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?
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”?