Special Issue Article: The Politics of Psychological Suffering

eminism&

sychologyFP

Toward a feministpsychological theory of“institutional trauma”

Lucy ThompsonMichigan State University, USA

Abstract

Public discussions about trauma are circulating exponentially in the wake of global

movements against structural violence, and efforts to mainstream “trauma-informed”

approaches in mental health, human services, and organizational contexts. Within these

discussions, the term “institutional trauma” is increasingly being deployed to make

sense of structural violence and its impacts. However, such discussions typically repro-

duce highly individualistic understandings of trauma. Recent feminist advances in trauma

theory articulate trauma as a distinctly socio-political form of distress, and critical

feminist psychological work argues that gender and other institutions play a substantial

role in defining and mediating experiences of trauma. However, the role of institutions

in the (re)production of trauma remains under-theorized in the psychological literature.

This paper applies feminist, critical mental health, and decolonial perspectives to iden-

tify the limitations of mainstream psychological perspectives on trauma and proposes a

critical psychological theory of “institutional trauma”. I apply this critical analytic to

argue that dominant biomedical and neoliberal frameworks fail to adequately account

for the socio-political dimensions of trauma. I then consider institutional theory as a

useful feminist psychological analytic through which to expand trauma theory and

subvert pathologizing accounts of trauma as disordered and maladaptive.

Keywords

institutional trauma, trauma, feminism, psychology, PTSD, resilience

Corresponding author:

Lucy Thompson, Department of Psychology, Michigan State University, East Lansing, MI, 48824, USA.

Email: [email protected]

Feminism & Psychology

2021, Vol. 31(1) 99–118

! The Author(s) 2020Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/0959353520968374

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In contemporary public discussions about structural violence, the inextricable linksbetween socio-political structures and trauma have repeatedly been drawn, invok-

ing the long-held knowledge that trauma is inherently connected to powerful soci-

etal institutions. However, mainstream psychological accounts of trauma continue

to draw on predominantly individualized and medicalized frameworks, couched in

the clinical diagnostic language of the psy disciplines (Foucault, 1988 [1965], 1975[1963]; Marecek, 1999). These accounts of trauma are culturally privileged and

inform a wide range of “trauma-informed” responses and treatment models, which

have been taken up and applied in diverse clinical, organizational, and therapeutic

settings. The medicalized concept of trauma has been enshrined most recently inbest-selling and widely embraced literature depicting profound impacts of trauma

on the body, which “keeps the score” on trauma (Van der Kolk, 2015). This lit-

erature accounts for trauma primarily as an instinctual bodily response, drawing

on evolutionary and behavioral theories of survival to advocate for an expansion

of diagnostic categories in the form of Developmental Trauma Disorder.In this paper, I argue that a feminist psychological expansion of trauma theory

is necessary to account for the institutional production of trauma. Drawing on

critical and feminist psychological critiques of trauma theory and treatment

models, I will argue that institutions are central yet undertheorized in knowledgeproduction and meaning-making around trauma. In doing so, I will advocate for a

feminist psychological theory of “institutional trauma”. I write from a position of

surviving sexual violence and complaint in the British higher education context,

and subsequently inhabiting a psychiatric diagnosis. Here I define surviving asexisting with, after, and in spite of violence. Thus, I do not aim to deny the physical

manifestations and implications of trauma. Rather, I offer an institutional analytic

of trauma to question the dominant biomedical frameworks through which these

manifestations and implications are commonly interpreted, theorized, and

“treated”. I offer this analytic to promote situated, institutional accounts oftrauma and traumatized subjectivities that are currently obscured by dominant

models.

Situating trauma

Lafrance and McKenzie-Mohr (2013, p. 119) argue that “suffering and challenge

are inherent parts of the human experience. How these are understood and man-

aged varies dramatically across time, culture and place.” Biomedical and neurobi-ological constructions of suffering dominate contemporary and widespread

psychiatric discourses about psychological distress (Lafrance & McKenzie-Mohr,

2013; Parker, 2007; Rose, 2019; Rose & Abi-Rached, 2013). These discourses have

become privileged as “master narratives” through the institutional power andstatus of science (Lafrance & McKenzie-Mohr, 2013). In the mainstream psy dis-

ciplines, these master narratives are reproduced through a language of

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symptomology, whereby trauma comes to be known (and known about) primarilythrough the identification and diagnosis of individual symptoms. Subsequently,these narratives, and the realities they construct, filter into academic domains,psychiatric practice, and the broader public imaginary through a lexicon of“trauma talk” (Marecek, 1999). This refers to a “system of terms, metaphors,and modes of representation” surrounding trauma, that “circulates freely notonly among feminists but also in the mental health professions and the massmedia” (Marecek, 1999, pp. 158–9). This system of knowledge assigns power topractitioners to define, detect, diagnose, and “treat” trauma, such that the traumamodel has been termed “close cousins” with the medical model, precisely becauseof its replication of medical diagnostic processes (Marecek, 1999).

Post-Traumatic Stress Disorder

“Post-Traumatic Stress Disorder” (PTSD) is the main diagnostic category fortrauma within the psychiatric disciplines. In the fifth edition of the DiagnosticStatistical Manual of Mental Disorders (DSM-5) (American PsychiatricAssociation, 2013), PTSD and its diagnostic criteria were re-classified underTrauma and Stressor-Related Disorders, reflecting a shift and expansion fromAnxiety-based Disorders in previous editions (American Psychiatric Association,1994, 2000). This reflects the broader fluidity of diagnostic categories, which aresocio-historically bound and produced (Lafrance & McKenzie-Mohr, 2013; Tosh,2016, 2020; Tosh & Carson, 2016).

