The Art and Science of Trauma and the Autobiographical: Negotiated Truths

By Meg Jensen

This book examines posttraumatic autobiographical projects, elucidating the complex relationship between the ‘science of trauma’ (and how that idea is understood across various scientific disciplines), and the rhetorical strategies of fragmentation, dissociation, reticence and repetitive troping widely used the representation of traumatic experience. From autobiographical fictions to prison poems, from witness testimony to autography, and from testimonio to war memorials, otherwise dissimilar projects speak of past suffering through a limited and even predictable discourse in search of healing. Drawing on approaches from literary, human rights and cultural studies that highlight relations between trauma, language, meaning and self-hood, and the latest research on the science of trauma from the fields of clinical, behavioral and evolutionary psychology and neuroscience, I read such autobiographical projects not as ‘symptoms’but as complex interrogative negotiations of trauma and its aftermath: commemorative and performative narratives navigating aesthetic, biological, cultural, linguistic and emotional pressure and inspiration.

• Language: English
• Publisher: Palgrave Macmillan
• Release date: Jan 4, 2019
• ISBN: 9783030061067

Meg Jensen

Dr Meg Jensen is Professor of English Literature and Creative Writing at Kingston University, London where her research centres on representations of trauma in various forms of autobiographically based art from novels to poetry to painting. She has published on the work of writers including Katherine Mansfield, Virginia Woolf, Vladimir Nabokov, Jack Kerouac and Louisa May Alcott. Her most recent publication is The Art and Science of Trauma and the Autobiographical: Negotiated Truths.

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© The Author(s) 2019

Meg JensenThe Art and Science of Trauma and the AutobiographicalPalgrave Studies in Life Writinghttps://doi.org/10.1007/978-3-030-06106-7_1

1. The Negotiated Truth

Meg Jensen¹  

(1)

Kingston University, Kingston upon Thames, UK

Meg Jensen

Email: [e-mail]

Narrative Swerves and Holding Spaces

The purpose of art, according to the philosopher Herbert Marcuse , is that it has the capacity to show that the world can be otherwise (Marcuse 1977, 138). I was reminded of this idea in 2006 as I read an essay by the novelist JG Ballard . In it, Ballard describes the process of writing his 1984 novel Empire of the Sun , a work of fiction that draws heavily on his harrowing childhood experiences in the Lunghua Japanese prisoner of war camp. He begins the essay by reflecting on the huge staying power of memories, noting that like dreams, they thrive in the dark (Ballard 2006, 1). Past experiences , Ballard observes, can survive for decades in the deep waters of our minds like shipwrecks on the sea bed, and, if they are painful, bringing them into the light can be risky (Ballard 2006, 1). In Ballard ’s case, that risk was so great that he avoided writing about his childhood for forty years: [t]wenty years to forget, and then 20years to remember (Ballard 2006, 1). In fact, he confesses, he was entirely unable to bear witness to that time in his life until it occurred to me to drop my parents from the story just as they had moved out of my life in Lunghua even though we were sharing the same room (Ballard 2006, 1). Removing his parents from the story, that is, enacted a narrative swerve that freed Ballard to recount what he felt to be the truth of his real existence: his sense of surviving the war on his own (Ballard 2006, 1). Once I separated Jim from his parents, Ballard reveals, the novel unrolled itself at my feet like a bullet-ridden carpet (Ballard 2006, 1).

Thus, despite the significant change Ballard had made in representing the circumstances of his past, he found that enough of it was based on fact to convince me that what had seemed a dream-like pageant was a negotiated truth (Ballard 2006, 1). The art of Ballard ’s novel, in other words, its narrative negotiation with the risky, dark, and shipwrecked memories of its author’s traumatic past, exemplifies the Marcusean capacity to show the world as otherwise. And it is precisely this strategy of negotiation with the truth, rather than its documentation, that I find in all the posttraumatic autobiographical projects I examine in the pages to come. From legal and rights testimony to traditional and graphic memoirs , from prison poetry to autobiographical fiction , from virtual to material monuments to traumatic histories, I see Ballard ’s negotiated truth as the key rhetorical figure of the posttraumatic autobiographical . Indeed, it is an approach to recounting traumatic past experiences that I have used myself.

