The Result of University Cost-Cutting Measures . . .

the Plausible Deniability Blog takes up where the PostModernVillage blog left off. While you'll see many of the same names here, PDB allows its writers and editors a space away from financial strum und drang that torpedoed the PMV blog.

Sunday, September 25, 2022

Against Against Trauma 2

Parul Sehgal makes some points I agree with in her “Critic at Large” column in the January 3/10, 2022 issue of The New Yorker: yes, the trauma explanation of character development in narrative fiction is overdone, and, yes, good writing creates an air of mystery; it’s subtle, complex, and presents individuals whose stories we can believe in. It’s also true that not everyone has the same reaction to trauma: yes, post-traumatic growth is possible (though her assertion that it’s the norm is questionable).

In fact, I am an example of post-traumatic growth.

But along the way, like Will Self in his screed against trauma in Harper’s, and whose name she drops and whose work hers largely replicates, Sehgal manages to be utterly dismissive of the lives and real experiences of actual trauma survivors. Like Self, she goes so far as to question trauma’s legitimacy while complaining about the trauma theory of Cathy Caruth, implying, ironically in true postmodern fashion, that trauma is a modern invention, the product of obscure 19th century medical musings about train travel (to which again, I react with a visceral “WTF???”) that just happened to have ballooned in the 20th century, by some historical accident, in order to explain away the experiences of war veterans and survivors of sexual abuse.

Sehgal traipses through the by now expected avenues of Freud and the DSM’s definition of PTSD—which she gets wrong, by the way: the current DSM does not acknowledge traumatic events as etiology but defines PTSD in purely symbolic terms. Sehgal does the de rigueur bashing of Bessel van der Kolk and the standard invocation of Shakespeare, all while studiously avoiding the voices of the traumatized except to expressly dismiss calls for the online collection of their stories.

For traumatized people like me, this comes as no surprise. Sehgal is just yet another prominent and well-regarded person brushing off our experiences or redefining them in ways that suit her purposes. She doesn’t speak for me any more than the DSM committee does or Bessel van der Kolk does or the writers of Ted Lasso do. The fact that trauma is having its day in popular culture right now is no reason to deny its reality; the fact that most of the writing about trauma is bad is no reason to throw the whole concept away.

Indeed, there are whole genres dedicated to unrealistic depictions of romantic relationships and science and war, but their existence does not mean that people never fall in love or do groundbreaking research or engage in combat, still less that those are modern inventions—just read the Greeks! Sure, not every scripted drama should use trauma as character development, just as not every home decorating show shouldn’t feature shiplap; for a while they all did, though, and, the case remains, shiplap is an actual thing.

Amid Sehgal’s calls for more subtlety, she also commits the fallacy at the heart of most explanations of trauma by the untraumatized, vacillating between “Oh, poor baby!” at one moment and “Just get over yourself!” at another. (To her discredit, Sehgal settles on the latter.) The truth is even more subtle and complex than Sehgal seems to be able to understand: you can be both forever changed by trauma and you can grow from it. I have spent 45 years learning from my traumatic experiences, but I also still get triggered. These seemingly paradoxical responses might make for good writing, but they wouldn’t be believed, either by editors at major publications like The New Yorker or by critics like Sehgal.

This paradox is only one of many reasons I’ve spent those 45 years avoiding dealing with “my trauma” (scare quotes Sehgal’s) in my writing; another (maybe more important) one is that trauma doesn’t define me as a person or as an artist. That Sehgal would approve of that is immaterial; her own opinion is invalidated, in my mind, by her dismissive tone and lack of a desire to understand what the lived experiences of trauma are really like.

Imagine, if you will, if an “able-bodied” (scare quotes mine, this time) writer presumed to know everything about the life and experiences of a wheelchair user or, as is the case here, merely dismissed these experiences as a cheap way to develop a character. It wouldn’t work— neither The New Yorker nor Harper’s would never publish it. Yet that is precisely what Sehgal and Self do in their essays on trauma.

We should also make a distinction Sehgal fails to make: legitimate criticism of an overused trope is one thing, but the kinds of trauma stories people share or create for therapeutic purposes are not intended to be great art, and they should not be read that way. That they do not rise to the level of complexity and sophistication she expects is no fault against them, and faulting them on artistic terms is simply cruel to those creating them. They exist solely for the purposes of healing and validation by the individuals who create them and by their peers, not for critics to leverage in lamentation over the way a trauma subplot has hijacked her favorite show on Apple TV .

Here’s my take on it: if you’ve never experienced trauma—and I mean real wake-up-in-the-middle-of-the-night-screaming trauma, not just the a-sad-thing-once-happened-to-me-once trauma—don’t write about it. That’s my advice if you’re a critic, a journalist, a novelist, a poet, a show-runner, a researcher, a therapist.

Just stay the fuck away from it.

If for whatever reason you feel you have to, privilege the voices of actually traumatized people, consult them in a genuine way in the creation of your work. Bring them in. It will be scary, yes, but anything less merely perpetuates the damage.

