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Young—The Harmony of Illusions

The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder

by Allan Young

[Young, Allan. 1997. The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton University Press.]

Points

  • Young argues that the concept of traumatic memory, which is seen by some as having roots hundreds of years ago, is actually quite a recent invention
  • He argues that: “this generally accepted picture of PTSD, and the traumatic memory that underlies it, is mistaken. The disorder is not timeless, nor does it possess an intrinsic unity. Rather, it is glued together by the practices, technologies, and narratives with which it is diagnosed, studied,treated, and represented and by the various interests, institutions, and moral arguments that mobilized these efforts and resources” (5).

He does not deny that the suffering accompanying a PTSD diagnosis is not real:

  • “My job as an ethnographer of PTSD is not to deny its reality but to explain how it and its traumatic memory have been made real, to describe the mechanisms through which these phenomena penetrate people’s life worlds, acquire facticity, and shape the self-knowledge of patients, clinicians, and researchers” (5-6).

The book is broken into threes sections:

  1. an historical overview of trauma theories up to the beginning of WWI
    • Erichsen—”railway spine” in the 1860s—to deal with railway insurance
      • fear is the body’s memory of pain—memories come form physical stimulus, not images or words
      • So the traumatic event itself causes the continued anxiety
    • Janet & Freud
      • Repression and dissociation—horrible buried memory
      • The memory of the trauma (rather than the event) is the cause of the anxiety
    • Rivers, WWI & “shell shock”
      • Although seen by many scholars as the precursor to PTSD, Rivers is “observing that, in most cases, it is not the traumatic memory that produces the physical and emotional symptoms of the war neuroses (anxiety disorder) but rather the reverse: the symptoms account for the memory” (83).
  2. The DSM III revolution
    • 1940s pre and post WWII war neuroses
      • Kardiner—The Traumatic Neuroses of War, based on post WWI studies from the 1920s
      • Grinker & Spiegel—War Neuroses, based on field studies during WWII
      • no matching diagnostic categories between the two, so the War Department makes one…
    • The DSMs
      • DSM I—1952, nomenclature not universal, listed on spectrum from “Mental Illness, to Mental Health”
      • DSM II—1968, better, but still involved “neuroses”
      • DSM III—1980, built from scratch on completely positivist basis, that is, it was all descriptive, some critiqued this “cook book approach … making mental disorder equivalent to their aggregate of their symptomatic parts” (100).
    • PTSD
      • in DSM III, a person “gas experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone (124).
      • system worked like this:
        1. first order feature (PTSD) is defined by
        2. second order feature (an event outside the range of usual human experience),
        3. but then what is the third order (usual human experience)? Unlike the anecdotal research of Rivers, Freud, or Kardiner, the DSM relies on analogical comparison, which has no bounds.
    • so throughout all this time:
      • “What counts as a reasonable question, a satisfactory answer, a significant difference, an anomalous finding, or even an outcome—the criteria for each of these changed during this period. What did not change was the belief in the solidity of scientific facts and the conviction that psychiatry’s facts, being scientific, are essentially timeless” (9).
  3. PTSD in Practice
    • This section is based off of fieldwork in a U.S. Veterans Administration unit for the diagnosis and treatment of Viet Nam veterans suffering from PTSD in 1986-87
    • There is a long section that includes case studies of four different Vietnam War veterans being considered for PTSD diagnosis.
      • The four men all present psychometric and standardized diagnostic results consistent with a PTSD diagnosis
      • The case studies consist of transcripts of narratives from the men, which are significantly different
      • Following the narratives, transcripts of meetings between professionals at the center show how they rationalize these differences back into the requisite parameters using the open ended language of the DSM designation
    • the centers espouse an ideology of PTSD that allows the patients to talk about their own experiences using specific terminology that feeds back into the center, and back into the diagnosis.
      • The seventh chapter has a lot of group therapy transcripts where you can see this happening.

In the end, the book basically shows how the social creation and maintenance of PTSD (like Scott with blindness) can work in the process of creating a “kind” of people (like Hacking with MPD).

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