Let me tell you a story. When I was ten years old, two very bad, but entirely unconnected, things happened to me: the sudden death of a sibling and a violent sexual assault. The first of these, my eldest brother’s fatal car accident, was shocking, tragic, and naturally had a very distressing effect on my family. Nevertheless, as the years passed, that loss began to heal. Now, more than four decades later, we miss Alan still and speak of him often, thinking of him especially on his birthday or at Christmastime, but there is no denying that the intensity of our grief has lessened. The other experience did not heal over time. For decades I sought help from various therapists for my crippling anxiety , periodic depression , and self-destructive behavior. In these settings, I was given reasons for my very different reactions to the two terrible things. It seemed that because my brother’s death could be explained, spoken of and shared with others, it could also be processed and eventually accepted. But the attack of which I could not speak continued to haunt me.

So, I took my therapists at their word and spoke. Time and time again I tried to tell them about that terrible experience, but for reasons I only now can understand, I found it impossible to do so. I was like a person recounting a dream: the sensory details were there, but I could not weave them into a story that would make sense to someone else. The attack existed for me in vivid flashbacks as if projected on to multiple, non-synchronized planes from a variety of viewpoints, a private screening that admitted only me. In this narrative muddle, I sometimes contradicted myself, conflating certain specifics, backtracking to try and explain, and ultimately telling different versions of what happened. Often, my therapists would challenge me about which of these accounts was the real truth. But I didn’t know. And I didn’t care. For while they were concerned about the who, what, when, and where of what happened, all that mattered to me was the question that could not be answered. The ‘why.’

So, I gave up on therapy and I suffered. And I wrote. And through writing, I negotiated a way of raising my dangerous memories from the deep. I invented a character (Bernadette ) with a past like my own and imagined what would happen to her in the future. I wrote this story as fiction rather than fact because (as my therapy had shown) my grasp of the facts was unreliable. And anyway, in fiction I could create my own answer to the unanswerable question.

Here is an excerpt from that work:

Bernadette ’s Creative Writing Notebook

Date: October 22 1999

Title: Time Line

Bernadette was attacked when she was nine or ten years old. She can’t remember the exact date. That is, she can’t remember if it was before Andrew died or after—which probably means it was after—in the time when nothing much worth remembering in any linear way happened. Bernadette remembers this period in an audible, aural way instead. She remembers sounds, words especially, words that were spoken and words that were choked, and who said what to whom. But when, and in what order, or with what consequences—it doesn’t come back to Bernadette that way.

This lack of chronological sequencing doesn’t bother Bernadette —it didn’t really matter in which order the plagues descended did it? Was it locusts first or floods? It is enough to know that they came. That the horrors did not desist. That some died, and others lived to write about it.

Her shrink didn’t see it that way, of course. Resistance, defense mechanisms—these were the words that hung about the analyst’s office. But why were you there, Bea? In the park?

Why indeed.

Bernadette could not follow. She did not want to remember, to place events in a continuum, to see their cause and effect. Bernadette ’s time-line was the project her shrink wanted to her to complete. So, she did. On a big piece of white poster board, using black stenciled letters and a large, red line to connect the dots. She’d made most of it up. ¹

While much of my novel is fictionalized, the passage I cite here recalls something I did in real life. I was fed up with being questioned. But what I did not know when I handed over that half-made-up time line to my therapist was that my inability to offer a consistent chronology of events was itself a key symptom of what is known as posttraumatic stress disorder , or PTSD .

I began to learn about the constrained relationship between traumatic experience and life storytelling in 2014 when the anxiety I had suffered from all my life became intolerable: I could not sleep and was terrified of travel and even of being on my own. I struggled to get to work and to care for my family. I decided (very reluctantly given my previous unsuccessful experiences with therapy ) that I had to get some professional help. For the first time, I received the diagnosis of Posttraumatic Stress Disorder, brought on by the violent assault in childhood. And I found out something else. Although I had many symptoms of PTSD , there was one that I did not have any longer: vivid flashbacks.

In my teens and early twenties, I had them all the time, especially at night. But more recently the images that chase me in my nightmares are vague and changing—not specific and recurrent. My new therapist wondered why. And he asked me to tell him my story. But this time instead of recounting it all again, I gave him my novel to read. Afterwards, we talked at length about the relationship between my writing and my symptomology. And here is what we came to understand: although writing the novel did not completely cure me, it provided a holding space on the page for my traumatic memories. ² By integrating those memories into a partially imagined story with a beginning middle and end, I was able to place those terrifying events in the past to some degree. As I understood it, my writing formed a barrier between my present-day life and the pain of my past. It enabled me to get on with life: get an education, get a good job, raise a child, and maintain good relationships. Nevertheless, to borrow a phrase from Ballard, the events of my childhood had staying power. While once they had remained behind the barrier I constructed, my anxieties had now become overpowering: the door needed strengthening.