The formal diagnostic category of PTSD was added to the third edition of theDSM in 1980. However, PTSD as a diagnostic category has its roots in deliber-ations over shell shock, which began to appear as commentaries on “soldier’sheart” after the American Civil War, and then in accounts of “war shaken men”in Europe and the US during the First World War. These observations of men’semotional and psychological distress attempted to locate trauma within the phys-ical fabric of the body and brain, in the form of “shell shock”, or as a failure ofappropriate masculinity, in the form of “malingering” (Davis, 1999). Here, traumawas either understood and treated as a physiological affliction through medicalintervention, or dismissed on the grounds of presumed fabrication. From its incep-tion, trauma theory has focused on developing physiological and biomedicalknowledge about trauma in line with these early deliberations, despite the factthat there were no functional brain imaging techniques available at the time tosupport or warrant the scientific claims made about men’s emotional distress.Indeed, the most advanced observations of the brain at the time came in theform of x-ray plates. While advances in technology have allowed for more detailedreadings of the brain and its functions, the initial focus of psychiatrists on the braincannot be attributed to such evidence. Thus, the search for physiological explan-ations of trauma can be more accurately explained as a consequence of the questfor scientific certainty that dominated the early psy disciplines, which led

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researchers firmly down the path of brain-based analysis, diagnosis, and cure. Thesubsequent inclusion of PTSD in the DSM-III in 1980 enshrined psychologicaltrauma in biomedical realms as part of a broader push toward symptom-based andneuroscientific paradigms within American psychiatry (Lafrance & McKenzie-Mohr, 2013).

PTSD: A colonial diagnosis

While the DSM claims an ostensibly neutral stance on psychological distress, crit-ical and feminist psychologists view the historical production of diagnostic cate-gories as enforcements of hegemonic worldviews (Lafrance & McKenzie-Mohr,2013). In the case of trauma, the military origins of the PTSD diagnosis reveal aninherently patriarchal and imperialist worldview. Prior to the identification of“shell shock”, other available diagnoses for suffering and distress were distinctlyfeminized, in the form of “hysteria”, “neurasthenia”, and “female maladies” (seeTosh, 2016, for a discussion), and there was reluctance to assign these labels to men(Davis, 1999). The need to recognize widespread trauma as a consequence of wartherefore required a new masculinized diagnosis, and the goal of treatment was to“fix” soldiers so that they could be returned to war or sent home as “functioning”members of society.

A critical consideration of PTSD in the context of military psychiatry andcolonial history also reveals PTSD as a white, colonial diagnosis. This is evidentin the fact that “shell shock” constitutes the first serious disciplinary engagementwith trauma in psychiatry, centering men’s experiences in the earliest formal rec-ognitions of trauma. Further, deliberations over “shell shock” prioritized onespecific conceptualization of trauma, brought about as a consequence of war.This served to privilege understandings of trauma incurred while furtheringEuropean and American imperial interests. Further, histories of colonial violencewere whitewashed through repeated denials of violence on the same scale in historyever before. In this context, medicalized narratives of trauma emerged primarily asa product of hospitalization for physical injuries acquired in the line of duty. Thecasting of trauma into the body as “shell shock” in this context constructed traumaas a physical deviation or abnormality rather than a normal response to thehorrors of war. These discursive constructions of abnormality underpin conceptu-alizations of trauma as a psychiatric “disorder”, which functioned to legitimizeveteran campaigns for its inclusion in the DSM-III (American PsychiatricAssociation, 1980). While more recent interpretations of the PTSD diagnosis (par-ticularly in feminist therapeutic spaces) view trauma as a “normal” response tosuffering, the medicalization and persistence of the PTSD diagnosis through psy-chopathological frameworks (which literally function to define abnormality) ren-ders this perspective paradoxical (Anderson & Gold, 1994; Marecek, 1999). This isnot to mention the fact that psychiatric standards of normality typically refer toEurocentric standards of “normal” and “natural” whiteness (Tosh & Carson,2016), and thus cannot be viewed outside of their colonial underpinnings.

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The “neurobiology of trauma”

Within contemporary mainstream psychological and mental health disciplines,biomedicalized histories persist in assumptions about the brain bases of trauma,which are not dissimilar from original theories of “shell shock” in their founda-tional principles. Indeed, PTSD is defined as a “persistent, abnormal adaptation ofneurobiological systems to the stress of witnessed trauma” (Sherin & Nemeroff,2011, p. 263) in the mainstream psychiatric literature. The contemporary captiva-tion with neurobiological accounts of trauma has been understood as part of abroader era of “neuroenchantment” (Ali et al., 2014), in which the brain and itsneurological processes are now considered to be wholly constitutive of the self. Inthis era, “brain claims” reign supreme, often with very little critical analysis of theirexplanatory relevance to complex social issues (Tseris, 2019). This neurobiologicaldiscourse has been taken up recently in notions of the “neurobiology of trauma”,whereby traumatic events are said to cause floods of neurotransmitters, whichimpede bodily function, memory, and mobility. It is argued that this leads todamaged, disorganized memories and tonic immobility. This discourse has beenenthusiastically embraced in a vast field of “trauma-informed” research and prac-tice, which spans domains including education, healthcare, social work, andcounselling. Within this field, biomedical discourses carry currency, and are her-alded as “bringers of truth” about trauma, often with very little critical attention tothe discourses constituting such “truths”.

