‘Repress Yourself,’

says psychiatrist Lauren Slater:

You’ve been in therapy for years.You’ve time-traveled back to your childhood home, to your mother’s makeup mirror with its ring of pearl lights. You’ve uncovered, or recovered, the bad baby sitter, his hands on you, and yet still, you’re no better. You feel foggy and low; you flinch at intimate touch; you startle at even the slightest sounds, and you are impaired. Hundreds of sessions of talk have led you here, back to the place you started, even though you’ve followed all advice. You have self-soothed and dredged up; you have cried and curled up; you have aimed for integration in your fractured, broken brain.

This is common, the fractured, broken brain and the uselessness of talk therapy to make it better. A study done by H.J. Eysenck in 1952, a study that still causes some embarrassment to the field, found that psychotherapy in general helped no more, no less, than the slow passing of time. As for insight, no one has yet demonstrably proved that it is linked to recovery. What actually does help is anyone’s best guess — probably some sort of fire, directly under your behind — and what leads to relief? Maybe love and work, maybe medicine. Maybe repression. Repression? Isn’t that the thing that makes you sick, that splits you off, so demons come dancing back? Doesn’t that cause holes in the stomach and chancres in the colon and a general impoverishment of spirit? Maybe not. New research shows that some traumatized people may be better off repressing the experience than illuminating it in therapy. If you’re stuck and scared, perhaps you should not remember but forget. Avoid. That’s right. Tamp it down. Up you go. NY Times Magazine

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The ‘trauma establishment’ in modern mental health care is an enormous edifice which largely arose as a legitimate feminist-driven backlash against at least a century of misogyny in psychiatric care — ever since Freud revised his theory of infantile trauma shortly after the turn of the century with the declaration that the memories of abuse he was seeing in his female patients with ‘hysteria’ were merely fantasies. Yet several crucial mistakes in the use of the trauma concept in modern mental health care have rendered it an overblown, ineffective approach that often does more harm than good (and leave it open to the embarrassing ‘Emperor’s-new-clothes’ findings about the ineffectiveness of post-trauma acute interventions such as those which have been emerging after 9-11).

First, the assumption that trauma underlies much psychiatric distress, at least in female patients, has been unleashed in the hands of inexperienced, unsubtle, polemical mental health practitioners with an irrational, religious zeal. In its most extreme fashion, the fervent and uncritical hunt for a history of abuse in their patients leads therapists to inject the infamous “false memories” of traumatic scenes which, although facile explanations, never happened. While dramatic, however, this is not the greatest harm induced by the uncritical application of the trauma hypothesis. Far more pervasive is the assumption, in cases where a patient did actually undergo some physical or sexual abuse, that it explains any and all mental health distress the patient currently suffers. This has led to the dilution of the concept of trauma and the diagnosis of post-traumatic stress disorder to the point of meaninglessness.

To paraphrase Bateson, a distinction is a difference that makes a difference, and ‘PTSD’ no longer makes a difference in describing symptomatology, suggesting a treatment approach, or predicting outcome, if almost any event seen as a precipitant to distress is ‘traumatic’. What then gets lost is the crucial clinical and research question — why do some people who suffer a trauma go on to develop PTSD or other post-traumatic syndromes, while others are resilient, integrate it and continue to function well? Both from the point of view of salient characteristics of the trauma and salient characteristics of the sufferer, the possibility of answering this question is obscured. Surely Slater is right that some trauma victims under some circumstances should repress and go on, but it is not clear that she zeroes in on which ones. Undertrained mental health practitioners on a mission, convincing their patients that any and all remembering is better under any and all circumstances, and armed with little more than platitudes about “the courage to heal” and “taking back the night”, certainly do not zero in.

Another aspect of therapeutic nieveté which Slater touches upon is one reaction to the suggestion that we bolster, instead of break through, repression. Some therapists feel that encouraging repression of ‘legitimate’ memories sacrifices the chance to help the patient reach the holy grail of the therapeutic process — the authentic, accurate, total truth about their lives. This ignores the fact that the ‘truth’ one helps a client create for her life in the psychotherapeutic process is narrative truth, inherently different from historical truth.

The next shortcoming in thinking about trauma (about which next to nothing is written and about which Slater is spot on) is to ignore the fact that most trauma sufferers probably never present to mental health providers. The selection bias in generalizing from the subset who are seen works to underestimate the capacity for healthy coping strategies to get one past even horrendous trauma. In the emphasis on psychopathology, as elsewhere in the mental health field, resiliency is not given its due.

