Gregory Bistoen
Preface
The
inclusion of Post-Traumatic Stress Disorder (PTSD) as an official
diagnosis in the Diagnostic and
Statistical Manual of Mental Disorders (DSM) in 1980 triggered a resurgence
of interest in trauma research, stimulating the production of a huge amount of empirical data and a
range of theoretical innovations over the past three decades. Interestingly, these intensive research efforts stem from a
variety of scientific disciplines, which, according to Vincenzo Di Nicola
(2012a), can be roughly divided into two large traditions. On the
one hand, psychological trauma has, of course, been extensively studied from an
explicitly clinical perspective. This
research pole encompasses disciplines such as the neurosciences, cognitive and behavioral psychology,
clinical psychiatry, psychoanalysis and so on. On the other hand, and rather
atypically for a psychiatric disorder, trauma has increasingly become a topic
of interest for cultural fields of
enquiry such as literature research, holocaust studies, women’s studies, and
postcolonial research. Needless to say, these various disciplines and, on a
larger scale, the clinical and cultural poles of trauma research, are characterized by radically divergent
values, epistemological assumptions, methodologies, beliefs and aims – to a
degree that it would be justified to speak of two separate ‘trauma
communities’, each with a distinctive and irreducible understanding of trauma,
despite their commonalities and interrelations (Di Nicola,
2012b).
Whereas the clinical research pole is largely associated with a positivist and
empiricist approach to trauma rooted in a biomedical model, the cultural pole
is more influenced by social constructionist and postmodern scientific paradigms.
The
combined research efforts of the last three decades can therefore be said to
have given birth to a body of knowledge that, with a wink to Jacques Lacan’s (1949) mirror stage theory, is best described
as a corps morcelé: an amorphous,
split or divided corpus that cannot be identified as a whole when viewed from
the vantage point of whichever of its constituent parts. In other words, the
sprawling knowledge of trauma that is produced in these various fields of
inquiry cannot be integrated into a single, unified discourse, due to the lack
of a point of reference from where such an operation could occur. As Dominick
LaCapra (2001) observed: ‘no genre
or discipline “owns” trauma as a problem or can provide definitive boundaries
for it’ (p.96).
My
own research starts from the observed tension between cultural and clinical
accounts of trauma. Because of the distinct perspectives on the same
phenomenon, their juxtaposition offers somewhat of a ‘parallax view’; the shift
between both vantage points apparently puts the scrutinized object in motion.
When we consider the points at which these traditions diverge in their
understanding of trauma, then the underlying presuppositions of both, which
often remain implicit, suddenly light up with great clarity. Moreover, it has
been argued that the gap that separates both approaches discloses something
about the studied phenomenon itself: from this point of view, the observed lack
of integration in the corpus of trauma knowledge is not merely the result of
the different perspectives from which trauma is studied, but rather indicative
of a split or gap in the concept of trauma itself (Di Nicola, 2012a). Every attempt to
describe and localize this gap, for instance by means of the introduction of a
dichotomy (for example, cultural versus clinical; moral versus theoretical (Fassin & Rechtman, 2009); mimetic versus
antimetic (Leys, 2000))
brings a degree of order to the confusing multitude of trauma studies and
theories, without however exhausting the tensions internal to trauma. As Di
Nicola shows, each posited dichotomy is ‘shifting, porous and unstable’ (2012a,
p. 103): it will always give rise to cases that cannot be allocated to either
of the proposed poles of the dichotomy. Psychoanalytic theory is a good case in
point: although it is first and foremost a clinical theory, its insights are
often adopted in cultural work on trauma.
This
book focuses on trauma in its relation to politics and ethics. It is my
contention that recent philosophical analyses of the dynamics of rupture in
sociopolitical change can be put to use to incorporate the political dimension
in our understanding of trauma. Whereas trauma is ordinarily understood as a
rupture on a psychological, intra-individual level, these philosophical
theories make use of Lacanian psychoanalytic theory to comprehend how rupture
appears on a trans-individual, collective or societal level – and how this
constitutes a possibility and a prerequisite for the creative invention of new
political or economical structures. Whereas current psychological trauma
approaches have been criticized for obscuring and neglecting the sociopolitical
aspects of trauma recovery, philosophical theories of rupture are at risk of
downplaying the suffering of those caught up in movements of radical social
change – in favor of an emphasis on the creative possibilities of such
disruptive moments. I believe the choice between an psychological and a
sociological level of analysis and intervention to be a false one. Through a
discussion of Lacanian psychoanalysis, I hope to show where this dichotomy
becomes unstable, and how this can broaden our understanding of trauma recovery
as an ethical endeavor with political consequences, beyond a medico-technical
framework.
