Amazing
course! Utterly transformative! I am now
approaching my traumatized clients in an informed, respectful, anti-oppressive way. Who could have thought that as practitioners, we could actually improve
the world? (a typical evaluative comment by my trauma class students)
Thank
you so much, Bonnie, for helping me stretch beyond my comfort level (remark made this year by a current student)
In
every agency where I’ve worked since taking this course, psych survivors begin
flocking to me. Nu? They quickly figure out that I won’t betray them and I
actually have a sense of how to help (a comment made six years ago by a former
student)
There are legions of ways that one can help
rescue the world from the clutches of institutional psychiatry—being an
activist, mounting consciousness-raising events, researching, writing books and
articles, writing sensitizing fiction, organizing, being a practitioner in a
whole new vein. All of these, I routinely pursue and am known for. Arguably, however,
my single strongest way is less known (except at my own university)—through the
courses that I teach and how I teach them. Obviously courses almost exclusively
focused on problematizing psychiatry serve but more widespread influence may
actually arise from more general courses in which antipsychiatry principles are
simply fully integrated. And of these, none of what I teach is more effective
than my trauma course (Working with Survivors of Trauma), which is a graduate course
intended for practitioners—broadly defined.
Now practitioners and academics, not to
mention the world at large, commonly employ a trauma frame when trying to
understand people’s troubles, hence the widespread interest in trauma courses. What
is particularly good about this when you consider psychiatry, is that a huge
percentage of psychiatric survivors have had major trauma in their lives, even
before psychiatry entered the picture, and the vast majority of times
psychiatry itself further traumatizes them. What is more general, and also
good, operating from a trauma framework means on some level understanding that
the problems that people face are not just “in their heads”—that people are
responding to very real and indeed
horrendous things that have happened to them. What the drawbacks are, not
just with the public at large, and not just with conventional practitioners but
even with progressive practitioners with a critique of psychiatry, people using
such a frame easily slip out of, and in fact, are lured into slipping out of
their critique, in the process falling into a conspicuously psychiatric framework. By way of
example, while progressive folk are at least occasionally wary of using other DSM
diagnoses, they tend to make an exception for “PTSD” (Post-traumatic Stress
Disorder), using it as if it were acceptable. Why? Because they appreciate the
terror of people who have been exposed to terrible events and are committed to
help of some sort being available, and so they somehow kid themselves that this
one diagnosis is acceptable. The point is, though, despite the presence of what
is called “Criterion A” which stipulates the existence of an external precipitating
event, like other diagnoses, PTSD pathologizes, individualizes, and
decontextualizes, in the process, additionally, reduces people’s meaningful ways
of coping to “symptoms” of a “disorder”.
By way of example, instead of cutting or self-injury being understood as
an activity meaningfully turned to by traumatized people to cope with emotional
pain, cutting gets turned into a “symptom” of PTSD—one, moreover, for which
“psychiatric drugs” may be in order (for a far more thorough critique of PTSD,
see Burstow, 2005). Which brings us to the question of trauma practitioners.
While most practitioners use the PTSD frame,
far better trauma work is done by practitioners who principally respond empathically,
largely ignoring the diagnostic frame. Empathy alone, while necessary and wonderful, however,
is insufficient. The point is, besides that there are skills to acquire, one
can be empathic and still not understand the role of oppressions in trauma, and
as a result in multiple ways fail the people one is trying to serve. What we
need, I would suggest, are once skilled and fully counterhegemonic trauma
workers, whose counterhegemony includes antipsychiatry principles. And for to
happen we need really enlightened counterhegemonic courses.
The course referenced in the quotations
with which this article began is one such course. And it accordingly is the
focus of this article.
LHA
1111: Working with Survivors of Trauma
For almost two decades I have taught a
graduate course called “Working with Survivors of Trauma” at the Ontario
Institute for Studies in Education. It is a counterhegemonic trauma course, which
means that it does not use traditional or conventional understandings of trauma,
but problematizes them. While employing the word “trauma”, it uses the term
metaphorically (literally, “trauma” means “wound”). It places a major emphasis
on circumstance, and it is vested in the understanding that a strong
relationship exists between trauma and oppression. The course prioritizes the
bringing together theory and practice. Correspondingly, the goals of the course
are to help people understand trauma in at once more personal and more
political ways, and to help people turn themselves into practitioners who contribute
to the creation of a better—hence less traumatizing—world. At the same time,
the course humanizes trauma work, conceptualizing it as something that anyone
can do. Ergo, there is an emphasis on sharing skills with the community; the
term “befriender” is used, with the understanding being that any of us can
“befriend”—and that befriending is the responsibility of all of us.
