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Essay: How Trauma Is Treated Clinically & Culturally in Society

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  • Published: 1 January 2021*
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There are many ways in which people within societies concern themselves with the concept of trauma. Trauma has been something that has become a characteristic element of the age in which we live in. It is a way for us to relate the suffering(s) of the present to that of our violent past(s), it is a scar that is both visible and invisible and we can see its trace(s) and aftermath(s) on individual victims, the perpetrators or even a collective culture. This collective imprint that trauma leaves on a group can be the result of decades and decades of violence or it could be the result of a singular event that has transcended their idea of time and has continually left its mark throughout the different generation that followed.

The discourse surrounding trauma has been addressed throughout history within many fields of study and through many accounts of the past, present, and future. This paper will mainly focus on the clinical as well as the cultural approach to the concept of trauma. It will serve as an archive of how the fields of psychology, sociology and anthropology come to look at and examine the concept of trauma and how it plays out on the micro and macro levels on a cultural as well as an individual level. A critique and analysis of the discourse(s) from the aforementioned fields of study will be included to serve as a demonstration as to how trauma manifests itself in the minds of those who are interested in studying the human condition. A focus of this paper will be employing the method of discourse analysis, taking into account the sociocultural and political zeitgeist in which the texts discussed take place as well as the implications such contexts have on the evolution of the concept of trauma in the minds of those who study it as well as those affected by it or its aftermath(s). This will also include commentary on the use of language and the reproduction of belief systems in discourse and where it is located in the wider social structure in which it dwells. Overall, this paper will look at how different perspectives perpetuate their interpretations of trauma and how that affects the experience of trauma itself and the perception of it. The main question guiding this paper would be: How does taking a clinical or social approach to addressing the concept of trauma affect the way in which trauma is experienced or interpreted in both the academic and personal context(s)? Nowadays, we have discussions and conversations about instances of rape and genocide, about occurrences of terrorism and environmental disasters, about methods of torture and slavery in the same language, both clinically and culturally, that it is the common thread of the many misfortunes that we are subjected to. Before delving into the intricacies of trauma in both the clinical and cultural discourses, one must first have a base as to what trauma is as a concept.

The word “trauma”, originating from the ancient Greek, was roughly used to denote a “wound” mainly accessed in surgical contexts by doctors. Leys (2000:19) further elaborates and describes trauma as “conceived on the model of a rupture of the skin or protective envelope of the body resulting in a catastrophic global reaction in the entire organism”. Fassin and Rechtman (2009), in their account of the history of trauma, the authors asserted that the term was repurposed for the treatment of the aftermaths of railway accidents. Nevertheless, in contemporary usage of trauma in medicine, psychiatry and literature, it “is understood as a wound inflict¬ed not upon the body but upon the mind” (Fassin & Rechtman, 2009). A wound emanating from a shock so powerful that it breaches “the mind’s experience of time, self and the world,” eventually expressing itself in dreams and/or flashbacks (Caruth, 1996: 3-4). On the same line of inquiry, Hartman (1996: 159) defines trauma as “events or states of feeling that threaten” the limits of experience and that “puncture lived time and exist only as phantasms”. Here we can see how different theorists come to define what trauma is, and we can see similarities in the way in which the experience of trauma is conceptualized. Moreover, Dominick LaCapra (2004: 61) sees trauma as “a shattering experience that distorts memory … and may render it particularly vulnerable and fallible in the reporting of events”. Building on that, Caruth (1996) asserts that an instance is not traumatic simply because it is done forcefully, but that it “resists simple comprehension”.

