The Triumph of the Traumatic? Wounds, Memory, and the Role of Medicine
Warren Kinghorn, MD, Associate Professor of Psychiatry, Duke University Medical Center; Esther Colliflower Associate Professor of the Practice of Pastoral and Moral Theology, Duke Divinity School; Co-Director of the Theology, Medicine, and Culture Initiative, Duke Divinity School; and Staff Psychiatrist, Durham VA Medical Center
In his 1966 manifesto The Triumph of the Therapeutic, Philip Rieff lamented a western culture in which a communally oriented account of selfhood and morality, rooted in a literary canon and a prevailing moral demand system, had given way to a focus on the self-actualizing and self-governing individual whose “normative institutions” are not family, nation, church, or party, but rather the hospital and the theater. Rieff charged that the language of the therapeutic had become the governing moral discourse of the west: “Religious man was born be saved. Psychological man is born to be pleased” (25).
Rieff’s critique still resonates over half a century later, but most people who enter psychotherapy today do not do so to pursue 1960s-style self-actualization. They are more likely to say that they are seeking relief of suffering from specific clinical conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD). The ascendance of these diagnostic terms as interpretive categories for human experience has further cemented the role of the hospital and clinic as normative cultural institutions.
Hovering behind many of these diagnostic terms is the broader concept of trauma, which functions both as an explanation for why many people suffer (e.g., “she is a trauma survivor”) and as a qualifier of moral agency and responsibility (e.g., “Don’t ask, ‘What’s wrong with you?’ Instead, ask, ‘what happened to you?”). Emerging in its current form in the 1970s and 1980s, trauma has continued to expand in cultural importance and interpretive scope, often used not only for instances such as sexual assault and combat brutalization but also for instances such as forced displacement, enduring systemic racism, experiencing childhood neglect, and so on. Psychological trauma, however, is not a naturalistic category. It is a socially negotiated category that is grounded, in the argument of Didier Fassin and Richard Rechtman, “not in the psyche, the mind, or the brain, but in the moral economy of contemporary societies” (276). But it is a socially negotiated category of great power that drives millions of people to turn to the hospital and clinic as normative cultural authorities.
In this paper I will argue that because trauma is not a naturalistic category, the “mental health care” disciplines, grounded as they are in therapeutic individualism and commitment to the relief of suffering, can appropriately define neither the essence nor the boundaries of trauma. What is needed, rather, is a broader conceptual framework that can account for the existence of evil, for the ways that evil contributes to personal suffering, and for ways to respond to suffering that will confront evil rather than perpetuate it. The language of trauma, as well as much of mental health care, requires something like a moral theology.
References
Fassin, Didier, and Richard Rechtman. The Empire of Trauma: An Inquiry into the Condition of Victimhood. Princeton University Press, 2009.
Rieff, Philip. The Triumph of the Therapeutic: Uses of Faith After Freud. University of Chicago Press, 1997.
Rieff’s critique still resonates over half a century later, but most people who enter psychotherapy today do not do so to pursue 1960s-style self-actualization. They are more likely to say that they are seeking relief of suffering from specific clinical conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD). The ascendance of these diagnostic terms as interpretive categories for human experience has further cemented the role of the hospital and clinic as normative cultural institutions.
Hovering behind many of these diagnostic terms is the broader concept of trauma, which functions both as an explanation for why many people suffer (e.g., “she is a trauma survivor”) and as a qualifier of moral agency and responsibility (e.g., “Don’t ask, ‘What’s wrong with you?’ Instead, ask, ‘what happened to you?”). Emerging in its current form in the 1970s and 1980s, trauma has continued to expand in cultural importance and interpretive scope, often used not only for instances such as sexual assault and combat brutalization but also for instances such as forced displacement, enduring systemic racism, experiencing childhood neglect, and so on. Psychological trauma, however, is not a naturalistic category. It is a socially negotiated category that is grounded, in the argument of Didier Fassin and Richard Rechtman, “not in the psyche, the mind, or the brain, but in the moral economy of contemporary societies” (276). But it is a socially negotiated category of great power that drives millions of people to turn to the hospital and clinic as normative cultural authorities.
In this paper I will argue that because trauma is not a naturalistic category, the “mental health care” disciplines, grounded as they are in therapeutic individualism and commitment to the relief of suffering, can appropriately define neither the essence nor the boundaries of trauma. What is needed, rather, is a broader conceptual framework that can account for the existence of evil, for the ways that evil contributes to personal suffering, and for ways to respond to suffering that will confront evil rather than perpetuate it. The language of trauma, as well as much of mental health care, requires something like a moral theology.
References
Fassin, Didier, and Richard Rechtman. The Empire of Trauma: An Inquiry into the Condition of Victimhood. Princeton University Press, 2009.
Rieff, Philip. The Triumph of the Therapeutic: Uses of Faith After Freud. University of Chicago Press, 1997.