Specifically, feminist researchers and advocates have adopted these discoursesas counterpoints of resistance against patriarchal victim-blaming discourses, whichdeny or minimize the profound impacts of trauma (Tseris, 2019). Against a back-drop of patriarchal violence – which works to normalize, minimize, or deny theimpacts of violence – a focus on the body and the brain can be strategically advan-tageous for those seeking to validate or legitimize the suffering of others, namelybecause physical suffering is more difficult to dismiss than psychological or emo-tional suffering (Marecek, 1999). Furthermore, biomedical theories that locate thecauses of suffering in the body, and specifically the brain, are seductive to practi-tioners because they occupy the highest status within mental health disciplines(Marecek, 1999). Subsequently, discourses that privilege the physical etymologiesof trauma have gained a great deal of power and currency in feminist and populardiscourse. However, as Tosh (2016) argues, one “unfortunate” consequence of thisis that “it can often be presumed that for someone’s suffering to be considered‘real’, it needs to have a biological basis” (p. 4). Moreover, the capacity of neuro-imaging to support broad neurobiological claims remains limited (Ali et al., 2014),and research is in its very early stages, meaning that claims about the neurobio-logical bases of trauma should be treated with caution (Tseris, 2019).

Concurrently, fierce debate has circulated within research and practitioner com-munities about the validity of such claims. This debate centers on the generaliz-ability of neurobiological evidence, the validity of generalizing data from studies ofanimals to humans (which is a highly problematic practice in and of itself), the

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ethical and empirical (im)possibilities of directly observing “trauma” within labo-ratory settings, and the motivations of those with opposing viewpoints (seeAssociation for Title IX Administrators [ATIXA], 2019; Lonsway et al., 2019,for an example). However, in centering speculation about the various brainbases of trauma, these debates neglect the trauma paradigm’s core politicalfocus on the social and relational production of psychological distress (Tseris,2018, 2019). For instance, in their (re)instatement of “basic and well-establishedneurobiological parameters”, Lonsway et al. (2019) insist that “the process ofevolution has selected for certain characteristics of mammalian and primatebrains that respond in the same basic ways to any traumatic stressor, even if thedetails can be extremely varied” (p. 4).

The tendency of social neuroscience to “reduce people to the effects of psycho-biological processes” (Gough et al., 2013, p. 49) is problematic because it reducescomplex social phenomena and denies the inextricable connections between indi-vidual psychological functioning and broader socio-political conditions. Theseconcerns are raised in China Mills’ (2014) critique of the rebiologization of psy-chiatry, which cites warnings from a former president of the AmericanPsychiatric Association, Steven Sharfstein, that “we have allowed the bio-psycho-social model to become the bio-bio-bio model” (Sharfstein, 2005, ascited in Mills, 2014, p. 33). In their quest to (re)affirm or refute the validity ofneurobiological knowledge, current debates within the field of “trauma-informed” practice prioritize the biological dimensions and impacts of traumaat the expense of psychological and social dimensions. Even when psychologicalor social dimensions are acknowledged, they are typically minimized, and bio-logical “factors” are presented as the ultimate explanatory factor, or “trigger”,for trauma “symptoms”. For Read (2005), this represents “a colonisation of thepsychological and social by the biological” (p. 597). Moreover, in a long-standingfeminist psychological critique of the bio-psycho-social model, Jane Ussher(1997) argues that:

the majority of scientists and clinicians working within this field still rely on realist

assumptions, failing to question the social or discursive construction of bodily expe-

rience, the influence of their own subjectivity or ideological standpoint on the theories

or therapies they develop, and the role of scientific or legal discourse associated with

the body in social regulation and control. (p. 4)

Thus, from a feminist psychological perspective, biological “neuro-knowledges”about trauma carry a number of problematic implications. First, (re)assertions ofbiomedical authority reproduce power and paradigmatic assumptions that have inthe past functioned to bolster biological determinism, dismissing socio-politicalexplanations and the agency of survivors of violence (Tseris, 2019). For instance,biomedical concepts such as “healing” construct docile subjects who must “waitpassively while processes of repair and restoration take their course” (Marecek,1999, p. 165). Second, the “elevation of neuro-knowledges above all other forms of

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research” (Tseris, 2019, p. 62) obscures the focus on diversity in lived experience

that is a central tenet of feminist research. This “reduces experience into discrete,

encapsulated symptoms (flashbacks; revictimization)” (Marecek, 1999, p. 165).

Here, the ideological standpoints of clinicians are deployed as privileged lenses

through which to decode and explain suffering and distress. Third, assigning priv-

ilege to these neuro-knowledges validates disciplinary constructions of trauma as a

biological maladaptation, and prioritizes regulatory efforts to “fix” those who are

in distress rather than addressing their suffering within socio-political conditions

(Tseris, 2019). For example, mainstream psychological knowledge fails to incor-

porate gendered and contextualized accounts of trauma (Segalo, 2015), and main-

stream interventions have yet to be validated in the context of racial trauma

(Comas-Diaz, 2016). It is also particularly problematic from a critical feminist

psychological perspective that those with a trauma-based diagnosis rarely have

access to the individual-level evidence that claims to explain their trauma. Those

who live with trauma are typically not presented with neurobiological evidence

during the process of diagnosis or meaning-making, and thus become the subjects

of scientific explanations to which they cannot have access or consent. Meanwhile,

an industry of research, therapeutic approaches, and commercial self-help prod-

ucts is built around their suffering. In this sense, these “neuro-knowledges” con-

stitute what Rose (2019) defines as a system of “diagnostic imperialism”, with/in

which biomedical regimes of psychiatric knowledge collaborate to regulate psy-

chological distress.

