I think I can't, I think I can't

December 28, 2004 1:03 AM

"Things just happen, he had decided; they happen and they happen again, and anybody who tries to make sense out of it goes out of his mind."

For this reason, Tom Rath, the hero of Sloan Wilson's 1955 novel The Man in the Gray Flannel Suit, decides not to "make sense" of the the atrocities to which he bears witness during World War II. Instead, he accepts that war is in itself irrational, and that he must simply forget its horrors before returning to civilian life. This New Yorker article contrasts Wilson's 1950's stoicism with today's veneration of the grieving process and suggests that this change in attitude has led us to vastly underestimate our own capacity for coping with trauma. The author also draws some interesting parallels with a controversial study in which victims of childhood sexual abuse were found to be no more likely than others to suffer from mental health problems as adults. Intriguing stuff, to say the least, and as I read it, I can't help but think of Johnny Cash's "The Man Who Couldn't Cry"

(Note: Having thankfully never been subjected to war or sexual abuse myself, I am in no way attempting to demean the anguish of those who have. Rather, I'm more interested in the idea that people are stronger than they give themselves credit for, and how different upbringings affect our experience of trauma.)
posted by idontlikewords (41 comments total)

I've heard about this before. Apparently that study was vociferously attacked, as it is sacrilegious to even suggest that some of what we consider child "sex abuse" is not. Of course it's a very touchy subject - sexual abuse of children is indeed a huge problem and is probably underreported everywhere. But social conventions force us to say that all child sex is bad, when clearly that is not ALWAYS the case. I don't think we'll be seeing any enlightenment on this subject anytime soon; our religiously-influenced views of sexuality are still amazingly primitive.
posted by aerify at 6:11 AM on December 28, 2004

One of the points of the New Yorker article was that the study in question did not even address whether or not abuse is bad; of course it is. What the study did was show that children recover from all but the worst abuse much better than many people imagine.
posted by TedW at 6:32 AM on December 28, 2004

Its seems to be summarised neatly here (from the New Yorker article):

"It's not as if the authors said that C.S.A. was a good thing. They just suggested that it didn't cause as many problems as we'd thought--and the question of whether C.S.A. is morally wrong doesn't hinge on its long-term consequences. Nor did the study say that sexual abuse was harmless. On average, the researchers concluded, the long-term damage is small. But that average is made up of cases where the damage is hard to find (like C.S.A. involving adolescent boys) and cases where the damage is quite significant (like father-daughter incest). "
posted by blindsam at 6:33 AM on December 28, 2004

I think that perhaps people are stronger than they give themselves credit for, however.... there are some basic assumptions to much of the above material, that i disagree with.

1.) assumption one, quietness and the ability to internalize/and or deny external events = healthy. This tends to be a masculine method of dealing with issues, and for short term effectiveness it is great, but anything beyond that it tends to suck.

2.) Assumption two. wether you intended to or not, you seem to indicate that mental illness can be dealt with by ignoring it. I don't think the rate of MI was any lower in previous generations, perhaps the rate of reporting was. In part because of the stigma attached to it.

3.) Trauma IS experienced differently and one cannot presume that the same coping methods work for everyone, however there are generalities that tend to work for most people, and that does not include clamming up.

4.) Without doing a search, it seems the most rectitude minded societies have been some of the most externally violent, Germany, Russia, japan, at least in my mind how internalized as a whole a nation is can be an indicator of how aggressive it can be.

5.) Regarding sexual trauma.... there are genetic predisposition towards certain mental illnesses in some (many) people, which does not mean that said individual will become MI, but under the right stressors/environmental factors this illness has a high chance of occurring. Sexual abuse is one. War is another, any large scale disaster....

We still do not understand mi very well, in part because each brain is unique. Which is why saying stuff like, "we'll HE didn't turn out funny, and he went through worse" is pointless and harmful. But i think we are making progress in some areas. Currently my belief is there is an overreliance on medication for everything. Psychotropic medication is certainly very vital to many people, but I question its current pervasiveness. [sorry that doesn't exact relate to above post]

[disclaimer: I do work in the mental health field, so some opinions are biased]

On preview: I think that might be a bit of a red herring aerify. Abuse from a functional standpoint is often looked at an act that causes harm, or an abuse of power relationships. So some consensual child 2 child sexual exploration may not be abuse, but child 2 adult may indeed be abuse because of the power relations and the absent of the choice of the child to consent. There is a reason why all societies have clear guidelines surrounding these issues.
posted by edgeways at 6:34 AM on December 28, 2004

oh, one thing C.S.A. = Child Sexual Abuse...
posted by blindsam at 6:35 AM on December 28, 2004

Yeah, and those 50's people who couldn't cry ended up beating their kids and wives. But hey, at least they weren't SAD in front of the neighbors, that'd be showing weakness!

