The trauma-activism school of psychotherapy
In a previous post, ‘Are we over-medicalizing suffering?’ , I criticised the dominance of the bio-medical approach to suffering and suggested a spiritual approach instead, in which suffering is accepted as a given of human existence and slowly transcended through spiritual practice.
But is the spiritual or contemplative solution to mental suffering also deficient? There’s an alternative approach, which you could call the trauma-activism school.
In the UK, it’s increasingly influential, and is led by psychologists including John Read, Lucy Johnstone, Peter Kinderman and Richard Bentall, and service-user or peer-support movements like the Hearing Voices Network. Together, they campaign for what Richard Bentall calls ‘a revolution in mental healthcare’.
A good manifesto for the movement can be found in a new collection of essays called Drop the Disorder. It’s a great book.
The authors argue (as I do) that our culture has over-medicalized suffering and become overly reliant on psychiatry’s biomedical, disorder-based system and chemical solutions.
Instead, the authors suggest emotional problems are usually caused by trauma and adversity, rooted in social circumstances like poverty and inequality.
It’s not the brain that’s the problem, it’s society.
The UK ‘trauma-activism’ movement (that’s my name for it) is influenced by the ‘trauma-informed care’ movement which grew in the US in the 90s, inspired by the work of Harvard psychologist Judith Herman.
Herman’s 1992 book, Trauma and Recovery, insisted that mental illnesses are often caused by sexual abuse, either in childhood or adulthood, and that such abuse is more widespread than society admits.
Herman’s clinical work went hand-in-hand with her feminist activism. She wrote:
to study psychological trauma means bearing witness to horrible events…It is morally impossible to stay neutral. The bystander is forced to take sides…All that the perpetrator asks is the bystander do nothing…The victim demands action.
She added:
To hold traumatic reality in consciousness requires a social context that affirms and protects the victim and that joins victim and witness in a common alliance…The systematic study of psychological trauma requires the support of a political movement.
The psychologist or care worker ‘must constantly contend with a tendency to discredit the victim…In spite of a vast literature documenting the phenomenon of psychological trauma, debate still centers on the basic question of whether these phenomena are credible or real.’
Healing comes through group activism. The feminist group comes together and even weaves their stories together like sisters weaving a quilt:
As each group member reconstructs her own narrative, the details of her story almost inevitably evoke new recollections in each of the listeners. In the incest survivor groups, virtually every member who has defined a goal of recovering memories has been able to do so. Women who feel stymied by amnesia are encouraged to tell as much of their story as they do remember. Invariably the group offers a fresh emotional perspective that provides a bridge to new memories.
Herman’s trauma-activism approach is evident throughout the pages of Drop the Disorder. The essays argue that violence, injustice and inequality is endemic in our society, and so is trauma. The cure for trauma is not simply to take a pill or change your negative thinking. It is to expose the abuse, tell your story, right the wrongs, get activist.
The activist drum beats loud throughout the book, and many of its authors are very active on Twitter, defending the rights of survivors against psychiatrists, patriarchy, racism, capitalism, and Tory austerity.
Activism — standing up together with fellow survivors and demanding justice — is very much part of the therapy. ‘Social media can make activists of us all’, writes one author. ‘We are all part of a wider struggle for a fairer society’, writes another. A third, the book’s editor Jo Watson, pens a poem:
Organise! Campaign!
Write a blog, make a sign
Retweet rage-filled tweets
Join a group, start a group
Fill the bloody streets
Wear a badge, start debates
Talk and rant and shout
Share allies’ posts all day long
Giving them more clout
To get the message out
there and smash down all the lies
that dishonour all the stories and just pathologise
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This activist model would probably criticize the contemplative model as deluded. The cure for suffering is meditation? That’s a fat lot of use to an abused wife in a sink estate. Survivors need action, not contemplation.
But trauma-activist therapy also has potential flaws.
The trauma-activist model wants to shift mental healthcare from saying ‘what’s wrong with you?’ to ‘what’s happened to you?’ But imagine having to tell everyone you’re a rape survivor every time you apply for time off work. Some people embrace that public identity. Others don’t want to.
The activist approach can endlessly defer the cure — you’re miserable because of capitalism / patriarchy, so you’ll only be happier come the revolution.
OK, anything I can do in the meantime?
Activism.
But activism can also, from the contemplative point of view, lead to the hardening of a certain identity — the self as victim, the self as survivor, the self as righteous warrior against evil oppressors.
You can get so caught up in this morally-pure identity, you ignore the social impact of your emotional disturbance on other people.
For example, the families of people with mental illness suffer terribly, for decades. They are ‘survivors’ too. Who represents them? Who bangs the activist drum for them, when their loved ones refuse treatment and blame everyone except themselves for their disturbance?
Yes, mental and emotional problems have social conditions. But the solutions will be at least partly personal — you have to take some responsibility for your own thoughts, feelings and behaviour, and not simply blame them on others.
Activism as therapy can turn into activism as obsession, even activism as bullying. If you follow some of the authors from the book, they tweet endlessly about the cause, as if nothing else ever happens in the world.
The activist can feel involved in a righteous war. You’re either with us or against us. Solidarity or war.
And it can lead to harassment of your opponents — Twitter becomes a constant turf war between gangs. Survivors versus psychiatrists, feminists versus the patriarchy.
You and your side are wholly right and wholly good, the other side evil.
You must support the victim, must validate their experience.
Share allies’ posts all day long
Giving them more clout
To get the message out
But what if their story isn’t totally true?
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The central idea of the trauma-activism school of psychology is that trauma is real, and rooted in genuine adverse events like child abuse.
