Monday, September 19, 2016

The Evil Hours: A Biography of Post-Traumatic Stress Disorder

The Evil Hours: A Biography of Post-Traumatic Stress Disorder is an outstanding book -- meticulously researched, but written in a compelling, accessible style, and with great humanity and compassion.

Author David J. Morris unearths the social and cultural history of post-traumatic stress disorder (PTSD), the fourth most common psychiatric disorder in the US. He surveys the potential treatments. He explores the role of social justice in our understanding of PTSD.

But above all, Morris confronts the meaning of trauma, in society and in his own life. Morris was a U.S. Marine stationed in Iraq. After narrowly escaping death, he returned home questioning everything he thought he knew -- and eventually having to face the reality of his own trauma. Morris' dual role as both researcher and subject give this book a unique power as history, social science, and personal essay.

People have known for centuries, for millennia, that traumatic events produce after-effects, but different cultures in different eras have explained those effects in different ways. The modern history of trauma is linked to the carnage of 20th Century war. And our current understanding of PTSD owes everything to the Vietnam War, and the experience of returning veterans who publicly opposed the war.

In this way, the history of PTSD encompasses a history of 1960s and 1970s peace activism, especially of the Vietnam Veterans Against the War, a group that began a sea-change in the culture of the United States. As a student of peace, I found this part fascinating.

Taking this even further, Morris links PTSD and social justice. Powerless and marginalized people are more likely to be traumatized by one or more of the four principal causes of PTSD: war, genocide, torture, rape. Taking a social and cultural perspective forces us to confront a world that causes these traumas. In this view, PTSD is not so much an illness as a moral condition brought on by the worst of human society.

The United States Veterans Administration (VA) sees it quite differently. To the VA, PTSD is strictly a medical condition. And this matters greatly, because research about PTSD is almost entirely funded and controlled by the VA. Explaining trauma as purely medical or biological doesn't address the causes at all. In fact, it does the opposite -- it normalizes PTSD as a natural consequence of unavoidable circumstances.

As for treatment, Morris surveys what's out there and finds most of it useless. VA hospitals and insurance companies prefer therapies that can be "manualized" -- made uniform, with a certain number of treatments and little or no emotional engagement from the therapist. Statistically, these types of therapies appear to be useful -- until one learns that the numbers don't include all the patients who drop out! Talk about cooking the books: everyone for whom the treatment isn't working or, in many cases, is actually worsening their symptoms, is simply ignored.

Morris himself feels that therapeutic talks with an empathetic person with some training goes further than neuroscience can. "What they [the VA] seem to want instead," Morris writes, "is mass-produced, scalable, scripted therapies that make for compelling PowerPoint slides."

I have PTSD, and much of The Evil Hours brought a shock of recognition -- the feeling that someone else is expressing your own thoughts, saying exactly what you've been thinking all along. Morris perfectly articulates how trauma plays out in one's life, the depths of change it brings about.

Morris writes: "We are born in debt, owing the world a death. This is the shadow that darkens every cradle. Trauma is what happens when you catch a surprise glimpse of that darkness.”

In the immediate aftermath of my own trauma, while trying to write about my experience, this is exactly the image I fixated on. We are, all of us, dancing on the edge of a great precipice, usually unaware of how terrifyingly close we are to that edge. Then something happens, and we understand it, not in some theoretical way, but immediately and profoundly, perhaps in a way humans are not equipped to understand. We talk about "the fragility of life" but we don't know what that is -- until we do. Then we spend a lifetime trying to live with the knowledge.

"One of the paradoxes of trauma," writes Morris, "is that it happens in a moment, but it can consume a lifetime. The choice of how much time it is permitted to consume is usually in the hands of the survivor."

