Soulfood

A Biblical Framing of the DSM-5 Criteria for Trauma

The DSM-5 is a scientific tool. To diagnose trauma there is a set of 20 questions to which responses are recorded and scores. If you have a high enough score, a trauma diagnosis may be made.

This has its uses. It can be helpful in assessing patterns and providing quantitative information about a person’s experience. It also gives the appearance (at least) of precision within a frame of reference.

However, it is important to note that the frame is self-referential and exclusive. It is not the whole truth about a person’s experience. It excludes meaning. It excludes God. It excludes personal relationships and puts them in categories for insurance purposes (talk about un-personing!). It exchanges quality for quantification. And it ignores what it can’t quantify and categorize.

Modern psychiatric practice has a framework that has these blind spots, based on a controlling narrative that psychiatric issues are primarily about chemical imbalances. When engaging with the DSM-5 criteria for PTSD, we must keep this in mind.

Criterion A: Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: experiencing it directly, seeing it happen to someone else, or hearing about someone close to you going through it. In this way trauma functions as anti-theophany – rather than a theophany (God is encountered in an extraordinary way), in trauma a person encounters evil or destruction in a profound way. The traumatized person is left asking, “Where is God?”

Criterion B: Intrusion symptoms – the past intrudes on the present and it is experienced again, with an inability to distinguish that it isn’t the present reality. The body, mind, and affections become organized around the trauma, and decisions are organized around avoiding re-experiencing the traumatic event in any way.

Criterion C: Avoidance. Self-isolation functions as an anti-communion, with the controlling beliefs being that other people cannot understand the trauma (no one else has ever experienced what I experienced) and views all others (or particular types of people) as potential perpetrators of new trauma or triggers of past trauma. “…among the poorest, the weakest, the most vulnerable person psychologically is the sufferer with PTSD. Not only are they utterly excommunicated, but all of their human energies are recruited to the fundamental task of deepening and preserving that excommunication. You can’t threaten this person with hell; they are already there, and they will fight with their last breath to stay there.” Timothy Patitsas, The Ethics of Beauty

Criterion D: negative alterations in cognitions and mood. Trauma involves lies and half-truths. Most of the lies involve a hopeless, despairing outlook on the future and a negative self-image. The traumatized person lives in an ugly story they can’t escape.

Criterion E: alterations in arousal and reactivity. The body has adapted to the threat of evil and becomes organized around safety. There is a sense that one is alone and utterly helpless, and a complete loss of agency (I have no control over what happens to me or what I do to others). This can lead to dissociation, especially during times of intense stress. The traumatized person loses a sense of connection between the body and the mind which is akin to death. It can also be a layer of death, a garment of skin worn to cover nakedness (ref. Gen 3).

To overcome trauma (a profound encounter with evil) we are tempted to counter with truth, but an encounter with beauty may be more helpful. Secular approaches such as cognitive processing therapy and other forms of cognitive behavioral therapy (CBT) can be helpful but they are centered around the Greek anthropology that puts the mind or thoughts at the center of being. Raw truth often fails to dislodge a person from entrapment in trauma. Biblical counseling must focus rather on the heart and desires, and beauty reaches the heart.

Beauty is not merely prettiness. The beautiful is that which is properly proportioned and coherent. Beauty reaches into and shapes our affections. Scripture teaches us how to recognize and respond to beauty. Evil is that which distorts beauty and makes it hideous or ugly, and it is incoherent.

Our culture is highly cynical towards beauty, making a concerted effort to eliminate beauty as an aesthetic. This works to blind us to the way back from trauma, settling for that which is not beautiful or good or true, because the good and the true and the beautiful are being erased from our culture (very intentionally) and replaced with ugly things we are told to call beautiful.

It is the beauty of Christ that transforms us. He takes the ugliness of our stories and beautifies them, and us. This beauty includes coherence and proportion of affection, action, and thought. Encounters with beauty leads us to goodness. The moral imperative to forgive flows from the beauty of God’s mercy towards us.

Liturgies shape us, whether liturgies of ugliness or liturgies of beauty.

Liturgies of ugliness include cutting, addiction, self-isolation, denigration of others, and self-loathing.

Liturgies of beauty include corporate worship, prayer, service, fellowship, and pursuing knowledge of God

Beautiful liturgies cleanse us from the liturgies of ugliness.

“No one has ever become holy by fighting evil. We only become holy by falling in love with Christ.” Saint Porphyrios

We fall in love with Christ when we see his beauty!

How do help traumatized persons to heal? First, know them well enough to understand their liturgies and seek to help them replace ugly liturgies with beautiful liturgies.

Be prepared to absorb abuse from them.

Help them move from anti-communion to community. The most vulnerable people are those who don’t have a community. Find ways to incorporate them into healthy communities.

Show goodness as often as possible.

If trauma is the anti-theophany, then healing involves noticing the Theophanies all around us. We see God everywhere, and his acts of kindness and mercy within their everyday lives. The ugliness of the world stands in stark contrast.

Surround traumatized persons with good people who don’t participate in evil and who present goodness as a way of life. Community matters!