Fature: Embodying Trauma: Acute and Accumulated

by Heather Stewart

Throughout most of the canonized history of Western philosophy –consider the work of Rene Descartes or Immanuel Kant as paradigm examples—“the self” has been understood as inherently atomistic, individualistic, rational, and autonomous. Importantly, when the self is understood in this way, one’s being understood as having a unified self at all rests upon their distinct individuality—that is, on their intrinsic separateness from other bodies and their total independence from other minds. To the contrary, feminist philosophers ranging from existentialist philosopher Simone de Beauvoir to contemporary care ethicist Virginia Held and post-structuralist Judith Butler (among many others) have critiqued this view that posits the self as independent and fully autonomous, instead attempting to uncover and understand the inherent situatedness of the self. On these alternative (read: feminist) views of the self, individuals are always already social and political beings, situated in a particular historical moment, geographic and cultural space, with particular sets of social norms operating around and upon them. Furthermore, individuals are always existing in relation to other people, who shape their activities, experiences, and interactions with the world.

If we accept the alternative view of the self proffered by these and other feminist philosophers, which contends that the self is formed, re-formed, and maintained always in relation to others, we can then think about the many ways in which the self can be affected by relations to others. Strong, healthy connections to others have the capacity to bolster one’s sense of self, making it more stable and secure. On the other hand, destructive experiences with others can negatively impact one’s sense of self, making it less stable, secure, or coherent. Thinking about trauma in particular can help bring this connection to light—insofar as individuals’ senses of themselves (how they relate to others and to their broader environment) is always dependent upon other people, other people have the capacity to “undo” the self of another—to fragment the previously stable connections one had to their environment, other people, and ultimately to their very own sense of self.

In her 2003 book, Aftermath: Violence and the Remaking of a Self, Dartmouth Philosopher Susan J. Brison uses a detailed account of her own experience of trauma (specifically, of her violent experience with rape and the traumatic aftermath of her rape) to defend such a relational theory of the self. On her view, the relational self and its orientation to the world and to other people can be fragmented by experiences of interpersonal trauma. Such fragmentation of the self can disrupt the self’s sense of past and future, of bonds to their community, and of general security and ability to move freely about the world. The self must then be reconfigured by re-establishing healthy bonds to one’s environment and community, which Brison contends can be done by allowing other people to bear witness to the trauma, helping the survivor to create a new narrative and ultimately remake a shattered self into a self that can persist through the trauma. For Brison, trauma brings to light the essential connectivity of the self to others– while one’s sense of self can be fragmented by traumatic encounters with others, it can also be rebuilt through positive interactions (i.e., empathetic witnessing) with compassionate others.

The relational self that Brison articulates in Aftermath is not only formed and reformed in relation to other people, but it is also necessarily connected to a particular body—we are all, she contends, embodied selves. As such, when a self becomes fragmented through an experience of trauma, that person’s relation to their own body can be impacted just as much (if not more) than their relations to other people and to their larger social environment. The first-person account Brison provides in Aftermath offers a stark example of the ways that trauma gets written onto and into the physical body—in the way the body interacts with its environment (the space it takes up, the speed at which it moves, the responsiveness to motion and sound), and the way the body’s very physicality (heart rate, muscle contractions) changes as well. Brison’s narrative of the aftermath of her traumatic experience helps to shed light on the larger phenomenon of what can be called embodied trauma. It is this concept, namely, that of embodied trauma, that I would like to explore in the remainder of this essay.

It likely goes without saying that trauma can take a serious emotional, psychological and/or social toll on those who experience it. I do not want to undermine the reality of these effects of trauma, and their immense significance to those who have experienced trauma in any form. However, what I want to highlight throughout this brief essay is an important, though often overlooked effect of trauma that does not get as much theoretical attention, namely, the physical and embodied consequences of trauma which impact one’s phenomenological experience of the world, and in many cases, constitute a detriment to one’s physical health and wellbeing. Using Brison’s testimony of her own experience of trauma and its embodied effects as a point of departure, I want to argue that those concerned with trauma need to pay far more attention to its many embodied consequences (which go beyond those understood to be symptomatic of Posttraumatic Stress Disorder). I also want to suggest that our understanding of trauma in general, and embodied trauma in particular, needs to be expanded to include the “mundane,” everyday traumas of living in a world that is structured by certain sorts of oppression.