Friday, July 15, 2022

The Problems with 988

A lot of reporting has been done on the purported boons of the new national 988 mental health crisis line. It promises to reduce the number of 911 calls on those experiencing internal distress, and, it is hoped, thereby reduce the number of people sent to jail inappropriately or traumatized or shot by cops showing up for a crisis instead of more helpful mental health professionals. The idea is that people experiencing extreme states of mind or psychological crises will “get the help they need” instead of criminal records and go on to lead fulfilling, productive lives.

There are numerous problems with this assumption. Let’s start at the point of crisis and go from there.

1. Calling 988 does not guarantee that a mental health professional will show up at your door.

That would only be the case in communities with an available crisis response team (CRT), which, geographically speaking, is a small fraction of the nation at this time (see The Takeaway podcast below), and even then, there’s no guarantee they meet national standards. In communities so served, CRTs may or may not be adequate in number or staffing to meet the needs of every 988 call deemed a true crisis. The trigger is generally “threat to self or others,” as determined by the 988 staff member who takes the call. Ideally, most calls will not result in a crisis being determined, and people will be referred to other services—a representative from NAMI, speaking recently on The Takeaway, estimates that 95% of callers will not be deemed to be in crisis, though it’s unclear where she got this statistic; a federal survey suggests 61% of crisis call outcomes were voluntary/collaborative.

However, if a CRT is not available, cops will show up, just like in the bad old days before 988, and it’s possible they will (re)traumatize you by tackling you, tasing you, handcuffing you, or, determining that you’re a threat to them, shooting you. This is more likely if you’re a person of color.

The way the members of this team treat you may or may not be appropriate for your situation or helpful to you: some CRTs may include, for example, a peer support worker, who is likely to understand what you’re going through, having experienced something similar. However, as someone who used to train peer support workers and support peer-to-peer program implementation, I can say that peer support workers are often dismissed by their co-workers and their opinions or actions overridden by mental health professionals who assume, by virtue of superior education or sane status, to know better. Even if your CRT has a peer support worker, there’s a good chance they won’t be allowed to do their job.

Indeed, crisis response is often an opportunity for coercion in the mental health field, and coercion generally just makes the problem worse. As the Intentional Peer Support model points out, it’s often better to take a non-coercive approach to crisis situations. But in the US, we’re stuck in an action-hero mindset that we must save people with direct action, even if we destroy half of Gotham in the process.

2. Often, people in crisis have been “get[ting] the help they need,” and it hasn’t helped. In fact, the help sometimes foments the crisis.

I read about mental health systems in which CBT, DBT, and other therapies are available, but I live in Kansas, and I don’t see that, except for privately insured people who are good at self-advocacy. What I do see in the public system are infantilizing and insulting psychosocial education groups and possibly helpful supported education and supported employment programs. Above all, though, what I see are psych meds—lots and lots of psych meds—a panoply of psychoactive substances doled out in massive doses and with almost ubiquitous polypharmacy.

These meds, while sometimes helpful, often have low efficacy (sometimes little better than placebo), and often have devastating and sometimes permanent side-effects. Switching meds when one doesn’t work for you is difficult, if not impossible for many: a person for whom I provide informal peer support was threatened by per prescriber with involuntary commitment to a state hospital if she didn’t stop asking for a change in medications, even though the side-effects of the ones she was on made it impossible for her work. (She was literally falling asleep on her feet at her retail job.) And this did not happen to her in the bad old days of Cuckoo’s Nest-level maltreatment. This happened last year, in 2021.

Side effects and few options, then, often lead people to stop taking their meds or to reject treatment to the degree they can; often people quit cold turkey. Or their prescibers actually listen to them but take them off of meds too quickly. Quitting or switching psych meds is always a perilous time, with withdrawal effects sometimes mimicking the very symptoms that got the person the diagnosis to begin with, and with others ranging from nausea and dissociation to “brain zaps,” which can last for weeks or months. In other words, the med merry-go-round can lead directly to, you guessed it, a mental health crisis.

988 advocates are relying on the very system that may have played a part in creating the crisis to fix the crisis. They are also assuming the appropriateness of crisis “care.”

3. Crisis “care” is often the source of trauma or retraumatization.

A few communities have short-term crisis centers. In Kansas, the three major metropolitan centers—Wichita, Topeka, and the Kansas City metro area—have short term crisis centers where people can cool off and get support and services for the 24-48 hours a mental health crisis generally lasts. These centers are much less coercive than traditional residential treatment (aka “psychiatric incarceration” to its critics) and tend to cost less and be preferred by users.

They’re also almost always full.

A handful of communities in the US are served by peer-run respite centers that house people for a week or more, and even fewer have short-to-medium-term residences run on the Soteria model.

Most places in the US have none of these things, which means a trip to the psych ward of the local hospital or to a state psychiatric hospital. In Kansas, you have two options for the latter, Osawatomie or Larned, and, as above, they are mostly full most of the time.

Based on my work in them, there you’ll find a situation little different from the way things were 45 or 50 years ago, only now you’ll stay for a few weeks instead of a few years. But it’s still involuntary commitment: you can’t leave until they say you can, and forced medication, seclusion, and physical restraint are common. And a trip to the state hospital is incredibly disruptive to a person’s life. If you’re single and live alone, as is the case with many who have long-term mental health challenges, during the weeks you’re there, you may lose your job, fall behind on rent and lose your housing, and lose any romantic relationships you may have formed. Your pets may die or be taken away, and if you have kids, they may be taken into the foster care system.

