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This is the Allusionist, in which I, Helen Zaltzman, refuse to give language its ball back.
Today’s episode is about complex PTSD, and my guest Stephanie Foo does refer a couple of times to the parental violence and abandonment she experienced, and we also mention sexual violence; but, we don’t discuss any of these things in detail. We’re mostly talking about what complex PTSD actually means, and other terms around that condition; so it’s a more general conversation about psychology and trauma, rather than stories of traumatisation. Just letting you know so you can suitably prepare yourself if you need to.
There are also a couple of swears.
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STEPHANIE FOO: I was diagnosed with complex PTSD in 2018. And I had never heard of complex PTSD before. I Googled it; it sounded very serious and very scary.
HZ: And was it very serious and very scary?
STEPHANIE FOO: I mean, yes! I think it is very serious and very scary. It seemed like a very serious thing that I needed to fix immediately. The way that the symptoms made me sound, to me, like kind of a terrible person. And so I started trying to read more about it, and I picked up all of these books that either kind of further pathologized complex PTSD, or took a very academic or scientific approach to it that didn't really make me feel better or more seen.
HZ: So now she has written the book that would have been useful to her at that time.
STEPHANIE FOO: I'm Stephanie Foo. I am a journalist and radio producer who has worked at places like This American Life and Snap Judgment. And now I am the author of the book What My Bones Know: A Memoir of Healing from Complex Trauma.
HZ: The difference, in brief, between PTSD and complex PTSD:
STEPHANIE FOO: So post traumatic stress disorder, I think most people are kind of familiar with this: it's basically, if you go through something really traumatic, you can sort of be in a state of fear and hypervigilance when you are reminded of that thing. For example, let's say you're hit by a car: you can absolutely get PTSD from that one traumatic incident, and you might get afraid when you're crossing the street and you see a car coming at you, or you might get afraid while driving. Complex PTSD is different, in that it's kind of like if you were hit by the car every day for many years. It's when the trauma happens over and over and over again. People who have lived in war zones might have complex PTSD, child abuse survivors, domestic abuse survivors. And it manifests differently than PTSD, in that you don't have necessarily very specific triggers that only manifest in specific situations, but it becomes a more constant presence in your life, that fear.
HZ: Complex PTSD was coined in 1992 by psychiatrist Judith Herman in her book Trauma and Recovery. The term PTSD was officially listed by the American Psychiatric Association in 1980 in the DSM-III, the third Diagnostic and Statistical Manual of Mental Disorders. This recognition followed years of study of the condition in veterans of the Vietnam war. Before that, when the condition was observed in veterans of the two world wars, it was called things like 'combat fatigue', 'shellshock', 'war neurosis', 'battle exhaustion', 'thousand yard stare'. And before those terms, in the mid-1800s particularly, they would diagnose military personnel with 'nostalgia' - yes, that was a medical condition for a while. But it wasn't just the military exhibiting the condition we now know as PTSD. For instance in the mid-19th century the epithet 'railway spine' described the psychological impact of train accidents on the injured and bystanders. And then key to the official identification of PTSD in 1980 were studies during the 1970s of survivors of the Holocaust and of sexual violence and domestic abuse. In 1974, sociologist Lynda Lytle Holmstrom and psychologist Ann Wolbert Burgess coined the term 'Rape Trauma Syndrome', a milestone in trauma research and in adding the word 'trauma' to official diagnostic vocabulary.
The word 'trauma' in its original Greek form meant a physical injury, which meaning entered English in the late 17th century from medical Latin - but in the mid-19th century, as psychoanalysis really started to take off, 'trauma' caught on to mean non-physical wounds.
STEPHANIE FOO: Webster's dictionary and the DSM-V have two very different definitions of trauma. Webster's dictionary is: “A serious injury to one's body or a very difficult or unpleasant experience that causes someone to have mental, emotional problems, usually for a long time.” That resonates with me more than the DSM-V version - and I have so many problems with the DSM - which categorizes trauma as “An actual or threatened death, serious injury or sexual violence.” Which tremendously narrows what would constitute trauma, correct? It goes from being any difficult or unpleasant experience in the world that could have caused you a mental or emotional problems, to very specifically, like, were you threatened with death? Were you raped? That's it, that's the only thing that is valid. And I think that's ridiculous. I think that is hogwash.