The Dominant Conception of Trauma

The dominant understanding of trauma (as exemplified by the American Psychological Association, which for better or worse is taken as authoritative on trauma-related knowledge production) understands trauma as event-based, that is, as occurring from acute, typically one-off events, such as an accident, rape, natural disaster, or war (American Psychological Association 2018). Importantly, on this view, traumatic events are interpreted as things that are out of the ordinary, viz., beyond the scope of what we are used to typically experiencing. With that understanding of trauma, it is not surprising that the American Psychiatric Association defines Posttraumatic Stress Disorder (PTSD) in a similarly narrow and restrictive way: as a psychiatric disorder that can occur in “people who have experienced or witnessed a traumatic event, such as a natural disaster, a serious accident, a terrorist attack, war/combat, rape, or other violent personal assault” (American Psychiatric Association 2018). In order to receive the diagnosis of PTSD, one must have been exposed (directly or indirectly) to a traumatic event (and the language used by the American Psychiatric Association makes it sound like they mean singular or isolated events which are extreme in nature, in most (if not all) cases). The institutions that govern dominant understandings of mental health (and thereby of trauma) offer an incredibly limited picture of what can count as traumatic, and therefore of what can be said to bring about trauma responses or other consequences.

The Embodiment of Acute Trauma

The dominant understanding of trauma as event-based, and subsequently the diagnostic criteria for PTSD, coincide with the particular experiences of Susan Brison, who retells in painful detail her experience with being grabbed from behind while on a run, violently raped, and left for dead, and how that event radically altered her relationship to her own physical body. She writes, “My body was now perceived as an enemy, having betrayed my new-found trust and interest in it, and as a site of increased vulnerability… My mental state (typically depression) felt physiological, like lead in my veins, while my physical state (frequently incapacitation by fear and anxiety) was the incarnation of a cognitive and emotional paralysis resulting from shattered assumptions about my safety in the world” (Brison 2003, 44). She goes on to say that her physical symptoms resulting from the aftermath of her trauma (her startle response, hypervigilance, and so on), were, much like her heartrate and blood pressure, entirely beyond her conscious control. They were, now, features of her body—her physical state—and they had significant impacts both for how she felt in her own body and how she experienced the world as embodied and as tied to that body which she no longer fully identified with. Traumatic memories remain in the body, Brison writes, “in each of the senses, in the heart that races and the skin that crawls… The most salient traumatic memories… are more tied to the body than memories are typically considered to be” (44).

Over a decade after the publication of Brison’s personal narrative-based Aftermath, another philosopher, Shannon Sullivan, developed the idea of embodied trauma in a more systematic way, incorporating important empirical findings that lend argumentative support to the more limited, personal claims made by Brison. In her 2015 book, The Physiology of Racist and Sexist Oppression, Sullivan analyzes the embodied effects of rape and sexual assault, specifically as they effect women’s gastrointestinal health, often manifesting in IBS, Crohn’s disease, and other functional GI disorders. The connection, she argues, is the result of the connection between the gut and the muscular structure of the pelvic floor, which is marked by the urinary, genital, and lower intestinal tracts. Sexual trauma that affects the genital area is fundamentally connected to intestinal health– when one suffers trauma to the area, subsequent unconscious muscle tightening, for example, affects all systems that rely on pelvic musculature, leading to gastrointestinal difficulties. Sullivan provides one stark (and largely ignored) way that sexual trauma can have tangible, physical impacts on the body, which provides at least some evidence that we need to be thinking in greater depth about the ways trauma effects physical health and wellbeing and bodily integrity alike.

