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.”