Posts Tagged “ptsd”

According to a recent book by Susan Clancy, The Trauma Myth, childhood sexual abuse is not traumatizing. In fact, according to Clancy, children may even enjoy it. Let me begin with this caveat: I have not actually read Clancy’s book. I read the Salon.com interview discussing her book. While Clancy is clear to point out that sex with children is a crime, her primary argument is that it does not result in trauma or PTSD. This is the “myth” she is referring to. According to Clancy

Most victims do not understand they are being victimized, because they are too young to understand sex, the perpetrators are almost always people they know and trust, and violence or penetration rarely occurs.

My first response to this is: of course they don’t understand that they are being victimized, they’re children and since, as Clancy notes, the abuse is usually perpetrated by people (and I would add “adults”) that they trust, they may very well think that it’s normal. Not consciously knowing that one is being victimized is quite distinct from the reality of being victimized. Many children who experience physical abuse at the hands of parents are also frequently unaware that they are being victimized. Quite simply, if it is the norm in their household, they assume that it is the norm in all households. Does this make the abuse less “wrong” or traumatizing? Furthermore, I wonder how Clancy defines “violence.” I would argue that all acts of sexual abuse are violent by nature. Perhaps these children aren’t being beaten, but they are certainly being coerced and forced to do something that they cannot freely consent to.

According to her interview, Clancy does believe that childhood sexual abuse is harmful but that the resulting psychological state is not traumatic. She cites the fact that few people seek treatment for the abuse in adulthood and that most of them first describe the experience as “confusing,” which she says is “a far cry from trauma.” She also notes that shame is part of the reason people don’t come forward about their sexual abuse. This is one of the few points that we agree on. However, Clancy argues that the shame isn’t so much a result of the abuse but rather that victims don’t see their responses as consistent with what they see portrayed in the media and pop culture. In other words, their response to the abuse isn’t identical to cinematic representations, etc. I disagree. The shame does not come from the fact that their responses may be different from those of others (although that may be a factor; I can’t say since I’ve seen no research on this) but is instead the result of feeling as though they are somehow to blame for the abuse.

I’m trying to not have a knee-jerk reaction to her argument, but knowing what I know makes that difficult. I’m sure that this is something I share with other researchers and survivors. Unfortunately, many of the comments posted on the Salon site reflect agreement with her argument. Certainly there are those who disagree and they have posted their refutations, but I am saddened by the number of people who dismiss the traumatizing effects of childhood sexual abuse.

In all honestly, I will probably not read Clancy’s book. I have neither the time nor inclination. This is a song that, sadly, I have heard before.

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And when I say fight, I mean research and write. For me, fighting (in the sense of working to accomplish something) is particular to who I am–a scholar, a writer, a teacher. As many of you know (or will discover from reading my blog), my research deals with psychological trauma. I research trauma because I believe that the people who have experienced trauma matter. That they deserve to have their voices heard. That their experiences have not been in vain.

While watching a rerun of one of my favorite television shows, Criminal Minds, something important occurred to me. My research focuses on those who experience what I call “personal” traumas. All trauma is personal, so when I say “personal trauma” I mean people who have experienced trauma as a result of individual acts of violence like sexual assault, childhood abuse, and domestic violence. One of the reasons that I focus on them is because of the stigma that is still associated with these traumas. For a long time all traumas and their aftermath, PTSD, were stigmatizing. Soldiers returning from war were seen as malingerers rather than as victims of the trauma of war. Since Vietnam PTSD has become a recognized psychological disorder and since the wars in Afghanistan and Iraq, there is greater public awareness of psychological trauma and with that awareness comes less stigma. However, it is important to note that the lessening of stigma does not alleviate the pain of trauma. The pain is real; it remains a living memory that haunts the individual who has experienced it. People who experience trauma during “public” acts of violence, like war and terrorist events such as 9/11, are more accepted as “real” sufferers. Their stories are less taboo, and their experiences tend to be validated more. Validation certainly helps. In fact, validation and awareness help to alleviate some of the sense of alienation felt by those who have experienced trauma. In spite of that, the reality of the trauma and the suffering that it engenders does not go away.