Introduction
The concept of trauma has become ubiquitous in
contemporary society. Whenever a sudden, unexpected and horrific event disrupts
the normal run of things, the language of trauma is deployed by professionals
and lay-persons alike in an attempt to make sense of the unthinkable. More
generally, it has been argued that in our postmodern times, the scientific
disciplines of medicine and psychology have increasingly taken over religion’s
primary role of providing meaning and coherence for a world continuously shaken
up by the unforeseeable. This is evidenced, for instance, by the observation
that ‘therapeutic forms rather than religious ceremonies are becoming the
predominant cultural rites that accompany public and private events’ (Pupavac, 2004, p. 495).
The old, biblical proverb that ‘God works in
mysterious ways’ still echoes the ways in which religion used to assure people
that the senseless would be revealed to be meaningful after all, once our human
restraints were transcended in the hereafter. If God is dead, then he can no
longer perform this pivotal task of holding the world together, of being the
universal hypokeimenon or subjectum of everything that is – or at
least of providing the semblance of possibility of such a harmonious unity in
which everything has purpose and makes sense, by grace of the bestowment of
some sort of divine Order that allocates everything its rightful place. In the
vacuum left behind in the West by God’s demise, then, science can be said to be
the prime candidate to take upon itself this abandoned function of providing
meaning and guaranteeing order. Understand that this is not necessarily science
per se, as it is practiced by
scientists themselves, but rather the way in which this form of human activity
is recuperated and put to work in popular discourse (that is, scientism). The
chorus of pre-modern religiosity with its returning theme of a unifying One
continues to stir up deep-rooted desires for a universe that closes in upon
itself, one that, in the final analysis, will be shown to make a whole. Deep
down we still believe that everything happens for a reason, and science has now
become the instrument on which we rely to unearth the obscured links in a
supposedly complete causal chain. God’s proclaimed death, then, did not prevent
the suffusion of theological images and sensibilities in the sciences of
modernity, as can be seen for instance in the fantasy of Nature as a cosmic
One-All ruled by unbreakable, timeless laws (Johnston,
2013). It is no longer God but Nature itself that is believed to
guarantee the rationality and ultimate cohesion of reality. Science, then, is
identified as our means to access these securing eternal laws of nature. We put
our faith in it to guide us through our existential predicaments. As we will
see, the psy-sciences occupy a central position in this dynamic, with trauma as
the central concept to think the effects of a confrontation with a point of
radical incomprehensibility.
The word trauma is, confusingly, often used in
two distinct ways. In lay terminology, it often denotes a type of event that is
considered both out of the ordinary and inherently destructive. Originally,
however, psychological trauma referred to a type of pathological reaction towards such a devastating event.
Trauma is what happens to a person’s psychological functioning when he or she
is confronted with something that defies his or her ability to grasp. In
cognitive psychology this is seen as a failure to ‘process’ a certain type of
data related to the traumatic event. Subsequently, this unprocessed material is
thought to incessantly haunt the psychic system, disrupting its normal
functioning and inciting a cascade of maladaptive sequelae, in a repeatedly
thwarted attempt to finally conclude this obstructed mental processing. In
other words: the psyche is understood as, ideally, an integrated or unified
system that smoothly combines external data with internal objectives to guide
behavior. Trauma describes what happens when an incommensurable element enters
and disturbs the psychic space. When we are confronted with the boundaries of
our capacity to process something, simply because it literally concerns the
impossible that nevertheless took place, trauma describes the potential psychic
consequences of this encounter: the shattering experience of a profound sense
of meaninglessness and dislocation. Ideas of integrative unity and its
disruption are thus central to these phenomena.
When today disaster strikes and cracks
suddenly appear on the purportedly smooth surface of life, it astonishes no-one
that the representatives of the disciplines of (trauma) psychiatry and
psychology are called upon to enter the field. Today, no-one is surprised to
find that thousands of psychosocial workers are dispatched to far-away,
non-Western countries in the aftermath of natural disasters or violent
conflicts, in an attempt to attend to the local population’s psychological
needs (Fassin & Rechtman, 2009). As Derek
Summerfield (1998,
p. 1580)
duly noted, the rise of trauma work in humanitarian operations is rooted in the
aforementioned way that ‘medicine and psychology have displaced religion in
Western culture as the source of descriptions and explanations of human
experiences’. The disciplines of psychiatry and clinical psychology have come
to proffer the culturally sanctioned answers to the impossible questions of
life’s contingencies. Science takes the place of religion in the precise sense
that it is called upon to provide sensible answers at times when there are
none. But more importantly, the scientific apparatus serves as a guarantee for
the validity of these answers: it offers us authoritative
answers in which we can trust.
As part of the shared belief system of Western
societies, the idea of trauma is experienced as both self-evident and natural.