Correspondingly, the concept of ‘trauma practitioner” itself is broadly
defined, with a trauma practitioner being anyone from a counsellor/therapist,
to an artist, to an activist, to a community organizer, to a spiritual leader, to
an advocate, to an adult educator, to a co-worker, to a friend.
Preceding the formal start of the class,
small group interviews are held by way of preparation. Here we begin dialoguing
about the role of oppression in trauma—e.g., sexism, racism, homophobia. Here the perspective of the course is
explained. Significantly, it is clarified right at these interviews, that just
as people are asked not to be sexist, racist, or homophobic, they are similarly
asked not to be mentalist.
Correspondingly, norms and perspectives with respect to psychiatry are
spelt out: What are those norms? The
most elementary is that “mental health” language is not to be used (e.g., with
all of us discussing why, ruled out are words like “symptoms”, “hallucination”,
“paranoid”, each and every DSM disorder, including PTSD itself). And we immediately start exploring more human
and more sensitive words which people can use instead (e.g., instead of
“hallucination” expressions like “seeing and hearing what others do not”). Correspondingly,
it is clarified that while many different resources can be used, and while what
people do outside the course is their decision, in this particular course psychiatry
is neither theorized nor used as a resource, but as an institution which is of
danger to the traumatized people with whom we work. What goes along with this, helping
people protect themselves from psychiatry just like helping people protect
themselves from all other traumatizing institutions is framed as a critical
dimension of trauma work. That said, psychiatry is afforded special attention
precisely because it is conventionally theorized as help, because of its
exceptional power, moreover, because what it overwhelmingly does is deprive
people of their freedom (called “institutional care”), medicalize what is not
medical (called “being scientific”), and brain-damage them (called “treatment”).
A multitude of different types of trauma
are explored in this course as well as ways of approaching them. Examples are
childhood sexual abuse, the trauma of residential school survivors, death
itself, trauma arising from natural disaster, refugee trauma, trauma in
war-torn countries, the insidious trauma involved in contending with daily
racism or sexism, the use of the arts in trauma work. Explored also are how to
work with two traumatized communities who are in conflict with one another
(including where one of these transparently oppresses the other). For obvious
reasons Palestinians in my class commonly choose to work in this area. The
trauma industry as a profit-making and growth industry is critiqued. Correspondingly,
not just European approaches to trauma are discussed, but also non-Eurocentric
approaches. What goes along with this, the class explores the damage done when mainstream
western understandings of and approaches to trauma are imposed on people from
other cultures (for an excellent book that documents just such a case, see Watters,
2011).
The course focuses on both individual work
and community work, with the understanding that: a) communities are traumatized
as well as individuals; b) community and connection are a critical route to
dealing with trauma. What goes along with this, oppression and the oppression
of one’s community are seen as necessary levels to understand even when dealing
with what is traditionally construed as “individual trauma”, with the point
being that history matters and that trauma is not “discrete”.
A multiple layer approach to trauma work is
encouraged. To aid with this, early on, course members are divided into small
groups. Each member of the class is then handed a diagram of mine called “Focal
Layers in ‘Individual’ Trauma Work”, which depicts such pivotal layers as “The Trauma
Experienced Now”, “Identity and Other Personal Factors that Serve as Context
and Shape Experience”, “Long Term Historical Identity-Based Trauma”, and “Dimensions
of the Human Condition” (for more details, see the diagram itself at https://www.dropbox.com/s/uf5nxjfkht9lvav/layertrauma%20burstow.pdf?dl=0
Whereupon, the groups are asked to follow
the instructions below, then to report back to the class a whole:
1.
Carefully examine the layers of
trauma diagram. In your small group, discuss the meaning of each of the layers
and how you think they connect.
2.
While respecting the need for
anonymity, choose a trauma to discuss that involves: a) an actual traumatized
person that at least one of you knows in depth and b) a traumatized community
of which this person is a part.
3.
Using the diagram, discuss the
different levels and layers of trauma as they directly or indirectly connect up
with this person’s trauma.
4.