No thanks.
posted by u.n. owen at 6:35 AM on December 28, 2004

While I agree that people tend to wallow in their trauma too much nowadays, this grey flannel stoicism sounds less like a successful coping strategy than a drinking game - blow up your best friend, take a drink. Live an unexamined life in the suburbs, take a drink. Become an alcoholic, take a drink.
posted by fleetmouse at 6:46 AM on December 28, 2004

If memory serves me correctly, O'Brien was in fact a combat vet of Viet Nam...he knows. I can not speak about the writer of The Man etc...I have met a number of vets from Nam war and they have or have had very strong reactions to that experience. If horrible memories are readily put aside, then chat with holocaust survivors or their children to see if it is stoically pushed aside. I can not speak about sexual abuse other than noting that I have read over and over that abusers tend to be children who themselves were abused.
posted by Postroad at 7:10 AM on December 28, 2004

edgeways - "3.) Trauma IS experienced differently and one cannot presume that the same coping methods work for everyone, however there are generalities that tend to work for most people, and that does not include clamming up."

So what does it take for a patient/client of yours to convince you that rectitude is in fact the best coping method for him or her?
posted by rainbaby at 7:15 AM on December 28, 2004

Wow, that's a doozy of a controversial study. I'll classify "Child Abuse, Not So Bad?" along with "Global Warming, No Big Deal?", "Racial Differences, Do They Matter?", and "The Holocaust, Did It Happen?" as science questions guaranteed to piss people off in this day and age. Personally, I think that's precisely why they deserve full and rigorous discussion. *ducks*

Here's what Google turned up on the outrage du jour:

The controversial article itself, "A Meta-Analytic Examination of Assumed Properties of Child Sexual Abuse Using College Samples", long and detailed: 1, 2 (both PDF)

Articles against: one details methodological shortcomings, then actually exclaims, "Where is the outrage?". Another calls the article an advocacy paper that inappropriately uses science in an attempt to legitimize its findings. FWIW both articles seem overtly political. However, they argue the original article is only pretending to be scientific (I wouldn't have thought this was a straightforward left/right issue, but what do I know). Article for: Politically Incorrect - Scientifically Correct. Also, discussion for and against on an APA forum.

Then there's the matter of the unanimously-passed 1999 Congressional resolution, which "condemns and denounces all suggestions in the article ... that indicate that sexual relationships between adults and `willing' children are less harmful than believed". Which reminds me of earlier attempts to legislate the value of Pi. Later that day, Congress bravely and unanimously rejected all past, present, and future suggestions that anything better than motherhood and apple pie might exist.
posted by Turtle at 7:25 AM on December 28, 2004

Coincidentally I was catching up on magazines last night and read this in the bath. Very interesting, though Gladwell, while being a tremendously accessible and entertaining writer, always leaves me with a sense of being a tad too glib and pat about complex and serious issues.

I do think it's interesting to question the current orthodoxy that exploring and venting your feelings is healthier than trying to ignore and forget them.

Edgeways, one of the things in the article that struck me was this:

"In 1955, the population of New York State's twenty-seven psychiatric hospitals was nearly ninety-four thousand. (Today, largely because of anti-psychotic drugs, it is less than six thousand.)"

Is it really because of drugs? Or funding cuts that sent many people to the streets? Or what? I would have assumed we had MORE people locked up now than 50 years ago.

Also, the article didn't specifically allude to it, but the art did: we must brace for a terrible wave of PTSD coming from Iraq.
posted by CunningLinguist at 7:28 AM on December 28, 2004

I learned at the age of 18 that there are some issues you just can't think about. You have to refuse to think about them and just bury them in the back of your consciousness. Ostracize them like the worst friend you ever had. No amount of thinking them over, rationalizing them will ever bring you to any resolution.

The number of issues that are hidden in that dark closet continue to grow throughout my life. There will always be new things to add. Having this closet hasn't given me mental illness or turned me into some abusive psychopath. It has made me happier. I learned that thinking about certain subjects only makes me miserable. As soon as I refuse to think about them and bury them in my mind, I feel much better.

