Trauma

What we still don't understand about the T-word.

This essay will be a little more personal, as for maybe the first time publicly I start to finally talk about my personal trauma, and the difficulties I’ve had about communicating it. We’re going to touch on the Neil Gaiman case, as this is what a lot of you are here for, and the rhetorical use of trauma as an explanative factor for the claimants behaviour has often been invoked.

I’d like to do something against the norm, and talk about why an understanding of trauma is important, but also the ways in which ideas surrounding it are misused.

A few years ago I experienced domestic violence. It was unexpected, unprovoked and there was little in the way of acknowledgement from my partner that they had done anything wrong. After this happened a few times, I left. In all sorts of practical ways I was disoriented. I called a family member expecting emotional support. Instead their response more or less sealed in the trauma.

It highlights what trauma-informed advocates have been saying all this time - the response from others is really important. ‘‘Believing survivors’’ is a thorny issue that we’ll get into later - but the simple fact of responding compassionately and normally when someone has had an adverse experience is important. Kneejerk disbelief has consequences.

Before I had that phone call I was not yet ‘‘traumatised’’. I had experienced a shock, and a trying situation, but it hadn’t yet deeply affected my worldview or sense of self. The knowledge that I was alone with this was deeply destabilising. It made it difficult to process what had happened as a simple episode, as one that had happened but was in the past.

Instead, I formed a new belief, ‘‘people you trust can hurt you, and nobody will understand or acknowledge it.’’

Some kind of an assumption necessary to ordinary existence, one of a buffer of safety and dignity was ripped away. I was not asking anyone take my word as gospel truth, simply that the emotional core was seen and heard.

Over the next few years I did not seek therapy, instead I did the opposite and put myself in the most trying, dangerous and psychological stressful situations imaginable short of a warzone.

I now realise that I was experiencing symptoms related to trauma. I was plagued by sudden fatigue, would have to lie down frequently in the middle of the day. My usual confidence disappeared. I was told I made sounds in my sleep growling as if being threatened (I had originally been attacked while laying on a bed). I also became increasingly unassertive over my boundaries, developing a tendency to lose myself in others.

Generally, I felt like a different person. I mourned the trusting, carefree and confident person who had gone.

My next two relationships followed a fatalistic pattern. Partners who presented themselves initially as nurturers who saw my suffering and wanted to help me get better, who took a certain satisfaction in this carer role. I didn’t lean on them too much, at the back of my mind I knew becoming too dependent was a sort of devil’s bargain. In fact, I didn’t really need much. A simple acknowledgement of what had happened to me was enough.

In my community at that time, many people talked loudly and openly about their trauma. I didn’t though. Except for a few people I kept it to myself. I’m sure people made all sorts of judgements, just thinking the nervous wreck I presented was my usual personality.

And during that time, I noticed a lot of the use of ‘'trauma’’ the idea as a kind of rhetorical tool, as a way of one-upping people. Having a long list of victim statuses was certainly useful, as in any disagreement people would usually side with whoever had the most impressive list. I didn’t seek to armor myself in this way. I felt there was something deceptive about this competition, but I was also fearful of that devil’s bargain. I felt that if I took on a ‘‘victim’’ role I would never escape the clutches of my experiences.

The unfortunate thing was my relationships followed the same pattern. Apparent care followed by increasingly controlling behaviour from them. Jealousy, possession and control had been driving force of my original abuser’s behaviour. So it felt like history repeating itself.

All of this constantly reopened the core wound: ‘‘people you trust can hurt you, and nobody will understand or acknowledge it….’’ and added the even more devastating, ‘‘those who appear to acknowledge it will become the next people you trust that hurt you.’’

Despite all the talk about safety and trauma, the community I was in was not really emotionally safe. There was a lot of bullying under the guise of social justice advocacy, clique behaviour, a lot of exclusion and gaslighting. I’d say most people lived in fear of ‘‘cancellation,’’ a fear really of getting on the wrong side of someone and not having the right sort of list to armour you.

‘‘I have Trauma’’ was itself a form of armour for those who had mastered the twists and turns of social justice posturing. ‘‘And you gave it to me’’ could easily become a sword.

It raises an important question though, when we get Traumatised who gives it to us? What seems simple on the surface is anything but. Two people can have the exact same experience and one not be traumatised, the other quite profoundly. During the time period I describe there were hundreds if not thousands of events that could have been traumatising, or re-traumatising.

The first time my partner had attacked me it did not cause trauma. I spoke to them calmly. I told them I would have to leave if it kept happening. My sense of self, and safety, held together just fine.

And I think if it were not for that phonecall, and the way that family member had responded, I could genuinely have integrated everything. It was the ‘‘one more thing to deal with’’ that I just had no capacity for.

I think we have a psychological reserve which we use to deal with potentially traumatic events. As such, the final trigger might be something relatively small, something that doesn’t need to be someone else’s transgression.

