The Biomedical Approach to Trauma and the Ethics of
4.1 Psychologization means depoliticization
In the context of major societal upheavals such as war and violent conflict, the psychiatric/cognitive framework psychologizes not only the consequences of and responses to these events. In recent years, the causes of such conflicts have been psychologized as well, to the degree
that war and violence are sometimes comprehended as a potential manifestation of ‘psychosocial dysfunctionalism’ and treated as ‘mental health emergencies’. Pupavac (2004, p. 498) summarizes the logic behind these claims as follows: ‘trauma is regarded as significant for not only impairing the development and mental well-being of the individual, but the future development and well-being of the society as a whole’. The sense of urgency permeating this discourse points to the idea that ‘rapid intervention can prevent the development of serious mental problems, as well as subsequent violence and wars’ (Summerfield, 1999, p. 1457).
The claim that ‘unresolved traumatic experiences are likely to ignite new hatred and new wars’ is, according to Summerfield, an extreme consequence of approaching war with a gaze borrowed from the psychi- atric clinic. He draws attention to the fact that there exist no empirical data ‘to demonstrate increased rates of psychiatric morbidity and anti- social behavior across exposed populations as a standard consequence, let alone whether talk therapies are preventive’ (1999, p. 1457). The idea that war represents a mental health emergency derives from our under- standing of trauma rather than from empirical observation.
The view of war as a mental health emergency entails a psycholo- gizing move that has become commonplace in Western thought.
Mihalis Mentinis (2013), for example, shows with great clarity how the so-called ‘Greek crisis’ is commonly couched in a rhetoric that identifies the ‘deficient psychology of the Greeks’ (p. 4) as the root of the coun- try’s problems. Mainstream media continuously repeat the message that what is required for Greece to surmount its sordid economic situ- ation is a modification of the psychological make-up of its inhabitants:
‘in the bourgeois psy-discourse the ‘Greek’ is constituted as a deficient being that needs to be radically re-educated, re-trained and radically changed if he/she is to survive in the new global conditions’ (p. 5).
Obviously, this psychologizing discourse is inherently depoliticizing, as it forecloses as a potential solution any form of action on a collec- tive, societal level. The desire for social experimentation and societal reconfiguration, according to this discourse, betrays a political imma- turity and an unproductive unwillingness to psychologically adapt to the economic spirit of the times. In sum: what needs to change is not the neoliberal, capitalist system but rather the ‘national selfhood’ of the Greek, so that he or she can fit the entrepreneurial requirements of modern-day society. This is but one example of how sociocultural and sociopolitical phenomena are reframed as psychopathology on European terms (Summerfield, 1999). As De Vos (2012) aptly remarks, in the psy-sciences the political and socioeconomic reality is reduced to
the individual; material conditions and power relations are replaced by intrapsychic processes.
The question arises whether the present referral to war-affected popu- lations as traumatized is helpful in formulating appropriate responses.
Higginbotham and Marsella (1988, p. 553) state that ‘investing authority in biomedical reasoning about human problems eliminates explanations of disorder at levels of psychologic, political and economic functioning.
Consequently, problems with origins in poverty, discrimination, role conflict and so forth are treated medically.’ Humanitarian psychiatry relocates phenomena from the social to the biopsychomedical realm.
The imposed psychiatric framework of trauma closes down alternative avenues of intervention as it opens up a medical one. The narrow focus on individual psychology ‘ignores and leaves unquestioned the condi- tions that enabled the traumatic abuse’ (Craps, 2010, p. 55). Put differ- ently, humanitarian psychiatry privileges ‘immaterial recovery’, that is, some form of cognitive restructuring that consists in having the sufferers confront their painful memory and integrate it into their life stories so that ‘psychological healing’ becomes possible, over ‘material recovery’.
