TRAUMA: A Genealogy
By Ruth Leys
University of Chicago Press, 318 pages, $19 paper
WHY WE HURT: The Natural History of Pain
By Dr. Frank T. Vertosick Jr.
Harcourt, 304 pages, $24
Everyone knows pain. And after decades of prompting by memoirs, pop psychologies, court cases, celebrity revelations, TV talk shows and our own therapists, we all know what trauma is, in vague phrases like childhood trauma or official diagnoses like post-traumatic stress disorder.
We know that not all trauma is created equal. Children caught in a war zone, watching their families slaughtered by machetes or napalm, raped by enemy soldiers, forced into sexual slavery, with limbs hacked off for the sole purpose of inducing terror–the psychological effects of such atrocities must be of a different order than the trauma suffered, say, by Paula Jones, for which she so famously sought recompense.
Ruth Leys, in her new book, “Trauma: A Genealogy,” suggests that there is an obvious disjunction between a child witnessing mass rape and murder and an adult being flashed by the leader of the Free World. And attending to that disjunction can help us understand the strengths and weaknesses of a concept that has, for better and worse, become a staple of our psychological understanding.
Pain has a less-complicated history as an idea, but it, too, is complex. There are toothaches and toothaches, back pains and back pains. Dr. Frank T. Vertosick Jr., in “Why We Hurt: The Natural History of Pain,” suggests that while physical pain has obvious survival value (we pull our hand out of the fire before we burn it off), the usefulness of psychic pain is less clear. Why, when we break a leg, must we compound our pain by bemoaning the fact that we’ll never ski again? Why, in worrying about getting a migraine, can we seem to call one into being?
Vertosick suggests that by understanding the combination of physiological and psychic mechanisms that combine to make that particularly human affliction, suffering, we gain whatever control we might have over it.
Both books examine the relation of minds and bodies, the nature of suffering, the interpretation of nervous activity, the practice of medicine and what we might call our culture of pain. The two authors have similar agendas in making us take a closer look at pain and trauma, convincing us along the way that we know less than we thought we did about these perennial phenomena. But there the similarities end.
Vertosick, a surgeon and the author of “When the Air Hits Your Brain,” is self-consciously a popularizer of medical science. He is careful to lay out the difference between, and names of, the nerves that relay pain to the brain or spinal cord and those that signal in the opposite direction to tell our muscles to snatch our hand out of the fire. And he walks us through surgical procedures–such as the laser burning of sections of the spinal cord to stop chronic pain–in such a way that anyone can follow. He tells personal anecdotes about his own migraines and crafts his stories of emergency-room horrors with a deft sense of suspense and timing. Vertosick is writing for a wide audience, and at least in part for chronic-pain sufferers he ends with an inspirational flourish of advice.
Leys, on the other hand, does not seem particularly desirous of a general audience. A research professor at Johns Hopkins University and the author of previous histories of psychology, Leys examines the philosophical and empirical assumptions undergirding our sense of trauma. She is less interested in trauma itself, in other words, than in the history of the idea of trauma, and she constructs that history by reading the work of turn-of-the-century theorists like Freud, Pierre Janet and Morton Prince through the lenses of post-Lacanian psychoanalysis, literary theory and contemporary philosophy, and repeating this procedure with psychological theorists later in the century.
In our thinking about trauma over the last century, Leys sees “an oscillation between mimesis and antimimesis” (more on which in a moment), and concludes by suggesting that the irresolvable contradictions embedded in our notions of trauma make any coherent theory, much less a rigorous therapy, impossible.
If some readers find in Leys’ book yet another reason to satirize and denigrate academic obscurantism and pretension, others can undoubtedly find in Vertosick’s an excuse to mock, once again, the philosophical naivete of physicians who would write history and philosophize about the human condition with no more philosophical equipment than a Bartlett’s Familiar Quotations. Both kinds of readers can find plenty of ammunition.
Leys sometimes lapses into sentences that require not just reading but parsing: “I also demonstrate that although van der Kolk’s work gains prestige by being associated with paradigms, technologies, and practices that conform to the dominant model of what constitutes good psychiatric science today, it offers a causal analysis of trauma as fundamentally external to the subject that is not only poorly formulated but is haunted by the same problem of mimetic suggestibility that the theory is designed to forestall.” This makes sense, finally, as an idea, part of her general dismantling of the idea of traumatic victimage. But it doesn’t work very well as the introductory statement it is intended to be.
