Ways of Being in Trauma-Based Society: Discovering the Politics and Moral Culture of the Trauma Industry Through Hermeneutic Interpretation of Evidence-Supported PTSD Treatment Manuals A Dissertation Presented to the Faculty of Antioch University Seattle Seattle, WA In Partial Fulfillment of the Requirements of the Degree Doctor of Psychology By Sarah Peregrine Lord May 2014 Ways of Being in Trauma-Based Society: Discovering the Politics and Moral Culture of the Trauma Industry Through Hermeneutic Interpretation of Evidence-Supported PTSD Treatment Manuals This dissertation, by Sarah Peregrine Lord, has been approved by the Committee Members signed below who recommend that it be accepted by the faculty of the Antioch University Seattle at Seattle, WA in partial fulfillment of requirements for the degree of DOCTOR OF PSYCHOLOGY Dissertation Committee: ________________________ Philip Cushman, Ph.D. ________________________ Jennifer Tolleson, Ph.D. ________________________ Lynne Layton, Ph.D., Ph.D. ________________________ Date ii © Copyright by Sarah Peregrine Lord, 2014 All Rights Reserved iii Abstract Ways of Being in Trauma-Based Society: Discovering the Politics and Moral Culture of the Trauma Industry Through Hermeneutic Interpretation of Evidence-Supported PTSD Treatment Manuals Sarah Peregrine Lord Antioch University Seattle Seattle, WA One-hundred percent of evidence-supported psychotherapy treatments for trauma related disorders involve the therapist learning from and retaining fidelity to a treatment manual. Through a hermeneutic qualitative textual interpretation of three widely utilized evidence-supported trauma treatment manuals, I identified themes that suggested a particular constitution of the contemporary way of being—a traumatized self—and how this traumatized self comes to light through psychotherapeutic practice as described by the manuals. The manuals included: 1) a trauma focused cognitive-behavioral therapy for children; 2) an eye-movement desensitization and reprocessing therapy for adults; and, 3) an early intervention and debriefing therapy series for post-traumatic stress disorder and other trauma related problems of military service members. Through the interpretation, I conceptualized trauma as a way of human being in contemporary culture, and in particular, as an unacknowledged way of expressing enactments of dissociated, unformulated, or unarticulated political arrangements and events. I identified and interpreted the following shared themes and exemplars across the three manuals: mind-brain as protector and the political use of cognitivist ideology; the healed trauma iv survivor as functional worker; trauma as universal and culture-free; and, indoctrination into a social void of scientistic managed care. I discussed how trauma treatment manuals instantiate how to be human in contemporary society through compliance with managed care and the embodiment of scientistic and cognitivist ideology. I then discussed how the way of being that contemporary society creates and idealizes is one in which people easily assume the identity of trauma survivor: an enterprising, functional and fiercely individual member of a warrior cult. In the warrior cult society, to think or talk about social causes and public solutions to daily political suffering is thought of as either non-germane or dangerous; individuals are seen as free from all dependencies and social ties, able to overcome personal and public adversity by arming or forifying their brain and replacing thoughts in their computer-like mind. In conclusion, I raised questions about how evidence-based trauma therapies may contribute to perpetuating a particular constitution of self that has disavowed society’s violent ethics and practices. The electronic version of this dissertation is at OhioLink ETD Center, www.ohiolink.edu/etd v Acknowledgements My experience of mainstream education in clinical psychology has been characterized by an emphasis on competencies, compliance, computerized forms, and learning to survive financially in a managed care world. Thinking critically, historically, and morally about our practice is not nearly as important as it should be. I can’t imagine graduating and not being concerned about the state of the field, and I am thankful to have had the guidance in this process to retain this concern. As my mentor and Chair, Dr. Philip Cushman reminded me throughout my training that the pain of participating in this world while questioning it is much more preferable to the pain of denial, dissociation, and withdrawal. The challenge is not to be defeated when we are confused and afraid—we must be free to think. Thank you Dr. Cushman for helping me to articulate my experience, connect with other political psychologists and scholars, and for giving me the confidence to write with honesty. Thank you to my Committee members, Drs. Jennifer Tolleson and Lynne Layton, for their thoughtful reviews, supportive comments, and for providing a model of courageous, politically engaged, and critically thinking women in the field. I have immense respect for your work and it’s been a privilege to work with you. I have been so thankful to have a partner who has a genuine curiosity in what I am learning. Rich, I have no words to express the immense amount of appreciation for your sacrifices and support throughout my education. There were times when writing this dissertation that I felt despair, anger, and exhaustion, but I never felt alone. I could not have done this without you. To my parents, friends and family members—thanks for your endless love and patience. To my future child—you were with me from the beginning to end of writing this dissertation. Thank you for being such a good baby during the pregnancy so I could become your Dr. Mom. vi Table of Contents Page Acknowledgements ....................................................................................................... vi I: Introduction ................................................................................................................. 1 II: Background and Literature Review ........................................................................... 8 Context for Trauma Culture .............................................................................. 9 Specific Background Information Relevant to Results ................................. 100 Statement of the Problem .............................................................................. 132 Description of the Study ............................................................................... 133 Areas of Inquiry and Research Questions ..................................................... 134 Importance and Purpose of the Study ........................................................... 135 Theoretical Framework ................................................................................. 137 III: Method ................................................................................................................. 154 Data Collection and Analysis: A Practical Application of Hermeneutic Interpretation ................................................................................................. 155 Summary of Methods .................................................................................... 170 IV: Foregrounding: My Personal Experience With Trauma Culture ......................... 171 Summary of My Experiences With Trauma Culture .................................... 191 V: Results and Discussion .......................................................................................... 194 VI: Manual 1: Treating Trauma and Traumatic Grief in Children and Adolescents (Cohen et al., 2006) .................................................................................................... 200 Context of the Manual’s Development ......................................................... 200 Shared Theme 1: Mind-Brain as Protector and the Political Use of Cognitivist Ideology ............................................................ 211 vii Shared Theme 2: Neoliberalism in Trauma Therapy: The Healed Trauma Survivor as Functional Worker .................................... 226 Shared Theme 3: Trauma Is Universal and Culture-Free (Versus Tied to a U. S., Western, White, and Middle-class Context) .......... 238 Shared Exemplar: Indoctrination into a Social Void of Scientistic Managed Care ......................................................................... 248 TF-CBT Theme 1: Children Are Born With Pre-Traumatic Innocence. ...... 263 TF-CBT Theme 2: Children Are Not Sexual ................................................ 268 TF-CBT Theme 3: Children Have No Agency During Traumatic Events .............................................................................. 274 TF-CBT Theme 4: Parents as Protectors or Perpetrators .............................. 280 TF-CBT Exemplar 1: Benevolent Restriction of Angry Responses to Political Events via Therapy ................................................... 285 TF-CBT Remaining Questions ..................................................................... 288 Summary of Treating Trauma and Traumatic Grief in Children and Adolescents (Cohen et al., 2006)...................................................................290 VII: Manual 2: Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles, Protocols, and Procedures (Shapiro, 2001) .................... 294 Context of the Manual’s Development ........................................................