Text by Lea Rebecca Minow (Freie Universität Berlin)
© Rebecca Eisele
Approaches to Trauma
Traumatic experience, Trauma Center, Trauma Cinema, trauma therapy, childhood trauma, the album “Post Traumatic” by Linkin Park’s Mike Shinoda, bodily, emotional, psychological trauma, trauma symptoms, collective trauma – trauma has arrived in the middle of Euro-US-American society (i) .
The term is established in everyday language. Even though there are probably as many concepts and ideas of trauma as people using the word, its meaning is still inspired by its origin in medical lingo. The term trauma is originally borrowed from the medical science where it mainly describes a physical injury, a knee injury for example. Nowadays applied in everyday language but more detailedly defined in the psychiatric context, it also describes certain kinds of events that are so deeply distressing that they can cause permanent and long- lasting psychological and physical ii harm, evidenced by persisting symptoms. Hence
trauma in this understanding describes an event followed by the complex set of responses a person has to the event. These responses, which take different forms, are mostly framed with the term “posttraumatic”, referring to their location in tim positioned after the initial traumatic event. A person who experienced a traumatic event, for example, lives with flashbacks, insomnia, panic, anxiety, lack of focus or forgetfulness (Hinton & Good 2016, 51, Lester 2013, 755). Certain characteristics of the word when used to describe physical trauma have been transferred to this more complex idea of trauma as an event that causes persisting psychological harm, which has dominated the discourse since the 1990s. For instance, trauma is often thought of as a moment-of-injury which is clearly recognizable and separable from the background of a person’s life. This moment or event is thought of to have an identifiable beginning, middle and end. It is constructed as something that is not taking
place in the flow of life but standing outside a person’s life and complex social world, invading this life. This idea is also reflected in the language of trauma that is applied
in a psychiatric context and partly in everyday language. Words like “pre-traumatic”,
“peritraumatic” and “posttraumatic” suggest that there is a life before trauma that is
interrupted from an event or an experience which then provokes posttrauma responses
and perhaps posttraumatic symptomology (Lester 2013, 755, 757-758). If responses to
the traumatic event persist, trauma quickly enters the pathological frame (ibid, 278-
79). Nowadays, this usually means that people are diagnosed with Posttraumatic Stress
Disorder (PTSD) (American Psychiatric Association 2013).
Even if not all diverse forms of responses to traumatic events must be experienced as entirely distressing (Seligman 2005), the experience as a whole for most severely traumatised people is a deeply shattering one. People do suffer to the extent that they might lose faith in life and consider ending their lives (Rousseau & Measham 2007, 284).
If able to, suffering people reach out for help, and turn to culturally available practices and structures for orientation and to stay alive. In the Euro-U.S.-American setting, this clutching at straws, struggling in an ocean of pain, mostly takes the form of psychiatric help. With the aid of medication and therapy the suffering individual works on dealing with what happened to her or him in medical and private spaces. Most Euro-US-American therapeutic approaches share the above-described ideas of what trauma is and put the traumatic event in the focus of their work (ibid, 286-87).
While these ideas of trauma appear clear on the first look, I found limited help in using these conceptualisations to grasp trauma when I researched the sensory worlds of traumatised female lives in Berlin. Facing lived realities, the dominant concept helped me to understand the vocabulary used and the steps people were taking due to external structures. For example, when people accept and pick up the framing of their suffering from trauma as mental disorder they go to a doctor to be signed off sick, they apply for therapy, go to a clinic, take medication, etc.. But the dominant concept only partially helped me to understand the here-and-now of peoples’ experiences. Therefore, I turned to anthropological approaches. Anthropology has not taken the dominant account of trauma for granted. While the edge-of-experience has early-on been a focus of anthropological work (Spiro 1987, Turner 1967), and transcultural studies in particular throw multi-coloured light on the Euro-US-American trauma discourse, the analytical lens of anthropology has zoomed in and out on trauma during the last years. While psychological processes and the cultural work of these have been in focus earlier (e.g. Obeysekere 1990), trauma, as it is mostly understood and treated in the Euro-US-American context, has been critically examined and analysed as a (cultural) category (e.g. Young 1995) that was exported into other cultural settings (e.g. Bubandt 2014). A wide critical lens has been directed towards the strategic use of the category of trauma (e.g. Fassin & Rechtman 2009). Transcultural Psychiatry and Psychological Anthropology have focused on the material basis of psychological trauma and the embodiment of traumatic experience, applying neurobiological methods (e.g. Kirmayer & Seligman 2008, Seligman 2018).
To grasp the lived experience of trauma, the lived reality of affected people, I found
helpful concepts in Critical Anthropology and Critical Psychology, which often set a
new focus. Rebecca Lester (2013) notes regarding ongoing discussions on trauma:
“What often falls through the cracks, however, is a serious attending to the fact that, regardless of whatever social or cultural meanings might accrue, people genuinely suffer. And people not only suffer; they endure, and sometimes even transcend. People find ways to go on living—not just by resolving deep psychological conflicts or by reorganizing their experience to meet existing categories, but through ongoing, iterative, continuous processes of meaning-making that emerge in relationship with others, across a variety of levels and contexts, and through time" (754).
