Feature: Maternity Stories as Social Change

by Sarah MacDonald

With the power of the #MeToo movement, more people are acknowledging the influence of women’s voices to affect lasting change. This same capacity of narratives has and continues to be utilized by women to stimulate changes in the medical community. Too often, women are dismissed by their doctors and others responsible for their care. Nowhere is this truer than during maternity. Many women have felt silenced and ignored during this time in their lives. In response, some have taken to writing their own stories to shed light on their experiences in the hopes that others will not have to undergo the same treatment. Sadly, while this problem and solution are seeing a new light, they are not new. Through a comparison of women’s life writing from the early 20th century and modern examples, it is clear that women still feel largely ignored and ill-informed about much of the childbearing process. It is essential that society, and especially the medical field, start to appreciate the knowledge and understanding women bring to their maternity experiences.

As early as the 1900s in Britain women collected their experiences to push for a transformation of patriarchal medicine. The Women’s Cooperative Guild compiled two fascinating pieces of political writing by working women from both identified and anonymous writers. The initial text, Maternity (1915), illustrates the enormous difficulties surrounding childbirth with limited available resources. The anonymous women shared sketches of their lives to encourage more governmental support for poverty-stricken women. The women answered a series of questions about their experiences in childbirth. The questions included the number of children they had that survived, how many did not, their household income, husband’s work, and general information on how much they knew about maternity as a whole.

Two pieces of introductory material highlight the purpose of the compilation. The first is the foreword by the Right Honorable Herbert Samuel M.P: “The Women’s Co-operative Guild, unresting in their efforts for the improvement of the conditions of working women, have rendered a most useful service in eliciting these letters and in making them public” (11-12). suggests the need for these individual voices that can speak for their own needs and offer suggestions to what will actually improve their childbearing life. The second piece is by the Guild itself:

The cry of a woman in travail has become a commonplace of literature, and the notion that pain and motherhood are inevitably connected has become so fixed that the world is shocked if a woman does not consider the pain as much a privilege as the motherhood. And this attitude of the world towards the pain of travail has been extended to all the sufferings attending motherhood. These letters show that this is the view of women themselves, for which doctors have been largely responsible. It is hardly too much to say that the ordinary professional attitude might have been summed up in the saying, “You’ll be worse before you’re better.” It would be foolish to cry aloud against the inevitable minimum of maternal suffering. (28)

We see in this introduction the basis for the problem women are still dealing with: that of a patriarchal medical community that decided women must endure any manner of pain, suffering, and trauma during pregnancy and childbirth for no other reason than tradition and the lingering impact of religious views. The letters mentioned, have a matter-of-fact tone that belies the suffering many of the women underwent. A representative letter reads as follows:

I can speak from experience. For fifteen years I was in a very poor state of health owing to continual pregnancy. As soon as I was over one trouble, it was all started over again. In one instance, I was unable to go further than the top of the street the whole time owing to bladder trouble, constant flow of water. With one, my leg was so terribly bad I had constantly to sit down in the road when out, and stand with my leg on a chair to do my washing. I have had four children and ten miscarriages, three before the first child, each of them between three and four months. No cause but weakness, and, I’m afraid, ignorance and neglect. I was in a very critical state for years; my sufferings were very great from acute weakness. I now see a great deal of this agony ought never to have been, with proper attention. It is good to see some of our women waking up to this fact. It is help and attention during pregnancy that is wanted, and I hope my own dear daughter, if she ever marries, will be one to benefit with others, by our experience. I do hope this letter is something of what you are wishing for, hoping for good results of our Guild work in this manner. Wages 25s; four children, ten miscarriages. (62)

Ten miscarriages was above average according to the rest of the letters, however, the lack of information that caused the author’s distress was typical. The women sought, more than anything else, education about the entire process from birth control through pregnancy and postpartum health. Some writers blamed taboos surrounding women’s health and bodies, quite prevalent in Victorian England, for their ignorance of childbirth and health. The collection’s purpose was to augment readers’ understanding of maternity.

