We Are All Victims Now
- The Empire of Trauma: An Inquiry into the Condition of Victimhood by Didier Fassin and Richard Rechtman, translated by Rachel Gomme
Princeton, 305 pp, £44.95, July 2009, ISBN 978 0 691 13752 0
In formal Japanese, I’m told, the word ‘trauma’ is written as a compound of two Chinese characters: one meaning ‘external’ and the other ‘injury’. Trauma is thus a hurt on the outside, as in ancient Greek – a wound. We still use the word in this way when we speak of ‘trauma surgeons’ or ‘trauma wards’, but this is not the sense that has made it so resonant and ubiquitous today. Having once been relatively obscure, it is now found everywhere: used in the New York Times fewer than 300 times between 1851 and 1960, it has appeared 11,000 times since.
The reason for this is not a resurgent interest in wounds but the elaboration of a new meaning which emerged in the late 19th century, when trauma’s unambiguous outsideness began to give way to interiority: it became a psychic injury, a ‘thorn in the spirit’, as William James put it, an injury done not to the body but to the mind by violence, or by any unspeakable or unassimilable experience. In the 19th century and much of the 20th these mental wounds were understood to be represented in the body by such symptoms as paralysis, sleeplessness, fatigue, palpitations etc. But today one doesn’t need to have any symptoms at all to be regarded as traumatised. The ‘condition of victimhood’ is democratically available; the past itself can lodge a ‘thorn in the spirit’. ‘All children,’ according to Alice Miller (or at least according to her obituary, which appeared as I was writing this review), ‘suffer trauma and permanent psychic scarring at the hands of parents.’
How trauma made its initial move from exteriority to interiority doesn’t much concern Didier Fassin and Richard Rechtman. Their book is an essay on the ‘historical construction and the political uses of trauma’ and a report on anthropological fieldwork aimed at ‘denaturalising’ it and ‘repoliticising victims’. Working in a Foucauldian tradition, they are interested in the way professional communities, through their daily practices, the internal standards of their disciplines and their interactions with the state and with clients, construct certain subject positions (categories of being in the world, like ‘trauma victim’ or ‘homosexual’) which those communities then regulate, benignly or otherwise. Governance, Foucault argues and Fassin and Rechtman agree, works as much, if not more, through the ‘production of truth’ as through the imposition of laws. The question is not whether someone actually is a victim of trauma but how the criteria for deciding who is a victim come into being and who manages them. ‘Governmentality’, as Foucault calls this process of determining how truth and falsehood are regulated and brought to bear, is what concerns these authors. The construction – not the reality – of trauma in the different areas of mental health, and the political implications of that process for assigning who can or cannot claim the rights of victimhood, form the subject of their book.
One could of course ask, and historians have, whether the symptoms of, for example, post-traumatic stress disorder were present in wars and disasters before the 19th century and whether their incidence has gone up or down over the centuries. But as a morally and medically exigent category, PTSD didn’t exist before the late 19th century. The American Civil War is the first war for which there exist relatively abundant medical records that allow retroactive diagnosis of symptoms close to our modern concept of trauma as an interior wound. Anxious to find a precise pathophysiology for seemingly inexplicable physical symptoms, 19th-century physicians combed these records in search of possible links between a violent past and present suffering. And they found something. In 1871 Jacob da Costa published a paper based on the cases of 300 soldiers whose strange somatic symptoms he connected to stress, but was unable to explain physiologically. It may be that the terror of charging into heavy enemy fire at close range as a lone unprotected figure in the open formations of the Civil War, as opposed to the tight square formations of earlier military tactics, induced something like shellshock and contributed to the emergence of the idea of trauma. Perhaps doctors were identifying a genuinely new clinical condition.
Fassin and Rechtman aren’t interested in the incidence of psychic wounds. They are concerned with the ways in which the category of the psychic wound is shaped – constructed – in debates about the moral legitimacy of victims. Their book is determinedly neutral on the much debated question of whether trauma is best understood psychogenically, as a culturally determined response to stress, or, as many now argue, neurologically, as a lesion in the brain caused by unassimilable memories. This lesion can be detected by distinctive EEG readings which are associated, for example, with post-traumatic nightmares as compared to everyday ones. If the brain lesion argument were proved correct, its proponents argue, the questions raised by Fassin and Rechtman about the social construction and normative evaluation of trauma would be irrelevant. A mental wound would no more need to be ‘constructed’ than any other lesion; the trauma victim would be no more or less culpable than the victim of a lightning strike or gunshot.
