Memories, Shame, & Social Quotient: Experiencing Trauma in Contemporary Psychiatry
The history of psychiatric care in the United States is crowded with eminent psychiatrists, theorists, doctors, hospitals, clinics, all of whom were committed to research and practice in the sciences of behavioral disease.
We know that all psychiatric care aims to improve the life and physical health of individual persons, prevent or reduce problems, and provide leadership in recovery.
To answer a pressing question, our medical social sciences consultants and psychiatrists spent a year, writing the Review of Trauma-Informed Practices, then interviewed leading experts in this arena and peers in other countries. Their outlook is not bleak but more sobering, indicating the challenges and opportunities ahead.
Psychiatrists are trained, for example, to evaluate medical symptoms (a symptom-based approach) of psychiatric illness, but there is little real evidence that a total health view of individual symptoms can reduce or eliminate them.
In 2007, after decades of gradual improvement, the DSM-IV declared that the “smoking cessation diagnosis” is likely to be more accurate. At the time, I argued that perhaps some medications actually “induced” chronic nicotine addiction, which the manual does not reflect. I also cautioned that even if nicotine “breathe-stoppers” prevent nicotine’s chemicals from reaching the brain, chronic use can still exert harmful effects, especially to the brain’s amygdala – the area responsible for emotional processing, emotional control, memory, and anger. A new Diagnostic and Statistical Manual that will be published next year should factor in long-term adverse physical effects of nicotine – both long before and during usage.
Communicative trauma has been recognized by the DSM-IV, but new research suggests that it may be a much more complex and deep-seated feature of human experience than was imagined by psychiatrist Robert Stickgold (who first described it in his book Trauma-Recognition Theory).
The DSM calls cognitive impairments such as inability to pay attention and to retain information “accidents,” but experience tells us that impairments rather reflect deep psychological injuries that cause cognitive dysfunction.
Other diagnoses that once had broad acceptance in the DSM may be increasingly dismissed: some were considered “defense mechanisms” to protect the immediate self or ego against something upsetting; others provided diagnosis of disorders we don’t even recognize in ourselves. The power of the DSM to identify and manage psychiatric disorders is fading, perhaps for the same reason that it had to exclude homosexuality decades ago.
A psychiatric disorder, once established, requires observation and development of a treatment plan.
Even in this atmosphere of readiness to use new diagnostics and treatments, trauma-informed practices are getting a toehold, as clinicians help patients move beyond the slow discomforts of anxiety and mistrust – reduced and delayed in some cases but not solved – to build resilience and new coping strategies. They also help patients experience safety, trust, and assurance that the psychiatric illness they have is real.