© Springer International Publishing Switzerland 2015
Margarita Sáenz-Herrero (ed.)Psychopathology in Women10.1007/978-3-319-05870-2_88. Corporality and Trauma
(1)
Department of Psychiatry, Marina Baixa Hospital, Alicante, Spain
(2)
CEU, Cardenal Herrera University, Alicante, Spain
Abstract
In trauma, silence is broken in giving way to the lived body, but aspects related to corporality as the most frequently lived experience of the traumatic event are not always included. In this chapter we review the different dimensions of the suffering and emergence of trauma in holistic, gender-sensitive, and integrated ways. The body is the epicenter of trauma in its individual experience, impact on identity, and excruciating remembrance of the event. Yet sociopolitical contexts and their ruptures also inhabit the human body: violence, poverty, abuse, and oppression. Thus, understanding trauma requires giving specific attention to the sociocultural fabric in which the wound is inscribed and suffered. It means reviewing integrating models in which the diverse dimensions of suffering are considered, gathering the much-heralded but less frequently performed psychosocial approach to health. In the first part of this article we approach the sociocultural elements surrounding the experience of trauma, without detaching corporeality and its gendered embodied reality. In the second part of this article we approach the concept of trauma from a humanist perspective around the extensive disruption that occurs in identity and in corporeality. The psychopathological conditions that may emerge after a traumatic event are many and varied; even though we do not attempt to cover them all, we provide an approach to two of the expressions more frequently affected by gender: somatization and self-harm.
The hands want to see, the eyes want to caress.
[Sehe mit fühlendem Aug’, fühle mit sehender Hand.]
Goethe
8.1 Introduction
The concept of trauma has been ubiquitously defined throughout human history. Body images have been deconstructed and reconstructed over the course of centuries. In our social and political moment, the ongoing debate on the concept of psychic trauma is still in force, and the notion has been changing with the international classifications in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) throughout its editions and revisions. To date, there is no universally accepted definition of trauma.
The body is often referred to as a thing intersected by society, biology, subjectivity, history, etc. Etymologically, the notion of intersection takes us to cut, to node, to section, to sword. The act of intersection as a concept about the body pierces its image of inscrutability. The body penetrated by trauma is no longer a mere bearer of signs and symptoms; instead, it is be able to capture sense and create meanings to be integrated into its identity. In phenomenology, the corporeality is the lived and living body: “The world is not what I think but what I live through” [1].
Nevertheless, in Western societies, the body has been and is undervalued against pureness and overvalued reason but still does not give way to “Je sens, je pense en dedans de moi.” Excessive expressiveness and body movements are left in the powerful hands of oblivion and symptoms become central. The body is extremely hierarchized in our culture as an image, a flat image that ceased to be volume to become a glowing silhouette highlighted on the screen, but with no subjective lived events. In trauma, silence is broken in giving way to the lived body. In the diverse contributions to the concept of trauma, aspects related to corporality as the most frequently lived experience of the traumatic event are not always included.
Following the biopsychosocial model, we know that diverse environmental and sociocultural aspects are risk factors in psychopathology and that they manifest complex interactions with neurobiological elements, which are directly connected to gender. In trauma, this panorama is maximized and sociocultural factors such as the absence of social support and the family’s exposure to violence are, in this context, determining. Thus, women are more likely to be exposed to some harmful environmental aspects causing the development of the disorder (sexual abuse), whereas men are more likely to be exposed to other factors (physical abuse).
In this article we review the different dimensions of the suffering and emergence of trauma in holistic, gender-sensitive, and integrated ways. The body is the epicenter of trauma in its individual experience, impact on identity, and excruciating remembrance of the event. Yet sociopolitical contexts and their ruptures also inhabit human body: violence, poverty, abuse, and oppression. Thus, understanding trauma requires giving specific attention to the sociocultural fabric in which the wound is inscribed and suffered. It means reviewing integrating models in which the diverse dimensions of suffering are considered, gathering the much heralded but less frequently performed psychosocial approach to health [2]. In the first part of this article we approach the sociocultural elements surrounding the experience of trauma without detaching corporality and its gendered embodied reality.
