Wednesday, November 21, 2018


Better "medicalize" it, subject to regulation and protection against abuse, than spiritualize it and make it a new grift industry.

Brooks ("Fighting the Spiritual Void") leading with the usual "it's a spiritual problem" maneuver as a way of explaining why nobody can do anything about it, or at least nothing that will cost him any tax money:
Our society has tried to medicalize trauma. We call it PTSD and regard it as an individual illness that can be treated with medications. But it’s increasingly clear that trauma is a moral and spiritual issue as much as a psychological or chemical one. Wherever there is trauma, there has been betrayal, an abuse of authority, a moral injury.
Note that he doesn't like calling it an "individual" illness. It's wherever "there is" trauma,  and "there has been" betrayal, like Trump's "there is no" collusion. It's a sickness of the social organism, not bound to any particular persons, which means that David F. Brooks suffers from it just as much as the Afghanistan vet. And he's not asking for any medication. What's wrong with you guys?

Medication can rebalance chemicals in the brain, but it can’t heal the inner self. People who have suffered a trauma — whether it’s a sexual assault at work or repeated beatings at home — find that their identity formation has been interrupted and fragmented. Time doesn’t flow from one day to the next but circles backward to the bad event.
I expect there's something to that, though I imagine I'd look for a less fruity way of expressing it. It really is about individuals. Something beyond chemical treatment is definitely called for, what we call talk therapy. Which is inefficient, because it takes a lot longer than writing a scrip, which is why, in our current healthcare system, it's reserved to the wealthy. Even if you have really good insurance your access to a talk therapist, whether it's rational-emotive or Jungian, is rationed. There aren't enough of them to go around.

And what do you know, that seems to be what Brooks is recommending:
The good news is that the people who are addressing trauma most directly are reviving a moral language and developing a moral curriculum. Edward Tick is a therapist who has been working with survivors of wars for decades. In his book “War and the Soul,” he writes that PTSD is best understood as a “soul wound, affecting the personality at the deepest levels.”
That's only half right: What Tick writes, in the introduction to his book, is that PTSD is a "soul wound" and an "identity disorder":

"Identity disorder" being an expression generally used only in the designation "dissociative identity disorder", which is the more precise newer name for what used to be called "multiple personality disorder, formerly understood as literally having two more more distinct personalities hanging out in one body, now understood as a complex dissociation or loss of connection with one's identity, which we have all experienced in the milder form of
daydreaming, highway hypnosis, or “getting lost” in a book or movie, all of which involve “losing touch” with awareness of one’s immediate surroundings
But it's terrifying when it's a scary place and you can't voluntarily "get back to" the expected self. If Post-Traumatic Stress Disorder is really a kind of Post-Traumatic Identity Disorder, then you can't successfully treat it by simply relieving the stress, the way a drug treatment does, you need to help rebuild a positive identity akin to the one the patient brought to the original deployment, or whatever the traumatizing situation was. And that's very difficult, chancy, and when it works expensive. And I should emphasize that I don't see any downside to trying and adopting techniques from pre-modern cultures, hippy-dippy as it sometimes sounds in Tick's telling:

What I do object to is Brooks using the situation, in the first place, to bolster his 17th-centiury mumbo-jumbo about the soul as a thing in an invisible, metaphysical universe, disembodied, and subject to its own metaphysical diseases doctors can't do anything about, like the one Hamlet thought he was suffering from ("Canst thou minister to a mind diseas'd?"), to be turned over to spiritual practitioners entirely separate from the helping professions, shamans and bishops, the bullying elders:
The Tohono O’odham, a Native American people from the Sonoran Desert, once practiced a 16-day purification ceremony.
These ceremonies had, Tick writes, what most rites of passage have: a sacred space, training by the elders, ordeals that prepare and test the initiate, rituals that symbolize the transformation taking place. After the cleansing, the blood-soaked soldier was now known as a warrior, a positive leader in the community.
Just make sure that it's for the benefit of the sufferer, not of the elder.

And to the opportunities for fraud and grift in the process of "de-medicalizing" PTSD. Doctors are more than mystifying enough. There has to be a regulatory way of controlling this, and that's what medicine is.

And the icky way he wants to participate in a kind of guilt absorption process covering an entire community, when it seems to me what we need to do is to transfer guilt from the warriors to the elders who sent them to war (people like Keyboard Commando David F. Brooks, as you'll recall), something with which Edward Tick might well have some sympathy:

The community is healed when it stops marshaling young men into an institutional Murder, Inc.

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