Trauma pathology: A bear in a forest is not a mental disorder.
| 19 min read
(Real quick - this essay mentions multiple types of abuse, psychiatric mistreatment, self-harm, and suicide. Nothing's graphic, I'm just giving you a heads-up.)
So - I don’t think trauma is medical, with the way that society defines each of those “typically.”
You might hear that and think I mean to downplay it, or that I’m saying some bullshit about “bootstrap” rhetoric, where you should just be able to magically think your way out of problems, or that I mean that the problems caused by trauma “aren’t real.” I’ve had people assume any of my household’s own problems “can’t be that bad” if I’m saying this shit, as well, because shitheads have been using similar phrases for years as a weapon against us traumatized people, as if those of us who have Been Through Some Shit should just be able to Buck Up And Get Over It, as if anything regarding heavy experiences like that works that way at all, and I will also say I suspect that oftentimes that Bootstrap Rhetoric is being peddled by people who, in all likelihood, haven’t experienced the kinds of trauma and trauma consequences that lead to years-long struggles with, for example, a PTSD diagnosis on charts in therapists’ offices and inpatient wards and self-harm and suicide attempts.
Hey. Hi. We’ve been in therapy for… oh, heavens, since we were at least 7 years old, and we’re early 30s now, so we’ve been going to therapy for possibly literally longer than some of you reading this have been alive.
We have been in and out of the mental health system for over two decades, and like I said - we're only in our early 30s. We have been through some Shit, and I am not one of those “bootstrap” bullshitters who thinks everyone should just get up and over it yahoo. We’ve self-harmed for years. We’ve attempted suicide. We’ve been in multiple abusive relationships. We’ve been sexually assaulted more than once as a child and as an adult. ’ve been abused psychologically and emotionally. Our family has a long history of trauma. Our parents were traumatized by their parents and that eventually got passed to us too. It's a long line of passed-down trauma and stressors that nobody ever learned to deal with, or possibly were never given the chance to deal with before we came up in the queue. We’ve been in therapy for years and years. We attended a near-daily outpatient facility for over two years in our adulthood and are now on disability benefits because we cannot work, and while it’s not the sole reason (we have a genetic disease as well), our trauma and its effects are absolutely a factor in why and how our case was approved. The judge for our case was one of the stricter judges, according to our legal advocate - she usually approves 30% or less of the cases that cross her desk, and that was after we spent two years waiting.
I don’t say these things to try to beat you over the head with depressing shit or go “woe is me.” I also should note that I am disclosing this all voluntarily, with the hope that it will give some context as to where I’m coming from, but that it should not be required nor expected of people, and if someone says “this hurt me a lot and I struggled with it” and you choose not to believe them, I hope you can ask yourself why you chose that and give it some real thought - even if you don’t change your mind in the end. Regardless - I’m saying this because I want to show that we have trauma. We have struggled enormously with it. I am not saying this with no skin in the game, if you get me.
…now. I still don’t think our trauma reactions are medical problems.
See - human neurology and physiology is incredibly adaptive, and so much of it is geared toward survival. A massive amount of time and effort throughout human history has just been dedicated to food production. You’re a hunter-gatherer foraging in a forest, and you find a bear. The bear flips out and attacks you. You almost die. That’s a very traumatic experience. Your nervous system activates because of that fear, and primes itself to react in specific ways if you encounter a bear again - specifically, with the intent of making you get the fuck out of there so you don’t, you know, get killed by a bear. (In fact - even your children may inherit that fear response so they, too, would be less likely to get killed by a bear. A study done at Emory University by Kerry Ressler and Brian Dias demonstrated that fear responses could be passed down through generations, even with no contact with the parent from whom the fear originated.)
The fear response is not fun. It’s not some nice empowering idea of a natural defense that keeps you safe in a pastel bubble where nothing can hurt you. It feels dangerous. It can feel like you’re fucking dying. But… here’s the thing: is that not my neurology doing what it’s fucking supposed to? What evolution has in part developed it to do? It’s not MALFUNCTIONING. It’s trying to keep me safe.
