Title: Postdoctoral Researcher in Writing Pedagogy
University: University of Delaware
Email: erjohns@udel.edu
Twitter: N/A
Website: http://www.emilyronayjohnston.org/
Description of Work:
My teaching and research interests emerge at the intersections of feminist pedagogy, narrativity, community literacy, rhetorical theory, and trauma theory, with a focus on rhetorics of sexualized trauma in contemporary global culture. My dissertation project, “Split Wounds: Diverging Formations of Trauma in The Diagnostic and Statistical Manual of Mental Disorders V (DSM-5), Girl With the Dragon Tattoo, And the Rat Laughed and Once Were Warriors,” counterpoints naturalized, normalized trauma wisdom that constructs trauma as an individual pathology—a personal failure to assimilate catastrophe—assessing the American Psychiatric Association’s clinical definition of PTSD (posttraumatic stress disorder) alongside representations of feminist vigilantism and digital technologies as rape interventions in Stieg Larsson’s Girl With the Dragon Tattoo; genre hybridity as a tactic for memorializing Nazi Holocaust trauma in Nava Semel’s experimental novel, And the Rat Laughed; and pedagogical approaches to bearing witness to domestic violence in Alan Duff’s Once Were Warriors. The piece I am workshopping at the RHM symposium is the first chapter of my dissertation project: an extended discourse analysis of PTSD symptomatology in the DSM-5. Most recently, my research has found expression in student literacies and the so-called “rape epidemic” on college campuses in the United States, with a particular focus on campus resources for assault survivors. I investigate—with my students—writing for social justice, and am directing an IRB study on the relationship between empathy and writing in an honors section of first-year composition. My work engages questions of representation and justice; language and power; identity and culture: What are the representations of social injustices in contemporary medicine? How do these representations shape different cultural understandings of “justice”? How do writers—whether students, published authors, or everyday citizens—use writing to survive, thrive, change, and transform sexualized violence? And, what are the risks of relying upon language to do such work?
Symposium Submission:
The Emergence of Posttraumatic Stress Disorder in Medical Culture
This chapter comes from my forthcoming book on rhetorics of sexualized trauma in mental healthcare, cultural studies and writing studies, Mending Wounds: Collectivizing Trauma in Global Culture. Following the book’s introduction, this chapter unpacks rhetorics of normalcy in PTSD symptomatology and diagnostic protocol in the American Psychological Association’s (APA’s) most recent edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To assess how psychiatric doctrine and embodied experience align and diverge, subsequent chapters of Mending Wounds apply DSM-5’s PTSD criteria to representations of rape in Scandinavian Noir, Holocaust speculative fiction and postcolonial New Zealand fiction, underrepresented genres in trauma studies.
PTSD has become “the international lingua franca of human suffering,” journalist Ethan Watters contends in Crazy Like Us: The Globalization of the American Psyche (71). However, trauma was only codified as a psychological condition in 1980, when the APA added PTSD to DSM-III. This chapter draws on PTSD historiography (Friedman, Herman, Luckhurst, van der Kolk) to illustrate how DSM functions as a normalizing force through which current theories of trauma develop. Widely regarded as “psychiatry’s bible,” DSM arbitrates mental healthcare standards worldwide. DSM has paved the way for psychological distress to be recognized as a medical condition, prompting more insurance providers to cover treatment and more patients to seek it out. That said, medical diagnosis presumes that the body is something to be classified, contained, controlled and capitalized upon for the pharmaceutical industry. Diagnosing mental illness isolates mind from body, individual from community, symptom from cause.
