The psychological battle over trauma There is a contradiction at the heart of our mental health

The problem is that no one can agree on a definition of trauma, let alone how it should be treated. Progressives and conservatives don’t see eye to eye: either you are a Lefty snowflake with self-diagnosed trauma, or else you are getting on with life’s difficulties without complaining about it.

Psychologists are split down similar lines. When clinicians talk about trauma, they tend to distinguish between two distinct but related kinds of human experience. The first is the type researched by Dr George Bonanno, a professor of clinical psychology at Columbia University, who has been investigating grief and PTSD for more than two decades. He explains that in the DSM, the key diagnostic manual used by psychiatrists in the US, trauma has a very specific definition: “It’s a violent or life-threatening event that is outside the range of normal experience.” This might include a car crash, sexual assault or a period spent in combat. However, Bonanno says, “even the term [‘traumatic experience’] is a misnomer, because even those events don’t always cause trauma reactions… I use the phrase in my research ‘potentially traumatic events’, as no event is inherently traumatic”.

In his book, The End of Trauma, Bonanno points out that most people who endure extreme events — or trauma — tend not to suffer from PTSD. But those who do tend to experience a range of symptoms, such as flashbacks and panic attacks, which usually decline over time. So rather than being slaves to our trauma, Bonanno argues that humans are defined more by our inherent resilience than by our fragility.

Others disagree. Many clinicians would argue there is another kind of trauma that isn’t yet included in the DSM, but which is increasingly seen as a fundamental cause of mental illness. It it caused by experiences that aren’t explicitly violent but which affect us deeply, such as an emotionally abusive relationship in adulthood, or severe emotional neglect in childhood.

The psychotherapist Alex Howard, author of It’s Not Your Fault, distinguishes between overt trauma, as described by Bonanno, and covert trauma, this less tangible, nevertheless traumatic experience. Most of the clinicians I’ve interviewed agree that while we’re relatively good at treating overt trauma when it manifests as PTSD, covert trauma and the resulting “complex PTSD” is harder to deal with as it’s transdiagnostic, encompassing various disorders, and so affects almost every aspect of someone’s life. But this covert trauma, for an increasing number of clinicians, explains why we are the way we are. And through this interpretation, we are moving our conception of mental health away from “what’s wrong with you” and toward “what happened to you?”

It’s hard to exaggerate the importance of this shift in our politics and culture. The degree to which our actions today are shaped by previous traumatic experiences has fundamental implications for criminal justice, social welfare, and healthcare policy. It also marks a dividing line between conservatives, who tend to value self-reliance in the face of adversity, and progressives, who believe we are defined by systems and forces beyond our control. The new narrative around trauma gives weight to the latter, to the ire of conservatives.

However, this new way of thinking about the mind is compelling for the public. Look at the extraordinary success of psychiatrist Bessel van der Kolk’s book The Body Keeps the Score, which spent more than 150 weeks on the New York Times bestseller list. Van der Kolk has argued powerfully for greater recognition of the effects of childhood trauma on adult mental health, and has lobbied for “Developmental Trauma Disorder” — a new construct that would take into account “covert trauma” — to be included in the DSM manual.

The most radical aspect of van der Kolk’s thesis is that past trauma is preserved within the body. While your mind might have dissociated from a traumatic experience, your body “keeps the score” and holds onto it. This means that, until we can fully process our original trauma, it continues to haunt us physically. The implication is that trauma is mysterious and hidden, but also vitally important to find. It dictates our lives and holds the key to our salvation. These are the perfect ingredients to drive a cultural obsession, with the end of suffering always just beyond our reach.

This concept of trauma is hugely popular in what some call the Trauma Industrial Complex: the inevitable industry that has sprung up to offer retreats, therapies, coaching programmes and courses to help people find and move through their trauma. When run by licensed therapists, some of these programmes can be helpful — but they also feed our “trauma-chasing” culture, keeping us chained to it.

Among clinicians, though, van der Kolk’s theories remain contentious. Bonanno is unequivocal in his critique. “There isn’t someplace we can hide memories away,” he tells me, “and there is no anatomical or neuroscience mechanism to explain how you have a trauma hidden in your body.” When I put this to van der Kolk, he listed a series of examples showing that humans could, in fact, repress traumatic memories. For instance, people in road accidents can experience anterograde amnesia, and there’s extensive literature on Holocaust survivors having no memory of their experiences, or of remembering them at a later date.

