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.

On the day after Christmas in 2004, a tsunami hit the coasts of Sri Lanka Indonesia, India, and Thailand. It drowned more than a quarter-million people in one of the worst natural disasters in modern history. In addition to the tsunami, a tidal wave of trauma counselors and researchers poured into the region from all over the developed Western world. Before the mid 1980’s, the relief of psychological trauma was not even on the agenda of aid agencies.

There is no denying that the people affected by the tsunami suffered psychological trauma. The question is whether they suffered PTSD. It is a question made more difficult to answer when those who failed to exhibit the symptoms of PTSD were often labeled as in denial. One trauma counselor working in a small coastal village worried in an interview broadcast on the BBC radio service that the local children appeared more interested in returning to school than discussing their experience of the tsunami. These children were “clearly in denial,” the expert told the listening audience. (77)

Gaithri Fernando, a professor of psychology at California State University in Los Angeles, and a native of Sri Lanka, was present in the country at the time of the tsunami, and was one of the few to argue that Sri Lankans’ experience of trauma differed from Western experience. When Sri Lankans spoke in an open ended conversation with people who spoke their own language, the distinctive features of PTSD, such as anxiety and numbing, were generally absent.

Rather than focus on their internal states, Sri Lankans tended to see the damage done by the tsunami in terms of its harm to social relationships. Those who suffered most were those who had become isolated from their social network, or were unable to fulfill their role in kinship groups, in some cases because the group itself had been destroyed. One way to interpret this difference is that Sri Lankans saw the damage done by the tsunami as located not in their minds, but in their social relationships.

From the perspective of PTSD, trauma causes psychological injury which results in depression, social alienation and withdrawal. From this Western perspective, the symptoms associated with PTSD would lead the victim to fail in his or her role as parent. For a Sri Lankan, this inner-self versus outer role distinction did not exist, at least not in the same way. The inside/outside distinction that we take for granted is a social construct. For Sri Lankans, according to Fernando, the failure to occupy and fulfill one’s place in the group was itself the primary symptom of traumatic distress, not the result of internal psychological problems. “The data empirically support the theory that intra-psychic functioning is not independent from interpersonal functioning for this community.” (Fernando, 2008, p. 236)

Fernando concluded that Sri Lankans interwove the social and the psychological to the point where the two could not be teased apart.
If people experience depression, withdrawal, anxiety, and hypervigilance as the primary symptoms of traumatic injury, then it makes sense to see the solution as one of discussing the symptoms and experience of trauma in that form of discourse known as therapy. If, however, the primary symptom of distress concerns the inability to perform one’s social role, that is the loss of one’s place in society, then individual counseling may be irrelevant, even harmful.

Is the concept of traumatic injury not poorer but richer in places such as Sri Lanka? Not necessarily. PTSD generates a critique of power that is absent in more traditional accounts (more about this in a moment). That is its virtue for modern, Western societies. And yet one must admit that Watters does not seem to be idealizing traditional societies overmuch when he states that

Looking at ourselves through the eyes of those living in places where human tragedy is still embedded in complex religious and cultural narratives, we get a glimpse of our modern selves as a deeply insecure and fearful people. We are investing our great wealth in researching and treating this disorder because we have rather suddenly lost other belief systems that once gave meaning and context to our suffering. (122)

Patrick Bracken (2001, p. 740) suggests that PTSD is itself a symptom of the postmodern world. “In most Western societies there has been a move away from religious and other belief systems which offered individuals stable pathways through life, and meaningful frameworks with which to encounter suffering and death.”
If this is true, then PTSD is a diagnosis that fits a certain culture at a certain time: modern Western culture that has lost other sources of meaning. “When one comes back home to PTSD, the starkness and thinness of the idea become glaringly apparent. In the modern Western world, the idea of PTSD is that of a broken spring in a clockwork brain.” (Watters, 120)

What Watters Misses

What Watters misses is the way in which PTSD can serve as powerful social criticism in Western culture. Judith Herman, in Trauma and Recovery (1997), probably the most influential book among clinicians, at least until recent years, argues that recognition of PTSD has always depended upon social changes. “Without the context of a political movement, it has never been possible to advance the study of psychological trauma.” (Herman, 32) “Every instance of severe traumatic psychological injury is a standing challenge to the rightness of the social order.”

If we see PTSD as the type of psychological disorder that would arise in an anomic, individualistic society such as our own, then one can either transform this society (unlikely), or recognize the utter vulnerability of its members to the type of individual dissociation and dislocation that are so often the result of social forces, such as the wars in Vietnam, Iraq, and Afghanistan, violence against women, and the thoughtless, careless response to natural disaster (Hurricane Katrina). This list is hardly inclusive.

Recognizing that social forces create PTSD may generate, if we are fortunate, the intellectual forces that help identify and help treat it. That’s good. What’s bad is the tendency to naturalize PTSD, treating it as a timeless, placeless disorder. An example of a book that does both the bad and the good is Achilles in Vietnam: Combat Trauma and the Undoing of Character, by Jonathan Shay (1994). Comparing the Trojan War with the Vietnam War, Shay gets basic principles of classical scholarship wrong, beginning with his assumption that the Trojan War was real. Nevertheless, his is a great account of why the rate of PTSD was so high among Vietnam veterans. It wasn’t primarily the combat. It was the failure of command to uphold standards of “what’s right.”

If one wanted to try to put all this together, then The Empire of Trauma: An Inquiry into the Condition of Victimhood, by Didier Fassin and Richard Rechtman (2009), would probably be the place to start. As they 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.” (276) They’re right, but we have to make sure we are not imposing our language of violence on those who speak another.

I think our language generates a more powerful political critique In general, the poor suffer more trauma, and they suffer it not just acutely but chronically. For example, it was the poor, who lived in coastal fishing villages, who experienced the worst effects of the tsunami. But, not everyone is going to value “political critique” as intellectuals do. There are lots of ways to come to come to terms with life in this painful world.

References

Bracken, Patrick (2001). Post-Modernity and Post-Traumatic Stress Disorder. Social Science & Medicine, 53 (6), 733—743.

Fernando, Gaithri (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.

Watters, Ethan (2010).  Crazy Like Us: The Globalization of the American Psyche.  New York: Free Press, 2010