Mental(izing) Health
Have you noticed the emerging backlash about trauma? Maybe something good can come out of this, helping us to clarify the construct that remains so contentious both inside and outside of the mental health profession. However, the search to secure middle ground seems tenuous as trauma skeptics have begun to line up against the advocates. The clamoring of the advocates of trauma—especially visible across social media sites—can be traced to the extraordinary and ongoing success of Bessel van der Kolk’s The Body Keeps the Score.[i] His argument that trauma is stored separately in memory from other memories and exists in the form of “body memory” has been widely embraced, both as an unfolding theory and as a direction for new forms of practice.
The skeptics who have emerged are worried about how trauma has been applied too loosely and how it contributes to unfortunate tendencies in our culture, like people relishing identities as victims. In this newsletter, I will mainly assess the efforts of skeptics to question the meaning and value of the term trauma in three pieces in the media:
1) “Hey American, Grow Up” by David Brooks in the New York Times (8/10/23): https://www.nytimes.com/2023/08/10/opinion/trauma-mental-health-culture-war.html
2) “Tell Me Why It Hurts: How Bessel van der Kolk’s once controversial theory of trauma became the dominant way we make sense of our lives” by Danielle Carr in New York Magazine (7/30/23): https://nymag.com/intelligencer/article/trauma-bessel-van-der-kolk-the-body-keeps-the-score-profile.html
3) “The Case Against the Trauma Plot” by Parul Sehgal in the New Yorker (12/27/21): https://www.newyorker.com/magazine/2022/01/03/the-case-against-the-trauma-plot
These articles have been widely circulated across list-servs, so you might well have seen them. Viewed together, they cover a lot of ground, making arguments that I find both cogent and dubious.
Although it almost seems unfair to heap more criticism on David Brooks in the aftermath of his embarrassing tweet about spending $78 at an airport restaurant (https://www.washingtonpost.com/food/2023/09/22/david-brooks-newark-airport-meal/), his piece happens to be the most polemical (and leans on the arguments made in the other two articles). In blaming the nebulous boogeyman “therapeutic culture” for why young people derive their self-worth from subjective feelings, rather than in the past from a moral order, which he suggests is from God or from being winners commercially (It’s strange to put God and capitalism on the same footing, but let’s ignore that here). Brooks labels young people who manifest this new trend as “fragile narcissists,” and he links this to the profusion of a mental health crisis that has been documented since around 2010. Young people are happy to endorse being anxious, depressed and/or traumatized.
At this point, neo-liberal shrillness begins to take over Brooks’ argument, as the fragility which he discerns is linked to “safetyism,” the hyper-concern with remaining secure from others who might be hurtful. His examples of safetyism are trigger warnings, safe spaces and microaggressions. The implication that microaggressions are a recent phenomenon is a grossly insensitive appraisal about race in America and speaks volumes about how far-removed Brooks must be from the daily lives and experiences of African Americans. The fact that microaggressions has become more widely embraced as a term does not mean that the phenomenon it describes did not previously exist.[ii]
Brooks’ argument rehashes Lukianoff and Haidt‘s book, The Coddling of the American Mind, which I discussed in a previous newsletter (https://elliot4cc.substack.com/p/mentalizing-health-2cd). He summarizes their main findings and concludes that there is a crisis in our culture around “maturity.” Maturity is invoked without any effort to define the term, to wonder if it might function in different ways for different people, or even to consider how maturity might represent a site of conflict as well as disagreement. Beyond the vagueness of maturity, Brooks compounds the issue by making the specific claim that the “therapeutic ethos” is responsible for people being cut off from “the moral order.” Brooks seems to be unaware of how the so-called therapeutic ethos has warmed considerably to spirituality and religion in recent years. There is also a Nietzschean argument to consider: that the moral order of “good vs. evil,” especially in its Christian incarnation, has always been organized around the appeal of victimhood and trauma.
Brooks dangles the notion of a moral order that promotes maturity as an inherent good, suggesting that we have lost touch with it. But shouldn’t he try to inquire how it could be possible for people to embrace a moral order that they may no longer believe in? Should we pretend to believe in it? Brooks’ argument does not pause to consider the possibility that living without a moral order, as it formerly existed, is a choice that can be both challenging and honorable.
Brooks’ argument becomes even more problematic when he proposes giving up “therapeutic culture” in order to help people feel connected and attached to others. The guy does not understand much about therapy: claiming that therapists encourage patients to care about themselves at the expense of others is a crude and unfortunate caricature. What an injustice to therapists whose everyday work is about helping patients to become invested in being responsible for themselves and their relationships to others. Therapists should take note and be prepared to respond to an attack like this, especially given that it is coming from one of the nation’s most prominent pundits.
Danielle Carr’s piece on the cover of New York magazine is more probing about trauma itself and more subtle in the way she portrays how that construct has become ubiquitous. Her article centers on her extended interviews with van der Kolk: presenting his argument about trauma, along with the controversies that have occurred throughout his career (like that Harvard took the step of intervening to vet his publications, like the accusation he had created a hostile work environment and thus was fired from the Trauma Center he founded). Carr seeks to present a balanced view, which is informative about van der Kolk’s history and work, coming from the new left and the anti-psychiatry movement, and helps us to appreciate his career-long, passionate effort to understand and treat trauma. Carr does raise questions about van der Kolk’s character, where he is shown to be moody and occasionally as a Horney-esque “moving-against” type.
Carr regards the success of van der Kolk’s understanding of trauma as integrating two completely different, competing strands: the neurobiological reductionism put forth by biological psychiatrists, for whom trauma was a literal state of the body, with the concerns from activist veteran groups, for whom trauma was a manifestation of social and political violence. Through his work with Judith Herman, van der Kolk came to affirm parallels between combat and rape victims and to appreciate the importance of the diagnosis of complex trauma, not just PTSD.
