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Trauma

Me Too: Big “T” vs. Little “t” Trauma: Fact and Perception

"Me Too" provides context for some eating disorders, but not for all.

The “Me Too” movement exploded in October 2017. Its intent was, and remains, to awaken people to the widespread prevalence of sexual harassment, misconduct and sexual abuse routinely occurring in the workplace.

As an eating disorder specialist, woman and mother, the news of the movement was met with enthusiastic relief, yet concern.

Most of the female patients and many male patients which have been treated with eating disorders throughout my career, have detailed their accounts of the psychological fall out or self-destructive and defeating symptoms resulting from recurring sexual harassment and/or sexual abuse/violence during their childhood and/or adult lives.

To be a woman in a civilized society, a patriotic American and forever New Yorker, one would think that I have lived in the “best” places for equality, fairness, respect and the transcendence of race, gender and age discrimination. I have indeed basked in the safety of environments most conducive to equality. However, there has not been any fewer incidences of sexual harassment, assault or abuse communicated by the hundreds of patients I have treated over the years in New York or anywhere else I have practiced. In other words, there is no geographic safe haven no matter how advanced the culture or society is.

Bottom line is, “me too” is everywhere.

The “Me Too” movement is a platform representing both a voice of authenticity and candor. It has also has been utilized for political overreach and as a rationalization for a very complicated set of behaviors that cannot necessarily be uniformly categorized.

CONTEXT: PREVALENCE

A recent New York Times article on the prevalence of sexual harassment, reviewed a national online survey of 2,000 people conducted in January 2018. The findings revealed that, “81 percent of women and 43 percent of men said they had experienced sexual harassment or assault over their lifetimes — higher than most other studies and polls have suggested.” Participants in the poll reported on incidences of being the recipient of verbal sexual harassment, unwelcome sexual touching, being physically followed and sexual assault. (Study by Stop Street Harassment titled, “What Happened, and to Whom.”)

The study found, “One in two women and one in five men have experienced sexual violence other than rape during their lifetime; one in five women and one in 67 men reported rapes or attempted rapes.”(1)

Statistics are generally consistent among studies; the majority of people (women and men,) who have been victims of sexual harassment and assault do not confront the perpetrator or report it to a superior or collateral worker. It is estimated that less than 2% of individuals report any incident. “They choose avoidance: 23 percent of women said they altered their routes or daily routines to avoid harassment.

THE EATING DISORDER CONNECTION

As many accounts and studies have shown, the most common reaction to sexual harassment and assault is Anxiety or Depression; 31 percent of women and 20 percent of men reported these effects after incidents.

Eating disorders co-occur with other major psychiatric diagnoses typically, Anxiety and Depression.

It is estimated that 30% of patients with eating disorders have suffered sexual abuse, although many researchers and clinical experts believe the percentage of occurrence to be much higher. The development of an eating disorder following Childhood Sexual Abuse is particularly alarming and the prevalence ranges generally from 50% to 95%.

So, “ Me Too” informs and forms “Me Three” — The Development of an Eating Disorder.

Big “T” TRAUMA versus Small “t” traumas

One of the many difficulties in the science of diagnosing psychiatric disorders is that it is rare to find uniformity; every person is different. Many medical conditions are diagnosed through tell tale symptoms and/or common variables among others affected with the same condition. Diagnosing Psychiatric Disorders generally requires taking a detailed history of the person’s life including medical, genetic and heritable conditions i.e. depression, anxiety, family member with a psychotic condition. Early childhood relationships, upbringing, social or familial experiences and social and cultural norms play a significant role as well. Understanding the person in her/his particular situation enables access to assessing what drives their bus and what their particular needs or psychological issues are. It is here where the art of psychotherapy and the skill and open mindedness of the clinician come in to play.

This is particularly true when it comes to assessing traumatic exposure and experience and in understanding the etiology of eating disorders in each individual person. What is a traumatic event in someone’s life can be a subjective experience. One person may experience the event as traumatic, but not by another person. The roots of someone’s eating disorder can never be uniformly answered. How does perception play a role? Does the person appear non-phased by an event that many would feel to be shocking? Why does one child develop an eating disorder in a household and given the same conditions another child does not?

