Trauma Nation

Trauma psychology dominates the American psyche, even as it exacerbates trauma.

Posted Jul 07, 2017

It is now customary for every addiction and psychology treatment program—even those claiming to be CBT—to advertise that they deal with trauma. Trauma is the psychology/therapy wave of the moment, resembling the psychoanalysis craze of the 1950s-60s, with some key similarities, but the trauma meme is much more widespread in the culture.

Thus it is fascinating to see that a well-placed—and well-heeled—group of psychologists, led by one of America's leading psychological figures, Martin Seligman, have taken on this meme. Only, despite their prominence and distinguished pedigree (Seligman pioneered learned helplessness), they will have no impact on the trauma template. Nor does it seem that they particularly intend to, perched within a protected academic niche at Penn.

Seligman is the Director of the Penn Positive Psychology Center. The advent of this blogpost is his announcement: "The main purpose of emotions is to guide future behavior and moral judgments, according to researchers in a new field called prospective psychology."

This research makes clear that:

While most people tend to be optimistic, those suffering from depression and anxiety have a bleak view of the future—and that in fact seems to be the chief cause of their problems, not their past traumas nor their view of the present. While traumas do have a lasting impact, most people actually emerge stronger afterward. Others continue struggling because they over-predict failure and rejection.

Trauma therapy is built on the misguided assumption, promoted by Freudian psychoanalysis, that the primary goal of psychology is to bring to the fore repressed childhood memories of trauma. This has been expanded to the idea that confronting and dealing with unpleasant, negative, or disastrous events head on is essential to mental health.

Witness two examples of this principle:

Disaster psychology processing.  It is now pro forma to bring in a corps of therapists and counselors whenever a major tragedy or disaster occurs in order to allow people to "process" the shock they experienced. However, no research finds this to contribute to a group's mental health outcomes, and rather the impact of such interventions is more often negative:

"People who received psychological debriefing exhibited more severe symptoms of post-traumatic stress disorder than controls; the intervention increased the risk of the stress disorder, and critical incident stress debriefing, in particular, was potentially harmful."

PSTD.  Sebastian Junger (a war journalist who himself confronted post-battlefield panic attacks) has done a comprehensive review of the literature on PTSD. Time and again, the research finds, the severity of PTSD is unrelated to stress experienced on the battlefield:

  • "there is no statistical relationship between suicide and combat, according to a study published in April in the Journal of the American Medical Association Psychiatry."
  • "[D]uring the 1973 Yom Kippur War, when Israel was invaded simultaneously by Egypt and Syria, rear-base troops in the Israeli military had psychological breakdowns at three times the rate of elite frontline troops, relative to their casualties."
  • "decade after decade and war after war, American combat deaths have dropped steadily while trauma and disability claims have continued to rise ... in an almost inverse relationship with each other."

Meanwhile, soldiers overwhelmingly recover from it (note the similarity of Junger's analysis to Seligman's):

Terrible as such experiences are, however, roughly 80 percent of people exposed to them eventually recover, according to a 2008 study in the Journal of Behavioral Medicine. If one considers the extreme hardship and violence of our pre-history, it makes sense that humans are able to sustain enormous psychic damage and continue functioning; otherwise our species would have died out long ago. “It is possible that our common generalized anxiety disorders are the evolutionary legacy of a world in which mild recurring fear was adaptive,” writes anthropologist and neuroscientist Melvin Konner, in a collection called Understanding Trauma. “Stress is the essence of evolution by natural selection and close to the essence of life itself.”

The benefits of disaster.  Is it possible that such experiences have benefits? Why are people nostalgic for war experiences that they survive? "What all these people seem to miss isn’t danger or loss, per se, but the closeness and cooperation that danger and loss often engender. Humans evolved to survive in extremely harsh environments, and our capacity for cooperation and sharing clearly helped us do that." 

Junger proceeds:

And the war that is missed doesn’t even have to be a shooting war: “I am a survivor of the AIDS epidemic,” a man wrote on the comment board of an online talk I gave about war. “Now that AIDS is no longer a death sentence, I must admit that I miss those days of extreme brotherhood … which led to deep emotions and understandings that are above anything I have felt since the plague years.”

What is going on? People confront unpleasant experiences in their own ways, often involving avoidance and slow assimilation, but proceed principally to take whatever possible steps they can to avoid future such misery. Per Seligman (and John Tierney):

The brain’s long-term memory has often been compared to an archive, but that’s not its primary purpose. Instead of faithfully recording the past, it keeps rewriting history. Recalling an event in a new context can lead to new information being inserted in the memory. Coaching of eyewitnesses can cause people to reconstruct their memory so that no trace of the original is left.