Still, if Leys forces us to work through her ideas rather than handing them to us in easily digestible chunks, Vertosick has the opposite problem. He is prone to such easily scannable pop aphorisms as, “Pain is to suffering what sex is to romance,” a formulation that makes you think, but the more it makes you think the less tenable it is. He also is wont to reduce some of the thorniest moral and existential dilemmas to remarkably simple answers: “The lesson of Job? That all pain has a purpose.” Or this, as a conclusion to the book: “Why do we hurt? Because despite all of our ethereal properties, humankind has not yet slipped the bonds of our mortal bodies.”
Vertosick’s facile prose works in his favor when he is telling the stories of his patients’ traumas. A man thrown from his motorcycle, his shoulder yanked apart when his leather jacket gets caught on the handlebars, suffers from intense pain despite the absolute severing of all nerves to the arm. The patient, himself an anesthesiologist, knows that the pain is not “real”–it is an effect of the nervous system’s white noise when the information flow is cut off–and yet it is nearly driving him to suicide.
Such phantom agony can be used to explain much about the psychic nature of pain, and Vertosick is brilliant at letting these stories make his arguments. He describes the physiology of traumatic injury and childbirth, of carpal tunnel syndrome, angina, rheumatoid arthritis, ruptured disks and a number of rarer diseases, in each case structured around the story of one or more patients. And he describes the full gamut of medical responses, from those used in the past to the experimental surgeries of the present, including some discussion of alternative therapies from acupuncture to magnets.
Leys’ complex argument about psychic trauma provides no such survey of current practice in psychotherapy, no personalized anecdotes (although she does reanalyze several classic case studies) and no inspirational message. Instead Leys rigorously dismantles reigning beliefs about the mechanisms and effects of traumatic episodes.
Two opposing views of psychic trauma have coexisted uneasily over the last century.
On the one hand, we believe that trauma expresses itself in our dysfunctional behavior, and there is good evidence that this happens. Parents who were abused as children are statistically more likely to beat their own kids. Women who were sexually abused as children are statistically more likely to become sex workers. This is one meaning of Leys’ notion of mimesis, or imitation, as fundamental to our theory of trauma. Traumatized people imitate their abusers, their adult relationships imitations of the original traumatic event.
On the other hand we have had, at least since Freud, a sense that trauma grows layers of psychic scar tissue that bury the trauma deep in our psyches, making it unavailable to memory, much less to imitation. And this view has the opposite outcome: the sexually repressed adult, we believe, may have been abused as a child. The pacifist may have been beaten. This antimimetic theory is part of our general culture of abuse as well.
Leys argues that these understandings of trauma involve not just opposing symptoms but incompatible notions of the individual’s part in the process. The mimetic theory assumes that since traumatized people identify with the abuser, they create, in effect, their own symptoms. The antimimetic theory relies on a notion of the trauma as entirely external, as a shattering of the ego by abuse, which often involves the destruction of identity. While the latter understanding is more prevalent in popular culture, the former is more central to psychoanalytic psychotherapy.
But here we have a further complication, because if psychoanalysis assumes the mimetic origin of trauma–indeed, the very theory of transference relies on a form of imitation in which the patient relives an earlier relationship by projecting onto the therapist–psychoanalytic cure requires the opposite, the telling of the story from outside the relationship, and therefore, according to Leys, the rejection of mimesis altogether. Leys shows how uneasily these two opposing theories coexist in therapeutic practice and psychotherapeutic writing. Whether it is as damning as she suggests, finally, is perhaps unimportant to what Leys accomplishes: In charting the oscillation between mimesis and antimimesis in the major psychological theories of the 20th Century, she displays quite convincingly the shakiness of their foundations and the need for a more coherent understanding.
Anyone interested in issues from false memory to the very validity of psychotherapeutic counseling will find their thinking transformed by Leys’ book if they make the effort required. Vertosick’s book requires less from its readers, with correspondingly less intellectual reward. It is filled with medical information that will be useful to the friends and families of chronic-pain sufferers, but at the level of ideas it only confirms what one already assumes. Leys’ arguments, on the other hand, can do what only the best can, and force us to reconceptualize our world.