Deconstructing mainstream trauma discourse

Rose (2019) argues that expressions of psychological distress could just as easily be

recast as “social adversity disorders”, and that the brain is a highly modulated and

open organ, stating that “if we focus the whole of our research endeavor on the

brain, we will limit our capacity to understand these complex processes”, and, “it is

not enough to simply acknowledge that social and environmental factors are

important, and then to maintain that research and explanation must focus on

the neuronal architecture of the brain” (p. 115). However – as with broader sci-

entific knowledge – neuro-knowledges have come to be self-sustaining. Indeed, as

Rose (2019) argues, “If the key funders make it a priority to seek the brain bases

for psychiatric disorders, it is not surprising to find that a very significant propor-

tion of research on psychiatric disorders focuses on these neurobiological proc-

esses” (p. 12). In the field of trauma studies, these taken-for-granted

“authoritative” discourses have been reproduced through institutions that fund,

publish, and adopt trauma research (Tseris, 2019). This has culminated in what I

will refer to as the “privatization of trauma”, which privileges individualist and de-

socialized accounts of trauma and the psychological subject through the psychiat-

rization and pathologization of trauma.

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Psychiatrization

Psychiatrization refers to “a violent state of being objectified through diagnosis”(LeFrancois, as cited in Mills, 2014, p. 79). The process of psychiatrization can betraced through the colonial recruitment of psychiatric patients (Mills, 2014; Rose,1998), whereby “mental illness” is defined, diagnosed, and regulated withinunequal relations of power. The psychiatrization of trauma through the diagnosticcategory of PTSD has occurred with very little critical attention or skepticism,primarily because of the long struggle for its recognition (Davis, 1999). However,this lack of critical attention has bolstered medicalized approaches and diagnosticinterventionism. Here, psychiatric definitions are administered by a network of psydisciplines and legitimized through global and institutional reproduction. Thisnetwork of institutions constitutes a psy-complex, through which “abnormal” indi-viduals come to be identified and recruited for psychiatric intervention (Parkeret al., 1995).

Pathologization

Pathologization refers to the construction of the “abnormal” individual throughthe power of the psy-complex (Parker et al., 1995). Pathologization has its roots inthe field of abnormal psychology and psychopathology, and promotes the identi-fication and treatment of individual pathologies using medicalized and therapeuticinterventions. On these grounds, pathologization justifies diagnostic intervention-ism, through which individuals are assigned diagnoses and subsequently treated inline with assigned diagnostic categories. Mainstream approaches to trauma rein-state the process of pathologization through reproduction of the PTSD diagnosis,and its inherent construction of trauma as an individual pathology (Tseris, 2019).Diagnosis then offers “cause-and-effect explanations that are linear, mechanistic,and mono-causal” (Marecek, 1999, p. 165), and draws invariably on a set of fixedsymptoms (Marecek, 1999). The psychological subject, conceptualized in medical-ized terms, is then identified as the target for “treatment”, “healing”, and“recovery” (Gavey, 1999). This “recovering” subject is “always already constitutedas lacking and in need of ‘betterment’” (Gavey, 1999, p. 74).

Privatization

Through practices of psychiatrization and pathologization, trauma comes to beprivatized in at least two key ways. Privatization in the first sense refers to marketprivatization, whereby therapeutic and research industries have been set up tomake financial gain through the psychiatrization and pathologization of trauma,its exploration, and its “treatment”. The market privatization of trauma within theUS context is further cemented through the “corporatization of medicine andthe bureaucratic management of health care” (Marecek & Gavey, 2013, p. 4)and the “re-medicalization” of psychiatry (Marecek & Gavey, 2013). These devel-opments have been made possible within the context of the broader colonial

106 Feminism & Psychology 31(1)

psychiatrization of global mental health (Mills, 2014). Thus, while psychiatricparadigms and interventions focus on supporting those who are suffering frompsychological distress, they typically do so in conjunction with neoliberal marketlogics (Tseris, 2019). Rarely do these logics promote broader critiques of capitalismor the assumptions underpinning biomedical therapeutic practices (Tseris, 2019).

Privatization in the second sense refers to psychological internalization, which isachieved through the promotion of individualized solutions to complex socialproblems. Here, individual-level interventions attempt to locate and treat “signsand symptoms” of trauma within the individual, encouraging a process of accep-tance and internalization. Indeed, Tseris (2019) documents the various ways inwhich individuals take up neurobiological explanations of trauma in order toattach credibility and certainty to their experiences. This process of internalizationusually takes place in the context of a dyadic relationship between “client” and“mental health professional”, through education or engagement with “expert”information. Both forms of privatization are further evident in the fact that“legitimate” forms of support under these conditions typically take the form ofbodily or psychiatric therapies, which Kaye (1999) argues can “implicitly locate theproblem within the person” (p. 24), encouraging a process of “interiorization”.