In the Neil Gaiman case, I do think claimant Scarlett Pavlovich may have trauma, just not for the reasons she describes. Or rather she describes it very well in the month after meeting Gaiman, where she doesn’t blame him for her mental breakdown but the whole situation around giving up her flat and job (importantly, only some time after Gaiman had left, she was never dependent on him, as this investigation has established). I think the sequence of events could very easily lead to trauma, but in a way that is not quite forseeable by others.

Pavlovich in photographs seems ecstatically happy around the time she spent with Gaiman. And why wouldn’t she be?

She’s hanging around with celebrities. They like her. She sees potential long-term security with them. She’s been sleeping with Neil Gaiman, and she later tells us she was in love with him at the time. It’s exciting and glamorous. With background in drama school she may have been waiting for something just like this to come along.

The future looked very, very bright.

She’s smiling the day Neil leaves. Then she gets ill. And somewhere along the line Amanda Palmer doesn’t want her around any more, and reneges on whatever promises she’d made her - carts her off to Auckland. Then there’s a huge controversy with Pavlovich in the centre, where she’s cast as the victim without her say so, a characterisation she strenuously denies. Two months later she ends up in a psychiatric facility.

In the WhatsApp Messages what appears to be a straightforward account, she doesn’t blame Neil, she says that the sense of abandonment from Amanda may have been the final push that landed her in hospital. Everything she thought she had a month or two ago has now evaporated. As she expresses, she has ‘‘uprooted her life for Amanda’’ and now it all seems uncertain.

The study of trauma tells us it can lead to profound issues with memory and autobiographical narrative. First there is the traumatic incident itself, which for a whole set of neurobiological reasons can get encoded differently, out of sequence, with ‘‘flashbulb memory’’ or tunnel vision.

Then the mental changes of long-term trauma itself lead to difficulties in retrieving memory, which tends to it becoming overgeneralised. Someone suffering PTSD when asked if they can remember a happy memory, will often say something like ‘‘I remember I used to enjoy walking on the beach,’’ but they will find it hard to access a specific memory of the beach itself.

This makes for a variety of gruesome dilemmas when it comes to sexual assault cases, or allegations of such. Trauma is often presented as proof that a sexual assault has taken place. However, the claimant’s memory may be a patchwork of moments rather than a clear narrative. Memory is finicky enough beast even for the healthy person. This is exactly the sort of account that defence lawyers can pick apart to claim the victim is an unreliable narrator.

But this has metamorphised into an argument that many of you will be familiar with, and that I see frequently turn up in my inbox. It will sound something like this:

‘‘Of course Pavlovich’s account is inconsistent, patchy, self-contradictory, that’s entirely consistent with how trauma affects people.’’

There’s so many issues with this, and it’s made more difficult by the kernel of truth in it - just not enough to draw the conclusion they want. The problem is that is becomes unfalsifiable. Fabrication, or delusion due to mental illness will also lead to inconsistent or self-contradictory accounts, so how are we to tell the difference?

And simply saying ‘‘you should believe them, otherwise you are only increasing their trauma’’, is not good enough. While it might be entirely appropriate to comfort someone in person, without scrutinising their story, when it comes to public debates it’s asking us to act as if the central questions are already proven. Ethical injunctions shouldn’t be used to guilt us in this way, and a lot of water is muddied because of this dynamic.

I think it’s clear by now that ‘‘believe survivors’’ can sometimes be misused. When we trace the origin of the idea back to psychiatrist Judith Herman, who first made the case for trauma-informed services, she definitely did not demand blanket credulity for any and all claims. Her point was that institutions and individuals have an irrational, kneejerk skepticism towards accounts of trauma, and this prejudice deepens the suffering and prevents healing. Her points still carry today, but it’s becoming increasingly obvious that the overwhelming value of skepticism itself has become a casualty to the culture wars.

Consider for instance that not all patients need validation. In fact, some need skepticism. Therapists have to handle this issue all the time asking, ‘‘is my patient a fantasist whose delusions need to be gently prodded and reality tested, or are they a trauma-survivor whose account needs to be believed and validated?’’

Erring on the side of caution is probably wise. Make the wrong choice and you could end up enabling the patient and deepening a sense of unwarranted persecution, or on the other hand invalidating them and deepening trauma. Therapists are not detectives, they are not in the business of establishing hard facts but figuring out what is likely to help their patient.

Discussion of specific, circumstantial harms of expressing skepticism when someone needs support, kindness and non-judgemental listening, have somehow transformed into an injunction to blindly go along with the majority.

Unfortunately ‘‘believe survivors’’ became ‘‘you better not disagree with us,’’ in a shockingly short space of time, taking on a political dimension far beyond its original therapeutic aims.

It’s not an easy thing to figure out if someone is genuinely suffering trauma, it’s a lot more probabilistic than the demagogues would have you believe.

PTSD in particular is frequently overlooked or misdiagnosed. It’s missed in primary care in up to 90% of cases. Where there’s another diagnosis, the issue is particularly acute. For instance schizophrenic patients are frequently PTSD comorbid, but the symptoms are almost always bundled up into their primary diagnosis. Symptoms often present similarly to depression and BPD and they are often mistaken for one another, leading to some therapists arguing that BPD is a special form of PTSD.