Recall that the peer I described above was threatened with a trip to the state hospital? All this is why. Mental health providers know the problems these facilities create, and they use the fear of them as leverage.

Further, there’s growing evidence that involuntary commitment in residential facilities actually increases suicidality, even when the severity of people’s distress is taken into account.

In other words, a call to 988 may not be preventing a suicide; it may merely be delaying one. And it may make one more likely.

As an alternative to hospitalization, many communities have implemented assisted outpatient treatment (AOT) or assertive community treatment (ACT) programs. But as these Orwellian titles suggest, these schemes merely bring the hospital into the community; they are sentences, not services, as the people involved have no choice but to participate (or the choice is these programs or the state hospital—which isn’t really much of a choice at all). These programs may be less acutely traumatizing, but they are still coercive by nature, and they rely on the “meds first and meds mostly” approach that has been the mainstay of mental health treatment for the past 40 years. The point is to keep you in the community and on your meds—to “stabilize” you and reduce your symptoms—not to foster actual recovery or return you to the driver’s seat of your life’s direction.

I am not saying that 988 is a bad idea; I am saying that it is attached to a set of mental health systems that are fundamentally and philosophically ill-equipped to actually help people (re)gain control over their lives and their life trajectories after a mental health crisis. 988 may appear to solve problems for the worried families and friends of suffering people and to those interested in “cleaning up” the places where people in frequent crisis end up—homeless encampments, shelters, local jails. But it won’t reform the system itself, the very system that has been failing these same suffering people over and over again.