The latter refers to
reparation or restitution and, more broadly, the transformation of a wounding political, social, and economic system. Insofar as it negates the need for taking collective action towards systemic change, the current trauma discourse can be seen to serve as a political palliative for the downtrodden. Survivors are pathologized as victims without political agency, sufferers from an ‘illness’ that can be ‘cured’ within existing structures of institutionalized psychiatry. (Craps, 2010, pp. 55–6)
Thus, although the infusion of trauma theory in humanitarian aid can be argued to have a depoliticizing effect on the situations in which it is deployed, it is paradoxically the exact same feature that turns it into a potential instrument of ideology and power – in servitude of the status quo. The idea that psychiatry concerns itself with ‘universal realities’, that it is ‘beyond ideology’, is the ultimate gesture of ideology itself (Žižek, 1989). Such a claim carves out an impossible, transcendental position for itself from where it is possible to speak with an unques- tionable authority. Questions of values are thereby transposed to the plane of scientific investigation and truth, which makes them harder to debate. De Vos (2012) claims that the humanitarian worker attempts to adopt a position of being the mere servant of a knowledge that covers
the whole field of being itself. As such, he or she is caught up in the production of what Agamben (1998) calls ‘bare life’. In De Vos’s (2012, p. 114) words:
the refusal of any higher Causes in the so-called post-ideological era is the biopolitical move at its sharpest. As we consider the ultimate goal of our lives as life itself, this stance cannot but become caught up in the production of homo sacer [ ... ]. The psy-worker, convinced he is merely tapping into scientifically proven universals, reduces the other to bare life, to homo sacer .
This ties the psychologizing and depoliticizing operations of the PTSD- framework to a more general ethical crisis in the West, related to the
‘refusal of higher Causes’. This will be the topic of the next chapter.
5 Conclusion
Although trauma has become somewhat of a commonplace or a ‘shared truth’ in the West, it has proven difficult to substantiate this truth with empirical evidence. Whereas we expected the response to radically disruptive events to be universal, it turns out to be highly diverse. Where we believed that ‘almost anyone’ would develop long-term pathology in the confrontation with a series of well-defined, horrific events, it turns out that it is impossible to predict the outcome of such confrontations.
Where we suspected that only a limited range of experiences could give rise to trauma, it turns out that other life events can equally produce the entire clinical tableau associated with trauma. And finally, when we intervene on the basis of what we believe is a universal truth, it turns out that the effects of these interventions are not as beneficial as expected and might even impede processes of recovery.
The biomedical approach in which PTSD is embedded attempts to gain objective knowledge about the phenomena it studies. The production of this sort of knowledge requires the acceptance of a series of assumptions that are not universally shared. Furthermore, as soon as the acquired knowledge is implemented in concrete situations, it imposes a medico- technical framework that renders some aspects visible while it inevitably obscures others. As such, the choice for a particular scientific paradigm can never be neutral, because it concerns the power to define the problem and its solutions. In the case of PTSD, the underlying presuppositions stimulate an emphasis on the individual; a preoccupation with immate- rial recovery; an inability to take the context into account; a technical
approach that misses the ethical dimensions of trauma recovery; and a depoliticization that serves the status quo of a given political and/or economical reality. It is precisely because PTSD purportedly describes a reality that transcends particular contexts and cultural determinations, that is, because of its avowed universality and neutrality, that it is able to serve as a disempowering political instrument. Academic knowledge thereby legitimates a series of interventions, which despite claims to the contrary, can never be politically neutral.
These points of criticism, and the desire to address them, serve as the driving force for the current project. Can we reinstate the often neglected dimension of the political in trauma recovery? How is psychological healing related to large-scale societal transformation? In Part II of this book, I argue that Lacan’s concept of the real can be utilized to think through these difficult matters in a novel and productive fashion.
In the next chapter, I will scrutinize the moral and ethical dimen- sions involved in this practice. Taking my cue from French philosopher Alain Badiou’s (2001) critique of contemporary liberal-humanist ethics, I will argue that the spectacular rise of trauma over the last 35 years – to such an extent that ours is an ‘age of trauma’, trauma being the ulti- mate emblem for our times (Di Nicola, 2012a) – is concomitant with the dominance of the human rights discourse as the sole moral compass for our times. In other words, it is no coincidence that trauma psychi- atry emerges, at this moment in time, as an important partner in the management of conflicts and in attempts at peace building. In fact, from within a certain ‘ethical ideology’, as Badiou would call it, trauma treat- ment has become the logical answer when faced with questions of insta- bility and rupture. As will become clear, the remarkable contemporary preoccupation with psychological trauma in its ever-increasing number of guises and the omnipresence and supposed universality of the human rights doctrine are two sides of the same coin. Many of Badiou’s points of criticism targeting contemporary ethics will thus inevitably echo the shortcomings of the PTSD model, touched upon in this chapter.