Denial works in many instances.

I think this is true even on a neurological level. Our memories and emotions are only responses to stimuli within our neurons. The connections between our neurons and the stimuli that move between them are dynamic.

The axons and dendrites of our brain are like muscles. They strengthen or weaken with use or disuse. The more you think about a painful or traumatic event, the more you reinforce that memory and the more connections you build between the neurons which form that memory and the neurons which form new memories.

By reliving a traumatic event, you are only insinuating it deeper and stronger into your consciousness every day.

If you refuse to think about a subject, the connections to that memory will whither and die. They may not disappear entirely, but their connection to new memories and to every day consciousness will weaken.

We do have control over our minds, our memories and our emotions. We are living in a culture that wants to deny this and turn us all into victims in need of psychiatric care. There is an entire industry built upon this. It also gives legitimacy to the goverment powers that want to impose more control over our lives.
posted by PigAlien at 7:51 AM on December 28, 2004

But social conventions force us to say that all child sex is bad, when clearly that is not ALWAYS the case.

Sex play between children can be fine, of course. However, I believe that all sex between children and adults is bad. Nor do I apologize for that belief. It is not inspired by my religious background, but by my own experiences of having been sexually abused as a child by a trusted adult.

As for this article (which I could have sworn we had discussed here before, but couldn't find it)--Gladwell's tying this to The Man in the Gray Flannel Suit is ridiculous. If he had read the book with any degree of care, he would realize that the character of Tom Rath (check out the name!) is meant to be a desperately angry, confused man.

Wilson is not commending Rath's approach to dealing with his experiences, but merely chronicling the approach. The message of The Man in the Gray Flannel Suit is no more "Repression is great!" than the message of Madame Bovary is "Adultery is liberating!"
posted by Sidhedevil at 8:03 AM on December 28, 2004

A buddy of mine, who happened to be an Army Ranger and D-Day vet, said he thought he was handling the trauma of war pretty well. He also said he understood why others might have handled it differently, as he had men he served with who were never the same after some horrible incident.

Then he said he got a real lesson in how well he was handling the things he had seen and done when he got married. Seems that after a year of being married he woke up alone, went to find his wife, and found her crying. She said she would be alright, in a bit, but it always made her so sad when his buddy Thompkins died.

Apparently, whle healthy as a horse during the day, he spent a good part of every night reliving battles, usually for about 20 minutes at a time, 2 to 4 times a night.

He didn't believe her, until she related to him the names of campaigns, towns, weapons, buddies, and worst of all, the dead. She told him names of people that died that he was certain he hadn't even known, and he didn't remember them until she told him their names, when suddenly "they were before my face, as if they were in the living room with us". Thompkins, Fitzgerald, Wyse, the list went on and on, "until the room was crowded with ghosts".

These "fits", as he called them, diminished over time but never really went away, and he said he always felt bad because while the war for him was just over a year long, his wife ended up living it fought in their bed for over 40 years.

When his wife died a few years ago, he buried her with his first Bronze Star, awarded to her by him for meritorious service after one particularly bad night.

He died this spring, and at the visitation his family had set up tables according to his wishes, one with examples of his life's work, another with pictures of his family, and the third with items related to his service in the war. Along with the Bronze and Silver Stars, his Purple Hearts, the commendations for his medals, was a single sheet of paper, small type, two columns, untitled, listing men's names, with no other indication of what it was supposed to signify. But I knew, as soon as I saw Thompkins, that this was the army of the night, and this service was also for them. For now, at least in one less bedroom, they would finally cease be summoned, and maybe a little more rest might be granted to them, and to their buddy, my friend, as well.
posted by dglynn at 8:14 AM on December 28, 2004 [19 favorites]

Thank you for this: The message of The Man in the Gray Flannel Suit is no more "Repression is great!" than the message of Madame Bovary is "Adultery is liberating!"

CL-There are several different things that contribute to the deinstitutionalization of people with mental illness. Medications are certainly one of them, even when the meds do not work very well. But, there is a kind of slight of hand with community based solutions to persistent mental illnesses, in that they do not take less managing in the community. Maintaining housing, ADLs, all of those things, is a full time job for many many case managers.