Sunday, May 29, 2022

The Book of Useless Similes


The Book of Useless Similes

As mingle as whale

As dance as cardigan

As drama as sedge

Lucerne like negritude

Immolation like a frankfurter

A tickle like a garbage can

As Helvetica as Norwich

Grackle like tincture

As forest as glimmer

Nuke like tanager

Restless as pao

Gerrymandered like tone deaf

As cuttlefish as dustbunny

As antiquated as iguana

As spiked as notion

As flow as tintype

As boom as purchase

Color like catastrophe

Bean like electron cloud

As theater as marzipan

As Lorelei as rampart

As banana as Ibrahim

A torture like dispensation

Noodle like armature

Release like burrow-owl

Awl like teenager

As orchard as tuna

Dispel like anchorite

Foil like turtledove

Orbit like omicron

Levity like fashionshow

Chow-chow like framework

Tank like harbinger

Naturalize like Waukesha

Titillate like evidence

As crucifix as divertimento

Rally like roadkill

Simper like jargon

As fumarole as switchback

Damage like corn pop

As Pope as wool

As ape as Cornwall

As dent as mote

As random as fizz

As extramarital as ecosphere

As rigid as rhyme

As Grendel as architecture

Wax like lung

Trash like hemisphere

Theory like bantam

Exoskeleton like Eeyore

As grain as noodle

As dark as sphagnum

As deer as ice

As sap as archway

As negative as sheep

As tankard as braincase

As murder as metaphor

As racial as burl

As noticeable as abstract

As cereal as Argonaut

As quince as abbey

As orchard as lamprey

As damage as wrinkle

Mendacious as barbecue

Undercurrent like prioritize

Aluminum as fuck

Dance like midwife

Enter like cheese

Roof like albatross

Essence like goat

Rumble like mountain

Excel like Snodgrass

Empire like larch

Resemble like Enoch

Enable like sassafras

Scandal like toenail

Edge like freedom

Mark like attitude

Darken like analog

As tablet as nature

As circumvent as Mercedes

As righteous as crackle

As duet as earnest

As favored as chicle

As numinous as apple

As effort as cheddar

As music as refuse

As numerous as legislate

As match as wrangle

As tank as tab

As roots as tangle

As masticate as satellite

As matrimony as escarole

Binnacle like marshmallow

Dirty as semaphore

Oceanographical like woodlouse

As silence as foeder

As dingle as damsel

As mandible as follicle

Trash like Hecuba

Mope like calliope

Creche like hinterland

Mind as potting shed

Dredge like nuclear

Crash like ambergris

Reckon like rock tumbler

Fragment like neutralize

Act like oscillate

Divine as doorknob

Flambeaux as rationalize

Timber as lubricated

Vape like singleton

Ask like ethanol

Oil like origin

Titrate like estimable

Grant as famish

As tire as strawberry

motive as cephalopod

tangent as miso

regent as woke

turbid as photoreceptor

reveant as nacho

foolish as stank

metaphorical as oak

staggering as puerile

risible as mud

credence as croquet

dirigible as snowflake

veritable as otters

rigid as consideration

cabbage as fame

similar as nosebleed

tackle like dank

frame like foreskin

crab like Toledo

orange like lapdog

rape as nuclear

tangle like grandiloquence

toodle like ice cream

as fascist as lux

as lurid as matchstick

as crawdad as calcium

as echo as mandible

as credible as pork-pie

as trashy as ileum

as nurture as crème brûlée

as notated as piston-ring

as various as smooth-bore

as paper as crowd

as vapid as lasso

as Dreamsicle as crease

as vegetable as facile

as shell as mark

as marl as dark

as pile as snack

as feral as rich

as rice as rock

as sand as maybe

as meat as joy

as plane as vapor

as wrench as rude

as bark as trash

as wire as sanctified

as wide as warship

as super as promotional

as weave as famous

as shadow as garrulous

as granular as magic

as drive as plastic

as muffin as static

as square as title

as gospel as lye

as quick as candle

as suspension as miracle

as branch as backing

as pincer as lens-cap

as massy as dial-tone

as database as ton

as wreck as headphone

as leather as tendon

as adaptable as mammary

premium as stain

verdant as brand

damnable as coffee

woolen as boys

as salt as abstraction

as melt as lobster

as quail as concentrate

as madrigal as bonesetter

as burble as blurb

as tincture as toast

as silicate as femur

as tummy as ratio

as linger as honey

as peristalsis as rotophone

as member as mouse

as crested as rubber

as tangent as Phocis

as Goethe as grab

as massive as ass

as cytokine as lambic

as neutral as gas

as passion as particle

as moon as noon

as missile as treacle

as terror as tan

as limber as acid

as purple as vision

as languid as linguine

as lungfish as asteroid

as maybe as badger

as pulpit as masticate

as random as roach

as diverse as purse

as famished as pardon

as nascent as dragon

as still as suggestion

as ranch as rein

as rat as rind

as dark as fool

as whet as wine

as tool as mandible

as hawk as heel

as maker as leave

as janky as pain

as matter as mule

as clog as happening

dirt like manservant

franks like astrology

pine like happening

corn like igneous

patch like rattle

frame like verses

bang like batter

time like exegesis

writhe like leases

vapid like vapor

torpor like hangman

biscuit like louver

wrench like tankard

as grass as gross

as murder as dust

as maker as Johnson

as fragile as antfarm

as deciduous as toast

as lingering as Maastricht

as taken as lizard

as fragmentary as star

as ricochet as barbie

as fantasy as nose ring

as guava as chessboard

as laggard as maple

as doggerel as fantasy

as womb as bomb

as wonder as target

 as how as milk

coast like turnip

trouble like marmoset

credible like Range Rover

miscreant as seat

dank as receiver

doctor as limestone

merchant as crossroads

wrangle as memory

timely like Sunday

as master as nutritive

as far-fetched as longitude

as wicked as femur

as coffee as campaign

as walk as stopwatch

as tease as tarsal

as vapid as electrolyte

as tensile as harbinger

as treacle as Dorchester

as pean as fiction

dirt like lacquer

as flake as floe

as rasher as shoe

as rose as marzipan

as ester as fine

as roll as hope

as axe as timekeeping

as rushed as ramps

as terror as marshmallow

as tincture as atavism

as whorl as donkey

as black-hole as baby

as divot as doubt

as fidget as fade

as pancake as vapid

as cocktail as simian

as refracted as dissidence

as magic as granular

as pyre as people

as fool as need

as drip as fashion

as dig as skin tag

as callous as kerning

as boil as brute

as whole as mingle

as scotch as blanket

as fragment as tease

as muscle as fedora

as wish as wisdom

as madam as fame

as glad as gland

as picture as funnel

as hammock as funeral

as Bambi as Manhattan

 as yank as yes

as motor as murder

as peace as pie

as neutral as sentence

as if as ask

as meat as nurse

as neat as further

as dream as dropsy

as distant as Steve

as linger as permanent

as mass as carpet

as dingo as Django

as barter as fate

as raucous as mimsy

as wimple as neutron

as sandy as crayon

as maple as rambunctious

as facile as dude

as Lamord as Wasatch

file like massacre

ring like turpentine

assimilate like orange juice

asymptote like fumble

tribulate like Donkey Kong

revert like sincerity

recapitulate like Maybelline

tender like two-dimensional

effort like cheese

endoscope like leviathan

femur like fumarole

tankard like Disneyland

scintillate like flex

deviate like underwear

pimple like hazelnut

twaddle like Rosemarie

phantom like tin

loom like lumberjack

tease like Tuesday

purchase as windpower

zip as holeshot

sample as “Free Bird”

wander as mush

banter as Matterhorn

butter as bachelor

doula as Montana

value as Rigel

sizzle as rot

as rat as umbrage

as feasted as brow

as moon as murder

as plastic as power

as deft as donut

as bourgeois as rust

as ramshackle as trident

as dark as stopper

as chopped as cheese

as classy as membrane

as ransom as stoat

as burdened as flour

as fancy as lodestone

as ripped as rimmer

as tangled as twist

as binge as Labrador

as fight as mansion

as glass as Benjamin


Sunday, January 9, 2022

Against “Against Trauma”*

 by Lael Ewy

*The cover headline of the issue of Harper’s describing the essay discussed here.

