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.”