On the other hand, under Reagan and beyond there was a huge defunding of institutions, and hence, a huge rise in the population of homeless mental ill folks. At the same time, there was a big rise in the prison population (although it was bigger under Clinton) and many of those prisoners are diagnosed with some serious mental illnesses. Some of those people would have been institutionalized in a different age.
posted by OmieWise at 8:17 AM on December 28, 2004

I've often thought the issue of child sexual abuse is similar to that of rape in islamic and hindu cultures. The woman who has been raped is a symbol of the shame that has been cast on the community by the rape itself, moreso than the man who committed the act himself. Women who have been raped are often killed and even beg to be killed rather than live with that shame.

The problem in our society is that we don't want victims of child sexual abuse to feel ashamed, but the end result is that they do feel ashamed because of the awful stigma that it bears.

I think the author of this article is correct in saying that we underestimate our own ability to heal after traumatic events. The problem is, it is very difficult to heal from something like child sexual abuse when every time you turn on the TV you see hysteria any time the topic is discussed. Opening up your mail to receive a sexual predator notice only reinforces that.

How can the victims of child sexual abuse put these memories behind them and move on when our culture is constantly bombarding them with how horrible and evil the whole experience is?

Child sexual abuse is a crime, and it should be treated as just that - a private issue between the parties involved and the law. Turning it into a cultural phenomenon doesn't help the victims, it only makes their situation worse.
posted by PigAlien at 8:31 AM on December 28, 2004

The thesis of this article as I read it:

Our contemporary view of the "healthy way" to handle trauma and grief may not be any more enlightened than the view from 50 years ago. Don't underestimate the mind's ability to recover - doing so may create more problems.

I think this is a liberating view.
posted by dammitjim at 8:40 AM on December 28, 2004

A thought transfixed me: for the first time in my life I saw the truth as it is set into song by so many poets, proclaimed as the final wisdom by so many thinkers. The truth--that love is the ultimate and the highest goal to which man can aspire. Then I grasped the meaning of the greatest secret that human poetry and human thought and belief have to impart: The salvation of man is through love and in love. I understood how a man who has nothing left in this world may still know bliss, be it only for a brief moment, in the contemplation of his beloved. In a position of utter desolation, when a man cannot express himself in positive action, when his only achievement may consist in enduring his sufferings in the right way--an honorable way--in such a position man can, through loving contemplation of the image he carries of his beloved, achieve fulfillment. For the first time in my life, I was able to understand the words, "The angels are lost in perpetual contemplation of an infinite glory."

Viktor Frankl

From the New York Times Obituary for Victor Frankl:

Frankl survived the Holocaust, even though he was in four Nazi death camps including Auschwitz from 1942-45, but his parents and other members of his family died in the concentration camps.

During -- and partly because of -- his suffering in concentration camps, Frankl developed a revolutionary approach to psychotherapy known as logotherapy.

At the core of his theory is the belief that humanity's primary motivational force is the search for meaning, and the work of the logotherapist centers on helping the patient find personal meaning in life, however dismal the circumstances may be.

Frankl wrote that one can discover the meaning in life in three ways: "by creating a work or doing a deed; by experiencing something or encountering someone; and by the attitude we take toward unavoidable suffering."

Viktor Frankl
posted by y2karl at 8:52 AM on December 28, 2004

A lot of coping has to do with the narrative into which one can fit troubling events.

You rarely hear of people with PTSD flashbacks of a marathon they finished, even though (objectively) they may have been in the worst physical distress of their lives around mile 20. That's because it fits into a narrative of triumph and satisfaction. Women who've delivered children, same thing.

It was exceptionally difficult for foot soldiers in Vietnam to construct a mitigating narrative around their experience. In part this was because of the tactical nature of the war -- very little in the way physical advances, conquest of defined geographic objectives one after the other. In part this was because of the geopolitical nature of the war -- it was easy to see it as "lost," a futile endevor. (Of course, if one views it as merely one campaign in a global war against communism, it could be easily seen as not lost at all, at least looking back from 1991.)

Most of all, the core of the normalizing narrative of war has to do with small group dynamics. World War Two combat soldiers served together in pursuit of a common long-term objective of victory, in units which were a very helpful combination of homogenity (virtually all young white Christian men with a very similar idelogical viewpoint, or perhaps nonviewpoint() and heterogenity (military service was universal, so virtually all regions, social backgrounds, and ethnic backgrounds served).

Vietnam combat units were the opposit in almost every respect. Almost always men joined units as individual replacements and had only an individual goal -- to survive through their required minimum term of service, after which they'd be replaced. The homogenity/heterogenity characteristics were almost completely reversed -- the men had highly varying ideological views of the war, were from different races, and arrived at service in a decidely non universal environment, where people volunteered, were drafted, and avoided service all together very unevenly with regard to race, class and region.