The fact that I focus on personal traumas and thus do not focus on the trauma of war compels me to write this post. While I am not researching and writing about soldiers and veterans who blog about trauma, their experiences are not unimportant to me. In fact, one of the reasons that my dissertation deals with blogging about trauma is due to reading the blogs of soldiers and talking to them. My original dissertation idea actually focused on veterans. I wanted to study narrative ability in people who’ve experienced trauma, and I hoped to conduct my study through the VA. Unfortunately, my qualifications do not include a PhD in Psychology, and the IRB isn’t keen on letting rhetoricians study protected populations. As a result, I returned to an earlier research idea conceived when I began stumbling on trauma blogs. I was researching blogging and continuing my research on trauma when the two somehow converged. I became interested in this counterpublic (to use Michael Warner‘s term) who were loosely connected through their strategic use of blogging. The subgenre of the trauma blog became the research topic for my dissertation, yet I chose to exclude the blogs of those traumatized as a result of war or terrorist attacks. Partly this was practical, I needed to limit the number of blogs that I used in my analysis. The other reason for this choice was more ideological in nature. Drawing attention to those who speak out about traumas that are still highly stigmatized will hopefully lessen the stigma or, at the very least, draw attention to these survivors brave enough to speak out.

In the future I hope to apply the same research strategies to the blogs written by veterans.

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I find myself in an interesting situation this morning: considering the ethics of what I do.  Much of the time my work is with vulnerable populations.  However, the majority of my research participants self-disclose online, which means that they have already agreed to divulge information about their personal experiences.  That being said, I find rich information, regarding experiences of people involved in traumatic situations, in my face-to-face life as well.  The challenge is: how much of their information can I disclose?  Obviously, I would leave out identifying information unless I had their explicit permission to do so.  However, is it ethical for me to quote them without permission?  My conclusion, influenced by the advice of a colleague, is to hold off on sharing information privately disclosed prior to gaining permission.  The challenge, then, is how do you ask someone who is maybe not as familiar with blogging, if you can quote them on your blog.  This, I feel, is relevant to my research because my particpant bloggers are divulging sensitive information and should they divulge information regarding others in their blog without permission, am I being unethical including it in my research?

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I have found, that living under circumstances of chronic traumatization, of sustained abuse, has made me a better critical thinker and has increased my ability to understand the needs, emotions and motives of other.  But this could be a mythos created by me to make sense of my disorder and pain.  Still, I think that those who suffer chronic traumatization as children, and thus during crucial brain development, experience a different development of mental capacity.  Forced to live in a mode of hypervigilance and to consider at all moments the thoughts and motives of those perpetrating the abuse, abused children learn a sort of “double consciousness,” W.E.B. Dubois’ name for the state of mind possessed by oppressed groups:

It is a peculiar sensation, this double-consciousness, this sense of always looking at one’s self through the eyes of  others, of measuring one’s soul by the tape of a world that looks on in amused contempt and pity. One ever feels his twoness,–an American, a Negro; two warring souls, two thoughts, two unreconciled strivings; two warring ideals in     one dark body, whose dogged strength alone keeps it from being torn asunder (The Souls of Black Folks)

Often I have felt as though those around me were seeing the world with a different set of lenses, ones which are blurry and leave images soft along the edges, whereas in my world all of the edges are hard and unyielding.  Speaking with other survivors has lead me to believe that I am not alone in this feeling.  Many of us feel that we see what others cannot.  Whether or not this is a deeper truth or a figment of the traumatized mind remains to be seen.

Judith Herman refers to a similar thought process in Trauma and Recovery, though she likens her version to George Orwell’s “doublethink” and the psychologist’s use of the word “dissociation”  According to Herman, “the dialectic of trauma gives rise to complicated, sometimes uncanny alterations of consciousness” (1).

“To speak publicly about one’s knowledge of atrocitites is to invite the stigma that attaches to victims” (2) I have plenty of friends from high school (middle and elementary) who do not believe that I was abused. I worked long and hard to create the appearance of a normal family, not because I wanted to be like everyone else, but because I didn’t want my abuse to be the thing that distinguished me from the crowd.  I wanted to stand out, but because of who I was not what was done to me.

Let’s take something horrible and make something good out of it.  I want to show the horror; give voice to the voiceless; but I also want to make what we have, take what we have suffered and transform it into something that gives the former meaning.  So that our sacrifices will not have been in vain.

