trauma work

[Adam Blatner]

Hello, All,

  I've been corresponding with someone not in the psychodrama community about trauma and thinking about the issues, and it occurs to me that the word has become fashionable and overgeneralized. I'm not sure that when some folks talk about trauma they don't include stress, affliction, difficulty, and so forth. What are the boundaries among these experiences? When does a stress become traumatic? And then of course there may well be degrees of trauma; and the problem of accumulated trauma and what that implies.

(I think a stress becomes trauma when it undercuts the person's defensive system and basic beliefs about self, others, or the world. For many people, events that are traumatic for others are certainly unpleasant, but not traumatic. Many people are able to incorporate horrendous experiences within their life schema and defensive system. It may harden them, but doesn't generate deep faults. 
        I wonder also if doubts in the social environment cannot turn an experience that had been assimilated into a trauma---i.e., if what was thought of as a just and necessary action in wartime is called into question.) 

        (A recent article on physical trauma---to the brain---in football--- in the New Yorker magazine--- is fascinating as a social phenomena: How much danger do we expose our modern-day gladiators to and what risk do we tolerate. The author dares to use the Michal Vick scandal about dog fighting to present an interesting moral problem: Is a sport that may involve some danger different from a sport that almost for-certain entails injury?  And if that injury shows up decades later, does that lessen its moral implications?)

          Back to psychological trauma: Then there is another question: I don't think that what most people experience as depression is a primary condition. Some of it is, or near primary; but often what this syndrome involves is sustained demoralization and disappointment due to an accumulation of stresses plus an admixture of a deficit of resilience or health-promoting factors. (Analogy: People with significant vitamin deficiencies are far more susceptible to infections.) 

        Point being that treatment must take into consideration recognition of individuality and complexity of problem. Some depression, for example, mirrors the culture's lack of clear purpose (for each individual), multiple competing and often unrealistic demands (or so it seems), and other factors promoting socio-cultural alienation. These are more common among teens who are diagnosed with "depression." 
              Some depression results from suffering which results from the consequences of being fired, abandoned, and otherwise losing that is in turn due to having engaged in self-defeating behaviors, addiction, and acts that drove supports away---parents, partners, dates, employers, etc. Yet the focus on trauma may reinforce the illusion of victimization when in fact the person has created his or her own negative situation.  I wonder whether therapists look for and diagnose these predisposing patterns. 

           Some depression results from the come-down from a period of over-stimulation---certainly from pharmacological agents such as cocaine or amphetamines. Again, I think some patients may not tell their therapists this and for therapists a fair degree of suspicion is appropriate. 

        Some depression is part of a histrionic life style, a role of victim, and some of these come to different therapists and to psychodrama groups and dominate the group with their manipulations. 

         And so forth. All of which suggests that taking an individual who presents at a psychodrama conference or in other short-term contexts and attempting to treat the trauma may be fine if the director gets a relatively healthy protagonist with a relatively limited symptom-complex and a relatively strong network for follow-up and other coping avenues---which sometimes happens; but there's also a risk of getting a protagonist without those resilience factors. 

     So to build on Marcia Karp's quoting of Zerka's line that psychodrama is a tool, like a hammer. It can be used in different ways, and also you can hurt people with it.  I love the concept of tool and think that there are a goodly number of tools created by Moreno that can be used in different ways. But also---using the metaphor of carpentry---there are other functions that require skill and judgment. In carpentry they include measuring, planning, stuff like that; in psychotherapy they include adequate diagnosis.

(Diagnosis doesn't mean pinning a label on someone. I despair of the idea that such labels have much meaning. More often, especially for depression, anxiety, and trauma, these are very large categories---akin to "belly-ache" in medicine---that could in turn have scores of different causes, some minor, some with desperate prognoses. So diagnosis for me means finding out what is going on, what the strengths are, what resources are available, what other conditions might be making it worse, etc.---some of which is acknowledged in the diagnostic manual, but these elements are rarely used.) 

    Warmly, Adam
Adam Blatner, M.D.
   website: www.blatner.com/adam/   
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