I think it's reasonable to suppose that the degree of PTSD coming out of Iraq will be much less than that coming from Vietnam. First, the tempo of combat is far lower. Second, the unit dynamics are probably somewhat better. The military is considerably more homogenous than it was in the 1960s. The anti-terrorist ideological basis of the war might be disbelieved on MeFi, but it's largely believed in the ranks. Units arrive in theater, and depart theater, together.
posted by MattD at 8:52 AM on December 28, 2004

Turtle - one of the articles you link to is from narth.com, an anti-homosexual site that claims homosexuality is a disease that can be cured. Run, naturally, by the Christian right.
posted by aerify at 8:53 AM on December 28, 2004

It is interesting to note that the "repressed" culture of the 1950s that all of us have been rebelling against for the past half century was created for the most part by people who had survived not only World War II, but the Great Depression. We Baby Boomers thought our dads were so out of it, so sheltered, and so uptight compared to ourselves. But for the most part, they had done and endured and seen things that were beyond our wildest imaginations. All those TV dads we hated so much -- from Ward Cleaver to Robert Young in "Father Knows Best" -- had probably killed men in hand-to-hand combat, raped German housefraus, shoved flame throwers down Japanese bunkers. They'd gone from Depression childhoods, to travelling around the world, meeting interesting people, and killing them.

The reason the culture of the late 1940s and 50s is so repressed is because the men who created had SO MUCH to repress. If those guys had let it all hang out, it wouldn't have been pretty.
posted by Faze at 8:55 AM on December 28, 2004

I think it's intuitive, but isn't that kind of the problem in the U.S., the lack of introspection?
I mean, actually thinking about, for example, why you were sent somewhere by whom, for what reasons, to do what...it might provoke rage! Or even refusal.
On preview, Faze, exactly; didn't their children (some of them) grow up to refuse to participate?
posted by atchafalaya at 9:04 AM on December 28, 2004

The ideas in the article reminded me of a favorite passage from Huxley's Island. Will Farnaby has just arrived on the island after surviving a horrible storm at sea and an arduous climb to safety during which he nearly died in a fall. Some children come across him trembling on the shore and begin asking him how he got there. Will is too shaken to relate his story, and being interrogated by the kids only seems to make it worse. Nevertheless, the children keep on with their questioning and finally ask:

"Remember what happened when you were a little boy. What did your mother do when you hurt yourself?"
She had taken him in her arms, had said, "My poor baby, my poor little baby."
"She did that?" The child spoke in a tone of shocked amazement. "But that's awful! That's the way to rub it in. 'My poor baby,' she repeated derisively, "it must have gone on hurting for hours. And you'd never forget it."

On Preview: Viktor Frankl's is a truly inspiring story, and the subject of one of David Foster's Wallace's Brief Interviews with Hideous Men.
posted by idontlikewords at 9:05 AM on December 28, 2004

Turtle's link above, labelled Politically Incorrect-Scientifically Correct, is a very good one. It lays out several of the issues surrounding our current notions of trauma and how it operates.

Trauma, and PTSD, as psychological entities are tied to war and to war-related neuroses. They have gradually expanded to encompass our general explanation of how the human mind works. Some of the expansion has been because we now understand that psych symptoms brought on by war look very similar to those brought on by a rape, but some of the expansion has been less well-grounded.

As it stands, the current notion is that trauma is psychologically bad for you, and that it produces affects that, even if unseen, will reveal themselves to your detriment later. A corollary of this supposition is that unwanted moods and affects are best explained by a trauma, so one should be sought if it is not proximate and obvious.

There are several problems with this view. The one that the study seems to be suggesting, albeit with an agenda that I think is misguided, is that not everyone reacts to trauma in the same way. For some, events are traumatic, for others they seem like adventures or things simply best ignored. None of these responses is the correct one, but more importantly, none is necessary either. In his classic book Narrative Truth and Historical Truth, the psychoanalyst Donald Spence relates the story of one of his patients who experienced her flight from the Nazis as a thrilling break from routine. Her parents were traumatised, she was excited.

Not only does a position which holds a certain type of event to be self-evidently damaging fail to account for the different psychological uses and adaptations that people make of experience, it also risks expanding the definition of trauma based on the affects that an event calls forth. This, in turn, risks trivializing both trauma and human experience. Raped? Trauma. Buddy blown up? Trauma. Boss snaps at you? Trauma. Spanked by your mother? Trauma. The problem with making trauma the gold standard for psychological assessment is that human beings have rich and varied mental lives that are not constrained by actual events or reactions to them. Not everything that effects me does so because it is traumatic, and not everything that could be traumatic effects me.

