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Myths of Trauma: Why Adversity Does Not Necessarily Make Us Sick
"Trauma is a term that describes damage to the mind caused by a distressing life event. Traumatic events, in and of themselves, are most certainly not a myth. Some events, such as shootings or rapes, are particularly likely to provoke post-traumatic symptoms. We need not lose sight of the fact that highly adverse life events can trigger serious psychopathology"--
- GenresPsychology
Unknown Binding
Published June 1, 2022
About the author
Joel Paris
41 books14 followersDr Paris is Professor, Department of Psychiatry, McGill University, and Research Associate, Department of Psychiatry, Jewish General Hospital. He obtained his psychiatric training at McGill. His research interests include: developmental factors in personality disorders (especially borderline personality), culture and personality.
Current projects: risk factors for borderline personality disorder in children the biological correlates of borderline personality disorder.
Current projects: risk factors for borderline personality disorder in children the biological correlates of borderline personality disorder.
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Displaying 1 - 4 of 4 reviews
May 12, 2023
¿Puedo ponerle seis estrellas? ¿No? ¿Por qué no?
Es tremenda la cantidad de información perfectamente estructurada que se puede meter en tan poco espacio. Imprescindiblemente para los que trabajamos en terapia y para quien quiera saber más trauma.
Es tremenda la cantidad de información perfectamente estructurada que se puede meter en tan poco espacio. Imprescindiblemente para los que trabajamos en terapia y para quien quiera saber más trauma.
April 4, 2023
I read this after hearing Joel Paris, Psychiatrist and specialist in treating Borderline Personality Disorder speak on the Art of Manliness about his concerns about the increasing diagnosis of Post Traumatic Stress Disorder (PTSD), based on peoples experience of trauma. He believes the diagnosis of PTSD has been expanded via concept creep into the realm of normative human experience that previous generations would have been expected to cope with.
In his conclusion he lists ten ‘myths’ of trauma:
1. Trauma has become a catchword for many kinds of adverse experiences, yet this is a construct that need to be more narrowly and precisely defined.
2. Traumatic events have always been a part of human life, and most people are significantly resilient to adversity.
3. While trauma is necessary for PTSD, it is not sufficient.
4. Trauma has often becoming a political issue that interferes with unbiased scientific study of its effects.
5. The concepts of repressed and recovered memories of traumatic events is scientifically invalid.
6. The wide comorbidity of PTSD, particularly when symptoms are chronic, means that it cannot be considered as a specific category with a specific treatment, and that treatment for patients should be biopsychosocial.
7. Complex PTSD is a new diagnosis but is a problematic construct, given that most of its features can be better explained by personality disorders.
8. Several evidence – based methods of treatment for PTSD have been developed, but their effectiveness is no greater than that of standard cognitive behavioural therapy.
9. Understanding experiences of trauma has a place in the treatment of PTSD, but an excessive focus on memory processing can be a mistake.
10. An excessive focus on trauma narratives can work against the interests of patients be encouraging victim-hood instead of a sense of competence and agency.
Paris argues these points well and makes references to contemporary research, but could have done a better job to ‘steelman’ the arguments he was opposing, creating a legitimate potential criticism he was creating straw-man arguments. I share his concerns around the faddishness of trauma and PTSD. Psychotherapy has a long history of following fads to the detriment of people seeking therapy. Paris does a good job of cataloguing both the ‘recovered memory’ and the ‘child care sex scandals’ phenomena of the late 80’s and early ‘90’s that damaged irreparably a number of families and people (read Meredith Maran – A True Story of False memory 2010).
Grinding my own axe, I was annoyed by his use of the word Myth to reflect something that was untrue. I use myth as a meta-truth, a story that can provide an analogy for living that is true for all time. I am aware of the duel usage, and it could be argued that those using trauma could be trying to mythologise trauma leading to PTSD. Make it a meta-truth. We have a corpus of mythology where the heroes overcome trauma and even the Gods to grow larger than their trauma. Avoidance does not work and only makes your world smaller. Adopting an archetype of victimhood, from a mythological perspective, seems to worsen the victims suffering from their own response.