This means that we expect the human response to adversity to be universal
across times and cultures. Consequently, the inclusion of trauma psychiatry in
humanitarian aid campaigns, which started only at the end of the 1980s, appears
to be both logically and morally justifiable. This innovation was premised on
the assumption of a distinct ‘psychological fallout’ of war and catastrophes
for whole populations (Summerfield, 1997).
Moreover, what was known about trauma suggested that this type of wound does
not heal simply with the passing of chronological time, but needs to be
addressed in its own right.
It came as a great surprise when researchers
found that the application of interventions based upon this supposedly
universally valid trauma framework resulted in paradoxical (that is, harmful)
effects when applied in both Western and non-Western settings (for example, Bisson, Jenkins, Alexander, & Bannister, 1997;
Bracken, 2002; Herbert, et al., 2001; McNally, 2009; McNally, Bryant, &
Ehlers, 2003; Raphael & Wilson, 2000; Rose, Bisson, Churchill, &
Wessely, 2002; van Emmerik, Kamphuis,
Hulsbosch, & Emmelkamp, 2002). Such findings, among others, prompted
a series of critical analyses of the assumptions behind the contemporary
dominant conceptualization of traumatic pathology, the diagnosis of Post-Traumatic Stress Syndrome or PTSD.
As a result, a great number of conceptual and practical deficiencies that haunt
this biomedical trauma model have been identified by trauma scholars from a
variety of academic backgrounds. The current project is built around a
selection of a number of interrelated core problems associated with the PTSD
approach to trauma.
First, the construct of PTSD effectuates a
problematic decontextualization that
determines the manners in which we understand and react to these phenomena.
There are many factors involved in this operation. At the level of the
definition of PTSD itself, for instance, there is the conceptual annulment of
the peculiarities of any given etiological stressor, in favor of an emphasis
on the commonalities between traumatic
responses at the level of pathological mechanism and symptom manifestation. The
idea that different types of events can cause the same symptoms through a
similar etiological pathway – one of the core ideas defining the PTSD
construct, which ties back to the historical background against which it was
conceived – can lead to negligence of the manners in which the specificities of
the social, cultural, political or economical context of the stressor play a
part in both the origin and outcome of trauma, as well as in processes of
recovery.
Second, the emphasis on the individual as the locus of scrutiny and
intervention in Western psychotherapeutic approaches seems particularly unfit
to address the problems that surface in the wake of a collectively suffered
event, as is the case with political violence, large-scale disasters, and so
on. Furthermore, it is antithetical to responses that aim to alter the social
conditions associated with various forms of distress. An increasing number of
trauma scholars have argued that traumatic pathology does not occur in a
vacuum, and that successful recovery from trauma requires the recognition of
the importance of an individual’s relations to the Other (a Lacanian concept
that refers to other people as well as to the socio-symbolic order in which we
are immersed).
Third, these decontextualizing and
individualizing operations have been argued to have a political effect in
themselves, as they produce a focus on immaterial recovery (that is, a change
in someone’s individual psychological functioning) over material recovery (the
modification of a trauma-generating context). Trauma psychiatry therefore risks
becoming a depoliticizing instrument
in service of the status quo.
Taken together, these points of criticism
suggest the need to acknowledge the influence of culture and context in trauma
definitions and interventions, and to depart from a limited focus on the
individual. Furthermore, although the political dimension is very present
whenever we deal with psychological trauma, it proves difficult to recognize
and engage it within the confines of the PTSD model. What is needed, then, is
conceptual work on trauma that takes into account context and culture, and that
helps to envision how sociopolitical change on a collective level is related to
processes of recovery. It is my contention that the Lacanian psychoanalytic
framework proves very powerful to deal with these issues, primarily because of
its unique conception of both the subject and the Other as the locus of the
symbolic order in which the subject is constituted.
I start off in Chapter 1 by unearthing the factors
that contribute to the decontextualizing and depoliticizing effects of the PTSD
diagnosis. To this end, I critically discuss some of its underlying
presuppositions and their relation to the biopsychomedical discourse from which
this diagnosis stems. I describe how these presuppositions, which remain
largely implicit, lead to types of interventions that neglect and obscure the
political dimensions involved in both the genesis of and recovery from trauma.
This analysis aims to show that far from being neutral and value-free,
PTSD-informed interventions have very real political consequences, as they
(unintentionally) reinforce the political and economical status quo and
foreclose alternative modes of responding to these situations. It is precisely
because PTSD purportedly describes a reality that transcends particular
contexts and cultural determinations, that is, because of its avowed
universality and neutrality, that it is able to serve as a disempowering
political instrument – in the sense that to claim ‘that one is beyond ideology’
is itself the ultimate ideological gesture. It follows that the application of
the knowledge associated with PTSD, for instance in humanitarian aid campaigns,
must be handled with great care. The discussion in Chapter 1 renders the link
between trauma and its often neglected political dimension more palpable,
suggesting the need for a conceptualization of trauma that includes it.
