Healing as “curing” trauma. (Part V)

Healing as “curing” trauma.
Welcome to Part V of the series exploring the question, “What does it mean to heal trauma?” As we turn our attention to this idea, that of healing as “curing,” I want to mention that there is not consensus around what is even possible when it comes to the idea of healing trauma. Therefore, the idea of healing as curing, in addition to other pathways being considered, may be a pathway of possibility for some and not for others. Regardless, this pathway is one in which we are working within the framework of the allopathic medical model in which there are symptoms which point to diagnoses, and then treatments to address both symptoms and root cause.

What is meant here by healing trauma as curing trauma is the idea of eliminating the symptoms of trauma, thereby in effect “curing” the “dis-ease.” At least in the “West,” it can be argued that seeking relief from symptoms comprises the vast majority of humanity’s efforts around “healing” and “health,” including mental anguish and psychological suffering. In the allopathic medical model, within which rests the DSM-V, the condition of PTSD is a pathology and the goal can be conceived as curing by eliminating the symptoms. The presence of symptoms is the very basis on which to make a diagnosis. If symptoms are no longer present for the period of time in which it is necessary to qualify for a diagnosis of PTSD, then one could be considered to have been “cured” of PTSD within this model.

That said, in the mental health field in general, it is usually not spoken of as “curing” mental health disorders in the idea that if treatment results in a condition’s disappearance, then it has been cured forever and will not return. My argument with this premise is that it is, for example, possible to have cancer, cure the cancer, and then later develop cancer again. The original state of disease was present, it was eliminated, and then cancer returned. Does that mean the first cure never happened? Or, for example my mother had COVID-19 in 2021. She received treatment and, along with her own immune response, recovered and was “cured” of COVID. However, she got COVID again in 2022, and again went through the process of treatment and her own body’s response, which eventually eliminated COVID. I would argue that in both cases, she was cured of COVID. The first experience of curing did not mean that it could never happen again, or that the first experience of curing was negated by the second experience of having COVID.

Just as with COVID or cancer and other more physically-based diseases, could it be possible that one might develop PTSD or other mental health disorders more than once, and that treatments and recovery may work in each instance? The answer might be both yes and it is also possible that what is happening with an experience like PTSD is periods of latency and activity. Perhaps symptoms come and go, which may or may not be due to treatments or efforts of some kind.

Some models of trauma would also consider that the neurological wiring that happens as a result of trauma, particularly in conditions referred to as developmental trauma and Complex PTSD (C-PTSD), make one’s system prone to firing patterns and patterns of behavior that are deeply entrenched, and while recovery may be possible, the idea of “curing” is less applicable as opposed to the idea of a possible trajectory of increasing one’s resilience and decreasing one’s reactivity to experiences that tend to bring on symptoms.
In this vein, which is still a clinical approach to treating trauma, there are still points A and B, where point A is the state in which one receives a diagnosis of PTSD; but then point B is considered to be a kind of “not-A,” meaning not the same state as point A, but also not a definitive destination. Thus, it is possible to continually increase resilience and recovery, to become more resilient and more recovered, but there may never be an “arrival” at point B in which there is no longer PTSD and therefore no additional recovery.

Finally, one addition to the clinical medical model for trauma healing is speaking of it in terms of “affect regulation” and “self-regulation.” In other words, modeling healing as the improvement of “self-regulation.” Affect is basically a clinical way of describing one’s emotional experience. One’s affective state is their emotional state at any given time. More “difficult” emotions – more difficult affect – would exhibit as challenges in self-regulation, which could simply mean that a person appears to have difficulty in managing their emotions.

I argue that Western American culture, although not alone in this by any means, values individuals who are able to manage their emotions and behavior in order to perform, as it were, according to our culture’s expectations and values around productivity and being “well-adjusted.” This cultural “voice” could be conceptualized as Freud’s “superego,” that internalized aspect of the human mind and personality which tells one that they should behave in particular ways that are expected of them according to their social values, mores, and roles (Freud, 2010).

The inability to perform or behave according to what is expected is often experienced as distressing for both the individual and those who desire a different set of behaviors; so in this particular conception, there runs the risk of inducing in a survivor a sense of personal failure at their inability to perform to standards due to their symptoms. This might also be coupled with adverse experiences of rejection, abandonment, or shunning until they, the survivor, are better able to bring their behaviors into line with what others want. This is, in effect, expecting a trauma survivor to “heal” in order to conform their behavior to expectations. This also creates a vulnerability by initiating a person’s repressive mechanisms in order to “correct” undesirable behaviors (trauma symptoms) and produce behaviors that are aligned with expectations. If we consider J. Krishnamurti’s injunction that it is not a sign of health for one to be “well-adjusted” to a sick culture or society, efforts to bring behaviors in line with social expectations may actually be the dis-ease in need of healing. Inherent within this framework is also the idea of the “norm” or “normalcy” or “normal behavior,” all of which is typically left unspoken, making it insidious and often undetectable within efforts to heal. There is, simply, an assumption about how things ‘ought to be,’ as well as when they should be like that. That thread aside, in the model of healing as improving affect regulation, we are in effect talking about ways in which behaviors can be “improved” in order to return a survivor to their desired, and oftentimes expected, roles in various aspects of society.

It is my opinion that this pathway is fraught with dangers and pitfalls, especially for survivors. However, in my lived experience as well as my anecdotal experiences with countless other survivors, this is a common condition: feeling and believing that one is somehow not performing according to expectations, and internalizing this inability to conform and perform as personal failure. In addition, if we consider the notion of “burden of responsibility,” the burden in this model is placed on the survivor and not on the survivor’s culture or society. The burden falls on the survivor because it is their responsibility to “self-regulate.” The society expects the survivor to take care of themselves and figure it out, and ideally within what the society deems the appropriate amount of time to do so. The reward: acceptance and, thus, safety and having a place within the society. The consequences of failure: rejection, and therefore no safety, support, or security from the society.

We continue our exploration of “What does it mean to heal trauma? in Part VI, “Healing as recovery.”

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