The End of Trauma
How the New Science of Resilience Is Changing How We Think About PTSD
George Bonanno
Having read it
★★★★☆
Aside from its title (clearly used to help grab attention!) the words within and the framing about life and people’s resilient abilities when faced with trauma, make it a surprisingly good read – one weighted in a fair bit of reality and medical nous about these things.
With it’s refreshing perspective bolstered with views and opinions from real people and cases that show how all these things change and adapt and that when they are allowed to and followed, good things can be learned; that attitude really helps modify ways-of-operating so that receivers and practitioners, over time (and generations) see that these things can change based on realistic and sensible contemporary attitudes and approaches to better understand and work with cases of trauma.
A good passage
A disease model of PTSD carries a rigid essentialist assumption that people either have the disorder or they don’t. There is no in-between. The problem here is that psychological problems, including the reactions people have to potentially traumatic events, tend not to fall into neat categories. We can invent categories. That’s easy. But inventing a category doesn’t mean it actually exists in nature. For example, we commonly think of people as young, middle-aged, old, and so on. But there are no inherent categories in aging. Age is simply a continually increasing number. The same is true for PTSD symptoms. People exposed to potentially traumatic events can experience a wide range of symptoms. Some have only a few of these symptoms, some have many of them, and some have most or all of them. The symptoms make the most sense as a continuum. Statistical analyses show that there is no coherent point, no latent or emergent category, that clearly marks when the disorder is present or absent. This turns out to be the case, actually, for most mental disorders.17
These problems arise in part because mental health disorders are not created empirically. They are essentially invented by committee: by groups of experts who debate and argue, sometimes for months or even years, until they finally come to an agreement about what a disorder should look like.
A second good passage
In the ambiguous cases, traumatic stress might be misdiagnosed as PTSD, for example. Or, worse, problems that emerge independent of a trauma reaction – problems such as loneliness, fatigue, or depression – might be viewed as just another variant of PTSD and treated as such. Similarly problematic, sometimes potentially traumatic events, such as the 9/11 attacks, change a person’s life in away that is confusing or disorienting, or just plain difficult, but not necessarily traumatic. These problems, too, can easily be misattributed to PTSD. And when that happens, whatever intervention might be considered would be targeting the wrong problem.
The even more pernicious problem, though, is that this kind of blind spot leads us to doubt that resilience can ever be genuine. We become suspicious. Where there is genuine recovery, we see deception. Where there is strength, we see weakness. Where there is optimism, we see only denial-and a dark future filled with hidden trauma symptoms lurking just below the surface. Insidiously, the resilience blind spot can lead us to doubt our natural abilities. It can do this so thoroughly, in fact, that a team of therapists once published a paper dismissing resilience as the ‘illusion of mental health.’35