BIG “T” TRAUMA

Rape, incest, sexual bodily assault at any age are Big “T” Traumas. It could be unequivocally argued that anyone who minimizes or dismisses the impact of such acts are coping utilizing a cocktail of defenses; Denial, Dissociation and Repression are a means to deal with the enormity of the trauma(s.) Despite Denial or Dissociation and/or Repression, the psyche is determined and self-preserving and is not left unscathed. Often relational issues regarding trust, symptom development i.e. substance abuse, self-harm, eating disorders are high among this population in an attempt to combat the psychological enormity of the trauma that was inflicted upon them. So, Denial may work to keep the conscious thoughts of the trauma at bay, but the body and psyche find a way to express it through symptoms and interpersonal issues i.e. relational trust.

Let’s take another example of a non-physical act. A woman walks in front of an all male construction crew working on a city street. The commenting, eyes following her, ogling feels assaultive and harassing. Another woman spots the construction crew and immediately feels threatened and feels compelled to walk on the other side of the street when noticing them, anxiety sets in. These events represent interpersonal traumas to both of these women. Are these experienced as BIG “T” Traumas or as little “t” traumas? How they are experienced by the individual is unique.

What about a woman who enjoys attention by men, even the catcalling or commenting as she crosses the street or walks in front of an all male construction crew in a major city?

Is she capitulating to patriarchy? Is she in denial, dissociative or repressing the actual assaultive impacts of these acts? She does not consider the comments harassing?

What happens if she catcalls back? Or turns her head to check out the men in jeans, work belts and rolled-up sleeves? Does this make her a creep? Is she as pathological as the men because she “likes the attention?”

Is the solution then to institute a law stopping all comments because it offends some or even many?

On a more interpersonal level, does a woman or man who flirts in an office setting with a co-lateral worker signal harassment? What if the person enjoys it? If there is no power hierarchy or subordinate relationship, is it harassment? Should this qualify as a behavior that under all circumstances must be curtailed or a law instituted to prevent it? Is it a “T,” a “t,” or neither?

LITTLE “t” traumas

Little “t” traumas tend to be those that are based on subjective experience and perception. Perception starts forming in early childhood and evolves and changes throughout life. Some researchers and clinicians assert that perception is based on disposition which is an inheritable trait; therefore, perception, in a sense, is predetermined by biological factors. One person’s terror i.e. hanging upside on a stuck Ferris wheel is another person’s adventure and provides an adrenaline rush. Yet, still another person has a neutral and calm reaction. i.e. “Don’t panic. Eventually it will get fixed and I will be back on the ground.”

Take another example of the practical jokester who may turn off the hot water on a friend/loved one in the shower. The person showering may feel the act to be hostile or shaming. Another person may be irritated or annoyed but laughs and then lets it roll off their back.

An interpersonal example of little “t” trauma, for example, may be the following: One partner in a relationship raises their voice during an argument in a public setting and the other partner may not be phased. The partner simply snaps back, roll's their eyes, walks away, states, "don’t talk to me that way" or perhaps even tries to console their partner because they sense stress underneath the anger. Another partner may immediately feel shame, cry, get flushed in the face and feel painfully exposed. What makes the difference in reactions?

Perhaps psychological make up and relational experiences throughout life, particularly during childhood left them vulnerable to shame and criticism and feeling intruded upon. Perhaps they are more sensitive by nature and are acutely aware of relational cues around them; the ones who don’t miss a trick.

Children who have been shamed as children have an increased tendency in experiencing shame by many events throughout life that signal the activation of their sexuality, aggression, wants and desires. They lack the “tough skin” to let comments that by some would be experienced as playful, roll off their backs. Many comments feel assaultive or intrusive and create shame.

EATING DISORDERS AND THE BIG “T” VERSUS SMALL “t”

BIG “T” Traumas

A study conducted in 2014 among 74 eating disorder patients revealed that 95% had experienced at least one Potentially Traumatic Event (PTE) in their lives. The highest number of reported traumatic events was eleven on average… The most commonly experienced traumas in both groups [Anorexia and Bulimia] were life threatening illness, death of a close person or family member, and sexual assault by a stranger or family member. The events considered most traumatic mainly belonged to the field of interpersonal traumatization.”(2)

The author’s then concludes: “As part of the comprehensive approach, it would be important not only to document the presence of PTEs, but also to explore how the person has internalized the events and whether or not they qualify them as traumatic.”(2)

Since all the patients interviewed had eating disorders does this mean that all the events were perceived as indeed Big “T" Trauma?

Eating disorders develop as a voice to convey what cannot be psychologically tolerated. It is also a way to cope with very difficult emotions, experiences and interpersonal relationships. The general assumption is that if a person resorts to the self-destructiveness of an eating disorder following assault, then, “Yes,” it is a Big “T” Trauma that has actually occurred and is not based on merely perception of an event that another person might experience as non-assaultive.