Rethinking Trauma: On the Traumatic Effects of Daily Injustice

If we accept the claim presented above, namely, that trauma (as conventionally understood) can have tangible (and most often detrimental) effects on the physical body, what do we make of more recent attempts to understand trauma as a broader concept? Theorist Anne Cvetkovitch, for example, has theorized trauma in a way that goes beyond the limited range of catastrophic events traditionally conceived of as traumatic (see the APA definition above) to include “traumas of everyday living” (2003, 3). More precisely, Cvetkovitch contends that traumatic histories (often which are tied to racial, class, gender, or sexual oppression or exploitation) are embedded within everyday life experience (2003, 12). She is explicitly challenging the pervasiveness of the clinical model and approach to trauma, as represented by the APA and transcribed into the pages of the DSM. This clinical model individualizes trauma and responds to it using clinical means that target individuals (typically through the use of prescription medications and individualized therapy regimes). Cvetkovitch, on the other hand, focuses on the various social, cultural, and political causes of trauma, and subsequently the interdependent nature of responding to trauma (2003, 18). If, as Cvetkovitch contends, trauma can be public, social, or group-based, individualized medical models wont fully target the causes of trauma that produce the detrimental effects clinicians are concerned with improving.

While posited in opposition to clinical models of trauma, this socio-political understanding of trauma might not be entirely incompatible with clinical and diagnostic measures, if institutions such as the APA are willing to make the epistemological shift to incorporate a broader understanding of trauma into clinical practice. Indeed, there have been ongoing professional debates regarding whether or not the clinical understanding of trauma and the diagnostic profile for PTSD out to be made more expansive (Joseph 2012). One advocate of this position, City University of New York Professor of Psychology Dr. Kevin Nadal, has argued that repeated experiences of microaggressions (subtle acts of discrimination or hostility leveled against members of marginalized groups) can, over time, elicit similar symptoms to the sorts of acute trauma that the APA has prioritized and given its institutional attention to (Nadal 2018). For this reason, he argues, it is not only theoretically important to expand our conceptual understanding of trauma, but rather carries significant practical weight. If Nadal is right, and subtle yet pervasive forms of discrimination (microaggressions, some forms of hate speech, etc.) can result in similar experiences of trauma to more acute, “catastrophic” event-based trauma, then we need to be conscious of the ways that more cumulative sources of trauma can too become embodied in particular ways.

In order to flesh out the point I am trying to make, I would like to explore one possible example of the phenomenon I am describing, namely that of the possibility of sustained or ongoing forms of trauma becoming embodied in particular ways. Consider a society in which there are shared cultural understandings and widespread awareness of the prevalence of rape and sexual assault. Women-identified people in such a society might have implicit memories or otherwise have their consciousness shaped by having grown up in a culture that tells them they are constantly at risk for being attacked—indeed they may have experienced such an attack firsthand, or at least personally know someone else who has. My claim is that this constant burden of being in fear, watching over one’s shoulders, planning around being alone at night, walking alternative routes in order to be in more public spaces, altering one’s dress or appearance to minimize unwanted attention—the repeat nature of these experiences (whether they are implicit or explicit, experienced firsthand or witnessed in others), can contribute to a cumulative, shared experience for women that can be traumatic. Rape culture and the set of fears, risks, mannerisms, and so on that accompany it can sediment into female and/or feminine consciousness, ultimately impacting modes of feminine body comportment (Bartky 1997, Young 1980). It becomes normal in such societies for women to have internalized fear of unwanted attention, contact, or the potential for assault, and as a result to comport their bodies in ways that are constantly on guard (legs crossed tightly, shoulders curved in), or to otherwise take up as little space as possible. Even if one has never directly experienced an attack, existing in a society which makes them hyperaware of the realities of rape and assault is traumatic, and has consequences that are physically embodied and which cause women-identified people to experience the world in different ways, namely in ways that are guided by excess caution, uncertainty, vulnerability and distrust (Cahill 2001).

