Stephanie Foo went through hell, finally coming to terms with C-PTSD.

Stephanie Foo is not a trauma theorist.  She is a radio journalist and author of an account of her journey through C-PTSD, What My Bones Know.  Not always well-written, it is a horrifying story of her childhood, her encounter with at least a dozen unavailing therapies, and finally finding one that worked.  It includes her account of intergenerational trauma in general and her family in particular.  Her use of intergenerational trauma theory is deeply touching and theoretically unsophisticated. 

In another post I’ve discussed the definition of C-PTSD.  Complex PTSD refers to long-term exposure to trauma, usually beginning in childhood and continuing for years.  Often it involves sexual abuse, but not always.  Almost always there is no escape.  Dissociation is a predominant coping mechanism.  The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM 5tr) does not recognize C-PTSD.  The International Classification of Diseases (ICD 11) does but limits it to those already suffering from PTSD, a compromise that has never made sense to me.    The psychiatric community generally seems less interested in the diagnosis than do those who suffer from it.  Foo, like so many, was relieved to find a diagnosis that helped make sense of her experience. 

A childhood in hell

It’s worth spending a little time with her story in her own words.  Her abuse was spectacularly awful, becoming worse as she entered puberty. 

A few times a year, my mother would get so tired of me that she decided God should take me back forever. She grabbed my ponytail at the top of a flight of stairs and used it to hurl me down. She raised a cleaver above my wrist, or she pulled my head back and pushed the blade into my neck, its cold edge pressing into the softness of my skin. I’d apologize frantically, but she’d scream at me that I didn’t mean it, to shut up before she sliced my jugular open. I’d fall silent, but then she said I was never repentant. So I’d start to apologize again, and she said my apologies were worth nothing, plus now my tears made me so ugly she was certain I had to die. So I stayed quiet until she screamed at me to speak again. We’d sit there, trapped in a senseless loop for hours. (p 13)

How did I feel about the fact that my mother blamed her suicide attempts on me? I couldn’t tell you. Those would be some very big feelings for a very little girl. But I do know this — that every night before bed, I kneeled and said the same prayer over and over like a mantra. “Please, God — let me not be such a bad girl. Please let me be able to make Mommy and Daddy happy. Please make me into a good girl.” (p 15)

Her father was no help.

“It’s not her [mommy’s] fault. It’s just that I’m bad, I’m awful, I’m evil,” I told him, and he believed me. “Why do you have to be like this,” he’d ask. “Why can’t you just be better?”

Worse was what she calls her father’s car terrorism.

My father didn’t hit me once after my mother left, but he was a fan of car terrorism.

“It’s time for both of us to die,” he’d sing, smiling. “I’m going to kill myself because I’m tired of this life, and you’re a fucking bitch so you’re coming, too.”  He almost killed us a dozen times; each time, I’d beg and plead and placate him, feeding him reasons why we needed to live. (p 34}

How did she survive?

Though she doesn’t linger on it, Foo seems to attribute her survival to her hatred. (p 30) Hatred that she put into practice after her mother left, and her father took over her abuse.

Then I heaved the ax up above us in a graceful arc that would end on his balding skull. And I started to scream .  . . . “ How do you like it? ” I said quietly, in that same chilling, deadpan, serial-killer tone I knew so well, and it felt delicious in my own mouth. “How does it feel to be on the other side of things? To be inches from death? How does it feel when someone wants to kill you?” (p 35)

“Okay, then let’s get one thing straight. You are never going to threaten my life again. NEVER. Do you understand me? ” “Yes.” “I SAID. DO. YOU. UNDERSTAND. ME.  “Yes!” “You will never grab me. You will never touch me. You will never go over the fucking speed limit. You will drive right. You will never use your car to punish me. Do you have any idea what growing up with a constant fear of death has done to me? It has turned me into the fucking monster you see right now. This is happening because you did this to me.” (p 35) 

Her anger, I believe, saved her from psychosis.  She cossetted her nascent self in rage.  “My anger was my power.”  But her rage only bought her time.  It didn’t heal; it only protected her fragile, broken self from obliteration.  That was no small thing. 