Assuming that you have been
turned for help, with reference to each of layers, begin reflecting on how you
might go about assisting this person.
To help students acquire a feel for dealing
with the types of problems which typically confuse practitioners and which most
deal with abysmally, much of the class involves concrete exercises in which
students grapple with difficult scenarios, figuring out together how to understand
what is happening to the person or group and what might be helpful. A large
percentage of the exercises focus on traumatized people who would be
traditionally seen as “seriously deluded” and traditionally slated for psychiatric
intervention. Why this is important is that unless practitioners can become
comfortable with and adept at working with such situations, regardless of how
good they are theoretically, here they are likely to slip up, and actually do
the person or the community harm.
To give you a “feel” for this use of
exercises, what follows is one of many written scenarios used in the class, together
with the instructions:
Emergency Call from Mark
A client called “Mark has just phoned. Mark is a
psychiatric survivor who was battered as a child. He tells you that someone is
strangling him, that there is a hand around his throat. You can hear him choking. You ask him who the
assailant is. And he tells you that he
can’t see anyone but that he can feel this hand choking him. You ask him how long the hand has been
choking him. He tells you for that it’s been going on for hours. Everywhere he goes, the assailant walks with
him, choking him.
a)
What do you think is going on here?
b)
Any hunches that you think you should check out? Which of these
would you check out initially?
c)
What might you want to check out in the long term?
d) How are you
going to help this man? Short term? Long term?
e) What role do you see advocacy as possibly playing?
f) Record your
agreements and disagreements so that you can report back to the class as a
whole
The report-back by each team is immediately
followed by the class as a whole grappling with what members came up with,
affirming some parts, problematizing others.
The vast majority of the scenarios are drawn
from my own practice. Correspondingly,
after—and only after—the class has grappled with everyone’s answer, I share as
something worth considering what I did, why I did it, and what in each case, the
consequences were.
I will not be discussing this scenario
above in detail here. Suffice it to say, however, that Mark was assaulted as a
child, that the hand choking him was one of his own hands, and that pivotal to resolving
the immediate crisis was walking him through removing what he sees as the hand
of the assailant, reminding him that he can remove this hand at any time if it
begins assailing him again, while in the short term, not questioning or
complicating his belief that an external assault is happening here. By the same
token, the crux of good work in the short run and the medium run includes
helping this person figure out who in his life it might be safe and who would
be risky to share this story with—in other words, helping him at once reach out
selectively and become skilled at protecting himself from unwanted
“intervention”. The crux of good work in the long run, while including all of
the above, to the extent possible, involves helping Mark start approaching the
“external hand choking him” metaphorically, see how the past affects the present,
and begin coming to terms with both what his father did to him and his own
response to it, though obviously only insofar as he is open to going there (For
further discussion of this scenario and for other scenarios, see Burstow, 2015).
Respecting People’s Wishes, Including
When It Comes to “Suicide”
If the question of respecting people’s
wishes—something absolutely paramount in counterhegemonic courses—needs to be
and is systematically reinforced when it comes to people who are traditionally
seen as “deluded”, it similarly needs to be reinforced when it comes to people
considering ending their lives. What I tell my students is that when we are
dealing with adults—regardless of how scared the trauma practitioner may be,
and in contradiction with what they are taught in clinical psychology, they
need to respect people’s right to end their lives and in no way rob people of
it. We have to be safe people for others to be with, to be able to share what they need to share with—and we
are anything but that when we think that we should be making their decisions
for them. Correspondingly, we need to be
alert to the fact folks seen as “suicidal” are in special jeopardy from
psychiatry, hence more energy often needs to put into helping them protect
themselves from it. Finally, I let my students know that for decades I
specialized in working with clients typically called “suicidal”, and I never
once interfered with their rights, and what I think is related, not once did
any of these clients kill themselves. The point is that if you create a safe
place where people can share anything—including their intention to kill
themselves—it minimally becomes increasingly possible for them to entertain
staying alive.
Nor, I would note in passing, as
counterhegemonic trauma practitioners do we in this class even hypothetically entertain
psychologizing solutions when it comes to populations with “high suicide rates”.
