“Bad experiences in my past caused my mental illness. It’s called complex post-traumatic stress disorder.”
Had you spoken those words anywhere in the Western world before 1980, your hearers might have taken them as further evidence of your insanity.
Trauma-informed approaches to mental illness are a recent development in the grand scheme of things. To the physicians of ancient Greece and Rome, madness, like most other diseases, came from imbalanced bodily humors. In medieval Christendom, your sins had angered God and given demons a soft target. For the early Victorians, the problem was your degenerate behavior, probably sexual, which had rotted your body and mind. The late Victorians were less judgmental; for them, the culprit was germ infection, pernicious hormones, or weak nerves resulting from unhealthy habits or simple misfortune.
There’s a threefold thread running through these historical views: mental illness was 1) certainly innate, 2) perhaps the sufferer’s fault, and 3) probably permanent—though as to the last point, some relief might come from “treatments” ranging from comatose sleep (maintained with heavy doses of barbiturates) to focal-sepsis surgery (removal of the tonsils, teeth, colon, or anything else that might be “poisoning” the brain) to multiple seizures (induced with insulin, convulsant drugs, or electricity) to the most lauded psychiatric procedure of the early 20th century: the mutilation of the brain’s frontal lobe, aka lobotomy.
But this standard model of madness—definitely innate, maybe your fault, likely permanent—was called into question when World War I soldiers started coming home with a mysterious derangement. These men didn’t just recall the horrors of war: they re-heard the whine of bullets, re-felt the blast of bombs, re-saw their comrades blown to pieces. They couldn’t work, couldn’t sleep. They screamed and cowered at the crack of a dropped plate in the kitchen.
People called it shell shock, and doctors were intrigued. Here was a madness caused neither by organic defects nor by unclean living, but by terrible experiences. The disease obviously wasn’t innate, and no one could call it the veteran’s fault. Was it permanent, though? Surely not. Shell shock, they decided, was best classified not as a form of insanity but as something like concussion: a physical blow that could, with rest and quiet, be cured completely. To the military brass, the advantage of this view was obvious: a soldier, healed of his temporary indisposition, could be returned to the front lines.
In World War II, shell shock was renamed “combat fatigue,” a term with an even softer ring. Treatment was accelerated: now, psychologists were embedded in combat units with instructions to redeploy combat-fatigued men as quickly as possible. Sounds harsh, but it turned out that keeping a soldier close to his comrades and reassuring him he wasn’t broken, only down for the count, worked better than long-term incarceration in a psychiatric hospital thousands of miles away with electroshocks and lobotomies on the agenda in case of no improvement. Regarding these men as “temporarily exhausted” rather than “incurably ill” was, on balance, helpful.
Or was it? In 1972, the New York Times published an op-ed on “Post-Vietnam Syndrome.” In it, psychoanalyst Chaim Shatan argued that battlefield trauma had left tens of thousands of Vietnam vets with severe psychic damage: lasting damage that deserved compensation. Shatan and other psychiatrists were joined in this view by Vietnam Veterans Against the War, and as a group they put organized pressure on Dr. Robert Spitzer, overseer of the soon-to-be-released third edition of the Diagnostic and Statistical Manual of Mental Disorders, to include post-Vietnam syndrome in the manual as an official mental illness.
Spitzer agreed, but with a big proviso. Writes Andrew Scull in his book Desperate Remedies:
The new diagnostic category … was not post-Vietnam syndrome, but a much broader and less specific stress-related disorder, post-traumatic stress disorder. A whole variety of traumas, not just those stemming from military conflict, were now recognized as possible triggers of lasting forms of mental disorder—sexual violence and assault prominent among them.
Ever since publication of the DSM III in 1979, common knowledge has it that repeated adverse or abusive experiences, even if not life-threatening, can cause mental illness. Many in the profession have also come to accept that “complex” PTSD, or CPTSD, can cause permanent changes to body and brain, creating an entrenched condition whose treatment, not incidentally, must be reimbursed by insurance.
The idea that bad experiences can damage us forever has been psychological dogma for four decades now. Bessell van der Kolk’s 2014 bestseller The Body Keeps the Score took the theory to a new level of popularity, and though his work hasn’t escaped skeptical interrogation (one example here), CPTSD remains a popular lens for mental disorders. After all, who wants to believe their suffering is inborn and/or their fault? A CPTSD diagnosis at least lets us off that stigmatizing hook.
So, when an eminent psychological researcher like Dr. George Bonnano seems to doubt the reality of CPTSD, explaining that trauma is rare and resilience is common, some people take umbrage. They sense the old accusations returning: Maybe it’s just you. Maybe you’re weak-minded. Stop playing the victim. C’mon, it wasn’t that bad. Get over it.
If someone’s really suffering, Bonnano’s research findings must feel like pokes to a bruise. I understand the inclination to give him the finger.
But it would be a mistake, I think, to brush Bonnano aside and rush back to Van der Kolk. The latter’s view is helpful in that it rejects innateness and faultiness, but harmful in that it reinforces permanency. “The body keeps the score” means bad experiences leave marks we can’t scrub away with our own efforts. Van der Kolk says we need professional scrubbers—for a long time, maybe for life—and even then, some stains will remain.
Bonnano’s take, though expressed a bit heartlessly, is more optimistic. He doesn’t say CPTSD symptoms aren’t real. He says they probably aren’t permanent. Survivors of mental breakdown know that when it comes to suffering, severity doesn’t predict duration. Although the tunnel may be horribly dark, it isn’t endless, and with help, we have the ability to traverse it. “Get over it” isn’t an imperative; it’s an observation that when we’re running the gauntlet, our Core Self (I call this resilient guardian Sane Me) is equal to the trial.
Wounded warriors made us rethink the first two labels in the standard model of madness. Now, let’s rethink the third part and ditch the “permanent” label. Dr. Bonnano may not be Mr. Sensitivity, but he’s got the right idea about CPTSD, and indeed, about the majority of mental health conditions:
They’re not innate.
They’re not your fault.
In the end, they’re no match for your enduring strength.
Learn more about Jocelyn Davis and her books on leadership, history, and mental health at JocelynRDavis.com.