I recently attended a seminar meeting at St Pancras Hospital, chaired by Dr Khaldoon Ahmed, on Post-Traumatic Stress Disorder (PTSD). Amongst an elite crowd of Dr Walter Busuttil, Medical Director at Combat Stress, Professor Roland Littlewood, University College London, and Dr Brock Chisholm, Forced Migration, whether PTSD is a socio-political construct or illness entity was debated.
We were reminded of literary legacies of trauma; Charles Dickens spent many hours among corpses after a train crash at Staplehurst, Kent, and suffered symptoms that crept into his being. Lady Mercy recalled Macbeth crying out during his dreaming of mercies that lay buried in the depths of his mind. As Allan Young has described, repression and disassociation are empty languages that the mind uses to keep secrets from (it)self; a form of self-deception.
How are our narratives determined? Our experiences of being-in-the-world are infinitely threaded through our referential to time and space. Yet, we surface from beyond the all-encompassing nature of our existential life to function, and reflect on memories, and create a future.
An event experienced as traumatic quashes and annilihates both who we believe ourselves to be and the way we believe the world to be.
An intervention such as a diagnostic criteria for a mental disorder such as PTSD is vulnerable to claims that distress is medicalized; sorrow is a symptom and pain is pathology.
Confronting trauma demands the recognition of dual contradictions. I have previously argued that a therapeutic model in trauma cannot re-cover a pre-ruptured narrative. A re-covered trauma survivor is non-sensical. There is a rupture in the life-form of an individual’s narrative, phenomenologically experienced yet categorically defined by the DSM IV.
In parallel to the cataclysm of trauma, the experience pronounces a mountainous terrain, an emergence of an unfamiliarity and a significant monument to prevent, or at least threaten, our perseverance.
PTSD refers to a plethora of symptoms and centered on elements that are crucial for the subjective matters of our writings, our memoirs, our poetry, and our sufferings whether interpreted in frameworks of psychiatry, physiology, and pathology.
The role of words serves as a vitalism for the individual who cannot bear to see, to feel, to hear, to think of their trauma.
Telling the story has the power to change the narrative from the past to present tense.
Emotional reasoning such as ‘I am scared. Therefore, I must be in danger’ are insights for both members of the therapeutic alliance; to gradually de(at)tach the conditioning that the trauma imposed in instant time.
Contemporary scientific technology permits a search for universalities in our neuro-anatomy and physiology. A controversial evaluation of evidence so far further divides the debate about PTSD.
To call into question the presence of PTSD as socio-political construct or an illness entity implicitly is a reflection on how are we to remember our lives. Memories during PTSD are categorized as; fragmented, flashbulb-like, repressed, recovered. Auto-biographical, or contextual memory – the sources for our narratives – are affected during trauma, meaning that recalling our narratives is ultimately characterized by inherent chaos and semantic reduction.
Classifying PTSD as a socio-political construct has the danger of minimizing or negating a form of suffering. Yet, the argument surrounding whether PTSD is an actual illness entity must account for certain socio-political con-texts that construct a platform for PTSD symptoms to be diagnosed.
However, a socio-political construct is also a particular culture; and culture shapes our memory.
How we tell our stories are related to our societies.
A culture with a strong oral story-telling history will be able to entertain voices of different languages about life within one dialect, and be able to detect how accents change during analogies, and images, and reflections on emotions. The mutuality between speaking and hearing will revere to be an avenue for communicating distress.
A culture that is individual-based will have a different structure for a dialogue. Perhaps the dialogue will be between the individual’s inner voice and the imposing life circumstances that the individual experienced.
Symptoms, then, become manifestations of cultural theories of psychopathology.
Nevertheless, a symptom is a story.
Underpinning the variety of discourses discussed; and before the transformations of an individual narrative to a clinical case report; there is, fundamentally, a human being in adversity.
Our life-histories, by virtue of an ontological existence of experience, are not empty.
Certain shades of the colors we view the world with will translate to us the world we contain within.
PTSD as either a socio-political construct, or an illness entity, will, unconditionally, remain a secondary observation to the fundamental and primary rawness of a time that severs our being from being in the world.
Defining and describing our narrative of suffering is a diagnosis of the human condition, and our treatment of such individuals must counteract the disbelief that is experienced during confrontation with our greatest threats.