If we now turn to modern discussions of maternity online, we see the need to be heard and appreciated as whole people is still something women are striving for. There are numerous websites and discussion boards devoted to women sharing their experiences with childbirth and how they felt their input was not wanted or included in decisions that intimately involved them. A small sampling for testimonials from the sites, ImprovingBirth, Babygaga, and Human Rights in Childbirth, show the continued need women feel to share their experience: “Every woman has the right to access the healthcare support that she, personally, needs for a healthy birth. Every woman has the right to be respected as the decision-maker about her own care and her baby’s care.” (HRiC-emphasis in original); “I knew deep down inside that things about my birth were wrong but everyone around me said I should just “get over it”, but I couldn’t.” Kimberly Turbin (ImprovingBirth); and “We typically all grow up with a “doctor knows best” mentality. It’s often difficult to understand that they too are working within a broken system that is built on fear of liability, a system that has significant financial motivators and a system that has come to the conclusion that more interventions solve both of those issues and it’s up to us to make sure it changes.” (ImprovingBirth) The last quote especially highlights the disconnect many women feel between their bodies and the medical community. Additionally, the crowd-sourced documentary, “Mother May I” also shares the stories of women’s traumatic birth experiences: “When women start telling their stories, there is so much power in that,” she said. Its trailer shows women speaking out about going through procedures without their consent during birth, facing pressure and ultimatums in the delivery room and more. “Mother May I?” (Pittman). The documentary materials are quite similar to an article in Babygaga that suggests women are experiences trauma during childbirth at an alarming rate. The stories told by these women all deal with traumatic births, which consists of the following:  

What constitutes birth trauma? It varies. Some women may end up feeling like they were coerced into interventions during their birth that they weren’t emotionally or mentally on board with. Others might feel as though they weren’t given informed consent, or even a chance to consent, to medical procedures. Some women are reeling over the C-section they never planned on having that they don’t think they needed in hindsight. Others feel sexually assaulted by doctors who insert their hands into their vaginas without permission. In fact, it appears it’s happening more and more. Between 25 and 34 percent of mothers identify with having a traumatic birth. As a result, women are speaking up and speaking out. (Bosley)

It is again this call for more knowledge and involvement that women are craving, just like they did in the cooperative text. Women are more than the vessel for a child, despite that being the treatment many have received as acknowledged by these narratives.  

One has to wonder how many compilations of narratives women have to share in order to receive the changes they demand. Childbirth should not be this traumatic and separated from a women’s body and mind, yet with the current system, having developed from the medical community from the 1900s, women are still considered less than the autonomous being that they were before pregnancy, are during their pregnancy, and will be after.


References

Bosley, Danielle. “14 Women Share The Heartwrenching Details Of Their Birth Trauma.” BabyGaga, 25 Apr. 2017.

ImprovingBirthhttps://improvingbirth.org/

Human Rights in Childbirthhttp://www.humanrightsinchildbirth.org/

Pittman, Taylor. “Inside The Documentary Uncovering Traumatic Birth Experiences.” The Huffington Post, TheHuffingtonPost.com, 9 June 2018.

Women’s Co-Operative Guild. Maternity; letters from working-women. Collected by the Women’s Co-operative Guild, with a preface by the Right Hon. Herbert Samuel, G. Bell, 1915.

Feature: The ART of Infertility: A Community Project Reimagining Reproduction Advocacy

by Maria Novotny, PhD

The Centers for Disease Control and Prevention reports that 1 in 8 couples in the U.S. will receive an infertility diagnosis, impacting an estimated 12% of women who are of reproductive age (15-44 years old) (“Facts About Infertility,” 2015). Of this, it is estimated that one-third of infertility cases are the result of male reproductive issues, one-third a result of female reproductive issues, and one-third either a combination of both sexes or unexplained (“How Common is Male Infertility, and What are Its Causes?,” 2016). Through advancements in reproductive technologies, options for treating impairments causing infertility as well as new developments in assisted reproductive technologies (ART) have helped patients successfully create families.

Nonetheless, as fertility treatments develop and become more advanced, how patients afford these treatments and who has access has not undergone much growth. Currently, only 16 states in the U.S. mandate full or partial insurance coverage of fertility-related treatment (“Infertility Coverage by State,” 2018). These limited options to accessibility and affordability are important, especially as The Journal of the American Medical Association (JAMA) reported in 2015 that two-thirds of patients must undergo six rounds of in vitro fertilization (IVF) before achieving a successful outcome, which they define as giving birth to a living infant. Such a finding reveals the extreme costs of fertility treatment -— financial, emotional, and physical. For example, one round of of IVF (including medications and the procedure) costs on average nearly $20,000. Multiply that by the JAMA’s findings and that total cost to build a family accumulates to over $100,000. Additionally, such financial costs can enhance already present mental and emotional stress of fertility procedures (Gana & Jakubowska, 2016; Greil et al., 2010; Jaffe & Diamond, 2011).

