2024: an autopsy, pt 4

this one got so long I needed headers

They’re cancelling polyvagal theory, and attachment theory isn’t safe either.

I’ve started to see significant pushback against two of the online trauma healing subculture space’s favourite methodologies.

It’s weird that psychology — or at least an online, pop-culture, meme-ified version of it — is a kind of subculture. I understand why, and I’ve benefitted from it both as a consumer and a contributor. To take a kind of anthropological perspective on it, I think it makes sense to position something like healing culture under the broader umbrella of wellness culture. Wellness culture predates the internet, but the internet has given it new and exciting wings. In North America, I tend to think of healing and wellness cultures both as bedfellows of the hippie movement.

After Reagan’s deregulation policies rapidly accelerated the privatization of the American healthcare system, wellness culture has, it seems to me, filled a kind of void in American culture specifically — often standing in for actual western medicine, in an emotional or spiritual sense if nothing else, where access is not financially viable — or where surrendering to the authority of doctors and conventional science feels too much like domination for the American exceptionalist imagination.

I think there’s a real benefit to wellness culture. I think that a lot of it, by definition, is much more like religion than it is like hard science, but I also don’t think we can live off of facts and data alone. I think we are naturally hungry for peace and magic and the Earth and for God. I think that if something makes you feel better and doesn’t hurt you, you should go for it. I think that if something makes you feel better, and hurts you an amount you thoroughly understand and can accept, also go for it. None of us get out of here alive. Might as well live your life the way you want.

I do tend to think that it’s probably best we wander into health-and-wellness culture with at least some idea of what we’re doing: with a healthy dose of skepticism, and with an eye on the exit. I don’t think that this is a refusal to surrender to the great mystery or whatever. I think that this is 1) how we navigate things safely and also 2) a product of a full-functioning theory of mind.

I’ve heard people describe theory of mind a few different ways, but this is my favourite way: a theory of mind is a cognitive capacity that humans have, and which we probably share with other primates. Whether other mammals have a theory of mind is controversial, but I would be shocked if anyone hung out with my dog for a few days and didn’t conclude he obviously has one.

I have a fully-functioning theory of mind when I know that I have beliefs, desires, intentions, emotions, and thoughts, and I know that these all inform each other, but also that they fall into categories which are functionally different. In addition to this, I also understand that other people have beliefs, desires, intentions, emotions, and thoughts, and that these are different from mine.

No unjustified beliefs unless you want to be normal, or happy

As someone with a philosophy background, I also think there’s a distinction to be made between beliefs that are justified and beliefs that are not. A justified belief is a belief corroborated by evidence and reason. It’s very obviously true to me that we inhabit a shared, material reality. I don’t think everyone around me is just “me pushed out.” I don’t think I’m living in a simulation. I think the idea that the reality I’m experiencing is literally some extension of myself is a kind of ritualistic exceptionalist dissociative delusion. I think it’s a maladaptive daydream.

An unjustified belief is something philosophers like to pretend they don’t have, but they totally do. It’s a belief that I have which cannot or has not been corroborated with evidence and reason. I don’t think unjustified beliefs are stupid. I think that literally everyone has them, and in fact I think that they’re a very large and essential aspect of a full, happy, functional human life. Here is an example: I am a moral realist. I think that there is such a thing as right and wrong. I think that there is a moral value to being a good person, to doing kind things and avoiding cruel ones, to knowing what my values are and living in integrity with them. I think that this is true even when living in my integrity or when choosing to be kind over being cruel causes me problems in my material reality. I would rather die poor and feel okay about myself on a moral level than die rich having sold myself out.

I spent years in a philosophy degree trying to justify this, and I never came up with an answer that I was satisfied with, except for this one: I feel good about being alive when I believe that, and I feel bad about being alive when I don’t. At some point I had to just decide that was reason enough.

I also think it’s important that — even as we enjoy our unjustified beliefs, even as they guide our behaviour — we keep in mind that what they are are unjustified beliefs. I think that conflating a justified belief and an unjustified one is something that’s really dangerous, actually.

Polyvagal theory is a way of talking about your feelings that doesn’t instantly make you gay which is a huge problem with talking about your feelings usually

In polyvagal theory, a lot of human behaviour can be summed up as being the result of functionally mechanistic phenomena which stem from evolutionary adaptations that we have as animals. I think it speaks to a lot of people because it slots very easily into a metaphysics that assumes scientific realism. Are you so depressed you can’t get out of bed? You are in a freeze state, have detected danger in your environment and your body wants you to lie down until it goes away. Identify the threat, overcome the fear, and you’re back in business. Did you rage out at someone who didn’t deserve it? Fight-or-flight, baby.