34
Alain Badiou’s Ethics: An Essay on the Understanding of Evil (2001) remains to date one of his more successful and bestselling books. It starts off with a polemical charge against contemporary ethics in its relation to the discourse on human rights (pp. 1–39). Badiou observes that ethics, today, has become a matter of busying ourselves with these rights, of making sure that they are respected. Despite the seductive power of this doctrine, rooted in its apparent self-evidence, Badiou contends that it must be uncompromisingly rejected. This is because, in his analysis, it operates as an ideological support for the current political situation by presenting as potentially evil any organized political collectivity that seeks to challenge the prevailing way of the world (that is, parliamen- tary democracy and neoliberal economics) and its absolute injustice.
Similar concerns regarding this discourse of the rights of man 1 have been formulated by, among others, Dominique Lecourt (2001) and, as Jacques Rancière (2004) remarks, Hannah Arendt (1951), who devoted a chapter of her book The Origins of Totalitarianism to the ‘Perplexities of the Rights of Man’. In what follows, we will first describe Badiou’s characterization of this form of ethics and the purported reasons for its dominance in our times. Next, we aim to show that the discourse of trauma is one of the most powerful representatives of this orientation, its avatar on the ground, one of the prime manners in which the ethical ideology of today is practically translated or applied in situ .
1 Contemporary ethics: characterization and situation The term ‘ethics’ traditionally denotes a branch of philosophy that inves- tigates the best way for human beings to live and how to judge what kinds of actions are right or wrong in particular situations. According to
2
A Critique of the Ethics of Human
Rights in Its Relation to PTSD
Badiou (2001, p. 2), ethics designates today a principle that, in a vague and fuzzy way, governs how we relate to and comment on a variety of historical, techno-scientific, social and other situations. He detects two major strains at the root of this principle. The first is related to the discourse of human rights and is founded on the work of Immanuel Kant. The second can be referred to as the ‘ethics of the other’ and has its origin in the theses of Emmanuel Lévinas. These two strains most easily meet in their agreement to organize ethics around the prevention of suffering and death. Although the merits of such a stance seem self- evident, Badiou asserts that it ultimately amounts to a nihilistic resigna- tion that must be resisted. In what follows, I will summarize Badiou’s analysis of this type of ethics.
At the core of this doctrine lies the presupposition that human beings possess a universal, a priori ability to discern evil. The assumed consensus regarding what is evil then provides the basis from which to develop an – inherently defensive – ethics: good is what intervenes visibly against these forms of evil. The good, here, only has a secondary status: it is derived from evil and not the other way around. Human rights are essentially rights to non-evil. Basically, then, this discourse spells out what must not be done; it indicates what is forbidden. At the same time, however, it struggles to formulate a positive alternative.
This emphasis on the prevention of suffering and death thus produces a strictly negative conception of ethics, and, ultimately, of the human being itself (Hallward, 2003, p. 256).
Indeed, one of the major philosophical problems with this position is that it necessitates the presupposition of a universal human subject, the identification of which is subordinated to the recognition of the evil that is done to him or her. As such, this ethics defines man as a victim, or as ‘the being who is capable of recognizing himself as a victim’ (Badiou, 2001, p. 10). For Badiou, this is unacceptable, because
‘the status of victim, of suffering beast, of emaciated, dying individual equates man with his animal substructure, [ ... ] reduces him to the level of a living organism pure and simple’ (Badiou, 2001, p. 11). We could say, with Arendt (1951), that human beings have not one but two lives:
first, we have bare, physiological life ( zoe ), but, additionally, we are char- acterized by a life that surpasses this bare existence, the political life of speech and action ( bios ). The Aristotelian distinction between zoe and bios was placed in the spotlight more recently by Georgio Agamben (1998), whose work on biopolitics allocates a central role to the concept of ‘bare life’ ( homo sacer ). The point is that the rights of man confuse these two lives, which ultimately means the reduction (or denial) of
bios to sheer zoe (Rancière, 2004). In relation to this, Alenka Zupančič (2000) remarks that the pre-modern ethical maxim par excellence was that of ‘the master’: sadder than to lose one’s (biological) life is to lose one’s reason for living (that is, bios as a particular way of life as an indi- vidual or a group). In other words: according to the pre-modern ethical maxim, when one has to choose between honor and life, one should never choose life and lose, for the sake of living, all that makes life worth living. Modernity, then, offered no alternative to the discourse of the master besides the feeble maxim ‘the worst thing one can lose is one’s own life’. The latter maxim, which identifies the preservation of ‘bare life’ as the highest value, ‘lacks both conceptual force and the power to
“mobilize”’ according to Zupančič (2000, p. 5).