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As I struggle to find the sample set (representative trauma blogs) for my dissertation, I have been able to separate the bloggers into three categories based on their rhetorical strategies for dealing with trauma. One set of trauma bloggers discuss the intimate details of their traumas, clearly focusing on the internal struggles of PTSD.  The other set of bloggers seem to externalize their trauma by focusing on the political aspects of post traumatic stress disorder without revealing a large amount of personal information. There is a third set of bloggers that I situate between the other two.  These bloggers have situated themselves as therapeutic experts in the sense that they provide a healing plan based on their own process of healing.  Most of them are careful to note that they are not trained professionals and that their advice should not be taken in lieu of seeking professional help.  Still, their strategy is an interesting one because it positions them as expert, helper, and survivor/victim.  To some extent these are the most complex.  They implicitly argue for the value of personal experience by positioning themselves as a form of expert.  This, of course, is not unusual in the blogosphere.  Bloggers typically position themselves as authorities based on their experience.  This is necessary to establish an ethos with their audience.  Productivity blogs are particularly focused on this, because, like trauma bloggers, they are presenting a kind of self-help regimine based on the strategies that have worked for them.

The rhetorical strategies of these bloggers raise interesting questions regarding standards of evidence.  In academia, personal experience, while not entirely eschewed, is not valued as highly as other forms of research.  Experience is not considered rigorous in the ways that quantitative and other forms of qualitative data are.  Thus, while situating one’s research within a personal context is acceptable, using personal experience as theory or evidence is not.  Rather than increasing one’s ethos, the academic who focuses on personal experience will most likely have their research regarded as spurious at best.  I realize that we are talking about very different genres with distinctly different audiences and that these are not necessarily comprable.  However, I’m interested in exploring this further.  Given that there are many academic blogs that contain a mixture of experience and theoretical discussion, might there be an opportunity for a hybridization of scholarly genres?  Could this provide inroads into increasing the valuation of experiential evidence?

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This may come as a surprise to some,  but I like deflecting attention away from myself.  At least, I like deflecting attention away from certain aspects of my self. [spacing deliberate] At this point in my life I am completely comfortable with putting my physical health on display.  It’s something that can’t easily be hidden, though many of my disabilities are “invisible.”  Still, when you have a tendency to jerk and twitch, convulse into seizures, have debilitating migraines, etc., it’s difficult to play normal.  It’s also marginally acceptable.  At least those who know me well aren’t usually made uncomfortable by my mention of physical illness.  It’s the mental illness that makes people squirmy.  The life experiences that don’t fall gently on the ears.

I’m thinking about this now because, as I read “trauma blogs” to select for my dissertation research sample, I cannot help but compare them to my own.  Many of the blogs that I find discuss their trauma in detail, bare their souls so-to-speak.  Not only in blog entries themselves, but in their profiles they identify themselves as survivors of a myriad of abuses.  My blog doesn’t do that.  My blog positions me as an academic and a feminist, someone interested in politics and trauma, but not the raw meat of the trauma victim.  Their blogs are personal to the point of being uncomfortable and I’m still afraid of putting some people off.  You see, I’m not sure who all reads my blog and there are people, people in my family, who, if they read some of the stories that I have to tell, would no longer speak to me.  I realize that this is a chance I am not yet willing to take.  I could, of course, start an anonymous blog, like many of the bloggers who I follow.  Yet something prevents me from doing so.  Perhaps it is that I would feel hypocritical.  In my research, I boldly proclaim the importance of breaking silences; I advocate for the removal of stigma from those traumatized by rape, sexual and child abuse.  Because they have no reason to feel shame; they didn’t do anything wrong; the shame should fall on the shoulders of the perpetrator not the victim.  But it doesn’t.  Mostly this is because perpetrators don’t tell the stories of the abuse that they have rendered.  They want silence.  And silence is what the public wants as well.

Tonight, I had dinner at the bar of a local restaurant.  I had been reading blogs all day, selecting ones for my research sample.  The bartender asked me about my dissertation work and I told her the topic.  Her response was: “yeah, that’s something that no one wants to hear about” tacking on “except in theory,” which was, I assume, her attempt to be polite given that “hearing those things” is part of my chosen line of work.  But I recognized truth in what she said.  When people ask me my dissertation topic and I tell them “trauma and narrative,” they want to hear more.  In the past when I’ve explained the work that I’d like to do with veterans, they want to hear more.  As soon as they hear the words “rape” or “sexual abuse” they no longer want to hear about my dissertation.  Ultimately, there are dining table traumas and kitchen table traumas and one doesn’t talk about kitchen table traumas in polite company.  In fact, kitchen table traumas don’t really get talked about at all.  It’s more like there are three tiers of where the food of experience is served: dining table, kitchen table, and yard scraps.  If anything, intimate traumas are yard scraps–thrown in the dirt and eaten by only the mangy and starving.  Eaten by those who’ve also had their lives turned into yard scraps. [Reminder: this is some of my exploratory writing and I've yet to really perfect the metaphors.]