The Why?

At around the same time I was working through these issues, a colleague and I began to develop a research project for the UK Foreign and Commonwealth Office (FCO ) that would adapt expressive life writing exercises for survivors of sexual violence in conflict in Iraq. In the process, I read through the FCO’s International Protocol on the Documentation and Investigation of Sexual Violence in Conflict (2014). As the Protocol makes clear, its central ethos is to do no harm to victims of such crimes in the process of investigation. The section on interviewing and collecting testimony, therefore, advises the interviewer that he or she should be sure to cover the ‘who’, ‘what’, ‘where’, ‘when’ and ‘how’ of the crimes (while remaining wary about asking the survivor/witness any ‘why’ questions, so as not to apportion blame to the survivor/witness ) ( Protocol 2014, 114). When I first saw the recommended list of questions for interviewers, however, I was thrown back into my own past, picturing the younger me offering her hurt, angry, and ironic time-line in response to just such interrogations. It occurred to me that the Protocol ’s suggested interview approach was not only likely to unknowingly do harm to victims by forcing them to recount experiences, but it was also impractical in terms of data collection: a survivor re-traumatized in the act of witnessing cannot offer reliable testimony . I saw too that while the Protocol advises interviewers to avoid any considerations of why, research suggests that victims of trauma cannot begin to heal until they are able to construct some narrative of meaning for their experiences. ³

And there is more. My educational background is eclectic to say the least: I am a bit of a magpie and have read and studied literature, cultural studies, creative writing, art history and philosophy as well as the biomedical sciences. My experiences of both psychoanalysis and psychotherapy and my recent contributions to applied psychosocial projects, have also given me deep understanding of the research emanating from those disciplines on traumatic injury, its causes, effects, and the efficacy (or otherwise) of a range of therapeutic interventions. In Isaiah Berlin ’s famous formulation, I am much more fox than hedgehog (Berlin 1953). ⁴ I am also very aware that despite my most earnest research, enquiry, and endeavor, in my fox-like rushing across multiple disciplines to draw connections and generate new ideas, I may succumb to the dangers of the wide-angle viewpoint. Details may be overlooked. Nuances missed. The disciplinary subtleties of biochemical theorems and neuroscientific findings blurred. Should any or all of these infelicities be contained in this volume I would be grateful for constructive, elucidating clarifications. I am not and do not claim to be an expert in all of these research areas and I defer to those who are. What my background does offer, however, is an ability to spot the significant gaps in knowledge in each discipline that might be aided by work being done in another, thereby providing an opportunity to facilitate interdisciplinary discussion, connection, and collaboration. Such exchanges, I hope, may lead to the creation of new knowledge and understanding of posttraumatic autobiographical narratives and the relations of these to mental illness and well-being.

My reading of the FCO Protocol is an example of the necessity for such cross-disciplinary conversations, as it suggests that ideas commonly discussed in literary trauma studies and clinical psychology are not fully informing this aspect of applied human rights work. Other gaps of similar kinds will be explored in the chapters to come. Importantly for me, therefore, this project is not only concerned with what knowledge I might generate. Instead, I hope to foster discussions that will lead to practical applications of collaboratively developed, effective, and targeted narrative-based therapies for the treatment of trauma. The negotiation of my truth gave me a new story to tell—a new narrative identity: Bernadette , my character, was a victim. I, Meg Jensen , am a writer/survivor, in charge of the story of my life. And through my work on this volume, I have come to further understand that this cycle of representation, reflection, and detachment from the past is a vital path toward well-being.

Altered Relations

Cultural critic Andreas Huyssen has argued that survivors of traumatic experiences face the difficult task of new beginnings, as trauma by its nature must necessarily remain unresolved, generating ever new attempts at resolution (Huyssen 2003, 151). Autobiographical narratives composed in the aftermath of traumatic experience are part of that compulsion to resolve what cannot be resolved, to generate meaning, knowledge, and justice in the context of trauma. In this way, although the symptoms of traumatic injury inscribe serious constraints on autobiographical storytelling, they are also generative, forging new, identifiable forms of expression across otherwise dissimilar narratives. To be clear here, I am not suggesting that there is a simple cause and effect relation between traumatic experience and art or even traumatic experience and storytelling. Traumatic injury does not in and of itself produce art, artists or autobiographical projects of any kind. Rather, representations of such experiences are composed within multiple and idiosyncratic familial, historical, economic, and political contexts including but not limited to the traumatic event and its aftermath. For the purposes of this study, however, I posit that there are striking similarities among literary, testimonial , generational, and memorial representations of traumatic experience that are in all other ways dissimilar, and that those similarities are created in the generative context of trauma.

