What is the BizOMadness Blog?

This blog is devoted to raising critical awareness of psychiatry generally. It is likewise devoted to the antipsychiatry research projects, publications, and related activities of Dr. Bonnie Burstow. Especially foregrounded are The Psychiatry Project, The Madness Project, and "Psychiatry and the Business of Madness". Related to one another, The Psychiatry Project and The Madness Project involve hundreds of interviews, a dozen focus groups, analysis of several hundred documents and their activation, and dedicated periods of institutional observation. The culmination of both as well as of decades of related interviews and activities is "Psychiatry and the Business of Madness" (timely updates on its publication will be provided)--a cutting edge book in which psychiatry is investigated from multiple angles and which begins to tackle the inevitable question: So if we get rid of psychiatry, where do we go from there?

For the Events page to find events related to this research or this book, see

To check out reviews of Psychiatry and the Business of Madness and related publications, see http://bizomadnessreviews.blogspot.ca/

Wednesday, May 30, 2018

Teaching Counter-hegemonic Trauma Courses: A " Kick-ass" Way to be Antipsychiatry

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.


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.

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