Perhaps I’ve chosen the trauma blogs because they are yard scraps rather than in spite of them being yard scraps. Someone has to dust them off and show them to be, not refuse, but sustenance for readers who are desperate to find someone, anyone, who will speak and listen.

Why do I write?  Because I want them to be heard, and, someday, I’ll be ready to be heard too.

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In my research on PTSD blogs and due to my own tendency to keep up with PTSD-related news, I keep coming across articles regarding a “pill” for treating PTSD.  It’s not a new idea; a bit of research into it reveals articles as far back as 2004.  So, why is it suddenly popping up everywhere now? Because the US Department of Veteran Affairs is currently recruiting for a clinical trial continuing the research into a pill that, as the popular press has put it, “erases bad memories.” The drug in question is propranolol, a beta-blocker used to control blood pressure.  I was a bit shocked when I read the name of the medication, having been previously prescribed it as a migraine prophylactic. If I knew more about neurophysiology, I could probably explain how a beta-blocker could also function as a preventative for migraines and a treatment for PTSD.  But I don’t.  What I can do is explain the process and assumptions behind this clinical trial.

Designed based on two previous studies, this trial will examine the effect of a 24-hour oral dose of propranolol as opposed to that of a placebo.  The participants, comprised of male and female combat veterans previously stationed in Iraq and Afghanistan, all meet DSM-IV criteria for Post Traumatic Stress Disorder.  The basic protocol of the study is thus: during each of six “memory reactivation sessions,” participants will be asked to spend ten minutes relating the traumatic memory of the event that they believe “caused” their PTSD to a trained psychiatrist, who will then continue to provoke the “reactivation” of the memory by asking questions, “keeping the participant focused on the traumatic event and encouraging him/her to identify aspects of the traumatic event that continue to provoke emotional distress“.  Immediately following the “memory reactivation sessions.” participants will be administered either propranalol or its placebo.  Following the treatment sessions, the protocol efficacy will be determined by measuring the physiological response that particpants have in response to recollections of the traumatic event.  They will also measure the presenting symptoms by using the Clinician Administered PTSD Scale (CAPS), which was previously used to diagnose participants.  The effects of the treatment will be determined based on the physiological response and a comparison between the two CAPS.

The treatment protocol relies on the reconsolidation hypothesis, which states that “a consolidated memory could again become unstable and susceptible to facilitation or impairment for a discrete period of time after a reminder presentation.”  In other words, for the purposes of this study, immediately following the memory reactivation the memory is susceptible to alteration.  Alterations of fear responses have already been accomplished in studies on animals.

So, what’s my problem?  My first response is that I don’t want anyone monkeying around with my memories.  Removal of the memory or even the fear-related response doesn’t necessarily include healing from the traumatic event nor does the erasure of symptoms necessarily include successful treatment of the underlying condition.  My other issue concerns the exclusion criteria for the study, one of which is:

Current participation in any psychotherapy (other than supportive). Subjects will be asked not to initiate psychotherapy during the course of the proposed study except in clinically urgent circumstances; if this becomes necessary, a decision will be made on a case-by-case basis whether to retain the subject in the study or terminate participation.

I understand the need to eliminate variables in research studies, but I’m also a firm believer in “do no harm.” In my opinion, restricting access to health care constitutes harm.  Of course, this is just my layperson’s opinion.  I’m not trained in medicine or psychology, though I do know a fair amount about the psychology of trauma.  Still, there are certainly nuances that I am missing due to a lack of training in the aforementioned areas. If anyone can explain it in a more satisfactory way, please post a comment here.

