Trauma and Western therapeutic paradigms

There’s been a recent crop of narrative nonfiction from India. I’m thinking about books all published between 2010 and 2011, and in particular, Sonia Faleiro’s Beautiful Thing, which shadows the life of a bar dancer. In a way, it represents the associated milieu of bar dancers, pimps, prostitutes, transvestite and transgender sex workers, etc.

To some extent, the language of post-traumatic stress disorder (PTSD) was used to explain the fallout of the kinds of sex work the girls did. One of the things I asked myself when I was reading that book was if it really was PTSD. Wasn’t it more like what the post-apartheid psychiatrists and psychoanalysts in South Africa were calling continuous traumatic stress? Because this is not trauma; what the bar dancer, whose name is Lila, goes through is not something that can be relegated to the past. It’s continuous. This also leads to that sense of helplessness, when it comes to the therapist or the immersive journalist forensically charting the different mental health issues that come with this line of work, that it cannot be stopped. You cannot really move them to a safe place.

I’m a literary critic and I find it very interesting to look at the narrative data of novels such as Aminatta Forna’s The Memory of Love or her Happiness. She is a British Sierra Leonean novelist. The novels speak about that contact zone between Western psychiatry and non-Western populations. In The Memory of Love, Adrian Lockhart, who is a British psychologist, has arrived in Freetown in the immediate aftermath of the Sierra Leone Civil War, around 2001. He’s told by another Western group that has been there for barely a few weeks that 99% of the Sierra Leonean population is suffering from PTSD. When he tries to share this with another character, who is also a mental health worker, the Ghanaian psychiatrist, Attila Asare (this is a character Aminatta Forna is very fond of and brings back in a later novel), says: ‘You call it a disorder, my friend. We call it life.’

That is a very important part of the kind of psychoanalysis in an international frame I am looking at. You frequently have these episodes in the novels where, for example, a Swedish doctor sees a woman with marks on her arm and thinks she has tried to kill herself. A local surgeon says that he has never, in his entire time in the hospital, seen anyone try to take their life because staying alive has been such a challenge that people have not really had the time to think about taking their lives.

We are looking at global war. We are also looking at new forms of torture, new forms of dehumanisation. We are looking at disappearances. We are looking at rape and genocidal violence. In a programme for survivors of torture that I worked at in Bellevue Hospital in New York, there was a Rohingya from Bangladesh who was suffering from sarcoma of the bone. There were asylum seekers from West Africa whose arms were chopped up in different places. They had been asked, before these amputations, whether they wanted short sleeve or full sleeve: full sleeve and an entire arm goes; short sleeve is being cut at the elbow. You had slaves from Mauritania. So we are looking at demographics with different histories of extreme violence, traumatising violence with different kinds of histories of trafficking, rape, mutilation etc. The Western paradigms will have to not only be translated, but enter conversation, sometimes in the languages that the torture victims speak, to also understand the paradigms of health and illness that are governing the symptoms that these so-called victims present.

In the Hackney Gardening Project there are very poor populations, many of whom are not literate in their own language, let alone in English, and many of them have been trafficked to England under horrendous conditions. They would be allowed to meet once a week for a year, and they would plant, sow and grow vegetables and flowers. Sometimes, if the crop was bountiful, they would sell them in the local market. They would cook the food and eat it. Every such gardening day would end with group therapy conducted by the Turkish therapists I worked with there.

I asked Ahmet Caglar, one of those therapists, ‘How does this work? If you are not really talking to them, how does talk therapy work?’ He is a Tavistock-trained psychoanalyst and a therapist. How does he manage to interact with people whose language is primarily transactional? They speak the same language – not English but Turkish. He said something very interesting. He mentioned this Arabic custom of sohbet, almost intra-psychic conversations you have with a group of people that you choose to be your community.

For example, there’s a 57-year-old Turkish man, poor, who runs a shop with his son, and he gets into a road accident. The road accident does not seem to be very severe, and he’s discharged from hospital after one day, but it completely discombobulates him. All he can say after the road accident is: ‘I don’t know.’ So, he is referred to his GP, and the GP refers them to Primary Care Psychotherapy Consultation Services (PCPCS). PCPCS sends him to the garden, thinking maybe something will come of it. He takes to the gardening programme as he really loves working with his hands. He loves touching the soil and putting things into the ground. He also is very moved by the concern a female group shows toward him. They ask him questions about his life and he, in turn, can return the favour, asking them about their lives.

After six months he says, ‘I don’t need this anymore. I can go back to work.’ Caglar says that somebody who could not wipe his nose had come back to see him after six months with his wife and was smiling. I ask, ‘What do you think happened? What exactly?’ because obviously when I’m charting different kinds of case studies I’m always after repeatable patterns. What are the blueprints I’m going to be presenting in my book? Like the sohbet, that intra-psychic conversation, this particular therapy is mysterious, Caglar says. They do mindfulness exercises; they do grounding exercises while also gardening, and Caglar said that the man was put in touch with his own capabilities. He was put in touch with his own innate resources, and he felt ready to leave the programme, which I thought was very beautiful.

It’s very important to be able to have some sort of therapeutic provision in the person’s language. This is something I’ve seen in India as well. They’re called barefoot researchers, and these are people who are trained from slums, who go back to slums with questionnaires and the non-judgmental interviewing techniques they’ve learned from psychoanalysts to talk about the depredations of slum living. I’m saying two things. One is that trauma theory needs to be embodied and embedded. The other is that trauma theory needs to learn new languages, and new cultural paradigms, if it has to work as both a master signifier but also as something that applies these vernaculars to alter lives.