All writing about mental health is, at least implicitly, a meditation on what the author thinks about her own. This is easy to see in the all-too-common-these-days semi-autobiographical novel. History bears out Esther Greenwood’s warning at the end of The Bell Jar that it may descend again, as, indeed, it did for Sylvia Plath. Joanne Greenberg’s mental health was relatively stable the rest of her life; the treatment Deborah Blau, Greenberg’s stand-in character, received in I Never Promised You a Rose Garden seemed to have worked. From the worlds of short fiction and poetry, there is Poe, whose work seems to be a denial of madness, a set of rational explanations for seemingly irrational acts, a (re)claiming of the very nature of interiority. Likewise, Dickinson, Lowell, Sexton, Roethke, and Plath (again) used poetry to posit their own experiences of madness not as incomprehensible but as a different, often higher, form of reasoning.

Examples from the world of literature are somewhat obvious; clinical, academic, and popular writing on madness, perhaps ironically, take a bit more to unpack.

By its definition in both common parlance and in the DSM, madness equals disorder. According to the clinical view, it is impossible to make sense of the content of madness because its content inherently makes no sense. The DSM uses medical terms such as symptomatology, remission, sequelae, prognosis, and diagnosis interchangeably with common terms like issues and factors to build a framework outside of the content of internal experiences it deems problematic. It mentions such things as persecutory paranoia, voice-hearing, sadness, and so forth briefly and through generalizations, only delving deeply enough so that these things can be identified and categorized and then allocated to places within the edifice of dysfunction, disorder, and disease. So committed is psychiatry to this experience-denying structure that it even ascribes the term “disorder” unironically to behavior that is defined by nothing other than order, namely obsessive-compulsive disorder, a contradiction on its face.

As someone who has used these behaviors in the past (You didn’t think I’d spare myself this essay’s opening notion, did you?), I can tell you that obsessions and compulsions are attempts to create order in a life, perhaps in a universe, that seems out of order, an attempt to regain control when things seem to be flying rapidly out of it, an overcompensation after a breakdown. It was terrible to go through and hard on those around me, but it served a purpose, one psychiatry and most of psychology could, by their natures, literally never understand. In their eyes, it was –I was—merely dys/dis, and for people who come to the psy-professions seeking help solving their personal problems instead of mere “treatment,” it’s hard not to feel dissed.

Clinical, academic, and popular approaches are, really, about othering experiences of extreme states of mind, denying those who experience them a right to their own stories. Those who write form these perspectives can safely distance themselves from the psychological toxin; they can convince themselves that, sufficiently dys/dissed, these experiences of extreme states of mind and overwhelming emotion in no way apply to themselves.

From my perspective not only as an English teacher, writer, and a lover of literature but also as a person with lived experience of some of these states of mind and feeling, it would have been much more useful to have been prescribed WB Yeats to deal with my issues in the ‘90s than Prozac. (In the end, I rejected Prozac in favor of Yeats by returning to school to study creative writing—something that a middle-class White male with private insurance could more easily get away with then.)

This brings me to Will Self’s “A Posthumous Shock: how Everything Became Trauma,” which appears in the December 2021 issue of Harper’s. If madness and literary writing about it are attempts at sensemaking; and clinical, academic, and popular approaches are attempts to deny extreme states of mind and emotion a right to make sense; Self’s essay seems to be an attempt to unmake the sense of trauma, which I am going to treat here alongside madness, as another example of an extremity played out in how we think, feel, and act.

Self begins with “Reassure me it’s like this for you too: you experience the unexpected—a psychic shock, a physical blow, a realization so disagreeable it sets you reeling—yet even as this event takes place in all its random spontaneity, it’s shadowed by the the thought: I should’ve anticipated it.” By doing this, he performs a bit of emotional ju-jitsu, pulling the reader into his perspective by calling on our help—we need to “reassure” the poor writer that our experiences are like his. He calls upon our kinder, better natures to help him, But then he describes the situation as “disagreeable.’ Really? This is how he wants us to help him think about trauma? The rest of the sentence uses terms we do associate with trauma, though: “psychic shock,” “a physical blow,” “sets you reeling.” As Self draws you in, asking for your empathy—begging for it, in fact—he simultaneously belittles the experience as “disagreeable.”

This is not a meditation on trauma we’re about to read; this is gaslighting.

Self’s essay continues in this vein:

I’m asking you, the reader, to identify with me at the outset. Not, I hasten to add, because I require your empathy for ethical reasons. It is easy to sleep in another man’s wound, as the old Irish proverb has it, and the discourses surrounding trauma all too easily default to this position at the individual level, while at the collective one they all too often raise their explanatory edifices on the high moral ground of other people’s suffering. No, I require your empathy in the strict sense: I want you to locate that response to even a mild shock securely in your own being.

“Mild shock”? As if trauma is even on the same scale.

He then goes on to claim to be writing this essay in order to understand “how” (emphasis his) trauma has “come to occupy” an “enormous role” in our lives, in our perspectives of the world.

He does nothing of the sort. Instead, Self moves to the DSM definition of PTSD—post-traumatic stress disorder—since doing so allows him to focus on the “post,” what we make of our experiences after we experience them, and thereby to dismiss most actual contemporary approaches to trauma, which are much more based on the Adverse Childhood Experiences (ACEs) study and the research it engendered than on anything else.

In fact, Self never mentions the ACEs study at all. It’s possible he’s never heard of it or didn’t bother to research it, but it’s also likely, since his essay mentions everyone from Dickens to Bessel van der Kolk, that he studiously ignores it since it shows overwhelming evidence against his point-of-view.