In the second part we approach the concept of trauma from a humanist perspective around the extensive disruption that occurs in identity and in corporeality. The psychopathological conditions that may emerge after a traumatic event are many and varied; even though we do not attempt to cover them all, we provide an approach to two forms of expression most affected by gender: somatization and self-harm. In parallel, these two expressions are closely related to early sexual abuse, a particular form of psychic trauma. Patients with borderline personality disorder are likely to embody most of those frustrated and blurred identities, those bodies acting as abnormal or altered. The emergence of these clinic cases at this particular time clearly shows a close link between social and cultural factors, which hinge on gender.
8.2 Trauma in Contexts
Following what Bryan Turner [3] calls the context of “emergence of the body,” different schools of thought in the social sciences have shifted toward a new model of understanding, the starting point thereof being the bodily experience. In this same light, bodily processes are construed as the core where the complexity of personal, sociocultural, and political reality is articulated. This paradigm shift seeks the disruption of the main western dualisms: nature/culture, mind/body, objective/subjective, passive/active, rational/emotional, etc. [4], since they are now obsolete and consequently inefficient at explaining human experience. Thus, this task requires new languages and narratives to rearticulate what has been split off.
The concept of embodiment allows us to illuminate a more complex understanding of the body. This concept is aimed at transcending the idea that the social is inscribed in the body to talk about corporality as a substantial process underlying its potential, intentional, intersubjective, active, and relational interaction [5]. Nancy Scheper-Hughes and Margaret Lock [6], for their part, respond to the dichotomies mind/body, individual/society, and their effects on the method of configuring health and care, with three perspectives from which the body may be observed: first, the individual body, in a phenomenological sense, as a lived experience of the self; second, the social body as cognitive mapping to represent relations with the natural, the supernatural, the social, and the spatial; and, finally, the political body as an apparatus for social and political control. Body politics constitute the different ways of controlling and disciplining the body—with torture or with more sophisticated maneuvers—which are masked in different socio-political systems and from which we can explain the structural violence with regard to gender.
The term psychosomatic has been criticized for setting both a semantic and a methodological dualism in the explanation of pain. In psychosomatic explanations there is a causal link between a psychic and a physical event, with a great correspondence between the royal and the vicarious, and may lead to victim blaming by lumping the failure of therapy together with their alleged mental health problems [7]. Scheper-Hughes and Lock [6] propose the category mindful body, understanding the body as a conscious agent, a more holistic approach in which emotions articulate the body, the mind, the individual, society, and the political body:
Sickness is not just an isolated event, nor an unfortunate brush with nature. It is a form of communication—the language of the organs—through which nature, society, and culture speak simultaneously. The individual body should be seen as the most immediate, the proximate terrain where social truths and social contradictions are played out, as well as a locus of personal and social resistance, creativity, and struggle (p 31).
These authors suggest that many of the subordinated corporal practices related to social suffering or illness carry a message in a bottle, a message of resistance and protest that needs to be decoded [8]. The experience of trauma frequently means, in Janzen’s terms: “the recurrence of the signs of symptoms of trauma” [9]. It is the body language that emerges in memory (visions, sounds, tactile sensations) recalling the traumatic event. It is also a metaphor of pain as a burden, an inner chaos, an out-of-order engine, an explosion or weariness as energy resource consumption. Or the metaphors: with a heavy heart, with a lump in the throat, with a feeling in the pit of the stomach. The bodily conscience is intersected by the suffering memory; yet, deciphering the materiality of the intangible involves developing our capacity to listen to the bodily expression in which the physical and emotional are indissoluble.
8.3 Identity Intersections
Addressing corporality in the common experience of trauma presupposes a consideration of the gendered dimension of our experience. The sudden shock in a traumatic event and the resultant narrative disruption do not cause a shifting, nor do they override gender; they rather structure common experience. These identity coordinates are analytical tools that enable us to better understand subjectivity and suffering, particularly in women. It is not that women need footnotes or chapters that are different from the human, but rather “both from an epistemological perspective as well as in biomedical practice, the ‘normality’ pattern has been and continues to be the hegemonic masculinity” ([10], p. 42).