The fluidity of memory may seem like a defect, especially to a jury, but it serves a larger purpose. It’s a feature, not a bug, because the point of memory is to improve our ability to face the present and the future. To exploit the past, we metabolize it by extracting and recombining relevant information to fit novel situations.

What should we do? This forward planning is a process to be encouraged in therapy, not defeated or counteracted. The malleability of memory and our future-oriented coping should be emphasized and encouraged: "Researchers have begun successfully testing therapies designed to break this pattern by training sufferers to envision positive outcomes  and to see future risks more realistically." (Of course, this has been the approach of CBT for depression and anxiety all along.)

Community, community, community. Community is the fundamental factor in human survival and satisfaction. In fact, Junger finds, it is the community to which people return that determines PTSD outcomes, and not the events that trigger it:

Many soldiers will tell you that one of the hardest things about coming home is learning to sleep without the security of a group of heavily armed men around them. In that sense, being in a war zone with your platoon feels safer than being in an American suburb by yourself. . . This is a radically different experience from what warriors in other societies go through, such as the Yanomami, of the Orinoco and Amazon Basins, who go to war with their entire age cohort and return to face, together, whatever the psychological consequences may be. As one anthropologist pointed out to me, trauma is usually a group experience, so trauma recovery should be a group experience as well. But in our society it’s not.

“Our whole approach to mental health has been hijacked by pharmaceutical logic,” I was told by Gary Barker, an anthropologist whose group, Promundo, is dedicated to understanding and preventing violence. “PTSD is a crisis of connection and disruption, not an illness that you carry within you.”

And are we responding to PTSD, trauma, and addiction by rebuilding our communities? No, we're going in the opposite direction:

This individualizing of mental health is not just an American problem, or a veteran problem; it affects everybody. A British anthropologist named Bill West told me that the extreme poverty of the 1930s and the collective trauma of the Blitz served to unify an entire generation of English people. “I link the experience of the Blitz to voting in the Labour Party in 1945, and the establishing of the National Health Service and a strong welfare state,” he said. “Those policies were supported well into the 60s by all political parties. That kind of cultural cohesiveness, along with Christianity, was very helpful after the war. It’s an open question whether people’s problems are located in the individual. If enough people in society are sick, you have to wonder whether it isn’t actually society that’s sick.”

I don't know about you, but I'm so looking forward to the movie Dunkirk, where the citizenry of Britain, like a team, got in their crappy little fishing boats to rescue British and allied troops from the Nazis under strafing by German aircraft:

In May 1940, Germany advanced into France, trapping Allied troops on the beaches of Dunkirk. Under air and ground cover from British and French forces, troops were slowly and methodically evacuated from the beach using every serviceable naval and civilian vessel that could be found. At the end of this heroic mission, 330,000 French, British, Belgian and Dutch soldiers were safely evacuated.

Isn't that thrilling?

But who is going to sign up for shared misery like this? Not you and me, Mr. And Mrs. America. We aren't volunteering for danger and privation for ourselves or our children, or even for sharing horrible memories with those who return from it—or who live in traumatizing environments currently. We do all we can to segregate ourselves from such settings, which is understandable.

They don't do that in Israel.

Israel is arguably the only modern country that retains a sufficient sense of community to mitigate the effects of combat on a mass scale. Despite decades of intermittent war, the Israel Defense Forces have a PTSD rate as low as 1 percent. Two of the foremost reasons have to do with national military service and the proximity of the combat—the war is virtually on their doorstep. “Being in the military is something that most people have done,” I was told by Dr. Arieh Shalev, who has devoted the last 20 years to studying PTSD. “Those who come back from combat are re-integrated into a society where those experiences are very well understood. We did a study of 17-year-olds who had lost their father in the military, compared to those who had lost their fathers to accidents. The ones whose fathers died in combat did much better than those whose fathers hadn’t.”

According to Shalev, the closer the public is to the actual combat, the better the war will be understood and the less difficulty soldiers will have when they come home. The Israelis are benefiting from what could be called the shared public meaning of a war. Such public meaning—which would often occur in more communal, tribal societies—seems to help soldiers even in a fully modern society such as Israel. It is probably not generated by empty, reflexive phrases—such as “Thank you for your service”—that many Americans feel compelled to offer soldiers and vets. If anything, those comments only serve to underline the enormous chasm between military and civilian society in this country.

And, so, as with addiction at large, we are embarked on a cultural delusion—the individualizing, medicalizing, and reifying of tragic ordeals—that actually perpetrates, rather than resolves, human trauma.  As to the consequences of our approach to trauma, its manifestations—as with addiction—continue only to worsen.  Per Yunger:

Thirty-five years after acknowledging the problem in its current form, the American military now has the highest PTSD rate in its history—and probably in the world.

And we proceed, "happily," ever further in this direction.