We’ll get to that point-of-view later. In the meantime, we have to address the problem of using the DSM, and the definition of trauma it implies, as a foundation, since, as noted above, it elides the meaning traumatic events have to the individual. To its credit, the DSM definition does include “marked physiological reactions” but then goes on to relegate these reactions to “internal or external cues that symbolize or resemble an aspect of the traumatic event.” For traumatized people, and I count myself as one, what the DSM is clumsily trying to describe here is what we commonly call a trigger. This word, like so many in the mental health realm, has been abused: a trigger isn’t just anything a person finds annoying—or, as Self might put it, “disagreeable.” It isn’t, as the DSM contends, merely “symbolic,” nor does it just “resemble” something traumatic; rather, it causes, for whatever reason, a physiological reaction to a perceived existential threat. When you’re triggered, you’re actually, not symbolically, reacting: you’re not being bothered by something “disagreeable”; you’re quite literally ready to fight, freeze, or flee

And that is the problem with both Self’s dismissive approach and the DSM’s inaccurate one: you can’t possibly understand it completely unless you’ve experienced it. It’s obvious from Self’s description early in his essay and from the DSM description that neither were written by anyone who has experienced what trauma is really like, and Self, by doing this, commits the very thing he accuses others of: occupying the moral high ground of other people’s suffering, claiming implicitly that he can define it when he really cannot.

Far from being in the past, trauma is very much in the present. Rather than a wound, trauma is a survival mechanism. Rather than, as van der Kolk contends, “the body keeps the score,” for the traumatized person, the trauma is the score played by the interaction between the self and survival.

Will Self goes on, immediately after the passage critiqued above, to claim to commit “heresy” by denying that trauma is physiological, contending that it is a function of Modernity that does not seem to be present in ancient literature. He then continues, claiming that, in contrast, schizophrenia is physiological, or at least ancient, since something like it is described in Western literature throughout time. There is very little evidence that schizophrenia is purely physiological, though, or even that the cluster of thoughts and behaviors associated with it in the DSM have much value as indicative of a single diagnosis, as Thomas Insel himself noted before he stepped down from his leadership of NIMH. (Notably, he later lamented that the “decade of the brain” research paradigm failed to produce much of therapeutic use at all.) Further, since many substances and conditions (everything from lack of sleep to corn smut) can create the same set of thoughts and behaviors we associate with schizophrenia, it’s difficult, if not impossible, to say what caused ancient accounts of this phenomenon.

The physiological underpinnings of trauma are not merely better founded than that of schizophrenia and other DSM diagnoses, they’re more clear: the aforementioned ACEs study showed an incredibly strong correlation between adverse childhood experiences and health problems later in life, and the role of such somatic substances as cortisol and adrenaline are much more closely related to fight-flight-freeze responses than dopamine is to schizophrenia or serotonin to depression.

Self should have mentioned this had he been approaching the subject responsibly. Instead, he picks on van der Kolk’s fMRI brain scans and the deconstructive literary criticism of Cathy Caruth, which, he later reveals, in lashing out at Jacques Derrida, that he fears as a threat to Western civilization and all its purported goods. This is ironic because, he claims, deconstruction is “wholly destructive of the Western Logos” and “absurd not only philosophically but morally as well,” as if denying the physiological reality of trauma, which affects millions of people, when he has ignored its best research, is somehow morally sound.

Self’s arguments here are hardly a case for why, or rather “how,” in Self’s parlance, trauma somehow took over the world. I worked for seven years in a role that often had me trying to help individuals and organizations become more trauma-informed, and I can tell you for sure that Cathy Caruth and Jacques Derrida never came up. Bessel van der Kolk’s 2014 book on trauma was mentioned occasionally, generally by social workers and a handful of psychologists, but it rarely factored in to actual practice. Far more useful, and a huge moral leap for most mental health services agencies, were the principles of trauma-informed care developed by the federal Substance Abuse and Mental Health Services Administration, which include such threats to the “Western Logos” as providing “empowerment, voice, and choice,” “collaboration and mutuality,” and respect for people’s sexual orientation and gender identity. (For the record, Bruce Perry’s neurosequential model was found to be more useful for those dealing with traumatized children, since it de-emphasizes talk-based therapy, which is generally less effective for children.)

If we were to take Self’s denial of trauma as both a physiological reality and a psychological state (Self denies that anything can be both) seriously and try to put them into practice, it would be a moral catastrophe, doing immensely more damage to traumatized people than our systems currently do, and far more damage than literary theorists have ever done. Simple acts such as creating opportunities for physical activity, breathwork, and having water available (as water is known to help metabolize cortisol) wouldn’t make sense under a Selfian trauma paradigm, and we would lose some of the easiest and most widely acceptable ways of accommodating trauma reactions.