Trauma, according to van der Kolk as reported by Carr, “is stored as changes in the body’s biological stress response, and the stress hormones released by a traumatic experience can cause chronic hyperarousal while making it less likely that the event will be stored in the ‘declarative’ memory system; instead, the event is stored as fragmentary images or physiological sensations in the ‘somatic’ memory system, which traps the traumatized person into continually reliving it.” Trying to access and treat trauma requires that we recognize how trauma is stored in memory and seek fitting therapies. Van der Kolk has turned to EMDR, somatic experiencing, and psychodrama, but Carr is not convinced that these treatment approaches render talk therapy to be no longer relevant.
Before the publication of his book, van der Kolk focused his attention of promoting “developmental trauma disorder” as a new diagnosis to be included in the DSM (which failed). Carr sees this as a crucial turn, as she links the notion of traumas from early attachment failures to opening the door to viewing them as chronic, not just acute, and thus more widely applicable. Trauma from a car accident is an objective event in a way that trauma from a history of neglect is subjective; so, as Carr avers, anyone can claim to have the chronic form of trauma. Carr is concerned about what she terms “trauma literalism,” invoking trauma an easy way to understand yourself using authoritative language, which has spread politically from its original source on the left to the right.
I like the idea of trauma literalism, as it captures how trauma has been simplified and elevated to have a prized role in public discourse. I do not agree with Carr in her assessment of blaming chronic trauma from early development issues without also acknowledging how it has served to help people understand and face the truth of their suffering in the present. The fact that some people might desire to find trauma in their history should not obscure that relational trauma is real and damaging, and that it benefits from establishing a trusting relationship with a therapist. Being able to mentalize trauma means that epistemic trust has been strengthened or restored, a basis for becoming less isolated.
Ironically, Carr herself seems misled by trauma literalism in portraying acute trauma as real and chronic trauma as suspect. Relational trauma, as Freud realized, is challenging precisely because it is so complex—there and not there, often evoked by later provocation. It is also true that we have learned more from research about the consequences of adverse childhood experiences and can hope that assessment tools will improve our understanding of complex trauma and PTSD (https://www.cdc.gov/violenceprevention/aces/index.html).
Carr follows van der Kolk around at a weekend retreat, and while she does not disparage his theory of trauma, she does seem hesitant about its link to practice, and unconvinced of the efficacy of the treatments themselves. In a telling exchange between them, van der Kolk distances himself from people who expect to be miraculously cured of trauma. Nevertheless, from Carr’s perspective, van der Kolk has unleashed a tsunami that has produced a seductive, overgeneralized way for us to understand ourselves. From my perspective, it is justified to worry about the overinflation of trauma, but in doing so, we should not inadvertently invalidate the experience of survivors of relational trauma.
Parul Sehgal’s article in the New Yorker, the first of the three articles to be published, does not seek to blame therapeutic culture; nor does she intend to question the experience of trauma survivors. She does ask us to face how the vast expansion of what is traumatic means that many more people, and people with different symptoms, can have the same (PTSD) diagnosis. She’s not a fan of the idea that modern life has become traumatic. In elevating the status of being a victim, our stories about ourselves have become totalizing, one-note explanations, where the backstory must be traced to trauma. Sehgal demonstrates this with several examples from fiction and film, like Ted Lasso.
In contrast, Sehgal suggests that in the past writers like Virginia Woolf recognized the power of uncertainty and partial knowledge, thereby stimulating our curiosity about characters, resisting automatic convergence on a single value of meaning, like trauma. Sehgal celebrates Shakespeare’s use of “strategic opacity” to ensure that his characters remain complex. She pulls no punches in concluding that the trauma plot “flattens, distorts, reduces character to symptom, and, in turn, instructs and insists upon its moral authority.” It would be hard to dispute the subtlety of character in great works of literature, but it is not obvious to me that trauma cannot be represented in complex ways.
The film Oppenheimer deals with the main character’s trauma at creating a weapon that killed many people (not just soldiers), but this is not traced back to his childhood, and there is room for portraying him as conflicted and overwhelmed—as egotistical, but as capable of post-traumatic growth in his recognition of the danger that weapons of mass destruction represent. I am currently reading Ariel Dorfman’s novel, The Suicide Museum, in which a character of the same name as the author, is traumatized by the death of Salvador Allende, the president of Chile, and the story weaves in and out of how this has continued to impact his life and how he understands himself.
As a conclusion to my reflection on the three pieces, I want to draw attention to Brooks’ claim that the discourse of victimhood arises once the moral order is displaced, whereas Carr and Sehgal are inclined to see the discourse as a new kind of moral order, one that is limiting in terms of how we see ourselves. Neither Carr nor Sehgal are nostalgic about the past. They are dismayed about how tempting it has become to appeal to trauma as a full and optimal explanation. It would be hard to dispute how prevalent trauma has become. On the one hand, I see this as a positive insofar as it means that more people are amenable to receiving help from therapists. On the other hand, I do see how trauma can occlude our understanding, if it is used as the only justified way of putting suffering into words. The middle ground exists, but it is in jeopardy in the crossfire between the advocates and the skeptics.
[i] B. Van der Kolk (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking.
[ii] The term “microaggression” was coined by Chester M. Pierce, a psychiatrist, in 1970, but has been given fresh meaning and wide circulation by Derald Wing Sue. See Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., & Esquilin, M. (2007). Racial Microaggressions in Everyday Life: Implications for Clinical Practice. American Psychologist, 62, 271– 286.