Rather, we frame the issues politically in alliance with—and taking our lead
from— counterhegemonic leaders (including activists) from the communities in
question. In this regard, there are “high suicide rates” among the Indigenous
people on Turtle Island and the answer of the respective governments has been
to fund more and more self-esteem training for Indigenous communities. On top
of the fact that, expectably, these programs keep proving to be ineffective, as
the Indigenous scholar/activist Roland Chisjohn (2017) so poignantly points out
and asks: In Nazi Germany, Jews had three times the rate of suicide as the rest
of the population. Does anyone think this was because of lack of self-esteem
training?’
Use of the Arts
Arts are integrated into the course in a
variety of ways. They are included in reading lists. There is invariably a student
presentation on the use of art in trauma work (art therapy is viewed as only
one of the many possibilities, with the class encouraged to be more political than
this). Art figures to varying degrees in the course assignments. Correspondingly,
ways in which artists have used art to help audiences appreciate or process trauma
is intermittently discussed, in the process with it being demonstrated that
“professionals” have no monopoly on knowledge, and beyond this, unearthing what
conventional trauma practitioners need to learn from artists.
By way of example, about three quarter ways
through the course, I tell the story of what happened when Marlene Dietrich went
to Israel to receive an award for her heroism during World War II. In a
nutshell, Dietrich was a German star of the silent screen in which the Third
Reich, took special pride. Horrified by what Germany had become, she defected
to the US, whereupon the Nazi regime did everything imaginable to get her back,
including eventually murdering her family. Despite the imminent danger that
this presented to her, determined to contribute what she could to the war effort,
day after day, Dietrich went into the front lines to entertain the troops of
the Allies.
What happened years later when she was informed
that she was to be presented with this award? She said she would like to sing to
the audience in her own Native tongue—German—seemingly totally ignoring the ban
against speaking German in Israel. Now obviously, on one level, Germany is just
a language and not something inherently offensive, but besides being a symbol,
the very sound of German was a trauma trigger for Jews. No one knew what to
do. How could they conceivably allow it?
And yet how could they possibly refuse a request from the legendary war hero
Marlene Dietrich? And so the people in charge of the ceremony said nothing,
hoping that she would forget about this request. Dietrich arrived. She was presented with the award. Then she announced
she was about to sing in her Native language.
While initially, a few people gasped, sing in German, she did. Cleverly,
skillfully, and probably to a large extent, intuitively, Dietrich sang a song
which brought to mind the millions of killed Jews, even though the song per se
had no direct connection to this topic. Correspondingly, each time she launched
into a new refrain, she sang louder and more angrily, in her own way expressing
outrage at the wholesale murder of Jews. The long and the short? She finished
to thunderous applause. And next day newspapers
throughout the country enthusiastically reported what a “hit” Dietrich was,
adding that the ban against speaking German in Israel was now gone.
Naturally, the question and the seeming
contradiction that the class wrestled with here is this: How could Dietrich
accomplish in one night what literally
hundreds of conventional trauma practitioners, indeed, a veritable army of
trauma practitioners over several years
could not? And as trauma practitioners, what
have we to learn from this artist? From
artists in general?
The Assignments
There are two assignments for this course. Assignment
One is a typical graduate course assignment, involving presentations to the
class by teams of two or three. Students are asked to both present on how to
work with one of the traumas focused on in the course, bringing theory and
practice together in the process, moreover, to make the presentation uniquely
theirs (e.g., not just a repetition of what others have said or done). If Assignment One is common enough in trauma
courses, albeit done with a counterhegemonic twist, by contrast, Assignment Two
is, as it were, “out of the box”.
Generally, when the first assignment in a
graduate course is doing a presentation, the second is writing an essay. Alas,
the usefulness of such essays is short-lived, and to a degree, it is make-work.
While of course, inevitably students learn something in the process, their
primary reasons for writing this essay is to get a mark—after which, all too
commonly, it is tossed in their filing cabinet and seldom looked at again. Why
not have an assignment that allows students to get a grade, while contributing
in a concrete way to their ongoing work as trauma practitioners? This in mind,
students are asked to focus on a specific traumatized population that they are
interested in working with, then create a “tool” or product that they can use in
their work with this population.
This assignment inspires students to be
creative. Some, of course, choose to pursue relatively conventional projects like
creating a design for a workshop for a specific traumatized population. While
this too can be good, far more allow their imagination to soar. To give you one
among many examples of the truly wonderful work students have done, one year, realizing
that there was almost no discussion of wife battery in the specific South Asian
community from which they come, two students or mine from the same community decided
to research the phenomenon together. They began by interviewing battered women
in their community, then out of that research created a play, this with the
voices of the women emerging loud and clear.
