
Today I’d like to share with you an example of the importance of getting the words right. The language we use is immensely consequential in not just how we think about real-world issues, but also how we handle those issues as a society: how much money is allocated, what kind of care people receive, and other important effects.
Bessel van der Kolk, M.D., exposes the faulty language we use surrounding trauma, and then he makes a fascinating argument for a change in the language—with a corresponding change in people’s decisions and actions.
(Note that this blog post is a brief synopsis of and commentary on a long and complicated expostulation. I encourage you to read The Body Keeps the Score to understand and appreciate Dr. van der Kolk’s full evidence and argument.)
Dr. van der Kolk argues that, over the past century or so, there has been a cover-up surrounding the scientifically demonstrated fact that abused children experience detrimental psychological effects. Moreover, he explains, these detrimental psychological effects are not random; there is what he calls a “consistent profile,” which he describes in detail. Not all abused children exhibit the same symptoms (just as, for example, people can experience different symptoms despite being infected by the same virus). However, such children have commonalities such as trouble regulating emotions, trouble concentrating, trouble getting along with others, sleep disturbances, unexplained pain, and doing things like rocking and cutting to relieve tension.
But, Dr. van der Kolk laments, there is no established diagnosis for this consistent profile. Instead, children are being given multiple diagnoses that describe symptoms, not the underlying cause. For instance, many children are being labeled as having “oppositional defiant disorder” or “disruptive mood dysregulation disorder.” As a result, children who desperately need care that addresses trauma are instead receiving care that addresses bad behavior. Such care, since it does not focus on the core problem, does not come close to resolving the core problem.
How did we get ourselves into this predicament of language? Why has there been a cover-up surrounding childhood trauma? Dr. van der Kolk takes us back to the time of Sigmund Freud:
“In 1896 Freud boldly claimed that ‘the ultimate cause of hysteria is always the seduction of the child by an adult.’ Then, faced with his own evidence of an epidemic of abuse in the best families of Vienna—one, he noted, that would implicate his own father—he quickly began to retreat. Psychoanalysis shifted to an emphasis on unconscious wishes and fantasies, though Freud occasionally kept acknowledging the reality of sexual abuse.”
It’s a hard topic. It’s not a great issue to talk about, politically speaking. What would you rather give a public speech on, child abuse or unconscious wishes?
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But Dr. van der Kolk gives the reader hope with his historical analysis of another kind of trauma, today known as post-traumatic stress disorder, or PTSD. When governments came to realize that fighting in WWI caused “shell shock,” they worked to hide this fact. Publicizing shell shock would cost money (soldiers experiencing it would need treatment and disability pay) and destabilize the war effort (governments wanted to encourage men to enlist, not emphasize war’s dangers). So WWI veterans were not treated for shell shock. Neither were WWII veterans. The politics during the Vietnam War era, however, were different; and a new diagnosis, PTSD, entered the books and the lexicon. Along with this new language to describe a medical condition came new awareness, treatments, and funding.
There was another huge benefit of the language change. As it turned out, veterans were not the only ones who had this medical condition:
“The adoption of the PTSD diagnosis by the DSM III in 1980 led to extensive scientific studies and to the development of effective treatments, which turned out to be relevant not only to combat veterans but also to victims of a range of traumatic events, including rape, assault, and motor vehicle accidents.”
Dr. van der Kolk argues that we are overdue for a language change in the realm of child abuse. He proposes the term Developmental Trauma Disorder. I am not a doctor and cannot comment on his suggestion with authority. However, I can comment with authority that I have read over and over about falsehoods told for political purposes. I don’t know about you, but I am tired of the fake news. If there is a problem and a solution, let’s name the problem in plain language and implement the solution. Covering up the problem and addressing symptoms never works over the long term. The doctor says it best:
“You would not want to have your appendix removed when you are suffering from a kidney stone, and you would not want to have somebody labeled as ‘oppositional’ when, in fact, his behavior is rooted in an attempt to protect himself against real danger.”
Do you fight for truth in language . . . despite the risk that someone will label you as “oppositional”?
Informative, enlightening, and fascinating article, Liza, and downright dead-on re: improvement of language in politics, citing wonderful medical and psychology examples.
Well, I hate pointing this out because this is such a great article, but I found a typo in the following sentence:
“I donāt know about you, put I am tired of the fake news.”
Typo fixed! Thanks so much for letting me know. š
Very thought-provoking Liza, on so many levels. There is such a need for research and understanding in the area of mental wellness. Not to mention access to appropriate and timely treatments!
I agree, Eileen.
I think this gets to the crux of an old societal dialectic: courage vs. vulnerability. There is a need for all people to accept the hardness of life. Life is usually difficult, occasionally terrible. Acceptance of this is tantamount to maturity and creates the essential worldview of courage. It is just this outlook which enabled the countless acts of military heroism on which our freedom rests.
It can also be asserted without contradiction that people are fragile. Traditionally, this was covered up by maintenance of a facade of bravado or at least stoicism and a cultural norm that encouraged this. To the extent that people had even heard of PTSD or “shell shock” they denied it or attributed it to character defect despite PTSD symptoms showing up in military heroes like Audie Murphy and Bob Kerry.
The only adequate way to approach this is to not see the two approaches as mutually exclusive. That is to look for a dialectical synthesis. This isn’t the kind of problem one sees in mathematics that has one definite answer. Both approaches are right and both, taken to an extreme, are potentially wrong. There is a need for acceptance of the difficult aspects of life and the reality of heroism and for recognition of and sensitivity toward people’s vulnerabilities. This approach is vastly preferable and more intelligent than the either-or thinking of seeing people as wallflowers or denying their sensitivities completely. Not simple, easy, and clear cut. By accepting that the truth and the best approach are a bewilderingly complex mixture of two extremes, it creates a lot of uncertainty. But, as far as I can see, that is how things are. Living with uncertainty, constantly trying to synthesize positions others see as opposite, is a significant advance over the black and white thinking one generally sees in public debates.
You bring up some great points. Yes, I think in some ways it’s important to be tough, and in other ways it’s important to seek tenderness and help. Thanks for the interesting comment.
Sure. Fight for truth in language but don’t expect everyone to hold to your idea of truth. We are a very complex species. And we do a lot of delusional talking to maintain the truth that we have decided is right.
Abuse in any form is traumatic. It doesn’t matter if it is verbal, physical or psychological. We all come away with a cloak of damage and discomfort which hinders functioning as a ‘normal’ human being. We’re often afraid that someone else will penetrate the cloak and hurt us again. So we hid behind our words and actions- even if they are wrong and disruptive.
Excellent article, Liza. I also wanted to point out that in Britain after WWI if a soldier who was diagnosed with “shell shock” was considered a traitor and disloyal to his country. So on some level we have become clearer and more honest about the language around trauma but we obviously have a long, long way to go.
Good point – people often don’t agree on what the truth is, which complicates things. Thanks for the thoughts, Jean.
Liza, bravo! Your blog (& Bessel’s book) beautifully break down how badness become baked into our brains, bodies & behavior…not to mention nosology.
Thanks so much, Phil! I really appreciate you saying that.