Gender inequality is not determined by biological facts. This is the reason why gender perspective neither concludes nor is limited to a gender breakdown in the statistics for psychic distress prevalence and incidence. It is not about searching, describing, and confirming differences between sexes, but rather explaining such differences. Gender is relational and dynamic, a structure of relations that are continually interacting. Thus, gender perspective implies considerations that go beyond the mystic of numbers and the essentialist constructions on sexual characteristics of each sex, in order to contextualize data within a well-defined social framework [11].
In fact, feminist authors denounce the fact that the complexity of traumatic experiences of women has not been considered by the prominent model for trauma in a society divided by gender [12, 13]. Other contributions from this same perspective include: the incorporation of some groups neglected by the first diagnosis of PTSD, such as women and children who are survivors of sexual abuse [14], the reformulation of key concepts such as coping strategies instead of symptoms [15], and the warning that gender violence is a disproportionate everyday occurrence, not only in the context of war but also in peace [11, 16].
Suffering intersects with gender, age, ethnicity, disability, beliefs, economic status, and other global processes affecting local environments. In other words, there is not a single way to suffer and the expression and perception of pain are different, even within members of the same community [17]. Nevertheless, the due consideration to particular contexts with their own cultural and identity settings, their own sources of domination and inequality, enables us to broaden our perspective and in doing so, to better understand the traumatic event, the consequent grief and process of recovery where they unfold. As Janzen reminds us: “[…] although war trauma certainly has physical consequences and imprints, it is culturally mediated and that is where its character, causes, consequences and avenues of resolutions may be best understood” ([9], p. 44).
8.4 Violence, Experience, and Care
There are numerous works and studies on trauma, but not so many mainstream ones that have a gender perspective in their design, not so many try to explain the psychological distress and its care in relation to the position women and men have in each society. In particular, I believe that an approach to trauma from this perspective needs to look into these factors, among others: sexual triggers for trauma, diversity in experience, dealing with suffering and expressing suffering, and analytical and health intervention models. Following this approach, in this section, I try to cover research and contributions showing the relevance of gender in violence, experience, and trauma care.
8.4.1 Violence
Certain groups are more likely to be exposed to violence, and consequently, exposed to painful and traumatic experiences [18]. The fact that the main threats to individuals and communities are inscribed in some specific areas and territories proves that violence is not fortuitously distributed. Marginalized populations living in poverty, violence against women, racism, homophobia, and other forms of oppression underline this. As a matter of fact, the proposition maintained in the model of PTSD, which claims that the world is a safe place until exposed to a traumatic event, has been questioned. According to Burstow [15], this could be true for a white, middle-class, straight man, given that trauma is not a neutral but a political experience.
Following the Galtung conflict triangle [19], there are three subtypes of violence. First, direct violence is visible and clear, given that this type of violence is behavioral. Second, structural violence results from an unequal access to resources, material or otherwise, such as education, health, peace, and consequently, power and opportunities. Lastly, cultural violence refers to those aspects of violence that may be used to justify or legitimize direct or structural violence. Gender violence has its roots in culture—in fact, one of the senses of the word violence in Spanish, violencia, is “the act of raping a woman” (DRAE)—and in terms of its consequences it emerges both direct and structurally. To illustrate this, there are supporting data: 1,161 violations of women are reported every year (Ministerio del Interior, Spain 2011), which means three a day; one every 8 h. Thus, structural violence, as Bourdieu [20] reminds us, is always perpetrated in countless small and great acts of everyday violence, which in most cases continue with impunity.
In the case of internal armed conflict, although they affect the whole population, there is evidence of gender dimension regarding grades of violence and suffering. While men are exposed to the risk of torture and mass killing, women are more likely to be victims of sexual violence and other types of violence, a violence that does not cease when conflicts officially end. Amnesty International (2001) denounced that violence against women is not incidental in war; yet, a weapon deliberately used for different purposes, such as the spread of terror, the destabilization of society, or as a means of rewarding soldiers and extracting information. Such violence includes different assaults of a sexual nature: rape and gang rape, sexual abuse, slavery, mutilation, forced impregnation, and prostitution. In the gruesomeness of war the way the logics of terror operate is made invisible. In fact, the broadcasting of numerous cases of rape and forced pregnancy in Rwanda and the former Yugoslavia drew international attention to the magnitude of this form of cruelty against women in armed conflict.
