This was going to be mainly about what is called Post Traumatic Stress Disorder but now since two of its very close relations–abuse, especially sexual abuse, and narcotics addiction–have entered the internet news cycle for which I am probably way too late at this point but I am actively ignoring myself as I offer myself rationalizations not to write or not to put it anywhere anyone will find it if I do write something and so because virtually anyone with a decent-sized megaphone with which to address addiction gets it completely and horribly wrong just as those speaking about trauma and PTSD also get it completely and horribly wrong I found myself with more to say than what I started out thinking I was going to say.
Neither of them, for instance–PTSD nor addiction–are diseases.
We would like them to be. For a million reasons but mostly nobody has to address anything they themselves might be doing to exacerbate a problem if that problem can be relegated to medical management and pinned on some vague notion of inherited disorder for which we have almost no empirical evidence that is not deeply founded in the sort of already-given interpretation my culture demands regarding health and disease, order and disorder, normality and perversity, function and dysfunction, productivity and loss, and–this list is endless as these lists always are. The point is still that blaming (genetic, medical, physiological) fate is slightly less odious than blaming those suffering under that fate but still too easy when problems are manifestly rooted in the specific cultures in which they appear, and in very complex ways that might cause discomfort to many who consider themselves beyond reproach because they did not really enjoy heroin that one time they tried it or maybe the painkillers they occasionally need to take are effective for the bluntest of physiological pain but no more than that and so they have managed so far to avoid becoming junkies of any kind.
In North American cultures, addicts of what are called hard drugs are almost always survivors of trauma–trauma severe enough that anesthesia from life itself can become the only thing that makes life bearable. And so addiction is what you do if you cannot kill yourself on a punctual, finalized schedule.
I cannot put it any more concisely than that. Probably one could investigate neural pathways and what sorts of environmental variables affect endorphin production in some cases or dopamine in others and oxytocin in other others and probably some indefinite several of neurological signaling agents we do not know very well yet. But my experience tells me that when a drug can simulate family in the absence of, you know, actual family, it answers a primal need that will not be denied once it finds what it thinks it is seeking. The idea of “will power” is laughable in the face of this sort of need, but my confused critique of whatever it is we call will–I haven’t a clue, honestly: I cannot find will in any of my personal faculties and would not recognize it if it were there staring me in the face and enacting things all on its own power as I squinted in incomprehension because where on earth did it find this original power because I have never come across any and believe me I have looked everywhere–ok well besides that much critique I am leaving the rest for later.
This will probably not make sense to you either: addiction can signal a tenacious sense of self-preservation and something like an inextinguishable hope: whatever and wherever my place is here on the planet I am doing all I can to stay here and make it into a dwelling place familiar enough not to set off serial panic even if my life will turn out to be nothing much else beyond surviving my own murder/suicide. The junkie shooting up is refusing to die even while taking into her body what may be that one bad hit. The chamber with the bullet. The all it took. The we knew this day was coming.
Sometimes that day never arrives. Contrary to legend, addiction is no surer a predictor of death than any other dangerous and desperate bid to stay alive long enough to give sunrise one more opportunity to justify its arrival.
Not entirely unlike life itself: a mortality rate of one hundred percent. Not one of us has survived it yet. I know some of you believe that to be untrue but the evidence is overwhelmingly pessimistic on this one.
That was just one thing.
Here are the others or some others or something:
somethings, I mean:
In the cultures I might call my own, PTSD is usually figured solely as either a soldier’s burden or the occasional outcome of large-scale disasters. Of those I have spoken to who are diagnosed or diagnosable with PTSD, I have known a handful of soldiers and maybe one or two survivors of the flood fire famine sort of disaster that we recognize as disaster. I have not counted up the rest but that is mainly because they are one of those vast majorities that are really hard for one person to count especially when every other day I meet another one of us. The rest of us are survivors of the more private disasters of childhood abuse, domestic abuse, andor rape.
“andor” because abuse is almost always sexual at some point whether it is primarily sexual or also physical, emotional, spiritual, or some terrible cycle of All Of The Above and so abuse and rape often as not are synonymous and even simultaneous. Other times they happen in succession. And maybe some more abuse later on because you were taught that it is part of the natural order and so it just looks like another day to you.
That’s two things. Here is where I stick my neck out:
The medicalization of addiction and of many conditions called mental illness, including PTSD, functions in part to divert public attention or maybe the public itself is diverting its own attention this way which seems a more faithful description but we whoever we are we cite models of disease for this among other things in order not to have to address our own complicity in one or another tradition of abuse–traditions which precipitate what is called mental illness and what is called addiction. Repeatedly. Predictably.
Those traditions of abuse are endemic to that culture or cultures with which I am most intimately familiar because they permeate me. Or us.
This is something I proclaim as a strong strong hunch and one for which the research necessary to show it conclusively is more than a single person could do or at least if I were the only single person doing it it could take a very long time and not just because I spend most days tending to some PTSD-related intermission or another. Statistics on childhood abuse, for instance: completely unreliable, and by the researchers’ own admission almost every time I look up another batch of them, almost certainly leading to gross underestimation of the extent to which the practices addressed in their studies are accepted as normal or at least tolerable by the participants/respondents.
Here is an interesting study on public perception of child abuse in the US (pdf file).
The Framework Institute has done other research on child abuse as well, all of it interesting.
That is almost all I have to say right now. But the other day I ran across another glib homage to the power of modern medicine or that is the power of the myth of modern medicine and it was so cheerfully reductive that I wanted almost to curse the very idea of research because no animal who forces itself to be as obtusely optimistic as we have seemingly become should be trusted with the care and feeding of a whole planet based on whatever knowledge it can produce for itself.
The most recent upsurge in despair followed this which is how this all got started insofar as my deciding to write something down goes:
A comprehensive PTSD drug would be the holy grail, of course.
the holy grail would be
a culture that does not deliberately impose multiple traumas on its offspring over and above the unpredictable and inevitable injuries that are standard-issue living.
the holy grail would be
a culture that does not use shame and silencing as its primary methods of discipline when overt violence seems unacceptable if that ever happens to happen.
the holy grail would be
directing some of the obsessive energy devoted to identifying the neurological and genetic causes of psychiatric disorders toward identifying and eradicating the cultural, social, and familial causes of those myriad physiological changes that so often result in syndromes we call mental illness. because we cannot bear the possibility that we may ourselves be the primary vectors of this sort of pathology we look for isolated, simple biochemical interactions where nothing isolated or simple ever takes place: in and among the bodies of complicatedly social, intelligent, and sensitive animals.
the holy grail would be
examining cultural assumptions about family that chronically make children open targets of abuse while simultaneously depriving them of the security they would need to be able to talk about what was happening to them without fear of retaliation for telling the truth.
the holy grail would be
asking ourselves with unhesitating honesty why our culture predicates itself on scarcity, competition, conformity and exclusion, deprivation, and a general hostility toward life as it occurs on Earth as the pillars of social, spiritual, and economic order and security. we have chosen homelessness as the guarantor of stability and I mean that both literally and metaphorically although the metaphor is itself as real as any shopping cart and tarpaulin city.