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The Pathways of Pain
Warfare, natural disasters, and violent personal experience can create trauma that can last for years, if not a lifetime. Researchers across Yale’s academic spectrum are pooling their knowledge in search of ways to ease the suffering.

Menachem S. is a survivor. At the height of World War II, when his parents were condemned to a Nazi concentration camp, the boy, then only 5 years old, was sent into hiding. First, he hid in a brothel, and later lived on the streets before being “adopted” by a Polish woman grieving for her dead grandson. While the tale has a happy ending—Menachem S. was reunited with his mother and father at the end of the war—he had nightmares about the ordeal for many years. Eventually, however, the bad dreams ceased, and to all outward appearances, he put the Holocaust behind him, marrying, raising a family, and becoming a doctor. “I thought I had walked in the rain without getting wet,” says Menachem S. “But I was wrong. My whole life was shaped by those experiences.”

So it is with most people who have “walked in the rain”—or in the valley of the shadow. At Yale, the study of trauma—not the kind associated with a trip to the emergency room, but rather the state of mind and body that persists after a physical wound has healed—has brought together an interdisciplinary team of scholars dedicated to learning how people deal with the tragedies that befall them, as well as why such tragedies occur in the first place. Neurobiologists are currently zeroing in on where in the brain the stubborn persistence of trauma lies, hoping to discover therapies to heal the pain that sometimes refuses to go away. But the investigators also include students of Slavic literature, psychoanalysts, architects, historians, dramatists, sociologists, and historians.

The researchers have no lack of material for analysis, whether it lies in Bosnia, Rwanda, Cambodia, Lebanon, Vietnam, the streets of a modern American city, or a muddy crash site. From the concentration camps to clinics treating child abuse, the history of the 20th century is too often read in a litany of violent acts suffered by, and directed against, members of our own species. To the “victors” go the spoils; to the survivors goes trauma, sometimes short-lived, sometimes lasting a lifetime and beyond. “All of us have narratives by which we live our lives,” says Kali Tal ’91PhD, an independent scholar and co-owner of a Woodbridge, Connecticut, publishing company devoted to exploring Vietnam War–era issues. “Trauma is a plot violation.”

The fallout from such “plot violations” takes many forms, and it leaves its signature in everything from the haunting accounts of survivors such as Menachem S., whose narrative is part of the Sterling Memorial Library’s Fortunoff Video Archive for Holocaust Testimonies, to novels like Call It Sleep, Henry Roth’s chilling story of child abuse, to the mythic tales of past injustices that soldiers—and governments—have used to justify current atrocities. At a monthly meeting of the “trauma group” at the Yale Psychiatric Institute, Michael Holquist, a comparative literature professor who chairs Yale’s Council on Russian and East European Studies, recently watched two videotapes that focused on Bosnia. One highlighted Bosnian Serbs involved in “ethnic cleansing”; the other was devoted to some of their victims, Bosnian Muslims who have resettled in New Haven and whose testimonies are being compiled into an archive similar to that for Holocaust survivors. “Accounts of trauma are never pretty, but some stories are more horrifying than others,” says Holquist. “These were particularly grisly.”

The Serbian soldiers, noted the scholar, kept bringing up Kosovo, the site of numerous battles more than 500 years ago, each of which was mentioned to fan the flames of nationalism. “There’s a timeless world of Serbian glory that’s caught up in the Kosovo epic,” says Holquist. “The way it is constantly being invoked to justify the unthinkable demonstrates the way a subject in the present negotiates the past.”

While the Bosnian Serbs, apparently secure that God and history are on their side, told their story with self-assured pride and animation, their Muslim victims talked in detached monotones. “The shock that results in psychic numbing is explicable in terms of narrative analysis,” Holquist argues. “These people simply cannot understand what happened to them, and they can’t create a story that makes sense.”

This inability to be able to come to grips with what Claude Lanzmann, the French filmmaker who directed the Holocaust epic Shoah, termed an “affront to understanding” is typical of those who have been traumatized, whether the cause is a war or any other act that does violence to the body and spirit. And while most studies have looked at how individuals cope, there is, says Kai Erikson, the William R. Kenan Jr. Professor of Sociology and American Studies, “a new species of trouble”—a trauma that afflicts entire communities.

