Odysseus & PTSD

Statistician Lyman Stone tweets out to a study of 1200 adults who had court-record documented abuse as children. The results were...surprising.

We found that, even for severe cases of childhood maltreatment identified through court records, risk of psychopathology linked to objective measures was minimal in the absence of subjective reports.

Lyman Stone's final tweet in his discussion:  "If the trauma-->psychopathology linkage operates primarily through self-appraisal then what happens if society suddenly encourages more scrupulous excavation of personal history, more intense reflection on past trauma, and lower tolerance for abuse?" This leaves us with a lot of but...but...we surely don't want people to get away with these things. Weren't we to understand that the culture of silence about abuse is a huge part of the problem? I would ask "OK, if true, where does this subjective impression of having an abusive childhood come from, if it's not clearly from abuse?"

I worked with many, many adults who had been abused as children or had traumatic events when younger, and was sometimes puzzled by the lack of linearity between severity of trauma, age the event occurred, duration of trauma...just everything. But not always puzzled.  One mostly notices such things at the extremes, when a person who experienced horrific events seems unaffected against all odds, or when the identified traumatic event(s) seem bad, but not horrifying. Those bring out the spontaneous observations from the staff. But I usually just considered those outlier events.  I figured that there would be a statistical linearity associating pathology with something about the severity or the event. 

Shouldn't more abuse trend toward more psychopathology? Wouldn't we expect that relationship to the abuser would matter, or severity or duration of abuse? But this study suggests that something less easy to define is a bigger issue, some subjective impression of whether one's overall experience was bad. It would be interesting to see whether something similar happens for combat veterans, that the overall experience counts for more than the incidents. More on that below.

I had read research over the last few decades of "protective factors," that helped in recovery from trauma, such as having a religious faith and especially a community, of having supportive friends and family, of not abusing substances (interesting in light of the later psychedelic-based treatments being touted now).  And of course, what you were like before the trauma figures in ways that are sometimes measurable. But this is a whole different level.

I would like to be clear that no one should be jumping to the conclusion that people can therefore have control on whether they develop symptoms or not.  People don't decide to have nightmares. Having startle reflex is...a reflex, not a choice. Responses to smells are involuntary. Whatever is bringing you to your subjective opinion of the whole experience in the broad sense, it is operating at some subterranean level.

I have wondered if expectations are a large factor. Most boys grow up with someone trying to pick a fight with them a few times, shoving them or sucker-punching them in ways we would regard as a clear assault as an adult.  Yet men believe these are not traumatic events worth reporting as adults. We have trouble even remembering them.  Only if they exceeded some level into the unexpected do we note them - if we were frequently outnumbered or bullied, if weapons were involved, if we got injured. We had a young woman at the hospital who was distraught because of an incident at a party in which a boy she knew tried to sexually assault her at least briefly before he believed her protests were...sincere?...loud and energetic enough? It had happened five months earlier and she still could not stop thinking about it and was afraid to go out.  One of the nurses was not sympathetic. "At my high school, we just called that dating." Others jumped on her for that, pointing out that the girl was quite the innocent and had been sickly and protected as a child. But that someone could even say that shows there is something up with expectations. In war zones where whole families or villages of women are raped, isn't that like to be a different experience than being the only one? Less bad...more bad? At one level no one is blaming you, but all the people you would go to for support are also wounded. 

An anecdote closer to home. My two Romanian sons were badly abused by both father and mother, though the neglect in the villages may have been worse. It was at a level nearly unknown in America. About a year after coming here, John-Adrian was at a church youth group event at which the educational game of how fortunate they are was being played.  Take a step forward if you ever stay with one of your parents. Take another step forward if you ever stay with the other. Take a third step forward if you stay with both together. Take a step back if no family member made a meal for you today...Well into the game, JA found himself near the front, then perked up his head and said "Oh, you mean ever in my whole life! I belong way back there near the beginning," and walked back. Laughing. When Son#5 came to us about a decade later after having been abandoned by both bio parents, JA shook his head angrily.  "I can't believe it. I can't imagine how this could happen.  This should never happen to a kid." I looked at him dumbfounded. "John-Adrian. That happened to you!" He was caught up short and then covered a bit (John-Adrian never admitted he was wrong). "I meant it should never happen in America."

The next younger brother did not shake off his past so easily, though things have gotten better over the years.  He is still locked in some contact with his Romanian siblings, including one who takes advantage of him, for example. His past haunts him more.

I will come back to the childhood abuse when discussing treatment, but for now let us go to the other major category of trauma, combat.

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Sidetrack, but there's a reason: A history podcast guest was discussing the response of ancient combatants to trauma. Interesting but not earth-shaking.  He did suggest that the story of Odysseus in the epic is supposed to represent the journey home that all soldiers make. A fun idea, but one I think can be defended only by forcing the episodes into some framework of what one believes returning soldiers go through.  However, I think that in some solid way we can enjoy it. Any story that has lasted this long must speak powerfully to a variety of circumstances. An epic about a journey home from war that did not speak to centuries of men returning from war in some way would not survive, except perhaps as an accidental curiosity. For readers of Tolkien's essays, this is the difference between allegory, which is limited and often stilted, versus myth, which has broader (if less-definable) applicability.  Certainly coming home and being recognised by the dog and finding that other men are trying to take off with your wife could be recognised as a country-music theme in our own era. The story has legs for a reason. If you are a Homer fan you might go back over the poem with that in mind to get more from it.  But I wouldn't impose that structure on it as a necessity. It has power, but not for box-checking.