In her work on the Haitian repression during and after the coup d’état in 1991, Erica Caple James [21] examines the influence of gender and its psychosocial after-effects. In this conflict, women were targeted on account of their active role in politics as well as their small-scale business role. They were also punished on behalf of their husbands, fathers, and brothers, deemed surrogate wives, and taken as “sacrificial substitutes.” Their vulnerability to the attacks of different military groups flowed from the responsibilities toward their children and their business activities in local markets, which kept them visible and reachable. The different forms of torture were not only aimed at the delegitimization and bodily disempowerment through pain, but also at destroying the production and reproduction of the victim, breaking social ties with the family and community through the violation of social norms.
Broadly, the after effects of the traumatic event were: embarrassment, humiliation, social isolation from the family and community. Raped women were frequently abandoned—labeled “the rapist’s wives”—by their partners and families. Alienated from their social group, they moved to other areas to rebuild and restore their lives, and in most cases their only resource for their survival was the reappropriation of their sexuality as a means of making a living. In male victims of violence, the feelings of shame and humiliation were rooted in their incapacity to protect their families and in the degrading treatment and torture. When working in therapy groups, men’s narratives on trauma touched on the loss of property, livestock, and social status. The lack of economic power and the failure to meet societal expectancies forced them to abandon their partners and families, leaving women and children in even more vulnerable conditions.
8.4.2 Experiences
Conception, construction, manifestation, symbolization, and management of suffering are also intersected by gender. As stated by Ana Távora [22], in some determined conflicts, the existing relations between perception and resolution and the mental distress or mental wellbeing of women is determined by the position the dominant system grants them—subordination. In other words, women’s distress is framed in a social psychopathology issue.
Inequality between men and women is intertwined by coercive elements, which are eminently corporal, and result in internalized relational models integrated into our subjectivity. According to the author, femininity provides us with such an identity that is centered in a being to be perceived, observed in a continuous state of bodily insecurity and symbolic alienation. In this identity, appearance has a fundamental value. Adolescent women, when bodily changes begin and secondary sexual characteristics appear, face their sexuality not through an encounter with their bodies, but by being mentally undressed by the other [23]. This is what Basaglia [24] calls “being-for” and “being in the being-of-others,” which defines a socialization environment for women reinforcing the importance of attachment and the emotional. Following Rosaldo [25] (p. 44), to this we can add: “It now appears to me that woman’s place in human social life is not in any direct sense a product of the things she does, but of the meaning her activities acquire through concrete social interaction.”
From a bodily experience, women tend to represent their bodies through instrumentality, dissociation, and tension. The body is an instrument, an object with which to perform social, reproductive, and productive functions. In addition, motherhood is the core around which most women build their identities. Motherhood and bodily reality are the constitutive elements of a dissociated reality where sexuality and sensuality coexist in tension [26]. In the same way, Carole Vance [27] narrates the tension produced in the experience of sexuality as a sphere of exploration, pleasure, and performance, yet also how this experience can lead in turn, to helplessness, repression, and risk of sexual violence.
Narratives with their own emphases, (in)consistencies, silence and oblivion are connected to the possibilities of the enunciation of women and the social impact of their experiences. Silences are pervaded by fear, embarrassment, and in the social sense, women stop talking. María Jesús Soriano [28] states that the proportion of sexually assaulted girls is 10 % higher compared with boys. It follows that, in the case of girls, most of the time, the assailant is someone in their immediate environment, and in 70 % of the cases the assailant is a close relative, while in boys it is usually a stranger. This fact allows boys to defend themselves, run, hate or despise the assailant as a means of protection akin to war situations where the enemy is perfectly defined. When there is an attachment, kinship or friendship relation between the assailant and the victim, as happens with girls, if is almost impossible for her to defend herself. Silence reflects how gender-based stereotypes work. Kurvet-Käosaar [29] illustrates this fact in his work on autobiographies by Baltic women during the Stalinist regime. He addresses the difficulties in reporting, giving testimony, considering their limits of self-representation, particularly with socially taboo issues, such as sexual violence.