Moving onto Freud’s conception of trauma, he posited that a traumatic experience is an experience that is of influential magnitude that it renders any holistic understanding of said experience, it however, must be recalled and reconstructed from the deep indentations of one’s memory (Breuer & Freud, 1957; Freud, 1990). There are a lot of instances where witnesses of vicious crimes report the experience as “surreal” almost as if time was somehow retarded, wired into slow motion. This perceived “surrealism” constitutes the primary body of what we come to define as the shock of the situation, the burdened inability to accept or process the coming inflow of information accompanied by a numbing of the senses. A confusion of space, being, and temporality can often be detected in the impacted sentiments of victims of traumatic events. This confusion fades away and a creeping reality sets in its stead, forcing itself into collective and individual consciousness. One must also note that for some subjected to this kind of violence, the aftermaths of such an instance never completely fades away and continues to haunt their memories and impede their behavior moving forward. On the collective feelings of shock that people might have in response to an instance of traumatic nature, one must not mitigate their inseparable integration into a person’s recollection of the context. Erikson (1978) shows us this idea of collective shock in a study he conducted after the Buffalo Creek flood, in which he uses the term “collective trauma” and asserts that trauma can result in a sense of communal cohesion, as much as it can have the ability to destroy it (Erikson, 1995). Instances of such caliber – as unfortunate as they are – bring about repressed issues of importance into the collective awareness. Issues of race, poverty, migration penetrate national debates surrounding the event, such public discourse undeniably results in a public advocacy of an increased social responsibility and reevaluation of civil society. Cultural trauma can thus be observed through such instances of calls to societal action. Before delving vigorously into conceptualizations of cultural traumas, an individualistic clinical understanding must first be reached.

Fassin and Rechtman (2009: 30), in their effort to archive the history of trauma, asserted that London doctors’ treatment of railroad accident victims in the 1860’s was the gateway which “opened the path to trauma psychiatry”. Freud and Breuer, in their studies on hysteria, initially diagnosed traumas as repressed sexual fantasies labeled as hysteric reactions, demarcating the condition as a female-specific malady (Freud & Breuer, 1895 as cited in Leys, 2000). However, Freud further developed this ‘diagnosis’ and related it to the aftermaths of transportation accidents and the treatment of victims during the First World War, for his court testimony as a specialist in a case against a prominent psychiatrist at the time (Fassin & Rechtman, 2009: 52). This, of course, readdressed conceptualized trauma beyond femininity to encompass masculinity as well, however, it was inclusive only of male soldiers and combatants at the time. Over time, this notion of trauma as an outcome of war expanded to non-combatants and included nurses and relatives of the soldiers, with an added emphasis on mothers (Higonnet, 2002). The concept of trauma in this context, refers to a physical strike that numbs the senses, one that the mind and body need to defend itself against.

Moreover, we can also see that amnesia is another defense mechanism of the mind that often comes in unison with the numbness. The victim of a traumatic event does not recall or simply denies that something of this kind has taken place. In an attempt to develop a model for this phenomenon, Freud hypothesized “the period of latency”, in which a period of forgetting takes place with the sole purpose of protecting one’s psyche. During that period, the person goes on with their daily life, as if nothing of importance took place (Fassin & Rechtman, 2009). There is no set time for this period of latency, it could span days, weeks, or even years, however, the experience in question will return and manifest itself in some form or another (either in nightmares or some other ‘abnormal’ behavior). Freud’s ideas about trauma, while giving room for subjective experience and offering a method of detecting victimhood, nevertheless focus on the individual level, as most psychology theories do. To understand trauma, however, is to also understand the variables in the world that eventually influences on the individual level. To understand what it means to experience trauma today ultimately means understanding what it means to be living in the world ‘today’. After the First World War, we saw a rise in the use of weapons in warfare, and thus an increase in the demand of finding innovative ways of preventing large-scale traumas.