HZ: We're not saying that those things are not traumatic, just that other things are also traumatic. Carry on, Stephanie.
STEPHANIE FOO: And I think that it's really dangerous to minimize trauma in that way. I think that we've been trying to minimize trauma for a very, very long time, intent on saying, “Whatever you went through, pull up your bootstraps, don't make a big deal out of it, you're going to be okay, you're going to be fine. Just bury it down deep inside you.” And I think we're still doing that to some extent today in this DSM, in trying to say like, “It's only war or rape, basically, that would constitute you feeling bad about something.” When in reality, if you look at the science, a trauma response can be caused by damn near anything.
HZ: Big things, small things, all the size things in between can cause trauma.
STEPHANIE FOO: So let's say you go through a breakup, it's a hard breakup. It really sucks. And then you start dating again. And this new person that you're dating, they seem like a totally pleasant, nice person, but you have a hard time trusting them, and you feel anxious around them, you feel kind of scared. That is a trauma response. Basically, you went through this hard thing of a breakup. And your brain encoded that relationships or romantic love are dangerous, so that if you're in a situation where you're dating someone again and you feel an attraction to them, it's pumping out these chemicals saying "danger, danger, danger," which isn't a weakness of us. This is how humans work, because we are animals, and this is how all animals work. If something unpleasant happens, our brain encodes it as danger to try and keep us alive so that we don't move towards dangerous things. That is a trauma response, which means that anyone can have a trauma response to anything tremendously unpleasant.
Of course, our brains aren't totally rational all the time. And so you're going to have to interrogate that trauma response of that, of your brain pumping these chemicals like adrenaline and cortisol into you, and say, “Is this my brain just trying to protect me and sort of overreacting, or is this a legitimate danger?” And then you can comfort yourself, do what you need to do: go on a run, meditate for a second, have some self-talk, take a break and be like, let me match my brain and body's response to the actual threat at hand.
So when we minimize the definition of trauma, we're preventing people from being able to say, "Alright, that was traumatic. Let me heal from it. Let me like try and figure out ways to deal with it." If you're just telling yourself all the time, "No, this isn't real, this isn't happening," you're not doing that process of like, let me interrogate my trauma response, the validity of it, what is, you know, how, how can I calm myself down? Like does my body's response match the reality of the situation? You're not doing any of that healthy stuff. You're just trying to bury it deep down inside of you. And that actually impedes and slows the healing process, and kind of makes things worse.
For years I minimized my trauma because I didn't think it was a big deal, because I thought like, I grew up in a community, in an immigrant community in San Jose where child abuse was really prevalent and really normalized. And so I was like, I just need to get the grades and work hard and do fine and everything will be great, and this is not a big deal. And it wasn't until I got my diagnosis of complex PTSD that I was like, oh, I think what happened to me might've been really bad, and I think that I need to actually sit down and get help. And all of that, those years of saying no, don't pay attention to it, it's not a big deal, it's fine, it's fine, it's fine, actually led me to much less healthy ways of coping, like workaholism and drinking a lot and ignoring my very valid needs until I got sick.
HZ: How did it feel when you got a term for what you'd been experiencing?
STEPHANIE FOO: I think that sometimes diagnosis can be comforting cause it can be like, "oh, so that's why. This explains everything." For me, it was not so comforting. For me it was tremendously pathologizing. And for me, it was like, "I am broken. Here's the scientific evidence I'm broken. I've always suspected it. But now, there's a medical term that says you are a completely broken, messed up person." So that was really difficult for me to grapple with.
HZ: Stephanie also couldn’t find that much helpful information about the condition. It is recognised by many official entities, including the World Health Organisation, but it's still not listed in the American Psychiatric Association's DSM.
STEPHANIE FOO: Actually the Department of Veterans Affairs in the United States recognizes that CPTSD is real too. They're going against the DSM. There was a movement actually to get complex PTSD put into the DSM a few years ago, with the DSM-V. And it was not acknowledged, because they were like, “PTSD is good enough. All we need is PTSD, it should encompass everything.” Even though the treatment for PTSD and complex PTSD is different; the symptoms can be very, very different; the treatment can sometimes be opposite. So, yeah, that's a little problematic. What happens too when you're not going to acknowledge something is real is:
A. You're not going to be able to get treatment for it because you can't get properly diagnosed for it and then get the proper treatment for it.
