Alan Young, PTSD, and is anything real?
Thoughts on trauma, social constructionism, and confusion
What do you think of when you think of post-traumatic stress disorder? Perhaps images pop into your head of Vietnam War veterans returning home and being offered no support by their government, suffering until silence around the war was broken many years after the fact. Or perhaps you think of the First World War’s name for it, shell shock, and how misunderstood it was and remains today. You might think of how horrific war must be to able to cause, according to some estimates, the suicides of 50,000 to 100,000 Vietnam War veterans — far more than the number of Americans who died during the conflict. (Other estimates sit at around 9,000, still an insanely high number.) I think of two things: George Carlin moaning about the euphemism treadmill and wishing it were still called shell shock; and Danny Whizz-Bang running into the pub in Peaky Blinders and still thinking he was in France during the war.
So what are we to think when we are told that the illness doesn’t exist, and that it’s actually a historical construction? For this is what Allan Young argues in his book The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Beginning in the introduction by outlining how, after PTSD was accepted by the American Psychiatric Association in 1980, clinicians found evidence that the illness had been written about throughout time albeit under different guises, he goes on to write
none of these writers — neither Pepys, nor Shakespeare, nor the author of Gilgamesh — was referring to the thing that we now call the traumatic memory, for this memory was unavailable to them.
His argument, in short, is that memory is unable to function without a sense of ‘I’. The ‘I’ — our sense of identity — exists partly as a byproduct of the fact that we are beings with memory; and simultaneously, that memory is only possible because we have a sense of ‘who we are’ and therefore these memories are, in some sense, ‘ours’. However, much as our conception of what the ‘I’ means is shaped, moulded, by the present — that is, the society in which we currently live — and is therefore different to the societies of the past, so the intrinsic concept of memory has changed over time, too. We do not identify as ourselves in the same way humans did in Shakespeare’s time; similarly, we do not remember how he did. Therefore, the term PTSD is anachronistic, to say the least, and moreover, constructed by the present reality in which we live. Just a couple of centuries ago, this trauma hadn’t been ‘constructed’ and couldn’t, therefore, have existed.
So far so good, right (notwithstanding the mass of inverted commas)? Well — no. The introduction uses the example of how different memory was conceived of in eighteenth-century Europe. Now, as Young notes, we are convinced there are three things which the word ‘memory’ refers to — capacity, content, and location. But a few hundred years ago, memory was a simple mixture of mental images and verbal content, its definition less profound than that which we have now. But this reveals the first flaw in Young’s position: how a society conceived of something is irrelevant to its inherent composition or — and here stuff gets shaky — truth. (We’ll come back to truth. It’s important.) Whatever people in 1750s France thought memory was, they were either right or wrong — and their understanding of memory had no bearing on its complexity. That would be to imply that as we have learned more about how memory actually functions, our memories have changed to reflect our knowledge — something self-evidently false.
But we’ll get bogged down in the quagmire of ‘true’ and ‘false’ later. Perhaps more important, one wonders how a Vietnam vet would feel reading that title. The lived experience of veterans speaks to the fact that huge percentages of them — perhaps upwards of ninety percent — experience some sort of mental trauma if they are exposed to a combat situation while on duty. The empirical evidence is, of course, backed up by the pathophysiology of PTSD, which suggests that actually, it does exist, in the same way that chemical imbalances in the brain cause other mental illnesses, such as depression.
Indeed, for the soldiers who experience it, PTSD is anything but ‘constructed’. Young admittedly concedes this, writing
the reality of PTSD is confirmed empirically by its place in people’s lives, by their experiences and convictions, and by the personal and collective investments that have been made in it.
Which is good of him, to admit that the symptoms aren’t all just ‘constructed’ in the heads of the soldiers who experience it, or worse, that they are making their symptoms up, something like those suffering from electromagnetic hypersensitivity. As Young concedes — though the concession comes across almost reluctantly — the fact that soldiers are willing to write about their experiences suggests the illness exists. Over half of Vietnam War veterans experienced PTSD according to some research, and the memoirs of these soldiers reflect that. For example, Phillip Caputo in his brilliant A Rumor of War writes
I… doubted my capacity to endure many more physical or emotional shocks. I had… alternating moods of depression and rage that came over me for no apparent reason. Recovery has been less than total.
And Bill Poffenberger is brutally honest about his attempted suicide, and how he (at the time of writing) still feels suicidal, writing ‘Today, sometimes I just want to aim my bike at a semi. End it. I hurt a lot sometimes.’ Examples like this litter the memoirs and letters of soldiers who fought in the Vietnam War, and it seems silly to suggest that veterans of other wars didn’t face similar experiences. (Anyone who wants some more examples is welcome to read my Master’s thesis.)