In Chapter 2, French philosopher Alain
Badiou’s (2001) work allows me to tie the discussed problems of PTSD’s
decontextualization and depoliticization to a more general crisis of ethics in
the West. I thereby agree with Fassin and Rechtman’s (2009) compelling thesis
that evolutions in trauma theory should always be read against the background
of an equally developing societal moral climate. I offer a reading of the
current success and omnipresence of trauma discourse as reflective of the
prevalence of the ethics of human rights as the dominant moral compass for our
times. Although this ethical doctrine seems self-evident to a contemporary eye,
considering its emphasis on the prevention of suffering and death, Badiou’s
controversial analysis suggests that it ultimately amounts to a nihilistic
resignation that must be resisted. The success of this doctrine is tied to the
catastrophic consequences of the utopian projects of the 20th
century. Badiou laments that the resultant fear of collective action in the
name of a shared cause has left us with a type of ethics that is essentially
negative, defensive and conservative. This ethical doctrine, then, is founded
on a number of basic assumptions and related to a series of undesirable
consequences that bear a striking resemblance to those discussed with regards
to PTSD. It turns out that a well-defined ethical position is at the heart of
several problems affecting PTSD, which presents us with the injunction to think
anew the interrelatedness between the fields of trauma, ethics and politics – a
project to be carried out in Part II of this volume.
The objective of the second,
psychoanalytically inspired part of this book is not so much to develop a
‘better’ alternative to existent practices, but to provide a conceptual
framework that clarifies the manners in which these three fields are related.
This will require an elaboration of how the psychiatric level (of the
particular, the individual) can be articulated with the sociological level (the
universal, the collective). The main hypothesis driving this work is that
Lacan’s concept of the real is at the intersection of trauma, ethics and
politics. The analysis of this concept will throw new light on the issues
touched upon in the first part of this book.
In Chapter 3, I discuss Lacan’s evolving views
of the real, while introducing a number of other key Lacanian concepts that
will be of use in what follows. I discuss the two major conceptions of the
real: ‘presymbolic’ and ‘postsymbolic’. It becomes clear that the real should
not be taken as the ultimate referent of external reality, but rather as a
productive negativity that dislocates the representation of external
(symbolic-imaginary) reality. Subsequently, I go on to show how this notion of
the real generates an interesting take on trauma that diverges from the more
familiar, biomedical trauma discourse. As will become clear, the Lacanian
approach to trauma breaks with the familiar inside/outside, self/other and
individual/collective dichotomies. Furthermore, it introduces a non-linear
conception of time to make sense of the counterintuitive dynamics of trauma.
In Chapter 4, I scrutinize the paradoxical
notion of an ‘ethics of the real’, which refers to Alenka Zupančič’s (2000)
denomination of the particular form of ethics that derives from Lacan’s
elaboration of the subject. Already here, we see an intriguing connection
appear: the real is defined simultaneously as traumatic on the one hand, and as
the condition of possibility for the subject, and thus of ethics as such, on
the other. This chapter aims to elucidate this estranging logic, which leads to
the identification of the Lacanian real as characterized by the dual function
of ‘productive destruction’.
In Chapter 5, I aim to show the centrality of
this same concept in the movements of politics. According to Yannis Stavrakakis
(1999; 2007), it is a disruptive encounter with the real that initiates time
and again a process of symbolization – along with the ensuing hegemonic
struggle between alternative symbolizations of this real. Rupture, in this way,
is connected with sociopolitical innovation. However, the traumatic impact of
such large-scale, societal ruptures has not been explicitly addressed within
these socio-political theories. The juxtaposition of Lacanian trauma theory and
philosophical contributions on rupture-predicated societal change allows us to
think the ‘moment of the political’ in its relation to trauma recovery.
The category of the real, then, is at the
centre of the interconnections that proved so difficult to account for in the
PTSD-model of trauma. In Chapter 6, I describe some of the consequences of this
interrelatedness centered around the real. First, I argue that many
psychological theories of trauma commit a logical fallacy in their description
of the process of trauma recovery, claiming that the psychological buildup
needs to be remodeled so that it can accommodate the ‘new trauma information’.
In this move, they take as a given that which must first be constituted by the
subject: the content or ‘meaning’ of the traumatic episode. Second, I argue
that Lacan’s notion of the act can be
put to work to conceptualize this neglected but primordial aspect of trauma
recovery. Furthermore, I demonstrate that it is this moment of the act that
opens up the path towards collective action and social change. The
incorporation of the dimension in the act in trauma recovery, moreover,
requires us to take up an alternative ethical position.