In today’s society, however, humans don’t really encounter bears on a daily basis that we benefit from feeling anxious about, and our neurons are… not that smart, like that. Bear gets replaced by a car swerving and hitting you at an intersection, and that survival-neurology doesn't understand that cars are not a natural predator of humans. (And brains aren’t always particularly good at differentiating between purely psychological or abstract threats and physical or concrete ones, as it is - and if we think about it, that makes sense. If your brain treats most threats, even the psychological and emotional ones, as heavily as it does physical ones, it also benefits survival, even if it’s fucking miserable for the experiencer.) So - glancing back up at the whole paragraph of trauma summary, my brain is doing what it’s evolutionarily supposed to do, but obviously it’s still a pretty big fucking problem, because now my neurology is primed to panic when I see a car, but a car is not, in fact, a natural predator of human beings that I need to fear every single time I encounter one. (Glib oversimplified example, but hopefully it gets the point across.)
But human civilization isn’t new. Humans sustaining trauma and surviving it and having to figure out how to navigate the consequences even when those consequences cause serious, real, debilitating conflicts with their daily life in non-bear-infested cities isn’t new. What is new, however - in fact, in current society, within the past 100 years or so, which is painfully recent in the whole breadth of human history - is the diagnosis of PTSD.
A bit of an interlude about how we’re defining disorder, before I continue: We do not think a disorder makes someone bad, or defective, or impaired, or flawed. That’s bullshit. But we do live in a society that has legal and institutional authorities that have their own definitions of the word “disorder,” as well as “disease” and “syndrome,” and each of those institutional definitions are almost exclusively about impairment, atypicality, or lack of “normal” function. That is, unfortunately, rather non-negotiable, unless anybody reading this has a lot of pull in a lot of courtrooms and medical headquarters. I don’t control how medical governing bodies nor how legal governments define these things, and I don’t really agree with how they define them either, but I cannot change that, and that isn’t isolated from how broader society conceptualizes these things - because that sets the tone for how people are legally and medically supposed to engage or think about it.
Also - a note on historical context: Humans have at various times “pathologized” problems, including erratic behaviors that would nowadays be termed “mental illnesses,” that they don’t understand, including trauma responses; some presentations that could be termed PTSD nowadays are present hundreds and hundreds of years ago. - but I disagree with that also, and will point to the historical examples of people once thinking completely unrelated shit is a “mental illness,” like sexuality (being gay was only fully removed from the DSM in 2013), gender (being transgender is still in the DSM today), hysteria (removed from the DSM in 1968), or things like drapetomania (a proposed “disorder” of which the symptoms were just enslaved people wanting to run away). There are also numerous instances of minority stress being misinterpreted as a pathology: transgender people being told their fears about transphobia are solely PTSD symptoms and they just need to “take care of themself more” and “be more gentle with themself” (our therapist that we saw prior to enrolling in our long-term outpatient facility pushed this at us incessantly, and even told us that she believed we were being intentionally argumentative because we didn’t want to talk about our trauma - and, in fact, it eroded our self-confidence and trust in our own perceptions badly enough that we were a mess by the time we stopped seeing her), Black clients being diagnosed with anxiety disorders or personality disorders because they are experiencing trauma from racism that white clinicians cannot see, so on.
Alright. Now. We still get therapeutic support! We go to therapy multiple times a week and still take psych medications, and we do not have any intent to stop.
I still don’t think it’s medical.
In order to access therapy, even if what I am experiencing is objectively not from a disorder, like wanting someone to talk to about transphobia or, say, we're nervous about a surgery coming up and just want to bounce ideas off someone in a more structured way than casually chatting to a friend, we are still required to be given a medical diagnosis declaring us to have some form of medical functional impairment. (I don’t like this definition, but again, I am not the one who made it, and I cannot change it; if you don’t like it, take it up with whatever medical and legal governing bodies oversee your area.) In our country, it is required for a therapist to file a diagnosis code for an insured client, at risk of legal consequences ranging from fraud to malpractice or possibly worse, depending on the case.
