blighttown

More thoughts on trauma: Therapists and their obsession with "root causes"

The trauma topic is one that won't really leave my mind. I've said it before, but it seems that everyone believes the yhave "trauma" to work through. I think in a lot of cases, the term "trauma" is being used in an incredibly vague way, and in the modern era talking about your "trauma" is simply how people talk about their feelings, or their personality. The observations and conclusions they draw from those conversations don't necessarily change much, but the language people use is decidedly modern.

One clear example that comes to mind would be a (very kind) older woman I know. She's in her 70s, and she has a couple of sisters, one of whom is in her early 80s. This woman -- let's call her "Cathy," a false name. Well "Cathy" was incredibly OCD, but as with so many people in her generation seemed to lack any sort of self-awareness. She'd move from obsession to obsession, panic attack to panic attack. Always riding the wave from one to the other. The pattern repeated over the decades of her life. I won't dive too much into this, but she had so little self awareness that she would tell you that she never really got anxious. She certainly would not have identified herself as OCD. I cannot be certain, but my impression is that instead she thought her fears were simply real and measured. "I don't have anxiety," she might say. "It's just that the upcoming storm could really be the end of the world for everyone." And then the storm in question would just have some gusts and rain, and she wouldn't even lose power or anything.

It's not great to pry, but her OCD was seriously impacting her life. She was imagining problems that either did not exist, or did not limit her in the way she imagined, and she was having trouble leaving the house, and really believed that she couldn't do the things she enjoyed. After a lot of conversations, "Cathy" was convinced to seek therapy. There is a lot that could be said about her therapy. It was at least partially successful, but in a lot of cases, she seemed to draw flawed or partial conclusions.

One conclusion that really stuck out to me was that "her parents never taught her how to deal with conflict." As part of her explanation, her parents never fought in front of the kids, so she never learned how to be assertive. In her telling years later, as an adult, she simply lacked the ability to stand up for herself; she'd never learned how to assert her preferences.

Now, I think this is maybe half-right. (at best) It's true that she had problems being assertive, but it seems like therapists are incredibly fixated on childhood trauma as a cause for ills of the present. "Cathy" may not have been very assertive, but her two sisters had no problem being assertive. If anything, the other two could have been more agreeable. One was sort of schizoid and could be quite hostile, and the other was just as OCD (but about different topics, of course) and was quite a dominant woman. If she was fixated on something you were doing wrong, you were going to hear about it loudly and often. So why did "Cathy" fail to learn how to stand up for herself but he other two sisters had no such problem?

And further, why didn't "Cathy" learn assertiveness from other areas of her life? Your parents cannot be a model for everything. She could have learned assertiveness through a variety of other methods: friends, teachers, coworkers, movies, television. Or, as so many of us learn, through sheer force of will combined with years of trial and error.

Additionally, "Cathy" was actually quite assertive in other situations. She was quite a fierce mother, often to a fault. But she never had any issue shouting down a teacher or administrator because she felt they were not doing right by one of her children. So with real observation, it would probably be more correct to say that "Cathy" had no problem being assertive, and no problem engaging in argument or disagreement; it just had to be on behalf of someone else. She couldn't stand up for herself, but standing up for others apparently came easily to her.

But, was her therapist aware of any this? Did her therapist know that there was not a strong basis for the claim that her parents had not taught her to assertive and so she never could be? At least from my reading, the better explanation would have been that "Cathy" lacked the proper self-awareness to be assertive. She didn't realize she was assenting to the needs of others until the frustration had built up enough to bubble up and cause anxiety and conflict. I'm not suggesting that's all there is to it, but a deeper understanding of the woman there does not seem to be any reason to seriously consider the parenting narrative. (her other two quite assertive sisters should be proof enough of that)

The other half of this that preoccupies me is why it matters if you identify a root cause when it comes to psychological issues. Let's say you have two kids: one whose parents raised them incorrectly and so they never "learned" (again, somehow failing to pick this up from either experience or other human examples in their life) how to be assertive. And a second kid, who maybe is just dispositionally unable to be assertive. How would the root cause help you here? The solution would sort of be what I laid out previously:

It strikes me that at best the "parental root cause" could be emotionally reassuring, but doesn't have any real utility for solving the problem you've ended up with. It's not as if once you learn it was "all your parent's fault" that a lock opens in your mind and you're released from the pattern of behavior. Even in the example where it is (again, somehow!) all the parent's fault, you could completely fail to identify this root cause, and I would claim it would do nothing with regard to what your next steps in therapy are.

In a sense, I think modern therapists are what I would call "accidentally Freudian." In the old Freudian model of transference, your past trauma is in some sense something physical. This is just a metaphor, but it's as if you're holding onto a glass of trauma as you need to do is "pour it out" (ie, transfer it to the therapist) and then your trauma is relieved. Although it can be quite a salve to talk about trauma and issues with other people, the trauma does not really disappear once you identify it and speak about it. In some cases, the trauma becomes more fixed as you spend more time thinking about it, talking about it, and identifying with it. The trauma may even come to take a larger place in your mind. My personal suspicion would be that a few things are going on here: there can be shame or confusion about the events of your life, and the social acceptance of talking about your trauma can be really reassuring. I also think therapists may accidentally be invoking some fake mysticism here. It's quite an emotionally powerful experience to talk to someone about the most upsetting topics in your past and have them really listen and really care. Because this experience is so powerful, I think therapists can be guilty of feeling the energy in the room, feeling the connection, and mistaking that for some kind of real progress. It's analogous to how a psychic might sight-read a customer and tell them about their dead husband; the emotion felt in that moment really carries the illusion, and implies a meaningful interaction than actually occurred. Another example might be job interviews. So many people seem to think they're good at judging candidates based on a short interview with them. I think the visceral feeling of the interaction is doing the real work there, and the interviewer mistakes that visceral feeling deep, accurate knowledge.

It's also worth nothing that there's no particular reason to believe current behavior is directly connected to past trauma. The key word there is "direct." Even if the past trauma were strictly causal, what the person has built up is a series of personality traits, thought patterns, behaviors. Talking about the trauma does not sever these from their "first cause." It does not arm you with the knowledge for how to tackle these. And conversely, you could work out how to tackle maladaptive thought patterns and behaviors whether or not a root cause was identified. It would be more important to accurately observe the person in front of you than to find the root cause.

Now in fairness, I think there are very many therapists who do not fall into these traps, and I definitely did not intend to write a "therapy is bad" essay. But of the people I know who go to therapy, so many have come out saying something like "I had no idea that I had so much unresolved childhood trauma." I think those therapists are accidental Freudians, and they think they're going to help someone by finding the trauma (which of course must exist) and then help by switching the "Freudian relief valve" in the patient's head so that the trauma escapes their mind and they are fixed. It feels pseudoscientific, and at least in some cases, like a waste of time and energy for the patient.