“These can be harder to recover from,” says Erikson, whose research has concentrated on such events as a flood in Appalachia, a bank failure in south Florida, a gasoline leak in Colorado, and mercury poisoning in Ontario. “These disasters tear the fabric of the community itself, and people come to feel they can’t trust anyone or anything, even the environment, in general. It’s horrifying—you can’t be more alone.’

When people bond together in times of tragedy, this “creates a climate for healing,’ says Erikson. Shared trauma, he has found, is somehow less enduringly painful than a disaster faced in isolation. Unfortunately, the modern human-caused environmental catastrophes, such as the Exxon Valdez oil spill, Love Canal, or the Chernobyl nuclear power plant meltdown, have precisely this kind of isolating effect. “The sense of danger stays in the environment virtually forever, and it gets into the tissues of the body where it remains for a lifetime, maybe several lifetimes,” Erikson says. “Those people affected report that they feel contaminated and betrayed. They’re treated as if they’re toxic.”

They are, says Erikson, the “new lepers,” a fact that anyone who is homeless or afflicted with AIDS is also likely to learn. But, adds Erikson, the feeling of being cast out of the human community is not the worst of it, for there is another cruel dimension to trauma: the notion that, initially at least, trauma seems to deny the very possibility of history.

“There’s a paradoxical quality to traumatic experiences,” says Cathy Caruth, an associate professor of English who recently joined the faculty of Emory University. “People are utterly and radically changed by these events, which are overwhelming. And yet, despite the urgent need to communicate, many people who have been traumatized have this feeling that they don’t own their experiences, that they’re not immediately accessible.”

This means that for literary researchers like Holquist and Caruth, who was a pioneer in trauma studies at Yale, the vast amount of writing that has poured out of the traumatized has to be read in a way that takes into account the delay between the event—a delay that allows a certain amount of editing to take place as a person attempts to make sense of what has happened—and the time the occurrence is finally committed to paper. “These texts communicate their truths in enigmatic ways,” says Caruth. “But not only does the enigma have a literary life, it also has a neurobiological one.”

At the Veterans Administration Medical Center in West Haven, a team of Yale researchers is studying the biology of one of the better-known consequences of trauma-post-traumatic stress disorder (PTSD). This syndrome, which is characterized by a cluster of symptoms—depression, jumpiness, fear, and flashbacks—emerged in the public consciousness as a result of the Vietnam War. John Krystal ’84MD, an assistant professor of psychiatry, says that while the mere existence of PTSD—which in the past has been described variously as shell shock, battle fatigue, and gross stress reaction—as a bonafide psychiatric disorder has been challenged by some in the medical establishment, work done by Yale and VA investigators has demonstrated conclusively not only that PTSD is real, but also why the brain seems unable to forget certain traumatic experiences.

According to Krystal, research in this area began at the University after the Second World War when Theodore Lidz, who became a Sterling Professor of Psychiatry, started to examine the long-term effects of combat on soldiers who had served in the South Pacific. The work was carried further by Robert Jay Lifton, a pioneer in the study of the psychology of resilience. It was a lecture by Lifton, now a professor at the John Jay College of Criminal Justice in New York City, in the early 1980s that interested Krystal, then a student at the Medical School, in the possibility that the symptoms associated with post-traumatic stress might have a common biological basis.

Working with PTSD victims, as well as with rats and monkeys, the scientist and his colleagues have since learned that certain types of “acute and uncontrollable” stresses, such as those veterans are exposed to in combat and, among research animals, electric shock, can cause long-term changes in the brain’s chemical messaging system. The most dramatic alteration, says Krystal, is found in the way the brain handles adrenaline, the “fight or flight” ingredient that is typically released in situations of high anxiety and fear. After a significant traumatic experience, the brain tends to be more easily provoked than usual into releasing adrenaline and is apparently less able to turn off the flow of the neurotransmitter.

Krystal recalls a particularly dramatic display of this cycle of “increased activation and decreased inhibition” several years ago in an experiment at the VA in which volunteers were given a substance called yohimbine, a “health food” marketed as an aphrodisiac and a known inhibitor of the adrenaline shut-off mechanism. Relatively healthy subjects and those with depression, schizophrenia, and other mental disorders had no reaction to yohimbine. But when a patient with PTSD—a Vietnam veteran who wasn’t having any symptoms at that moment—was given the chemical, he quickly began flashing back to a jungle firefight he had been involved in a quarter-century ago.