This is really appealing to me. It feels intuitively true. It’s been extremely useful as a framework in my life. I have evidence that it’s true that a lot of my personal low-grade-but-persistent avoidant depression can be resolved, at least temporarily, by putting on extremely angry music and running straight at what scares me — moving my body out of freeze and into fight-or-flight, where I can solve my problems. Learning this skill has been invaluable to me. Also? Polyvagal theory is probably not literally true. It is, at the very best, impossible to test. At worst, it’s thoroughly-debunked pseudoscience.

Attachment theory is a framework for turning your real life into Twilight fanfiction

Attachment theory is based largely on objects-relations theory, which is a school of thought in psychoanalysis, which is the school of thought pioneered by Good old Professor Motherfucker: Sigmund Freud.

It’s got Daddy Sigmund’s dirty little hands all over it: all of your close personal relationships are being recognized by your body and subconscious mind as direct correlates of your relationship to your childhood caregivers. If you struggle with intimacy, closeness, feeling like you lose yourself in relationships, feeling like nobody will ever take care of you the way you need, loss, abandonment as a whole concept —then the secret to secure relationships is digging deep into all of the yucky parts of your childhood that you would much rather not think about, to seek out errors in programming and resolve them, so you stop trying to make your adult relationships resolve them for you.

Girls on the internet took attachment theory and ran with it. I think probably part of its appeal is that it offered an alternative to just-not-that-into-you-ism — a term I invented, just now, for the school of thought based on the book of the same name. Attachment theory offers, instead, an adult version of only-mean-because-he-likes-you-ism, another term I invented just now for the kind of rationalization offered to little girls for why little boys pull their hair at recess.

I think that it’s obvious why it would be appealing for a young woman to hear that when the boy she likes is not interested in a loving, committed relationship, this is not because she is an undesirable woman, but in fact because she is such a desirable woman that he is afraid and seeking distance by pushing her away. That’s a very attractive idea to sell to people — which is why they do that. Who among us has not paid $19.99 and accidentally signed up for the world’s weirdest mailing list so that we could read a questionably-formatted .PDF about why you should feel better, ladies, because it’s not that he’s mean, it’s that his dad was mean, and his mom liked his dad more than her children, which means he also hates his mom, and also there is some level on which he very literally can’t tell his mom and you apart, but also here are eight easy steps you can use to either fix him — or — hand your children some weird twisted version of the exact same generational curse.

I am also somebody who has gotten a lot of good out of attachment theory. According to the language of the paradigm, I have a mostly-secure attachment strategy, which swings avoidant platonically, and disorganized — that’s the crazy one — when I’m in the early stages of romantic attachment. Attachment theory has been an extremely useful language through which to translate issues with lovers and close friends. There are tons of criticisms of it, too. Its primary tenets would be either impossible or immoral to test in a scientific way, which means that even if it is true, we cannot confirm it. Belief in attachment theory is, essentially, a faith position.

My favourite criticisms of the theory are these: first, it’s really, really hard to make a clear distinction between the impact of genetics (nature) and the impact of environment (nurture) when it comes to personality formation. If adult personality was 100% the result of environmental factors, then somewhere in the ballpark of 100% of abused children would grow up to abuse children. This is verifiably not the case, and in fact only a minority of parents who were abused as children go on to abuse their own children. Somewhere in the ballpark of a third of severe mental health diagnoses occur in people who have no history of adverse childhood experiences. Most people who had even very severe adverse childhood experiences do not have diagnosable mental health issues.

Second, I think that a lot of people use attachment theory to justify sticking around in situations where their partner is treating them in ways that are cruel and disrespectful. For reasons that I think are basically a cultural tradition, women are encouraged to view themselves as redeeming angels in the lives of their complicated partners — and men are encouraged to see women as resources they’re entitled to, in this respect. It’s a kind of badge of honour, for a lot of women, to succeed in bagging an ultra-avoidant man. It serves, in these situations, as a kind of gender-affirming ritual — a lion-lays-down-with-the-lamb, Twilight-y fantasy. I have taken what I need from attachment theory, and added this additional part: when someone treats you like they hate you, for whatever reason, that treatment is much more important information than the why. When people treat you like they hate you, believe them.

