Abstract
This essay discusses the observation of Western culture’s fascination with trauma, along with the history of post-traumatic stress disorder (PTSD), and how that diagnosis has expanded its scope. It also notes that most humans are resilient in adversity and trauma. For those who suffer long-lasting effects of trauma and exhibit PTSD symptoms, they should seek professional help and support.
Introduction
For many movie-goers, the summer is a great time to head to the silver screen and watch action, drama, and intriguing stories play out in spectacular visuals and chest-thumping sounds. This year, audiences are anticipating the third installment of the Deadpool series. For the uninitiated, Deadpool is an antihero known for his sharp sarcasm and dark humor. For example, in a scene from the first Deadpool movie (Miller, 2016), when he meets his girlfriend, Vanessa, the two enter a back-and-forth banter about the trauma and rough childhood they’ve endured. While this essay won’t recall the entire repartee, one of the less dark and non-sexual exchanges gives a good sense of the dialogue. At one point, Deadpool quips his bedroom was a hall closet, to which Vanessa volleys back she had to sleep in a dishwasher box, to which Deadpool replies, “you had a dishwasher?” (Miller, 2016). While dark and humorous, this represents the zeitgeist of modern culture’s romanticization of trauma .
In a recent Psychology Today article (2022, January 4), Robin Stern wrote regarding her observations of many examples of how society, particularly Western society, has become enamored with stories of trauma. From a conversation she had with her trainee about how she couldn’t get enough details of her clients’ trauma, to books by Bessel von der Kelk and Paul Conti on bestsellers lists and to a documentary by Gabor Maté, all are examples of how the topic of trauma is having a significant cultural moment. However, Stern and others have wondered if there is a misunderstanding of what trauma is. Are people truly experiencing trauma, or are they simply experiencing stress, grief, or big life events ? Maddux and Winstead (2016, p. 162) in the chapter on trauma and stressor disorders note that there is “larger debate [regarding the] pathologizing of normal human suffering and the overdiagnosis of disorders .”
This essay will discuss the phenomenon of society’s romance with trauma and the issue of pathologizing normal behaviors (Harrist & Richardson, 2014). It will then pivot to a discussion on what constitutes real, clinical trauma and two psychosocial models of the etiology of post-traumatic stress disorder (PTSD) (Maddux & Winstead, 2016). Lastly, the essay will contend that many people suffer significant stress and emotional events, however, most are resilient and will recover (Bonanno, 2021). For those who truly suffer trauma, they too will largely recover, but for those who meet the criteria of PTSD, they should seek professional help.
Pathologizing Normal Behavior
Harrist and Richardson (2014) discuss many ways in which seemingly normal behavior has been pathologized in Western culture. They note how melancholy and despair may actually be perfectly normal responses to the instable world in which we live, yet modern science attempts to solve these responses with pharmaceuticals . They further wonder why hoarding is considered a mental disorder when people fill their house to the roof with junk but people who “amass billions of dollars while other people starve” are not pathologized (Harrist & Richardson, 2014, p. 202). But more importantly, they discuss the roots and genesis of the PTSD diagnosis.
They cite an article published in the British Medical Journal of how the old diagnoses of battle fatigue and war neurosis were replaced by PTSD. The early supporters of the PTSD diagnosis were also part of the anti-war movement during the Vietnam War. Under the new diagnosis of PTSD, war veterans could receive unique medical care. But more importantly, PTSD fundamentally changed the way soldiers were viewed and treated. Instead of the focus being on the unique history of the soldier and his psyche, PTSD “legitimized their victimhood” and the PTSD diagnosis was perhaps more of a statement against the nature of war than anything else (Harrist & Richardson, 2014, p. 203). This change was a pivotal moment as the diagnosis expanded in scope for the next several decades to explain not only battle trauma, but also “symptoms of distress following disturbing events, even ones relatively commonplace or just witnessed, not directly experienced, by individuals” (Harrist & Richardson, 2014, p. 203).