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After my original dissertation idea was determined to be unfeasible (by myself and my dissertation chair), I found myself struggling to find a topic that still fit the spirit of my work.  Ideally, I would use the dissertation to create a theoretical base for my future study into narrative and trauma.  This, however, is much easier said than done.  The truth is that I don’t know how to write a theory without the use of real world applications.  I imagine this has something to do with the way that I value theory as praxis and vice-versa, and, while I am by no means rejecting that belief, it’s making this dissertation thing kind of difficult.  So, I’m trying to determine how, given the resources readily available to me, I can make a significant contribution to the field of trauma studies. (It’s times like these that make me think that I should have gone into psychology.) Here’s what I’m getting so far:

Thought #1: In the struggle to use writing as a way of healing, trauma survivors use unique rhetorical strategies for approaching their trauma.  My sample set would be blogs, discussion forums, and memoirs, which I would examine using a combination of Burkean theories of identification and feminist content analysis.  Using Jeanne Perrault’s idea of feminist autography, I would loosely categorize my samples as such, perhaps even going so far as to include theory within the scope of my research into autography.  Perreault defines autography as “a writing whose effect is to bring into being a ‘self’ that the writer names ‘I,’ but whose parameters and boundaries resist the nomadic” (2)*  While Perreault examines exclusively female-authored texts that have been published in print, I will be exploring mostly self-published blogs.  Also, my focus will be on how the writing brings into being a self that has been formed in response to and in spite of trauma.  I would also be looking into the Burkeian concepts of identification and consubstantiality as strategies for repairing the rift between self and other that is characteristic of trauma.

Thought#2: Focus on traumatic autography as a way of fighting back.  Writing as a way of healing seems too optimistic, as though writing can make the trauma all better, which I do not think is true.  Titles tend to help me focus, so I’d tentatively title this: “Writing/Fighting to Stay Alive: Rhetorical Strategies for Survival” or “Writing/Fighting to Survive: A Rhetorical Theory of Trauma”

Thought#3: [The most ambitious of these and the most difficult to put into concrete terms.]

My dissertation will serve as a basis for future research into memory, trauma, and narration.  By first establishing a methodology based on a synthesis of feminist, psychological, and narrative theory,  I will lay the groundwork for future study of the significance of language in identity formation and the effects of trauma on that process.  For the purposes of this dissertation, I will be taking a small sampling of writing by those who have experienced traumas.  These samples include: single-authored blogs, discussion forums, and memoir.

I want to create a theoretical basis for the argument that trauma is inherently a linguistic issue and that the loss of language is more than a symptom of the trauma; it is the trauma itself.

Okay.  Here’s a start.  Any feedback is appreciated.

*Perreault, Jeanne.  Writing Selves: Contemporary Feminist Autography. Minneapolis: U of Minnesota Press, 1995.

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The framework for understanding trauma that I am using in my dissertation defines trauma as the emotional/psychological impact to a person’s psyche as the result of an event, experience or set of experiences that overwhelm those individuals who experience it. This results in an inability to integrate the experience into their narrative memory, and it is this inability to integrate the traumatic experience(s) that results in a psychological state of being that impairs the trauma victim’s ability to live completely within the world of the present.  Instead of current actions and feelings, the trauma victim lives with both the horrific memories of the past and the fear that they engender.  Because traumatic memory is not integrated into the narrative memory, it cannot be controlled and recalled at will; rather, it is often elicited without the individual having a conscious choice and unlike memories subject to recall and control, these feel as though they are temporally present.  In addition to the ability of these memories to intrude upon the present, they are also responsible for the state of fear and hyper-vigilance that characterizes the life of the traumatized.  Thus, the memories themselves not only interfere with the ability of the traumatized to live in a current reality by intruding upon that reality; they also impair the individual’s ability to negotiate within the world around them because of the state of fear that they have engendered, both a fear of the traumatic event and a fear of the memory’s ability to surface and disrupt beyond their ability to control it.  Posttraumatic stress disorder (PTSD) is the clinical term encompassing the development of these traits “following exposure to an extreme traumatic stressor” (DSM-IV 424).

To further clarify, when we use the term “memory,” we are usually referring to either “working memory” or “narrative memory.”  Working memory “holds short term information for the purposes of performing a current process” (Field 326).  On the other hand, narrative memory is a form of long-term memory in which past experiences have been integrated and are available for conscious recall and reflection.  Since trauma occurs “[u]nder extreme conditions, existing meaning schemes may be entirely unable to accommodate frightening experiences, which causes the memory of these experiences to be stored differently and not available for retrieval under ordinary conditions” (van der Kolk 160)*. This loss of meaning schema makes trauma narratives disjointed and fragmented.

*van der Kolk, B. (1996). Trauma and memory. In B. A. van der Kolk, A. C. McFarlane,
& L. Weisuth (Eds.) Traumatic stress : the effects of overwhelming experience on mind, body, and society. New York: Guilford Press.

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