The guest went on to his real topic, of evidence of trauma in ancient sources of returning soldiers. The example of Epizelus, an Athenian soldier who was struck by what we would now call hysterical blindness at the Battle of Marathon is often referred to, but as with many things - as with allegory above - people try to shove the story into whatever theory they have going. I am not going to do that, I only bring him up to note that context and expectations seem to matter in this sort of trauma as well. Being so frightened by a phantom opponent that he went blind did not make him a figure of scorn in Athens upon his return.  He had done his duty as a hoplite, a citizen-soldier whose main task was to go into battle without much training, wearing minimal armor that he could afford himself, and getting slaughtered in a phalanx creating space for the trained professionals to fight. That was enough and he was still held in regard. It was not unusual to be a hoplite, it was expected.  You came back to a world where most men had seen whatever battle horrors you had or could be expected to in the future. 

So it is worth looking at the two ancient examples to carry that over to the centuries-long story of soldiers and trauma, of return and expectations. It is different in every time and place. It is different to come home to American from a modern war, because so few have seen what you saw. Heck, a lot of the actual military has not seen combat but have jobs in support. It's the reverse of Epizelus's situation. So if we are to look at common factors for the understanding and perhaps treatment of trauma, it is going to have to cover a lot of ground.

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Enter EMDR and Dr. Andrew Huberman, Stanford neurolscientist, who I linked to WRT gratitude being something that seems to be actually physically good for you. Huberman has become very popular, with a YouTube channel and lots of videos purporting to tell you how to stay awake, reduce your attention-deficit symptoms, calming or energizing your mind with various Hz frequencies (40 and 528, reportedly) and learn to become a force in the world and mostly happy. Anyone this popular this fast arouses my suspicions, and more than suspicions.  At this point in my life I am primed for disbelief in such things, regarding them all as medicine-show stuff. "...and the diminution of the marital impulse" as Garrison Keillor once joked. And yet. The research looks good, sounds plausible. I comment only on one bit of it here.

When EMDR came out in the 90s I thought it was voodoo. Moving your memories to another part of your brain? Sliding your eyes back and forth while recalling your traumas and getting coached through that to store the memories differently?  Preposterous. Over the years I did come to accept that there was something to this memory-storage bit, that some memories are stored in places that also hold a lot of emotional information while others are set down in a more boring file cabinet.  That sounded good, to store high-emotion memories in a boring place. Some evidence came out that writing boring reports after a trauma actually helped create some distance.  Recalling the event, but in its most stripped-down, bloodless fashion seemed to help. This is new and may not play out, but would make some sense in terms of putting horrible memories in a boring place, so that when the events occurred to you, you could use the boring version instead, eventually making it the main version.  Not that the other version would ever go away, but you could take a different past it. You put the deep ruts in the road you want to use, not the one you are trying to avoid.

Huberman has this idea that the eye movements back and forth mimic traveling, especially walking.  When we travel we scan from side-to-side automatically. We are literally telling our brain "I am walking" now. Whether that is walking onward to the next skirmish if you won, or walking away from a place you hope never to see again, it just might be much better than being physically stuck - such as in a siege, or if your village was raided and you are staying on surrounded by memories. The actual physical walking - or sailing, or riding - may have been part of the treatment, and being trapped and unable to get away may be a huge risk factor.

And maybe that works for those victims of incest and abuse as well.  We use therapy to walk away from the past metaphorically, and even call such things a journey, or a leaving behind, and related metaphors.  But maybe involving other parts of our brain, instead or in tandem, is much more important than we realised. Thousands of years of traumatic experience developed hard wiring that responds to literally walking away. I knew a few returning VN vets who took up backpacking or even hiking the AT upon return who thought it had helped. I had female patients who thought a "road trip" across the country as soon as they turned 18 had been beneficial in terms of independence from toxic families. (Though they often exposed themselves to trauma in that way as well.) We tell ourselves the story that such hikes and trips cause us to think about deep things and put events in perspective and that's what was good about them.  Those of us who are talk-people instead of action people may be especially prone to that. But the very movement itself may have been key. 

For a next speculative step, if any of this pans out, that the treating your brain - or tricking it - by just getting the hell out of Dodge in reality by walking or virtually with simple eye movements actually works in some way, it will be interesting if it becomes something we can self-administer.  EMDR therapists don't take walks with you at the moment, you go to their offices. But what if it's technique, and the treatment for trauma becomes repeated walks, or drives, or cycling with a very specific agenda of remembering the trauma and automatically putting it in a different place. I don't recommend trying this at home until we know more about how it might work.

Like the soldier from the invading army who kept going to the next place and morale remained high, however horrible the last encounter.