Artist Frida Kahlo dealt with chronic pain from a train accident and childhood polio. For her, art provided a form of liberation from her physical body. (Source)
First published in 1990, Judith Lewis Herman's Trauma and Recovery is a cornerstone publication in the field of post-trauma studies. Her appreciation for the extent to which reality is socially constructed enabled Herman to step outside the presumptions of her own academic field and examine the similarities in post-trauma experience for war veterans and rape victims- groups usually standing on other sides of the fence.
“Combat and rape, the public and private forms of organized social violence, are primarily experiences of adolescent and early adult life. The United States Army enlists young men at seventeen; the average age of the Vietnam combat soldier was nineteen. In many other countries boys are conscripted for military service while barely in their teens. Similarly, the period of highest risk for rape is in late adolescence. Half of all victims are aged twenty or younger at the time they are raped; three-quarters are between the ages of thirteen and twenty-six. The period of greatest psychological vulnerability is also in reality the period of greatest traumatic exposure, for both young men and young women. Rape and combat might thus be considered complementary social rites of initiation into the coercive violence at the foundation of adult society. They are the paradigmatic forms of trauma for women and men.”
Though Herman's experiencea as a physician and therapist led her to coin "Complex PTSD" in 1992, the diagnosis is not one that insurance companies are likely embrace. This is because Complex PTSD acknowledges the ongoing, lifelong impact of trauma on victims of repetitive trauma. When your trauma is as constant and reliable as a paycheck, it takes more than a few months to treat its symptoms and overcome its crippling effects.
Currently, the APA includes a diagnosis of PTSD recently updated to include a subdiagnosis of complex trauma. Perhaps the drastic increase in treatment and therapy needs for recent veterans has drawn a bright arrow between more frequent, prolonged tours of duty and a more complex, intractable form of PTSD. I refuse to thank the Bush administration for their silence and complicity in this matter.
Nicolas Lampert's contribution to "Operation Exposure- War Is Trauma". (From Justseeds)
An Australian veteran and co-founder of the MyPTSD website addresses the issues of including dissociative and borderline personality disorders in the updated PTSD diagnosis:
The reason a dissociative and/or personality disorder is often present in those with complex trauma is that the perceptions of reality after enduring prolonged trauma are radically altered. This perception is much different than the reality perceived without prolonged trauma. Reality becomes torn, molded, and shaped to fit within a traumatic atmosphere. Due to longevity and exposure, this distorted picture of reality becomes normalized for the patient who experiences complex trauma.
Given the stigma associated with BPD, few psychiatrists are willing to touch patients tarred and feathered by this diagnostic brush. I've even spoken to a few psychiatrists who refuse to take on patients with bordeline-related diagnoses because "those patients are always very manipulative and dangerous". [The MyPTSD website suggests the "fail-safe for CPTSD is Disorders of Extreme Stress, Not Otherwise Specified (DESNOS)", since it enlarges treatment opportunities and reduces the negative associations which our brains tend to turn into facts (per Daniel Kahneman's "Type I thinking" rubric).
What Herman calls "the social ecology of prolonged and repeated interpersonal trauma" is central in grasping the intricacies of complex trauma. As distinguised from other forms of trauma, complex trauma is "always embedded in a social structure that permits the abuse and exploitation of a subordinate group". In addition, Herman suggests that complex trauma "is always relational". This means that the trauma takes place while the victim is "in a state of captivity, under the control and domination of the perpetrator".
Complex trauma is more likely to result from spousal rape than stranger rape due to the entangling, continuous nature of the relationships involved. Trauma experienced at the hands of those who are most perceived to control a social unit (family, community, etc.)- trauma that recurs and repeats, weaving itself into the fabric of distorted relationships- is likely to fall under the Complex PTSD description.
For Herman, treating victims of complex trauma has been complicated by professional, political, and social limitations. In an interview with Harry Kreisler more than twenty years ago, Herman expressed, again, her frustration and wariness of the usual "boxes":
....psychology is a very soft science. That's putting it at its most charitable light. What one observes about human behavior, human consciousness, human relationships is so embedded ... what we observe and how we conceptualize what we observe is so embedded in the context of what we're looking for. And how we name it. This isn't physics. So that even the paying of attention, the selection of what it is that we're going to consider interesting and significant in human behavior is formed by the social and political context that we're embedded in. And I think that's particularly true about the emotions related to power and control, the emotions related to one's place in society, one's place in the family, the emotions of shame, of resentment, of pride, of a sense of legitimacy or illegitimacy. So, even to pay attention to what women say about sex, motherhood, relationships, depends so much on what one thinks a woman ought to be saying, ought to be feeling, on what is legitimate to express. Unless you have a political movement that says, "Forget what everybody else thinks you ought to be feeling, what you ought to be saying. Get down to it. Tell the truth. What did you actually think and feel and notice in your body." You need a safe space to be able to do that. You need a political context to be able to do that.