But the questions aren’t irrelevant, and the reasons are to be found outside medicine. Once the category of trauma was established in the 1880s, many doctors – and not only doctors – focused on an epidemiological inquiry into its incidence: why do only a small percentage of those exposed to a given violent or stressful event develop symptoms? A century later, the inquiry had become an ethical one: how might they, as doctors, read trauma as evidence of the experiences of their patients (i.e. treat their patients as reliable witnesses to their own suffering) and thus understand them and others who might, under similar circumstances, suffer similarly? If the question is posed, as it once was, primarily as a problem of incidence, then investigators will focus on the vulnerability of victims; if it is posed in terms of what has been witnessed, attention turns to the event. No clinical advance can explain the historical shift from one mode of inquiry to the other: the framing of the question about trauma has little if anything to do with substantive knowledge of psychology, psychiatry or neurology. It does have a great deal to do with what Foucault called the production of truth, with the way these disciplines can be mobilised for novel purposes.
The Empire of Trauma tells the story of three new professional arenas for the production of such ‘truths’. ‘Psychiatric victimology’, developed in Toulouse after an explosion at a chemical plant, validates victim status and focuses on reparation; ‘humanitarian psychiatry’ draws attention to the causes of suffering in the Occupied Territories and, more controversially, in Israel; ‘the psycho-traumatology of exile’ concerns the persecution of refugees seeking asylum in an inhospitable country, France. Together, these movements represent a radical shift in the ‘anthropological significance’ of victimhood, from a world in which victims were suspect, to one in which ‘their suffering, no longer contested, testifies to an experience that excites sympathy and merits compensation.’
This comes as a surprise, because at first the book seems to take the line that so much talk of trauma is folly. Nine thousand mental health workers rushed to New York after 9/11, we’re told, but very few people suffered even temporarily from what might be labelled post-traumatic stress. The authors also cite the case of a schoolchild in Toulouse who was said to have been traumatised not by the explosion itself but by seeing a teacher in tears. ‘Traumatised’, they point out repeatedly, can mean almost anything: it is a ‘floating signifier’ that denotes any number of ills which have little in common other than a name.
Yet the authors turn out not to be neutral observers but ‘observant participants’ in the story they tell. Fassin is an anthropologist now at Princeton and also a physician, a former vice president of Médecins sans frontières and president of Comede, the Medical Committee for the Exiled. Rechtman is an anthropologist and psychiatrist who directs a clinic and has worked for a long time with Cambodian refugees. Both, therefore, are active in organisations that have helped to construct the notion of ‘trauma’ in our time. They don’t rank victims or condemn what some see as the increasingly widespread and inappropriate attribution of victim status: they claim, rather, that this is ‘a sophisticated but classic way of denying injustice, inequality and violence’. They also refuse to moralise, saying that their role is not to condemn or applaud but only note, although in this they are not entirely successful. It is clear where their hearts lie. They believe that trauma has become the arena in which people can acquire their status as victims and find treatment for their suffering; that it has created new avenues for exposing the reality of persecution and prejudice; and that it has given the victims of such persecution a tool in their struggle for recognition and compensation. All this they applaud; they are not anti-imperialist in their attitude to the empire of trauma.
The dual genealogy of trauma as a medical and a moral category begins with Charcot, who in the 1870s encountered what others would call ‘trauma neurosis’ through his studies of hysteria. The strange somatic symptoms he encountered among his patients at the Salpêtrière were not only exhibited by women (the usual suspects because of their ‘constitutional weakness’) or effeminate men, but by a wide spectrum of people of both sexes. Hysteria, and by extension trauma, could not, therefore, be regarded as a gynaecological problem or one of gender mix-up; and Charcot was too much the materialist to relegate the problem to some vague psychological realm. He postulated instead an inner wound, a pathology of the nerves, to which even navvies and blacksmiths were vulnerable: trauma was a neurological condition. Of course, a congenital weakness – this was the great age of degeneracy theory – might explain why only a few people’s nerves were injured while those of many others in similar situations were not. But Charcot’s formulation contributed relatively little to the moral strand of the story.