Paris does not directly go after Gabor Mate, but I cannot think of anyone else who better advocates for the trauma movement. I was interesting to listen to Mate on Joe Rogan, as Rogan followed Mate’s ideas toward their conclusion and called ‘bullshit’ if Kant’s Universal Imperative were applied to Mate’s ideas. Mate’s acknowledgement that he needed to do more thinking. Fair enough, I liked that Mate could walk back his ideas when he was not around sycophants. I still think he is to Rousseauian in his thinking. I disagree with a lot of what he says, but he is worth reading to provide the best arguments to steelman the concept of trauma causing PTSD. Steel sharpens Steel. I would pay money to watch these two debate the value of a CPTSD diagnosis.
Paris shares my concerns about the validity of diagnosis. “Clinicians have been using DSMs for so long that they mistakenly assume that psychiatric diagnoses are scientifically valid categories. That is far from being the case. The manuals we use describe syndromes, not diseases, which overlap so much that some have suggested replacing all categories of mental disorder with dimensional scores” (p 94). Clinically, I understand vaguely what the different diagnosis mean (I am not sure that they provide anything other than a vague description). I am not sure how they improve people lives, other than providing a sense of validity to their suffering. Once you have been validated, you are still in the same situation with the same suffering and struggles in life. It seems a pyrrhic victory, which leads to the question, is false hope better than no hope at all.
This will not be a popular book within the therapeutic community. It does highlight legitimate concerns. As clinicians we should not be in the business of creating customers. This maybe an attack on those who even sub-consciously create dependence in the people they work with. I have found if you want to upset someone, dispute their mythology. Paris achieves this within the therapeutic community by asking uncomfortable questions about what I believe is the current fad within psychotherapy.
In his conclusion he lists ten ‘myths’ of trauma:
1. Trauma has become a catchword for many kinds of adverse experiences, yet this is a construct that need to be more narrowly and precisely defined.
2. Traumatic events have always been a part of human life, and most people are significantly resilient to adversity.
3. While trauma is necessary for PTSD, it is not sufficient.
4. Trauma has often becoming a political issue that interferes with unbiased scientific study of its effects.
5. The concepts of repressed and recovered memories of traumatic events is scientifically invalid.
6. The wide comorbidity of PTSD, particularly when symptoms are chronic, means that it cannot be considered as a specific category with a specific treatment, and that treatment for patients should be biopsychosocial.
7. Complex PTSD is a new diagnosis but is a problematic construct, given that most of its features can be better explained by personality disorders.
8. Several evidence – based methods of treatment for PTSD have been developed, but their effectiveness is no greater than that of standard cognitive behavioural therapy.
9. Understanding experiences of trauma has a place in the treatment of PTSD, but an excessive focus on memory processing can be a mistake.
10. An excessive focus on trauma narratives can work against the interests of patients be encouraging victim-hood instead of a sense of competence and agency.
Paris argues these points well and makes references to contemporary research, but could have done a better job to ‘steelman’ the arguments he was opposing, creating a legitimate potential criticism he was creating straw-man arguments. I share his concerns around the faddishness of trauma and PTSD. Psychotherapy has a long history of following fads to the detriment of people seeking therapy. Paris does a good job of cataloguing both the ‘recovered memory’ and the ‘child care sex scandals’ phenomena of the late 80’s and early ‘90’s that damaged irreparably a number of families and people (read Meredith Maran – A True Story of False memory 2010).