A dozen therapies

As one would expect, Foo’s adult life was difficult.  Surprising was her professional success in public radio and producing her own popular podcasts.  Dread seemed to be her core experience, the great black dread that ruined everything (p 52).  Her diagnosis of C-PTSD by Samantha, an early therapist, was helpful, for it not only put a name to her suffering but helped her organize her diverse afflictions.  She read about C-PTSD in books like Bessel van der Kolk’s The Body Keeps the Score, but books didn’t help her get better. 

She tried at least a dozen different therapies, including:

• EMDR (eye movement desensitization and reprocessing)
  
• Meditation
• Mindfulness
• Grounding
• Yin restorative yoga
• Mindful eating
• Trauma support groups
• Massage
• Hallucinogens (“magic mushrooms”), of which she was fond.
• Gratitude (which she approached as a technique) “Gratitude turns what we have into enough. ” (p 140)

Each helped.  A little bit and for a little while, but never enough.  Some helped more than others. 

What she could do

Foo’s experience supports a distinction between C-PTSD and Borderline Personality Disorder (BPD).*   She maintains a long-term relationship with her partner Joey, she holds a difficult and demanding job, she is not suicidal, and she does not engage in risky or impulsive behavior, such as drug abuse, gambling, or unsafe sex, though she drinks too much.  These are some of the markers of BPD (DSM 5, 301.83 [F60.3]).  One could of course respond that she has chosen not to write about these matters, but she has certainly been open about other unflattering aspects of her life. **

C-PTSD, on the other hand, is characterized above all by dissociation, an experience to which she frequently refers.  Dissociation is a loss of connection between experience and feeling, which results in a sense of feeling unreal, not fully present.  PTSD, it has been recently recognized, is also a dissociative disorder and there is certainly an overlap.

Foo’s frequent reference to dissociation, particularly her therapist’s noting the flatness with which she recalled terrible episodes from her past (p 101), as well as the way Foo often feels not quite real, suggests she was able to protect her nascent self through dissociation when in the midst of abuse.  Only in better circumstances did dissociation become a problem, for dissociation doesn’t just turn itself off when no longer needed.  It becomes a way of life, undermining the pleasure in existence.

Intergenerational trauma: where Foo goes wrong, mostly

Where Foo goes wrong is in her search to explain her experience in terms of intergenerational trauma.  Coming to America from Malaysia at the age of two, she was a member of what is sometimes called the 1.5 generation, born abroad but raised in the United States by immigrant parents.  Attempting to explain her experience in social-psychological terms, she talks with other students at her high school, who at the time had been beaten by their parents for getting bad grades.  It was just part of the Asian experience.

I read up on my classmates’ painful family histories: the Chinese Cultural Revolution, the Vietnam War, the Korean War, the Cambodian genocide. I realized that my community was built in large part from the wreckage of America’s brutal proxy wars against communism. (p 176)

Certainly, it’s possible to place Foo’s experience in the context of contemporary history.  Her parents can be sociologically characterized in terms of their status as immigrants, their Asian heritage, and their coming to America at a particular time and to a particular place on the West Coast.  But social psychology doesn’t explain everything. 

Foo’s mother was psychotic, her father hysterical, as well as suicidally/homicidally depressed.  All families are alike, all families are different.  Hers was more different from other Asian immigrant families than she is willing to admit, at least as the book progresses.  It is as if she finds comfort in belonging to this community of the intergenerationally traumatized.

Returning to Malaysia, she asks her Auntie, “did you see her beat me?”  Yes, her Auntie responded, “everybody also seen.” (p 183)

When my mother slapped me so hard I fell to my knees, Auntie was likely peering around the corner, mulling the kind words she’d share later about how I was a perfect, good little girl. (p 183)

Is Foo wishing for an Auntie that never was?  “How come you never say anything when she beat me?” Foo asks (p 184), but the discussion goes nowhere.  The relatives were implicated bystanders, and Foo quickly turns to epigenetics, the study of how trauma can change the epigenome, transmitting trauma down the generations. 