The Evil Hours may be very useful for people who are figuring out how to stop PTSD from consuming any more of their lives. It is certainly a must-read for anyone interested in the effects of trauma on the human mind. [This review was originally published on]

Saturday, September 3, 2016

Women, Fire and Dangerous Things: What Categories Reveal About the Mind

The phrase “Conceptual categories” is a technical term for something we all do whether consciously or not. When we see a tree we know it to be a tree because of our concept of trees. The tree you see over there fits the category in your mind called tree. Sounds simple enough---but it isn’t. What I have described is called the correspondence theory of truth in epistemology. To have knowledge according to this theory two things have to happen. My concept has to be correct and my concept must be correctly linked to the experienced object “out there.” There is much controversy with this theory. For starters there is the troubling worry about how I can be certain I have the right concept (is it the same as yours? What about the guy living on the other side of the planet?), and can I be certain the object out there really is the thing I think it is, be it tree or whatever.  You might think this is just an academic problem that philosophers spend way too much time pondering. Yet suppose we aren’t talking about trees, suppose instead we are talking about a landmine that you think you may have just stepped on. Questions of knowledge and certainty would suddenly loom large wouldn’t they?

George Lakoff (co-author of the celebrated title Metaphors We Live By) has written an account of the latest multidisciplinary findings on the cognitive act of categorizing. His thesis is that the old way of construing knowledge, which I have called the correspondence theory of truth, has been largely discredited. Why? Because research in cognitive sciences, psychology and linguistics has shown that objectivism as understood in correspondence theories of truth, that is the idea that there is one concrete and correct way of experiencing a given object, is simply not true.  Instead of this old objectivist view of knowing Lakoff’s own theory, which he calls experiential realism, takes each person’s experience as being uniquely her own. This is a much more relativistic approach to epistemology. Relativism is an ancient bugaboo of philosophy and Lakoff knows it.

What is at issue isn’t the truth of how we come to know the things we know, but the nature of reason itself. You can intensify the significance of these findings by saying our whole understanding of what it means to be a knowing, acting human being is being altered by what cognitive scientists are discovering. That is some heady stuff.  Is the mind like a machine? If it is like a machine how does it connect to the things out there to know them? If there are objects out there won’t they necessarily transcend the mind? Lakoff declares all of these ideas discredited, but it is that word, transcendence, that I think is really behind the motivating spirit of this work, or more accurately the attack upon any notion of transcendence as a guiding principle in epistemology.  The idea that we are minds in bodies (or more traditionally phrased, souls in bodies) and that the world has been created with purposes and meanings out there to be discovered by these minds in bodies is an old idea that science has long wanted to discredit. Minds, souls and essences are very hard to locate under a microscope. Cognitive scientists maintain there are no spirits, souls, or minds capable of existing independent of the body and no essences to things. We are thoroughly biological beings in a physical world and we use our various different conceptual schemes to categorize the world in unique ways. The way you categorize your experience is different, not better or worse, than the way I categorize my experience. This is the new, revolutionary science of the mind.

The problem is this understanding of our situation is not new and hardly revolutionary. As I read through the book I kept asking myself, is the picture of the philosophic tradition being presented here correct? Have philosophers since ancient times simply taken it as common sense that we are minds/souls working to have our ideas correspond correctly with the essential natures of the things in the world? Just about every word (concept) in that last sentence has been debated by philosophers for over 2000 years. As soon as Plato drafted the first version of his theory of Forms (transcendent, eternal essences that are the real objects of knowledge) there were philosophers lined up and ready to challenge him on the idea of disembodied ideas. This is precisely Aristotle’s main complaint of his teacher. Despite what Lakoff maintains, philosophers have never wholly endorsed the correspondence theory of truth. It has been widely known and for a long time that the theory has its problems. Indeed it has been widely known that the notion of a soul in a body is problematic. Medieval theologians, thinkers one might assume would be most readily accepting of a correspondence theory of knowledge based on a soul seeking to know God’s creation, were aware of the issues with the rather puzzling notions of souls and essences.

What is interesting in Women, Fire and Dangerous Things is the attempt to deal with the charge of relativism. If you see the world in your unique way and I see it in my unique way, can it be said that we share a world? What is it that is being shared? Clearly there is something “out there,” independent of you or I. One could say it transcends us, even if it doesn’t transcend our various ways of categorising it. This is the stuff that philosophers find endlessly intriguing. Lakoff has not ended the debate on the question of how the human mind comes to know the world, but he has contributed to it.