There is a space between an event and how we understand that event. Within that space there is a choice made about how we are going to deal with the event. That choice is not always ours to consciously make, but we make it nonetheless. This is one of the reasons that therapy works, because we can begin to choose differently. Not better or worse, just differently. This choice is not a choice like what movie we're going to see, it is a choice like what kind of personality we're going to have: it is constrained by many variables, it is largely made for us by circumstances, it is persistent and the fact that it is a choice does not suggest any kind of value judgement about which choice we have made. We may have made the only choice open to us.

The CSA community is very adamant that CSA is always traumatic, and they are so with good reason. CSA is largely unreported, too often dismissed, and its affects are mosst often blamed on the victim. It's an untenable situation and should not only be deplored, but fought with whatever means available. Arguing for the salience of trauma is one of those means.

On preview: yes to MattD on narrative.
aerify-the org is ridiculous, but the first part of the link is actually decent if you read it.
posted by OmieWise at 9:15 AM on December 28, 2004

dglynn that was a gorgeously written post. Thank you.
posted by CunningLinguist at 9:38 AM on December 28, 2004

What an informative and helpful thread. dglynn, omiewise, edgeways, and everyone else, excellent comments.
posted by chicobangs at 9:47 AM on December 28, 2004

great read, and i tend to agree with the author and PigAlien. to me, the major point of the article was that expectation of trauma is greater than the reality.

idontlikewords' reference to Island is good too. the perception of our traumas are affected significantly by how the people close to us perceive them. because their expectations are worse than our reality, it affects our own perceptions drastically. consider a baby who falls down and the parents say "oops!" and laugh about it with a baby who falls down and the parents say "OH MY GOD!"

when my apartment burned down and i lost everything i owned, i was pretty fine when talking to the firemen and my roommates. it was only after i called relatives and loved ones that i began to feel bad, but mostly because they felt so bad.

of course, there's a big difference between "normal" grief and the atrocities of war, but i think the main point is very accurate. again, great read. i might have to pick up The Tipping Point now.

excellent reference, y2karl. i almost missed it with all the small print.

Happiness must happen, and the same holds for success: you have to let it happen by not caring about it. I want you to listen to what your conscience commands you to do and go on to carry it out to the best of your knowledge. Then you will live to see that in the long-run - in the long-run, I say! - success will follow you precisely because you had forgotten to think about it.

amen.
posted by mrgrimm at 10:39 AM on December 28, 2004

mrgrimm - the Tipping Point is really interesting. Though he often bugs me with his glibness, I can't wait for his new one, which is coming out soon.
posted by CunningLinguist at 10:48 AM on December 28, 2004

Fascinating article. Yes, people deal with traumatic events in different ways. And one of them can be to say, "this was irrational and horrible. I shall move on, back to the rational world, and not dwell on the irrational horror".

I've dealt with all too many people, including more than a few mental health professionals, who insisted that, as someone who went through long term CSA, physical abuse and emotional abuse as a child, I had to be messed up, treated, medicated, encouraged to explore my victimization and pitied. This infuriated me.

Now, I just avoid people like that while living my boring, functional, adult life and coping with the occasional flashback or other issue. I'm not some damaged victim, I'm a sane adult who went through some insane stuff, survived, and moved on.

This isn't to say that other people shouldn't get the kind of treatments they need. It is simply pleasant to see acknowledgement that "one size fits all" psychiatry doesn't work.
posted by QIbHom at 12:31 PM on December 28, 2004

dglynn - that was stunning. thank-you.
posted by andrew cooke at 12:48 PM on December 28, 2004

one of the advantages of a more "victim-centred" approach is that, while people who don't need help are free to get on with their lives, those that do are provided with a supportive environment.

here in chile a report on torture was recently published. my impression is that, since democracy returned some time ago, issues like this were largely put aside. in any case, i know of at least one case where the report has started people talking who have gone on to find some help in knowing that the long-term effects they experience and/or see in their family are shared by others.

unrelated to that, one other thing that struck me is that the people we rely on to report such things - people like primo levi or jean amery - are going to be those who are driven in some way. so the people we get information from are those that either "haven't handled the situation well" or, more accurately handle it by sharing their experiences. i'm not sure how that biases things.
posted by andrew cooke at 1:00 PM on December 28, 2004

dglynn, thank you for that gorgeous piece of writing and for sharing that story with us here.