Kappa rating is a measurement that essentially tells you how often two psychiatrists will diagnose the same patient identically. In PTSD it is 0.67, which means that for every 10 patients they will disagree on 3 or 4 of them. And PTSD is actually has one of the better kappa ratings.

In a paper titled A Systematic Approach to the Detection of False PTSD it’s estimated that false diagnosis, ‘faked’ or exaggerated PTSD symptoms may be present in 20-30% of personal injury claims. This isn’t surprising given that a diagnosis is often used to ‘prove’ emotional damage, which gives it a monetary value in civil tort.

Nothing is genuinely proven because a diagnosis is a judgement call, based on probabilities and intuitions with tests as guide rails. Therapy is not about proving things, it’s about helping people and requires them to engage in good faith in order to do so.

All this really complicates the prevalent practice of untrained third-parties armchair diagnosing someone with PTSD or as a trauma victim, then using it as a rhetorical device to explain away inconsistencies or inaccuracies in their account.

When a hefty dose of moral judgement is added to the mix, the sketchy argument gets locked in and questioning it becomes taboo. The over-certainty of this moralistic bullying crowds out the genuine usefulness of psychological science.

And then we have self-diagnosis, or self-narration of trauma, which admittedly I began the article by doing. Just to be clear, I don’t make any scientific claims there. I have no idea whether I would have had a PTSD diagnosis if I’d gone for one at the time.

There’s always a tension between reaching for the right language to describe one’s experiences and the scientific origin of that language which demands more rigour than our spontaneous self-narration.

Using self-diagnosis to make claims about another person’s behaviour is even deeper into the shifting sands. ‘‘I have trauma, therefore their actions were wrong,’’ doesn’t necessarily work. In the case of my abuser, their actions were wrong whatever my psychological response might have been.

Even if I did have iron-cast diagnosis, it would be difficult to say which exact event caused the trauma - and therefore to lay the blame on any particular individual.

In my case was it the violence I experienced? Why then did the initial attack have no impact me? Was it my family member’s inadequate response and lack of emotional support? What about the months of controlling behaviour beforehand.

Perhaps the emotional damage would have been avoided if there were accessible publicly available services, a sort of therapeutic A&E. Even positive factors can conceivably be contributive - if the relationship had good points its collapse may have been more impactful than if it was just solidly rubbish all the way through.

So we can’t really say ‘‘this one thing caused Trauma.’’ Even though that’s often the main argument in civil tort lawsuits. I feel it’s an inherently weak one for the reasons outlined, and fairly easy for an expert witness to cast doubt on.

What we can say is whether people broke the law, whether something was assault, sexual assault, rape, fraud, battery. They are violations of someone’s rights and personal dignity. It’s worth pointing out that these are all crimes whether or not they result in trauma.

This can complicate a court room appearance, where victims are expected to act in a certain way. We don’t see other crimes in the same way, say for the victim of car-jacking to cry in the exact right way to show they are really traumatised,(while at the same time not appearing too emotional as to undermine their credibility.)

I think it’s obvious that the entire way we as a society deal with sexual assault, rape and domestic abuse cases needs to be rebuilt from the ground up, probably with different courts and procedures and an inquisitorial rather than an adversarial legal approach.

Some of what I believe about this falls into the category of ‘trauma-informed’ but most of it is just common sense. I don’t think we really needed to draw on polyvagal theory (the neurobiological concepts that trauma is currently framed within) to see that the therapeutic, police and courts system struggle to handle genuinely fragile people and is a much more amenable environment to perpetrators than those they victimise.

That question of who is victim and perpetrator, is also a potential issue. There’s now more awareness of abusers utilising administrative, legal or media processes to switch roles and present the victim as a perpetrator, often manipulating vulnerable patsies to play the various roles in their public stage play.

When it comes to the Gaiman case, it may be a lot easier to unravel if we focus on what he did and did not do, rather than the trauma that is often blamed on him by third party non-experts.

What we do know is that Pavlovich confirmed consent multiple times in writing. We now know that the claims of dependency, or that she was under duress at the time due to homelessness and economic insecurity, are based on misleading statements and outright inaccuracies.

This was originally going to be far more scientific and skeptical article. But in the process of writing I had to open up to myself about my own experiences. The stance of standing objectively outside the discussion with no skin in the game turned out, on self-reflection, to be defense mechanism, a way of not dealing with the truth of how deeply these adverse experiences had affected my life.

I’m sure I open myself up to all sorts of criticisms by writing this. Some will see me as too credulous towards claims from the trauma-informed crowd, others as too dismissive. I will obviously be accused of the exact same armchair psychiatry that I’m criticising. But I did need to get this off my chest, and express my frustration of the uses and abuses of psychology for rhetorical purposes, which today is happening in ways that seem to have a corrosive effect on our ability to discuss and stabilise a shared social reality. Some will be offended by it, but I’m sure there are also some who will feel helped.

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