The costs of privatization: Neoliberal resilience and trauma discourse

Within organized psychiatry, trauma narratives often follow a linear path, where-by individualized symptoms or manifestations of trauma lead to some kind of“detection” or identification by a professional “expert”, leading to personal (re)discovery and private transformation, followed finally by “recovery”. Central torecovery is the concept of resilience (Tseris, 2019), which is intertwined with otherneoliberal sensibilities, including ableism and individualism. The notion of resil-ience—which is widely understood to mean the capacity of an entity to “bounceback” after damage or disruption—responsibilizes individuals to manage their owninternal state of equilibrium, such that damages can be covered and (re)covered.This form of neoliberal governmentality (Foucault, 1991 [1978], 2008 [2004]) con-stitutes a form of domination, which renders individual subjects “responsible” foractively managing social adversity (Lemke, 2010). In the case of resilience, subjectsare positioned as rational self-entrepreneurs who must take sovereign responsibil-ity for participation in self-care in order to “recover”. However, “participation hasa ‘price-tag’: the individuals themselves have to assume responsibility for theseactivities and the possible failure thereof” (Lemke, 2010, p. 202).

This (re)covering carries with it a requirement for “overing” (Ahmed, 2017),which expects for trauma to be over: Those who experience distress are expected toget “better” (Gavey, 1999) or get “over it” (Ahmed, 2017). Within neoliberal resil-ience discourse, and often in mainstream feminist discourse, trauma is told as astory with a clear beginning and a foreseeable end, which can be found throughengagement with the correct form of intervention, or state-endorsed judicial struc-ture such as police or the law. Subsequently, a large industry of therapeutic

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interventions, frameworks, and research has been built around trauma. This has

been termed the “trauma industry” (Afuape, 2011; Tseris, 2018), which has bur-

geoning overlaps with the “therapy industry” (Moloney, 2013). The trauma indus-

try conjures a celebratory “aesthetic” of resilience, which normalizes the damage

inflicted within white supremacist patriarchy, responsibilizes inflicted individualsto manage their own recovery, and celebrates those who are able to overcome the

damage (James, 2015). On this basis, remedies are offered that place the imperative

for recovery on the individual (Tseris, 2015). Within these regimes of treatment

and care, the transformation of trauma into “empowered” and “healthy” person-

hood is expected without transformation of the conditions through which trauma

is produced, situated, and negotiated. Moloney (2013) argues that under the con-

ditions of neoliberalism, “the therapy industry sells us illusions about our ability to

better our lives through individual effort” (p. 6). Here, psychological therapy

becomes “the internal makeover, par excellence” (Moloney, 2013, p. 6). Thus,

individual transformation becomes the goal of mainstream therapeutic interven-

tions, which assert a neoliberal imperative to “manage the effects of patriarchal

social forces through individual efforts” (Tseris, 2019, p. 52).On this basis, Sara Ahmed (2017) argues that resilience can be understood as a

command or technique of regulation, rather than an essential quality ofindividuals:

Resilience is a technology of will, or even functions as a command: be willing to bear

more; be stronger so you can bear more. We can understand too how resilience

becomes a deeply conservative technique, one especially well suited to governance:

you encourage bodies to strengthen so they will not succumb to pressure; so they can

keep taking it; so they can take more of it. Resilience is the requirement to take more

pressure, such that the pressure can be gradually increased. . . . Damage becomes the

means by which a body is asked to take it; or to acquire the strength to take more of

it. (p. 189)

It is a patriarchal logic that violence against the body should be “taken”, or pri-

vately (re)(c)overed, managed, and contained. Thus, while a focus on the body or

the individual per se may not be inherently conservative, the subsequent imperative

for resilience, which requires individuals to manage violence and trauma privately,

can reproduce logics of violence: In asking us to cover up the consequences of

violence, resilience encourages us to reproduce silence around violence (Segalo &Fine, 2020).

The silencing of trauma is further re-inscribed through the framing of those who

“speak out” about trauma as remarkable or exceptional, where “speaking out” is

generally either celebrated or vilified in public discourse, but never viewed as nor-

mative. This framing reflects and (re)produces a public-private dichotomy wherein

trauma is normatively viewed as a private problem. In turn, silencing is publicly

108 Feminism & Psychology 31(1)

reinforced through various techniques of control and containment, such as fear,tone policing, intimidation, retaliation, backlash, harassment, and vilification. Forexample, those who “speak out” are often publicly harassed: “If you complainabout harassment, you are harassed. Harassment is a means by which a complaintabout harassment is stopped. Those who are not stopped from complaining areoften harassed all the more” (Ahmed, 2018, para 8). Within this public-privatedichotomy, traumatized subjectivities are separated from socio-political condi-tions, and trauma is dislocated from the realms of institutional power, all whileinstitutions police the ways about which trauma can be spoken. This includespositioning those who publicly name violence as hostile and “damaging”(Ahmed, 2017). Arguably, then, if we are to take resilience to mean the capacityof an entity to “bounce back” after damage or disruption, it is institutions whomost effectively deploy resilience as a “technology of will” to (re)cover, reconfig-ure, and survive such supposed “damages”. Here, traumatized subjectivities areproblematized —rather than critically located—within the institutional conditionsthat (re)produce trauma. Surely, then, a critical psychological institutional analyticof trauma is both necessary and overdue.