Find the trauma, find who caused the trauma, tell your story, wage your campaign.
But trauma is subjective. What is traumatizing to one person is no big deal to another.
Whether an event traumatizes a person depends not just on the event but on their view, their perception. Epictetus pointed this out millennia ago: ‘People are disturbed not by events, but by their opinion about events.’
One person might feel utterly crushed by an event, by a break-up, say, or a parent’s death, or a car crash, or being sent to boarding school, or going to war. Another might not.
I was traumatized by a bad LSD trip, and suffered PTSD for several years. Many of my friends also had bad trips, but it didn’t really affect them.
The view we take of what happens to us in turn depends on our physiology, our nervous system and our genes
The psychologist Jerome Kagan found that some babies were more ‘reactive’ than others at four months old — more likely to cry if you prodded them. Those ‘high reactive’ babies were more likely to develop into shy children at 7 and 11 because, Kagan suggested, they have a more excitable amygdala.
Just as the biomedical psychiatric model tries to fix suffering in a particular brain disorder, the trauma-activism school tries to fix it in an event that is objectively traumatic. You are like this because this happened to you. Says who? Says the trauma experts and the survivor-experts.
But there are all kinds of reasons why a person’s narrative about a traumatic event might be unreliable.
There are instances where trauma could be displaced — something bad happened to you in your past but you project that pain onto someone else in the present. In your disturbed and highly triggered mind-set, you perceive everyone as a bully and abuser.
Or your traumatic event could be fabricated. Perhaps you want to be perceived as a victim because then you’re special and worthy of special treatment (so-called Munchausen syndrome) or you want to harm the person you accuse (as the defendant argued in the Columbia University rape controversy).
Or you might subconsciously imagine a traumatic event or series of events because it gives a clear story to your suffering, or because the story was suggested to you by your therapist or survivor group.
Child abuse, unfortunately, happens all the time and is probably under-reported. But there are also sometimes lurid hoaxes and panics.
The most famous example is the ‘Satanic panic’ of the 1980s and 1990s, in which the media helped stoke a global panic about an epidemic of Satanic ritual child abuse. The panic was fed by evangelicals eager to believe in demonic abuse (particularly by rock bands), and by a group of psychologists keen to discover suppressed child abuse as the cause for every neurosis.
Some of these psychologists hypnotized their patients and then encouraged them to recover forgotten details of Satanic ritual child abuse — acting just like 17th-century witch-hunters of the Inquisition, who groomed people into confessing to all kinds of outlandish Satanic activity.
If the panic was to be believed, the epidemic involved thousands of Satanists abusing and murdering tens of thousands of children. But after a series of investigations, no evidence was found for a single Satanic child abuse ring. Some of the allegations were simply lies, others were false memories implanted by over-eager psychologists. The damage to the people accused was, of course, devastating.
Here’s a brief history of the 1980s Satanic panic in the US. Here is a PhD by an investigative British journalist, Rosie Waterhouse, looking at the Satanic panic in the UK in the 90s. See also the work of Elizabeth Loftus on ‘false memory syndrome’ as it relates to the Satanic panic, and chapter 8 of Ian Hacking’s Re-writing the Soul: Multiple Personality and the Sciences of Memory, which looks at how psychotherapists stoked the Satanic panic by coaxing patients into constructing memories of Satanic abuse.
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We have to tread a fine line at this cultural moment between victim-shaming and believing every accusation uncritically.
It is a terrible thing not to believe someone who says they have been hurt by someone else, but it is also a terrible thing to automatically believe and promote their accusations against others — thereby causing them serious harm — without asking ‘where’s the evidence?’
Can we believe two things: first, rape and abuse are under-reported and often covered up; and second, not all allegations are true?
Can we recognize that (a) trauma is subjective — there is no external board that can decree what is objectively traumatic / awful.
(b) memory can be unreliable, particularly repressed memories that suddenly appear decades later, or accounts that seem unreliable and incoherent. On the whole, the scientific evidence suggests we usually remember traumatic incidents quite clearly.
c) false accusations cause a huge amount of suffering. It’s not just the person who says ‘I’m the victim’ who is the victim.
d) the activist mentality of ‘we’re at war and you’re either with us or against us’ may not be the best mindset for navigating these waters.
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I completely agree that biomedical psychiatry has a tendency to gross over-simplification. It reduces human suffering to brain disorders requiring a pill. It can easily ignore a person’s story, what has happened to them and the meaning they make from their experience.
I also very much support peer-led initiatives like Hearing Voices, and believe individuals’ stories and their journey to meaning and integration are a crucial part of recovery from mental illness. I’ve supported that for over a decade.
Yes, poverty, racism and patriarchy make it more likely that people develop mental illness — but not always. White middle-class people sometimes lose their minds as well.
Social determinants and genetic determinants of mental illness intersect in complicated ways. If you’re in a messed-up family, you’re more likely to be exposed to potentially traumatic events. But you’re also more likely to have a genetic susceptibility to mental illness. Is it genes or society? It’s both.
Too often, different schools of psychology or psychiatry focus just on one level of the psyche for their explanation of suffering. They focus just on genes, just on society, just on thoughts, just on Serotonin, just on meditation, just on trauma, just on your parents. They try to overturn one religion, one dominant school, but end up replacing it with their own cult, their own dogma and priest-hood, which again only captures part of the story.
Aldous Huxley said of psychoanalysis: ‘The original sin is over-simplification.’ We need to be able to see suffering at multiple levels, and work on all those levels, while also accepting that humans are messy, suffering is messy, reality does not always fit into tidy theories or neat stories. As Kant wrote, ‘out of the crooked timber of humanity, no straight thing was ever made.’