of my anatomy not in it. There is a layer between what I was born with and what I experienced and values given to me over the course of my life. Talking therapy helped me because I needed to tell my story about how I survived the harrowing experience of being abused by the one I loved and supposed to love me and being abandoned by my father (figuratively speaking).
    As I said before probably, one must let the mind die a bit to release the power of familial values that are embedded at the top of what one was born with that was tampered with during childhood abuse.
    I had to reconstruct my life from the get go and work my way back layer by layer to imagine, when the first layer was laid on me. Am I cured? No. But I have a profound understanding of my soul’s journey and how my body protected me along the way, while my mind played tricks for those around me to ward off their psychic powers… so at least my soul was intact and this may not be true for all.
    The body pain was real. The cure is my story. My mind opened up and spoke to my body to say, you are safe now and my body heard and relaxed!
    I think a super, positive, resistant free, safe and controlled psychosis might be one way of curing c-PTDS. It is recharge. It does not delete all memories but it interjects glimpses of the gap between the soul that came to this world and the early experience that was given. When one sees the gap, it is not magic to say, one just wants to expand the width further and further and fill it one’s own values.
    How to have that safe and resistant psychosis is another story.
    I even think (and this may be just over the top more) shock therapy was an attempt to create this type of psychosis to produce a void to recharge the brain to that of the baby brain, creating new pathways fast and fast. Where in adults, we just somehow lost that creating of new defenses or even activating old defenses fast enough.


      Dear Hopeful, it sounds like you have made great progress is overcoming your c-ptsd. And I think you are right that it is a “layer disease,” at least in the sense that you were not born with it. It is done to you.

      I’m doubtful about the worth of “controlled psychosis.” It sounds like risky business, but perhaps you meant this as a metaphor. To get better one can hardly avoid feelings that resemble psychosis in their intensity. In any case, you seem to be a success story, but I’m struck by how much it cost you. And I think that ptsd will never go away; it just becomes less overwhelming. Fred

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