B. Nobody's learning to treat complex PTSD as like a therapist, because they don't see a need for it, because it's not in the DSM, it's not real.
C. There's no research for it: if it's not in the DSM there aren't more government dollars being spent to try and say like, okay, this is a legitimate condition, so let's do as many brain scans as we can, let's try and see what works to heal it. So it doesn't have the resources, you don't have the resources, therapists don't have the resources. If you don't acknowledge there's a problem, how do you solve it?
HZ: I asked Stephanie for her take on some of the words that come up around trauma, like 'trigger'.
STEPHANIE FOO: I know that there's a lot of social judgment around the word 'trigger', because there's like this whole snowflake aspect to it, which means like, “Oh, you know, uh, you're triggered by what I said, and you are now crying like a baby, so get over it, you baby.
HZ: All very dismissive isn't it?
STEPHANIE FOO: Right, it is very dismissive and also, we all get triggered! To think that like it's only people with PTSD who get triggered is ridiculous and sort of stigmatizes and pathologizes people who have PTSD, because having triggers is, again, a normal human response. Trauma responses are a normal human response. If your mom died on a ventilator, and now when you hear a ventilator, you get a horrible feeling, that's a trigger. HZ: Ventilators are very much mine, so thank you.
STEPHANIE FOO: Yeah. I mean, that's very valid. It's horrible.
HZ: Better than dying, but it's not fun being on one.
STEPHANIE FOO: It's not fun being on one. It's not fun hearing one. Hospitals can make people really uncomfortable or triggered. And if you're triggered, it doesn't necessarily mean you were non-functional, it doesn't mean that you're lying down on the floor, curled up in a ball, being like, aaaargh.
HZ: Another term that has wandered into mainstream use is ‘self care’, which seems to mean anything from extracting yourself from a harmful workplace or family situation to taking a bubble bath and having a protracted skincare routine.
STEPHANIE FOO: Right. Absolutely. I think self care is really problematic, actually more problematic than trigger, because yeah, it is really wild. People are like, "here's my giant glass of wine. This is self-care. This is my $500 shopping spree. This is self care. Anything that gives me a hit to my dopamine receptors, anything that makes me happy, regardless of whether it's actually healthy for me or not, that's self care." And I think that's not necessarily the healthiest way we shouldn't look at that. I think self care can sometimes be really uncomfortable, like sitting with your pain or trying to figure out what you're feeling, why you're feeling what you're feeling or sitting through a hard meditation or going to therapy and being like, “Hey, maybe there's some stuff I need to work on.” All of that is real self-care. Aong with the bubble bath. I'm pro bubble bath.
HZ: You can sit and have a hard meditation in a bubble bath.
STEPHANIE FOO: Yes, that's true. And a lot of times, like when I had to go read really miserable papers about PTSD, I would go and lie down in the botanical garden on a big lawn next to blue bells, because I was like, well, this Is my version of self cares. If I have to read really depressing stuff, I'm going to do it in a field of bluebells. Sometimes care looks a little different: sometimes care is saying no. Sometimes care is doing what's best for you. Sometimes care is taking a shower, even though you don't want to. And sort of learning how to self-parent yourself is, is a real skill, that I've had to learn relearn while going through this healing.
HZ: I’ve seen some people say what you're calling ‘self-care’ with the wine and the baths is ‘self-soothing’. But the way you use that term seems to be quite different.
STEPHANIE FOO: Yeah, I think self-soothing, for me, is more when you're in an activated. When you become quote unquote triggered and you have that heart rate going up, what can you do to sort of get yourself back into a state where you're ready to engage, ready to go forward with a healthy, calm mind into what's next. When you're in a state of understanding, like, you know, my brain and body are tuned to the reality of the situation, my reaction is the same size that it should be. And sometimes it should be like, "Wah!!" Other times, you just got to get back to that place where you're like, okay, that was hard, but it was necessary. I'm ready to go do the work. So yeah. That's the way that I have used it. I know that if you, again, look at the dictionary definition it's of a young child being able to stop crying without being comforted by a parent or caregiver. But it's sort of similar, right? Do we ever totally stop being young children and having that same response?