Trauma and modernity were as a result linked systematically in a way that was rather general and abstract (Bauman 1989; Caruth 1996; Horkheimer and Adorno 2002; Kaplan 2005; and LaCapra 2001). Taking this into account, there was, as a result of this cataclysmic modern age we live in, no single narrative that could adequately capture what it means to go through a traumatic experience. Regardless of that, generated from this state of being is more and more research being conducted on the notion of traumatic experience and traumatic memory (LaCapra, 2001; White 2004). The notion of trauma has been amended to further focus on two elements, first, how trauma affects the victim, imbedding unwanted memories and undesirable resultant behaviors. Secondly, the “impossibility” of memory and the specificity of the repressed experience that is available to be accessed by the therapist and the theorist; trauma, in that sense, exposes the person to an otherwise hidden and repressed world (Caruth, 1995). One can draw a parallel between trauma at the individual level and trauma at the societal level…A national crisis, such as a natural disaster or an economic downturn, is also a shocking occurrence that has the ability to cause a rupture in the daily routines and put a dent in the guiding principles and values that guide people at the same time. Crises, such as the aforementioned, reveal to a certain collective group the intricacies of their collective identity (Habermas, 1975). Much akin to individual trauma(s), a societal crisis or cultural trauma can be an opportunity that reveals what would otherwise be hidden and it has the ability to reaffirm old collectives, while also creating news ones.

Upon making the distinctions between psychological (i.e. clinical) and cultural trauma, Neil Smelser (2004) points out a major point in that cultural trauma(s) are not born, but rather are made. He provides us with a definition of cultural trauma as, “an invasive and overwhelming event that is believed to undermine or overwhelm one or several essential ingredients of a culture or the culture as a whole” (Smelser as qtd. in Alexander et al. 2004: 34). Smelser, in considering the discursive nature of cultural trauma, reduces the process to an event and narrows the scope a bit. One must take note of a specific sentence in the aforementioned definition and that is “believed to undermine”, which sort of negates the idea that an event could be traumatic in its nature. This brings us to question if an event can be made traumatic, that is can it be “believed to undermine” a collective people? If that is not the case, what makes us to deem some events traumatic and others that are of equal valence and intensity not?

The first part of this complex, two-part question addresses this notion of creating belief and the power that has. One can argue, as a social constructivist, that if you had the power to persuade you could make any event or occurrence be categorized as “traumatic”; this would further push this idea of how trauma is made not born. On the other hand, a strong believer of the naturalist movement or the lay trauma movement (Alexander, 2004) might make the argument that certain events are traumatic in essence, due to the direct impact they have when they occur. Eyerman (2001, 2008), however, makes the argument that there is a middle ground between both polar extremes. This argument poses that some instances may create circumstances that kick start a progression of cultural trauma, without being traumatic in themselves. Alexander (2004) further asserts that this will not happen sans the aid of outside forces that catalyze the process of making meaning such as the mass media and certain “carrier groups” such as intellectuals, who have a direct and looming influence on the way cultural trauma is constructed and processed. We must acknowledge that not all instances or occurrences will make sense or fit within the available framework of such trauma(s). Not only that, cultural trauma(s) are not tangible, but are processes of making meaning and attribution; in which various people and groups have a hard time defining situation, let alone controlling it. Such trauma(s) must originate from somewhere, an occurrence that is powerful enough to create space for emotions and opinions to be made. Thus, we can deduce that are two sides to cultural trauma, one of emotional experiences and one of a reaction based on the interpretation such an experience. Being in a state of shock due to a traumatic occurrence arouses emotion by causing a rupture in the everyday (actions and cognitions) and would thus require a process of interpretation. In this rupture, there becomes a discursive space where some individuals may play an integral part in guiding the interpretation. Individuals such as those in the mass media have a significant role to play when it comes to this interpretation process.

Cultural Trauma as discourse can be differentiated by this propagated dichotomy of perpetrator and victim that is generated from a powerful occurrence that has happened in the distant past. Much akin to Frantz Fanon’s Wretched of the Earth where this dichotomy plays a central role in uncovering this idea of how only through means of physical violence does the colonizer assert their superiority and thus be a potential cause to some of the cultural trauma faced in some societies. Smelser (2004) further attempts to ground the concept of cultural trauma by looking at it as a “memory accepted and publically given credence by a relevant membership group and evoking an event or situation which is a) laden with negative affect, b) represented as indelible, and c) regarded as threatening a society’s existence or violating one or more of its fundamental cultural presuppositions”.  This essentially means that once an occurrence of this caliber happens, the established collective identity is shaken, and its basic foundations get called into question. Hence, we can say that it is a process through which emotions are triggered due to an event of traumatic nature, and said emotions are processed in an attempt to move towards a healing process for a collective suffering (Erikson, 1995); despite there not being any guarantee that this process will be seen to completion.