Shortly thereafter, they submitted a proposal to perform their play in
an upcoming cultural festival of their community. The proposal was accepted. They enacted the play. It was enormously well
received and ended up being brought back yearly by popular demand.
Correspondingly, it was used by these students, by priests, by women activists,
and by other leaders in their community to help mobilize the community to begin
talking about and actually addressing wife battery. What stellar trauma work! Work
that actually does what trauma practitioners should be doing—finding ways that
witnessing and empowerment can happen and helping create a better and less
traumatized world! And how preferable to penning an essay that quickly
disappears into a filing cabinet!
Questions Frequently Posed to Me About
this Course
As we approach the end of this article, to
touch on questions frequently posed to me by people who are curious about this
course: Do I include more radical work such as Freirian codification work?[1] Yes, to varying degrees,
depending on the interests of the class. Do I include such standard components
of trauma courses as: helping clients with their coping skills, exploring possible
stages in trauma work, helping traumatized people ground themselves? Explaining
dissociation, splitting, traumatized memory and ways to work with them? Yes, absolutely. How could I not? But always
in a politically literate way and in ways compatible with counterhegemony. Do
students read and discuss “the trauma literature”? Again, yes, of course, but with an emphasis placed
on trauma literature written by feminists, by people of colour, and by other
oppressed communities, with emphasis likewise placed on transgenerational
trauma literature and on culture-explicit literature. Moreover, while problematizing
even what is widely recognized as radical literature.
Closing Remarks
This article has focused on a counterhegemonic
trauma course which I created and which I have been teaching and modifying for
almost two decades. Hopefully, it will inspire other educators/practitioners to
create counterhegemonic trauma courses of their own.
If you decide to go down this route, some
parting advise: Be sure to take apart the PTSD diagnosis and by the same token,
critique the very existence of psychiatric diagnoses. Problematize psychiatry, showing why it
should not be used as a resource. Help
learners understand that language is not “innocent”, that we cannot use
institutional language without deeply implicating ourselves in institutional
rule. Stress advocacy and involvement. Ensure that issues of systemic oppression
are solidly integrated. As appropriate, help learners understand the importance
at least in the long run of people approaching their networks and the community
at large—as opposed to professionals—as the main “trauma workers” to whom to turn—note
that a world in which professionals, however “skilled” or compassionate they
may be, are at the centre is a horrifyingly impoverished world—one that can
only keep increasing the levels of alienation and trauma. Far better we be part
of building community.
At the same time, help students
respectfully validate rather than invalidating, or to put it bluntly, rather
than “robbing” people of their coping skills—for we can only safely help people
expand their coping repertoire if we truly understand and humbly accept what
they already “bring to the table”. Encourage your students to find ways to
transfer their own skills into the community, even if it means “doing themselves
out of a job”. Encourage them to listen and to heed the wisdom of those whom
they seek to help, for even when it does not look like it, people really are the
ultimate experts on their own trauma. Include the arts strategically for good
artists are society’s unacknowledged but most exemplary trauma workers. Ensure
that students fully understand the importance of consent, the importance of
respecting people’s rights. Help students find and trust in their own unique
calling, for all intents and purposes, spread their wings and fly. Make the
creation of a better world pivotal.
And finally, remember, as trauma workers, minimally,
we should do no harm.
References
Burstow, B. (2015). Psychiatry
and the business of madness. New York: Palgrave Macmillan.
Burstow, B. (2005). A critique of Posttraumatic Stress Disorder and
the DSM. Journal of Humanistic Psychology, Vol. 45, No. 4, pp. 429-445.
Chrisjohn, R. (2017). Dying to
please you. Penticton Indian Reserve: Theyton Boooks.
Freire, P. (1970/2005). Pedagogy
of the oppressed. New York: Continuum International Publishing Group.
Watters, E. (2011). The wave that brought PTSD to Sri Lanka. In E.
Watters, Crazy like us: The Globalization
of the American Psyche. New York: The Free Press, pp. 65-129.
[1]Freirian
work (see Freire, 1970/2005) joins dialogue, reflection, and action with
politically sensitizing pictures called “codifications”, which body forth the
hopes and aspirations of the oppressed community, together with whatever blocks
those hopes and aspirations.