The third crucial error of the trauma establishment has been to confuse and conflate several different types of ‘trauma”. (Bonanzas in research funding come from having a larger constituency, especially one that can tap directly into federal dollars!). First is the attention to ‘shellshock’ or combat victims paid by the nascent postwar American psychiatric establishment and augmented by the profession’s advocacy for Vietnam veterans, especially within Veterans’ Administration psychiatric departments. Arguably, most combat veterans had undergone a normal course of development prior to their service. Second has been the research and early intervention edifices that have grown up around horrendous but momentary traumatization due to natural disasters (the 1972 Buffalo Creek flood), massive accidents (airplane crashes, fires and building collapses), and terrorizing crimes (the 1976 Chowchilla, CA schoolbus kidnapping; hostage incidents). Again, the majority of those exposed to such events were ‘normally functioning adults’ previously. Finally come the instances (which I am convinced are the vast minority of cases seen in trauma clinics) in which a person has been repeatedly or continuously traumatized, often for a significant portion of their childhood, within a family or pseudo-family situation, essentially kept captive and terrorized. This subjects the person not only to unbearability but inescapability, and betrayal of the beneficence of early caretakers which is essential to normal development, so early and so repetitively that they never have the chance to develop the resources for trusting relationships or coping strategies. In my impression, these people do not so much develop post-traumatic symptoms as a pervasive post-traumatic personality formation. I have been amazed by the lack of perspective by all but a few of the most thoughtful trauma theorists — such as Dr Judith Herman — about the crucial significance of these distinctions. Slater quotes, but largely dismisses, a psychiatrist acquaintance of mine, Dr. Amy Banks, who aptly puts it this way:

Trauma that happens at the hands of another human being has a much greater psychological impact than trauma that happens from a physical illness, accident or even natural disaster. There’s a bigger destruction in trust and relationships. And to further complicate things, sexual abuse usually happens over time, in a situation of secrecy, to what may be a preverbal child. A heart attack is a public event that involves fully verbal adults who have so much more control over their world.’

Without an appreciation for which trauma sufferers may have the capacity for repression or the ability to keep themselves safe and get to an alliance with a therapist, it is hard to strategize where to apply Slater’s suggestion that we should forsake reexperiencing and leave well enough alone. Certainly, my objections to the ‘trauma establishment’ and the harm it does to patients are largely built on an understanding similar to Slater’s that uncovering and talking-through are overrated and applied indiscriminately. But there is a reprehensible and ignorant attitude attitude toward most sufferers of mental illness abroad; my patients are often reporting to me that family, friends or work associates are telling them to “get over it”, “tough it out”, “try harder”, etc. The danger is that Slater’s argument will be used uncritically as ammunition for this misguided message. As Amy Banks, again, puts it:

…(R)epression is useful for repressors. Is repression useful for those of us with different styles? I doubt it. I think it’s probably harmful.

Is Google too powerful?

A technology consultant (read: not a journalist) writing on the BBC site takes the occasion of the news of the Google purchase of Blogger having been broken on a weblog to beat a dead horse again: Blogging is not journalism.

Ridiculous comments, such as Dan Gillmor’s claim that “with the advent of weblogging, the readers know more than the journalists” only stoke the fires of hyperbole and do not help us understand this new tool.

Blogging is not journalism.

Often it is as far from journalism as it is possible to get, with unsubstantiated rumour, prejudice and gossip masquerading as informed opinion.

Without editors to correct syntax, tidy up the story structure or check facts, it is generally impossible to rely on anything one finds in a blog without verifying it somewhere else – often the much-maligned mainstream media.

The much-praised reputation mechanism that is supposed to ensure that bloggers remain true, honest and factually-correct is, in fact, just the rule of the mob, where those who shout loudest and get the most links are taken more seriously.

He then goes on to some more cogent comments about the dangers Google’s expansion might represent in the privacy sphere, much as I suggested in my initial reaction to the news of the purchase. He concludes, “Perhaps the time has come to recognise this dominant search engine for what it is – a public utility that must be regulated in the public interest.”

Foreign Policy Meets Biblical Prophecy:

“For many believers in biblical prophecy, the Bush administration’s go-it-alone foreign policy, hands-off attitude toward the Israeli-Palestinian conflict, and proposed war on Iraq are not simply actions in the national self-interest or an extension of the war on terrorism, but part of an unfolding divine plan.” — Paul S. Boyer (professor emeritus of history at the University of Wisconsin at Madison and currently a visiting professor of history at the College of William and Mary, and author of When Time Shall Be No More: Prophecy Belief in Modern American Culture), AlterNet.

"Just Shut Up:

Nobody gives a shit what anti-war or pro-war writers think. Really. So shut up. That goes double for poets. Shut the hell up, poets. Everybody just shut up.” The inimitable Neal Pollack thinks what 9-11, the War-on-Terror ® and the impending Just-Because War have mostly subjected us to is bad writing. Lots of it. theStranger And I still think Pollack is the self-important Dave Eggars trying to be provocative. Shut the hell up if you don’t agree.

Perhaps the only reason to watch the Grammy Awards is to see if this happens. [via Drudge Report] Oh, and to see if they continue to heap adulation on the ignorant misogynist Eminem…