Jonathan Shay, at least, wrote a negative review of Young’s work — by the way, the only negative review of the book I could find, and it isn’t even that negative; Shay writes that the historical section of the book is ‘informative and well written’ — , taking snide digs at the fact that Young refers to academic peer-reviewed papers as ‘science discourses’. He should also have mentioned that Young refers to those working to better diagnose and treat PTSD as ‘knowledge workers’ rather than, oh, I don’t know, healthcare specialists, even PTSD professionals. Shay concludes
the extreme cultural constructionism that Young deploys when it suits his rhetorical posture and then abandons to assert his own authority with the reader is as unstable a place to stand as its historicist predecessor was fifty years ago. We cannot write psychiatric nosology with perfect objectivity (pure “discovering” with no contextual admixture of “inventing”) any more than we can write history with perfect objectivity. But if we can never claim a conclusive account of human activity, this does not mean that truthfulness in disclosure of interests, methods, data, and analysis is unattainable or irrelevant, or that any method, data, analysis is as good as any other.
Other reviews of Young’s work are less critical, lauding, brown-nosing, even, such as from the definitely-not social constructionist American Historical Review, the probably-not-pseudoscientific Journal of Psychotherapy, and some obviously-nonpartisan bloke who studies the Philosophy and History of Science (not the science itself, mind), who rave about it as ‘brilliant’, ‘fascinating’, and a ‘model study of the construction of mental illness’. It’s interesting that an ethnologist feels himself at all qualified to discuss the science and pathophysiology of a mental illness that even the experts don’t fully understand yet, in a manner that Shay essentially describes as (paraphrasing) pretending to know about it but not really knowing anything.
Social constructionism
Young’s book fits into a longish history of literature which argues that everything is just a social construct, even illnesses which are making people commit suicide. The debate about whether reality is a predominantly a social construction or whether an objective reality exists is one that has been going on in earnest since at least the seventies in history and the humanities, and far longer than that in philosophy.
And yet, when one considers the Sokal Affair, in which a respected physicist published a paper in a scientific (admittedly non-peer reviewed) academic journal arguing that gravity is a social construct, it becomes clear that social constructivism isn’t a particularly watertight theory. (Repeat: that gravity is a social construct.) His prank on a respected academic journal became famous, and was conducted as a means to show that a postmodern (constructivist? poststructuralist?) conception of reality has, in effect, ‘gone too far’.
There’s confusion with terms, too. While social constructionism as a term makes sense, there’s the related phenomenon of social constructivism, which is essentially the same thing but argues that knowledge is socially constructed, not just the basis of reality — though one would assume the latter necessitates the former. In the humanities, the cultural turn which happened in the 70s was mostly influenced by poststructuralist ideas, which were a development — but not rejection — of structuralist ideas which had been formulated throughout the twentieth century. One could make the argument that poststructuralism — generally defined as ‘there is nothing outside the text’ in literature and my field, history — is just social constructionism when applied to words on a page; that is to say that any interpretations of the text are simply constructions, and that there can be many, many interpretations of a text (though not necessarily not endless amounts, but at the same time, potentially endless amounts), as texts themselves have no inherent meaning, regardless of who the author was. (‘Text’ here doesn’t necessarily just refer to a piece of paper with words on it, but language in general; moreover, language itself is said to be the foundation of all of culture.) Jacques Derrida then invented deconstructionism as a technique to interpret these texts which were suffocating under the weight of poststructuralism.
But particularly between structuralism and poststructuralism is there a lot of confusion, seeing as the main difference between the two is that the ‘signs’ (or words) referred to in structuralism are stable, but in poststructuralism unstable. Indeed, many of the theorists who adhered to the ideas of poststructuralism were originally structuralists, and even rejected the former label; nonetheless, it has become widely used, and from anecdotal experience, is the prevailing theoretical and methodological framework of most humanities departments. (That being said, my Master’s course in Global History attempts to develop a sort-of in between that isn’t strictly constructionist/post-structuralist but doesn’t deny its influence.) All of which means it’s not easy to define what these terms really are, particularly when the academics who use these theories are generally some of the worst writers who have ever lived. (The best definition of poststructuralism I have ever seen was this two part Buzzfeed list that used hipster beards to explain it.)
The biggest problem I have particularly with poststructuralism is best described by an anecdote, perhaps. In my very first semester of my History Bachelor’s, we had a seminar entitled ‘History in Practice’. It was an attempt to take us through the history of historical approaches (historiography, if you will), in an effort to help us understand its development. One of our classes focused on Garibaldi. We read a text that used Freudian analysis to try and figure out why Garibaldi acted the way he did. The analysis was solely concerned with getting into the mind — not to mention extrapolating therefrom what his childhood must have been like — of a man who had died over a century before. I knew at the time that many of Freud’s theories had been disproved, despite his fame as the father of psychoanalysis; I had heard about his sexism; and I was certain that his theories (as, may I add, many theories in psychology) were unscientific, couldn’t be falsified, were pseudo-scientific, even. Nonetheless, the article we were reading, which our PhD-student seminar leader was defending, was regarding his theories as gospel and conducting relatively rigorous analysis of Garibaldi’s mind with them. I raised this criticism, and was reprimanded that while the theories may not hold any scientific weight in psychology — and are therefore, by extension, necessarily, useless — that doesn’t make them not useful for historical analysis, because the disciplines are different.