The healing subculture

The healing subculture doesn’t talk about genetics much. In fact, I have observed that in the healing-subculture-adjacent spaces I enter, discussions about genetics and its role in mental health are actively suppressed as unhelpful. I think there’s two reasons for this: the first is that a lot of the appeal of the healing subculture is that it’s an alternative to mainstream, western medical psychiatric approaches to mental health. If you believe that adult mental health is all or mostly the result of genetics and the mechanics of brain chemistry, there’s already a stream of treatment available to address that. Where I live, it’s even free. The idea that mental health is the result of genetic variations in brain chemistry is called the medical model of mental health. The medical model of mental health is very unpopular in a lot of the healing subculture.

Here is a reason given by medical model skeptics: it’s easy to use the medical model to deny that environment has any effect whatsoever on the mental health of children or the adults they grow into, which can suppress information about child abuse, and as such perpetuate the circumstances that make it possible. It’s also claimed that psychiatric models have a long history of pathologizing the reasonable emotional responses of disempowered people, especially women and racialized people. I have no counter-argument to either of these, because they are true. It’s not controversial that the history of psychiatry is full of examples proving both of these points. It seems very self-evident to me that if we categorize as mental illness any deviation from a fairly rigid norm, and assert unquestioningly that this is always the result of a kind of physiological defect, a lot of very messed up conclusions logically follow.

Your mileage may obviously vary but I have personally met zero doctors, psychiatrists, or mental health professionals who think that mental health is 100% genetic or bio-physiological. Instead, it’s always been explained to me this way: severe adult mental illness is usually the result of genetic predisposition at birth, plus adverse developmental experiences. I recently read a bunch of books on obsessive-compulsive disorder. The most common adverse experience that precedes the onset of OCD symptoms appears to be a sudden increase in inappropriate levels of responsibility. The theory is that this chronically stresses a young brain into developing rigid neurological patterns that manifest in the symptoms of OCD. But the rate of neglected children who had inappropriately high levels of responsibility who go on to become adults with obsessive-compulsive disorder is nowhere near 100. So the person has to be born with the right brain to get OCD first, and then also experience The Bad Thing.

Here are two unspoken reasons that I think a lot of people tend to want to reject the medical model: the first is that there’s nothing you can do about genetics. By the time you know you’re fucking depressed all the time, you already exist. The only suffering that can be alleviated is suffering on the level of environment or experience. Even if this only accounted for 20% of a person’s symptoms or even if this work only reduced suffering in intensity by 20%, that’s not nothing. That can improve a person’s quality of life a lot, actually.

The second secret reason that the medical model is not popular in the healing subculture, I think, is that it’s easy to jump from maybe I am like this because I was born like this to maybe I am like this because I was born a fundamentally bad and/or broken person. If I wasn’t born like this, but was made like this, then I can un-make it. A very consistent symptom across the whole spectrum of mental illness is a persistent feeling of worthlessness, and also guilt about worthlessness. This is something I’ve felt before, if only transiently: the idea that if I am not an example of the fundamental malignancy of life on earth, it’s only because I am, somehow, its originating source.

The trauma-only model

There is a model of understanding mental illness that completely rejects any genetic or medical classification, which insists that all psychological suffering is always a reasonable response to abuse or neglect. I have been calling this the trauma-only model of mental illness. The trauma-only model offers to return the burden of guilt from the innate qualities of my soul and back onto the people who actually bear responsibility for failing me in whatever essential way they did. In this model, I get to shift my perspective from self-hatred at not being normal, to love and appreciation for the very intelligent ways my brain has adapted to keep me alive. In this model, I can root out these adaptations and lovingly shift them in a direction that’s better-adapted for a world where I’m not in the kind of danger I was in when I was a kid. This view provides a remedy to self-loathing. I’ve done a lot of this kind of therapy, and it’s been massively useful.

Here are my two favourite issues with this model: the first was brought up in a piece of writing (which I don’t remember the name of) by Kai Cheng Thom, who very astutely brought up that the method of lovingly correcting the body out of a state of defensiveness and into a state of calm only actually works if you’re not still in danger. A trans woman of colour, Thom points out that — duh — this is not the case, for her. She is, in fact, in danger, because it’s exceptionally dangerous to be a trans woman of colour.