The suffering, enduring and transcending I was faced with from participants was
happening during the research, and before and after, it was not a thing of the past.
The Ongoing-Lived-Experience of Trauma
During the research I conducted in the context of TCTSY (iii) , a special form of
trauma sensitive yoga in Berlin, people experienced moments of connection to, and
awareness and feeling of, themselves and their bodies, and the present moment became
more and more central as a moment of relief and healing. This revealed much about
the lives of persons who live on after edge-of-existence experiences. One of my
collaborators sums up her daily experiences:
“The general trembling, dissociation, constant attentiveness, insomnia, the tendency to traumatic reexperience, depression, self-destructiveness ... the burden" (Atara Interview 1). (iv)
First of all, a life shaped by such states was for none of my research partners traceable
back to the one and only traumatic event. They might refer to several nameable events
or conditions. Some of the events were not nameable, some remembered, many not
remembered, some were locatable in time, others not locatable. It often appeared to me
as a complex web of (familiar, social, political) conditions with some more central,
dense woven areas, which are remembered as traumatic events or as an increase of
suffering taking different forms. This web is in process, connections are spun, others
cut, new parts are formed. The distinction as some may imagine of a high-level
suffering close to the initial event which then little by little subsides was never met. It
does not seem that there is a linear process. The conditions for an identifiable “before”
and “after” trauma were seldom met. People grow up and live in conditions that may
later on be referred to as traumatic. This means that there is not necessarily a “before”,
no destructive invasive event (v) . “Welcome to my life” Isabelle once said to me,
accompanied by bitter laughter, when we were talking about dissociation and the
recurring re-experience of horror. Dissociation and traumatic re-experience are very
central in the sensual descriptions of a life with trauma. These states, which are not
necessarily continuous but intense and recurring (also depending on the individual
developmental arc of trauma and where the person is positioned on this arc at the time),
were referred to as a contrast to moments of connectedness during the yoga practice.
The experience of trauma is an “edge-of-existence experience”, an experience of
“ontological alienation”, and a deep “relational injury” (Lester 2013, 753-54). So deep
that the world, other beings, life itself, and oneself may feel unreal, unreachable or
alien. The terror, the aloneness, the pain, the “unmaking of the world” (Scary, 1985)
persists. Trauma is hardly over with the event which is designated as being traumatic.
While some may refer to what people describe as symptoms, I have to say that this
does not fit into what I found. The mostly multi-sensual, vivid recurring re-experience
of what is not bearable, including psychological and bodily reactions, makes it often
impossible to distinguish past and present, memory and current moment. The recurring
experience of horror and the accompanying feeling of ontological alienation are part
of everyday life instead of one event anchored somewhere in the past that a person is
fighting to “get over” (Lester 2013, 757-58). I find it much more helpful to define
trauma as an ongoing experience and a process which has an individual developmental
arc which is not linear and has no defined end (ibid, 757-59). This also means that
trauma does not always end with healing. So, if trauma is an ongoing-lived-experience,
isn’t that horrible? Yes, it is. But it is what people do experience. And it won’t be
changed by not facing it. People will just feel misunderstood and left alone. They also
feel ashamed and isolated, because of outward and inward expectations “to get over
it”. It, what the person just experienced again yesterday, may grow with time, and a
person living with trauma cannot meet these expectations. Ideas of a linear timeline of
a person’s life where experiences can be positioned as memories does not necessarily
make sense in the context of trauma. A forty-year-old woman may vividly re-
experience the rape of her mother that (according to our understanding of time)
happened thirty-five years ago. She may experience it again and again during the rest
of her life, vividly, seeing her, hearing her screaming, feeling the accelerated pulse in
her own body, the rising bodily tension, holding her breath. She also may not
experience it for a while and then experience it again. Isn’t this a hopeless situation
then? No, it is not hopeless. As we have seen that the nature of trauma is not necessarily
5the one cut-out event, but a process, it also becomes clearer, that the experience of
trauma is not isolated but happens in the flow of a person’s life (ibid. 2013, 755). This
life, which is not isolated but connected to other lives and embedded in a social network
called society, was there and continues to be there and always includes cultural, social
and personal understandings of being alive, being human, being part of society, being
healthy. The traumatic suffering takes place in this flow of life, and all of these
understandings influence the experience of trauma. If a person finds the power to go
on living, and many do, the experienced horror, the “un-making of the world” leads to
a “making of the world” (Scary 1985). People find new ways to connect to life, to the
world, to make their world. In my research, this experience took the form of becoming
aware and developing a feeling of one ́s own body and self in the present moment. At
first this process is experienced as extremely terrifying and energy-taking but changes
with continuous TCTSY practice (vi) . It is never a straightforward process, but a back-
and-forth movement between relating and detaching, tethering and untethering. States
of dissociation, such as perceiving the own body from outside, which are forms of
being unrelated, may take place during a TCTSY practice. However, in the same fifty
minutes of time, people also experience moments of being present and feeling their
own bodily state, for example, the right hand on the top of a warm leg, or a feeling of
hunger in an empty stomach. While most psychiatric approaches to trauma focus on
avoiding so-called harming symptomology like dissociation, much more potential and
hope is carried by the interplay of connecting and disconnecting (Lester 2013, 757-59,
Rousseau & Measham 2007, 281). Not denying either state, but taking both as part of
the process, enables courage to risk moments to connect, to feel. This position accepts
that disconnecting is part of lived reality and the other side of connection. This
interplay and along with it the experience of connection through feeling is perceived
as positively influencing the ongoing experience of trauma.
