Epistemic Status: Bloggy and curious, literally “thinking out loud”. I haven’t given this any sustained thought, and this is more or less unedited. Take it for what you will, and be gentle with my ignorance.
Waiting at a doctor’s office for a family member’s appointment this morning, I picked up a copy of The Body Keeps the Score that was sitting in the waiting room. As I made my way through Bessel van der Kolk’s background narratives, a particular statement caught my attention: that the various drug treatments worked out by psychiatrists and pharmaceutical companies over the last four decades work quite well for most of the trauma cases… but not the most classic PTSD patients there are, the ones who helped get the term defined in the first place: veterans.
If the thing that van der Kolk identified in his work with Vietnam veterans is the same thing that other people experience, why doesn’t it respond the same way clinically? To his credit, van der Kolk freely admits his confusion on that point in the book. Would that more authors were so honest.
But it’s still really weird.
My friend Matt Loftus wrote this piece on trauma late last year, noting among many other things that “trauma” has become the de facto primary descriptor for talking about the hard things people experience in life. And, critically:
…it seems that trauma discourse is being used to reconceive our entire psychological, religious, social, and political milieus in a therapeutic manner — a manner which, of course, can then only be cared for by professionals.
This is not to say (and Matt very much went out of his way not to say) that trauma, including psychological trauma, is not real. To the contrary:
Trauma is something that affects many people a little and a few people a lot, so Christians should understand how trauma can affect people in profound and frustrating ways.
But the discourse launched by The Body Keeps the Score certainly lacks that nuance. The book itself, at least from the first 70 pages, is at least somewhat to blame for this: On the one hand, it consistently points to things we would all agree are things we would file under Matt’s “a few people a lot.” On the other hand, it opens by describing how trauma actually affects everyone, how it’s at the root of many of the relational problems we all have, etc. (It’s a popular-level psychology book, in other words: Making stronger and more engaging claims than is perhaps warranted is basically the stock-in-trade of nearly all popular science books, after all.)
Regardless of how much van der Kolk’s own framing is or isn’t careful on this point (and again, I’ve only read the first fifth or so of the book!), the cultural discussion going on around trauma is simply not careful at all. Everyone is traumatized, and quite deeply, by things that in the past we might have filed under The Preacher’s comment:1
…the righteous and the wise and their deeds are in the hand of God. Whether it is love or hate, man does not know; both are before him. It is the same for all, since the same event happens to the righteous and the wicked, to the good and the evil, to the clean and the unclean, to him who sacrifices and him who does not sacrifice. As the good one is, so is the sinner, and he who swears is as he who shuns an oath. This is an evil in all that is done under the sun, that the same event happens to all. Also, the hearts of the children of man are full of evil, and madness is in their hearts while they live, and after that they go to the dead.
These things are real and grievous. They are also universal to the human experience. To call them all trauma is new.
The trauma that is PTSD as experienced in modern combat veterans may be new, too. I’ll point you here primarily to this post by Bret Devereaux. Devereaux is interested here primarily in the question of whether there is anything like a universal experience of war. With the caveat that he himself freely admits he isn’t an expert on it: PTSD per se seems to be a modern experience. Devereaux’s hypothesis seems to be roughly that it is the product of the combination of the way modern warfare works with the cultural milieu in which it happens. In the trauma discourse’s own terms, what we are emotionally equipped to process and deal with makes an enormous difference in whether something becomes a trauma or not. A culture may prepare us more or less to deal with different classes of awful things; and some things it may not be possible ever to be prepared for by any culture.
Maybe these things just aren’t the same. Maybe the horror that is being abused is a different kind of thing than the specific psychic violence that is modern warfare. Maybe both of those are different from the kinds of ordinary difficulties that we encounter in life, even when we for whatever reason fail to properly resolve and move on from those difficulties. Maybe those all genuinely have real factors in common because they all involve humans dealing with strong emotions — but maybe the commonalities between those different kinds of things are presently overstated in a predictable overcorrection to having missed those commonalities in the past.
I put a lot of “maybes” there and sometimes that’s a way of saying: I actually believe this and just want to hedge my bets to avoid having to account for those. Here, it isn’t that. It’s genuinely a “maybe”. I don’t think any of us have a particularly good handle on this; and my own epistemic confidence in our current analyses based on my own (admittedly limited) reading is pretty well summarized with a shrug emoji. 🤷🏻♂️
As van der Kolk admits freely in The Body Keeps the Score, we are in the infancy of neuroscience, and psychology and psychiatry have a deep-seated cultural desire to be real science. What’s more people are desperate to make sense of the real challenges they face in every day life, and to know how to respond to them, because they largely lack the long-standing tools which society has historically employed for those — mostly religion. Those factors are a complicated sociological mix. They mean (at least) two key things:
We are just going to get a lot of it wrong, because there is still so very much we simply don’t know about the brain and the mind (which I distinguish here verbally for a reason!).
The internet-era phenomenon Kerwin Fjøl describes as “exegesis hatcheries” guarantees that culture will riff on all ideas, no matter how qualified, until the Discourse™ about them may be unrecognizable when compared to the original.
On balance, then “trauma” as such is a very fraught concept today. It may be useful, as Matt suggests, to have in our bag of tools. It is, though, as Matt also suggests, a concept to be deployed with rather more care than is common these days. That goes for professionals, and it goes double for people working through “how to cope with life” with their therapists.
To that I would add my initial hesitation, coming back to where I started with van der Kolk’s confusion about why various medical interventions for PTSD don’t work the same way for vets they do for other trauma victims. I suspect these things… just aren’t the same. Symptoms in common does not make the malady the same.
I read Scott Alexander’s review of The Body Keeps the Score a few years ago. I did not reread it today. It’s very possible I’m subconsciously echoing some of his sentiments, and/or riffing on ideas I picked up from that post. (I literally don’t know, though, because I didn’t reread it before writing this!)
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