Returning to Stern (Psychology Today Contributors, 2022, January 4), she describes why PTSD and related disorders have seemingly expanded their scope. The experiences people share of trauma are often remarkable and fascinating and “have a strong emotional charge” especially when compared to more normal experiences of people from overprotected and isolated lives. There is an aura about traumatic stories and people who live through those experiences are imbued with a type of fame and fascination. Others wish to share their own stressful experiences to gain traumatic credibility. But as Harrist and Richardson (2014) warn, while people may indeed experience big emotional events, the trauma of soldiers, war victims, and victims of sexual violence, to name a few, should not be “trivialized.” Definitions matter and delineation must be made clear between normal behavior in response to a significant event, and clinical trauma that people suffer from living through horrific events.
Clinical Trauma and Psychosocial Etiology Models of PTSD
While there have been changes to the PTSD entry between the DSM-4 and the DSM-5, such as moving it from an anxiety disorder to the newly created category of trauma- and stressor-related disorders, the key features of PTSD remain relatively the same (Maddux & Winstead, 2016, p. 165). The traumatic experiences must be related to death, the threat of death, significant bodily injury, or sexual violence. Victims may either experience these events directly or they may indirectly experience them such as when a close family member directly experiences it and then conveys the details of the horrific event to the victim. Stemming from one or more of these experiences, the victim should demonstrate intrusive memories, dreams, or psychological and even physiological effects from reminders of the traumatic event. They will avoid any reminders of the event and may begin to have cognitive distortions, memory loss, emotional distress, and even detachment. From there, they will develop and exhibit strong response arousal, careless behavior, hypervigilance, or experience problems with concentration or sleep. The victim must suffer many of the above symptoms for more than one month after the event. Underlying all these symptoms is the victim’s inability to process or integrate the traumatic experiences into their life. In turn, they are left with less than adequate coping mechanisms.
Based on a sample of people in the United States, it is estimated that over 60% of men and 51% of women experience trauma (Maddux & Winstead, 2016, p. 163). The majority of those adapt and do not experience long-term maladaptive coping mechanisms. As for why some people might cope well and adapt to a traumatic experience while others do not, there are many etiological theories that explain why some suffer PTSD. This essay will only touch on two: cognitive and emotional processing .
The cognitive etiological model theorizes that the individual’s beliefs and knowledge about himself, the world, and other people are maladaptive and weak, and when the individual experiences a traumatic event, their beliefs and conception of safety, are crushed (Maddux & Winstead, 2016, p. 169). They are unable to process the events and make meaning out of the experience. In fact, Harrist and Richardson (2014, p. 207) note that in a highly individualistic culture, many people don’t experience “shared meanings and coping strategies” and are thus left to their own devices to cope with trauma. In turn, they become overwhelmed and experience PTSD.
The emotional processing etiological model is based on the theory that the individual creates fear structures to deal with dangers in their environment. However, when these fear structures build excessive responses, the individual becomes inflexible in learning how to modify their responses (Maddux & Winstead, 2016, pp. 170-171). For example, a person with PTSD will demonstrate avoidance behavior, which in turn prevents them from tapping into and updating their fear structure in a way that would enable them to successfully adapt to an event.
As briefly noted, most people who suffer a traumatic event are able to make meaning out of the experience, adapt, and recover from the stress of trauma. In all this discussion on trauma and PTSD, it has been broadly observed that humans are quite adaptable, even when confronted with the worst of trauma.
The Resilient Human
Maddux and Winstead (2016, p. 163) produce a chart that visually demonstrates that even with the traumatic events of sexual and non-sexual assaults, people are able to recover and adapt well after the event. For sexual assault victims, 70% report PTSD symptoms one month after the event. That percentage continues to drop over time, going as low as 30% one year after the event. For non-sexual assault victims, 40% report PTSD symptoms one month after the event with a declining trend over time, going to 10% at the one-year mark. Overall, the data suggest there is a “natural recovery curve” (2016, p. 162), in which most victims can make a strong recovery. Only a small minority of victims experience PTSD .