Badiou ties the return to the doctrine of the natural rights of man to the collapse of revolutionary Marxism and all the forms of progressive engagement that it inspired. If the ethical consensus is founded on the recognition of evil,
it follows that every effort to unite people around a positive idea of the Good, let alone to identify man with projects of this kind, becomes in fact the real source of evil itself. Such is the accusation so often repeated over the last fifteen years: every revolutionary project stigmatized as ‘utopian’ turns, we are told, into totalitarian night- mare. Every will to inscribe an idea of justice or equality turns bad.
Every collective will to the Good creates Evil. (Badiou, 2001, p. 13) In other words: evil is what happens when we collectively try to bring about, in reality, the good. To make ourselves the bearer of a ‘positive idea’ (what Badiou calls a ‘truth’) and to try to change our worldly reality to fit this notion: was this not the recipe for the horrors of 20th-century totalitarianism? The Holocaust and the Gulag linger in our collective memory, amongst other atrocities, as a traumatic reminder of what the will to the good has produced in the past. Evil is proclaimed to be tied up exactly with the ‘life of great actions and noble words’, that dimension of life which exceeds our bare existence as living beings. In this manner, contemporary ethics, as the struggle against an a priori recognizable evil which, in its turn, is linked to collective projects around a positive notion of the good, makes it very hard to envisage any transformation of the way things are now. The price paid by the ethics of the rights of man, Badiou (2001, p. 14) concludes, is ‘a stodgy conservatism’: ‘the ethical conception of man [ ... ] prohibits every broad, positive vision of possibilities. What is vaunted here, what ethics legitimates, is in fact the
conservation by the so-called West of what it possesses.’ In other words, Badiou recognizes the political impact of the ethics of human rights, its potential to undercut any form of militant engagement with a shared cause.
It follows that any genuine ethics, for Badiou (2001, pp. 11–12), is
‘antihumanistic’ in that it necessitates the affirmation of a superhuman or ‘immortal’ aspect of the human. In fact, it is this ‘immortal’ aspect, which in Badiou’s philosophy only comes to the fore when man is sustained by a truth that surpasses him yet passes through him, that defines the human being as human, as something more than just an animal: ‘To forbid him to imagine the Good, to devote his collective powers to it, to work towards the realization of unknown possibilities, to think what might be in terms that break radically with what is, is quite simply to forbid him humanity as such’ (2001, p. 14). Here, we witness a remarkable inversion of the starting positions: the human rights discourse is claimed to violently reduce man to his animal substruc- ture, a being for whom basic comfort and the continuance of life are deemed the highest value. Conversely, an antihumanist position affirms man in the potential of becoming something more than just an animal, and situates his humanity exactly in the realm that exceeds his bare existence.
It should be remarked that it is not only the contemporary equa- tion of man with his status as victim that bothers Badiou; on a more fundamental philosophical level, he questions altogether the existence of a universally recognizable human subject, possessing rights that are somehow ‘natural’. Thinkers such as Louis Althusser, Michel Foucault and Jacques Lacan, who have all influenced Badiou’s own strand of antihumanism in some way, have repeatedly debunked this idea of a natural or spiritual identity of Man, and, as such, the very foundation that underlies the assertion of the existence of ‘natural rights’ and the notion of universal ethics. Their analysis led to the conclusion that ‘the humanism of human rights and ethics in the abstract sense were merely imaginary constructions – ideologies’ (Badiou, 2001, p. 5). Nevertheless, and perhaps somewhat surprisingly, these authors’ critical, antihu- manist position did not lead them to embrace a kind of cynicism, an attitude of resignation or indifference to the suffering of people. As Badiou (2001, p. 6) aptly remarks, all three of them were ‘militants of a cause’. Paradoxically, then, the dismissal of the existence of man and his natural rights ‘is not incompatible with rebellion, with dissatisfac- tion with the established order, or with a committed engagement in real situations’ (p. 6).