HZ: Just thinking about endurance and resilience, and how those words are often used to mean sort of the same thing, a kind of courageous persistence. But etymologically, 'resilence' was springing back into shape or rebounding. And ‘endurance’ originally meant 'continued existence in time', which I thought was interesting: rather than "you have extra fortitude", it's just, |you're managing to still be here.|
STEPHANIE FOO: That's what endurance means?
HZ: Yeah. Originally, yeah,
STEPHANIE FOO: I love that.
HZ: It feels a lot more fair.
STEPHANIE FOO: Yeah, it absolutely is. It's hard just being here, man. I think I like endurance as a word, and I don't know if I see it misappropriated as much as I do resilience. I think that's kind of the problem with resilience, the way that it's used to me: it is used like not in the sense of: "they were resilient at that moment. They handled that with resilience." It's more like: “this person is resilient.” And for a long time there was this understanding that resilience was something that was innate, that you either had it or you didn't, kind of like grit; and it wasn't something that you could learn or acquire, and that it wasn't something that comes and goes depending on the situation. And also resilience, it is sort of correlated with success, especially in the books that I've read about trauma, where people look at almost like financial and commercial capitalistic success as resilience. Because how else are you going to measure it? You see somebody who has gone on to become a doctor or like a quote, unquote productive member of society or whatever it is. And you say, oh wow, look at them, they went through a really traumatic childhood and now they're a lawyer, and that's true resilience. But resilience really is something that people feel like they can quantify. And the parameters of it are a bit sketchy to me.
HZ: And if you're pointing at someone else and congratulating their resilience, is that to make other people feel bad for not feeling good?
STEPHANIE FOO: Right. That's really how I felt, when I was first diagnosed and I was reading so much about resilience, I was like, am I not resilient then? Because I'm sad, because I'm anxious, because I have social anxiety, because I, whatever. And I really convinced myself I'm not a resilient person. I don't have resilience. Which is crazy because I survived immense child abuse and neglect and loneliness throughout my life. And I still have been able to build like nurturing relationships and I'm a strong person and a smart person, and a good person overall, I think. And yet, because I didn't meet certain parameters, I was made to feel like I'm not resilient? I'm resilient as fuck!
HZ: Well, in your case, if people are calling you resilient, that's sort of like congratulating you without really challenging the people that harmed you and the systems that ignored that or actively upheld it.
STEPHANIE FOO: Yeah, I hear that. Yes, I agree. And it puts like a lot of pressure on the individual, rather than what they've gone through. Are you going to put that on them for being like, “look, you're just not resilient. You need to build more resilience. You need to learn more resilience”? Rather than being like, “Hey, this person is the victim of some really, really gnarly shit that happened that's much bigger than them. And we're going to yet put this weight on them for not being resilient enough”? That doesn't sound quite right, does it?
HZ: You mentioned in the book the Chinese word for endurance.
STEPHANIE FOO: Yeah. It's walking with a knife in your heart. I think it's the word knife on top of the word heart.
HZ: So it's like, feel the knife through your heart and do it anyway?
STEPHANIE FOO: Do it anyway.
HZ: It's hardcore.
STEPHANIE FOO: Yeah. It's poetic. And brutal.
HZ: I wonder how long people can be endurent under those circumstances, because at some point you're going to leak out to death.
STEPHANIE FOO: Yeah, I don't know.
HZ: Stephanie Foo is a journalist and radio producer - you can hear some of her work on This American Life and Snap Judgment. And her new book is what My Bones Know: A Memoir of Healing from Complex Trauma. It’s out in print and audio versions - but if you get the audiobook, it includes actual recordings from Stephanie’s therapy sessions. Whichever you choose, I thoroughly recommend reading this book, whether with your ears or eyes.
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Your randomly selected word from the dictionary today is…
lactometer, noun: an instrument for measuring the density of milk.
Try using ‘lactometer’ in an email today.
This episode was produced by me, Helen Zaltzman, with music by Martin Austwick of palebirdmusic.com and the podcasts Neutrino Watch and Song By Song. Many thanks to Lilly, Kat, Tort and Chris for your help in getting the Discord sorted. Our ad partner is Multitude, to sponsor an episode of the show this year get in touch at multitude.productions/ads. Hurry!
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