With regard to words, as stated by Bertaux-Wiame [30], there are differences both in the way in which women and men narrate and in the signification of the narration. Women recall the events in a different way and in more detail, they bind the act of narration to their social experience (family and community networks); thus, they tend to narrate about others [31]. They express feelings and conceive fear from everydayness, thereby granting the testimony a special meaning. This is justified by the fact that time in most women is organized according to reproductive events and a different learning process for the emotional [31].
When women speak, they not only do so through words. The work of Kimberly Theidon [32] shows the great variety in response to traumatic experiences and stressful events. In her research on women who had been sexually assaulted and raped by the government forces in Ayacucho (Peru) during the internal war that shook the country, several women asked her: “Why should we remember everything that happened? To martyr our bodies—nothing more?” In these communities, the language of memory is corporal and women carry the burden of pain and suffering in their communities. This research describes the belief that sorrow can be transferred to the child through breast milk. With the term la teta asustada (the frightened teat), the researcher sought a way of capturing how the powerful negative emotions alter the body itself and how through blood in utero and breast milk (the milk of sorrow and worry) they could transmit this sorrow to their babies. In this division of emotional labor, women embody history [33].
According to Cyrulnik [34], two shocks are required to cause trauma: “a shock in reality (damage, humiliation, loss) and a shock in the representation of reality, that is, in what others say about the person after the assault.” Sabine Dardenne, kidnapped in 1996 by a pedophile, stated that she later wrote her story as a means of retrieving her story from under the media spotlight, to express her pain, to put it out there, and to prevent judges from granting shorter sentences for good conduct to pedophiles [34]. Other women, such as the Grandmothers of the Plaza de Mayo continue with demonstrations as a reminder, for social recognition, and for state reparation.
8.4.3 Trauma and Care
The acknowledgement of sociocultural factors is determining the way in which the problem may be seen and nested, and consequently determines the subsequent approach [35]. Thus, these studies provide sex-disaggregated reference data, but the aim in this data collection should be to further elucidate what elements determine such outcomes. Eliana Suárez [36] compiles and questions some of these statements. For instance, several studies suggest that women might be more likely to suffer PSTD than men. One may wonder to what extent these data can be related to differences between women and men in an emotional and biological response to interpersonal traumatic events, or rather consider that such data is mapping the high incidence of gender-based violence. Some other issues must still be addressed, such as the possible overrepresentation of women in the diagnosis of PSTD owing to the gender differences in care seeking behavior after exposure to a traumatic event. At the same time, one may consider that gender intersection with factors such as disability, poverty, discrimination, and ethnicity could be the triggering cause for the greater vulnerability of women to PSTD.
Being sick or suffering is not enough to be cared for or assisted. It has to be socially accepted that the person needs to be cared for. The decision whether to give care or not is based on the societal expectancies in the group and the case given. The decision to care for and assist depends on global criteria through which communities construct the situation based on their past experience, their collective appropriation thereof, and the resources available to them [37].
The hegemonic masculinity model [38] constitutes a hindrance in men’s health given that, because of their different way of configuring, dealing with, and solving their health issues, it blocks access to care services. Men have been socialized to be active, be in control, be defensive, be strong, look after themselves, endure pain, use their body as a tool, never ask for help, and cope. This is a model that encourages self-sufficiency, recklessness, competitiveness or omnipotence. It also requires undergoing certain testing to prove that they are on their way to manhood. The predominance of mainstream male education reinforces the idea that care and self-care are feminine; while values such as strength, courage, and boldness are considered masculine. The accident rate and the disproportionate prevalence of men in the suicide rate illustrate this hypothesis [39].
Related posts:
Gender and Corporality, Corporeality, and Body Image
Improving Our Science in Psychosis Research with a Sex- and Gender-Based Analysis
Paraphilic Disorders: Sexual Sadist and Masochistic Disorders
Gender Differences in Post-traumatic Stress Disorder
Psychosexual Development and Sexual Dysfunctions
Psychopathology, Art, and Gender
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