Psychiatric Retraumatization: A Conversation About Trauma and Madness in Mental Health Services

Political, cultural, and financial forces have made many mental health professionals so unaware about the reality of trauma and adversity that they often harm instead of help. In her recently published book Trauma and Madness in Mental Health Services (Palgrave Macmillan, 2018), clinical psychologist Noël Hunter offers an insightful critique of mental health’s diagnostic and treatment irrationalities, and she also provides concrete tools for trauma survivors and for their helpers.

Hunter has a unique vantage point to view the mental health profession. Not only is she a psychologist with extensive knowledge of the empirical research, she herself was “diagnosed” and “treated” for “serious mental illness.” Prior to becoming a clinical psychologist, Hunter was an actor involved in improv comedy—which she still does—and she made a living for a decade as a personal trainer. However, her own experiences as a patient resulted in her returning to school to become a psychologist. Her doctoral dissertation, on which the book is based, includes interviews with individuals with first-hand experience of the mental health system—experts by experience—who Hunter quotes throughout her new book.

Recently, I reviewed Trauma and Madness in Mental Health Services for CounterPunch, and I was curious to hear more from Hunter about her new book.

Bruce Levine: You write: “Not only were my experiences in the mental health system re-traumatizing, but they also critically altered my view of myself and the world. Further, the dynamics between me and several of the mental health professionals I encountered eerily mirrored those with my abusers.” Noël, tell me more about this, and how common do you think it is for psychiatric treatment to be re-traumatizing?

Noël Hunter: I think the more extensively one has been hurt in life, particularly if it was during development, the more likely one is to be hurt again and again and again in life. The mental health system is a reflection of that. I believe that, on the whole, the system is part of one large re-enactment of early dynamics—whether they be experiences of marginalization, discrimination, rejection, dismissiveness, judgment and condemnation, etc.—and there is a huge lack of awareness on the part of most professionals of how they are complicit in playing these out.

A black man spends his life being marginalized and aggressed, dismissed because of his fear and pain—should he enter the system, he is no longer “less-than” because of his blackness, now he’s marginalized and dismissed as “schizophrenic.” A sexually-abused young woman who was told she “wanted it,” was blamed, and was never given the opportunity to be angry enters the system—she now is “borderline” and once again blamed for being too sexualized, for causing staff to behave in shameful ways, and condemned for her anger, even when it is taken out on herself.

Perhaps more than any other, the most common enactment is that associated with the individual who grew up with a narcissistic parent in constant need of adulation, intolerant of discomfort or self-reflection, and who was a master in the art of gaslighting.

Bruce Levine: There is so much that establishment psychiatry has wrong that those of us who write articles and books criticizing this institution can overwhelm a reader. What, for you, was most important to get across to readers in Trauma and Madness in Mental Health Services?

Noël Hunter: That the problems do not stem from a few individuals or even one profession. Rather, the entirety of the mental health field and the paradigm under which it operates is a modern-day religion rife with all the familiar problems and benefits that exist in any religion. Most importantly, however, there is hope if people are willing to move beyond what society tells us we “must” do. People have been healing from great pain for 200,000 years—the mental health professions have existed for less than 200. While there are some things we have learned, we need to stop trying to re-invent the wheel. People need love, support, community, to be heard, to be valued, to be validated, to have purpose, to have health and housing, to have nutrition both physically and emotionally—it is not rocket science and doesn’t become such just because we keep saying that it is.

Bruce Levine: From my experience, nothing gets establishment psychiatrists more pissed off than being confronted with this truth: Their biochemical imbalance and genetic flaw theories are essentially labeling people as “defective,” and this results in people who are already suffering being stigmatized and marginalized owing to this defect status. This is hugely important, and you discuss it in your book.

Noël Hunter: This might be one of the most common things I come across in my clinical work, next to that of individuals who are constantly trying to prove themselves to phantoms of their past to no avail. If patients willingly adopt the role of defectiveness, then how is the doctor doing anything harmful or wrong? People who grew up as the scapegoat, who believe they are dirty or defective or bad, who are ashamed of their existence or believe they should be someone they are not, who have led their entire lives being marginalized and discriminated against in society—these are the people who most frequently enter mental health services. They are also those most readily vulnerable to accepting these messages under the guise of treatment and care. It is not until people are willing to start to consider that, in fact, they are not defective in the least, rather, that they are just flawed and unique human beings adapting to incredible pain that they can start to actually believe in themselves enough to heal.

Of course, there is simply the existential issue of mental health professionals that may be unbearable for them to face: If I am not fixing a distinct and identifiable problem, what, then, is my purpose? If the real healing power I have is something that any human being could ostensibly provide, if willing, why did I spend all those years in school and possibly hundreds of thousands of dollars? If these are not specific diseases related to specific biochemical or genetic flaws, why have I specialized—and who doesn’t like feeling special? And, worse, if I am not addressing people with genetic illnesses and biochemical problems, what, really, am I doing when all I have to offer are drugs and technological interventions?

This problem is not unique to mental health professionals. Medical doctors are caught in a similar dilemma when it comes to obesity, heart disease, diabetes, chronic inflammation, and many auto immune diseases, even cancer. What do these doctors do when they realize that these problems are almost entirely due to an industrialized diet largely based on corporate interests—the sugar industry, soy bean manufacturers, Monsanto—and that if people just ate the way humans are designed to eat, these problems mostly would not exist? And, of course, these issues are entirely intertwined with mental health problems! If these are not specific diseases related to specific biochemical or genetic flaws, why have I specialized? If these problems are not really genetic illnesses and biochemically-based problems, what, really, am I doing when all I have to offer are drugs and technological interventions?