And, QIbHom, I agree wholeheartedly with your conclusion--"Everybody explore!" doesn't work any better than "Everybody repress!" Each person needs to do his or her own understanding, grieving, and recovery in his or her own way.
posted by Sidhedevil at 1:06 PM on December 28, 2004

Great article, great discussion.

I've noticed a funny thing in how much trash media, be it fiction or the news, treats CSA like some Grimm's tale, or a horror movie. It's this mutated moral outrage. Child abuse is treated not as this thing that happens by and to real people, but as this horrible event from another plane of reality - I'm thinking of hysterical news pieces on how to avoid trenchcoated sexual predators, or the glib manner in which awful movies such as "The Cell" exploit the trauma of child abuse into something resembling demon possession, or something like that. There's a certain banality of evil here not addressed, if not completely excluded.

This demonization of CSA, in the sense of branding the abusers as purely evil monsters and the victims as damaged for life, if not future monsters themselves, strikes a curious note with me - it goes past real compassion for the victims, into a sort of territory where some people would rather deal with horrible, pointy-teethed creatures than with a very real (and terrifying) reality. This extends to this dehumanizing myth that all CSA survivors will forever be emotional cripples.

I feel that this sort of wildly simplified moral theater is more a thing of pop culture - extending into pop psychology - than the serious therapeutic community. But nonetheless, at least in part, I feel that this sort of shrill view of CSA contributes, at least in some small way, to the difficulty victims may find in reporting their abuse. CSA is made to seem so impossible to even contemplate, that almost no one actually does. The knee-jerk reaction to CSA as the worst thing there can ever be impedes a true appreciation of how it can and does hurt people - it's not that there's anything wrong with "CSA is bad" as a conclusion, but having that a priori as part of this heavily fictionalized myth in our culture could obstruct the sort of reflection that could lead to happier lives for survivors. In having such a loud, emphatic conclusion thrown at you, it could short-circuit your own thoughts on the matter.

Am I making sense? I dunno. I'm rambling. I haven't the foggiest idea of what to do about this, but there you go.

For further ululations on this topic, watch the Brass Eye Special on pedophilia, which was the first thing to get me to think on this matter.
posted by Sticherbeast at 1:14 PM on December 28, 2004

That Brass Eye special was so hysterical - especially when they blasted the paedophile into outer space and accidentally locked a child in the capsule with him!

Anyway, I got exactly what you were saying, Stitcherbeast and wholeheartedly agree.
posted by PigAlien at 1:33 PM on December 28, 2004

I guess my original point was that sometimes what we think of as trauma can be avoided by the individual's conscious state, that doesn't change the fact that the trauma has burned a hole into the inside of one's head. PigAlien's idea that "some issues you just can't think about" just reminded me of my friend. He lived his waking life with a perfect realization that what was done was done, and apparently had no problems at all, but had an alternate life of the mind, totally against his will, where the past was still wrestled with almost nightly.

And I don't want to leave anyone with the wrong impression, he was in no way what we would think of as a tortured soul. He was in fact one of the most outgoing people I ever knew, kind and generous, with a great big sprawling happy family.

He was also haunted in his sleep, and was lucky to have a wife that refused to let him go through it alone.
posted by dglynn at 2:08 PM on December 28, 2004

I think it's reasonable to suppose that the degree of PTSD coming out of Iraq will be much less than that coming from Vietnam. First, the tempo of combat is far lower. Second, the unit dynamics are probably somewhat better. The military is considerably more homogenous than it was in the 1960s. The anti-terrorist ideological basis of the war might be disbelieved on MeFi, but it's largely believed in the ranks. Units arrive in theater, and depart theater, together.