DSM-5 defines PTSD along five “characteristic symptoms” that normalize understandings of trauma as a personal failure to assimilate catastrophe, reduce multiplicity and force certain events into one interpretive framework (APA 274). Firstly, traumatic exposure signifies defenselessness and victimization in the face of life-threatening events, and situates control as a normal state. To assess traumatic exposure, clinicians ask patients to identify “the worst thing that has ever happened” to them (Nussbaum 90). This screening question assumes a level of trust that cannot be expected from patients in an initial therapy session, might not facilitate a therapeutic alliance and could retraumatize patients. Secondly, traumatic intrusion signifies a hostile takeover and situates autonomy as a normal state. To assess traumatic intrusion, clinicians inquire into a patient’s ability to control emotions following exposure to trauma. Recommended diagnostic questions about “intrusive memories,” “recurrent, distressing dreams” and “intense or prolonged distress” presume an ability to link emotions and memories that patients may not actually possess (Nussbaum 90-91). Thirdly, traumatic avoidance signifies conscious, strategic efforts to forget and situates agential attempts to recreate “self” after a traumatic event as pathological. Clinicians ask patients if they “work hard to avoid thoughts, feelings, or physical sensations that bring up memories of this experience” (Nussbaum 91). By its own logic, DSM-5 stipulates that trauma is disorienting. Yet these diagnostic questions assume an ability to assimilate past and present stressors that might not be available to patients in the wake of traumatic events. Fourthly, traumatic negativity signifies distortion of so-called “reality,” which presumes that reality is shared. Recommended questions for diagnosing traumatic negativity inquire into the patient’s self-image, social relationships and ability to experience positive emotions, all of which apply to other mental disorders as well, like depressive disorders. While DSM-5 acknowledges overlaps among different disorders, and overlaps do not intrinsically diminish key differences among disorders, assessing PTSD through a negativity framework may actually miss the mark. Finally, traumatic arousal signifies a metaphorical alarm clock, without a snooze button, going off in the brain. To assess traumatic arousal, clinicians ask patients if they “often act very grumpy,” “self-destructive” or “are always on edge” (Nussbaum 91). These questions may pigeonhole patients, directing them to link particular emotions with particular behaviors (e.g., feeling “on edge” with “act[ing] very grumpy”). The recommended protocol for assessing traumatic arousal imposes a cognitive-behavioral framework for understanding trauma.
In conceptualizing trauma through the individual psyche, DSM-5 centralizes the aftermath of traumatic events, not preexisting cultural conditions that may cause such events. Moreover, PTSD criterion deemphasizes how the sociocultural settings in which traumatic events occur may impact people’s ability to survive and/or thrive. In its classification of PTSD, chapter two concludes, DSM-5 relies upon a particular notion of normalcy: functionality. To function is to work, rendering productivity among the most important criterion for leading a healthy life. Yet for some, so-called dysfunction in the wake of traumatic events (e.g., decreased productivity at work) may actually indicate a different cultural valuation of “career” as a means to an end, not an end-goal in and of itself. DSM-5’s yardstick for measuring psychological health may fail to produce the “consistent and reliable diagnoses” the manual purports to establish (APA 20). Rather than researching how rape survivors develop PTSD, trauma researchers and practitioners might explore how rape itself traumatically exposes, intrudes upon, avoids, negates and arouses.
Works Cited
American Psychological Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Ed. Washington, D.C.: American Psychological Association, 2013.
—. Diagnostic and Statistical Manual of Mental Disorders. 3rd Ed. Washington, D.C.: American Psychological Association, 1987.
Friedman, Matthew J., M.D., Ph.D. PTSD: National Center for PTSD. “PTSD History and Overview: A Brief History of the PTSD Diagnosis.” U.S. Department of Veterans Affairs, 25 Mar. 2014. Web. 19 June 2015.
Herman, Judith L. Trauma and Recovery: The Aftermath—From Domestic Abuse to Political Terror. 1R edition. New York: Basic Books, 2015.
Luckhurst, Roger. The Trauma Question. London: Routledge, 2008.
Nussbaum, Abraham M. The Pocket Guide to the DSM-5 Diagnostic Exam. Washington, DC: American Psychiatric Pub., 2013.
van Der Kolk, Bessel A. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York City: Viking, 2014.
Watters, Ethan. Crazy Like Us: The Globalization Of The American Psyche. United States of America: Free Press, 2010.