Krystal says that demonstrating that the syndrome was the result of an observable, “long-lasting disregulation” of brain chemistry was a critical event in trauma studies. (More recent studies have shown patterns of metabolic activity in the brains of PTSD patients that are consistently different from those of healthy individuals.) Equally important, he continues, is that understanding what is going wrong has helped point scientists in the direction of medications that might be useful in treating the disorder. So far, much of the testing has involved antidepressant drugs, but, probably because the aftereffects of trauma may significantly alter other chemical systems in the brain, the results from medication therapy have been mixed at best.

Yale researchers are also experimenting with non-drug-based therapies. One strategy, developed by Hadar Lubin, a psychiatrist who works at both the VA and the Yale Psychiatric Institute, has, in preliminary tests, proven both promising and controversial. Traditional thinking, Lubin says, insists that only those people who have suffered a particular kind of trauma can understand and help each other. This has meant that therapy and support groups have been homogeneous, with, say, rape victims in one, child-abuse sufferers in another, and Holocaust survivors in a third.

“I’m challenging the notion of homogeneity,” says Lubin, who works with women assembled into small, heterogeneous therapy groups in which, for example, someone trying to recover from domestic abuse may be sitting next to the traumatized witnesses to a deadly fire or a shooting. For 16 weeks of collective psychotherapy, the women work with their disparate experiences, and although many professionals would hold that such differences might prevent, rather than facilitate, recovery, Lubin says “patients report that they’re feeling better. Their morale is up, they’re more hopeful, and their esteem has increased. In such a short time, it’s not our goal to cure their trauma or make them forget it. Rather, we want to provide these women with the tools they need to deal with the effects of trauma in their lives. We can’t answer the existential questions, but we can do something to help them tolerate having the questions.”

Dori Laub, an associate clinical professor of psychiatry who has treated many victims of Nazi persecution, told of hearing these chilling words from a Holocaust survivor: “Once at Auschwitz, always at Auschwitz.” Substitute for the Nazi death camp the names Khe Sanh, Hiroshima, Bhopal, Sarajevo or any other location in which people are the victims of natural or unnatural disasters, and the assessment of the aftermath of trauma would read the same.Some wounds never completely heal.

And yet, although the lives of the victims may be forever altered, there are ways to make accommodations and go on living, says Laub, who spent part of his early childhood in a concentration camp. Memories of the experience—seeing a hanging, talking to a man who had been flogged—are forever seared into his mind; dealing with them, however, had to wait for many years because of a phenomenon well known to anyone who has been traumatized. “We avoid knowing,” says Laub.

Indeed, when the self has been violated by some monstrous act, there’s a natural tendency, says the psychiatrist, to deny that anything ever happened. Although the truth may surface in nightmares, people can often successfully repress their history for decades. But as the victims age, says Laub, they seem to experience a need to tell their story—and bear witness.

From this need was born the Fortunoff Video Archive, a project Laub helped launch in 1981 to store the taped testimonies, some of them from patients, that the psychiatrist and his colleagues had begun collecting two years earlier. There are more than 3,300 tapes in the Archive, and Laub is now hoping to establish a Yale center for the study of genocide, violence, and trauma. “You have to know the shadow so you can avoid it,” he says. “Not knowing, either individually or politically, is a most dangerous thing.”

Werner Bohleber, a German psychiatrist who is president of the Frankfurt Psychoanalytical Society, would certainly agree. Last December, Bohleber was a guest speaker at the monthly meeting of the VA trauma researchers’ group, where he presented an account of his analysis of a patient who was burdened by a hellish past. During the Second World War, the man’s father had been a doctor at the Nazi concentration camp in Buchenwald and had committed numerous atrocities. Rather than face a war crimes tribunal, the father fled to Saudi Arabia. As a youngster, the son did not know the full extent of his father’s crimes—that came out during therapy in the 1980s—but the father’s absence for most of the boy’s childhood and the secrecy that pervaded his upbringing hinted at the truth. When the boy reached his 30s, the past overwhelmed him.

“He was carrying the guilt repressed by his parents,” says Bohleber. “There’s unfinished business in the second generation, for only when you acknowledge the past can you be free. Our task is to deal with it and not forget it. Even though it is painful, we can’t—we mustn’t—avoid this work.”  the end


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