In The Limits of Autobiography (2001), Leigh Gilmore explored representations of traumatic experience in a range of autobiographical texts, considering both the coincidence of trauma and self-representation, and what this relation reveals about autobiography, its history and especially its limits (Gilmore 2001, 36). Telling dangerous truths, Gilmore explains, calls forth an alternative jurisdiction for self-representation in which survivors can produce an alternative jurisprudence about trauma [and] identity (Gilmore 2001, 143). This notion that autobiographical representations forge an extralegal, alternative jurisdiction, suggests the complexity of such symbolic sites in which memory is not simply exercised but, to use Ballard ’s term, negotiated. Narratives of the suffering self or the victimized community simultaneously enact commemoration of that suffering and are emblematic of avoidance.

In the alternative jurisdiction of posttraumatic representation, Gilmore argues, a distinction is drawn between the sovereign self who can articulate who I am and how I came to be this way and the knowing self who does not ask who am I, but instead how can the relations in which I live […] be re-enacted through me (Gilmore 2001, 43). Adapting Julia Kristeva ’s observation of the altered relations to power, language, and meaning, translated by sexual difference (Kristeva 1981, 13), posttraumatic autobiographical narratives may be said to evoke a difference inscribed by the posttraumatic state: an altered relationship to meaning and to the body, and therefore to the experience of life itself. The discourse of such representations, whether voiced individually or collectively, articulates the violent incursion of the traumatic event(s) rather than representing a stable, sovereign voice that has access to all the facts. Trauma narratives of all kinds are produced in the interrogative space between a haunted present and an unattainable future and concern the interplay between what can be known and remembered, and those sounds, images, and feelings trapped in the decontextualized echo chamber of traumatic memory .

While the negotiation of truth is the key strategy of such narratives in all forms, the character of that negotiation (whether in fiction , poetry , testimony , or public memorial art) is questioning, interrogative, and generative of ambiguous responses. Their cultural value, moreover, comes precisely from this unique perspective. As Huyssen observes, if we acknowledge the constitutive gap between reality and its representation in language or image then we must also be open to many different possibilities of representing the real and its memories and accept that the semiotic gap cannot be closed by any orthodoxy of correct representation (Huyssen 2003, 19). In the case of traumatic histories, this semiotic gap is widened by difficulties in the processing and retrieval of memory that ultimately lead to boundary-breaking forms. These forms challenge representational and generic orthodoxies, and in doing so produce vital new understandings of what it means to be human in the context of trauma (Gilmore 2001).

In Unclaimed Experience: Trauma, Narrative and History, Cathy Caruth argues that what haunts the victim of traumatic experience is not only the reality of the violent event but also the way in which that violence has not yet been fully known (Caruth 1996, 6). The role of the posttraumatic autobiographical narrative, therefore, is to stand on the threshold asking questions at that locked door. In the pages to come, I will consider numerous such representations of traumatic experience , reading them not simply as symptoms but as complex interrogative negotiations of trauma and its aftermath, commemorative and performative sites that have been reached via insecure transit across networks of aesthetic, practical, cultural, economic, linguistic, and emotional pressures and inspirations. ⁵ In order to make these arguments, it will be useful first to offer an overview of trauma itself—both its historical origins and its development as a diagnosable condition, and the latest (though not uncontested) definitions of what trauma is and does.

Defining Trauma

Throughout history, human beings have understood that there was a relationship between traumatic experiences and mental illness (Andreasen 2010). As early as 2000 BC, ancient Egyptians noted the adverse effects of warfare on soldiers. In 440 BC, Herodotus wrote in his Histories of a marvel that occurred in the Battle of Marathon. There, he told the story of an Athenian named Epizelos, who, while fighting in close combat lost the sight of his eyes, despite not having received a blow in any part of his body (Herodotus 440 B.C., trans. Macaulay 1890, 6:117, 1–3). In a diagnosis suggestive of our contemporary understanding of chronic PTSD , Herodotus observed that while not physically injured, Epizelos continued to be blind for the rest of his life from this time as a direct result of being witness to horrific scenes (Such was the number which fell on both sides, Herodotus explained) (Herodotus 440 B.C., trans. Macaulay1890, 6:117, 1–3).