Herman's wariness comes not from personal inclinations but from the way in which silence and secrecy conspire against the recovery from trauma. Silence is collusion- it is the obvious social mechanism of compliance and the cause of what we call "complicity".
When the cost for telling the truth is socially hazardous, the majority of people will convince themselves there is "nothing" they can "do". Think of the "ordinary men" when became Nazis; the collaborators under Ceausescu's brutal regime; the consumers of American war porn; the frightened wife of the child molester- all those who prefer to deny the truth they know so they can secure the security inherent in keeping things as they are.
“In order to escape accountability for his crimes, the perpetrator does everything in his power to promote forgetting. If secrecy fails, the perpetrator attacks the credibility of his victim. If he cannot silence her absolutely, he tries to make sure no one listens.” (Judith Herman)
"To study psychological trauma," Herman writes, "means bearing witness to horrible events." Psychologists devoted to helping patients with PTSD find their hands tied. They can't gain or expect "respect" for studying a subject that most people would rather deny. In addition, the dominant social fear of being labelled a "victim"- and they way in which this fear undercuts a trauma victim's ability to acknowledge their own experiences- keeps both victims and perpetrators in the dark about the consequences of their actions.
There is no escape from the event/s- or from the convoluted forms in which its memories are encoded. There is no part of life that it leaves untouched. In Herman's words:
"The traumatic moment becomes encoded in an abnormal form of memory, which breaks spontaneously into consciouness, both as flashbacks during waking states and as traumatic nightmares during sleep. Small, seemingly insignificant reminders can also evoke these memories, which often return with all the vividness and emotional force of the original event. Thus, even normally safe environments may come to feel dangerous, for the survivor can never be assured that she will not encounter some reminder of the trauma."
Since "the ordinary response to atrocities is to banish them from consciousness", speaking the truth- naming the experience- is part of regaining control of one's life. But the cost of rocking the boat often involves being thrown into the water.
"Certain violations of the social compact are too terrible to utter aloud: this is the meaning of the word "unspeakable".... Atrocities, however, refuse to be buried....Remembering and telling the truth about terrible events are prerequisites for the restoration of the social order and for the healing of individual victims.... When the truth is finally recognized, survivors can begin their recovery. But far too often secrecy prevails, and the story of the traumatic event surfaces not as a verbal narrative but as a symptom...."
"In the telling, the trauma becomes a testimony," writes Herman. But this testimony is not of the sort best articulated in the context of the adversarial court system. Herman's insight on rape, sexual violence, and the courts:
“The legal system is designed to protect men from the superior power of the state but not to protect women or children from the superior power of men. It therefore provides strong guarantees for the rights of the accused but essentially no guarantees for the rights of the victim. If one set out by design to devise a system for provoking intrusive post-traumatic symptoms, one could not do better than a court of law.”
If you know a victim of trauma who refuses to acknowledge it's hold on their lives (possibly by self-medicating with alcohol), don't kid yourself about the benefits of letting the past lie dormant. Seeking help and reclaiming the narrative thread of their lives will not restore their innocence of faith in the world. The most it can do is allow them to speak without shame- to acknowledge and honor themselves, to inhabit a world that long threatened to annihilate them. Herman's story offers hope without promising restoration.
Because "traumatized people suffer damage to the basic structures of the self', they find it almost impossible to truth themselves, their lovers, their family, their friends, their co-drinkers at the tailgating party, and their God. The pre-trauma trust and ease is an impossible wish. Given that "the identity they have formed prior to the trauma is irrevocably destroyed," they must learn to live in a world they KNOW is hostile and humiliating. The manner in which this struggle works itself out for each individual deserves our respect and encouragement. Likewise, the extent to which we complain about "women who wanted it" or glorify the beauty of war to recent veterans makes us complicit in their continued oppression.
HUMANE RESOURCES FOR COMPLEX PTSD
Real Warriors (geared towards veterans & families)
National Center for PTSD (US Veterans Administration)
National Child Traumatic Stress Network
The Centre for the Study of Violence and Reconciliation (the South African experience)
When a loved one has been traumatized (ISTSS)
Trauma and relationships (ISTSS)
Children and trauma (ISTSS)
Gift From Within (a nonprofit for victims of trauma)
Trauma Center (Justice Resource Institute)