I would take this even further: some people are more unsafe than others, but I also think that fear about unsafety is, in fact, the human condition — if only because every single one of us knows we’re going to die. You cannot heal yourself out of that. You can’t heal yourself out of the looming threat of climate catastrophe. You can’t heal yourself out of the lonely alterity of human existence, and you cannot heal yourself out of the fact that your children are going to suffer, and you can’t heal yourself out of the inevitability of pain or heartbreak or disappointment. I worry that the trauma-only model, by assuring you that The Bad Thing already happened, seems to forget that this was only the first of many completely unavoidable Bad Things which will, in fact, happen — and keep happening, until you die.

Here is the other one: the trauma-only model seems to need it to be the case that if someone presents with severe mental health symptoms, it’s always because something happened. If the sufferer insists nothing happened, they’re wrong. If their parents seem normal, they’re lying, or at least don’t understand the harm they caused.

I think that the idea that sometimes people are lying to cover up abuse can exist at the same time as the idea that also, sometimes, adults have problems that aren’t abuse related. The self-protective methodology of shame — if I suffered because I’m bad, then I can just be good and avoid suffering — is the same one in blame. Blame is a balm. I remember how much anger there was when my mother died. This seemed, even then, like bargaining — if I can identify whose fault it is that she died, then I can just be angry, and I won’t have to grieve. If I can identify who is at fault whenever anyone dies, punish their wrongdoing, and not repeat their mistakes, then maybe, somehow, I won’t also get sick and die one day.

I can imagine that if I hated myself, and I had decided that the reason I hated myself was because I was traumatized, I might need it to be the case that all other people who have the qualities I hate about myself are like that because they were also traumatized. I might need it to be the case that any child who was treated the way that I was treated will end up like me. If that’s not true, then maybe there was some other way I could have chosen to be. If it’s not true I might be bad.

I think it’s precisely this framework that has lead to questionable practices that implant false memories, incentivize lying, encourage vulnerable people to separate from support systems, and manufacture wildly codependent interpersonal dynamics. I live in a city which has a reputation as a kind of bohemian utopia, and I went to a university that had as its main strengths a fundamentally punk rock sensibility, a sincere belief in alternative and community care. I loved it there. Also, I witnessed so many codependent, self-destructive people enter into all-consuming interpersonal and community relationships with trauma and its healing as their central tenets. Sometimes these made people better. Sometimes it made them a lot worse. I’ve known of more than a few people whose parents had to come in after their kid flew off the handle and, essentially, deprogram them.

But that’s not even the problem, really. Here’s the problem: if it’s true that the problem of I am bad is only solvable by I am only like this because someone made me this way, then what if there is, somewhere out there, even one person who wasn’t made that way? The problem with blanket statements is that they only need one counter-example to fall apart. What if there is even one kid who was born like that? By the trauma-only logic of someone made me like this and that’s why I’m not bad, then the kid who was born like that is bad. And I don’t think that’s true. Children are innocent by definition. Bad kids do not exist.

Mirror promises

What I think is interesting is that my suffering is not because I’m bad is also the promise of the medical model. People for whom the medical model works, as a framework, just don’t necessarily correlate being born like this with being bad. People who have had their lives permanently and fundamentally changed for the better by medication and other medical interventions talk about how much time they’d spent absolutely sure they were irredeemable, lazy people — and how diagnosis and subsequent treatment lifted this enormous burden off of their shoulders. If this is the result of the brain I was born with, then it’s not just because of my choices, which means that it isn’t my fault even if it is my responsibility. If I wasn’t cursed with a family who fundamentally let me down, then I can leave my childhood behind me. If I am suffering in a recognizable pattern, then I am not alone.

I think that probably, thinking about mental health treatment from a perspective of justified beliefs, from the perspective of figuring out the truth conditions of your exact flavour of suffering, is probably less important than working out the unjustified beliefs that make you feel better. Each model of understanding provides a shape to put your suffering into, so you can see it from a different perspective. Different models make different people feel better. The trauma-only model never made me feel better. The trauma-only model is a shitload of work. It’s expensive. At its most absurd, it seems to be so much work and be so expensive that it — very conveniently — holds the sufferer directly responsible if they are incapable or unwilling to meet the rigorous demands of rooting out and correcting for trauma. At its most absurd, the trauma-only model seems to sneer at the unwillingness to abandon family of origin, leave stable long-term relationships, or engage in hours-a-day wellness rituals that seem more like a symptom of a mental illness than a solution for it. I wasn’t surprised when people who disappeared from the Montreal scene would pop back in, a ten months or a year-plus later, and described the way that their ideology had reached an unsustainable breaking point. Even at my most non-functionally turbo-miserable, a lot of healing culture looked like a cult.