Toward a feminist psychological theory of institutional trauma

In the first half of this paper, I have considered how institutions regulate knowl-edge production and meaning-making about trauma. Biomedical and diagnosticdiscourses are treated as discursive objects, which allow us to identify how traumaknowledge has been constituted through institutional regulation and (re)produc-tion. I will now turn my attention to feminist psychological responses to biomed-ical discourses, before discussing the limitations of current institutionalengagements with trauma and potentials for institutional analytics informed byfeminist psychological critiques.

The constitution of privatized, individualized selfhood in mainstream psycho-logical theory has been a foundational point of feminist psychological critique,based on the failure of realist and positivist epistemologies to account for embod-ied experiences within structures of power. Feminist psychological studies in var-ious fields, including madness, sexuality, reproduction, and sexual abuse, haveadvocated for a focus on the body, arguing that understandings of embodiedexperience are critical to the project of socio-political analysis (e.g. Kitzinger &Thomas, 1995; Tosh, 2020; Ussher, 1989, 1997, 2000). This project of socio-political analysis is crucial in order to identify the assumptions, definitions, andmeanings surrounding constructions of bodies, and the boundaries and limitationsplaced on these constructions. In feminist psychological work, it is argued that thebody is both material and discursive (Ussher, 1989, 1997, 2000), and located insocio-political context, culture, and history (Tosh, 2020). Drawing on Williams(2006), Tosh (2020) argues that when biomedical discourses prevail, “this

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multiplicity and complexity often gets overlooked and the body reduced to a solid,universally similar, and unchanging object” (p. 3–4). In the historical context of theclinic with its focus on pathology, classification, and measurement, this unchang-ing object was modelled on the bodies of white, non-disabled, cisgender men,constructing a “normative” body against which “deviance” could be constructed(Tosh, 2020).

Those who resist constructions of deviance turn to analyses of socio-politicaland historical context, not only to deconstruct “normativity” but also to under-stand the body, arguing that the body becomes meaningless out of context (Tosh,2020). Surely, then, accounts of trauma that do not engage in socio-political anal-ysis are limited in their explanatory potential. Segalo (2015) concurs, arguing thatpsychological theories of trauma levelled solely at the body put a “clinical cast” (p.448) on socio-political problems, and reduce local, contextual, and collectiveunderstandings of suffering to psychological terms. Thus, while a focus on thebody is necessary and important from a feminist perspective, there are clear prob-lems with theories of trauma that focus only on the body or lift bodies out of socio-political relations.

Institutions

The feminist psychological theory of “institutional trauma” proposed herein holdsthat institutions are centrally implicated in the production of knowledge, truths,and embodied experiences of trauma, and therefore must be accounted for as suchin theory, research, and practice. Institutional theory (e.g. Ahmed, 2012, 2017;Foucault, 1988 [1965], 1975 [1963], 1977; Smith, 1987, 1991 [1978], 2005) offersa valuable analytic through which to expand psychological knowledge abouttrauma. As Sara Ahmed (2017) argues:

The personal is structural. I learned that you can be hit by a structure; you can be

bruised by a structure. An individual man who is given permission: that is structure.

His violence is justified as natural and inevitable: that is structure. A girl is made

responsible: that is structure. A policeman who turns away because it is a domestic

call: that is structure. A judge who talks about what she was wearing: that is structure.

A structure is an arrangement, an order, a building; an assembly. (p. 30)

From this perspective, institutions are conceptualized as structural assemblies(Ahmed, 2017), including ideologies, histories, regimes of knowledge and power,disciplines, and spaces. Contemporary psychological conceptions of “trauma”reflect a broader disciplinary problem in mainstream psychology, which avoidscomplex concepts such as power, ideology, discourse, social relations, and institu-tional practices (Gough et al., 2013). These concepts are often viewed as ambigu-ous, and thus outside the purview of psychology, due to the disciplinary privilegingof positivist and realist epistemological viewpoints. As a consequence, the inextri-cable links between trauma and socio-political power have been under-theorized,

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and a comprehensive psychological account of trauma as a function and productof institutions is missing in mainstream psychological discourse. This is despite thefact that “trauma-informed” approaches often acknowledge that institutions serveto compound trauma and suffering.

Institutional betrayal

One of the most popular concepts used in contemporary research exploring insti-tutions and trauma is “institutional betrayal” (Smith & Freyd, 2014).“Institutional betrayal” is defined as “individual experiences of violations oftrust and dependency perpetrated against any member of an institution” (Smith& Freyd, 2014, p. 577). The focus of this work is on understanding interpersonalinteractions and mistreatment within contexts such as schools, colleges, the mili-tary, and legal systems, using the concept of “betrayal trauma” (Freyd, 1994). Theconcept of “institutional betrayal” holds that deficits or “failures” in institutionalprocesses function to produce or compound trauma. This typically refers to instan-ces whereby institutions are negligent, incompetent, or betray the trust of individ-uals, particularly when they report violence. However, “institutional betrayal” isincreasingly being conflated and deployed as an explanatory frame through whichto theorize and understand “institutional trauma”. Indeed, a broad search of theliterature or any internet search engine for the term “institutional trauma” willreveal that these terms are generally considered to be synonymous. From an insti-tutional perspective, there are various problems with this conflation.