While financial and emotional strains are often correlated with fertility treatments, discussions of access to fertility care must also be understood by examining who has access. For example, a National Survey of Family Growth from 2006 to 2010 reported that married black women are nearly twice as likely to be diagnosed with infertility than married white women. Yet, women of color frequently do not seek treatment. According to data from the Department of Health and Human Services and from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention, fifteen percent of white women ages 25 to 44 in the United States have sought medical help to get pregnant, compared to 7.6 percent of Hispanic women and 8 percent of black women. These studies help emphasize that access to care remains not only a financial barrier but is a social justice health issue connected to particular racial demographics.  

Sociocultural Silencing & Invisibility of Infertility

The issues described above which concern access to fertility care, however, remain absent in public discourse. Much of this is the result of a cultural silencing around infertility and similar forms of reproductive loss, such as miscarriages and stillbirths. Rather than normalize these experiences of loss, sociocultural practices continue to confine these discussions to the hospital room and/or private home.

The idea that infertility is a rhetorical and physical act that should remain silent or limited to private conversations within the domestic or medical sphere can be traced to historical notions of propriety and fertility. For example, Robin Jensen (2015) notes that nineteenth-century notions of fertility were rooted in medical models of care that viewed the reproductive aspects of a woman’s body as machine-like “parts” that needed to be “fixed” in order to operate (Jensen, p. 27-36). This approach situated the reproductive features of a woman’s body in two distinct categories: If the female reproductive system were “broken,” (i.e., infertile) then discourses around the body should be limited to the home or medical sphere until the situation could be remedied (i.e., a woman became pregnant). By contrast, evidence that a woman’s reproductive system was “working” (i.e., pregnancy) shifted rhetorical conversations around reproduction from the silos of the domestic and medical realms to the public sphere, where individuals could openly disclose and celebrate a woman for her fertility.

Jensen’s work offers a historical perspective on infertility and how it is rhetorically constructed as a private matter that should be quietly dealt with — either within the home or a medical facility. However, as Jensen notes, “it is difficult not to draw parallels between these discourses of the past and discourses of the present day” (p. 42). In other words, the rhetorical machinations of the past that celebrate pregnancy and closet infertility are very much present today.

Similarly, cultural rhetorician Kristin Arola (2011) in her reflective video essay “Rhetoric, Christmas cards, and Infertility” suggests that discourses of infertility are publicly silenced and circulate almost exclusively within the private sphere. She contends that, unlike stories of fertility, narratives of infertility “remain silent” and are removed from our public “life narrative” because “we are not comfortable with infertility” (min 4:00-4:49). Nonetheless, for the nearly 7.5 million women who rely upon fertility services to build their families, experiences of reproductive loss and questions of self-identity become deeply woven into their life narrative. Infertility becomes an embodied identity that is all to often under-recognized and misunderstood by more dominant sociocultural narratives that presume the female body as naturally a fertile body. Such a presumption, however, is simply false.

Given how predominant experiences of infertility and reproductive loss are in our society, how may we begin to disrupt its cultural silencing?

One answer: art.

The ART of Infertility is a traveling art exhibit and oral history project portraying intimate moments of grief that have led fertility patients to create. The exhibit reveals the often unseen and everyday encounters of infertility told from the perspectives of women and men who have suddenly found themselves confronting unanticipated paths of family-building. For some in the exhibit, infertility is a disease to be conquered, to be beaten. For others, infertility is a social construction that does not define them. Other stories represent more of a liminality, individuals still processing: their diagnosis, their next step of action, their definition of family, and, ultimately happiness. Assembled together, this exhibit represents the spectrums of living with infertility and is a statement on how artistic creation can become a source of comfort when confronted by the body’s unpredictability. Two examples shown below illustrate both the range of experiences, mediums, and embodied translations that occur when making experiences of reproductive loss and infertility visible to others.

dosis_novotny_1tornado

Image 1. “Fertility Tornado” by Kristin Phasavath. Oil on canvas.