“With each iteration of the memories, and as the person is in different circumstances when they occur, new associations, sensations, emotions, and thoughts can accrue. Over time, the nature of the trauma-as-lived-experience can be changed. As different meanings are attached to the recollection of the past traumatic experiences, the moment of injury becomes, literally, a different event” (Lester 2013, 758).
This process can be described as healing.
This new light on trauma emphasises another aspect of the trauma experience.
As the experience of trauma is not restricted to one or a series of events in the past, the
handling, a person’s resilience, the support, the arguing for what is right and everything
that might influence the horrible experience, is also not restricted to the past. This
underlines that people’s experience in the aftermath of the edge-of-existence is
important and strongly influences the ongoing process, which includes among others
the new (re)experiences of trauma. In other words: multiple factors of the surrounding
conditions deeply influence coming traumatic (re)experiences and ongoing lives: if and
how people are supported by family, friends, social surroundings and societal
institutions, how and if sense is made of their experiences and which responsibilities
and which (legal) consequences are taken. As it becomes clear that all dimensions of
life are deeply influencing the traumatic process, trauma must be put in context, in the
context of a biography but also in a socio-cultural, historical and political context! The
experience of trauma is not disconnected from the world or society, or the flow of life,
even if the dominant approach to trauma treats it like that. Positioning trauma where it
belongs, in the middle of society, means also to hold everyone who surrounds a person
living with trauma and society accountable for trauma, not (only) the event but the
whole process of trauma (Brenssell 2013, 2-6).
Conclusion & Outlook
In this essay I have shown that the dominant understanding of trauma as a
temporally fixed one-moment-of-injury with a clear-cut beginning, middle and end
falls too short and bears the potential for deep misunderstanding of what people
experience, of their suffering and their needs. Drawing from personal as well as from
field experiences, I find it much more helpful to consider trauma as an ongoing-lived-
experience, a non-linear and multi-temporal process, which is part of a life process,
influenceable, endurable and transformable. I agree with Lester (2013), that this view
on trauma carries much hope and highlights different levels of agency in the present
that carry the capacity to change the trauma experience. Every interaction, every new
experience in the course of life, has the ability to change the experience of trauma. Also
based on my data I deeply underline that trauma has to be put in socio-cultural,
historical and political context as the trauma process is embedded in these spheres and
is therefore extremely influenced by them. This account of trauma does not condemn
all existing therapies or accounts. Still it takes trauma from the individual to society
and switches the perspective, opening up new possibilities “ for working from within
the trauma as it is unfolding rather than viewing interventions as resuscitation attempts
7on a long-dead patient” (Lester 2013, 759).
(i) The term “Euro-US-American society” is to be viewed critically as there is no homogenous Euro- US-American society. I do refer to the dominant cultural discourse in Europe and the U.S. and especially to the reach of psychiatry as it developed in Europe. And do so as most of the literature I refer to does also apply the term.
(ii) Classical ideas restrict effects to the intrapsychic domain whereas more recent understandings include the body into the effects of trauma (e.g. van der Kolk 2015).
(iii) My field was the practice of a special form of trauma sensitive yoga in Berlin. This practice was developed by the Center for Trauma and Embodiment (Boston) and is called Trauma Center Trauma Sensitive Yoga (TCTSY).
(iv) Interviews translated from German to English by the author. All names have been changed.
(v) The new diagnosis complex traumatic stress disorder (complex PTSD) tries to capture some of these aspects. But as it is still controversial (DSM-V does not include it whereas ICD-10 does) and has not entered the mainstream understanding of trauma I will not discuss this approach here further.
(vi) Research findings are drawn from people who (with one expectation) did decide to continue the practice of TCTSY. Neither research findings nor the therapeutic concept of TCTSY claim that the practice is working in the ways outlined above for everyone as people and their lives differ and people do need different forms of support and different tethering to the world.
References
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