Self’s critique of van der Kolk continues with the latter’s citation of Sophocles’s Ajax as useful for soldiers dealing with diagnoses of PTSD. Self dismisses this citation by contending that the play is “actually about the universal predicament of the human psyche balletically poised between fate and freedom,” and that “Ajax is a perpetrator rather than an innocent victim.” But the moral universe Self likes to invoke cannot so easily be divided between the innocent and the guilty, the perpetrators and the victims—an error, not incidentally, that Sophocles himself never would make. Further, Self here uses Modern notions of the psyche to describe what he claims to be a universal phenomenon, another example of making the exact mistake he claims others make, in this case, claiming the universality of trauma, which he contends is a Modern idea. Self goes on to sarcastically praise van der Kolk’s “exemplary patriotism” for not judging veterans for having participated in “wars undertaken since September 11 [that] have pitted overwhelming firepower against lightly-armed guerrilla forces.”

There’s a lot to unpack here, but we’ll start with the reality of the “stagings” of Ajax to which Self refers, claiming that this “perpetrator-friendly approach might appeal to the US military.” The project is called Theater of War, and it uses not just Ajax but other Greek tragedies as well. The plays are rarely, if ever, staged as such; they are informal reader’s theater-style performances, with town-hall-style question-and-answer sessions afterward. This reduces the sense of performance and increases the ability of those in the audience to process the play; it’s catharsis made manifest instead of implied in the work.

It never seems to occur to Self, though, that a veteran’s interpretation of Ajax might differ from his own, given that they have actually gone to war instead of just read about Charles Dickens’s reaction to a train crash. (More about that later.) Self commits the same fault, in this case, that White audiences of Raisin in the Sun did after its initial run, interpreting specific experiences of specific people as being necessarily universal. Early on, the producers of Theater of War noted that when Sophocles’s play was first staged, most, if not all, of those in the audience would have had lived through the realities of war, either as soldiers or as civilians at a time when war was literally much closer at hand.

Further, Self implies that the military somehow sanctions these performances. Theater of War is an independent organization, which has since branched out to use Greek tragedies to address other social issues as well, such as intimate partner violence and racial inequality. Notably, the early performances were aimed at veterans, not necessarily active-duty soldiers. And there is nothing about the performances that suggests absolution for the guilt that comes with having actively participated in war; rather, they are, to return to a theme, methods of sensemaking, of trying to get a handle on what happened “over there.”

Having worked with a veteran who took in one of these performances, I can say they do, in a very practical way, help people deal with what has come to be known as moral injury, another term Self fails to use, and, perhaps studiously ignores, as it would be hard to accuse all soldiers of being “perpetrators” of evil otherwise. The idea of moral injury is that being a soldier harms the soldier as well as anyone else caught up in the conflict. Rather than all being jolly killers happy to enlist in the ugly end of yet another example of American imperialism, most people who signed up to fight after 9-11 had a genuine, if misguided, sense of patriotism: they really believed they were on a mission to rid the world of terrorism. That they found themselves part of Dick Cheney’s cynical imperial project was only apparent to some of them later, when they were actually doing the fighting, a fact that only added to the moral injury they experienced. Sure, some of them were and remained terrible people, joining militias when they got back and joining the ranks of Trump’s irregulars. But most did not, opting instead to work for the greater good and to improve the lives of those around them. As the veteran I worked with, who was studying to become a social worker, put it: “I want to save at least as many people as I took out.”

To not be moved by this sentiment is to be without a soul, and as much as Self tries to constantly reclaim the moral high ground in his essay, to dismiss the experiences of the veterans of America’s forever wars as “perpetrators” suggests he doesn’t bring his to bear. These wars have been pointless and horrible, but to equate all the people doing the dirty work of a jacked-up US foreign policy with Cheney, Bush, and Rumsfeld, none of whom Self mentions, shows little understanding of morality at all and none of the empathy Self insists, at the outset, we reserve for him.

The term “guerrilla” better describes the scrappy anti-imperialist fighters of the Cold War than those faced by American troops in Iraq or Afghanistan. The Taliban and the Iraqi forces were the established powers in these nations when we invaded, and even al Qaeda had deep pockets and strong connections to Saudi power and wealth. Certainly, those forces were hopelessly outgunned, and their foot soldiers were in much the same positions as ours, but their overall aims were also imperial or, in the case of Saddam Hussein, neo-fascist. Need we remind Self how the Taliban treated women and all those it deemed insufficiently pious, or how Hussein treated his political enemies? Freedom-fighters they were not. We would have to look to the Kurds or the Yazidis to find Self’s guerrillas these days.

In Self’s desperation to deny that trauma is anything more than an invention of “disagreeable” Modernity, he assumes that Ajax is a depiction of trauma instead of a reaction to it, a recapitulation instead of sensemaking, a fallacy he commits throughout. That gets us back to Dickens, who Self quotes recounting a train wreck from which Dickens escapes unharmed: “But in writing these scanty words of recollection I feel the shake and am obliged to stop.” In quoting so, Self equates “the shakes,” or, as we might say today, being shaken up, with being traumatized. Dickens, who, it should be noted, had a flair for the dramatic, was suffering the same thing one experiences after a mild fender-bender: a rush of adrenaline, a cold sweat, quaking as the chemicals the body uses to address a threat move through the system and are metabolized out. We might recall this incident with similar responses for a week or two, maybe a month. Soon enough, though, we’re driving again, but maybe now with a bit more care.