First, there is a core issue with the theory of “betrayal trauma” (Freyd, 1994)grounding this approach, which is a “theory of psychogenic amnesia for childhoodabuse” (p. 309). Drawing on evolutionary and cognitive psychological perspec-tives, this theory was originally offered to improve understandings of amnesia inthe context of child sexual abuse. Couched in a language of symptomology andadaptation, this concept of trauma is aimed at understanding the specific bodilyimpacts of abuse, particularly on memory repression and impairment. Thus, thetheoretical concept of trauma underpinning the theory of “institutional betrayal”is not concerned with the kind of socio-political analysis needed to examine insti-tutions. This is further evidenced by the fact that there are no clear definitions,theoretical engagements, or conceptualizations of “institutions” in explanations of“institutional betrayal”.

Second, implicitly realist assumptions about “institutions” as literal organiza-tional spaces in which interpersonal betrayals take place construct institutionsprimarily as physical sites where trauma occurs. This invests in realist notions ofthe environment as a “stimulus” or “variable”, which have been heavily critiquedby critical social psychologists (e.g. Gough et al., 2013). Here, the “institution” isconstrued as an objective entity rather than a complex assembly of socially nego-tiated power relations. To locate trauma within this objective space constructstrauma in relation to—not as a product of—institutions, thereby (re)constructingtrauma as “other” to the institution. Subsequently, trauma is cast back into

Thompson 111

individuals, leaving the “institutional” dimension of this theory unclear andundertheorized.

Third, the conflation of the “institution” and the literal “organization” excludesbroader definitions of institutions as diverse formations of knowledge, history, andpower. Institutional theory conceptualizes institutions broadly as “structuralassemblies” (Ahmed, 2017), including bodies of knowledge and practice(Foucault, 1988 [1965]), socio-historical orders (Ahmed, 2012, 2017), and social,ideological, and discursive arrangements (Smith, 1987, 2005). Further, institutionssuch as hetero-gender (Ahmed, 2017), “the family” (Burman, 1994, 2008), whitesupremacy (Ang-Lygate, 1997), mainstream Anglo-European epistemology(Alcoff, 2007; Mills, 2007), and neo-colonialism (Segalo, 2015) all constitute pow-erful institutions that profoundly shape embodied identities and experiences. Byconceptualizing institutions primarily as objective organizations, the concept of“institutional betrayal” stabilizes definitions of institutions in ways that violateconstructionist assumptions and limit the scope and explanatory power of institu-tional theory.

Fourth, from an institutional perspective, the concept of “institutional betrayal”is limited in its explanatory power due to its narrow focus on institutional“failure”. This delimits understandings of the institutional production of traumato the realms of negligence and incompetency. From a critical perspective, insti-tutional practices of “doing nothing”—or doing the “wrong” thing—are inextri-cable from the institutional reproduction of trauma, because they are highlyintentional activities. For instance, the “failure” to act when a complaint ismade is often a coordinated decision. More importantly, this orientation alsopositions institutions as normatively trustworthy and functional, albeit prone tofailure. The privilege inherent in the claim that institutions can and should betrusted cannot be overstated, and ignores the histories and legacies of institutionalviolence that have instilled mistrust or distrust in those against whom this violencehas been directed. To begin from a normative assumption of institutional trust is tothose histories and their legacies.

Finally, notions of (inter)personal “failure”, “incompetence”, “negligence”, orother kinds of mistreatment fail to account for the institutional (re)production ofsocio-political relations, such as white supremacy, hetero-gender, and ableism,which create the conditions of possibility for violence against certain bodies.While the concept of “institutional betrayal” cites a concern for “systemic issues”,these are boiled down to “factors” or characteristics of “settings in which trau-matic events are more likely to transpire” (Smith & Freyd, 2014, p. 580), ratherthan the very stuff from which trauma is made. Thus, “institutional betrayal”could be understood as one facet of “institutional trauma”, but not as a synony-mous term or comparative analytic.

A feminist psychological analytic of institutions requires a significant departurefrom theoretical explanations that consider institutions simply as the contexts orenvironments for “exposure” to trauma: In order to account for the profound andformative entanglement of institutions and trauma, we must understand

112 Feminism & Psychology 31(1)

institutions not only as environments and settings, but also as situated knowledges,

histories, ideologies, practices, structures, and methods of power. While much

attention has been focused on developing scientific methods to study the character-

istics of “institutions”, very little has been spent on accounting for institutions as

methods for the (re)production of trauma.

Institutional trauma

The institutional analytic presented here subscribes to the observation that only

“epistemologies of ignorance” (Mills, 2007) view violence and trauma as small

ruptures in an otherwise easy life (see Segalo & Fine, 2020, for a discussion).