Grinding my own axe, I was annoyed by his use of the word Myth to reflect something that was untrue. I use myth as a meta-truth, a story that can provide an analogy for living that is true for all time. I am aware of the duel usage, and it could be argued that those using trauma could be trying to mythologise trauma leading to PTSD. Make it a meta-truth. We have a corpus of mythology where the heroes overcome trauma and even the Gods to grow larger than their trauma. Avoidance does not work and only makes your world smaller. Adopting an archetype of victimhood, from a mythological perspective, seems to worsen the victims suffering from their own response.
Paris does not directly go after Gabor Mate, but I cannot think of anyone else who better advocates for the trauma movement. I was interesting to listen to Mate on Joe Rogan, as Rogan followed Mate’s ideas toward their conclusion and called ‘bullshit’ if Kant’s Universal Imperative were applied to Mate’s ideas. Mate’s acknowledgement that he needed to do more thinking. Fair enough, I liked that Mate could walk back his ideas when he was not around sycophants. I still think he is to Rousseauian in his thinking. I disagree with a lot of what he says, but he is worth reading to provide the best arguments to steelman the concept of trauma causing PTSD. Steel sharpens Steel. I would pay money to watch these two debate the value of a CPTSD diagnosis.
Paris shares my concerns about the validity of diagnosis. “Clinicians have been using DSMs for so long that they mistakenly assume that psychiatric diagnoses are scientifically valid categories. That is far from being the case. The manuals we use describe syndromes, not diseases, which overlap so much that some have suggested replacing all categories of mental disorder with dimensional scores” (p 94). Clinically, I understand vaguely what the different diagnosis mean (I am not sure that they provide anything other than a vague description). I am not sure how they improve people lives, other than providing a sense of validity to their suffering. Once you have been validated, you are still in the same situation with the same suffering and struggles in life. It seems a pyrrhic victory, which leads to the question, is false hope better than no hope at all.
This will not be a popular book within the therapeutic community. It does highlight legitimate concerns. As clinicians we should not be in the business of creating customers. This maybe an attack on those who even sub-consciously create dependence in the people they work with. I have found if you want to upset someone, dispute their mythology. Paris achieves this within the therapeutic community by asking uncomfortable questions about what I believe is the current fad within psychotherapy.
April 16, 2024
Muy buen libro. Compendio de la aproximación psicológica basada en evidencia científica al trauma.
Ideas muy interesantes:
- The ubiquity of resilience is one of the most consistent findings in the trauma literature.
- Personality is therefore a psychological immune system that determines how experiences are processed.
- Neuroticism describes people who are easily upset by their environment and who have trouble calming down after an emotional reaction. Neuroticism is high in all mental disorders characterized by anxiety and depression.
- The concept of repressed and recovered memories of traumatic events is scientifically invalid.
- Patients need to tell their stories and have them validated. But they need not be viewed as victims of circumstance. A beter way to look at them is as survivors, who, in spite of a traumatic past, are capable of resilience, moving on and geting a life.
Sin embargo, como parte negativa, tiene choques con el determinismo y el sentido de la agencia, puesto que para que las terapias funciones tienen que obviar como se toman las decisiones y recurrir a la narrativa:
- No mater how badly traumatized people are, they can choose agency over victimhood. This is the lesson I draw from research.
¿Seguro que los pacientes pueden elegir?¿Hasta que punto no estas determinados? El eterno debate del libre albedrio.
Ideas muy interesantes:
- The ubiquity of resilience is one of the most consistent findings in the trauma literature.
- Personality is therefore a psychological immune system that determines how experiences are processed.
- Neuroticism describes people who are easily upset by their environment and who have trouble calming down after an emotional reaction. Neuroticism is high in all mental disorders characterized by anxiety and depression.
- The concept of repressed and recovered memories of traumatic events is scientifically invalid.
- Patients need to tell their stories and have them validated. But they need not be viewed as victims of circumstance. A beter way to look at them is as survivors, who, in spite of a traumatic past, are capable of resilience, moving on and geting a life.