Trauma is an order of magnitude more severe. In my case, the trauma I survived happened in a medical setting when I was five. Certain sights and smells, such as rubbing alcohol or hypodermic needles, still elicit a physical response over 40 years later. I cannot stop the response, but over time, I have learned to temper my reaction to it. When I encounter these triggers unexpectedly, my body tells me to flee, with my whole gait changing, my feet stopping mid-stride, though it would take a careful observer to see anything amiss. The veteran I worked with was unable to enter alone large buildings such as big-box stores because of an incident in Iraq in what he referred to as “the cement factory.” Self, for his part, follows up the Dickens quote with an excursion into the memory and Freud, and the idea that “the form that memory might take was framed in terms of metaphors derived from the emergent technologies of the era.” Rather than being any kind of insight into the nature of trauma, this is a fairly mundane reality of sensemaking: of course we do that; everyone does that. That is how culture works. That is how sensemaking works.

Rather than observing the birth of trauma at the birth of Modernity, Self merely recognizes how the people at the time made sense of what was already there. We do this with cognition as well: Plato has Socrates using the terms of caves and torches, shackles and sunlight—the available images. In the 20th Century we used light bulbs and electricity; in the 21st we use terms like processing and bandwidth.

In this light, it should be no surprise at all that Sophocles might describe the trauma of war differently than Freud did or than does the DSM. But if Self wants to see Sophocles tackle trauma and its impact on the psyche, he need look no further than Antigone, whose behavior after the loss of her brothers (in war, no less) aligns rather well with unaddressed grief: the inability to go forward until mourning can be properly done, the devaluation of her own life (so-called “survivor’s guilt”), acting out against authorities that want to control and contain her behavior. Compounding matters, as a woman in ancient Greek culture, Antigone’s life would have been closely tied to her male relations—her brothers, her uncle, and her betrothed—two of whom are taken from her by the intransigence and lack of empathy of the fourth. Sylvia Plath, also, addresses unprocessed grief in The Bell Jar and in “Daddy,” noting in the former, through Esther Greenwood, that she had not been truly happy in the intervening years since her father’s death, whose passing her mother did not let her mourn, an ancient/Modern connection that may have been illuminating had Self bothered to expand his scope.

A cross-cultural lens is instructive here, one Self fails to acknowledge is at work in his treatment of Ajax. We are not ancient Greeks, after all, even though we can see some similarities in how we think and feel. When international NGOs descended on Indonesia after a tsunami destroyed local fishing villages in 2003, they insisted in bringing a Western approach to the trauma the locals must have felt, treating it as PTSD. The fishermen insisted they needed to rebuild their boats and nets. They have their own way of dealing with trauma; that does not make the trauma not real for them. In fact, physical activity is known to be healing, an aspect of trauma treatment no drug, talk-therapy, or Will Self essay can ever meet. I know this from experience as well: pacing, walking, running, over the course of years, trying to work through the constant tension of my traumatic past, often doing this while I was watching the medical dramas of the ‘80s that also triggered me, slowly deprogramming my body’s responses through physical action, an ad hoc aversion therapy.

By denying that trauma is physiological and that it existed before Modernity, Self reimposes a dualism that predates Descartes but that, through him, has dominated Western thought far more completely than trauma theory ever has. We still use—and I use here—terms such as mental health in contradistinction to physical health. We say we want to treat mental health problems the same way we treat physical health problems, but then we work to understand physical ailments as part of the sociological and evolutionary forces impacting the human condition, all while denying the same to mental health. At the same time that somatic medicine recognizes that heart disease, hypertension, and diabetes can be related to stress, the DSM denies that general anxiety is related to stress at all, and insists, despite little evidence, that bipolar and schizophrenia are largely genetic. Even as we increasingly understand how the gut and the brain relate, we still speak of the “hard problem” of the mind versus the brain.

All of the prevailing good evidence points to a collapse of duality, not that the psychological is all immaterial, nor that it’s all biological, but that these experiences and states are always both/and, that our experiences have biological impacts and that those impacts influence how we think and feel. Indeed, traumatogenic explanations, including their physiological components, are much better at both explaining and predicting extreme states of mind and emotion than the framework of the DSM. Further, we can change our psychology and our physical reactions through what we think and through the meanings we ascribe to experiences, through our intentions, our relationships, and our connections. We do this every day when we learn, exercise, meditate, socialize, and engage with art.

Eastern philosophy has long recognized this lack of duality, and with no loss of moral reasoning. If the duality Self (re)posits for the sake of trauma really does reach the heart of the Western Logos, and the Western Logos fails to make meaning out of trauma, maybe it is about time we destroyed it.

It’s hard to say, in the end, what Self’s real intentions are, but his essay suggests he is angry at trauma theorists for presenting him with perspectives that conflict with his notion of a sound and ordered universe. Separating the psychological from the physical keeps things clean, clearly dividing the nasty realities of abuse, violence, cruelty, physical injury, tragedy, and misfortune from the ethereal reaches of the mind. It’s a world Self may want to live in, but it’s not the one we have, and dismissing it dismisses the experiences of literally millions of suffering people. There is nothing in Self’s essay for them.

Or maybe Will Self is just an asshole, begging for his readers’ empathy while being utterly unable to empathize with those whose lived experiences go anything beyond the merely “disagreeable.”