All of this data supports the claim that perhaps by pathologizing and stigmatizing many big, emotional, stressful events, as a whole, society may be undercutting the process of recovery . To lend greater support and care for a victim, pathologies are created, and focus is placed on the symptoms, rather than successful and creative coping mechanisms. There is also a significant individualization and rights-based view of modern pathologies. Harrist and Richardson (2014, p. 204) note this paradigm “underestimates and tends to undermine the creative capacity of people to cope with, and even at times find meaning in, suffering and traumatic experiences.”
Harrist and Richarson (2014, p. 204) continue their discussion with examples of two non-Western cultures that do not pathologize not only big, emotional, stressful events, but not even trauma. Researchers and counselors went to Sri Lanka after the 2004 tsunami and worn-torn Afghanistan and realized people exhibited symptoms not on the PTSD list and when they tried to provide individualized grief counseling, the isolation “actually [exacerbated] fears of loss or disturbance of one’s role in the community.”
Returning to Stern (Psychology Today Contributors, 2022, January 4), she contends our judgment becomes impaired when we become captivated by stories of trauma . By immersing ourselves in our own emotions, we may overlook the needs of the person telling his or her traumatic story. Most importantly, we underestimate our resilience and fail to recognize our true strength. She goes on to discuss some broad observations from one researcher who has studied this topic for many years. She quotes George Bonanno who says, “Most people are resilient …some people are traumatized; some people recover. There are different trajectories.” In fact, in one of Bonanno’s more recent articles entitled The Resilience Paradox (2021, p. 2), he and other researchers reviewed 67 studies to better understand “outcome trajectories” of people who endure a potentially traumatic event (PTE). He writes, “two thirds of the participants showed the resilience trajectory. Thus, not only is resilience to PTEs common, it is consistently the majority outcome.”
In sum, many studies and researchers have noted that the human is resilient in the face of big, emotional, stressful events and even traumatic events. While trying to determine the root cause of why some suffer PTSD and others do not, researchers are finding that PTSD is fairly rare. For those who do suffer many of the symptoms of PTSD for months after the traumatic event, they should continue to seek support from clinicians, counselors, and a support structure.
Conclusion
In conclusion, this essay examined the phenomenon of society’s romance with trauma and the issue of pathologizing normal behaviors. Western culture seems to be experiencing a cultural moment with its fascination of hearing others’ traumatic experiences. While many people do experience big, emotional, stressful events, they are most likely not suffering clinical PTSD. PTSD is reserved for people who experience events related to death, the threat of death, significant bodily injury, or sexual violence. Furthermore, they develop long-lasting, maladaptive coping mechanisms. There are many theories of the etiology of PTSD, of which two are emotional processing and cognitive. Ultimately, many people suffer significant stress and emotional events, however, most are resilient and will recover. Even for those who truly suffer trauma related to death, bodily and sexual violence, they too will largely recover, but those who meet the criteria of PTSD and who have lasting effects, they should seek professional help and support from their family, friends, and social networks .
References
Bonanno, G. A. (2021). The resilience paradox. European Journal of Psychotraumatology, 12(1), 1942642–1942642. https://doi.org/10.1080/20008198.2021.1942642
Harrist, R. S., & Richardson, F. C. (2014). Pathologizing the Normal, Individualism, and Virtue Ethics. Journal of Contemporary Psychotherapy, 44(3), 201-211. https://doi.org/10.1007/s10879-013-9255-7
Maddux, J. E., & Winstead, B. A. (2016). Psychopathology : Foundations For A Contemporary Understanding (4th ed.). Routledge/Taylor & Francis Group.
Miller, T. (Director). (2016, February 8). Deadpool. 20th Century Fox.
Psychology Today Contributors. (2022, January 4). 5 Big New Trends | Psychology Today. Www.psychologytoday.com. https://www.psychologytoday.com/us/articles/202201/5-big-new-trends
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