This institutional analytic advocates for the following reorientation: While tradi-

tional theories view trauma as a deviance or aberration, institutional theories view

trauma as an organizing and sustaining feature of institutions and institutional

power. Central to this thesis is the argument that the everyday world, and its

constitutive institutions, are problematic (Smith, 1987). An institutional analytic

therefore articulates trauma as a product of institutional power, and views insti-

tutions as methods for the production of trauma. This analytic offers a set of

foundational claims from which to develop knowledge:

1. Institutions are methods for the (re)production of violence in ways that (re)

produce trauma. Therefore, we must account for trauma as an institutional

phenomenon in order to appropriately address the implications of institutional

violence. This claim holds that institutional (re)productions of violence provide

the most fundamental evidence for the institutional (re)production of trauma: If

violence is institutional, then so is trauma.2. Experiences of and knowledge(s) about trauma are always situated. Central to

this claim is the assertion that institutions tightly regulate and control narra-

tives, knowledge(s), and experiences of trauma, thereby regulating the forma-

tion of “traumatized” subjectivities. For instance, trauma narratives can be

mediated through “appropriate” outlets, such as therapy, research, creative

projects, and press releases, or silenced through complaints procedures or

non-disclosure agreements, which control how, when, and even if, trauma is

and can be made intelligible and understood. This is how traumatized subjec-

tivities come to be institutionally produced, controlled, and regulated.3. Trauma can be viewed as an ongoing and constant product of institutional

power. This claim calls for an expansion of trauma theory beyond the clinical

and diagnostic realms of significant, profound, or isolated events and incidents.

Specifically, this claim holds that trauma is an ongoing feature of a violent

world. In this world, violence is an organizing practice through which power

relations are sustained and identities are organized. Resisting pathologizing

labels of “normal” and “abnormal”—and further efforts to re-biologize

trauma through the concept of “Continuous Traumatic Stress” (e.g. Eagle &

Thompson 113

Kaminer, 2013)—this claim instead prioritizes a sharp political focus on con-stant socio-political and relational productions of trauma.

Locating trauma within the personal-political nexus:

Possibilities for subversion and resistance

Ongoing historical and collective feminist reckonings with trauma have opened upcritical sites for the analysis of solidarity and its limitations, exposed the scale andscope of trauma, and established trauma as a collective and institutional phenom-enon. While these public reckonings with trauma have reasserted the knowledgethat “the personal is political”, mainstream psychological and psychiatric practicehas yet to adequately address this knowledge. The proposed theory of“institutional trauma” offered herein aims to provide a foundation from whichwe might attend to the personal-political dimensions of trauma.

Ahmed (2017) theorizes institutions as “feminist pedagogy”. That is: we learnabout and gather feminist knowledge from our encounters with/in institutions. Inline with this theorization, institutions can be viewed as “trauma pedagogy”. Thatis: we know and learn about trauma by living with trauma with/in and throughinstitutions. While the implications of these arguments for how we study andunderstand trauma are larger than the scope of this article, future work mayfocus on “trauma pedagogy” through autoethnographic or ethnomethodologicalapproaches, whereby those who survive trauma with/in and through institutionsdevelop accounts of situated experiences and shared social realities. It has alsobeen suggested that programs supporting those who live with trauma should lookbeyond “symptoms” and respond to legacies of patriarchy, capitalism, and colo-niality when responding to trauma (Segalo, 2015; Segalo & Fine, 2020). Withoutrecognition of histories and legacies of violence, “there can be no collective frame-work of intelligibility for survivors’ privately lived experiences” (Segalo, 2015, p.448). Clinical practice can also look beyond individual symptoms, and insteadfocus on the conditions in which individuals are situated. In their work on dia-logicity in psychiatric practice, Seikkula and Arnkil (2006) acknowledge that“people live in social relations even if professionals are approaching them individ-ually” (p. 1). Their approach replaces a search for explanatory symptoms andpathology with dialogue, which is viewed as a forum through which new under-standings and meanings can be generated between those participating in discus-sion. Here, “the entire interaction system becomes our focus, not just specifictherapeutic techniques” (p. 104). Using this approach, new modes of meaning-making about trauma could be made available.

Conclusions

In this paper, I have presented a foundational rationale for a critical feministpsychological analytic of trauma, which aims to expand the limited modes ofunderstanding made available and intelligible through dominant genealogies of

114 Feminism & Psychology 31(1)

trauma and the “trauma industry”. In doing so, I have considered some of the

problems and potentials for understanding trauma that come into view with an

institutional analytic. This necessarily includes a deep recognition of the limita-

tions and boundaries placed on collective understandings of trauma within indi-

vidualized, neoliberal, and clinical diagnostic frameworks. Trauma is a deeply

personal experience, but this experience is not located in a vacuum. Dominant

individualized conceptualizations of trauma give little credence to such complex-

ities. To address these complexities, we must decouple understandings of trauma

from the individualizing logics of diagnostic imperialism, biological (mal)adapta-

tion, and “resilience”, which function to regulate traumatized subjectivities,

responsibilize individuals for recovery, and privatize psychological suffering.

Then, we may turn our attention to understanding trauma as it comes to be pro-

duced, situated, felt, and negotiated through institutions that would have us

believe our suffering is ours alone.

Acknowledgements

The author thanks the two anonymous reviewers and the editors, Jeanne Marecek and

Michelle Lafrance, for their feedback and support during the development of this article.

The author thanks Katy Day and Jemma Tosh who supported this work from the begin-

ning. The author is especially indebted to those with whom she has learned about institu-

tional trauma first-hand.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, author-

ship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication

of this article.

ORCID iD

Lucy Thompson https://orcid.org/0000-0001-6820-7030

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Author Biography

Lucy Thompson is Assistant Professor in the Department of Psychology and SeniorResearch Fellow in the Center for Gender in Global Context at Michigan StateUniversity. She is interested in the personal-political dimensions of institutionalpower, violence, and identity. She is currently working on a book project withRoutledge, titled: A Feminist Psychological Theory of Institutional Trauma:Interrogating Power, Violence, and Harm.

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