Some people might be saying “Well, the diagnosis is really just for insurance.” Okay, maybe for the provider, if the provider knows their stuff well enough. But it has legal consequences. A mental disorder diagnosis on file can be legally used to deprive people of rights. Involuntary commitment because an ER doctor interprets something wildly wrong, depriving people of their driving licenses despite no record of unsafe driving, even a diagnosis from years in the past, that a person hasn’t had an issue with in that entire time, can still preclude someone from certain careers (even if it was a misdiagnosis). There are providers (both physical and mental) who will deny patients care or not believe what they say, and that can actually delay treatment for years if not indefinitely sometimes, even for things like cardiac problems and life-threatening infections (we’ve had issues with both).
Finding a doctor for some of our physical issues resulting from our genetic disease has, at times, even taken months or years longer than our peers because we have had doctors tell us to our face that neurological symptoms we were experiencing because of our genetic disease were due to bipolar disorder - and we do not even have bipolar disorder. We had been put on a mood stabilizer, which he saw in our chart, did not ask us about, and I assume he concluded meant we had bipolar and were too stubborn to admit it. No amount of calm explanations that eventually escalated to begging him to call our psychiatrist and ask her himself worked, and we got turned out of the office and were unable to get treatment for that condition for another year. And these mistreatments can have serious consequences, whether directly as it exacerbates other stresses and drives someone to suicidality, or because someone’s physical conditions become so bad in the meantime that they die or sustain physical damages. A filed mental diagnosis can have severe, long-lasting, and debilitating effects on a person’s legal freedoms and medical safety, even if it provides them access to mental care. (Note: this isn't a reason to never seek mental care. I've mentioned we are still in therapy and don't plan to quit. But it is a reality, and one that mmmmaybe needs more open discussion, y'know. People get blindsided by it and it does damage.)
…so. We have been through trauma. Our brain responded how it’s supposed to, evolutionarily, even though it’s causing significant problems in current-day.
I can describe our trauma extremely medically. We’ve been in therapy long enough for it. If we do, there are shitheads who believe the stigmas and remain assholes about it all, sure, but we are also applauded in “mental illness” groups and therapy offices as a survivor, given compassion and commiseration, and generally taken seriously by our peers. We have access to therapeutic supports and broader communities. We are also given a label that can and has been used against us to deprive us of multiple rights and freedoms, which has inhibited our ability to get medical care for other things in serious ways, and which has significantly hindered whether medical providers of any kind will take us seriously.
(…I was going to write an interlude about the psychological effects of trying to engage wholeheartedly and in good faith with the medicalization of our experiences, but I think that may need to be its own essay as well. The main point, though: it really damaged our self-understanding, self-confidence and trust, and our relationship with our body and brain. We’ll build it again over time - that’s what growth is, but it’s no small amount of frustration and hurt.)
I can also describe it - the same experiences, the same troubles, the same pain and struggle - non-medically, and I am offered significantly less compassion. I am told that saying it isn’t medical is either downplaying serious issues or that my own must not be that bad. If I do not want to use that filed label, I would be deprived access to therapeutic supports, and as I speak about this, I am even disbelieved by other traumatized people who get defensive and apparently think I’m saying that none of their problems are real, when I am trying to get people to question why is the only way to be taken seriously to be to use words that - regardless of how I personally define ANYTHING - legally and institutionally define me as impaired? This has all happened over the past few months I’ve been mulling this over and trying to talk to my peers, friends, and family about it.
If I want to be taken seriously, I have to take that label of “medically mentally impaired,” and I’m supposed to… be fine with it? Feel empowered by it? I’m not really sure. When I asked, some people expressed feeling like their disorder label makes them feel like “it’s not just them/not their fault,” but I don’t believe anything I am saying here invalidates any of it nor blames the experiencer for it. If anything, I’m trying to say you shouldn’t need a doctor to be the arbiter of your experiences. I would really like to ask: why does it have to be a medical impairment for you to take yourself seriously? Why are experiences not allowed to stand on their own and still be treated seriously? I am not the person from your childhood who told you that you weren’t enough. I am not a doctor gatekeeping whether you’re treated humanely. I will believe you if you say “this hurt me very badly, and I am struggling with it.” Why is "brain disorder" the only "valid" way to have a serious mental struggle worthy of attention and care? And on that - why am I only taken seriously when I have the words of old white xtian men who once thought Jewish people were inferior and gay people were sick and diseased and trans people were amoral perverts and that women were irrational weaklings in my mouth??
…Personal frustrations aside.