HOW DOES ACCEPTANCE OF BIG “T” AND little “t” TRAUMA APPLY TO THE ME TOO MOVEMENT?

France recently proposed changes to its law to increase the ‘Legal Age of Consent’ to 15 after two high profile cases in which men escaped rape convictions after having intercourse with 11-year-old girls. This move is seen as unprecedented in French culture and has been met with praise by all groups who have interest in the welfare of children. Most of us in the American mental health community ardently believe that the age of consent ought not be less than 18. It is difficult to accept that any child less than 18 years of age has the emotional and mental maturity to understand what exactly is consensual sex when there is an apparent age discrepancy between the sexual partnering of a teenager and an adult.

France’s change in policy signifies a beginning recognition of the risk of exploitation of children when it comes to sexual standards for age of consent. This policy will help stem the tide of BIG “T” Traumas.

On another French matter, “Balancetonporc,” which translates to “Expose your pig,” went viral as thousands of French women posted stories of inappropriate sexual behaviors and abuse. “According to the French research institute Odoxa, 335,300 tweets with the hashtag #balancetonporc were posted in just five days. Seventeen thousand of them were testimonies of sexual aggression and harassment.” (3). Did these represent Big “T” or Little “t” traumatic events?

On an opposing note, an article was published recently in The Guardian, aired the voices of Catherine Deneuve and other known and prominent French women who accused Hollywood of for the Me Too Movement of promoting “censorship and intolerance”

“What began as freeing women up to speak has today turned into the opposite – we intimidate people into speaking ‘correctly’, shout down those who don’t fall into line, and those women who refused to bend [to the new realities] are regarded as complicit and traitors”.
“…What they refuse to countenance is an image of women “as poor little things, this Victorian idea that women are mere children who have to be protected, the same one extolled by religious fundamentalists and reactionaries."

The article continues: “As women, we do not recogni[z]e ourselves in this feminism, which beyond denouncing the abuse of power takes on a hatred of men and of sexuality.”(4)

The argument is made that in censorship of expression is a return to an old moral order against freedom for women, their bodies and their sexuality.

THIS OR THAT: SOMETIMES IT IS BOTH OR NEITHER

Western cultures live in the polarization of Laws and Subjective Experience.

Questioning, criticizing, and articulating a rational argument is the right and freedom that western societies embrace.

Certain acts are morally reprehensible and illegal and constitute TRAUMA — rape, incest sexual assault. Eating Disorders are extraordinary high among this population.

Should women start behaving as men as a form of combat? For, the most part, my answer to that is, “No!!!” Turning both genders in to Diplomats in interpersonal, social and political ways is not just a lofty notion; it takes intellect, reasoning and respect — no easy feat these days to accomplish. However, women and men have the power to fight what is wrong and unjust and be courageous for causes that are just and morally and ethically sound. Fighting to protect and defend has its merits in many arenas.

Is there an answer?

We live in constant culture clash and extremes of sexual expression versus exploitation.
The disparities are often defined by others as needing to be “this or that;” we like easy answers. But, subjectivity and the experience of the individual is determinant, certainly in a free society like America. Right?

The “Me Too” is having an extraordinary impact in and outside of the United States. Rape, pedophilia, sexual assault or misconduct and harassment toward a subordinate are clear and cannot be rationalized or mistaken for anything else. Does room exist for discrepancy and discussion among some behaviors seen by some as assaultive but considered playful, flirtatious, ego gratifying and expressive by others?

Distinguishing between the Big “T” Traumas and little “t” traumas may offer some form of solution, or at least some fuel for thought when it comes to the “Me Too” and “Me Three” Movements. Big “T” are real acts inflicted upon the individual where there is overall, if not complete, agreement by people from all walks and locales in life. Little "t" traumas are often based on subjective experience and interpretation by the individual of the event or experience; perception is key in assessment. Little “t” traumas can be no less impactful for some.

References

1. The New York Times. “Numbers Hint at Why MeToo Took Off: The Sheer Number Who Can Say Me Too." S. Chira. 2018.

2.Eating Disorders. Eating Disorders, Trauma, PTSD, and Psychosocial Resources. Eating Disorders. Tagay, et al. Vol 22(1) 33-39)

3. ABC News. “More French women are reporting incidents of sexual misconduct." Pradier. 11/16/17.

4. The Guardian. “After the Me Too Backlash, An Insider’s Guide to French Feminism.” Poirier. January 2018.

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