Prof. Mark Smith – 25th November 2021
There are serious debates to be had around the nature of care, some of which have been surfaced by Common Weal’s Care Reform Group. Of course, most of us would profess to wish to see a more caring and compassionate society. The trouble is that, in the current political climate, many of the claims as to how we might get there are reduced to trite soundbites. This is especially apparent in the attention given to the linked concepts of Adverse Childhood Experiences (ACEs) and trauma, which have been major drivers of Scottish public policy in recent years.
ACEs and trauma are linked by a common understanding of the impact of the past on the present. And while, of course, some experiences from the past might impact on a person’s psychological state and functioning in the present, any linkage is rarely direct or necessarily causal, nor is it inevitable. Yet, we have come to assume that any difficult past event should be considered traumatic, that we are damaged and need help to deal with this. We have been subject to major ‘trauma-creep’ whereby the term trips off the tongue and everyday events that were once considered uncomfortable or distressing are now re-labelled traumatic – we are all trauma survivors now!
The claims made for policies and practices based around such ideas (or one might suggest, ideologies) assume evangelical proportions. The ACEs movement holds out an almost biblical vision of a community founded on ‘care and love’. They go further to claim that policies integrating an awareness of ACEs with ‘trauma-informed’ practices are showing remarkable results and are having a profound impact on our lives. The problem with such assertions is that there is no independent or sustained evidence for them! Serious researchers who have sought this evidence have invariably reached the same conclusion, that while the idea might be seductive, the terminology and concepts are unclear and that there are no examples of such approaches having improved outcomes. Some researchers go further to caution that policies based around trauma may have unintended consequences, producing the very symptoms they claim to assuage.
In a recent case reported in the newspaper of hit and run incident involving a 12-year-old boy, the Police put out a statement asserting that ‘The victim will possibly require surgery on his leg as well as being left completely traumatised by what happened’. It is hardly unusual for a 12 year old boy to sustain a broken leg.This quote raises a number of questions about what is understood by trauma, what completely, as opposed to just a little bit, traumatised means, who gives a police officer the locus to make such a claim and what are the implications of such a way of thinking? This is the kind of nonsense we get into when trauma becomes ‘everyone’s business’. People start to talk about it when they have no idea what they are talking about. Moreover, if the poor boy were indeed to be ‘traumatised’ by his experience, then that outcome becomes far more likely after a newspaper article telling the world that he is.
But there is another thing going on here too. The incident (which the police were at the time still investigating) was labelled ‘despicable’, thus attributing a moral evaluation to the claim of trauma. More broadly, at a cultural level, trauma has come to imply categories of victim and perpetrator that entangle scientific and moral discourse. This is a Manichean development that reduces policy discourse to one of goodies and baddies, and encourages punitive and carceral responses to the baddies.
Despite the lack of evidence for trauma-based practices, the Scottish Government has gone ahead and initiated (and funded to the tune of £1.35mil) a National Trauma Training Package, which exhorts everyone to approach their work through a ‘trauma lens’. It goes further and asks that agencies across Scotland sign up to a public pledge of support and shared commitment to adopt and embed trauma-informed practices. Many have already signed this pledge – not to do so may not make good business sense. This development represents a troubling imposition by The Scottish Government of a singular worldview of social welfare practice, especially when that worldview is one that is devoid of evidence.
So what is going on here? Trauma’s empire, I would suggest, chimes with the current therapeutic zeitgeist apparent in polities across the Western world but finding particularly fertile soil in Scotland. Turning to ACEs and to trauma allows the Scottish Government to appear progressive and compassionate while sticking closely to a neoliberal agenda, what the American philosopher Nancy Fraser calls progressive neoliberalism. This sustains an individualised view of the world in which social problems are limited to what goes on behind closed doors in family settings, leaving structural determinants of unhappiness untouched.
In an increasingly liberalized welfare market, the role that can and should be played by the social professions such as social work and community education, to relate life world processes to systemic conditions has been abrogated to a range of caring, coaching and managing activities, all no doubt, claiming to be trauma-informed. These do not bring anything new or progressive to the table, offering form over substance.
The organisation ACE Aware Scotland questions whether its vision of a community of care and love might sound too emotional, too airy-fairy, too soft to ‘seriously guide public policy-making and cultural regeneration’. It does because it manifestly is. It advances a narrow, therapeutic worldview, which fails to recognise alternative intellectual or professional perspectives, particularly those that express any level of social analysis or critique.
As we move towards a National Care Service, as we are assured we are, we need to be able to engage in serious debates about the nature of care and how notions of care and compassion might construct the human subject in ways that don’t see them as prisoners of their pasts requiring therapeutic intervention. Compassion and empathy are empty, and arguably dangerous, words and concepts when they do not get beyond a level of emoting to incorporate serious and transdisciplinary conversations about what they might mean and how we might work towards them.
Mark Smith’s article, on which this piece is based, (with Sebastian Monteux and Claire Cameron) ‘Trauma: an ideology in search of evidence and its implications for the social in social welfare’ was published in the most recent issue of the journal ‘Scottish Affairs’ 30.4 (2021): 472–492 (versions are available on author pages at University of Dundee or Abertay University)