This awareness of (and often direct contact with) rape culture also impacts the physical (Sullivan 2015) and mental wellbeing (Schroeder 2016) of women and girls. Specifically, living in a culture where women anticipate that they will not be taken seriously when they report sexual assault or trauma, or when they are met with doubt or victim-blaming when they attempt to do so, can result in a secondary trauma, which often results in physical and psychological consequences such as heightened anxiety and stress response (Schroeder 2016). Knowing these realities (such as the impact of social responses to victim testimony) has on women and girls gives us reason to believe that much of the trauma related to assault is social in nature. As such, clinical models which individualize the diagnosis of (and treatment response to) trauma are going to be limited. Robyn Cadwallader (2016) has made this argument in response to clinical excitement around the discovery that propranolol, a beta-blocker, can reduce some effects of post traumatic memory. However, this is only the case to the extent that we take traumatic memories to be individualized. If we take the insights above, gleaned from feminist phenomenology and embodiment theory seriously, then we can reimagine the role that oppressive social norms, shared memories, and cultural understandings have on physical bodies and their interactions with the world. Medicine’s attempt to “fix” individual bodies is thus misguided—it fails to account for the ways in which the injustice of rape and assault, and the traumatic memories of them, extend far beyond individual bodies, but are infused with social, political, and cultural dimensions as well.

The sedimentation (see Merleau-Ponty 1945, Butler 1997) of shared knowledges of rape into female bodies, which then alter how those bodies experience and exist in the world, is one example of the broadened understanding of trauma (and specifically embodied trauma) that some theorists and clinicians are calling for. These are the forms of trauma that have been marginalized within the institutions of psychiatry and clinical psychology, insofar as they do not fit within the dominant paradigm of trauma and the associated diagnosis of PTSD, understood narrowly as being caused by isolatable, unusual, large-scale events. This brief essay has attempted to suggest that our understanding of trauma needs to be more expansive than that—we must account for the ways that the mundane, daily traumas of living in oppressive social systems and operating within unjust social institutions and hierarchies can cause embodied effects that closely mirror the difficult and damaging physical symptoms already recognized under the diagnostic criteria of PTSD. In order to combat the detrimental effects of trauma, trauma needs to be understood, analyzed, and dealt with in all of its forms. This means we must start thinking beyond curative paradigms of treating individual bodies that have experienced trauma, and look much larger – at our social and political institutions and the very interactions that structure our public lives.


References

American Psychiatric Association. “What is Posttraumatic Stress Disorder?” 2018.

American Psychological Association. Psychology Topics: Trauma. 2018.

Bartky, Sandra Lee. “Foucault, Femininity, and the Modernization of Patriarchal Power.” In Writing on the Body: Female Embodiment and Feminist Theory. (Katie Conboy, Nadia Medina, and Sarah Stanbury, eds.) pp. 129-154. New York: Columbia Univeristy Press. 1997.

Brison, Susan J. Aftermath: Violence and the Remaking of a Self. Princeton University Press. 2003.

Butler, Judith. “Performative Acts and Gender Constitution: An Essay in Phenomenology and Feminist Theory.” in Writing on the Body: Female Embodiment and Feminist Theory (Katie Conboy, Nadia Medina , Sarah Stanbury, eds). Columbia University Press, 1977.

Cadwallader, Jessica Robyn. “Forgetting Rape: Trauma, Pharmaceuticals, and Embodied (In)Justice. Australian Feminist Studies. 31.88:125-138. 2016.

Cahill, Ann J. Rethinking Rape. Cornell University Press. 2001.

Cvetkovich, Ann. An Archive of Feeling: Trauma, Sexuality, and Lesbian Public Cultures. Duke University Press. 2003.

Joseph, Stephen. “What is Trauma? Is It Time to Dump the Diagnosis of PTSD?Psychology Today. January 5, 2012.

Nadal, Kevin. Microaggressions and Traumatic Stress: Theory, Research, and Clinical Treatment. American Psychologoical Association. 2018.

Schroeder, Michael O. “The Psychological Impact of Victim-Blaming – and How to Stop It.U.S. News. April 19, 2016.

Sullivan, Shannon. The Physiology of Racist and Sexist Oppression. Oxford: Oxford UP. 2015.

Young, Iris Marion. “Throwing Like a Girl: A Phenomenology of Feminine Body Comportment, Motility, and Spatiality.” Human Studies. Vol. 3, No. 2: 137-156. 1980.

 

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