It is too dangerous to one’s own existential anxiety and identity to tolerate any questioning of genetic and biochemical theories; the idea that these theories and their related treatments are actually harmful and discriminatory is beyond even the realm of acceptability. In the professionals’ defense, patients also have come to believe that they are not receiving “real” care or quality treatment if they are told to exercise, eat healthy, take a walk, etc. —they feel they are being short-changed if they do not walk out with a concrete plan or prescription. Of course, chicken or egg, right? They onus still lies with professionals to tell the truth.

Bruce Levine: Trauma and Madness in Mental Health Services is about a very serious topic, but you had me laughing out loud a few times. For example, when you discuss mental health professionals’ financial need to stand out from their numerous peers via pretentious specializations, you write: “I live in New York City where the population of therapists is rivaled only by that, perhaps, of actors, finance professionals, and rats.” Too many mental health professionals are afraid to be irreverent about aspects of their profession that nobody should revere. Do you think their socialization damages their spontaneity and authenticity?

Noël Hunter: What is the point to life if we cannot laugh! Laughter is so incredibly healing and allows us to face the most painful aspects of our existence without being suffocated under the weight of it all. It allows us to digest that which is otherwise intolerable. In essence, laughter is like a highly pleasurable laxative. A good laugh truly is like a good … well, you know.

Unfortunately, laughing is frowned upon, and I agree that many mental health professionals appear to be somehow afraid of humor, at least when it comes to their work. I don’t think this problem is unique to mental health professionals. I think it is a byproduct of one’s own painful development wherein they may have been laughed at or not taken seriously as a kid, and also, yes, socialization. We live in a society that values stoicism, complete control over one’s behaviors, lack of emotional expression, “politeness” at the expense of authenticity—I love New York! —and an eerie Stepford Wife-like ideal of conformity. Mental health professionals often are selected for their ability to represent these values. Those trouble-makers who tell the truth, are spontaneous—otherwise called “impulsive,” who laugh or find humor in the darkness— or “inappropriate affect,” who refuse to conform—or my favorite, “oppositional”—are ostracized and pathologized for the threat they pose to propriety. They generally don’t make it through the training process. I know I almost didn’t. It is the Anglo-Saxon way. It also is what makes most of us completely miserable.

Bruce Levine: What do you think is most important to get across to mental health professionals who are treating people who may be behaving in ways that seem bizarre to them or which frighten them?

Noël Hunter: Try to understand that which you do not. Know that there is almost always a reason why a person is behaving in the ways they are. It is our job to take the time to try and understand what that is, not to write it off and judge. We all can imagine a scared and trapped animal—it snaps, writhes, runs in circles, jumps, and if it could speak, it probably wouldn’t be working very hard to help you feel better, it would be trying to protect itself. We understand this with animals and we instinctively know that we must help calm the animal and help it feel safe. Yet, with people, suddenly all common sense and instinct goes out the window and instead of compassion and understanding, we judge, condemn, avoid, aggress, and dehumanize. The standard reaction to individuals who are scared and in pain too often is the exact opposite of what they need.

In short: Just because someone is different than you, this does not make them wrong, diseased, personality disordered, defective, less-than, or beneath you. If you cannot be curious or control your own fear, seek counseling.

Bruce Levine: Finally, did you have any reactions to my CounterPunch review? CounterPunch is a Left anti-authoritarian political publication with most of its readers having antipathy for both Donald Trump and Hillary Clinton, and part of what I wanted to do in my review of Trauma and Madness in Mental Health Services was to get these kind of readers to become as critical of the psychiatric-industrial complex as they are of the military-industrial complex. Anything I said in that review you take issue with?

Noël Hunter: I loved this review and the parallels you draw. It’s important to be able to recognize the greater picture—psychiatry exists within a larger context. We live in a society run by corporate interests and our “expert advice” in almost any given area is more about protecting those interests than it is humanity.

I also appreciate that you point out that many individual clinicians do have the honest desire to help their patients, but that the greater industrial-corporate system ruins almost any possibility that they can actually do that. I don’t see the value in attacking individual professionals any more than we wish them to attack us—backing a person into a corner with vitriol and aggression rarely, if ever, gets such a person to listen or connect.

People who enter services are frequently society’s most vulnerable—people who have experienced extensive trauma, adversity, abuse, and oppression throughout their lives. At the same time, I struggle with the word “trauma” because it signifies some huge, overt event that needs to pass some arbitrary line of “bad enough” to count. I prefer the terms “stress” and “adversity.” In the book, I speak to the problem of language and how this insinuates differences that are not there, judgments, and assumptions that are untrue. Our brains and bodies don’t know the difference between “trauma” and “adversity”—a stressed fight/flight state is the same regardless of what words you use to describe the external environment. I’m tired of people saying “nothing bad ever happened to me” because they did not experience “trauma.” People suffer, and when they do, it’s for a reason.

Also, it is important to recognize that “recovered ex-patients” are a select group of mostly privileged individuals, like myself, and are not the only voices of value. The participants that I quoted throughout my book exist along a large continuum of functionality, distress, and self-identified status of recovery—although most did, in fact, identify as “recovered.” Almost all were still in some kind of therapy or mental health treatment, and so would not be considered ex-patients. Many individuals do not have the luxury of escaping the system, whether it’s due to drug dependence, lack of other support, fear, loneliness, or the law. Their voices matter too.

And that is really the entire purpose of my book. To give these voices a chance to be heard. I hope people will listen.


Dr. Bruce Levine

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