Cultural traumas are thus not just a struggle between the interpretations of individual or collective agents, the dichotomy between perpetrator and victim, and the very nature of pain…but rather it is deeply reflected in the felt emotions and identities that express themselves in this discursive process, showing us that this type of trauma has elements of expression and communication. We must also take note that as this process is a result of extreme violence and the extreme exposure of the deep emotions that ground the individual and collective identity, cultural traumas are an exemplification as well as an expression of an attempt at collective reparation. Such an attempt surely requires efforts to “define the situation” and an openness to be manipulated by agents, however, it cannot be simplified to just that. Giesen (2004) brings us this idea that anything connected to identity can be placed in the realm of what is considered sacred and in that sense is associated with powerful emotions such as shame, assurance, envy, dignity…etc. Therein lies deeply rooted emotions and manufactured identities that are partially formed through cultural trauma (ethnic or national identities, for instance) that can be under the surface when it comes to the everyday but may rise to the surface when faced with a shocking/traumatic occurrence.

When we talk about a collective or group of people, it begs the question of, “trauma for whom?” (Giesen, 2004; Eyerman, 2008). Imaginary collectives, such as nations or ethnic minorities, are more often than not divided. One side effect of a traumatic experience is that it provides this sense of coherence and collectivity, even if it imaginary and temporary as well, as asserted by Erikson (1995). I am immediately reminded of the 2011 revolution and how it appeared to unify the Egyptian nation into this emotional collective, in turn creating practices that helped its sustainability, just as phrases such as Aeesh, Horeya, A’adala igtmaaya (Bread, freedom, social equality) were meant to create this idea of a shared experience and understanding throughout the collective movement. Nevertheless, if we look closer beneath the surface, which is itself created through mass representations, one could arguably find people or even groups of people that would oppose this established collective understanding.

Consequently, a traumatic experience has the ability to both unite and divide, to create an in-group and an out-group. This is something that we must take note of, and it is in this context that Alexander (2004), building on Max Weber, coined this idea of “carrier groups” and the importance of their role in the greater scheme of things. These kinds of groups are important because they can put the trauma into words, making it accessible for shared understanding. They help in making sense of the emotional response that happens and articulate them into words and images that can be shared and remembered. One can argue that some professional/social categories such as political leaders, journalists, writers are instrumental in this articulation and play a crucial role in the trauma process, however, these “carrier groups” are broader in their scope than these professions. “Carrier groups” can be formed as a response to trauma or they can be already present and active within a society; professional categories such as the aforementioned can be noteworthy agents within these broader groups. These groups are central to the notion of cultural trauma, they are architects of memory, responsible for the continuous remembrance(s) of traumatic experiences propagated through time.

Trauma is a complex and an all-encompassing phenomenon that is part of the human experience as we know it. There is no one approach to it, as we have seen exemplified by the aforementioned approaches. Through the clinical approach, we saw an archive of how the conceptualization of trauma came to be in clinical settings and how this has informed the way we experience trauma in the sense of what it means to us and what we deem traumatic based on the scientific definition that were socialized to associate with trauma. Moreover, we turn to the wild notion of cultural trauma and how the social structures involved further inform the way in which we come to know the concept of trauma in our experiences. Ultimately, we cannot deny the way in which trauma and violence are heavily rooted in our every day and one must learn to become aware of the ways in which this phenomenon informs the way in which we exist in the world, but also understand what we can do armed with the knowledge of such processes to better the experience of our day-to-day.

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