In the seventeenth century, Swiss physician Johannes Hofer used the term nostalgia to describe a set of symptoms suffered by soldiers stationed in France and Italy who pined for their native mountain landscapes. They complained of melancholy, insomnia, loss of appetite, anxiety , heart palpitations, and incessant thinking about home (Hofer 1688). In the Napoleonic period, French physicians followed up Hofer ’s observations, attempting to more clearly categorize both the symptoms of this illness and to identify those most at risk. In 1823, Napoleon’s chief surgeon Dominique-Baron Larrey prescribed exercise and music to treat this condition (Shorter 2015, 54–55), and by the late nineteenth century, similar observations of a long-lasting event-based disorder not predicated on physical injury were being made in many Western countries. In the United States , for example, Dr. Jacob Mendez Da Costa made note of what he called soldier’s heart, the symptoms of which included a thumping chest, anxiety , and breathlessness (Shorter 2015, 55). In Great Britain , a series of train disasters gave rise to a condition termed Railway Spine, in which seemingly healthy and uninjured accident victims complained of a range of physical disorders (Harrington 2001).

The first recorded breakthrough in understanding and treating conditions like these came from the research of French physician Jean Martin Charcot . Charcot worked with women who were diagnosed as hysterics, a term which suggested that their symptoms arose from a disease of the uterus (the Greek word for womb is "hystera") (Goetz et al. 1995, 211). The symptoms of hysteria included sudden paralysis, amnesia, sensory loss, and convulsions and the usual treatment was hysterectomy. Charcot was the first to understand that the origin of these symptoms was psychological rather than neurological —and that they arose as a result of terrifying and often violent experiences. In the 1880s, Josef Breuer and Sigmund Freud likewise concluded that hysteria was caused by psychological trauma. In Freud ’s view, hysteria might be the result of a traumatic experience , but was more likely to arise from repressed and socially unacceptable desires. In 1893, Breuer and Freud developed Charcot ’s ideas in their Studies on Hysteria , and took particular note of what they called an hysterical attack, observing that it comprised the recurrence of a physical state which the patient has experienced earlier, ⁶ a definition similar to the one used to diagnose PTSD flashbacks today.

Further development of treatments for trauma came during the First World War when psychiatrists observed soldiers suffering from what was then termed shell-shock , or battle fatigue . Symptoms of shell-shock were like those of hysteria in that they included uncontrollable weeping, screaming, memory loss, and physical paralysis (Herman 1992). Doctors discovered that quick intervention near the battlefield could enable some traumatized soldiers to return to the front, while those who could not be cured were usually branded as weak or cowardly. The treatment used on these soldiers drew on Freudian psychoanalysis : the patient told the story of what had happened to him, perhaps several times, as a way of desensitizing himself to the stressful memory. In 1923, however, psychoanalyst Abram Kardiner , himself a former patient of Freud ’s, observed that in some cases it was best not to encourage the soldiers to revisit their harrowing experiences. Reexposure of this kind often slowed recovery, Kardiner found, and he further theorized that by telling their stories, the soldiers reawoke their suffering (van der Kolk et al. 1996 , 60). Kardiner thus argued that traumatic symptoms were not related to an individual’s cowardice or moral weakness but were instead a normal and understandable result of exposure to suffering and atrocity.

During World War II , psychiatrists relied on hypnosis as a treatment for trauma, and, after the war, a new category of patient was described: survivors. Multiple studies were undertaken of the impact of long-term stress on prison and concentration camp detainees as well as combat veterans. Psychoanalyst Henry Krystal , for example, studied prolonged traumatization in concentration camp survivors. He argued that many of them lacked the ability to imagine, to symbolize and to dream. As a result, they experienced emotions through the body, without being able to interpret the meaning of what they are feeling (van der Kolk et al. 1996, 60). The traumatic experiences these survivors had undergone, Krystal suggested, brought about an inability to imagine the future or reflect on the past as past.