"People see the figure 1,200 dead," Dr. Evan Kanter, a psychiatrist at a Seattle veterans hospital, told Scott Shane of The New York Times. "Much more rarely do they see the number of wounded. And almost never do they hear anything at all about the psychiatric casualties." Given the bloodshed they have seen and inflicted in intense urban combat, and the fear they experienced from the moment they arrive to the moment they leave Iraq—including, as the rocket attack on the Army mess hall in Mosul horrifically dramatized, when they are "off-duty"—the number of Iraq and Afghanistan war veterans who will suffer symptoms of serious mental illness may exceed 100,000. They "are going to need help for the next thirty-five years," according to Stephen L. Robinson, the executive director of the National Gulf War Resource Center. To use Cordesman's scale, if the war lasts four more years it may inflict several hundred thousand psychiatric casualties. Already 31,000 U.S. veterans have applied for "disability benefits" for physical and psychological injuries. Nine thousand have been "wounded." A combat wound is a rifle grenade hitting you on the jaw and driving your bottom teeth into the roof of your mouth. It is a rain of hot metal pulping your eyes. It is all the booted feet in the world concentrated in one piece of shrapnel crushing your groin. It is never walking again, never making love again, losing your sense of taste forever because Donald Rumsfeld did not care enough about you to armor your vehicle. Readers who can tolerate the sight of amputated limbs should see the photographs that accompany a recent New England Journal of Medicine article on battlefield wounds. If the occupation—and insurgency—drags on until the end of Bush's term, the wounded will number more than 25,000. A member of the provisional Iraqi government recently said that, given the growing strength of the insurgency, U.S. troops may need to stay ten years, long enough to double Cordesman's numbers...

The Butcher's Bill
posted by y2karl at 3:47 PM on December 28, 2004

dglynn, your post was one of the best things I've ever read here. Thanks.
posted by melissa may at 4:02 PM on December 28, 2004

I found the take refreshing, too. I had destructive habits that needed to be addressed. Insurance the way it is, I was flying blind. All the professionals I was referred to were caring individuals, but seemed to follow a protocol of "what was the trauma." The nature of my habits led them ALL to ask: "were you abused." The answer was no. And to their credit, none of them pushed it. All I wanted was for some help as to what to DO. Yes, I went cognitive, but they all said, "this is what works, talk it out." Or, "find God" whom I don't believe in. "Go to meetings." Yech. Those folks also assumed I was abused. On the plus side, I decided all that didn't work for me, and I was able to mitigate my problems. But it would have been nice if the professionals had an alternate protocol for people wired like me, and things could have been taken care of quicker. Am I cured? No. But I totally function. And I dread and fear and will not go back to get HELP in the future.

Great post.
posted by rainbaby at 4:02 PM on December 28, 2004

Everybody wants to be a victim these days.
The actual victims, more often than not, just wanna get on with their lives.
How much of the emotional trauma people experience is caused by having everyone focus intently on the idea that you should be upset?
You start wondering, "Is something wrong with me? Why am I not more upset about this?" It becomes a fixation, you search for any sign that you're reacting "normally", and eventually you find some molehill of pain and make it into a mountain for them.
I was abused. I got over it. Whenever I mention it to anyone, it seems they can't.
posted by nightchrome at 5:25 PM on December 28, 2004

I think it's reasonable to suppose that the degree of PTSD coming out of Iraq will be much less than that coming from Vietnam. First, the tempo of combat is far lower...

General MattD of the 82nd Couchborne

After factoring in medical, doctrinal, and technological improvements, infantry duty in Iraq circa 2004 comes out just as intense as infantry duty in Vietnam circa 1966—and in some cases more lethal. Even discrete engagements, such as the battle of Hue City in 1968 and the battles for Fallujah in 2004, tell a similar tale: Today's grunts are patrolling a battlefield every bit as deadly as the crucible their fathers faced in Southeast Asia.

....Without controlling for any of the advances in medical technology, medical evacuation, body armor, or military technology, U.S. losses in Fallujah almost equal those of Hue. If you factor in the improvements in medical technology alone, then the fight for Fallujah was just as costly (or maybe more so) as that for Hue, as measured by the number of mortal wounds sustained by U.S. troops.

Iraq 2004 Looks Like Vietnam 1966

/derail
posted by y2karl at 5:41 PM on December 28, 2004

Now, I just avoid people like that while living my boring, functional, adult life and coping with the occasional flashback or other issue. I'm not some damaged victim, I'm a sane adult who went through some insane stuff, survived, and moved on. - QIbHom

And that's being a survivor. It does work differently for different people. I survived a rape, and for the first year I tried to ignore it, forget about it, etc. Then I started seeing effects from this in my everyday life - falling grades, low self-esteem, lack of motivation, quick to anger. Then I did some of the talk-it-out therapy stuff for a while. And now I live similarly to what you describe. A boring functional adult life where occasionally issues will come up, but it doesn't dominate my life anymore. I refuse to give up the rest of my life to my abuser.
posted by raedyn at 2:18 PM on December 29, 2004