At this point I was unable to suspend disbelief any longer. If Freud’s ideas had been disproved within the very discipline in which he purported to be working, in what world could they be useful for historical analysis? The ideas were wrong, it was time to discard them. And the same problem is true of poststructuralism. Poststructuralist ideas of signs and symbols and signifiers and whatnot are all based on the ideas of turn-of-the-century linguist Ferdinand de Saussure, whose ideas were widely challenged in the mid-twentieth century and who is almost never cited by linguists today.
Linguistic problems
Saussure’s ideas were, at the time, revolutionary, and he is sometimes cited as one of the founders of linguistics, until his ideas were completely replaced by those of Noam Chomsky. The father of modern linguistics made the argument that humans possess something called Universal Grammar, which is to say we are in possession of an innate ability to learn language — language is, in other words, already within us, and it merely needs to be ‘activated’ by some external input, such as the speech of our parents and others around us, for us to learn it. This was in contradiction to earlier ideas, particularly those of B. F. Skinner, who argued for behaviourism, which posited children learn language simply by hearing it and copying. Chomsky argued that this couldn’t be the case because of the ‘poverty of the input’ — often, speech is very ungrammatical, so a child’s ability to construct completely grammatical sentences cannot be predicated solely on their hearing and repeating things. He hence concluded language production must be innate. Indeed, Chomsky’s initial review of Skinner’s Verbal Behavior is thought to have kickstarted what is know known as the cognitive revolution, which essentially gave birth to cognitive science, along with a few other texts by scientists working in artificial intelligence and George Miller’s seminal psychology paper ‘The Magical Number Seven, Plus or Minus Two’.
Postsructuralism’s cynical take on the possibility of objectivity in language is predicated on the idea that language is something that was ‘created’ by humanity, and is therefore subject to the same inherent biases that any other human institution is. However, spoken language is only ‘man-made’ in the same way that your ability to see is: it’s an evolutionary development that has helped humans survive, and if we take Chomsky’s ideas seriously (which we definitely should), it is something innate within us that we don’t ‘control’ any more than we control where we are born or who our parents are. Naturally written language is a man-made ‘institution’ which is subject to errors and biases, but poststructuralists extend this idea to all forms of language, which includes spoken language, seeing as they are working off the back of linguistic ideas. None of which is to say that language isn’t replete with inherent racist, classist, sexist etc. ideas, merely that the basis for arguing that it is which poststructuralists use is based on flawed, disproved theories — namely that language itself is a constructed thing. As Norman Holland put it,
Saussure’s views are not held, so far as I know, by modern linguists, only by literary critics and the occasional philosopher. [Strict adherence to Saussure] has elicited wrong film and literary theory on a grand scale. One can find dozens of books of literary theory bogged down in signifiers and signifieds, but only a handful that refers to Chomsky.
It’s a legitimate point. Chomsky is the greatest linguist who’s ever lived at the the time of writing; his contributions to linguistics revolutionised the profession; he is regularly referred to as the father of modern linguistics. Despite being one of the most cited scholars ever, it doesn’t seem that his ideas hold much weight in literary studies, or even cultural studies, despite their scientific falsifiability and influence on the left-wing anti-imperialist political viewpoints that many of those sympathetic to poststructuralism have. An interesting contradiction, wouldn’t you say? Perhaps this is similar to Young’s use of neuroscientific and biological concepts in his book; that is to say, that an ethnologist probably doesn’t have much experience in these fields, much as the cultural theorists and philosophers who coopted the bits of linguistics that appealed to them didn’t actually know anything (or presumably give a toss) about linguistics.
Goodbye to postmodernism/structuralism/constructionism?
None of this is to say that poststructuralism, or deconstructionism, and the social constructionism, or social constructivism, which comes with it, haven’t done anything good. Queer theorists who used poststructuralism to tear down binary ideas of being either gay or straight undoubtedly helped the LGBT community, breaking down stigma and maximising inclusivity. Gender theorists like Judith Butler deconstructed differences between genders, famously describing them as a ‘performance’ which helped to liberate women. And however unintelligible the ideas are, Michel Foucault, perhaps the most famous poststructuralist who didn’t want to be called a poststructuralist, developed his ideas of changing power dynamics throughout history which have influenced just about every social science and humanities discipline since. More recently, the emerging field of animal studies (you heard that right) is potentially developing upon these ideas and methods to break down traditional binaries between humans and animals, which has the potential to lead to us having a more humane relationship with them
But just because these ideas have been useful in the past, doesn’t make them the theories to end all theories. This is not the end of the road, and Young’s book more than anything shows how essential it is that we appreciate some level of scientific objectivity, meaning a level of falsifiability within the health and natural sciences. This isn’t something which ethnography or anthropology gives us — it is only something we can get from rigorous scientific disciplines, the disciplines which convince us that when people say they are sick, they probably are sick, and that illnesses which we experience today convincingly have had parallels in the past. A middle ground between these ideas if potentially possible. Harmony of Illusions, though, fails to walk the divide between the two, and is a good example of when these ideas go haywire — and, more important, when postmodern ideas are used in completely the wrong places.