In Boston in 1942, four hundred and ninety-three people died in a fire in the Cocoanut Grove nightclub. Studies of this terrible event further developed trauma theory in a civilian context. Dr. Erich Lindemann , Professor of Psychiatry at Harvard Medical school, treated many of the survivors of that fire and in doing so laid the groundwork for our contemporary understanding PTSD in his 1944 paper Symptomatology and Management of Acute Grief . In it, Lindemann identified some of the symptoms we recognize today as the effects of trauma, such as expressions of guilt and hostility, low mood, anxiety , disorganization, and certain physical complaints.

PTSDand Contemporary Understandings

The past four decades have witnessed a tremendous growth in our understanding of traumatic disorders, their symptoms , and their treatment. ⁷ Investigations into the causes of trauma have led to great advances in our ability to map its psychological processes. Most recently, through research in neuroscience , knowledge of how the delicate circuitry of the brain is affected by traumatic events has increased hugely. ⁸ As these developments have coincided with a sustained period of global conflict and the consequent mobilization of international rights activism and public health interventions, this same period has also seen a dramatic increase in the incidence and diagnosis of traumatic disorders in general and PTSD in particular. ⁹ Posttraumatic Stress Disorder was first used as a diagnosis in the late 1970s mainly in relation to the sufferings of large numbers of US military veterans of the Vietnam War who returned with, or later developed, chronic mental health problems including drug and/or alcohol abuse, violence, inability to sustain employment, depression , anxiety , and flashbacks.

Psychiatrists Chaim Shatan and Robert J. Lifton were anti-war activists who became involved in organizing rap groups with returning veterans in the New York City area during this period. These discussion groups enabled veterans to share their problems with one another in the hope of recognition and healing. Shatan and Lifton campaigned for a new diagnosis that would enable the veterans to receive publicly funded treatment for their symptoms . They went on to identify twenty-seven common effects of what they called traumatic neurosis, which eventually informed the first formal diagnostic criteria for PTSD (Shatan 1974). At the same time, as a consequence of the women’s movement in America in the 1970s, trauma in women’s lives began to be studied. Women’s consciousness-raising groups, like the rap groups established for war veterans, helped victims of domestic violence and sexual abuse to discuss their experiences publicly and overcome barriers of denial, secrecy and shame (Herman 1992, 29). In the 1980s, Dr. Diana Russell conducted a survey of more than nine hundred women chosen at random that revealed then-shocking statistics. One woman in four of those questioned in the survey had been raped. One woman in three had been sexually abused in childhood . Russell ’s study eventually gave rise to further investigations of the frequency and long-term effects of sexual and domestic violence on women’s mental health (Russell 1982, 1983).

In 1980, the term PTSD entered modern psychology in the Diagnostic and Statistical Manual, Third Edition of the American Psychiatric Association (DSM -III , APA). The current edition of this manual (DSM -V , 2013) used by clinicians and researchers to diagnose and classify mental disorders, contains an entire chapter devoted to trauma-related disorders. This addition reflects advances in knowledge and understanding of trauma, and the variety of ways it might present itself in different people at different times. According to the DSM -V (2013), PTSD is a stress-related disorder that arises from involvement in certain kinds of traumatic events . PTSD can arise from being a victim of such an event, or from witnessing it. The trigger for developing PTSD and related disorders is exposure to actual or threatened death, serious injury or sexual violation. ¹⁰ Regardless of which kind of exposure was the trigger, PTSD goes on to cause significant distress to those who suffer from it, interfering not only with emotions, but also with the executive functions that control behaviors like social interactions, self-care, reasoning, and problem-solving.

It is worth noting here, however, that most people who witness a traumatic event will not develop PTSD , and that at present there is no clear agreement among mental health practitioners about precise or discreet risk factors. ¹¹ Recent research shows that approximately 25% of people may be more likely to become traumatized than others, whether through a genetic predisposition, gender, or because of their early life experiences. As we shall see in Chapter 7, more work is being done to identify most those at risk, thereby predicting and possibly preventing them from developing traumatic disorders.

