Abstract
The concept of trauma has been used as an intervention paradigm for marginalized communities, refugees/asylum seekers and people who have experienced different forms of sexual and gender-based violence. Nowadays its extensive use presents those who insist in supporting its value-free character with an inconvenient truth: the detrimental socio-political implications for the service users. Emma Tseris’s book is an important attempt to question, reflect on and critically discuss the trauma paradigm and its practices. Tseris’s personal account as a social worker provides the reader with an account of her own shifting involvement with the trauma concept. Through her personal reflection, she strongly argues that we should be aware of the limitations of the trauma paradigm as a means of understanding mental distress related to women’s experiences of violence. Tseris argues that the advancement of women’s rights may be supported by notions of trauma in mental health, but that the mainstreaming of trauma treatments and therapies has had varied results. Sometimes, these interventions supplant social change efforts, and offer novel psychiatric means of oppressing women. In response to this, Trauma, Women’s Mental Health, and Social Justice offers some practical recommendations toward a feminist-informed socio-political perspective on trauma.
Tseris explores the various ways in which trauma informed practices are conceptualized and depicted in contemporary debates by providing a careful exploration of the trauma paradigm, as well as its particular implications for women who experience various forms of gender-based violence. She acknowledges the feminist contributions that have led to the development of trauma informed practices. Through the extensive “interrogation” of the trauma paradigm, she brings to light women’s experiences of abuse, violation and emotional distress, and confronts them not as a biological process but as the negative impact of lived violence.
Further, Tseris moves towards a critical evaluation and careful reading of trauma as a socially constructed concept, highlighting the socio-political consequences on women’s lives and experiences of distress. She stresses that this book is an attempt to demonstrate that the trauma paradigm at times is presented by researchers and mental health professionals as fully detached from psychiatric and/or biological discourses or as being “inherently or necessarily aligned to feminist aims, and in turn, the empowerment of women” (p. i). Consequently, this paralyses any investigation of the consequences of the psychologization and medicalization of women’s experiences.
In the introductory chapter, Tseris describes the key concepts that will be utilized in analysis and discussion in the following chapters. She reflects on commonly used and often taken-for-granted concepts in the mental health field such as “trauma-informed practices”, “trauma concept”, “trauma paradigm”, “trauma discourses”, “psychiatric hegemony”, “mental illness” and “social justice”. Specifically, she provides the reader with an up-to-date socio-historical perspective and its context, while making apparent the negative connotations/meanings in relation to their use by the “psy-practitioners”.
Having delineated the need of a critical conceptualization of the concept of trauma, Chapter 2 focuses broadly on the limitations of mental health discourses. Tseris explores in more detail how mental health discourses are embedded in everyday life, perpetuating power relationships and inequalities. This chapter presents central aspects of critical mental health theory and feminism, regarding their contribution towards understanding the ways in which psychiatric discourses are involved in perpetuating gender inequalities and social discrimination overall. Tseris then moves on to discuss the diagnostic practices of mental illness as cultural tools, used to classify and label people according to their race, ethnicity, gender and/or class. In particular, the use of psy-labels tends to overlook and render invisible the reasons women experience gender-based violence. This links to another argument: far from being uncritical towards mental health interventions/practices, Tseris challenges the individualistic character of treatments/practices that often sustain power relations (e.g., patriarchy, neoliberalism and Eurocentrism) and restrict attempts at broader social changes for women. This discussion lays the groundwork for Chapters 3 and 4: the investigation of the reappearance and/or the mainstreaming of trauma approaches in mental health.
In both chapters, Tseris presents a cutting-edge argument, that the alternative concept of violence-trauma provides a closer understanding of women’s experiences of violence than biomedical approaches. Tseris’s account of the historicity of the trauma paradigm and its shifts in meaning over time allows the reader to understand how women have been doubly oppressed by gender-based violence and systemic violence as exercised by psy-practitioners and their diagnostic tools and labels. Continuing the critical exploration of the trauma paradigm, she traces the links between neuroscience and so-called “mothering capacity” discourses. The “privileging” of neuro-biomedical approaches tends to decentralize and render invisible any diverse experiences of mental health among women. Since it often essentializes and homogenizes women’s experiences of distress (and symptoms), overlooking the significance of intersections of race, age, ethnicity and religion, the trauma paradigm is rendered inadequate.
Chapter 5 presents the qualitative interview data of women’s accounts “regarding their negotiation of psychiatric and therapeutic discourses after violence” (p. 75). After providing an overview of the methodological approaches, the ethical considerations and analytical process, Tseris analyses the main themes in participants’ narratives. Despite previous literature-based chapters having already set the scene for the analysis and contextualization of women’s accounts regarding the psy-constructions of the trauma paradigm, this empirical chapter seems to be disconnected from previous chapters, with the discussion lacking in depth. I would look forward to a follow-up piece, which integrates women’s stories with previous literature and deepens the discussion.
Chapter 6, as a continuation of the previous chapters, attempts to address the complex question of how trauma discourses can be used strategically with the aim of achieving social justice and transformation of women’s lives. Tseris brings together some of the main points discussed in the previous chapters; she highlights the “slipperiness of the trauma concept” (p. 108) but also how it could be an answer to biomedical constructions of women’s experiences of distress. Based on this, she proposes five questions which could support a critical analysis of the trauma-informed interventions. Tseris stresses the need for a de-therapizing approach to trauma that will utilize the positive aspects of the trauma concept in recognizing women’s experiences of violence but also critically question the socio-political context/circumstances. Notwithstanding my agreement with Tseris’s suggestions in regard to the trauma concept, it would be useful if at some point in the discussion she engaged with women’s experiences of violence and the negotiation of therapeutic discourses, rather than drawing upon the work of other scholars.
In sum, this book is much-needed, given the prevalence of more traditional neuroscientific approaches or the mainstreaming of trauma in mental health settings. Tseris convincingly argues that the concept of trauma needs more nuanced conceptualizations; by putting women’s experiences of gender-based violence at the centre in order “to resist the positioning of trauma theory as a panacea for women’s mental health” (p. 120). This line of argument underlines hidden power relations but also stresses the inability of trauma-informed interventions “to fully address the origins of women’s distress” (p. 120).
I highly recommend this book for those with an interest in critical perspectives of the trauma paradigm and mental health overall. It is vital reading for upper level students, researchers, and professionals in mental health, psychology, social work, policy and related fields as it is opens up a series of important questions and debates, problematizing the violence-trauma concept. Overall, the author clearly demonstrates that the field of mental health and social justice in relation to women’s lived experiences of violence continues to be a promising field of study.