Sin embargo, como parte negativa, tiene choques con el determinismo y el sentido de la agencia, puesto que para que las terapias funciones tienen que obviar como se toman las decisiones y recurrir a la narrativa:
- No mater how badly traumatized people are, they can choose agency over victimhood. This is the lesson I draw from research.
¿Seguro que los pacientes pueden elegir?¿Hasta que punto no estas determinados? El eterno debate del libre albedrio.
October 25, 2023
Fantastic book exploring the many myths surrounding trauma – namely, that
1) trauma is very likely to lead to adverse experiences, personality disorders, and mental health disorders,
2) trauma is a sufficient condition for such adverse outcomes, and
3) adverse outcomes caused (partially) by trauma should be treated by avoiding exposure to the event(s) that precipitated these outcomes.
This book is an excellent antidote to simplistic claims that trauma is always and only responsible for bad outcomes, and brings forth the realization that human resilience is much more likely than not.
The book is well-written and is essentially a massive literature review written for an educated, general audience about all things trauma-related. Some of my main takeaways from the book are as follows:
-Trauma is one variable that statistically increases the risk for personality disorders and psychopathology (e.g., PTSD). Other risk factors include previous histories of symptoms, trait neuroticism (of the five factor model of personality [FFM] aka the Big Five), social support, and genes (40% heritability), and their interaction effects.
-A biopsychosocial (BPS) model is thus recommended to understood whether an individual is likely to experience disorder.
-However, altogether, models with these variables only account for a minority of the variance in outcomes (PTSD symptoms).
-Most people who experience trauma do not suffer from PTSD, so perhaps reframing the issue in terms of resilience would be more instructive.
-“Trauma” has experienced concept creep, in that it has come to refer to more minor hardships over time. This in turn can lead to overdiagnosis and blur the distinctions between severities of adverse life events.
-Trauma or adversity at really early periods of life is NOT more dangerous than trauma/adversity a little later on (Kagan, 1998; Lewis, 1997)
-Trauma-based treatment is NOT necessary to improve PTSD. Many different psychotherapeutic treatments appear to be roughly equally efficacious ("dodo bird verdict"). These can be complemented by pharmacotherapy, which is easier to access but unfortunately less effective on its own (without psychotherapy).
1) trauma is very likely to lead to adverse experiences, personality disorders, and mental health disorders,
2) trauma is a sufficient condition for such adverse outcomes, and
3) adverse outcomes caused (partially) by trauma should be treated by avoiding exposure to the event(s) that precipitated these outcomes.
This book is an excellent antidote to simplistic claims that trauma is always and only responsible for bad outcomes, and brings forth the realization that human resilience is much more likely than not.
The book is well-written and is essentially a massive literature review written for an educated, general audience about all things trauma-related. Some of my main takeaways from the book are as follows:
-Trauma is one variable that statistically increases the risk for personality disorders and psychopathology (e.g., PTSD). Other risk factors include previous histories of symptoms, trait neuroticism (of the five factor model of personality [FFM] aka the Big Five), social support, and genes (40% heritability), and their interaction effects.
-A biopsychosocial (BPS) model is thus recommended to understood whether an individual is likely to experience disorder.
-However, altogether, models with these variables only account for a minority of the variance in outcomes (PTSD symptoms).
-Most people who experience trauma do not suffer from PTSD, so perhaps reframing the issue in terms of resilience would be more instructive.
-“Trauma” has experienced concept creep, in that it has come to refer to more minor hardships over time. This in turn can lead to overdiagnosis and blur the distinctions between severities of adverse life events.
-Trauma or adversity at really early periods of life is NOT more dangerous than trauma/adversity a little later on (Kagan, 1998; Lewis, 1997)
-Trauma-based treatment is NOT necessary to improve PTSD. Many different psychotherapeutic treatments appear to be roughly equally efficacious ("dodo bird verdict"). These can be complemented by pharmacotherapy, which is easier to access but unfortunately less effective on its own (without psychotherapy).
Displaying 1 - 4 of 4 reviews