The piece above is titled “Fertility Tornado”. Kristin, the artist, describes the piece: “The fertility tornado is an easy place to get sucked into while going through your personal fertility journey. When you walk through the door of a fertility center, it’s about having a baby but when the road gets long and drawn out, it’s about conquering a problem. It’s about beating something. Navigating through this infertility world can leave you feeling like you have truly been drug through a tornado. It’s important to try and keep focused on why you started this journey in the first place.”

dosis_novotny_2left

Image 2. “Left Behind” by Kevin Jordan. Photography.  

The piece above is titled “Left Behind”. Kevin Jordan submitted this piece and describes his photo: “This photo essay features my baby shoes, worn almost 32 years ago. Looking at them & photographing them naturally makes one think into the past and into the future. It has been almost 8 years since my wife and I started our infertility journey. At first, the infertility journey made me feel left behind, it had thrown my wife and I off course like we were wandering two seperate paths, and not together. It took years to get our bearings, find that common path again and turn that narrative upside down. We often find ourselves reflecting on how short life is, especially when unexpected events occur, which has pushed us to live genuinely and authentically. Ironically, now I feel as though we have left others behind; we can only hope to serve as role models who embody how precious life is.”

Art Disrupts Silence, Allows for Reproductive Loss to Be Validated

While recounting experiences of reproductive loss can be difficult to do with words, visual art serves as a method that translates these experiences into embodied representations. This allows both the artist and general public to view and find new perspectives on the challenges of alternative family-building. Feminist artists and art activists have a well-documented and exhibited history of confronting sociocultural attitudes towards motherhood, yet infertility and infertile bodies “remain largely invisible in both artistic practice and academic discourse” (McClure, 2014, p. 253).

Community art organizations that situate their focus around issues of infertility, like The ART of Infertility, assist at poking at the culturally embedded s/m/othering discourse by calling attention to the “misunderstandings of the complex reality of mothering and parenting experiences in all their expressions” (McClure, 2014, p. 253). This is achieved through strategically curated exhibits that assemble together a variety of voices, experiences, and representations of infertility and loss to — when taken in — illustrate the multitude of people touched by loss. Further, public art galleries allow for infertility experiences to be visualized and thus begins to make a sociocultural space for the public to recognize and validate these experiences. Art, I argue then, is one method that responds to the sociocultural silencing of infertility and begins to make visible these experiences so as to evoke greater public awareness surrounding the issues of access to fertility care.


References

Arola, K. L. (2011). Rhetoric, Christmas cards, and infertility: A season of silence. Harlot: A Revealing Look At The Arts Of Persuasion 6 (2011).

Chandra, A., Copen, C. E., & Stephen, E. H. (2014). Infertility service use in the United States: data from the National Survey of Family Growth, 1982-2010.

Facts About Infertility”. (2015, April 15). 

Gana, K., & Jakubowska, S. (2016). Relationship between infertility-related stress and emotional distress and marital satisfaction. Journal of health psychology, 21(6), 1043-1054.

Greil, A. L., Slauson‐Blevins, K., & McQuillan, J. (2010). The experience of infertility: a review of recent literature. Sociology of health & illness, 32(1), 140-162.

How Common is Male Infertility, and What are its Causes?”. (2016, Dec. 1). 

Infertility Coverage by State”. (2018). 

Jaffe, J., & Diamond, M. O. (2011). Reproductive trauma: Psychotherapy with infertility and pregnancy loss clients. American Psychological Association.

Jensen, R. (2015). From barren to sterile: The evolution of a mixed metaphor. Rhetoric Society Quarterly, 45(1), 25-46.

Lepkowski, J. M., Mosher, W. D., Davis, K. E., Groves, R. M., & Van, J. H. (2010). The 2006-2010 National Survey of Family Growth: sample design and analysis of a continuous survey. Vital and health statistics. Series 2, Data evaluation and methods research, (150), 1-36.

McClure, M. (2014). s/m/othering. Studies in Art Education, 55(3), 253-257.

Smith, A. D., Tilling, K., Nelson, S. M., & Lawlor, D. A. (2015). Live-birth rate associated with repeat in vitro fertilization treatment cycles. Jama, 314(24), 2654-2662.

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

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