I believe therapy should be available without medicalization and pathologization. I believe everyone should have access to therapy and guided access to therapeutic medications without having to take an institutional label and removal of agency. I am a big proponent of therapy, also a big proponent of thinking very critically about that therapy - and, if you are being told not to criticize or question it, to think very critically about why that is, as well - and also a very big proponent of safe access to medication support if desired.
I don’t expect you to suddenly stop using the term “medical” for yourself. You can define it however you want. Depending on how we’re defining it, I might even agree with you. But - as much as I hate it, you and I aren’t the ones who define that legally nor institutionally, and the problems that arise from that - including stigmas, whether starting them or making them worse, plus deprivation of rights, disbelief and pathologization of experiences (especially those the provider cannot understand), and more - are pretty vast.
At the very least, I hope this encourages you to think about the terms, their exact definitions, and where those have come from - and, possibly, encourage you to consider reframing your PTSD, even your BPD, your NPD, any trauma conditions, ever so slightly away from the framing that our brains and bodies are the source of the malfunction, instead of circumstances over the course of human culture and civilization clashing with them. Are they still a problem? YES. Should you have access to the full range of supports necessary to address that? ALSO YES. And yeah, the current setup of how this is treated institutionally is not something we can change right now. I’m still going to keep going to my therapy, because the other option is just… no support. But I’m not “malfunctioning.” I’m not “brain-diseased.” I’m not “impaired.” I’m not “functioning wrong.” And realizing that has made it so much easier to work WITH my body and brain instead of against. We've had therapists who claim to want us to do that, and can even hold detailed conversations discussing how maybe you are not, in fact, your own enemy, but then... they will still talk about how "the depression" or "the PTSD" is still, in one way or another, something we have to FIGHT. But we have a wonderful body and brain that might be real fuckin’ misguided sometimes by today’s reality, and that still deserves help and support! including therapies! but that doesn’t mean they're working wrong. They’re just kind of outdated, honestly.
I want to reaffirm that trauma reactions cause significant struggles and pain, but people deserve access to therapies and supports without being denied agency or told their experiences have to be institutionally labeled as medical impairments. Our bodies and brains are trying to keep us safe. Our neurons don’t understand that there is no bear, and - yeah, it hurts!! and it's hard!! and there's all sorts of mental rewiring that might need to happen if you want it to not keep clashing!! - but if we approach these things with a bit more holistic of a view - not just genetics, not just memories, not just “nature” and not just “nurture” and not just “atypical behavior” and “symptom” but rather what has come before you up to this moment, I do think it would... help. It won't fix everything, but maybe it can help.
Postlude: There's actually still a lot that I did not manage to get to here. I didn't get to touch on why I think the psychology and psychiatry fields are like this, nor why the "medical validation" aspect is so appealing, despite the pitfalls, nor the bizarre phenomenon that is psychiatry and psychology actually - albeit accidentally, I think, often enough! - encouraging people to be be scared of their own selves and brains. Or the dangers of pathologizing people without their full input, which has a lot of far-reaching dangers for a lot of minority populations - as far as our own personal experience goes, it led to us being essentially accidentally gaslit by a therapist who kept trying to tell us that we just needed to relax and take care of ourselves more and talk about our trauma when a big part of the problem was that we were not, in fact, objectively safe because of things like queerphobia and antisemitism. (We now have a therapist who is, dare I say, a bit less privilege-ignorant - someone who has actually seen some of those -isms themself and can actually provide us with better feedback than "it's just your PTSD, honey :)" - and we are doing a lot better, genuinely.)
Or about how I'm slowly becoming more convinced that even "non-trauma" disorders are still, in fact, results of "what has come before you," and how I still want to challenge the idea that "disorder" is the only "valid" way to have a mental struggle worthy of attention and care. Or about how various experiences, like our own plurality, has been sanitized as fuck and stripped of any context and repackaged as a fracturing disease, and yet there's things in our own Jewish heritage that, through translations and assimilations, got labeled nonsense myths and "possession" and discarded, but genuinely could have been descriptions of, or inspired by, some form of plural experience. I have a lot to say! But this is long enough as it is. I'll write more some other time.
Thank you for reading. Take care of yourselves. <3