Date Stamping

One compelling psychological model of PTSD ’s mechanisms comes from clinical psychologist Robert Strickgold . Strickgold argues that the defining characteristic of PTSD is failed memory processing, which is characterized by the inappropriate dominance of specific episodic memories of traumatic events (Strickgold 2002, 63). In Strickgold ’s account, traumatic symptoms are the effect of biochemical processes in the brain that are triggered by the traumatic event, disrupting memory, and the ability to produce a coherent, chronologically accurate, account of that event: an autobiographical narrative. Autobiographical narratives are composed of memories, and memories are produced by a complex set of systems in which both sensory and semantic perceptions are processed in different areas of the brain and then stored. In the first instance, they are either stored as declarative episodic memories —those specific events that we can remember clearly—or as general knowledge or semantic content only—for example the general knowledge that enables us to drive a car without necessarily being able to recall all the moments in which we learned each element of driving (Strickgold 2002, 63).

In normal memory processing, our memories are date-stamped : our brain files them chronologically so that we know that the events of Monday came before the events of Tuesday and so on (Strickgold 2002, 66). That system allows us to remember a specific experience, such as our first day of school or the last time we ate sushi, and at the same time to understand that this experience was in the past. If we had to, we could probably put a date and time of day on such memories. In PTSD , on the other hand, the brain does not integrate the episodic memory of a traumatic event into the semantic memory system properly. This lack of consolidation means that links do not develop and the memory of the event is created in an inappropriately strong and affect-laden form that can neither be reflected on, nor fade in the usual way (Strickgold 2002, 67). ¹² While normally processed memories are ascribed a context in which they can be read (my childhood, my school years, my trip to California, etc.) traumatic events are stuck as unprocessed sensory perception, and can reemerge at any time and place as if they are occurring right now. Moreover, because these traumatic experiences are not date-stamped as past experiences that are no longer threatening, they can easily trigger distress in the present.

Research by neuroscientists suggests that this processing failure occurs because trauma causes the complex circuitry of the brain to break down in several ways. The lateral, prefrontal, parietal, and posterior midline structures of the brain become structurally remodeled by traumatic stress experiences. As these regions are particularly involved in episodic memory , emotional processing, and executive control, these changes might form the physiological substrate of PTSD symptoms (Schauer et al. 2011, 21). Firstly, in trauma, the amygdala, the part of our brain responsible for reacting to fear, overreacts (LeDoux 2000; Shin et al. 2006). The functions of the amygdala are related to basic survival emotions: threat detection and the fight or flight response. People with PTSD tend to have a chronically overactive amygdala that exaggerates fear responses even to things that are not in and of themselves threatening: triggers such as bright lights, motorcycle engines, or stern facial expressions. At the same time, the hippocampus, another part of the brain that is related to processing memory, is underactive in many cases of PTSD (Bremner 1999). As I will explore in the pages to come, normal brain functioning requires a complex set of interactions between these parts of the brain and the cerebral cortex or executive branch. When any one part of this system breaks down, as it does in PTSD , the results are wide-ranging. There may be disruptive active symptoms such as hyperalertness, exaggerated anxiety flashbacks, or sleeplessness as well as de-activating symptoms such as emotional numbing, low mood, and unreliable or fragmented memory.

Treatments for Trauma

Several kinds of therapy have been shown to be effective for many people with a history of traumatic experience , whether they are victims of, or witnesses to, violence in combat, sexual assaults, accidents, natural disastersor other traumatic events . The treatments used most commonly are Exposure Therapy and Cognitive Behavioral Treatment (CBT ) (Bichescu et al. 2007). ¹³ Exposure Therapy targets the unhelpful learned behaviors that many survivors engage with in order to avoid situations or thoughts that are reminiscent of the original trauma. Through this therapy , survivors undergo careful and controlled confrontation with sensory experiences or fearful triggers so that they can become desensitized to them (Mørkved et al. 2014). Trauma-focused Cognitive Behavioral Therapy (CBT ) has also been shown to be effective (Bisson and Andrew 2007 ). CBT is based on the idea that a person’s thoughts and beliefs about themselves and others, and about their past and future, will have major impact on how they feel (Galovski and Gloth 2015 ). This treatment thus focuses on processing the trauma survivor’s memory of the traumatic event and challenging the validity of their thoughts and beliefs about that event and its power in the present (MacPherson 2012, 30).

In addition to these treatments, the past ten years have seen great advances being made in the mapping of neurological , chemical, and biological causes of PTSD and its symptoms in the hope that such knowledge will aid in the development of more consistently effective interventions . Nevertheless, neurologically based treatment is only in its early phases. Likewise, at present, there is no straightforward psychopharmacological remedy for PTSD —no single drug therapy works for a convincingly large number of patients (Bowirrat et al. 2010). And while CBT is the most well-studied and most common treatment, research shows that