The simplest thing to say is that the epigenetic transmission of trauma through the environmentally modified expression of the genome is quite unnecessary to explain Foo’s experience.  It is explained as all implicated bystander behavior is explained, as a result of social pressure and individual cowardice.  This was no normal case of Asian “tiger mom” syndrome.  Her mother was nuts, and no one wanted to confront it, sacrificing Foo in the process.  I’ve hardly begun to name all the terrible things her mother did.

It’s understandable that Foo would want to protect her relatives so that some would stand outside the circle of those who would willingly sacrifice a little girl to destruction, but the intergenerational transmission of trauma is not well-used in this project.

Every cell in my body is filled with the code of generations of trauma, death, birth, migration, of history that I cannot understand. Just piecemeal moments I collected from Auntie over the years. My family tried to erase this history. But my body remembers. (p 202) 

To say her cells carry generations of trauma is a good metaphor.  It’s what she means with the title of her book.  But it’s a metaphor.  This is important because we live in an age in which neurological metaphors have become so reified that those who use them no longer know the difference.

I want to have words for what my bones know.  (p 202) 

She does, but they were lost to dissociation, as well as the desire to protect her horrible mother and complicit father and family.   

Conclusion 

Dr. Ham was a traditional psychotherapist.  Foo met him through her work, first interviewing him for her radio program.  Complex trauma, he explained, is caused by bad relationships with people who are supposed to be caring and trustworthy but aren’t.  Complex trauma is mended by long-term relationships with people who are trustworthy.  No tricks, no eye movements (EMDR), no neuropsychological theory about an enlarged amygdala (p 85), just a reliable person who takes one’s suffering seriously, and tries to understand, all the while recognizing the limits of understanding (p 270). Foo enters therapy with Ham, and it helped, as did her reliable relationship with Joey.  Foo thinks that it also helped that Ham was Asian; probably it did. 

The book ends with an observation that does not do justice to her own suffering.

I had never felt that I could compare my own experience to the great historical tragedies my ancestors survived: poverty and sexism and racism, not to mention the great wars, dotted with sepia-toned images of bombs and blight. (p 314)

Beyond a certain point, everyone’s suffering is his or her own.  It cannot be compared.  Nor can individual suffering be measured against historical suffering.  Foo was alone her entire childhood with an insane sadistic mother and crazy father  with no escape.  There’s not a lot worse than that.  C-PTSD seems like a good diagnosis.  For Foo, and for all who suffer from the effects of intense childhood trauma.  As long, that is, as one remembers that it’s not the diagnosis that counts.  Acknowledging the suffering and doing something about it are what count.  If the diagnosis helps the victim make sense of her experience, then that’s good.

____________________

** The relationship between C-PTSD and Borderline Personality Disorder (BPD) is theoretically fraught.  One recent study found that 25-30% of adults meeting the requirement for one disorder met the requirements for the other.  (Ford and Courtois).  Psychiatrists seem committed to keeping the diagnoses separate, and there is patient pressure to do so, as BPD is sometimes seen as stigmatizing.  Foo’s experience supports this separation on clinical grounds. 

** I’m aware of the possibility that Foo is not being truthful.  It’s almost impossible that she simply made it up.  Her story is too well known.  It’s certainly possible that observers would see aspects differently, but hers is a subjective story subjectively told. She relied on journals she kept since when she was six, a practice forced upon her by her mother for which she is grateful (AAJA, Feb. 24, 2022).  Her statements about intergenerational trauma and so forth can be judged by the usual psychiatric and scientific standards, as I have.

References

American Association of Asian Journalists, “Behind the Story: Stephanie Foo.” February 24, 2022.  https://medium.com/aaja-defined/behind-the-story-stephanie-foo-on-writing-what-my-bones-know-and-coping-with-c-ptsd-5601f615f1b5

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).  (DSM 5)

Stephanie Foo, What My Bones Know.  Penguin Random House, 2022

Julian Ford and Christine Courtois, “Complex PTSD and Borderline Personality Disorder.” In Borderline Personality Disorder and Affect Dysregulation 8, 16 (2021). https://doi.org/10.1186/s40479-021-00155-9.