At first, I was confused that two world experts could disagree about something as fundamental as whether we can forget bad memories. But as it turned out, I’d inadvertently stumbled upon one of the deepest tensions in psychology. This abiding rift over memory stems in part from a controversy in the field that took place three decades ago.

In 1990, a university student called Holly Ramona started therapy for her depression and bulimia. Her therapist, Marche Isabella, told Holly and her mother that bulimia was usually caused by incest, and that 70% of her bulimia patients had been sexually abused as children. Through the course of therapy, Isabella worked with Holly until she seemed to uncover memories of being sexually abused by her father. Her father vehemently denied this, but would go on to lose his job, his marriage, and his family. He became the first person to successfully sue a therapist over implanted memories.

There were hundreds of similar cases involving “recovered memories” of childhood sexual abuse in the Eighties and Nineties, with therapists pushing their patients towards memories they didn’t have. It is a complicated moment in the history of psychology, because childhood sexual abuse is devastating and disturbingly common, and cases of false memories need to be carefully parsed out from real recollections. Some studies have also shown that traumatised people are more likely to have false memories, and Elizabeth Loftus, arguably the most influential researcher in this area, has shown convincingly how suggestible we can be to forming new memories. And even though there was no scientific support for the approach, a cohort of therapists were convinced that memories of abuse could only be unlocked through treatment. But many patients would later recant their “recovered memories”, and a host of lawsuits followed. For more medicalised psychologists, this episode was proof that psychoanalysis was vague, unscientific hokum.

This had lasting consequences for the field of psychology, leaving practitioners stuck between two reductionist positions: that either traumatic memories are entirely real, or that they are entirely manufactured. Neither position seems convincing when we consider the complexity of the mind and the prevalence of childhood abuse. But it partly explains why Bonanno and van der Kolk are at such odds.

It feels like clinicians such as van der Kolk are making the same mistakes as their Eighties predecessors as they encourage millions of people to “find their trauma”.  While there are benefits to destigmatising trauma, there are dangers too. Rachel Yehuda, Director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine, cautions that “if you attribute everything that happens in the world that you don’t like or that you didn’t expect [to trauma]… that can take a concept that could have been very useful and change it quite drastically”.

Just look at the rise of “trigger warnings”. A 2020 study on trauma survivors found that these warnings may in fact worsen anxiety by increasing the “narrative centrality” of trauma among survivors. “Narrative centrality” refers to the degree to which someone identifies with their trauma, and how central it is in how they understand their own life. By increasing narrative centrality, you risk keeping people stuck in their trauma.

This points to the double-edged sword of increased cultural awareness of trauma. On one edge, it opens up more honest and vulnerable conversations about emotional suffering and mental health. On the other, it increases the narrative centrality of trauma throughout society.

As a result, therapists and psychologists are filling the role left by the clergy in providing guidance for how to live. As the Memory Wars show, psychoanalysis has the right DNA to fill that void. It is mystical, insofar as it deals with the unseen realms beyond our awareness. It is confessional. It is revelatory, revealing to us why we do what we do. In the absence of a metaphysical framework that can help us understand why we suffer, trauma is becoming a creed that can explain all.

And if the rise of therapy-speak is frustrating, it is also understandable. We need some way to make sense of suffering and redemption. It’s a problem, though, when we focus too much on our fragility and forget our resilience, a critique often levelled at progressives by conservatives. Likewise, if we ignore our vulnerability entirely, we create repressive societies — as liberals are fond of pointing out.

With its focus on emotional safety and the deterministic qualities of trauma, psychology often coincides neatly with social justice ideologies. Yet what works in the therapy room doesn’t necessarily work in the real world. Take the example of emotional validation: the idea of a therapist acknowledging and connecting with the emotional reality of a client. When this becomes a value in society, we can quickly fall into a moral relativism that gives undue value to people’s emotional reality.

But a healthy society should be sophisticated enough to know that humans are both fragile and resilient at different times and in different contexts. A healthy perspective requires us taking our “emotional reality” with a pinch of salt. Knowing when to focus on trauma and when to let it go requires a kind of wisdom that we won’t find on social media feeds and university safe spaces — but in the grit and contradiction of the human experience.

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Alexander Beiner is the author of The Bigger Picture: How psychedelics can help us make sense of the world. His Substack is The Bigger Picture.

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